By E. Arokkh. Dixie State College. 2018.

Lactivit physique de loisirs au Qubec: une analyse en fonction des bnfices pour la sant [Monographie #5] order lithium 150 mg mastercard. Longitudinal tracking of adolescent smoking order 300mg lithium mastercard, physical activity cheap 300 mg lithium with visa, and food choice behaviors. Problems with the report of the Expert Panel on blood cholesterol levels in children and adolescents. Challenges to implementing the current pediatric cholesterol screening guidelines into practice. The psychological functioning of children with hypercholesterolemia and their families. Cholesterol screening of children at high risk: behavioural and psychological effects. Effects of secular trends in obesity on coronary risk factors in children: The Bogalusa Heart Study. Relation of serum lipoprotein levels and systolic blood pressure to early atherosclerosis. The relation of atherosclerotic lesions to antemortum and postmortem lipid levels: The Bogalusa Heart Study. Coronary risk factors measured in childhood and young adult life are associated with coronary artery calcification in young adults: The Muscatine Study. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Impairment of endothelium-dependent dilation is an early event in children with familial hypercholesterolemia and is related to the lipoprotein (a) level. Endothelial dysfunction occurs in children with two genetic hyperlipidemias: improvement with antioxidant vitamin therapy. Increased intima-media thickness of the common carotid artery in hypercholesterolemic children. Cholesterol and carotid artery wall in children and adolescents with familial hypercholesterolaemia: a controlled study by ultrasound. Usefulness of childhood low- density lipoprotein cholesterol level in predicting adult dyslipidemia and other cardiovascular risks. Use of cholesterol measurements in childhood for the prediction of adult hypercholesterolemia. National Cholesterol Education Program: Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents. Efficacy and safety of lowering dietary intake of fat and cholesterol in children with elevated low-density lipoprotein cholesterol. Growth of hypercholesterolemic children completing physician-initiated low-fat dietary intervention. Report of the Joint Working Group of the Canadian Paediatric Society and Health Canada. Acceptability and compliance with two forms of cholestyramine in the treatment of hypercholesterolemia in children: a randomized, crossover trial. Efficacy and safety of cholestyramine therapy in peripubertal and prepubertal children with familial hypercholesterolemia. Treatment of familial hypercholesterolemia in children and adolescents: effect of lovastatin. Short-term efficacy and safety of pravastatin in 72 children with familial hypercholesterolemia. Efficacy and safety of lovastatin in adolescent males with heterozygous familial hypercholesterolemia: a randomized controlled trial. Atherosclerosis of the aorta and coronary arteries and cardiovascular risk factors in persons aged 6 to 30 years and studied at necropsy. Doppler evaluation of left ventricular diastolic filling in children with systemic hypertension. Determinants of cardiac involvement in children and adolescents with essential hypertension. Factors affecting tracking of coronary heart disease risk factors in children: the Muscatine Study. Persistence of multiple cardiovascular risk clustering related to syndrome X from childhood to young adulthood: The Bogalusa Heart Study. Women appear to be protected from the complications of atherosclerosis until menopause, at which time the incidence of cardiovascular events increases (2). Women are less likely to be referred for cardiac catheterization; however, when they are, they are appropriately referred for revascularization procedures (5). Morbidity and mortality rates after angioplasty and bypass surgery are higher in women than in men, and fewer women are referred to cardiac rehabilitation programs (4). The incidence and prevalence of stroke are higher in men than in women; however, after age adjustment, the differences dis-appear (4). The mortality rates for both men and women, however, are similar for all ages (1). In particular, the prevalence of smoking among adolescents aged 15 to 19 years is now higher in girls than in boys.

These results suggest that the presumed loss of genetic variability in the Iberian lynx has not yet signifcantly affected its seminal parameters order lithium 150mg with amex. However buy lithium 300mg low price, it could also mean that semen traits in Eurasian lynxes and bobcats examined may be low due to some inbreeding in the individuals sampled generic lithium 300 mg free shipping. We have analyzed the ability of semen extenders to support cryopreservation of Iberian lynx spermatozoa. On the other hand, there were differences between diluents with regards to survival after freezing and thawing. Oocytes collected from domestic cats and matured in vitro were used to test the fertilizing capacity of Iberian lynx spermatozoa. We have also obtained and cryopreserved epididymal spermatozoa from fve out of 14 dead Iberian lynx males. Most males from which spermatozoa could not be recovered were young or died outside of reproductive season. These results demonstrate the importance of rescuing male germplasm for possible future uses via assisted reproduction. Xenotransplantation of testis grafts is successful even when done between distant species (Honaramooz et al. However, although tissue from immature individuals survive and develop after transplantation, leading to the generation of spermatozoa that can be used by means of intracytoplasmic sperm injection, our results revealed that tissue from adult individuals of several species seldom survive and multiply after transplantation (Arregui et al. Therefore, alternatives that would allow proliferation and differentiation of testes from mature individuals should be explored in more detail (Arregui et al. In any case, if testicular tissue and cells are to be useful in the future, one critical factor to bear in mind is the method for recovery of testicular cells and tissues. For this reason it is essential that testes are collected and transported to the laboratory as soon as possible and under appropriate conditions after the death of individuals. Initial work on domestic cats shows that this approach is indeed promising (Snedaker et al. In v I t R o m a t u R a t I o n, feRtIlIzatIon a n d c u l t u R e o f o o c y t e s Oocytes recovered post-mortem as well as those collected after hormonal treatments from animals in captive breeding programmes represent a good source of female germplasm to maximize the preservation of genetic diversity. For the development of in vitro maturation and fertilization techniques, as well as for the required methods for oocyte and embryo cryopreservation, it is necessary to resort to domestic cat oocytes as models. Oocytes have been matured in vitro, fertilized with fresh epididymal spermatozoa, and cultured up to the blastocyst stage (Gonzlez et al. Oocytes matured in vitro can be used to test the fertilizing ability of spermatozoa. In addition, primary follicles could be collected and saved for future in vitro maturation (when reliable techniques become available). At the moment, efforts in our group are directed towards ensuring an adequate collection and in vitro maturation of oocytes from Iberian lynx females killed in road accidents (Gonzlez et al. This has some limitations due to the fact that animals die outside the reproductive season, and that there is usually a delay between the moment when the animal dies, the timing of necropsy and the opportunity to transfer one ovary to the laboratory. In spite of this, we have managed to achieve in vitro maturation of Iberian lynx oocytes in our laboratory and we anticipate that it may be possible to advance towards in vitro fertilization, culture and cryopreservation of in vitro-produced Iberian lynx embryos. Ovaries from fve females that died due to different reasons were transported to the laboratory and processed for oocyte collection. Oocytes could be collected in two occasions and they were incubated for in vitro maturation. These results are the frst example of in vitro maturation of oocytes from this species and they are most encouraging because they suggest that a routine rescue and preservation of female germplasm may be possible for its future use by means of assisted reproduction. The preservation of such biomaterials represents a valuable opportunity to maximize the conservation of genetic diversity in this species. In addition, they allow us to carry out studies to characterize the reproductive biology of this species in order to develop adequate assisted reproductive techniques. With these tools it will be possible to assist in conservation efforts facilitating the flow of genetic material between captive sub-populations, between natural and captive populations and also between natural populations. The support of the Ministry of the natural, Rural and Marine Environment and Andalusian Government is deeply appreciated. Xenografting tissue for the study and preservation of fertility, in: Roldan, of sheep testis tissue and isolated cells as a model E. Xenografting of adult conservation and Study of Mammals, Valencia, Spain, 3-6 mammalian testis tissue. In vitro oocyte maturation, fertilization and culture in the critically endangered Iberian lynx (Lynx pardinus). Felid Biology and conservation conference, heterologous in vitro fertilization in the bobcat (Lynx rufus). Effect of egg yolk, cryoprotectant, and situ conservation: An Interdisciplinary Approach. Fundacin various sugars on semen cryopreservation in endangered Biodiversidad, Madrid, Spain. Live birth of a Mohor gazelle (Gazella dama mhorr) calf Reproduction, Fertility and Development 18, 77-90.

Because diabetes and high blood pressure are both big risk factors for heart disease buy lithium 150 mg on line, people who have both problems need to make especially healthy choices in their lives buy 150 mg lithium. For people who already have high blood pressure cheap 300 mg lithium amex, you can still consider talking to them about all of the things in the list above. Some other things to talk to them about are listed below Many people who know they have high blood pressure have seen a doctor for it. Make sure to encourage them to continue seeing their doctor as often as the doctor wants. Tell them to bring this log book or wallet card with them when they go to any doctor. This is very important because sometimes people want to stop taking their medicines when they think they have gotten better, but that can have very bad health effects. Just because the blood pressure is controlled while the person is on medication does not mean that they are cured and can stop these drugs control of the problem tells you only that the medications are working. So, tell them that they need to keep taking the medicines so that they can remain well. If they still want to stop taking the medicines or have any questions about them, urge them to call their doctor to talk about their concerns. Let them pick the cast members they would like to be, and let the group perform (read) the fotonovela together. If anyone in the group cant read give them another role; maybe they can ask questions to clarify anything they heard. Being active (engaging in moderate to vigorous activity) for at least 150 minutes a week. The client is told that he or she will feel some pressure on the arm that will be used. Usually, people take medicine for many yearsoften the rest of their livesto control their high blood pressure. Eat more fruits and vegetables, whole-grain breads and cereals, and low-fat dairy products. National Center for Chronic Disease Prevention and Health Promotion Division for Heart Disease and Stroke Prevention Get the Facts: Sources of Sodium in Your Diet Activity 7-3 All across the United States, high sodium intake is a major problem. On average, American adults eat more than 3,300 milligrams (mg) of sodium a day, more than double the recommended limit for most adults. The Dietary Guidelines for Americans, 2010 recommend that Americans aged 2 and up reduce sodium intake to less than 2,300 mg per day. People 51 and older and those of any age who are African Americans or who have high blood pressure, diabetes, or chronic kidney disease about half the U. Having accurate information about where dietary salt comes from can help Americans stick to the recommendations. First number (systolic pressure): ________________ Second number (diastolic pressure): ________________ What should your goal numbers be? First number: ________________ Second number: ________________ National Center for Chronic Disease Prevention and Health Promotion Division for Heart Disease and Stroke Prevention Other Questions to Ask Your Doctor Can someone show me how to check my blood pressure with my own blood pressure monitor? Should I take just one reading, or should I take three readings and then average them? My Blood Pressure Wallet Card Activity 7-5 It is important to know your blood pressure numbers. Be sure to ask what your blood pressure numbers are each time someone takes your blood pressure. You may want to give copies of the card to others in the community, and if you like you can order more copies of the card (please see Appendix A). One of the most important parts of taking a blood pressure is helping the patient to feel comfortable and relaxed beforehand. Sit and talk with the person for a few minutes and help them relax before you put on the blood pressure cuff. There should be an armrest or table on which they can rest their arm when it comes time to take their blood pressure. Blood pressure measurements will be more accurate if you place the cuff directly on the patients skin. If their shirt or blouse is tight, the person may have to take their arm out of the sleeve. If their clothing is very loose, they can roll it up until the upper arm is exposed. When the upper arm is free of clothing, rest the persons arm on a table or other stable surface with the palm facing upward. The whole arm should be relaxed, and the upper arm should be about at the same level as the persons heart as shown in the picture. Arm at Correct Position Before putting the cuff on the patients arm, make sure that all the air is out of the cuff. Turn the screw valve counterclockwise, and then squeeze the cuff tightly to force out any air. Once you are sure that all the air is out, turn the screw valve clockwise until it is snugly in place.

There are no herpes are minimum estimates of contacts with health signifcantdifferencesinprevalenceamonggeographic care providers; thus order lithium 300 mg without prescription, patient visits for initial episodes regions of the United States cheap lithium 150 mg otc. In 1998 buy cheap lithium 150 mg on line, the rates seen but because of the increasing incidence, this cost has among male and female Medicare benefciaries were been predicted to rise to $2. Note that Medicare offces per year for genital herpes rose from fewer benefciaries under age 65 include the disabled and than 10,000 in 19661970 to more than 150,000 in persons with end-stage renal disease and are distinct 19952001. The highest rates were seen among women (426 of analysis is the individual patient. However, the datasets we analyzed are rates of patients diagnosed with genital herpes from useful for describing trends in care-seeking behavior 240 241 Urologic Diseases in America Sexually Transmitted Diseases Table 4. A much higher rate of symptomatic, are more likely to prompt medical care visits was observed among women enrollees (88 per and to represent incident infections. Another recent 4044 198 92 (79104) study has underscored the diffculty of using drug 4554 287 61 (5468) claims for acyclovir as a way to estimate the burden 5564 105 29 (2435) of symptomatic genital herpes (11). Overall, the best estimates aThe number of medical visits includes both inpatient visits and of the prevalence of genital warts are based on outpatient visits; however, most medical visits were outpatient visits. Approximately Rate per 100,000 enrollees who were continuously enrolled in a health plan throughout 1999. In MarketScan data, rates of inpatient $1,692 in costs per 1,000 person-years) and men 25 and outpatient visits for genital herpes varied by to 29 years of age (5. Risk factors for developing enrollees in the West to 61 to 72 per 100,000 in the genital warts have been diffcult to assess because other regions. However, urologists and other clinicians who engage in procedures directed at ameliorating genital 244 245 Urologic Diseases in America Sexually Transmitted Diseases Table 9. Therefore, for any warts, of which 207 (66%) were men and 280 (89%) population in a given dataset, the total numbers of resided in urban areas. In 2000, there was a weighted frequency of 315 persons under 65 years of age (16 per 100,000). Counts for 1992 refect the relative lack of specifcity in coding for that year as compared to subsequent years. The highest rates <10 61 25 (1931) were seen among those 20 to 24 years of age (520 1014 92 53 (4264) per 100,000). Rates varied by geographical region, 1519 390 209 (188229) from 127 per 100,000 in the West to 201 per 100,000 2024 597 520 (478562) in the Northeast. A difference was also seen between 2529 458 466 (424509) urban (186 per 100,000) and rural (144 per 100,000) 3034 498 349 (318380) residents. As with genital herpes, the highest rates information on genital warts will require an in-depth of genital warts in 2001 were seen among women (90 understanding of the coding practices of offce-based cases per 100,000 unique outpatients), persons 25 to 34 clinicians with respect to diagnoses and procedures. However, unlike genital women made the majority of outpatient visits for herpes, no consistent trend was seen when comparing genital warts. For example, genital warts in outpatient visits and 18 inpatient visits for genital women are more likely to come to medical attention warts accompanied by a claim for services associated than genital warts in men, if only because women 248 249 Urologic Diseases in America Sexually Transmitted Diseases periodically seek Pap smears. In 2001, a total trachomatis also causes asymptomatic infection that of 783,242 cases (278 per 100,000 population) were can result in serious and costly sequelae if acute reported to the Centers for Disease Control and infection is not treated promptly and properly. These included cases with and Congenitally exposed infants may develop neonatal without symptoms or signs detected during medical inclusion conjunctivitis and pneumonitis syndromes. Forty percent Over the past two decades, there has been a dramatic of the cases of chlamydia were reported among increase in the use of various measures for diagnostic persons 15 to 19 years of age. Chlamydial infection is common through 1998 were too sparse to permit meaningful among all races and ethnic groups, but prevalence interpretation (Table 14). For example, Medicare is generally higher among women than among men hospital outpatient visit rates decreased from 2. Of these tests, rather than a higher underlying incidence of 767 visits, 558 were by women and 209 were by disease. The higher rates observed among women screening guidelines (22), 19% of those 16 to 20 years and persons under 25 years of age may be due in part of age and 16% of those 21 to 26 years of age received to higher rates of screening of younger asymptomatic screening in managed care organizations that reported women during family planning and prenatal care. However, a marked family planning clinics) screen higher percentages of difference was seen between urban (38 per 100,000) women. Inclusion of screening costs for patients with and rural (24 per 100,000) residents. Neisseria species, including those normally in the In the 767 medical visits coded as being for fora of the oro- and nasopharynx, have a similar chlamydial infection in the 1999 MarketScan data, 178 appearance. Culture testing has been the standard drug claims were fled for a recommended or alternate against which all other tests for N. These tests are substantially more sensitive than the The incidence of gonorrhea is highest in high- frst-generation nonculture tests were (17, 24-29). Increases in gonorrhea prevalence have in 2001, with an age distribution similar to that for C. The decline in underlying trends over time or differences in disease prevalence that began in 1987 may be attributable rates by demographic characteristics.

They migrate from this position inferiorly purchase lithium 150mg on-line, reaching their final locations by the 7th week cheap lithium 150mg with amex. The 3rd pharyngeal pouch develops into both the thymus and the inferior parathyroids discount 150 mg lithium visa, while the 4th arch becomes the superior glands. About 3% of patients will have only 3 glands, and 13% of patients may have 5 or more glands. The superior parathyroid glands normally reside postero-medial to the superior thyroid lobes, near the cricothyroid junction, while the inferior glands tend to be on the postero-lateral side of the inferior thyroid lobe, inferior to where the recurrent laryngeal nerve and inferior thyroid artery cross. The inferior parathyroids are usually found within 2 cm of the lower pole of the thyroid. However, aberrant migration is common, and the glands can be found in ectopic locations in many cases. Ectopic superior parathyroid glands may be retroesophageal, intrathyroidal, or in the posterior mediastinum. Inferior parathyroid glands have more variable ectopic sites as a 136 Thyroid and Parathyroid Diseases New Insights into Some Old and Some New Issues result of their longer migration. Understanding of this anatomic variability is important in interpreting preoperative imaging and directing operative exploration. Hyperparathyroidism may be caused by a single parathyroid adenoma, multi-gland hyperplasia, double adenomas, or parathyroid carcinoma. Single adenoma accounts for about 81-96% of hyperparathyroidism, depending on the series. Multigland hyperplasia accounts for 4-14%, double adenomas 2-11%, and parathyroid carcinoma <1%. Single adenoma 81-96% Multi gland hyperplasia 4-14% Double adenoma 2-11% Carcinoma <1% Table 1. Even as recently as 1998 nearly of parathyroid surgeons were still performing bilateral cervical exploration as the primary surgical technique. This typically entails anteromedial retraction of the thyroid lobe to reveal the parathyroids posteriorly. Those that are questionable may be biopsied and sent for frozen section pathology to guide decision of whether or not to resect. If all glands appear abnormal as is the case with multi-gland hyperplasia, the surgeon may perform a subtotal or total resection with autotransplantation. A subtotal resection, also Minimally-Invasive Parathyroid Surgery 137 known as a 3. A total resection with autotransplantation involves resecting all found glands and then implanting small sections of the gland into a distant site; typically 12-24 sites within the subcutaneous tissue or the brachioradialis of the non- dominant forearm. Again, this maintains functioning parathyroid tissue to reduce the risk of lifetime supplementation and permits titration of hormone level by future selective removal of auto-transplanted parathyroid tissue. If all ectopic sites have been explored and the Miami criterion has not been met, the operation is concluded and further work-up postoperatively with imaging must be done. Postoperatively patients are admitted at least overnight, and postoperative calcium levels are followed to screen for hypocalcemia. Patients are typically placed on vitamin D and calcium postoperatively and go home on this supplementation. Minimally invasive techniques The term minimally invasive is applied to several different techniques. These techniques share the objectives of reduced dissection, operative time, and duration of hospitalization as well as an improvements in patient comfort and cosmesis through smaller or more discretely located incisions. Technological advancements in imaging, laboratory, and operative techniques have made these approaches possible. These adjuncts will be discussed, followed by an explanation of the techniques themselves. Parathyroid glands that are hyperplastic or adenomatous tend to concentrate sestamibi to levels significant for detection, while normal 138 Thyroid and Parathyroid Diseases New Insights into Some Old and Some New Issues glands are not typically seen. This is likely due to increased mitochondria as well as increased blood flow to these glands. Due to their anatomic relationship and shared affinity for the radiotracer, signal from the thyroid and parathyroids may overlap, obscuring the definition of an abnormal parathyroid gland. Fortunately, the retention of the radiotracer over time is greater in parathyroid than thyroid tissue. Combining early and delayed (2-3 hours) imaging permits better identification of abnormal parathyroid tissue. Additionally, an abnormal signal contour or a signal clearly separate from the thyroid bed raises suspicion of abnormal parathyroid tissue on either early or late images. Uptake and retention of the radiotracer by abnormal parathyroid tissue may be variable. If washout from an adenoma is rapid, no discrete signal will be seen on the delayed images, despite the presence of a diseased gland (false negative). False negatives are also more commonly seen in patients with multi-gland disease, such as double adenomas or multi-gland hyperplasia. Moreover, ultrasonography enables excellent visualization of the thyroid gland and can diagnose concurrent thyroid disease, limiting re-operation rates.

At the same time he was being surrounded by screaming women and feared that he might be blamed for the accident generic lithium 150 mg online. His disease developed over time lithium 150 mg on line, but he did not see a psychologist until 2003 lithium 300 mg online, when several of his mates had been killed in an accident in Kabul in Afghanistan while he himself was back in Denmark. He was there to receive the killed and the wounded and went to see the parents of the deceased, together with army representatives. The Danish Defence verified the described accidents in Bosnia, Eritrea and Afghanistan. The Committee found that the mine sweeper had developed anxiety attacks mainly as a consequence of the severe and mentally stressful incidents he had been part of, in particular in Bosnia and Eritrea where he was directly involved and felt under threat. Example 13: Recognition of unspecified stress response after sexual harassment (office worker) A 54-year-old female office worker developed an unspecified stress response with effects such as anxiety, sadness, lack of energy, sleeping problems and isolation tendency after experiencing sexual harassment from a middle manager at work. The middle manager had on several occasions made sexual comments towards her and the other female employees and had on several festive occasions fondled her and others. During a lunch meeting in the city with the rest of the staff the middle manager touched her under her dress and she had to push him away. Two colleagues confirmed the incident and later a settlement was reached in the workplace. The Committee found that the office worker had developed an unspecified stress response mainly as a consequence of sexual advances made over some time, culminating with offensive fondling during a lunch meeting. She experienced thefts in the workplace, also of some of her things, which were found with the relatives of the employee in question. Subsequently she and her daughter received severe threats on the phone from the employee in question, and later the employee received a judgement because of this. Example 15: Claim turned down periodic depression (vicar) In the course of a number of years, a 50-year-old vicar developed increasing symptoms of depression of a periodic (recurrent) nature. The vicar had worked in a small town for more than 10 years, and there had been several disagreements between residents and the local church council. In addition the vicar had some stressful tasks like helping in connection with funerals after severe deaths, etc. Among other things there had been disagreement as to how to conduct the service, and protesters ran for the church council election due to changes in the physical surroundings of the vicarage. All complaints were turned down by the bishop, however, who also had several talks with the vicar in connection with the current of complaints from the local church council. The Committee found that the periodic depression had not developed, mainly or solely, as a consequence of the mental stresses as a vicar. The reason was that the exposures described, such as the work of supporting relatives in connection with severe deaths and the poor cooperation with the church council and others, including repeated complaints and criticism, could not be deemed to be sufficiently mentally stressful to substantially increase the risk of developing a depression. Example 16: Claim turned down mental illness (work environment and child pornography accusations) A man worked for about a year as a skilled day-carer in an after-school day-care facility. He described a mentally unfavourable working environment and co-operation difficulties. He was furthermore accused of having downloaded child pornography on one of the institutions computers. The Committee found that the mental illness was not, solely or mainly, a consequence of the described stresses in the workplace. The Committee took into consideration that the described co-operation difficulties and the mentally unfavourable working environment could not be deemed to have been stressful to such a degree that it involved a special risk of developing mental illness, including a post- traumatic stress response. Any mental disorders caused by the charges of downloading child pornography could not, according to the Committees assessment, be regarded as a consequence of the work. Example 17: Claim turned down unspecified stress response (office worker exposed to sexual harassment) An office worker was for a long time exposed to mental and sexual harassment from a superior and eventually developed an unspecified stress response. Once when they were out driving, the manager allegedly stopped the car, pulled her towards him and fondled her. Over a 5-year period, according to the office worker, there were at least 20 episodes of sexual harassment. Furthermore she felt that she was being socially excluded from the office, bullied and prevented from doing her job. As the information from the office worker and the employer did not coincide and it was not possible to verify the incidents in any other way, the National Board of Industrial Injuries requested that the Legal Advisor to the Danish Government (Kammeradvokaten) should interview the parties to the case. This did not, however, lead to any additional information that might document the events in question. The majority on the Committee took into consideration that the office worker had described many instances of offensive and excessive sexual harassment over time and that there was good correlation between this information and the development of a mental disorder. There was no emphasis on any factors that were directly contrary to the information from the office worker, even though it was not possible to provide specific documentation of the incidents described. A minority on the Committee found that there was insufficient documentation of the incidents. The claim was recognised by the National Board of Industrial Injuries as a majority on the Committee had recommended recognition of the claim.

There is good correlation between the exposure from dust and vapours in connection with cleaning work and the symptoms 300 mg lithium for sale, which disappeared temporarily after a long absence from work and completely when he stopped doing the work in question discount lithium 150 mg mastercard. Furthermore she had to close and move bags full of work clothes from the production buy 300 mg lithium. The bags were often overfilled and when the clothes were transferred to another bag, it generated dust. Already after a couple of years work she developed symptoms in the form of shortness of breath and was later diagnosed with allergy to various enzymes. The cleaner developed asthma as a consequence of exposure to dust from enzymes in the workplace. She tested allergic to enzymes and the symptoms of the disease developed in close time correlation with her work. In connection with gold and silver work the materials were warmed up, which released isocyanates from the materials. After 15 years the goldsmith experienced episodes of breathing problems, coughing and wheezing. For a considerable number of years the goldsmith suffered considerable exposure to isocyanates when working gold and silver into jewellery. There is good correlation between the exposure from isocyanates and the symptoms, which disappeared during holidays and completely disappeared in connection with cessation of work. After 4 years he began to work in the spray paint department and subsequently developed coughing and wheezing in connection with physical exertion. He stopped smoking, but the symptoms continued and also interfered with his sleep during the night. For a considerable period of time the auto spray painter suffered substantial exposure to isocyanates in connection with spray painting of cars. There is a good time and causal relationship between the exposures in the workplace, where he was in contact with isocyanates in connection with painting of cars, and the asthma symptoms, which likewise receded after he began to use better respiratory protection. He was inside the pig stables for most of the work day and was in close contact with the animals in connection with mucking out, piglet births, etc. Furthermore there was a constant reek of pigs in the stable, and the exhaust equipment was inadequate. It appeared from the medical information that he had been suffering from asthma since childhood and that he had experienced continuous and periodic, very severe attacks of asthma, right up to the beginning of his work in the pig stable. There was no record of any change in the attack patterns, and he had just as frequent and just as severe attacks during weekends and holidays as in connection with work. He furthermore suffered relevant exposure to pigs while working in a pig stable for 6 months. However, before starting in this job he had asthma attacks for a significant number of years and previously tested allergic to many different sources, including pigs and dogs. He is in contact with pigs in his free time and also has a dog himself, even though he is allergic to such animals. Furthermore there is no evidence of any substantial aggravation in his condition in clear connection with his work. Overall it is likely beyond reasonable doubt that his asthma was primarily caused by his previous asthma and the continued private exposure, including in particular the daily contact with pigs and his dog. Item on the list Lung disease with restricted lung function of the obstructive type is included on the list of occupational diseases (Group E, item 9): Disease Exposure Lung disease with restricted lung function of Isocyanates the obstructive type 4. Exposure requirements In order for a lung disease with restricted lung function of the obstructive type to be covered by the item on the list, there must have been one or more relevant exposures for many years, as described in detail below. Exposure to isocyanates Isocyanates are a generic term for a group of chemical substances which are much used in industry today, for instance in the production of lacquers. It is used for instance in: The building and construction industry The plastics industry The iron and metal industry The wood industry The car industry The electrics and electronics industry Isocyanates belong to the group of components that make various materials harden. This is the case, for instance, with lacquered car parts which are repaired/welded in garages or electronic parts that are repaired. Time correlation In principle there need to have been 4-5 years of daily or almost daily exposure to isocyanates. In the event of particularly massive exposure the time requirement may be reduced after a concrete assessment. Working conditions In the assessment of whether the exposure in the workplace is sufficient for recognition of the disease, it is relevant to look at the conditions under which the work was performed. The exposure will be 244 greatest in small rooms without proper ventilation, whereas the exposure will be smallest when the work was performed out of doors. If the work was performed indoors, it is essential to look at whether there has been ventilation and whether respiratory protection equipment has been used. If the protection measures have been efficient, it requires a longer-lasting exposure in order to recognise an occupational disease than if exhaustion and other protection measures were deficient. Examples of pre-existing and competitive diseases/factors Examples of possible competitive factors that may affect the development or course of the disease: Tobacco smoking Alpha-1 antitrypsin deficiency, which is a hereditary gene disorder Smoking is a substantial cause of lung disease with restricted lung function of the obstructive type. Therefore, in some cases, smoking may lead to a reduction in the compensation amount.