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Apart of the Cold decreases the pain and the muscular favorable effects perindopril 2mg amex blood pressure medication micardis, which were reported in convulsion purchase perindopril discount blood pressure chart to keep track. It also leads in vasospasm which clinical situations buy 8mg perindopril amex blood pressure chart 15 year old, there are experimental results in the reduction of tissue evidence in models of animals on decreased metabolism, inflammation and edema. Due correspondence in the pain in hot and cold to these effects it constitutes the classic stimuli, in inflammatory arthritis. Hot and treatment for direct care after a traumatic cold don’t alter the articular inflammation, damage of the musculoskeletal system. It is but improve the secondary answer in the locally applied for a time of 30 minutes, (12) pain and the behavior. Such bibliography regarding to the application of reduction of the temperature is observed in hot and cold shows that there are minimal deeper tissues and it depends from the tested studies of acceptable quality, duration of the application of cold and the particularly regarding the fortuity and the depth of these tissues. However Typically, cold is applied with the form of of the studies that fit these criteria, hot and cold pads, pads with gel, pads that contains cold do not affect the activity of disease, as chemical substances or ice massages directly it was evaluated objectively, included the onto the painful region. All the patients reported that contain chemical substances produce cold they prefer hot or cold comparatively with with endothermic reactions have little the absence of this treatment, without a usefulness because of their big cost and the certain particular preference between time that they require. Due to the fact that this treatment chloride ethyl, are used in the Rheumatology has no damaging effects, it should be in combination with the application of recommended for treatment at home, when muscular distention, especially regarding to there is a need for alleviation from the pain. A low potential electric stimulus is achieved with the use of splints or transported in the skin in a periodical or “chaperon” and with pressure sore. Short continuous manner after the activation of periods of immobilization as parts of a the appliance, which can be sustained in the complete program help the patient to patient’s belt and functions with batteries. However intensity of the stimuli depending on his extended immobilization, local or needs. After just a few weeks of local chronic pain in the shoulder or pain in other immobilization, a reduction of muscular major articulations of body. It is usually mass of 21% can be observed and there are recommended in patients that are hardy in references that show that the extended the application cold, hot, distention, pressure sore as a fundamental treatment exercise and other methods of does not help and should not be physiotherapy. Hydrotherapy Hydrotherapy combines the treatment with Treatment with exercises or kinesitherapy exercise and the buoyancy of hot water. The In its application it should is be taken into progressive application outside the hospital account the activity of the amenable or as a part of a therapeutic form with the disease, included the degree of form of spa therapy can be recommended. There are however some short- and long-term functional objectives, references that the individuals that were have to be anticipated. The exercises that submitted in hydrotherapy regularly outside would be applied can be energetic or the hospital, had benefited comparatively passive, abetted or aerobic. A elasticity of the articulations and to restrict more extensive systematic examination of the rigidities. The passive exercises are the published bibliography with regard to applied in situations that correlate with the spa therapy showed several weaknesses severe pain and weakness, like the acute like the planning of the treatments, with articular inflammation, inflammatory minimal use of measurements for the myopathy and postoperatively periods. The evaluation of the results, like the use of isometric exercise, during which energetic tools (calibration systems) that evaluates muscular twitch without shortening of the the change in the quality of life. The length of the complete breadth of movement because of walking stick should be selected so that it’s pain, like individuals that were recently kept with the elbow in a bending position of (18,19,20) submitted in arthroplasty. With the use of a walking stick Most individuals with a rheumatic disease or a cane from only the one side of the are profited by programs of exercises of patient, it can be transported up to 25% of resistance and aerobic exercises. The the normal load of the body weight from the exercises of resistance should be adapted in feeble or painful articulation of the opposite the situation of each patient, the region of leg. With bilateral support, up to 100% of body that presents muscular weakness and the weight can be transported from the the amenable disturbance, aiming in the painful lower member in the upper increase of muscular force and resistance. Certain patients, that have Walking exercises and resistance are selected to carry a walking stick, they don’t recommended for one hour three times a use it or support but as a point of indication week and correlate with less pain, smaller towards the others, that they have kinetic (23,24) disability and bigger force of bending in problems. Similar Patients need guidance for the right use of effects are presented by the patients with their walking aid. In its results, mild to is transported into the opposite from the mediocre improvement of pain, painful side, foot and it is used so that it improvement of functionalism and profit as raises the weight during the time that the for the opinion of patients, are included. For individuals, that should not In ankylosing spondylitis the recreational load the their wrist or present important exercise of 30 minutes at least per week deformities in their hands, the auxiliary improves the pain and the stiffness. In order to avoid The outmost profit was observed in excessive load to the wrists and the hands (18,19,20) individuals with precocious disease. They are more useful in the the functional status, muscular force and postoperative period and in acute disease or (21,22) status of the cardiovascular system. They should be Auxiliary means for walking adapted in a manner so that the pressure in For the improvement of walking and the the armpit is avoided. The patients should alleviation of muscular weakness, pain and be guided with regard to the way that they instability of the lower members, walking hands and upper members can raise the sticks, special canes and walkers are weight in the right way with their wrist and recommended. The canes with a platform sticks are manufactured by timber or should be recommended in individuals with aluminium. They should not be expensive, severe arthritis of the wrist and upper they should be light-weighted, to be easily members that presents the pain during the (24) adapted to the patients stature, they have use of the usual cane. They are also useful in the with problems in the mobility of their postoperative period with regard to old shoulders. They evaluated during the visits of should be light in order to be lifted off and physiotherapists and ergo therapists. For comfort and safety moving with problems of mobility can be facilitated seats with brakes, may be used. Wheel with steps of half from usual height, with chairs can improve the independence and side supports (ramps) and handgrips in the the social contact, when the mobility of beginning of the scales. A as wide as for the patient to have an easy wheel chair moved by the patient’s hands is pass through them either on foot or in a recommended in individuals with physiologic wheel chair. The placement of the furniture operation in the upper members and and the size of a room should allow the easy sufficient force for his movement. The transfer of the patients with auxiliary means wheel chairs that can be moved with the and with wheel chairs. For may be recommended in the postoperative patients with problems in their knees and period, as well as for feeble old patients, hips, the height of the seats can be where they do not wish to move by increased with additions under the feet of themselves. Electrically driven chairs should the chairs or with the placement of cushions be recommended to patients with not of four inches thickness (4x2,5cm = 10cm), satisfactory operation in the upper of high density foamy material. Elements from Auxiliary means of the upper members rubber in the bathtub and in the basin of the A wide variety of auxiliary means bathroom, improve the ability of the patient commercially available can improve the to seat and to be lifted off by supporting activities of daily life of individuals with themselves in them and also they anticipate disturbances of operation of their upper the falls. The ability to capture and the supports, as well as seats in the basin of the ability to capture and hold like a tong with bathroom should be used from individuals the thumb and the indicator can be with balance problems. The washing of the improved with the use of suitable handholds body is facilitated by a suitable handhold in (23) in various tools, utensils of cooking and the shower. Appliances supplied by electric power, as Lifting up structures electric knives and tools, can replace the The splints and the chaperons can improve usual instruments in individuals with the stability and decrease the pain and the reduced ability of capture and not inflammation. Splints for the upper members are and sponges can help in the body hygiene more frequently used and they are more (23) and the cleanness of the perirectal area.

Most The Burden of Disease and Mortality by Condition: Data quality 2 mg perindopril arrhythmia beta blocker, Methods buy perindopril 8 mg visa blood pressure record, and Results for 2001 | 81 studies of diabetes prevalence did not indicate the type of were excluded from prevalence estimates order perindopril overnight delivery sheer heart attack. Point prevalence estimates for dependence and harmful use, excluding cases with comor- episodes of unipolar major depression were derived from a bid depressive episode. All available population-based surveys population studies on depressive disorders, which identified using diagnostic criteria that could be mapped to this case 56 studies from all World Bank regions (Ustun and others definition were identified. Variations in the prevalence of unipolar depressive prevalence of alcohol use disorders were obtained from disorders in some European countries, Australia, Japan, and 55 studies (Mathers and Ayuso-Mateos 2003). New Zealand were estimated directly from relevant popula- Published data on alcohol production, trade, and sales, tion studies (Ayuso-Mateos and others 2001). For other high- adjusted for estimates of illegally produced alcohol, were income European countries, country-specific prevalences used to estimate country averages of the volume of alcohol were estimated using a regression model of available preva- consumed. These preliminary estimates were then further lence data on suicide rates (for ages 15 to 59, both sexes com- adjusted on the basis of survey data on alcohol consumption bined). For other regions,prevalence estimates were based on to estimate the prevalence of alcohol use disorders for coun- regional prevalence rates applied to country-specific popula- tries where recent population-based survey data were not tion estimates for 2002. This resulted in an overall disability weight for as does the quality of data collected. This compares reasonably well with a more recent dependence and harmful use or cocaine dependence and analysis of the distribution of depression by severity and dis- harmful use, excluding cases with comorbid depressive ability weights for a Dutch community, which resulted in an episodes. Data on the prevalence of problematic illicit drug overall disability weight of 0. A literature search was conducted of all studies episodes were estimated separately using the disability weight that estimated the prevalence of problematic drug use and for mild depressive disorders. Other data sources Subregional prevalence rates for bipolar disorder were included the United Nations Drug Control Program and the derived from a systematic review of all available published European Monitoring Centre for Drugs and Drug Addiction. Persons with comorbid lence rates for panic disorder, obsessive-compulsive disor- depressive disorder or alcohol or drug use disorders were der, and post-traumatic stress disorder were also derived excluded from the prevalence estimates. Those with comor- ondary to other diseases or injury, were derived from sys- bid depressive disorder or alcohol or drug use disorders tematic reviews of available published and unpublished 82 | Global Burden of Disease and Risk Factors | Colin D. For countries for which no data recent epidemiological studies (Warren and Warren 2001). The prevalence rates, incidence rates, and durations for DisMod software was then used to obtain internally consis- Alzheimer’s disease and other dementias were estimated tent age- and sex-specific estimates of incidence, prevalence, based on 110 available population studies and assumed to remission, and relative risks of mortality. Ratios of blindness apply to countries within each subregion (Mathers and to low vision for each region were used to estimate the preva- Leonardi 2003). Regional incidence to mortality rates for Parkinson’s disease estimated by Murray and Lopez Hearing Loss. Despite the number of published studies on (1996d) were used to derive country-specific estimates for hearing loss, many of them use different criteria and relate incidence from the estimated country-specific mortality rates. Migraine has been ing threshold level in the better ear is 41 decibels or greater treated as a chronic disease lasting from 15 years to around averaged over 0. The case definition was or greater hearing loss (hearing threshold level in the better taken from the International Headache Society’s definition ear is 61 decibels or greater averaged over 0. Regional tion provided prevalence estimates that were quite similar estimates of the prevalence of hearing aid use were used in across most regions. For details of methods and data sources see Fewtrell and others (2004) and Pruss- Angina Pectoris. Both regional and subregional the prevalence and case fatality rates for angina pectoris prevalences for blindness and low vision were updated using (Mathers, Truelson, and others 2004). Observed correlations all available data gathered since 1980 (Resnikoff and others between the prevalence of acute myocardial infarction sur- 2004; Thylefors and others 1995). Subregional prevalences vivors and the prevalence of angina pectoris (whether inci- were estimated from more than 50 cross-sectional, dent before or after acute myocardial infarction) were used The Burden of Disease and Mortality by Condition: Data, Methods, and Results for 2001 | 83 to estimate the prevalence of angina pectoris from the mod- populations based on spirometry were available, both direct eled prevalences of acute myocardial infarction survivors. Asthma prevalence estimates were based on a case rates for acute myocardial infarction. Because accurate prevalence A total of 149 population-based studies were used to data based on spirometry are not available in many regions, derive estimates of asthma prevalence for a wide range of an alternative approach was used to infer disease occurrence countries for children, teenagers, and adults. The relative risk of mortality due to chron- European Community Respiratory Health Survey of adults ic obstructive pulmonary disease across subregions was esti- ages 20 to 44 using self-reported symptoms and bronchial mated as a function of its two leading risk factors—tobacco hyper-responsiveness (Chinn and others 1997; Pearce and smoking and indoor air pollution from solid fuel used for others 2000). Estimates from the population-based studies cooking—along with regional fixed effects (Lopez and oth- were then used to derive subregional average prevalence ers forthcoming). Data on risk factors were derived from the rates, which were assumed to apply in countries without comparative risk assessment carried out for the World specific population studies. Subregional prevalence rates for estimated regional prevalence with data from available pop- rheumatoid arthritis were derived from available published ulation studies. For regions where surveys of representative population studies using case definitions for definite or 84 | Global Burden of Disease and Risk Factors | Colin D. Subregional prevalence rates for in determining the overall health status of populations in all osteoarthritis were derived from available published popu- regions of the world. Prevalence numbers were based on regional causes dominates the overall burden of nonfatal disabling prevalence rates for edentulism estimated by Murray and conditions. The disabling burden of neuropsychiatric condi- tions is almost the same for males and females, but the major contributing causes are different. While depression is Injuries the leading cause for both males and females, the burden of An incident episode of a nonfatal injury is defined as an depression is 50 percent higher for females than for males, episode that is severe enough for the person to be hospital- and females also have a higher burden from anxiety disor- ized or that requires emergency room care (if such care is ders, migraine, and senile dementias. In higher than that for females and accounts for one-quarter of brief, the incidence of nonfatal injuries by external cause the male neuropsychiatric burden. Adult-onset hearing loss is extremely prevalent, with of health facility data provided by 18 countries in five World more than 27 percent of men and 24 percent of women aged Bank regions. For most cause categories, extrapolations 45 and over experiencing mild hearing loss or greater. The total attributable burden of disability due to alcohol use is much larger (see chapter 4). Although healthy life lost through time spent in states of less than full the prevalences of disabling conditions such as dementia health. From 1991 to 1994, average, poor health resulted in a loss of nearly eight years of the risk of premature death increased by 50 percent for healthy life globally. This once again illustrates the importance of Latin America and the Caribbean taking nonfatal conditions into account, as well as deaths, Middle East and North Africa when assessing the causes of loss of health in populations. East Asia and Pacific In 2001, the leading causes of the burden of disease in low- and middle-income countries were broadly similar to South Asia those for the world as a whole (table 3. Between ed for 36 percent of the world’s total burden of disease and 1994 and 1998, life expectancy for males improved, but injury in 2001 and adults ages 15 to 59 accounted for almost declined again significantly between 1998 and 2001 (Men 50 percent. While the proportion of the total burden of disease stantially higher burden of noncommunicable disease than borne by adults ages 15 to 59 was the same in both groups of high-income countries (figure 3.

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Retinol-binding protein transports vitamin A from the liver to the rest of the body discount perindopril american express blood pressure index chart. Vitamin A is involved in production of visual purple buy perindopril online pills arrhythmia ppt, mucopolysaccha- ride synthesis buy perindopril american express heart attack 42 year old, maintenance of epithelial tissue, and regulation of genes. Retinol, the alcohol form, can be reversibly oxidized to retinal, the aldehyde form, which can be irre- versibly converted to retinoic acid. All-trans retinoic acid, 9-cis retinoic acid, and 13-cis retinoic acid are isomers that are interconverted in humans and that may be less hepatotoxic than retinol. Opsin releases this retinal isomer, changing the configuration of the visual pigment. Retinoic acid is the form of vitamin A necessary for the normal growth and differentiation of epithelial tissue. The effects of vitamin A on cellular differentiation are mediated by two sep- arate classes of nuclear receptors, retinoic acid receptors (α, β, and γ) and the retinoid X receptors (α, β, and γ). Retinoid receptors modify the effects of 677 678 Part Three / Dietary Supplements many compounds, including prostaglandins, vitamin D, and steroid and thyroid hormones. Vitamin A deficiency impairs innate immunity by impeding normal regeneration of mucosal barriers damaged by infection and by diminishing the function of neutrophils, macrophages, and natural killer cells. Studies in animal models and cell lines show that vitamin A and related retinoids play a major role in immunity, including expression of mucins and keratins, lymphopoiesis, apoptosis, cytokine expression, and production of antibody. In particular, vitamin A deficiency diminishes anti- body-mediated responses directed by Th2 cells, although some aspects of Th1-mediated immunity are also diminished. At the molecular level, aberrant expression and function of nuclear retinoid receptors have been found in various types of cancer, including premalignant lesions. About half of the vitamin A activity is derived from animal and half from plant sources. Preformed vitamin A (retinol) is present in liver, fatty fish, dairy products, and fortified margarine. Inclusion of fortified dairy products in the diet may be a practical, sustain- able, and cost-effective approach for improving vitamin intake and status in the elderly. A proportion of dietary carotenoids are converted to retinol in the intes- tine and liver. However, recent studies have shown that the basis for describing vitamin A activity of carotenoids overestimates the bioavailability of provitamin A carotenoids and their bio- conversion to retinol (vitamin A). An intake of at least 3 mg vitamin A, along with 130 mg vitamin C and 67 mg vitamin E or more daily, is thought to possibly reduce the risk of cancer. Unlike vitamin A, β-carotene can reduce lipid peroxidation and modulate enzymatic activity of lipoxygenases. However, the immunologic impact of vitamin A is not solely attributable to its carotene precursor. Animal studies do suggest vitamin A and retinoids regulate epithelial cell differentiation and maintenance and inhibit tumor angiogenesis. Vitamin A decreases serum insulin-like growth factor-1, inhibits 5-α-reductase (the enzyme that catalyzes formation of dihydrotestosterone), and up-regulates transforming growth factor-β. Vitamin A has a number of other promising and interesting clinical appli- cations. Retinoids protect gastric mucosa against the ulcerogenic effects of indomethacin treatment without any inhibition of gastric acid secretion. There is a potential for therapeutic supplements of vitamin A in children with insulin-dependent diabetes mellitus to reduce or prevent atherogenic risk. A case-control study found children with poor metabolic control of their type 1 diabetes mellitus were at greater risk of atherosclerosis and relative vitamin A deficiency than those with good metabolic control of their ill- ness. With new, more effective, and less toxic retinoids being developed, there are great expectations for the use of these derivatives, alone or in combina- tion with other drugs. With new delivery systems being developed, it is hoped vitamin A may provide therapeutic solutions to conditions as diverse as benign proliferative skin diseases, such as psoriasis and skin cancer. The relative sever- ity of side effects varies widely between patients and, apart from skeletal and skin changes, most signs and symptoms disappear within 7 days. Hypervitaminosis A is sometimes associated with abnormalities of calcium metabolism and bone mineral status, and a recent study found a negative association between reported dietary vitamin A intake and bone mineral density. A prospective study with 18 years of fol- low-up suggested long-term intake of a diet high in retinol may promote the development of osteoporotic hip fractures in women. While large doses of vitamin K may impair absorption of vitamin A, hyper- vitaminosis A causes hypoprothrombinemia, which can be corrected with vitamin K. Vitamin E may enhance the therapeutic efficacy of vitamin A by protecting against the oxidative destruction of this vitamin. Zinc deficiency impairs vitamin A function, limiting the bioavailability of this vitamin. A random- ized, double-blind, placebo-controlled, intervention trial found combined zinc and vitamin A supplementation improved vitamin A nutriture in vita- min A-deficient children. Vitamin A deficiency also leads to drying of the conjunc- tiva and mucous membranes; a rough dry skin with follicular hyperkeratosis is common. A critical and constructive review of epidemiology and supplementation data regarding cardiovascular disease and cancer, Biofactors 7(1-2):113-74, 1998. Brighthope I: Nutritional medicine tables, J Aust Coll Nutr Env Med 17:20-5, 1998. Breuer-Katschinski B, Nemes K, Marr A, et al: Relation of serum antioxidant vitamins to the risk of colorectal adenoma, Digestion 63(1):43-8, 2001. Primack A: Complementary/alternative therapies in the prevention and treatment of cancer. Majewski S, Kutner A, Jablonska S: Vitamin D analogs in cutaneous malignancies, Curr Pharm Des 6(7):829-38, 2000. Mozsik G, Bodis B, Figler M, et al: Mechanisms of action of retinoids in gastrointestinal mucosal protection in animals, human healthy subjects and patients, Life Sci 69(25-26):3103-12, 2001. Ballew C, Galuska D, Gillespie C: High serum retinyl esters are not associated with reduced bone mineral density in the Third National Health And Nutrition Examination Survey, 1988-1994, J Bone Miner Res 16(12):2306-12, 2001. This water-soluble B vitamin is essential for converting carbohydrate into energy. It works synergistically with other vitamins of the B complex, particularly riboflavin (B2) and niacin (B3). Thiamin is required for synthesis of acetylcholine and is important for neural transmission. Thiamin is best taken with meals, since it is better absorbed in an acidic environment. Treatment in adults is 5 to 10 mg of vita- min B1 three times a day; in children, the dose is 10 mg/day.

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These may take the form of anatomical or functional abnormalities apparent at birth or later in life generic perindopril 8 mg online arrhythmia games. The risk following an accumulated dose of 5 mSv per year over a career span of 20 years will be 1 in 1 purchase perindopril master card heart attack like symptoms,000 order perindopril 4 mg with amex arrhythmia 4279. Risk to the Health of the Foetus The possible effects of radiation to the foetus are cancer and mental retardation. There is a background rate for both of these conditions and it is estimated that exposure to cosmic radiation for 80 block hours per month for a period of 4 weeks will increase the risk by between 1 in 6,000 and 1 in 30,000 depending on the routes flown. In general, pilots and flight engineers have an increased life expectancy compared to the general population. Death rates from heart disease and all cancers combined are considerably less than for the general population and, although still rare, death from melanoma (which is associated with exposure to sunlight) is the principal cancer in excess. Further larger studies are continuing and more information will be available in due course. Below is a list of the commonly encountered terms which, whilst not exhaustive, will help to explain some of the terminology. The unit is the Gray (Gy) and is a physical quantity that does not take account of the differing effects of different types of ionising radiation. The Effective Dose Equivalent to the whole body is obtained by multiplying the Dose Equivalent to various tissues and organs by a weighting factor appropriate to each and summing the products. Recommendations on prevention of the spread of these vectors were given as early as in the 1930s. An update regarding the use of pyrethroids in aircraft disinsection was published in 2005. A balance has to be found between the need to avoid air traffic related spread of disease-bearing vectors and other pests and the need to avoid discomfort and health hazards to passengers and crew by disinsection procedures. Public discussion and media attention on this subject are focused on: the contribution of air traffic to the risks of emerging and re-emerging diseases; the concern about possible adverse toxic or allergic effects caused by the chemicals used in aircraft disinsection. The results of epidemiological surveillance through the last decade clearly have proven the necessity of preventive measures against the spread of insect vectors by means of air traffic; currently there are no effective and applicable methods in aircraft disinsection other than procedures using “chemical” insecticides. Specialists agree that airport vector control is more efficient than aircraft disinsection. Nevertheless aircraft disinsection procedures should regularly be reviewed in the light of new technical, biological or pharmaceutical developments. Cases of air traffic related malaria infections in people who have never stayed in malaria endemic areas have given the most direct evidence. Infected mosquitoes may transmit disease: to passengers and crew in flight between malaria-free areas if the aircraft had been operating in a malaria endemic area and was not properly disinsected. Well documented examples of “airplane malaria” have been published; to passengers and crew travelling between malaria-free areas during a transit stop in a malaria endemic area, “runway malaria”; to travellers, people working at or living near international airports in malaria-free areas. Between 1969 and 1999 some 89 cases of “airport malaria” were reported; to people living in malaria-free areas by chance after infected mosquitoes escape from the baggage of travellers coming from malaria endemic countries “baggage-malaria”. The same mode of direct disease transmission can also apply to aircraft imported vectors of dengue, yellow fever, Chikungunya, Japanese-B-encephalitis, West-Nile virus, leishmaniasis, filariasis and others. Even the importation of uninfected insect species which are susceptible to certain diseases can contribute to the emergence of new diseases. Establishment of imported insect vectors is most likely if the climatic and environmental conditions at the destination are similar to those at the place of origin. Cockroaches, ants and other insect pests can enter the aircraft through cargo goods, baggage or catering equipment. They are not usually regarded as direct disease transmitters but can be harmful as they may contaminate food or cause damage to the aircraft infrastructure particularly the electronic equipment. Some of these insects may find suitable conditions and breeding sites on board if regular treatment and preventive measures are not undertaken. Some countries allow health authorities to order disinsection of arriving aircraft if proof of properly performed disinsection is not demonstrated. Insects and other pests entering aircraft usually emerge from the area around the aircraft, from the airport and equipment brought into the aircraft. Aircraft disinsection in its broad sense therefore includes preventive pest control measures in and around airports. Aircraft disinsection methods have to take into consideration: that insecticides have to be applied in very close contact to passengers and crew; that the interior of aircraft contains a number of sensitive materials such as electronic equipment, with the attendant fire risk; that the active ingredients used for disinsection must be effective against a broad spectrum of insects. Reports on the growing development of resistance among insect vectors in many regions indicate the need for continued development and evaluation of alternative insecticides. Efficacy of disinsection methods does not depend only on the active ingredients used but also on the mode of application and the technical properties of the dispenser used for aerosol spraying. The empty spray cans are to be retained for inspection by the Port Health Authority on arrival. Although not regarded as a preferred method, the on-arrival-method may be retained as an acceptable back-up method if an aircraft, coming from areas of threat, has not been adequately disinsected by any of the recommended methods. On arrival, before doors are opened and disembarkation is permitted, agents of the Health Authority board the aircraft and perform disinsection of the cabin and flight deck similar to the “blocks-away” method. Pre-flight spraying The pre-flight spray containing 2% permethrin must be applied to the flight deck, all toilet areas, lockers, wardrobes and crew rest areas, except where approval has been granted for the residual treatment (see below) of these areas. Pre-flight spraying of the residual insecticide shall equate to a rate of 35 g of the formulation per 100 m3 (10 g per 1000 ft3). Top-of-descent (in-flight spraying) The second step of this method is carried out at “top-of-descent” as the aircraft starts its descent to the airport of arrival. A quick-acting “knock-down” insecticide is sprayed into the passenger cabin by crew members walking along each aisle holding 2 ´ 100 g cans at a slow walking pace of one row per second starting at the rear of the aircraft. An announcement shall be made before in-flight spraying is started and passengers who feel that it may cause them inconvenience should be advised to close their eyes and cover their faces while the procedure is carried out. The spraying is to be applied as near as possible to the ceiling at a rate of 35 g of the formulation per 100 m3 (10 g per 1000 ft3). An entry confirming the treatment should be made in the aircraft “declaration of health” and the empty spray cans of pre-flight and in-flight spraying must be retained in the aircraft and delivered to the appropriate authority on arrival. The procedure aims at producing an even film of the residual insecticide permethrin on all interior surfaces of the aircraft to ensure that if an insect gains access to the aircraft and lands on a surface it will receive an effective dose of insecticide. After spraying is completed, air conditioning packs should be run for at least one hour to clear the air of the volatile components of the spray. Treatment must be at intervals not greater than two months to ensure efficacy of the insecticidal film. Replacement carpets or seat covers which are exchanged within the 2 month period shall be retreated. A “Certificate of Residual Disinsection” shall be issued by the appropriate authority and signed by the person who supervised the treatment. It does not require passengers and crew to be exposed to aerosol sprays and has the added benefit of lessening the workload of aircraft cabin crew. Many airlines operating flights scheduled to destinations where disinsection is needed are using the residual treatment as the current method of first choice. Even without adverse health effects, many airline customers find the spraying of aerosols in the cabin a nuisance. This disinsection procedure consists of spraying all interior spaces of the aircraft with an aerosol containing 2% permethrin insecticide before embarkation.