Sadie Costello PhD, MPH

• Assistant Researcher and Lecturer , Environmental Health Sciences

https://publichealth.berkeley.edu/people/sadie-costello/

Maintenance Each water point must have a caretaker to look after it women's health quick weight loss estrace 1mg for sale, keep it clean and make sure it is not abused (women are usually the most appropriate caretakers; in the long term they must be trained in maintenance skills) womens health jan 2014 buy cheap estrace 1 mg line. Domestic storage It is important to provide clean storage containers for use in the home menstruation orange blood buy cheapest estrace. Providing high-quality water at a tap-stand is of little impact if people are unable to carry and store that water hygienically or do not appreciate the importance of this women's health big book of yoga download discount estrace 1mg mastercard. In the acute phase of an emergency women's health center saskatoon buy 2 mg estrace with amex, household storage is likely to be in plastic containers menstruation 3 weeks estrace 1mg with mastercard. People may use a plastic jerrycan for carrying and storing water and a bucket for washing. Vegetable oil is often distributed in this type of container, and they can be used for water when empty. These allow for the safe storage of water, plus a reserve to cope with a short break in supply. These jars improve storage and, in addition, the skills learned in making the jars can be used when the emergency is over. The provision of latrines and the development of methods of waste disposal are essential elements of the programme. These measures are only fully effective, however, when complemented by a sanitation education programme. It contributes to the transmission of numerous diseases (which can be particularly when combined with low levels of nutrition) and can also be a breeding ground for flies and other insects. In the acute phase of an emergency, any form of excreta disposal is better than none. The simplest and quickest methods should be adopted; these can later be improved on and changed. Water must be provided in alternative locations to control this practice effectively. These measures must be announced throughout the camp with the assistance of the community leaders, and displayed on signs, using both words and pictures. Latrine design the most common cause of failure of a sanitation system is the selection of the wrong system of latrines for a given situation. As potential latrine users will be relied on for inspection and maintenance, it is essential that they be involved from the beginning in planning, design and implementation. In designing the system, the requirements of women, young children and people with disabilities need to be considered. Education and promotion Where it is necessary to introduce unfamiliar types of latrines, the emergencyaffected population may need training in the proper use of the system. Where acceptable latrines are provided, intensive education and promotion is still needed to maximize the numbers of displaced persons using them. This is especially important for the children, who may not have used latrines before. Babies will not use latrines, and their faeces are more dangerous than those of an adult. A complete camp coverage of one latrine per 50 people should be the first target; then one per four families; and finally one per family. Often the best ratio achieved in an emergency situation is one latrine per four families. A system for the safe storage, collection and disposal of waste must be implemented in the earliest stages of an emergency. Consultation with the emergency-affected population is very important, as they may already be motivated to carry out some of the necessary tasks without outside intervention, and may also want to use their waste in a constructive way. Every household must be no more than 15 metres away from a refuse container, with one waste container for ten houses. Holes drilled in the bottom allow liquids to drain away and also prevent them from being stolen and used as water storage containers. A small hole can be dug and the waste, if dry enough, can be burned before burying. Transport of waste by If the affected population are interested or experienced in composting householders to a community their waste, compost pits can make a very efficient disposal system. If the pits are small enough to be located at various sites throughout the camp, there may be no need for solid waste collection. If the population understand the dangers of flies and rats they will be more inclined to manage the compost heap correctly. They may also be motivated by the possibility of utilizing or selling the compost. Waste collection near homes and the most expensive option; often the only solution in large, overcrowded transfer to large disposal site settlements. It must be drained away as it attracts flies and mosquitoes and can contaminate water supplies. Sullage also provides a breeding ground for Culex mosquitoes, vectors of filariasis, Japanese encephalitis, and other vector-borne diseases. People tend to do their washing and bathing close to the water source, such as a river or lake, unless alternative facilities are provided. If water is in short supply, water distribution points can be linked to laundry areas as spillage at tap stands can be drained to the clothes-washing area. Laundry washing water needs to be drained carefully since it contains a large amount of phosphates and should not be directed toward water sources. There is no need for a roof on a shower room, although a screen-like superstructure is necessary. If the sun dries the room each day then any pathogens existing in stagnant water will be killed off. Sullage can be channelled into the storm-water drains, but this will not be washed away in the dry season. If the sullage cannot be drained away it may be necessary to divert it into a soakaway or a waste stabilization pond. Medical waste should be burnt in an incinerator, preferably as close as possible to the source. In temporary situations, a 200-litre drum can be used as an incinerator, divided in half by a metal grate and with an access hole at the bottom to provide air for combustion and as a way of removing ash. In hospitals where there is no incinerator, placenta pits can be used for human tissues. Organic waste such as placentas and amputated limbs can be burned and then buried deep within these pits, although measures should be taken to ensure that the groundwater will not be contaminated. At small medical facilities such as clinics, a small hole 1 m 1 m 1 m can be dug for the burning and burial of hazardous waste, such as syringes and soiled dressings. Great care should be taken with sharp materials such as broken glass, scalpels and old syringes. They should be placed within old metal containers (cooking oil or milk powder tins) that are sealed before burial (see safe disposal of needles in Section 2. Settlements with little or no vegetation are not only dusty but are also full of rubbish blown from disposal sites. Dust can be settled by spraying water on the ground: this is particularly useful around health centres and feeding centres. The diseased living are a far greater hazard than the deceased, because most pathogens do not long survive the chemical and temperature changes that occur after the death of their host. Even if they do survive, the conditions suitable for multiplication of the organisms are rarely met. In the case of cholera, bodies should be disinfected with a 2% chlorine solution and the orifices blocked with cotton wool soaked in chlorine solution; they must then be buried in plastic sacks as soon as possible. Those who have died of typhus should be bagged as soon as possible to prevent the migration of lice to others. Individuals who have died of viral haemorrhagic fever should be handled with full biohazard precautions, wrapped in sealed leakproof material (body bag) immediately, and either be cremated or buried at a depth of at least 2 metres. If body bags are not available, wrapping the corpse in a fabric soaked in a disinfectant such as formaldehyde, then covering with a plastic sheet and sealing in a plastic bag, is recommended. It generally has little effect on the disease risk as it is rapidly neutralized and it presents a hazard to the handlers. Ideally the method of disposal should follow the cultural practices of the population of which the deceased was a member. In the acute phase of an emergency, where many deaths have occurred, there may be pressure to conduct mass burials. However, this should be avoided if at all possible, to ensure relatives of the deceased have the opportunity to identify the bodies and allow burial in a marked site. Burial sites must be identified early on, and the site should ideally be located at the outskirts of the settlement (or community) and away from water sources. During an outbreak with a high mortality rate, the collection of bodies and their rapid burial is a priority. With a large number of bodies there is not enough time to undertake the normal ceremonies of burial. Everything should be done to try to record the names of the dead and the number of bodies interred. If possible, a culturally appropriate ceremony should be held at the end of the epidemic. Graveyard and crematorium attendants should be in place to record the name, age, gender, and address of the deceased, the cause of death, the plot space used and the depth of burial. Records on the cause of death can be compiled to draw up a picture of the health problems in a camp. If a mound is made over a shallow burial, there should be at least one meter between the edge of the mound and the cadaver. The reason for this is to prevent access by carrion feeders (such as jackals) or rodents (many species can burrow at least two feet) and also to prevent access by burrowing flies, some of which can dig down at least 45 cm. Problems identified can be addressed by means of changes in design, location or improved education methods. Monitoring is essential in ensuring that all sectors of the population receive an adequate water supply. The purpose of a vector control programme is to reduce disease transmission by rendering the environment unfavourable for the development and survival of the vector. Prevention is better than cure, and when the planning and construction of camps is undertaken, preventing the development of vector problems should be taken into account. Complete eradication of a vector is rarely possible nor necessarily desirable, but the vector population and its life expectancy should be kept to a minimum. Community adhesion and participation in a vector control programme is essential for its success. Early diagnostic and treatment are needed to prevent severe forms of the disease (especially for malaria) when transmission control 2. Both are complementary and two essential components of any effective vector borne disease control programme. The major biological vectors are mosquitoes, sand flies, triatomine bugs, tsetse flies, blackflies, ticks, fleas, lice, mites. Important carrier reservoirs or intermediary hosts are synanthropic flies, snails and rodents. The diseases most commonly spread by vectors are malaria, filariasis, dengue fever, yellow fever, leishmaniasis, Chagas disease, sleeping sickness, onchocerciasis, borreliosis, typhus, and plague. Major diseases transmitted by intermediate hosts or carriers are schistosomiasis, diarrhoeal diseases and trachoma. The main methods of vector prevention and control can be classified as personal protection; environmental control; campsite, shelter and food store sanitation; community awareness; and chemical control such as residual or space spraying, insecticide-treated traps, selective larviciding and the use of rodenticides. Vector control is very specific to the ecology of the vector, the epidemiology of the disease, the human and social environment as well as resources locally available. It is important to seek the advice of an entomologist/environmental hygienist when designing a vector control programme. Mosquitoes Mosquitoes are the vectors of malaria, filariasis, dengue, Japanese encephalitis and yellow fever. Many species feed on humans, but only some of them are vectors of the diseases mentioned in Table 2. All mosquitoes lay their eggs in moist areas, but each species has a specific preference for a given type of area. The control measures should be specific to the species and their ecological preferences. Head lice are not vectors of any particular disease but cause discomfort for those infested. Body lice are widespread in impoverished communities in temperate climates or in mountainous areas in tropical countries. Louse-borne diseases, associated morbidity and mortality, treatment and prevention are presented in Table 2. Louse-borne infections are common in overcrowded situations, particularly in settlements.

An antecedent event (most often a viral infection) precipitates clinical presentation pregnancy indigestion cheap estrace amex. Tachycardia and hypertension are treated with short-acting medications such as alpha-adrenergic blocking agents menstruation 9 days cheap estrace online mastercard. Headache is actually a symptom rather than a disease entity and may indicate organic disease (neurologic) menstruation age 8 purchase estrace 1 mg fast delivery, a stress response breast cancer z11 study buy estrace 1 mg mastercard, vasodilation (migraine) women's health equity act buy 2 mg estrace overnight delivery, skeletal muscle tension (tension headache) womens health 5k cheap estrace line, or a combination of these factors. A secondary headache is a symptom associated with organic causes, such as a brain tumor or aneurysm, subarachnoid hemorrhage, stroke, severe hypertension, meningitis, and head injury. Onset typically occurs in puberty, and the incidence is 18% in women and 6% in men. Headache Phase this phase, occurring in 60% of patients, involves a unilateral, throbbing headache that intensifies over several hours. Pain is severe and incapacitating, often associated with photophobia, nausea, and vomiting. Abortive approach is used for frequent attacks and is aimed at relieving or limiting a headache at onset or while in progress. Preventive approach is used for those who have frequent attacks at regular or predictable intervals and may have medical conditions that preclude abortive therapies. Continuing Care the National Headache Foundation provides a list of clinics in the United States and the names of physicians who are members of the American Association for the Study of Headaches. H Other Headache Types Cluster Headache Cluster headaches, another severe form of vascular headache, are seen most frequently in men. The attacks come in clusters of one to eight daily, with excruciating pain localized in the eye and orbit and radiating to the facial and temporal regions. Cranial Arteritis Infiammation of the cranial arteries is characterized by a severe headache localized in the region of the temporal artery. Tension Headache (Muscle Contraction Headache) Emotional or physical stress may cause contraction of the muscles in the neck and scalp, resulting in tension headache. This is characterized by a steady, constant feeling of pressure that usually begins in the forehead, the temple, or the back of the neck. Tension headaches tend to be more chronic than Head Injury (Brain Injury) 335 severe and are probably the most common type of headache. Relief may be obtained by local heat, massage, analgesics, antidepressants, and muscle relaxants. Reassure patient that the headache does not indicate a brain tumor, and teach stress reduction techniques (biofeedback, exercise, medication). H Head Injury (Brain Injury) Injuries to the head involve trauma to the scalp, skull, and brain. Clinical Manifestations Symptoms, other than local, depend on the severity and the anatomical location of the underlying brain injury. Other characteristics can include tissue alteration and neurologic deficit without hematoma formation, alteration in consciousness without localizing signs, hemorrhage into the tissue that varies in size and is surrounded by edema. Deep contusions are more often associated with hemorrhage and destruction of the reticular activating fibers altering arousal. The patient has no lucid intervals and 338 Head Injury (Brain Injury) experiences immediate coma, decorticate and decerebrate posturing, and global cerebral edema. Epidural Hematoma (Extradural Hematoma or Hemorrhage) Blood collects in the epidural space between the skull and dura mater. When compensation is no longer possible, sudden signs of herniation may appear, including deterioration of consciousness and signs of focal neurologic deficits (dilation and fixation of a pupil or paralysis of an extremity); the patient deteriorates rapidly. Medical Management this is an extreme emergency because marked neurologic deficit or respiratory arrest may occur within minutes. Subdural Hematoma Blood collects between the dura and the underlying brain and is more frequently venous in origin. Head Injury (Brain Injury) 339 Subdural hematoma may be acute (major head injury), subacute (sequelae of less severe contusions), or chronic (minor head injuries in the elderly may be a cause; signs and symptoms fiuctuate and may be mistaken for neurosis, psychosis, or stroke). Medical Management Presume that a person with a head injury has a cervical spine injury until proven otherwise. If both pupils are fixed and dilated, it usually indicates overwhelming injury and poor prognosis. Improvement may take 3 or more years after injury, during which time the family and their coping skills need frequent assessment. Several systemic conditions (eg, progressive renal failure and uncontrolled hypertension) can contribute to the development and severity of cardiac failure. Instruct patient to avoid prolonged bed rest; patient should rest if symptoms are severe but otherwise should assume regular activity. If patient tolerates the activity, develop short-term and long-term goals to increase gradually the intensity, duration, or frequency of activity. Restraints are likely to be resisted, and resistance inevitably increases the cardiac workload. Signs are ventricular dysrhythmias, hypotension, muscle weakness, and generalized weakness. Both types are inherited as X-linked traits, so almost all affected people are males; females can be carriers but are almost always asymptomatic. Hematomas within the muscle can cause peripheral nerve compression with decreased sensation, weakness, and atrophy of the area. Ammonia is considered the Hepatic Encephalopathy and Hepatic Coma 357 major etiologic factor in the development of encephalopathy. Circumstances that increase serum ammonia levels precipitate or aggravate hepatic encephalopathy, such as digestion of dietary and blood proteins and ingestion of ammonium salts. The hepatic lesion is potentially reversible, and survival rates are approximately 20% to 50%, depending greatly on the cause of liver failure. The virus is found in the stool of infected patients before the onset of symptoms and during the first few days of illness. Recovery from hepatitis A is usual; it rarely progresses to acute liver necrosis and fulminant hepatitis. No carrier state exists, and no chronic hepatithis is associated with hepatitis A. It replicates in the liver H and remains in the serum for long periods, allowing transmission of the virus. Hepatitis B remains a major worldwide cause of cirrhosis and hepatocellular carcinoma. Assessment and Diagnostic Findings Hepatitis B surface antigen appears in blood of up to 90% of patients. Hepatitis C A significant portion of cases of viral hepatitis are not A, B, or D; they are classified as hepatitis C. It is the primary form of hepatitis associated with parenteral means (sharing conH taminated needles, needlesticks or injuries to health care workers, blood transfusions) or sexual contact. The clinical course of hepatitis C is similar to that of hepatitis B; symptoms are usually mild. A combination therapy using ribavirin (Rebetol) and interferon (Intron-A) is effective for treating patients with hepatitis C and in treating relapses. Because the virus requires hepatitis B surface antigen for its replication, only patients with hepatitis B are at risk. Hiatal Hernia In a hiatal (hiatus) hernia, the opening in the diaphragm through which the esophagus passes becomes enlarged, and part of the upper stomach tends to move up into the lower portion of the thorax. Sliding, or type I, hiatal hernia occurs when the upper stomach and the gastroesophageal junction are displaced upward and slide in and out of the thorax; this occurs in about 90% of patients with esophageal hiatal hernias. Individual nodes are firm and painless; common sites are the cervical, supraclavicular, and mediastinal nodes. Medical Management Treatment is determined by the stage of the disease instead of the histologic type. Researchers believe that glutamine abnormally collects in certain brain cell nuclei, causing cell death. During the early stages of illness: uncontrollable fits of anger; profound, often suicidal depression; apathy; anxiety; psychosis; or euphoria. Medical Management No treatment stops or reverses the process; palliative care is given. Pathophysiology Persistent hyperglycemia causes osmotic diuresis, resulting in water and electrolyte losses. Although there is not enough insulin to prevent hyperglycemia, the small amount of insulin present is enough to prevent fat breakdown. Hypertensive urgency exists when blood pressure is very elevated but there is no evidence of impending or progressive target organ damage. Hypertensive emergencies and urgencies may occur in patients whose hypertension has been poorly controlled, whose hypertension has been undiagnosed, or in those who have abruptly discontinued their medications (see Box H-1). Secondary Hypertension Secondary hypertension is characterized by elevations in blood pressure with a specific cause, such as narrowing of the renal arteries, renal parenchymal disease, hyperaldosteronism (mineralocorticoid hypertension), certain medications, pregnancy, and coarctation of the aorta. Hypertension can also be acute, a sign of an underlying condition that causes a change in peripheral resistance or cardiac output. Gerontologic Considerations Compliance with the therapeutic program may be more difficult for elderly people. Monotherapy (treatment with a single agent), if appropriate, may simplify the medication regimen and make it less expensive.

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The study found that when proper basic limb hygiene menopause estrogen levels purchase estrace american express, skin care breast cancer 5k harrisonburg va buy estrace amex, and other self-care measures women's health boutique in houston discount estrace 2mg online, including limb elevation and exercise were implemented womens health jacksonville cheap estrace, the incidence of secondary bacterial infections decreased to 31% of earlier levels women's health issues canada discount 1 mg estrace with amex. A follow-up study two years later found that the incidence of secondary infections not only remained low unique characteristics of women's health issues 1mg estrace with mastercard, but had even decreased further (Addiss et al. Feasibility and efectiveness of basic in reducing acute attacks in subjects with lymphedema management in Leogane, Haiti, an area lymphatic flariasis in Burkina Faso. Transactions media-center/press-releases/2012/01/ of the Royal Society of Tropical Medicine and Hygiene, private-and-public-partners-unite-to-combat-10105, 58-60. Annual Review of acute adenolymphangitis with special reference to Entomolog, 54, 469-487. Haiti: An efective, sustainable and replicable model program for lymphatic flariasis morbidity control. Efect of water resource development adenolymphangitis in lymphoedema caused by and management on lymphatic filariasis, and brugian flariasis. Annals of Tropical Medicine and Parasitolog, World Health Organization (2013a, October 24). The efcacies of afected-limb care with penicillin diethylcarbamazine, the World Health Organization (2013b, October 24). Guinea worm disease, also known as dracunculiasis, is caused by consuming water containing water feas that carry the microscopic larvae of the parasitic worm. The disease results in the female worm emerging through a blister in the skin, usually on the foot or leg. The traditional method for removing the Guinea worm is slowly winding it around a small stick, a process that can take weeks and is very painful. The suferer often seeks relief by submerging the blister in surface water, like a pond or river, which causes the female worm to release larvae into the water, thus continuing the cycle of infection. Thanks to concerted eradication eforts, Guinea worm, once widespread, now only occurs in four body, a process that can take weeks. It is only the second disease of humans, of the worm emergence, the sufferer experiences a after smallpox, set to be completely eradicated from burning sensation, swelling and pain, and the emergence the world. The Health and Development Impacts disease has a severe adverse efect on productivity of of Guinea Worm Disease communities, especially of agricultural workers, and People infected with Guinea worm sufer extreme pain decreases school attendance, as suferers are unable and debilitation while the worm emerges from their to work or attend school (Hopkins et al. Global Burden of Guinea Worm Disease Guinea worm has nearly been eradicated from the world. In 2013, 144* cases worldwide were reported from four countries: Chad, Ethiopia, Nigeria and South Sudan. Cloth flters were systematically distributed throughout some 94,000 villages across the country, along with health education messages about how to use the flters and other ways to ensure drinking clean water. Guinea worm disease is seasonal, increasing during dry periods when water bodies shrink and the density of water fleas on which the Guinea worm parasite lives increases. Unreliable tube wells or boreholes that fail can result in increased dependence on unsafe sources contaminated with the Guinea worm parasite. Gubb, the Carter Center unprotected wells or from surface water, using fne-meshed cloth or a flter made from a 0. If this is done in a pond or lake where sources to prevent people from entering the water. Health benefits from that may be helpful to you as you explore opportunities improvements in water supply and sanitation: for collaboration. Please note that this is not an survey and analysis of the literature on selected exhaustive list; you should seek to identify many diseases. Partnerships and Programs for Guinea W orm Eradication Efects of improved water supply and sanitation on the Carter Center. Dracunculiasis Public Service Announcements in multiple Eradication: Delayed, Not Denied. Monitoring ensures that important because their long-term sustainability is a organizations are accountable to benefciaries and signifcant challenge in many developing and developed donors, and is essential for tracking progress towards countries. Opportunities and next steps identified for sectors to plan and adapt their future programming. Local government benefted from construction of improved school should also ensure that mechanisms exist for citizens latrines as well as hygiene promotion and water to get involved and voice their concerns, thereby treatment had signifcantly higher fecal promoting greater transparency and accountability. Support for funding is contamination represents a much greater risk of important, as there will continue to be gaps. Integration of Water, Sanitation, and Hygiene for the Prevention and Control of Neglected Tropical Diseases: A Rationale for Inter-Sectoral Collaboration. This keeps the lines of communication open over Ability to make a measurable contribution to time, which can lead to eventual partnership or improved health and well-being of target populations. In order to ensure that partnership in mutually Opportunity to build and strengthen relationships benefcial, it is essential that partners agree upon with Ministries of Health and other health-sector the following: players at various levels. They developed an ambitious work plan through which the three parties agreed to work together on issues including the scaling up of sanitation services, joint advocacy, staff training, joint review of the National Health Strategic Plan, development of the National Environmental Health Strategy, and joint impact monitoring. This process has given WaterAid the opportunity to build relationships with the Ministry of Health and other actors at various levels. The infectious agent within a given geographic area carrier state may occur in an individual with an or population group; may also refer to the usual infection that is inapparent throughout its prevalence of a given disease within such area course (known as an asymptomatic carrier), or or group. Mass the state of health of persons in a defined drug administration is one modality of population. The denominator is the population at risk; the numerator is the transmission of infection: Any mode or mechanism number of new cases occurring during a given by which an infectious agent is spread through time period. However, there have of soil and particles of feces ingested via oral contact been gaps in the evidence base examining the impact with contaminated hands. Examining facial cleanliness has been used as a proxy indicator for the activity of face washing. An individual having a clean face with no visible ocular discharge is associated with a reduced risk of having signs of active trachoma and a reduction in risk of infection with C. Individuals living in households with access to a latrine have an estimated 19% reduction in risk of active trachoma, and a reduction in risk of infection with the bacteria that causes trachoma. A systematic and meta-analysis on the associations of improved review and meta-analysis on the associations of water, sanitation, and hygiene on infection with improved water, sanitation, and hygiene on trachoma. Presence of reaction) evaluations <i>Chlamydia trachomatis</i> bacterium Soil-transmitted Stool sample Presence and Laboratory Schools District level helminths (Kato-Katz method) number of eggs technician in feces Lymphatic Filariasis Blood test Level of microflaria Laboratory Communities National level (baby worms) in technician blood Guinea worm Observation Emerging worm Specialized Communities Village or of symptoms: from ulcer on the knowledge not community level community health body, usually the needed surveillance foot or leg Schistosomiasis Stool sample Presence and Laboratory Schools District level Mansoni (Kato-Katz method) number of eggs technician Japonicum Mekongi Intercalatum Schistosomiasis 1. Facial cleanliness has been used as a proxy indicator for the activity of face washing. Messaging that demonstrates cost-efectiveness and efciency of Problem programs and actions may be most efective. The average cost per life-year saved if households have complete water and sanitation coverage ranges between 65% and 80% of the annual gross domestic product per capita of developing countries (Gunther & Fink, 2011). Global attend school and unable to concentrate on lessons Burden of Trachoma and Economics of the Disease. Disease and Development: Evidence from Hookworm Eradication in the American South. Retrieved from Role of Vector Control in the Global Program to onlinelibrary. Dracunculiasis Contribution of Sex-linked Biology and Gender eradication: delayed, not denied. Social and Economic Impact Review on Antimicrobial Agents and Chemotherapy, 41, 1131. The economic burden of lymphatic Association between genital schistosomiasis and flariasis in India. A systematic review and meta-analysis on the associations of improved Lima e Costa, M. W orld Health Organization Technical Report Series, 912, About Guinea worm disease. Soil-Transmitted Helminth Infection: Systematic Lymphatic Filariasis: Managing Morbidity and Review and Meta-Analysis. This and other progress notwithstanding, the challenges remain daunting and the consequences of failure as serious as ever. New figures on official development assistance within the sector are a cause for optimism. Over the 2001-2007 period bilateral donations increased by an average annual rate of 19 per cent and multilateral donations by 11 per cent annually. However, the new figures also reveal continuing structural inequities in sector financing patterns: less than a quarter of funds are allocated for basic water and sanitation, and a disproportionate amount of financing is channelled to a relatively small number of countries. There was significant progress in the fight against guinea worm in 2008 and there is new optimism that the disease can be eradicated. The programme continues to be strongly field-based: 98 per cent of expenditure and 92 per cent of professional staff postings are at the country level. Many more people, numbering in the tens of millions, were reached through handwashing promotion campaigns and in water quality interventions, including through the distribution of water treatment chemicals in emergencies. This was achieved in various ways, both at the global level and within countries around the world. One way this is being done is through a renewed focus on refining and taking to scale more effective ways to promote sanitation and handwashing with soap. For hygiene a key trend is the use of more evidence-based approaches for the promotion of handwashing with soap, with more systematic partnering arrangements with the private sector. The subsequent call to action from this and other meetings in 2008 highlights the scale of the challenge still ahead. Over the 2001 2007 period bilateral donations increased by an average annual rate of 19 per cent and multilateral donations by 11 per cent. In addition, middle income countries and countries with medium coverage levels are still receiving far more sectoral aid per capita than are poor countries with low coverage levels. Finally, the figures show that a disproportionate amount of financing is channelled to a relatively small number of countries: 51 per cent of the 2006/2007 commitments were being disbursed to the top ten recipient countries. It included a call for increased national and international investment in the sector and more effective assistance strategies building on the Paris Declaration on Aid Effectiveness. The High-Level Event also identified the need for harmonization and coordination of existing mechanisms for sector monitoring and evaluation. There is also increasing anti-corruption activity of various types at country level, and within stakeholder organizations. This threatens the health of children and contributes to low school attendance, 80% n=33 countries (water) performance and completion rates, especially for n=25 (sanitation) girls. In reality, the situation is 6 Global Corruption Report 2008: Corruption in the Water Sector, Transparency International. For example, standards in many countries do not take into account the need for handwashing facilities near toilets, for private toilet facilities for girls, or for the need for lower 8 student-to-toilet ratios for girls. Guinea Worm Eradication the number of cases of dracunculiasis (guinea worm) fell to 4,615 cases in 2008, a 52 per cent reduction from 2007 and the lowest number ever. If guinea worm is eradicated, it will be only the second disease ever eradicated (after smallpox). However, much remains to be done to achieve this, and 2009 will be a watershed year in determining success. Most programme expenditure (90 per cent) continues to be focused on the 60 priority countries. It is also management working towards increasing its role in the 3% area of upstream programming. Expenditure classified as "capacity Water supply building, management, advocacy" increased 38% from 16 per cent of the total expenditure in 2007 to 22 per cent in 2008 (see Figure 5), indicating an increase in activities related to advocacy, sector development and building enabling 10 United Nations Economic and Social Council (2006). Expenditure on hygiene and sanitation also increased in 2008 to a total of just under a third of the overall programme, and to 41 per cent of the direct expenditure on primarily 11 field-based programmes (from 37 per cent in 2007). This heightened profile was used in various ways to influence programme prioritization and funding decisions within governments and financing institutions (see Sections 1. These efforts included the publication of new 11 Expenditure on activities other than capacity building, management and advocacy. Many more people, numbering in the tens of millions, were reached through a range of handwashing with soap promotional activities (see Sections 3. Many more were reached in water quality interventions, especially through the distribution of water treatment chemicals in emergencies (see Sections 3.

Horses probably ingest the sporocysts Opossums pose a potential threat to human health inadvertently while eating grass women's health center dover discount estrace 2 mg on line, hay women's health big book of exercises walmart discount estrace american express, or grain contamithrough direct injury or as a reservoir/carrier of infecnated with infected opossum feces women's health center norwich ny purchase estrace on line amex. Wounds Classic murine typhus occurs worldwide womens health lynchburg discount 1mg estrace visa, most often should be immediately cleaned with soap and water as a rat-flea-rat cycle where humans represent an aband medical attention sought women's health clinic overland park ks estrace 2mg lowest price. In suburban areas of the of transmitting rabies via bites and scratches (see beUnited States menopause kidney stones estrace 1 mg overnight delivery, especially southern California and low). The cat flea (Ctenocephalides felis) was the for an injured or sick opossum, but call animal most prevalent flea species (97%) found in these incontrol for assistance. Seek medical attention vestigations and opossums showed the heaviest infesimmediately if bitten or scratched by an opostations (105 fleas per animal in one study). Oposunusual behavior such as daytime activity, aggression, sums are particularly attracted to dog and cat weakness, and neurologic signs (circling, seizures, etc. Attach a section of inch hardVisceral and Ocular Larval Migrans ware cloth to the opening which is hinged at Carnivores (dogs, raccoons) are the primary carriers the top and left loose on the other three sides. Local ordinances may resystem by providing food for natural predators and strict the trapping and relocation of opossums. A suburban focus of endemic typhus in Los Angeles County: Association with seropositive domestic cats and opossums. Bats are the only mammals that can fly, and their wings make any of the approximate 925 living species in the world instantly recognizable. However, the many variations in the basic structure of their anatomy and social lives reflects a greater degree of specialization than any other order of mammals. Order Chiroptera the wing is formed from skin stretched between the Suborder Megachiroptera (Megabats) arm, wrist, and finger bones. Although the skin on the 1 family 166 species wings is very thin and appears delicate, it is fairly reSuborder Microchiroptera (Microbats) sistant to tears or punctures. Wing membranes usually 16 families 759 species (3 families 23 attach along the sides of the body and to the hind legs. The tail Bats comprise the order of mammals called Chiroptera, membrane also aids in flying. Megabats do not rely on echolocation, have large bodies and eyes, eat primarily fruit, and are limthe hind limbs of bats are small relative to the wings ited in their distribution to the Old World tropics. In and oriented 180 degrees relative to other mammals, contrast, microbats rely on echolocation for foraging such that the knees point backwards. This feature aids and maneuvering, have small bodies and eyes, eat priin flight as well as in the characteristic head-down roostmarily insects, and are widely distributed throughout ing posture. Forty-two species of bats are found in the United States, the head and facial features of bats exhibit a great deal all microbats. In California, there are 23 species within of diversity, reflecting different foraging styles and 3 families the Phyllostomidae (leaf-nosed bats; 2 spefeeding preferences. The fleshy nose leafs and facial cies), the Vespertillionidae (plain-nosed, ornamentations function in the transmission of echolovespertillionid, or little brown bats; 17 species), and cation waves. The importance of hearing in echolocathe Molossidae (free-tailed bats; 4 species). Note the upper arm (humerus), elongated forearm (radius), and fingers that form the wing. Eyes are large in megabats, which cial structure, diet, flight behavior, predation risks, and generally do not echolocate, but relatively small in reproduction of each species. Bats exhibit a great range of body sizes, from the tiny Most species of bats eat insects, often taking insects in hog-nosed or bumble bee bat of Thailand (~2 g) to the flight, but occasionally from plants or from the ground. However, most bats are relatively small, such as frogs, lizards, mice, other bats, and fish. The western pipistrelle is the smallspecies, especially in the tropics, feed on fruit and the est bat in California and one of the smallest mammals pollen and nectar from flowers. Roosting Behavior Navigation (Echolocation and Feeding Behavior) Bats are active and feed at night. During the day, bats In order to find prey items and to maneuver within their roost in dark, sheltered places such as caves, mine tunenvironment, most bats echolocate. Bats emit high-frenels, rock crevices, hollow trees, under loose tree bark, quency sound impulses and discern information about in trees and understory vegetation, in buildings, under objects in their path from rebounding echoes. Some species the structural characteristics of bats, including their roost alone, while others form colonies that vary from varying shapes and sizes of ears and their occasionally a few to millions of individuals. Many vided into day and night roosts, hibernation roosts, sumaspects of echolocation are specific to each species and mer roosts, nursery roosts, feeding roosts, and tranrelate to foraging for food. The roosting habits of bats are 26 Bats (Class Mammalia, Order Chiroptera) Key to the Families of Bats in California 1. Tail entirely or almost entirely contained within the tail membrane; if tail tip projects beyond margin of tail membrane, face has a leaf-like nose appendage. Vespertillionidae Variations in face, tail, and uropatagium (tail membrane) of California bats. A represents a California leaf-nosed bat (Phyllostomidae); B a plain-nosed myotis (Vespertillionidae); and C a Mexican free-tailed bat (Mollosidae). Bats serve as pollinators and seed disthe winter, bats either migrate south to a warmer clipersal agents for hundreds, and probably thousands, of mate, as many birds do, or hibernate in a protected lospecies of plants. The migration patterns and the seasonal districally valuable crop plants which rely on bats for surbution of many bats are unknown. In California, some vival are bananas, avocados, dates, figs, mangoes, cashmigration patterns may be limited to changes of elevaews, and agave (tequila). Reproduction, Litter Size, and Longevity Some bat species breed in the spring while others breed Despite benefit to human communities, and their abilin the fall and delay fertilization until spring. In either ity to adapt to various environments, bat populations case, birth coincides with the emergence of insects in are often negatively affected by environmental disturthe spring. Therefore, bat populations may lion bats in 1936, but since 1973 houses fewer than be very slow to recover following injury. Wanton destruction by humans devastated bat populations at Eagle Creek Cave, Arizona, which Bats have much longer life spans than is typical for declined from 30 million bats in 1963 to less than small mammals, sometimes exceeding 30 years. The propensity of bats to longed life spans may be a function of reduced metacongregate in huge numbers leaves them vulnerable to bolic rates on the bases of daily torpor, seasonal hiberhuman disturbance. Distribution Even innocent exploration of caves at the wrong time Because of their ability to fly, bats are the most widely of the year can dramatically disturb hibernating bats, distributed group of terrestrial mammals. Representaforcing them to use up valuable energy necessary to tives inhabit every continent except Antarctica. Twelve of the 23 species in California are found throughout California, with the exception of the southeastern deserts and the San Joaquin Valley. Seven species inhabit principally southern California, especially the southeastern desert regions. The remaining four species have limited or disjunct distributions which do not fit the other two basic patterns. Ecological and Economic Value Bats play an important beneficial role as the major consumers of night-flying insects, as pollinators of plants, and in the dispersal of seeds of fruits. Mexican long-tongued bat (Choeronycteris mexicana) Description: A leaf-nosed bat with a very long snout. Tail reaching less than half way to margin of tail memCalifornia leaf-nosed bat brane. Roosts in the darkest regions of caves Description: Snout with simple leaf-like appendage at and mines. Tail extends slightly beyond tail Food: the extremely long snout and tongue are adapted membrane. Food: Mostly large and heavy bodied insects, such as Reproduction: A single offspring is born in the spring. Until the infant is rather large, it is carried by the mother Reproduction: A very unusual pattern of fertilization while foraging. Embryonic development is slow for the first five months, and then accelerates in the spring, with birth following mating eight months later. Silver-haired bat (Lasionycteris noctivagans) Description: Dorsal fur dark brown or black conspicuously white-tipped, giving a frosted appearance; ears short and broad; tail membrane well-furred on basal half. Little brown myotis (Myotis lucifigus) Distribution: Common in forested areas of northern half Yuma myotis (Myotis yumanensis) of California. Long-eared myotis (Myotis evotis) Reproduction: Fall-spring pattern; two young per litter Fringed myotis (Myotis thysanoides) is normal Long-legged myotis (Myotis volans) Protected Status: None. California myotis (Myotis californicus) Western small-footed myotis (Myotis ciliolabrum) Description: Some species vary by ear size and forearm length, but all myotis species are difficult to differentiate by physical characteristics. A few species occur in the southeast desert region only, while some others are absent only from the southeast and central valley. Food: Diet depends upon availability, but feeds mostly Western pipistrelle (Pipistrellus hesperus) on small flying insects, especially aquatic insects. A voracious appetite: known to eat half their body weight Description: Very small with light-colored fur and very each night. Reproduction: Mates in the fall; ovulation and fertiliDistribution: Occurs throughout most of California, zation in the spring (fall-spring pattern); a single young especially in open arid areas at lower elevations. Distribution: Widespread and abundant throughout Distribution: Generally distributed throughout the California. Roosts frequently in buildings and caves; wooded areas of California; absent from the southeastcolonial. Roosts singly in dense foliage of medium Food: A large variety of insects, especially early flyto large trees. Reproduction: Fall-spring pattern; generally two young Protected Status: None, but known to be very suscepper litter. Western red bat (Lasiurus borealis) Description: Dorsal color is brick to rusty red with tips Southern yellow bat (Lasiurus ega) white; underparts slightly paler; tail membrane wellfurred on basal half. Previously known as Lasiurus Description: Medium-sized; dorsal fur a light yellow; blossevilii. Previously Distribution: More common in the central foothills and known as Lasiurus xanthinus. Roosts in trees, espeFood: Feeds on primarily moths and beetles, but occacially palms. Distribution: Rare; from both montane, open coniferous forests and deserts of southern California only. Description: Medium-sized, buff or sandy-colored fur; Reproduction: Probably fall-spring pattern; a single ears very long and clearly separated at the base. Distribution: Found in most of California, especially Protected Status: California Species of Special Conin open, lowland areas, generally below 6,000 feet. Roosts in small colonies in caves, crevices, mines, and occasionally hollow trees, buildings, and under bridges. Food: Feeds primarily on large, flightless insects (Jerusalem crickets, June beetles, and scorpions) which it captures by foraging on the ground. Frequently utilizes night roosts, such as porches and open buildings, to consume large prey, under which is often found the uneaten legs and body parts of its prey. Protected Status: Although common in some areas, it is a California Species of Special Concern. Distribution: Found throughout California, especially in more arid areas; once common, now considered rare. Distribution: An extremely rare vagrant from Arizona and New Mexico found in southern California. Description: Small, chocolate brown, and with ears Protected Status: California Species of Special Conextending to the tip of the snout. Roosts in caves, mines, under bridges, crevices, and buildings, often in large colonies. The largest colony in California is about 100,000 at Lava Beds National Monument. Food: Eats primarily small moths; forages above 30 m off the ground; and a very fast flyer (25 mph). Western mastiff bat (Eumops perotis) Description: Large; fur short and dull, gray or dark brown, very light at base of hairs; and broad, truncate ears that are joined across the top of the head.