Spam is back.

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  • Question
  • Updated 6 years ago
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My email was migrated last week and for the past few days there has been NO spam. However, for the last 4 hours or so I have had several spam emails delivered into my inbox. What gives? I thought the migration would take care of this.
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Bonnie6409

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Posted 6 years ago

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Mike F., Alum

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How many did you get? Can you post one of them here including the senders address and the body of the email?
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Forest Hills9183

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Return-path: <>
Envelope-to: admin@godfatherpestcontrol.com
Delivery-date: Mon, 08 Sep 2014 09:36:44 -0400
Received: from [10.115.3.11] (helo=smtp.maileig.com)
    by bosmailscan14.eigbox.net with esmtp (Exim)
    id 1XQz7c-0004jb-RF
    for admin@godfatherpestcontrol.com; Mon, 08 Sep 2014 09:36:44 -0400
Received: from bosmailout06.eigbox.net ([66.96.190.6])
    by bosimpinc11 with bizsmtp
    id odcj1o03b08jniy01dckgP; Mon, 08 Sep 2014 09:36:44 -0400
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    for admin@godfatherpestcontrol.com; Mon, 08 Sep 2014 09:21:04 -0400
X-Failed-Recipients: lisa.brashears@am.jll.com
Auto-Submitted: auto-replied
From: Mail Delivery System <Mailer-Daemon@eigbox.net>
To: admin@godfatherpestcontrol.com
Subject: Mail delivery failed: returning message to sender
Message-Id: <E1XQysS-0008ST-26@bosmailout06.eigbox...>
Date: Mon, 08 Sep 2014 09:21:04 -0400

This message was created automatically by mail delivery software.

A message that you sent could not be delivered to one or more of its
recipients. This is a permanent error. The following address(es) failed:

  lisa.brashears@am.jll.com
    SMTP error from remote mail server after RCPT TO:<lisa.brashears@am.jll.com>:
    host smtp2.am.jll.com [205.144.71.150]: 550 #5.1.0 Address rejected.

------ This is a copy of the message's headers. ------

Return-path: <admin@godfatherpestcontrol.com>
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    for Lisa.Brashears@am.jll.com; Mon, 08 Sep 2014 09:21:03 -0400
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    id 1XQysR-0002xz-AR
    for Lisa.Brashears@am.jll.com; Mon, 08 Sep 2014 09:21:03 -0400
Received: from bosauthsmtp15.yourhostingaccount.com ([10.20.18.15])
    by bosimpout11 with
    id odLz1o0070KWaAJ01dM2Hi; Mon, 08 Sep 2014 09:21:03 -0400
X-Authority-Analysis: v=2.1 cv=AeA/HhnG c=1 sm=1 tr=0
 a=6thTdk0GfRoQwv0zj4iWMg==:117 a=GgnRh0aA7FjRVGTMTjeK0w==:17 a=pq4jwCggAAAA:8
 a=QPcu4mC3AAAA:8 a=ke8OsyCnWOwA:10 a=D3k5-TuDrxIA:10 a=B6VB-tIrAAAA:8
 a=r77TgQKjGQsHNAKrUKIA:9 a=9iDbn-4jx3cA:10 a=cKsnjEOsciEA:10 a=UdAFKlzRAAAA:8
 a=z7RfkbDo_qa6UhzCtYUA:9 a=wPNLvfGTeEIA:10 a=cgn4dWXQrPMA:10
 a=iyHVzUHy73MA:10 a=XvFJhGNq6mwA:10 a=g6pJ3Moe9WkA:10
 a=i4oubXzxZSdHky_82gwA:9 a=_W_S_7VecoQA:10 a=DcH97Z9X7DMA:10
 a=nl4ZlFLwsZoA:10 a=UF909vspFEgA:10 a=UBz-Jv_xNXcA:10
 a=v9BoJ1tZYCmKFCBenYcA:9 a=64PKKumqiA8A:10 a=hpJqIMcrnAEA:10 a=W96eQrp0IUYA:10
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    id 1XQysM-0008P2-Ct; Mon, 08 Sep 2014 09:20:58 -0400
Message-ID: <aabca45cbe8f$256faacd$2d51344c$@godfa...>
From: autumn moreno <admin@godfatherpestcontrol.com>
To: "jeremy oxford bowling world" <jpo298@hotmail.com>, "robert b eden boxman alpha packaging" <rbeden@alphapackaging.com>, "Lisa US Brashears" <Lisa.Brashears@am.jll.com>, "brasslarson8" <brasslarson8@yahoo.com>, "teresa joans breast cancer center" <t.jo@live.com>, "randy bridges" <rbridges@fortsmithschools.org>, "bullington family" <bullington_family@yahoo.com>, "johnna burns" <johnnaburns@ikumon.com>, "calme2323" <calme2323@yahoo.com>, "Carla Cravey" <Carla.Cravey@northporthealth.com>, "john robben chevy nissan smith automotive" <jrobben@smithchevyworld.com>, "keith snyder chevy nissan smith automotive" <ksnyder@smithnissanmail.com>, "melinda chilsom" <melinda.chisolm@vbsd.us>, "choctawndnpimp" <choctawndnpimp@yahoo.com>, "christian" <christian@yahoo.com>, "christopher dickson2001" <christopher_dickson2001@yahoo.com>, "chulodurodr" <chulodurodr@yahoo.com>, "patrick clark" <patrickclark@hearst.com>, "mona cole" <mc_cola2001@yahoo.com>, "collinsgreen2007" <collinsgreen2007@googlemail.com>
Subject: autumn moreno
Date: Sun, 8 Sep 2014 02:20:22 +0000
MIME-Version: 1.0
Content-Type: multipart/alternative;
    boundary="----=_NextPart_000_DDF4_B7D2A4EF.1C5192B7"
X-Priority: 3
X-MSMail-Priority: Normal
Importance: Normal
X-Mailer: Microsoft Windows Live Mail 16.4.3522.110
X-MimeOLE: Produced By Microsoft MimeOLE V16.4.3522.110
X-EN-UserInfo: 7751a371fc7b98c6b50d98f0b66026b2:931c98230c6409dcc37fa7e93b490c27
X-EN-AuthUser: admin@godfatherpestcontrol.com
Sender:  autumn moreno <admin@godfatherpestcontrol.com>
X-EN-OrigIP: 217.131.213.132
X-EN-OrigHost: unknown
X-EN-Class: impinc
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Drew N, Alum

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This has been reported.

Thanks

Drew
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Bonnie6409

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I got probably 6-8 in a 4-5 hr period. They seemed to have stopped again. It just seemed odd to go from none to several so quickly. Here is the last one I received which came in at 5 pm (EST) yesterday.

Return-path:
Envelope-to: bonnie@triadprefinish.com
Delivery-date: Mon, 10 Feb 2014 17:00:17 -0500
Received: from bosimpinc06.eigbox.net ([10.20.13.6])
by bosmailscan25.eigbox.net with esmtp (Exim)
id 1WCyYd-0003v7-7W
for bonnie@triadprefinish.com; Mon, 10 Feb 2014 16:38:27 -0500
Received: from beachbrat.bapafter.com ([173.212.199.226])
by bosimpinc06.eigbox.net with NO UCE
id QleR1n02b4taa8l01leRFS; Mon, 10 Feb 2014 16:38:27 -0500
X-EN-OrigIP: 173.212.199.226
X-EN-IMPSID: QleR1n02b4taa8l01leRFS
Content-Type: text/plain; charset="us-ascii"
MIME-Version: 1.0
Content-Transfer-Encoding: 7bit
Subject: Get Fluent in Spanish - Trial Begins (02.10.2014)
From: Start Spanish Trial
Date: Mon, 10 Feb 2014 13:38:25 -0800
Reply-to:
To:
Message-ID:

Hey Bonnie,

Have you always wanted to learn a second language?

Hola, my name is Mauricio Evlampieff.
Welcome to Rocket Spanish your place for learning Spanish online.

I'm from the beautiful country of Chile, and Spanish is my first language.
Together with my English speaking colleague, Amy,
I'll be joining you on your Rocket Spanish adventure.

Start Your Cost-Less Trial Here: http://www.bapafter.com/34kjht/wgtf32...
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Bonnie6409

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This was the first one which came in just before 11:30 am (EST) yesterday.

Return-path:
Envelope-to: bonnie@triadprefinish.com
Delivery-date: Mon, 10 Feb 2014 11:26:26 -0500
Received: from bosimpinc05.eigbox.net ([10.20.13.5])
by bosmailscan17.eigbox.net with esmtp (Exim)
id 1WCtgf-00031m-V0
for bonnie@triadprefinish.com; Mon, 10 Feb 2014 11:26:25 -0500
Received: from orb262.bottrue.com ([184.82.8.20])
by bosimpinc05.eigbox.net with NO UCE
id QgSN1n03q0RvyGQ01gSPHB; Mon, 10 Feb 2014 11:26:23 -0500
X-EN-OrigIP: 184.82.8.20
X-EN-IMPSID: QgSN1n03q0RvyGQ01gSPHB
Content-Type: text/html; charset="us-ascii"
MIME-Version: 1.0
Content-Transfer-Encoding: 7bit
Date: Mon, 10 Feb 2014 08:26:22 -0800
Message-ID:
To:
From: Target Supports You
Reply-to:
Subject: Target Give-Away - We thank you for your support

<!doctype html>

Target
Target would like to thank you with a $25-bonus card.

It's easy to enjoy your bonus.


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Don't forget to check out more cool stuff.

Women Men baby home patio

I've tried ground round, beef and sirloin, pre frozen patties and even Philly Gourmet burgers from my local grocery store, but they don't taste as good as what I can buy at a local bar or car shows that I go to.

You can add almost anything to ground beef, but you need to start with good quality beef. I prefer ground chuck.

Otherwise, I recommend charcoal over the Foreman grill or propane, but that is just my preference. You can devise a way to support a grate over the fire, such as a couple of cinder blocks and the grate from most any kind of grill.

You can kill two birds with one author, Marcel Desaulniers. Both your burger and chocolate cravings. "The Burger Meister" and "Death by Chocolate".

Thank you for taking the time to read this. From - TTG Mallard Productions [] 167 Decatur St [] Corning [] NY [] 1 4 8 3 0. You may write or go to this-location to remove yourself.

Ground chuck patties seasoned simply with S&P and grilled on a screaming hot charcoal hibachi are da bomb. Best burgers in L.A.

As CharlieD says don't press the burger down when its cooking, best to press it down fairly flat before you put it on to cook, that way it will cook through and stay moist.



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Bonnie6409

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Day 2 of spam - this came in a few minutes ago...

eturn-path:
Envelope-to: bonnie@triadprefinish.com
Delivery-date: Tue, 11 Feb 2014 09:52:24 -0500
Received: from bosimpinc04.eigbox.net ([10.20.13.4])
by bosmailscan15.eigbox.net with esmtp (Exim)
id 1WDEhE-0008VO-8d
for bonnie@triadprefinish.com; Tue, 11 Feb 2014 09:52:24 -0500
Received: from mccannprotectiveservices.hahbrewed.com ([66.197.136.70])
by bosimpinc04.eigbox.net with NO UCE
id R2sN1n03X1XJZUa012sPZB; Tue, 11 Feb 2014 09:52:24 -0500
X-EN-OrigIP: 66.197.136.70
X-EN-IMPSID: R2sN1n03X1XJZUa012sPZB
Content-Type: text/plain; charset="us-ascii"
MIME-Version: 1.0
Content-Transfer-Encoding: 7bit
Date: Tue, 11 Feb 2014 06:52:18 -0800
Message-ID:
Subject: The lazy workout actually works. - Hottest Celeb tip
From: Workout For Lazy
Reply-to:
To:

Good Morning Bonnie --

What is the secret to success that the celebs use to get fit and get-fit fast.

The secret to rapid fat-loss is easier then we think-
http://www.hahbrewed.com/abcnewsGMA/o...
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Mike F., Alum

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Thank you for reporting those. I'll have them submitted. I don't know how quickly they can get blocked but I'll work on this.

Mike
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Mike F., Alum

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Hi Bonnie6409,

Good news. Each of those have already been blocked.
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Bonnie6409

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Awesome! Thank you!!
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Bonnie6409

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Just got another - is there somewhere other than here that I should report these?

Return-path:
Envelope-to: bonnie@triadprefinish.com
Delivery-date: Wed, 12 Feb 2014 11:10:17 -0500
Received: from bosimpinc06.eigbox.net ([10.20.13.6])
by bosmailscan10.eigbox.net with esmtp (Exim)
id 1WDcO9-0002xg-9r
for bonnie@triadprefinish.com; Wed, 12 Feb 2014 11:10:17 -0500
Received: from matrixtoolusa.anedozen.com ([96.9.142.183])
by bosimpinc06.eigbox.net with NO UCE
id RUA91n02l3xd7Wg01UA95Y; Wed, 12 Feb 2014 11:10:11 -0500
X-EN-OrigIP: 96.9.142.183
X-EN-IMPSID: RUA91n02l3xd7Wg01UA95Y
Content-Type: text/html; charset="us-ascii"
MIME-Version: 1.0
Content-Transfer-Encoding: 7bit
From: Overeating Fixed
Date: Wed, 12 Feb 2014 08:10:02 -0800
Reply-to:
Subject: Latest celebrity buzz - Kick 22-pounds to the curb
To:
Message-ID:

<!doctype html>

THE DR.OZ SHOW
More OZ: Triple Your Fat-Loss

The popular doctor explains how you can drop 19LBS's in 22 days.

The show aired a little over 12 days ago and is gaining much attention.
We have over 121,000 Facebook likes in just a couple days.

This is no joke and we put this information to the test last week.

Learn About This

Do you have a story you would like to share with us? If so please send us the details.

FACEBOOK | SHARE | BLOG

This letter is in hopes to teach healthy values. this letter is from Manner CareNetworks. 11343 Snow Rd -- Middleburg Heights -- OH -- 44130. You may want to stop further messages by going to this U.R.L.

FDA Issues Rice Warning After Students Break Out In Burning, ItchyRash

here has been a series of illnesses associated with Uncle Bens Infused Rice, according to.

TIME is reporting that the government is investigating this claim.

The infused flavors are usually only bought by restaurants, schools, hospitals, or other commercial establishments, but the FDA says these products may be availableand at warehouse-type retailers.

The Food and Drug Administration has issued a warning due to three separate incidents across the country.

The latest incident occurred at three different public schools in Katy, Texas. Thirty-four students and four teachers reported burning, itching rashes, headaches, and nausea The FDA said that they reported thefor between 30 and 90 minutes before they went away. All the students ate Uncle Bens Infused Rice Mexican Flavor prior to showing symptoms.

An earlier incident happened in Illinois on December 4 when 25 students who had eaten Uncle Bens Infused Rice Products reported similar symptoms. Around the same time in December, four people had similar symptoms in North Dakota after eating the product.

Uncle Bens rice is owned by Mars Foodservices and is currently being recalled. The flavors include Roasted Chicken, Garlic & Butter, Mexican, Pilaf, Saffron, Cheese, and Spanish flavors. They are sold in 5 and 25 pound bags.

<!--

Error Code 201
System error code 201 means "The operating system cannot run %1." This error code may also display as "ERROR_RELOC_CHAIN_XEEDS_SEGLIM" or as the value 0xC9.
Error Code 202
System error code 205 means "No process in the command subtree has a signal handler." This error code may also display as "ERROR_NO_SIGNAL_SENT" or as the value 0xCD.

-->
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Mike F., Alum

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This one has also been blocked. Our new spam filter utilizes something called a feedback loop, where it obtains information/feedback from several sources. By time you report these, it's most likely our system will have already blocked them, but, if for some reason you have messages repeatedly coming through feel free to post them here.

Mike
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Jane9132

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Hi Mike, I too am having some spam issues. I have not found any way to advise you of spam received - no spam marker, no filter access??? I have only had a few so I have just been deleting them. Also frustrating, is getting shut out when trying to access this blog. The "HELP" guide is very little help and has no SEARCH feature so wastes too much time. The latest spam is below:
Return-path:
Envelope-to: jane@janefletcher.com
Delivery-date: Sun, 23 Feb 2014 18:26:19 -0500
Received: from bosimpinc04.eigbox.net ([10.20.13.4])
by bosmailscan16.eigbox.net with esmtp (Exim)
id 1WHiR9-0003TC-7i
for jane@janefletcher.com; Sun, 23 Feb 2014 18:26:19 -0500
Received: from mobile1.mobile.cn.tcu.ac.jp ([133.78.203.141])
by bosimpinc04.eigbox.net with NO UCE
id VzSH1n01H33ZUil01zSJ2g; Sun, 23 Feb 2014 18:26:19 -0500
X-EN-OrigIP: 133.78.203.141
X-EN-IMPSID: VzSH1n01H33ZUil01zSJ2g
Received: from User (unknown [41.203.69.6])
by mobile1.mobile.cn.tcu.ac.jp (Postfix) with ESMTP id 04CED1F0442;
Mon, 24 Feb 2014 08:21:48 +0900 (JST)
Reply-To:
From: "GOVERNOR CBN"
Subject: BANK TO BANK TRANSACTION
Date: Mon, 24 Feb 2014 00:22:15 +0100
MIME-Version: 1.0
Content-Type: text/html;
charset="Windows-1251"
Content-Transfer-Encoding: 7bit
X-Priority: 3
X-MSMail-Priority: Normal
X-Mailer: Microsoft Outlook Express 6.00.2600.0000
X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2600.0000
X-Antivirus: avast! (VPS 140223-1, 02/23/2014), Outbound message
X-Antivirus-Status: Clean
Message-Id:
To: undisclosed-recipients:;

CENTRAL BANK OF NIGERIA

Plot 33, Abubakar Tafawa Balewa Way Central Business District,

Cadastral Zone, Abuja, Federal Capital Territory,

Nigeria

 

 



Our Ref: FGN/CBN/SH-VOL.04/2014





 

Attention: Beneficiary

 





YOUR CONTRACT PART-PAYMENT

 

 



How are you today, Have you received your part-payment of USD10.5M, (Ten Million Five Hundred Thousand Dollars), because Mr. Obinna Olisah Director Foreign Remittance (CBN) called me and told me that you have received your fund into your account since Friday last week hence am writing you to know why you have not written or called to notify me.

 

 

I hope you know that it is my effort that made it possible for the payment of your fund because I have not relented all this while since I was appointed by the President and Commander in Chief of the Armed Forces of Nigeria, Dr. Goodluck Ebele Jonathan GCFR to make the appropriation for the payment of Beneficiary, hence including your file.

 

 

As soon as you receive this mail, kindly let me know if you have not received your payment, which I have already included for payment. However, please try to forward your banking details.

 

 

 

Full Name:

Your Address:

Your State:

Your Direct Mobile Phone:

Your Office/ Home Phone:

Your Bank Name:

Bank Account No:

Account Holder:

Your Bank Swift Code Id any:

Your Occupation:

Your Next Of Kin Names:

Your age:

 

 

 

BEST REGARDS,



Mr. Mallam Lamido Sanusi

GOVERNOR, CENTRAL BANK OF NIG.

NOTE: UPON THE RECIPT OF THE ABOVE FEE, YOUR FUNDS (US$10.5MILLION) WILL BE SUBJECT TO TRANSFER TO THE ABOVE ACCOUNT.

 
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Mike F., Alum

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Jane9132, Thanks for posting the full message with the header! This really helps us a lot! This particular message has been blocked by our filter. You should not see it anymore.

Mike
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Jane9132

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Thanks Mike. Here is another one:
Return-path:
Envelope-to: jane@janefletcher.com
Delivery-date: Mon, 24 Feb 2014 07:39:02 -0500
Received: from bosimpinc04.eigbox.net ([10.20.13.4])
by bosmailscan10.eigbox.net with esmtp (Exim)
id 1WHuoH-00044N-G5
for jane@janefletcher.com; Mon, 24 Feb 2014 07:39:01 -0500
Received: from externalrelay1.mondoserver.com ([151.1.154.154])
by bosimpinc04.eigbox.net with NO UCE
id WCf01n0163L8Fcv01Cf0Fn; Mon, 24 Feb 2014 07:39:00 -0500
X-EN-OrigIP: 151.1.154.154
X-EN-IMPSID: WCf01n0163L8Fcv01Cf0Fn
Received: from hulk.mondoservermail.com (server7.net1.3net.it [151.1.155.7])
by externalrelay1.mondoserver.com (Postfix) with SMTP id 3906061120
for ; Mon, 24 Feb 2014 13:32:27 +0100 (CET)
Received: (qmail 5179 invoked by uid 89); 24 Feb 2014 12:38:54 -0000
Received: from localhost (HELO mail.pieroiunco.it) (127.0.0.1)
by mail.mondoserver.com with SMTP; 24 Feb 2014 12:38:54 -0000
Received: from 41.66.233.1
(SquirrelMail authenticated user info@pieroiunco.it)
by mail.pieroiunco.it with HTTP;
Mon, 24 Feb 2014 12:38:54 -0000 (GMT)
Message-ID:
Date: Mon, 24 Feb 2014 12:38:54 -0000 (GMT)
Subject: HAPPY NEW YEAR
From: "Mr Benni Gaspar"
Reply-To: gaspar.benni@yahoo.de
User-Agent: SquirrelMail/1.4.9a
MIME-Version: 1.0
Content-Type: text/plain;charset=iso-8859-1
Content-Transfer-Encoding: 8bit
X-Priority: 3 (Normal)
Importance: Normal

Hello Friend,

I am Mr Benni Gaspar , Principal Fund Manager of my Bank. I have an
obscured business suggestion for you with trust if you are sincere
person.That will be of great benefit for you and I. It involve the
transfer of ($16,500,000.00 USD) if interested please get back to me on my
private email: for more details of this operation. I need you to
signify your interest by replying to this email (gaspar.benni@yahoo.de)
Your earliest response to this letter will be highly appreciated.

In Kind Regards,

Mr Benni Gaspar
Principal Fund Manager
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Bonnie6409

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OK Spam is coming in still - I have received several and will be posting them here. This is the latest that has just come in:

Return-path:
Envelope-to: bonnie@triadprefinish.com
Delivery-date: Fri, 14 Feb 2014 11:58:09 -0500
Received: from bosimpinc06.eigbox.net ([10.20.13.6])
by bosmailscan21.eigbox.net with esmtp (Exim)
id 1WEM5Z-0003Ab-LZ
for bonnie@triadprefinish.com; Fri, 14 Feb 2014 11:58:09 -0500
Received: from mhbt.tabletwet.com ([66.172.94.20])
by bosimpinc06.eigbox.net with NO UCE
id SGyB1n00U0SNADN01GyBcF; Fri, 14 Feb 2014 11:58:11 -0500
X-EN-OrigIP: 66.172.94.20
X-EN-IMPSID: SGyB1n00U0SNADN01GyBcF
Content-Type: text/plain; charset="us-ascii"
MIME-Version: 1.0
Content-Transfer-Encoding: 7bit
Message-ID:
Reply-to:
Date: Fri, 14 Feb 2014 08:58:08 -0800
From: TJ Maxx Benefits
Subject: Valentines Bonus: $25 Voucher (02.14.2014)
To:

Hello Bonnie,
TJ Maxx Rewards: e962fe05070bb31bd501c95198d05200
Issued: 02-13-2014 18:35:50
=================================

|TJ Maxx Rewards|

We are celebrating Valentines Day with a $25 Gift Card for you.

Redeem $25 Gift Card:
http://www.tabletwet.com/k3kr/n9s8u3/...

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write to 1127 Barcelona Drive Greenwood, IN Four Six One Four Three or visit first alert media at http://www.tabletwet.com/tjmaxx/knw4e...
to change your message status

The Kardashian sisters are touted as "style icons with killer curves" in The Sunday Mirror's latest issue of Notebook, but those "killer curves" seem to have been digitally erased on the magazine's cover.

Sisters Kim, Khloe and Kourtney are dressed in their Kardashian Kollection apparel, but their suspiciously altered appearance had fans crying Photoshop fail after their mother, Kris Jenner, posted the magazine cover to her Instagram account. Kim looks even prettier without her make up (SplashNews)

It was claimed last Summer that following the arrival of baby North, Kimmie had set aside her intense make up schedule.

"She has always had a schedule with every hour of the day taken," an insider told Us Weekly. "Now, she hasnt had her hair or makeup done since she had the baby."

Looks like she's back to her old habits now though. The ladies are currently filming the latest series of Keeping Up With The Kardashians, with the cameras following Khloe Kardashian, Kris Jenner and Scott Disick to Tru nightclub on Monday where the family partied with close friend The Game.
Kardashian sisters Khloe, Kim and Kourtney have had their natural figures downsized for the cover of the British edition of Notebook in what is another Photoshop controversy.
Ironically, the cover is titled, "Style icons with killer curves". But instead of curves, the sisters are showing off tiny waists, elongated necks, petite shoulders and sunken cheeks.
Posting the cover to her Instagram, Kourtney said, We are all rocking @KardashianKollection on the cover of the British edition of Notebook. Major shout out to @beautybyrokael and @jenatkinhair for my fab glam.
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Baltimore awoke to of snow Thursday morning, measured in Pimlico, the neighborhood that is home to the Preakness Stakes horse race. Snow blowers roared, breaking the quiet of downtown as they cleared city sidewalks in a sleeting rain. But every cleared strip created a potential hazard as it quickly iced over. Traffic was light, with some pedestrians taking to the middle of the road.

Streets were similarly deserted in Washington. As Southerners did a day earlier, many heeded warnings to stay off the roads. The sound of plastic shovels against the sidewalk rang out, and cars were capped in white. Eleven inches of snow had accumulated, with more falling. People trudged through it on foot, hopping over piles built up at intersections. Federal offices and the city's two main airports were closed.

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KUWTK 904 Recap
Clear your schedules for Sunday night, dolls
Kim Kardashian is about to experience the ultimate birthday when best friend and boyfriend Kanye West gets down on one knee to propose.
For such a special event, we think it's the perfect time for a full-on Kardashian viewing party. But how can you make sure your event is as successful as Kanye's surprise?
From food and drinks to dress code and social media etiquette, we've got you covered with a few simple party tips. Check out our party guidelines below.Rob Kardashian, of Keeping Up with the Kardashians fame, recently talked about his thoughts on marriage. His latest insights come after reports that Kris Jenner may have called him fat, following photos that seem to show Bruce Jenner undergoing change surgery to become a woman.
For some unknown reason, Rob Kardashian decided to bash his mom and sister, over their highly-publicized marital woes.
While he didn't name Khloe and Kris specifically, he did say that he doesn't believe in divorce (whatever that means). When asked by HuffPo what he is most afraid of, the reality star told the paper:"Probably picking a proper wife and not just rushing something. Actually, I'm probably not afraid of that because I probably just won't get married. But probably like finding the right one, because I don't really believe in divorce, so just finding the right girl."
Of course, some have suggested that Rob was taking a swipe at Kris Jenner, following a tabloid's claim that Kris harassed Rob over his weight. According to one insider who spoke to Star, Kris has had enough of Rob's overeating:
"Rob is fatter than ever, and Kris finally flat out told him that he's an embarrassment to the family. She called him a fat slob and said he's losing out on business opportunities because no one wants someone as huge as him representing their products."
His sisters, according to the same alleged insider, act just as petty as their mother:
"They're embarrassed to be photographed with him and bully him for being fat. They also tease him for by leaving cakes and cookies around to tempt him.

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<div>
<span><p><i>A children's play center in Medford, N.Y., is under fire from parents
after it hosted an after-hours adult party.MyFoxPhilly.comThe owner of a
childrens play center in New York is under fire from parents after
it was revealed he rented out the facility for an after-hours adult
party that advertised nudity and Jell-O wrestling.The adult event took place
Saturday night at Krazy Kidz Play Center in Medford, Long Island. It
was billed as a jungle gym and pajama party with tasteful nudity,
but with no strippers or sexually lewd content, MyFoxNY.com reports.However,
pictures posted on social media by partygoers showed what appeared to be
naked revelers inside the building, according to CBS New York.On Facebook,
the business said it rented out the facility to help cover their
operating expenses, which was met by outrage from parents and members of
the public.Are you serious? Holding an adult party where children play!!!!!
You should be ashamed, one parent wrote.Krazy Kidz posted numerous apologies
for hosting the event and said it was reviewing its private party
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no different [than] an ordinary Halloween party that you would hold at
your home, the business wrote on Tuesday. As always, that facility has
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to pride ourselves on the cleanliness of our facility.Krazy Kidz added that
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</i></p></span>
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GGSCOUUO
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_Looking for some No-Strings attached fun?  - (bonnie)-bonnie

_Looking for some No-Strings attached fun?  - (bonnie)



<!--
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<span><p><i>the world who are deeply religious, who get enriched by the
wonderful sense of community by their religion," said Nye, who wore his
trademark bow tie. "But these same people do not embrace the extraordinary
view that the Earth is somehow only 6,000 years old."The debate drew
a few Nye disciples in the audience, including Aaron Swomley, who wore
a red bowtie and white lab coat. Swomley said he was impressed
by Ham's presentation and the debate's respectful tone."I think they did
a good job outlining their own arguments without getting too heated, as
these debates tend to get," he said.Some scientists had been critical of
Nye for agreeing to debate the head of a Christian ministry that
is dismissive of evolution.Jerry Coyne, an evolution professor at the University
of Chicago, wrote on his blog that "Nye's appearance will be giving
money to organizations who try to subvert the mission Nye has had
all his life: science education, particularly of kids." Coyne pointed out
that the Creation Museum will be selling DVDs of the event.The debate
was hatched after Nye appeared in an online video in 2012 that
urged parents not to pass their religious-based doubts about evolution on
to their children. Ham rebutted Nye's statements with his own online video
and the two later agreed to share a stage.

</i></p></span>
<div>
Thu, 13 Feb 2014 10:36:06 -0800
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Sochi 2014 live: Shaun White finishes fourth in Winter Olympic halfpipe final won by Swiss rider Iouri Podladtchikov

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18.07 29ff0de2b68bbc2b5a327cf4fa28b9e5 Greg Bretz. Double cork but then it's over before it's begun. He continues but will end up in 12th place like he did four years ago in 29ff0de2b68bbc2b5a327cf4fa28b9e5.
18.05 29ff0de2b68bbc2b5a327cf4fa28b9e5 of the 29ff0de2b68bbc2b5a327cf4fa28b9e5 Air Kent Callister from Ozzie. Frontside 29ff0de2b68bbc2b5a327cf4fa28b9e5. Double McT. Frontside 540 Japan Air. Ripper. 68.5pts. Nice run. Nice method.

18.00 Currently in 29ff0de2b68bbc2b5a327cf4fa28b9e5 medal place is Zhang who repeats his compatriot's mistake. He hits a lip after trying a big double McTwist but makes contact with the coping on his way down. 58.5 there so his first run stands.

17.59 Shi 29ff0de2b68bbc2b5a327cf4fa28b9e5 with big 29ff0de2b68bbc2b5a327cf4fa28b9e5. But he bangs into the lip of the pipe. He was 29ff0de2b68bbc2b5a327cf4fa28b9e5 so well. He lets out a cry but he's ok. 29ff0de2b68bbc2b5a327cf4fa28b9e5 run score stands.
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Bonnie6409

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Two new ones - several of these coming through have Dr Oz themes...

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Subject: // weight-loss Results in days - w/o fasting (DocOz)
Date: Fri, 14 Feb 2014 12:06:29 -0800
Message-ID:
From: Doc Oz Digest
Reply-to:
To:

Doc Oz Blog
Posted - February 13, 2014

========================================
Fast Way To Lose Weight [Video Summary]: http://www.firraised.com/weight/loss/...
========================================

Doc Oc Reports - With So many American fighting obesity,
Doc OZ realizes that he needs to help his viewers loose weight quickly.

He devoted an episode to talking about how you can
lose it quick without working out or dieting: http://www.firraised.com/weight/loss/...

Enjoy your favorite snacks and still loose 1 lb per day.

[ Doc Oz Team ]

to modify your correspondence status with First Alert Media write to 1127 Barcelona Drive G r e e n w o o d ,
IN 46143 or visit http://www.firraised.com/kns3/09ujg/l...

I thought I'd share. I am a bit of a health nut, not only am I calories, fat, etc conscious but I hate chemical in my food! But I am in alaska so my budget and overall options have me a bit limited. We don't have a whole lot of organic up here, so I do what I can by making jus about everything from scratch... Seriously everything. I know exactly what is in it and I can control the calories.

So, the tips... I feel you can use these any where and probably cheaper than me! First and foremost whether your budgeting, watching what you eat or both... PLAN!!! It doesn't take that long and you can plan as far or as not so far ahead as you'd like. I plan my husband and my meals about a week in advance. I typically plan to cook every other da, so I make enough for 4 servings. I hardly ever waste... EVER! I hate wasting it is throwing money away... And wasting all the hard work I out into a meal :-) I work with my husband (you can with your kids, my parents did!) I ask if he's craving anything, or if there is something we haven't had in awhile. Then I take what he says, if anything and PLAN MY MEALS AROUND THE SALES. Now DO NOT fall for the sales trickery! Only buy it if you need it! That is why you're planning after all :) Stay on track. If you don't feel like eating the meal you planned then use what you have and switch it!

Now tips for keeping it healthy. This is a bit hard because my husband hates chicken! And beans! And most potato! And loves cheese and pasta and beef... Ugh! So I make things like tacos with low fat beef, fajitas and I use lettuce as a wrap instead of tortillas. I make risotto with barley and no cheese, I'll bake instead of fry, and use bulgur (my secret amazing ingredient that I'll put in another post) to fluff things up. Spend a little extra for the organic where you can and make from scratch as much as possible. I make all of my lunches on Sunday or at least all of the pieces. For example, this week I had chicken caesarean salads! So I prepped the chicken, bulgur, and homemade Cesar dressing on Sunday.
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And this one:

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From: Family Assurance
Date: Fri, 14 Feb 2014 10:27:42 -0800

<!doctype html>

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I don't think so, since heating them in boiling water, then dousing them in cold water after does that http://www.organdonor.gov/becomingdonor/index.html

Cant see this important message?
View it online here

It gets lots of starch out of it so when you put it directly in soup it doesn't affect the broth as much.vI cook noodles to al dente, rinse them and then add to the soup. Keeps the broth clearer. Not sure if it makes a big difference in texture, though.

http://www.ready.gov/get-involvedFidelity/Options 080600935412241

Hi there! I was recently eating my mom's noodles and when I asked her how she cooked it, she said she bathed them in cold water for a while, then boiled it.
rem img -52346
Like the recipe for baked ham. One girl always used to cut her ham in two. When asked why, she said "that's the way my mother always used to do it" When she asked her mother, she said"that's the way my mother used to do it" When she asked her grandmother she said" Back in the old days, the oven



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Mike F., Alum

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Bonnie6409, I am looking at these messages for you. This is pretty excessive. I'm going to email you in the hopes you can reply back with some information. Please watch your email.
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Bonnie6409

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Mike - Just wondering how you are doing on isolating the reason for all the spam. After receiving none on Saturday and only 3 yesterday, I have received 5 already today. I forwarded a couple of them to you via email as an attachment but didn't want to clog your inbox with all of them.
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Mike F., Alum

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I emailed you earlier today with instructions on how to send the emails as attachments. I'll need you to forward them to me as there will be information in the headers of the email that we'll need.

Mike
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Bonnie6409

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Have you received my emails? I haven't heard anything back from you. The spam just keeps coming in. I've received 5 in the last 3 hours alone. Thanks!
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Sorry for the delay Bonnie6409, I just replied to your email if you can please check it when you have a chance.

Mike
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Mike F., Alum

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Bonnie I do see quite a few emails in the spam folder. When you received them, did they go directly into the spam folder or did you have to move them from the inbox into the spam folder?

Feel free to change your password back and log in if you need to. I'll let you know if we need to log in again.

Mike
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Bonnie6409

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None of them went to the spam folder - they all came into my inbox and I moved them to the spam folder.
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Bonnie6409

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Any update on the spam issue? It seems to be getting worse instead of better. I have received 5 in the last hour & a half. That is almost what it was like before the migration.
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Bonnie6409

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Any update on the spam issue? It seems to be getting worse instead of better. I have received 5 in the last hour & a half. That is almost what it was like before the migration.
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Mike F., Alum

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Bonnie6409, I don't have a resolution yet. But. I'll need to log in and get some other details from the new spam messages. So we'll have to change the password again. If you need to log in and use the email, just do another password change. This will only take about 5 minutes.
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Kathy Wildman

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I have been irritated by increased spam this week; especially spam that comes in as an image. Without the little boxes to check there is no way to remove them without opening and even then it takes further clicks to use the move to function to put the e-mail in a spam folder. I prefer to move spam without opening it and thereby confirming my address and attracting more spam. I miss the old intuit e-mail. I also miss the more powerful search function which now does not find things in the body of the letter and will only search the subject line in one folder at a time. Much less effective than the old search.
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Mike F., Alum

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Hi Kathy, Until we get some sort of way for you to flag spam, the only option we have is if you would like to copy the emails body and header and paste it here, we can report it as spam. To obtain the header, click the "show source" button with the email open and copy the contents on the screen.
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even worse today:

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While it might not quite be time to pop the bubbly, there's reason to believe that hiring in several key industries will be on the upswing in the first few months of the new year. The latest Manpower Employment Outlook Survey indicates growing optimism among U.S. employers. Of more than 18,000 surveyed, 17 percent anticipated raising staff levels in their first-quarter hiring — the best outlook in six years.

This adds to other upbeat numbers. Last month, the U.S. economy added more than 200,000 jobs, the Bureau of Labor Statistics estimates. The unemployment rate dropped to its lowest level since 2008, to 7 percent.

Overall, things were brighter for workers of all ages in November than in quite some time, says Sara Rix, senior strategic policy adviser at the AARP Public Policy Institute.

Sign up for the AARP Money Newsletter

Discover great deals and savings on travel, shopping, dining, entertainment, health needs and more.

Looking at older workers, the November unemployment rate for those age 55 and older fell to 4.9 percent, down sharply from October's 5.4 percent. The rate fell both for older women and older men.

"Fewer workers were unemployed, employed part time for economic reasons or discouraged about their job prospects," Rix says.

While these numbers may be encouraging, workers who remain without jobs continued to struggle, as the average duration of unemployment rose once again. The November survey found that jobless people age 55 and over had been that way for an average of 50.7 weeks, up slightly from 49.7 weeks in October.

That said, don't give up. If you're job hunting, some industries are reporting rising numbers of vacancies. Below are five sectors where you can expect to find openings in the next few months.

Pay will vary depending on the employer, your experience and where you live. The jobs may have flexible hours and be full or part time. Some may require you to go back to school for specific training. But in others, you may be able to repurpose skills you already have.

Regarding This New Opening
Mon, 24th - February (5:00pm)
Beginning Salary: $75.00 per hour
Status: PENDING YOUR REVIEW
Relax in the comfort of your own home and enjoy making big bucks with these companies

ebay , amazon ,

Google,craigslist &

facebook

A response is needed and this once in a lifetime position wont be available long.
Please get back to us here

Turn the year around and make +$89,000 the rest of 2014

Go here and submit your info for job id: 2463682740844409661

Its easy to just end these by checking-out this page today. Thank you

Put this to an end right/here today. or send a written note 492+Sandfield+Court+Montgomery+AL+36117-4408

While it might not quite be time to pop the bubbly, there's reason to believe that hiring in several key industries will be on the upswing in the first few months of the new year. The latest Manpower Employment Outlook Survey indicates growing optimism among U.S. employers. Of more than 18,000 surveyed, 17 percent anticipated raising staff levels in their first-quarter hiring — the best outlook in six years.

This adds to other upbeat numbers. Last month, the U.S. economy added more than 200,000 jobs, the Bureau of Labor Statistics estimates. The unemployment rate dropped to its lowest level since 2008, to 7 percent.

Overall, things were brighter for workers of all ages in November than in quite some time, says Sara Rix, senior strategic policy adviser at the AARP Public Policy Institute.

Sign up for the AARP Money Newsletter

Discover great deals and savings on travel, shopping, dining, entertainment, health needs and more.

Looking at older workers, the November unemployment rate for those age 55 and older fell to 4.9 percent, down sharply from October's 5.4 percent. The rate fell both for older women and older men.

"Fewer workers were unemployed, employed part time for economic reasons or discouraged about their job prospects," Rix says.

While these numbers may be encouraging, workers who remain without jobs continued to struggle, as the average duration of unemployment rose once again. The November survey found that jobless people age 55 and over had been that way for an average of 50.7 weeks, up slightly from 49.7 weeks in October.

That said, don't give up. If you're job hunting, some industries are reporting rising numbers of vacancies. Below are five sectors where you can expect to find openings in the next few months.

Pay will vary depending on the employer, your experience and where you live. The jobs may have flexible hours and be full or part time. Some may require you to go back to school for specific training. But in others, you may be able to repurpose skills you already have.

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Only 4 sports are left - Start earning 75 dollars an hour for the rest of 2014


Regarding This New Opening
Mon, 24th - February (5:00pm)


Beginning Salary: $75.00 per hour
Status: PENDING YOUR REVIEW
Relax in the comfort of your own home and enjoy making big bucks with these companies




ebay , amazon ,

Google,craigslist &


facebook


A response is needed and this once in a lifetime position wont be available long.
Please get back to us here

Turn the year around and make +$89,000 the rest of 2014

Go here and submit your info for job id: 2463682740844409661






Its easy to just end these by checking-out this page today. Thank you


Put this to an end right/here today. or send a written note 492+Sandfield+Court+Montgomery+AL+36117-4408


While it might not quite be time to pop the bubbly, there's reason to believe that hiring in several key industries will be on the upswing in the first few months of the new year.

The latest Manpower Employment Outlook Survey indicates growing optimism among U.S. employers. Of more than 18,000 surveyed, 17 percent anticipated raising staff levels in their first-quarter hiring — the best outlook in six years.


This adds to other upbeat numbers. Last month, the U.S. economy added more than 200,000 jobs, the Bureau of Labor Statistics estimates. The unemployment rate dropped to its lowest level since 2008, to 7 percent.


Overall, things were brighter for workers of all ages in November than in quite some time, says Sara Rix, senior strategic policy adviser at the AARP Public Policy Institute.


Sign up for the AARP Money Newsletter


Discover great deals and savings on travel, shopping, dining, entertainment, health needs and more.


Looking at older workers, the November unemployment rate for those age 55 and older fell to 4.9 percent, down sharply from October's 5.4 percent. The rate fell both for older women and older men.


"Fewer workers were unemployed, employed part time for economic reasons or discouraged about their job prospects," Rix says.


While these numbers may be encouraging, workers who remain without jobs continued to struggle, as the average duration of unemployment rose once again. The November survey found that jobless people age 55 and over had been that way for an average of 50.7 weeks, up slightly from 49.7 weeks in October.


That said, don't give up. If you're job hunting, some industries are reporting rising numbers of vacancies. Below are five sectors where you can expect to find openings in the next few months.


Pay will vary depending on the employer, your experience and where you live. The jobs may have flexible hours and be full or part time. Some may require you to go back to school for specific training. But in others, you may be able to repurpose skills you already have.


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Kathy Wildman

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kathy@kathywildman.com

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Obstructive sleep apnea is a disorder in which breathing is briefly and repeatedly interrupted during sleep. The "apnea" in sleep apnea refers to a breathing pause that lasts at least ten seconds. Obstructive sleep apnea occurs when the muscles in the back of the throat fail to keep the airway open, despite efforts to breathe. Another form of sleep apnea is central sleep apnea, in which the brain fails to properly control breathing during sleep. Obstructive sleep apnea is far more common than central sleep apnea.


Obstructive sleep apnea, or simply sleep apnea, can cause fragmented sleep and low blood oxygen levels. For people with sleep apnea, the combination of disturbed sleep and oxygen starvation may lead to hypertension, heart disease and mood and memory problems. Sleep apnea also increases the risk of drowsy driving. Sleep apnea can be life-threatening and you should consult your doctor immediately if you feel you may suffer from it.


More than 18 million American adults have sleep apnea. It is very difficult at present to estimate the prevalence of childhood OSA because of widely varying monitoring techniques, but a minimum prevalence of 2 to 3% is likely, with prevalence as high as 10 to 20% in habitually snoring children. OSA occurs in all age groups and both sexes, but there are a number of factors that increase risk, including having a small upper airway (or large tongue, tonsils or uvula), being overweight, having a recessed chin, small jaw or a large overbite, a large neck size (17 inches or greater in a man, or 16 inches or greater in a woman), smoking and alcohol use, being age 40 or older, and ethnicity (African-Americans, Pacific-Islanders and Hispanics). Also, OSA seems to run in some families, suggesting a possible genetic basis.


Chronic snoring is a strong indicator of sleep apnea and should be evaluated by a health professional. Since people with sleep apnea tend to be sleep deprived, they may suffer from sleeplessness and a wide range of other symptoms such as difficulty concentrating, depression, irritability, sexual dysfunction, learning and memory difficulties, and falling asleep while at work, on the phone, or driving. Left untreated, symptoms of sleep apnea can include disturbed sleep, excessive sleepiness during the day, high blood pressure, heart attack, congestive heart failure, cardiac arrhythmia, stroke or depression.


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PO Box 52079
Pheonix, Arizona, 85072

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Obstructive sleep apnea is a disorder in which breathing is briefly and repeatedly interrupted during sleep. The "apnea" in sleep apnea refers to a breathing pause that lasts at least ten seconds. Obstructive sleep apnea occurs when the muscles in the back of the throat fail to keep the airway open, despite efforts to breathe. Another form of sleep apnea is central sleep apnea, in which the brain fails to properly control breathing during sleep. Obstructive sleep apnea is far more common than central sleep apnea.

Obstructive sleep apnea, or simply sleep apnea, can cause fragmented sleep and low blood oxygen levels. For people with sleep apnea, the combination of disturbed sleep and oxygen starvation may lead to hypertension, heart disease and mood and memory problems. Sleep apnea also increases the risk of drowsy driving. Sleep apnea can be life-threatening and you should consult your doctor immediately if you feel you may suffer from it.

More than 18 million American adults have sleep apnea. It is very difficult at present to estimate the prevalence of childhood OSA because of widely varying monitoring techniques, but a minimum prevalence of 2 to 3% is likely, with prevalence as high as 10 to 20% in habitually snoring children. OSA occurs in all age groups and both sexes, but there are a number of factors that increase risk, including having a small upper airway (or large tongue, tonsils or uvula), being overweight, having a recessed chin, small jaw or a large overbite, a large neck size (17 inches or greater in a man, or 16 inches or greater in a woman), smoking and alcohol use, being age 40 or older, and ethnicity (African-Americans, Pacific-Islanders and Hispanics). Also, OSA seems to run in some families, suggesting a possible genetic basis.

Chronic snoring is a strong indicator of sleep apnea and should be evaluated by a health professional. Since people with sleep apnea tend to be sleep deprived, they may suffer from sleeplessness and a wide range of other symptoms such as difficulty concentrating, depression, irritability, sexual dysfunction, learning and memory difficulties, and falling asleep while at work, on the phone, or driving. Left untreated, symptoms of sleep apnea can include disturbed sleep, excessive sleepiness during the day, high blood pressure, heart attack, congestive heart failure, cardiac arrhythmia, stroke or depression.

If you wish to end these then please go to this page
PO Box 52079 Pheonix, Arizona, 85072

make these stop here or send a written note 60|Pierpont|Road|Waterbury|CT|06705-3840
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Kathy Wildman

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Subject: The sleep you need is in this bottle
From: "Top sleep-aid"
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Procede-here or at 180-Edgewood-Road-Vestal-NY-13850-1202









According to the National Institutes of Health, 50 to 70 million Americans are affected by chronic sleep disorders and intermittent sleep problems that can significantly diminish health, alertness and safety. Untreated sleep disorders have been linked to hypertension, heart disease, stroke, depression, diabetes and other chronic diseases. Sleep problems can take many forms and can involve too little sleep, too much sleep or inadequate quality of sleep.

The Institute of Medicine recently estimated in its report, Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem, that “hundreds of billions of dollars a year are spent on direct medical costs related to sleep disorders such as doctor visits, hospital services, prescriptions, and over-the-counter medications.” Sleep problems and lack of sleep can affect everything from personal and work productivity to behavioral and relationship problems. Sleep problems can have serious consequences. According to the National Highway Traffic Safety Administration, drowsy driving claims more than 1,500 lives and causes at least 100,000 motor vehicle crashes each year.

Compounding the problem is the fact that most people know when to seek medical help for physical discomfort such as fever or pain—but sleep problems are often overlooked or ignored. In fact, the overwhelming majority of people with sleep disorders are undiagnosed and untreated.

Should Your Sleep Be Evaluated?

To determine whether you might benefit from a sleep evaluation, ask yourself the following questions:

Do you regularly have difficulty getting to sleep or staying asleep?
Do you have a problem with snoring? Has anyone ever told you that you have pauses in breathing or that you gasp for breath when you sleep?
Are your legs “active” at night? Do you experience tingling, creeping, itching, pulling, aching or other strange feelings in your legs while sitting or lying down that cause a strong urge to move, walk or kick your legs for relief?
Are you so tired when you wake up in the morning that you cannot function normally during the day?
Does sleepiness and fatigue persist for more than two to three weeks?
If you answered yes to any of these questions, then a complete sleep evaluation should be considered and discussed with your physician. Before your visit, it may be helpful to track your sleep patterns and medications.

Primary Care Physicians and Sleep Specialists

Depending on your insurance plan and other factors, your primary care physician may start your evaluation by running tests for specific medical disorders that are known to affect sleep. Your physician might even be able to diagnose a sleep problem based solely on your symptoms and recommend initial treatments. At some point, you may be referred to a sleep specialist for a more extensive assessment of your sleep complaints and for more specific treatments.

If this occurs, be sure to ask your physician to refer you to a certified sleep physician. Certification requires that a physician undergo formal training and pass an examination in sleep disorders to demonstrate a higher level of expertise. To find a sleep professional or check if your sleep physician is certified, or to find a certified sleep doctor, go to either www.absm.org to check ‘verification of diplomates,’ or to the ‘who is certified’ section of www.abim.org.

Sleep Studies (Polysomnograms)

After an initial consultation with your physician or a sleep specialist, you may be referred for a sleep study. The medical term for this study is “polysomnogram,” which is a noninvasive, pain-free procedure that usually requires spending a night or two in a sleep facility. During a polysomnogram, a sleep technologist records multiple biological functions during sleep, such as brain wave activity, eye movement, muscle tone, heart rhythm and breathing via electrodes and monitors placed on the head, chest and legs.

After a full night’s sleep is recorded, the data will be tabulated by a technologist and presented to a physician for interpretation. Depending on the physician’s orders, patients may be given therapy during the course of the study, which may include medication, oxygen or a device called continuous positive airway pressure therapy, or CPAP.

Preparing for Your Sleep Study

A list of specific instructions is typically provided to patients before their arrival at the testing facility, but you may want to consider asking additional questions before your test, such as:

Does it matter if I take a nap the day before or the day of the study?
Should I refrain from drinking coffee, tea or other caffeinated products or energy drinks? If so, for how many hours before my test?
What can I eat before the study? In addition to caffeinated products, are there any other foods/beverages that I should avoid?
Should I avoid stimulants, alcohol or sedatives? What about other prescription and non-prescription medications, dietary or herbal supplements? How long before the sleep study should these be discontinued?
What should I bring to wear?
May a family member or attendant stay with the patient during the study?
On the day of the procedure, should I change my cosmetic, skin or hair care routine?
Are personal comfort items, such as snacks, a pillow, slippers or robe, allowed?
What time will I be able to leave?
May I take a shower and dress for work the morning after the study?
Will I be able to discuss the results of the study with my doctor before leaving the facility?
Will my primary care physician or the sleep specialist take the lead in providing continuing care after the study?





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Procede-here or at 180-Edgewood-Road-Vestal-NY-13850-1202

According to the National Institutes of Health, 50 to 70 million Americans are affected by chronic sleep disorders and intermittent sleep problems that can significantly diminish health, alertness and safety. Untreated sleep disorders have been linked to hypertension, heart disease, stroke, depression, diabetes and other chronic diseases. Sleep problems can take many forms and can involve too little sleep, too much sleep or inadequate quality of sleep.

The Institute of Medicine recently estimated in its report, Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem, that “hundreds of billions of dollars a year are spent on direct medical costs related to sleep disorders such as doctor visits, hospital services, prescriptions, and over-the-counter medications.” Sleep problems and lack of sleep can affect everything from personal and work productivity to behavioral and relationship problems. Sleep problems can have serious consequences. According to the National Highway Traffic Safety Administration, drowsy driving claims more than 1,500 lives and causes at least 100,000 motor vehicle crashes each year.

Compounding the problem is the fact that most people know when to seek medical help for physical discomfort such as fever or pain—but sleep problems are often overlooked or ignored. In fact, the overwhelming majority of people with sleep disorders are undiagnosed and untreated.

Should Your Sleep Be Evaluated?

To determine whether you might benefit from a sleep evaluation, ask yourself the following questions:

Do you regularly have difficulty getting to sleep or staying asleep?
Do you have a problem with snoring? Has anyone ever told you that you have pauses in breathing or that you gasp for breath when you sleep?
Are your legs “active” at night? Do you experience tingling, creeping, itching, pulling, aching or other strange feelings in your legs while sitting or lying down that cause a strong urge to move, walk or kick your legs for relief?
Are you so tired when you wake up in the morning that you cannot function normally during the day?
Does sleepiness and fatigue persist for more than two to three weeks?
If you answered yes to any of these questions, then a complete sleep evaluation should be considered and discussed with your physician. Before your visit, it may be helpful to track your sleep patterns and medications.

Primary Care Physicians and Sleep Specialists

Depending on your insurance plan and other factors, your primary care physician may start your evaluation by running tests for specific medical disorders that are known to affect sleep. Your physician might even be able to diagnose a sleep problem based solely on your symptoms and recommend initial treatments. At some point, you may be referred to a sleep specialist for a more extensive assessment of your sleep complaints and for more specific treatments.

If this occurs, be sure to ask your physician to refer you to a certified sleep physician. Certification requires that a physician undergo formal training and pass an examination in sleep disorders to demonstrate a higher level of expertise. To find a sleep professional or check if your sleep physician is certified, or to find a certified sleep doctor, go to either www.absm.org to check ‘verification of diplomates,’ or to the ‘who is certified’ section of www.abim.org.

Sleep Studies (Polysomnograms)

After an initial consultation with your physician or a sleep specialist, you may be referred for a sleep study. The medical term for this study is “polysomnogram,” which is a noninvasive, pain-free procedure that usually requires spending a night or two in a sleep facility. During a polysomnogram, a sleep technologist records multiple biological functions during sleep, such as brain wave activity, eye movement, muscle tone, heart rhythm and breathing via electrodes and monitors placed on the head, chest and legs.

After a full night’s sleep is recorded, the data will be tabulated by a technologist and presented to a physician for interpretation. Depending on the physician’s orders, patients may be given therapy during the course of the study, which may include medication, oxygen or a device called continuous positive airway pressure therapy, or CPAP.

Preparing for Your Sleep Study

A list of specific instructions is typically provided to patients before their arrival at the testing facility, but you may want to consider asking additional questions before your test, such as:

Does it matter if I take a nap the day before or the day of the study?
Should I refrain from drinking coffee, tea or other caffeinated products or energy drinks? If so, for how many hours before my test?
What can I eat before the study? In addition to caffeinated products, are there any other foods/beverages that I should avoid?
Should I avoid stimulants, alcohol or sedatives? What about other prescription and non-prescription medications, dietary or herbal supplements? How long before the sleep study should these be discontinued?
What should I bring to wear?
May a family member or attendant stay with the patient during the study?
On the day of the procedure, should I change my cosmetic, skin or hair care routine?
Are personal comfort items, such as snacks, a pillow, slippers or robe, allowed?
What time will I be able to leave?
May I take a shower and dress for work the morning after the study?
Will I be able to discuss the results of the study with my doctor before leaving the facility?
Will my primary care physician or the sleep specialist take the lead in providing continuing care after the study?
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US National Security - Serious Threat

Recent Events Present Immediate Danger This event could have consequences to your way of life - February 24th

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It is vital that you watch this video

Its time everyone knew the truth.








This shocking story can be stopped by going to this page today. Thanks for your help.
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<!-- The World Health Report 2003limited attention here. Similarly, the human impact on the natural environment and the health consequences of environmental change for human populations are given little direct attention. However, these processes will significantly shape health patterns, and the demands on health care systems, in the years ahead. The purpose of this World Health Report is to encourage action for health improvement, especially for the poor and disadvantaged. This is no longer the time for academic debate the moral imperative is for urgent action. Cooperation between governments, international institutions, the private sector and civil society spurred remarkable public health progress in the 20th century. In an increasingly interdependent world, such collaboration across political and sectoral boundaries is more vital than ever. This report urges every reader, whether inside or outside public health institutions, to share in the task of shaping a healthy, equitable and sustainable future for all.Chapter summariesChapter One contains an assessment of the global health situation, with some important and unexpected findings. Over the last 50 years, average life expectancy at birth has increased globally by almost 20 years, from 46.5 years in 19501955 to 65.2 years in 2002. The large life expectancy gap between developed and developing countries in the 1950s has changed to a gap between the very poorest developing countries and all other countries. Of the 57 million deaths in 2002, 10.5 million were among children of less than five years of age, and more than 98 of these were in developing countries. Globally, considerable progress has been made since 1970 when over 17 million child deaths occurred. In 14 African countries, however, current levels of child mortality are higher than they were in 1990. Overall, 35 of Africas children are at higher risk of death today than they were 10 years ago. The leading causes of death in children are perinatal conditions, lower respiratory tract infections, diarrhoeal diseases and malaria, with malnutrition contributing to them all. In subSaharan Africa, HIVAIDS was responsible for an estimated 332 000 child deaths in 2002. Across the world, children are at higher risk of dying if they are poor and malnourished, and the gaps in mortality between the haves and the havenots are widening. The state of adult health at the beginning of the 21st century is characterized by two major trends slowing of gains and widening health gaps and the increasing complexity of the burden of disease. The most disturbing sign of deteriorating adult health is that advances in adult survival in Africa have been reversed so drastically that, in parts of subSaharan Africa, current adult mortality rates today exceed those of 30 years ago. The greatest impact has been in Botswana, Lesotho, Swaziland and Zimbabwe, where HIVAIDS has reduced life expectancies of men and women by more than 20 years. The fragile state of adult health in the face of social, economic and political instability is apparent elsewhere. Male mortality in some countries in eastern Europe has increased substantially. Globally, most countries are already facing the double burden of communicable and noncommunicable diseases. Almost half of the disease burden in highmortality regions of the world is now attributable to noncommunicable diseases. Population ageing and changes in the distributions of risk factors have accelerated these epidemics in most developing countries. Injuries, both intentional and unintentional, are on the increase, primarily among young adults.OverviewxiiiChapter Two traces the origins of the Millennium Development Goals and charts the progress so far towards achieving them. These goals represent commitments by governments worldwide to do more to reduce poverty and hunger and to tackle illhealth, gender inequality, lack of education, access to clean water and environmental degradation. Three of the eight goals are directly healthrelated all of the others have important indirect effects on health. The Millennium Development Goals place health at the heart of development. This chapter warns that without significantly strengthened commitments from both wealthy and developing countries, the goals will not be met globally, and outcomes in some of the poorest countries will remain far below the achievements hoped for. Chapter Three reviews major trends in the HIV epidemic and examines successes and failures in the struggle against the worlds most devastating infectious disease, before discussing goals for the coming years. These include narrowing the AIDS outcome gap by providing three million people in developing countries with combination antiretroviral ARV therapy by the end of 2005 known as the 3 by 5 target. Although robust HIV prevention and care constitute a complex health intervention, such interventions are not only feasible in resourcepoor settings, but are precisely what is needed. The chapter shows the often stark division between AIDS prevention and care, which in the developing world has meant that, for most people living with HIV, there is simply no decent medical care available at all. But it also provides examples, such as Brazil, where prevention and care have been successfully integrated. The chapter acknowledges that there is still a great deal to be done if the target of three million people on ARV therapy by 2005 is to be met. For this reason, WHO has formally declared inadequate access to ARV therapy to be a global health emergency, and has set in place a number of initiatives to respond accordingly and to progress towards the ultimate goal of universal access to ARV therapy. Chapter Four is the encouraging story of how a major, ancient disease can be conquered. As a result of the Global Polio Eradication Initiative, one of the largest public health efforts in history, the number of children paralysed by this devastating disease every year has fallen from over 350 000 in 1988 to about 1900 in 2003 the number of countries in which the disease is endemic has fallen from over 125 to seven. This chapter records the expected last days of polio, one of the oldest known diseases, as the campaign to eradicate it nears its end. The vision of a poliofree world is within reach, although formidable obstacles remain. The successes to date are the result of a unique partnership forged between governments, international agencies, humanitarian organizations and the private sector. Through this partnership, over 10 million volunteers immunized 575 million children against polio in nearly 100 of the lowestincome countries in the world in the year 2001 alone. The most visible element of the polio eradication initiative has been the National Immunization Days, which require immunizing every child under five years of age nearly 20 of a countrys population over a period of 13 days, several times a year for a number of years in a row. In many countries, the scale and logistic complexity of these activities were even greater than those of campaigns undertaken during the height of the smallpox eradication effort. To capitalize on progress so far, substantial effort is now required to interrupt the final chains of polio transmission, certify that achievement, and minimize the risk of polio being reintroduced in the future. The ultimate success of the eradication effort, however, is still not guaranteed it now rests with a very small number of endemic areas, where all of the children must be immunized, and with donors who must close the chronic financing gap for these activities.xivThe World Health Report 2003Chapter Five, on SARS, is a tale of how a completely new disease can emerge with major international implications for health, economy and trade. Its rapid containment is one of the success stories of public health in recent years and represents a major victory for public health collaboration. SARS is a newly identified human infection caused by a coronavirus unlike any other known human or animal virus in its family. Transmission occurs mainly from person to person during facetoface exposure to infected respiratory droplets expelled during coughing or sneezing. The overall casefatality ratio, with the fate of most cases now known, approaches 11 but is much higher in the elderly. The international outbreak eventually caused more than 8000 cases and 900 deaths in 30 countries. Seven key lessons emerge from the SARS epidemic and will help shape the future of infectious disease control. First and most compelling is the need to report, promptly and openly, cases of any disease with the potential for international spread. Second, timely global alerts can prevent imported cases from igniting big outbreaks in new areas, provided the public health infrastructure is in place and an appropriately rapid response occurs. Third, travel recommendations, including screening measures at airports, help to contain the international spread of a rapidly emerging infection. Fourth, the worlds scientists, clinicians and public health experts, aided by electronic communications, can collaborate to generate rapidly the scientific basis for control measures. Fifth, weaknesses in health systems, especially in infection control practices, play a key role in permitting emerging infections to spread. Sixth, an outbreak can be contained even without a curative drug or a vaccine if existing interventions are tailored to the circumstances and backed by political commitment. Finally, risk communication about new and emerging infections is a great challenge, and it is vital to ensure that the most accurate information is successfully and unambiguously communicated to the public. Chapter Six, in contrast, describes the impact on developing countries of the stealthy but rapidly evolving epidemics of noncommunicable diseases and injuries, particularly cardiovascular disease CVD, the global tobacco epidemic, and the hidden epidemics direct and indirect resulting from the growth in road traffic. Today, the burden of deaths and disability in developing countries caused by noncommunicable diseases outweighs that imposed by longstanding communicable diseases. In examining the impact of the combination of these two categories, this chapter proposes a double response involving the integration of prevention and control of communicable and noncommunicable diseases within a comprehensive health care system based on primary health care. Ironically, rates of CVD are now in decline in the industrialized countries first associated with them, although not all population groups have benefited. But from that irony stems hope the decline is largely a result of the successes of primary prevention and, to a lesser extent, treatment. What has worked in the richer nations can be just as effective in their poorer counterparts, although particular attention is needed to ensure that the benefits flow to the entire population. There is now abundant evidence to initiate effective actions at national and global levels to promote and protect cardiovascular health through populationbased measures that focus on the main risk factors shared by all noncommunicable diseases. The application of existing knowledge has the potential to make a major, rapid and costeffective contribution to the prevention and control of the epidemics of noncommunicable diseases.OverviewxvThe consumption of cigarettes and other tobacco products and exposure to tobacco smoke are the worlds leading preventable cause of death, responsible for about 5 million deaths in 2003, mostly in poor countries and poor populations. The toll will double in 20 years unless known and effective interventions are urgently and widely adopted. The recognition that globalization of the tobacco epidemic can undermine even the best national control programme led to the adoption by 192 Member States at the World Health Assembly in May 2003 of the WHO Framework Convention on Tobacco Control WHO FCTC. The opening of the Convention for signature and ratification provides an unprecedented opportunity for countries to strengthen national tobacco control capacity. Success in controlling the tobacco epidemic requires continuing political engagement and additional resources at both global and national levels. The resulting improvement in health, especially of poor populations, will be a major public health achievement. Chapter Six concludes with an assessment of the rising toll of road deaths and injuries and emphasizes the indirect, but equally important, effects of the growth in road traffic. More than 20 million people are severely injured or killed on the worlds roads each year. The social and economic burden falls most heavily on developing countries and will grow significantly heavier still in these countries because of the rapid increase in the number of vehicles on their roads. Existing knowledge must be converted into successful interventions for developing countries, taking account of each countrys unique road safety circumstances. More generally, crosssectoral collaboration can improve public health and make more efficient use of the resources of the health, environment and transport sectors. Chapter Seven emphasizes that health systems must be strengthened to meet the formidable challenges described in earlier chapters. Without significant health systems strengthening, many countries will make little headway towards the Millennium Development Goals, the 3 by 5 target, and other health objectives. The chapter proposes an approach to scaling up health systems based on the core principles of primary health care formulated in the 1978 Declaration of AlmaAta universal access and coverage on the basis of need health equity as part of development oriented to social justice community participation in defining and implementing health agendas and intersectoral approaches to health. While these principles remain valid, they must be reinterpreted in the light of dramatic changes in the health field during the past 25 years. The chapter clarifies the conceptual basis of the development of health systems that are led by primary health care, then explores how health systems based on primary health care principles can confront four major contemporary challenges the global health workforce crisis inadequate health information lack of financial resources and the stewardship challenge of implementing proequity health policies in a pluralistic environment. The World Health Report 2003 closes by showing that reinforced cooperation with countries to scale up health systems is part of WHOs new way of working. Strengthening the Organizations presence and technical collaboration in countries is the best way for WHO to speed progress towards the global health communitys most important goals measurable health improvements for all, and aggressive strides to close equity gaps. Health inequalities scar the present and threaten the future. New forms of collaboration for comprehensive health systems development are needed to shape a world in which all people can enjoy the conditions of a healthy, dignified life. This report shows how WHO and its partners are drawing the lessons from recent achievements to press forward with this work.xviThe World Health Report 2003Global Health todays challenges1Chapter OneGlobal Healthtodays challengesReviewing the latest global health trends, this chapter finds disturbing evidence of widening gaps in health worldwide. In 2002, while life expectancy at birth reached 78 years for women in developed countries, it fell back to less than 46 years for men in subSaharan Africa, largely because of the HIVAIDS epidemic. For millions of children today, particularly in Africa, the biggest health challenge is to survive until their fifth birthday, and their chances of doing so are less than they were a decade ago. This is a result of the continuing impact of communicable diseases. However, a global increase in noncommunicable diseases is simultaneously occurring, adding to the daunting challenges already facing many developing countries.2The World Health Report 2003Global Health todays challenges31 -->

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Kathy Wildman

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20063552012 20S40P57 Postnatal codeine prescription a survey of UK practice N Thiagarajan, P Mackie, G Dickinson, J Bain Anaesthetics, Queen Alexandra Hospital, Portsmouth, UK, Anaesthetics, University Hospital Southampton NHS Foundation Tru, Southampton, UK, Anaesthetics, Royal Hampshire County Hospital, Winchester, UK Introduction Codeine is a commonly prescribed opioid for acute pain following caesarean section. Its use in different forms in UK, such as codeine phosphate, co dydramol, cocodamol, dihydrocodeine, is widespread. We were prompted to carry out this survey in light of recent evidence of adverse reactions, including one neonatal death, in breastfed infants whose mothers were prescribed codeine phosphate, 1,2,3 and new guidelines issued by NICE and the FDA. The aim of this survey is to establish the prevalence of codeine use in UK obstetric units, the circumstances in which it is used and what information the mother is given about its use. Methods F o l l o w i n g a p p r o v a l f r o m t h e O b s t e t r i c Anaesthetists Association , an electronic mailing survey was sent to all UK lead obstetric anaesthetists with specific instructions as to answer the survey questions as per their protocol rather than their own opinion. Results We had a response rate of 79. 69 of units prescribe codeine to breastfeeding mothers. Only 36 of the units have guidance on prescription of codeine for postnatal analgesia. Codeine is not prescribed by 22 of units and factors that influence codeine prescription include constipation, concerns with baby, increased side effects, allergy, not in guidelines and not a good analgesic. Codeine has been prescribed in 14 of units for specific groups like post caesarean section, post perineal tear and post instrumental delivery. Codeine was prescribed regularly in 33 of the units and as required in 67. 64 were prescribed by anaesthetists and 14 by obstetricians. Prescription doses varied between 30 mg43 and 60 mg57. 35 of the units discharge women with codeine and only 24 give information about its use. Out those, 68 gave verbal advice and 24 used leaflets. Key messages given to patients include constipation and sleepy baby. Discussion Are we taking into account the genetic factors and the physiological alterations in pregnancy in relation to opioid metabolism and response The use of codeine in breastfeeding mothers should be at the lowest effective dose and for the shortest duration as per NICE recommendations. There is a need for continued vigilance when patients are prescribed codeine. Practice has changed significantly following the case report. Some units have stopped prescribing codeine whereas others prescribe it as required. References1. Madadi P, Shirazi F,Walter FG et al. Establishing causality of CNS depression in breastfed infants following maternal codeine use. Paediatric Drugs 200810399 404 2. Koren G, Cairns J, Chitayat G Leeder SJ. Pharmacogenetics of morphine poisoning in a breastfed neonate of a codeine prescribed mother. Lancet 2006368704 3. Madadi P, Ross CJ, Hayden MR et al. Pharmacogenetics of neonatal opioid toxicity following maternal use of codeine during breastfeeding a casecontrol study. Clin Pharmacol Ther 20098531 5International Journal of Obstetric AnesthesiaP58 Efficacy of transversus abdominis plane block as part of multimodal analgesia for management of pain following caesarean delivery an institutional experience W D H Lakshman, K Gardner, V Annam Anaesthetics, ColchesterHospital University NHS Foundation Trust, Colchester, UK Introduction The transversus abdominis plane TAP block as part of multimodal analgesia for postoperative pain relief following caesarean delivery CD has shown to be effective when performed in combination with intrathecal fentanyl, 1 but not with morphine. 2 There are no randomised controlled trials, of TAP blocks in combination with intrathecal diamorphine, a drug widely used in the UK. An audit conducted in our unit in 2008 showed only 12.5 of women had a pain score in the first 24 h of 3 VAS 010 against a national best practice standard of 90. 3 This figure improved to 45 in 2009 with addition of TAP blocks to a multimodal analgesic regimen that included paracetamol, NSAIDS and opioids. We then introduced a staff and patient education programme on postoperative pain management along with self administration of oral analgesia SAM. We reaudited our practice in 2010. Methods After obtaining hospital audit committee approval, we collected data prospectively from women having a CD over a 6 week period. We collected patient demographic details, category of caesarean section, anaesthetic technique and the amount and type of postoperative rescue analgesia administered by midwives. We also collected the worst pain scores on movement VAS 010 and PONV scores for the first 3 postoperative days or until discharge, which ever was earlier. We also obtained data on postoperative length of hospital stay from the hospital records. Results There were 60 women who had a CD during this time, 53 elective and 47 nonelective 46 spinal, 8 epidural and 6 general anaesthesia. 90 of women who had a spinal anaesthetic with intrathecal diamorphine also had TAP blocks. No TAP blocks were performed on women who had an epidural top up. All women were entered into the SAM programme. A total of 40 did not require any rescue analgesia. The median total oral morphine used in the first 24 h was 10 mg IQR 020. The median worst pain score in the first 24 h was 0 IQR 03 this had been 4 in 2009 and 6 in 2008. 90 of women had a worst pain score of 3 12.5 in 2008 no TAP blocks and no SAM, 45 in 2009 TAP blocks but no SAM. The median length of stay was 2 days IQR 12 it was also 2 in 2008 and 2009 IQR 23. Discussion The quality of postoperative pain relief following CD has improved significantly in our unit following the addition of TAP blocks to a multimodal analgesic regimen. Further improvements have been achieved with the introduction of SAM, patient education and staff training . References1. McDonnell JG, Curley G, Carney J et al. The analgesic efficacy of transversus abdominis plane block after caesarean delivery. Anesth Analg 2008 106 186 92 2. Abdallah FW, Halpern SH, Margarido CB. Transversus abdominis plane block for postoperative analgesia after caesarean delivery performed under spinal anaesthesia A systematic review and meta analysis. Br J Anaesth 2012 109 679 87 3. Pickering E, Holdcroft A.Pain relief after caesarean section. In Colvin JR, ed. Raising the standard A compendium of audit recipes for continuous quality improvement in anaesthesia. Royal College of Anaesthetists,London. 2nd edition 2006168 9International Journal of Obstetric AnesthesiaS41International Journal of Obstetric AnesthesiaP59 Incidence of pelvic girdle pain in Peterborough Hospital M Morosan, R Kare, R Abulamagd, M Weisz Anaesthesia, Peterborough and Stamford Hospitals NHS Trust, Peterborough, UK Introduction We conducted a prospective survey to establish the incidence of pelvic girdle pain PGP in our population, in order to better stratify its severity and to facilitate an early referral to the anaesthetic clinic. Methods After gaining clinical governance approval from our hospital, we prospectively collected data from the obstetric antenatal clinic. We devised a questionnaire based on a validated pelvic girdle pain collection tool, looking at a 20item activity scale and 5 item pain related scale permission for usage being granted by original researchers. 1 Between March and July 2012 we collected 502 completed questionnaires. 20 were excluded from the final analysis, due to difficulty in data interpretation. Demographic data were collected on age, smoking and working status. Further data were collected on gestational age, parity, history of inflammatory or chronic pain conditions, presence of PGP in previous pregnancies and time frame for improvement, onset in current pregnancy and treatment received. Results In the 482 analysed questionnaires, we found an incidence of 9.5 severe and 26.1 moderate PGP. In 19 patients affected in a previous pregnancy it took between 6 months to 2 years to notice an improvement in their symptoms. The majority of patients informed the midwives and GPs about symptoms and few received treatment or physiotherapy referral despite an increased severity. As a result, we started a new PGP pathway in our hospital. Patients with mild and moderate disease will be brought to exercise classes, while severely affected patients will attend anaesthetic antenatal clinic and receive physiotherapy. Discussion Pregnancy associated PGP is a source of disability and distress to the mothers and their families. These patients are more likely to require an anaesthetic intervention for delivery. There are few evidence based interventions related to this condition. 2 Recent animal studies report a protective effect of oxytocin at spinal level in the development of postpartum chronic pain. 3 References1. Studge B, Garratt A, Krogstad Jenssen H, Grotle M. The Pelvic Girdle Questionnaire a condition specific instrument for assessing activity limitations and symptoms in people with pelvic girdle pain. Physical Theraphy 2011911 12. 2. Vleeming A, Albert HB, Ostgaard HC, et al. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J 200817794 819. 3. Gutierrez S, Liu B, Hayashida K, et al. Reversal of peripheral nerve Injuryinduced hypersensitivity in the postpartum period role of spinal oxytocin.Anesthesiology.2013118152 9.S41P60 Patient survey regarding enhanced recovery interventions for elective caesarean sections at a tertiary obstetric unit. S Aluri, R Bhosale, C R Anderson, I Wrench Anaesthetics, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK Introduction In our unit the median length of stay following elective caesarean section is two days 60 of patients. We are planning to adopt the principles of enhanced recovery programmes 1 to allow some patients to be discharged the day following surgery currently 2.5 of patients. To support this initiative we distributed a questionnaire to patients, based on these interventions to know their views and to assist with pathway design. Methods This project was registered with the Trust Clinical Effectiveness Unit as a service evaluation. In total 58 patients who had undergone elective caesarean section were seen on the first or second postoperative day and asked to complete a questionnaire. Results The proportion of patients who would like to have gone home at least a day earlier was 46. In terms of discharge medication, 59 of patients felt that regular paracetamol and diclofenac with or without codeine would be sufficient with the remainder preferring something stronger such as oramorph.Figure Patient responses in percentage to the questionnaire. Discussion A significant minority of patients would like earlier discharge following elective caesarean section. As a group they also welcome preoperative high calorie drinks and early skintoskin contact in theatre. There are concerns about getting out of bed at 8 h and in terms of warming, many patients do not perceive this as a problem at all despite evidence from our own unit that many are cold postoperatively. Our data suggest that interventions for enhanced recovery following elective caesarean section will be welcomed by patients. We also believe that they will result in significantly more being discharged the day following surgery. Reference1. Varadhan KK, Neal KR, Dejong CHC et al. The enhanced recovery after surgery ERAS pathway for patients undergoing major elective open colorectal surgery A meta analysis of randomised controlled trials. Clin Nutr 201029434 40.S42International Journal of Obstetric AnesthesiaS42P61 The state of post caesarean section pain management services in tertiary hospitals in Nigeria in 2012 J A EziheEjiofor, E OgboliNwasor, C O Imarengiaye, S FynefaceOgan, C C Makwe, A O Lawal Anaesthetics, Conquest Hospital, Hastings, UK, Anaesthesia, Coordinator, The IMPRACSE Team, Nigeria, Obstetrics and Gynaecology, Coordinator, The IMPRACSE Team, Nigeria Introduction In September 2011 the League of Obstetric Anaesthetists of Nigeria LOAN was inaugurated. This was a significant milestone in the evolution of obstetric anaesthesia as a subspecialty in the country. In a bid to improve the standard of obstetric anaesthesia services LOAN has embarked on the IMPRACSE IMproved Pain Relief After CaeSarean sEction project. This multicentre obstetric anaesthesia project aims to develop a blueprint for improving post caesarean section CS pain management in a way that is practical and sustainable in an economically challenged environment. 1 We found no previous report on similar multicentre obstetric anaesthesia research in Africa. This survey was necessary to obtain baseline data. Methods An electronic questionnaire was sent to tertiary hospitals having an identified consultant with a subspecialty interest in obstetric anaesthesia. We received responses from all five hospitals. Two hospitals are located in Lagos and one each in Benin, Port Harcourt and Zaria. We sought information on the number of caesarean sections for 2009 2011, drugs and techniques available for post CS analgesia and who wrote the analgesic prescription . Results In 45 hospitals 80 the obstetrician was solely responsible for the post CS analgesic prescription. Only in one hospital was the anaesthetist jointly involved. There was no preservative free morphine or diamorphine in any hospital. However, intrathecal fentanyl was used in three 60 hospitals. In one hospital there was no opioid available for intrathecal use. Pentazocine was the commonest drug used for post CS analgesia but prescription practice varied widely.Drugs used for post CS analgesia 1st 48 h Drug Hosp 1 Hosp 2 Hosp 3 Paracetamol no no yes Diclofenac no yes yes Tramadol no no no Codeine no no no Pentazocine yes yes yes Pethidine no no no Hosp 4 no no yes no no no Hosp 5 no yes no no yes yesInternational Journal of Obstetric AnesthesiaP62 Wound infection is significantly associated with chronic pain after caesarean section YM Nawaz, L Parks, PF Bell Anaesthesia, Craigavon Area Hospital, Portadown, UK Introduction Chronic pain after caesarean section CS is a debilitating condition which affects a mothers ability to care for herself and her new baby. The prevalence of this condition is estimated to be between 6 18. 1We report a study of chronic pain after CS in a maternity unit with approximately 4000 deliveriesyear and a CS rate 35. Methods Following Regional Ethical and Trust Governance approval, a postal patient questionnaire was sent to 300 consecutive women who had a CS between August and October 2011. Data were collected on patient demographics, past medical history, perioperative care, duration of postoperative pain and characteristics of chronic pain. The primary aim was to identify the prevalence of chronic pain lasting two months after CS and until the time of survey in the study cohort with calculated 95 confidence intervals CI. The secondary aim was to identify the factors which were significantly associated with this condition. Results Six patients were excluded due to wrong address details. 124294 potential participants returned a completed questionnaire and consent form giving a 42 response rate. Postoperative pain lasting two months was present in 29 95CI 21.8 to 37.6 and lasting for a mean of 363 days was present in 22.6 95CI 16.1 to 30.7 of respondents. The overall wound infecton rate was found to be 22 and the most common sites of pain persisting until the time of survey were the wound 57 and back 43. Several factors were significantly associated with chronic postoperative pain. Table Factors associated with chronic pain CP after CSAssociated Factor Past history of chronic pain General anaesthesia Severe acute post operative pain Wound infection CP n36 7 20 4 11 18 50 15 42 No CP n88 3 3 2 2 15 7 11 12.5 P Value 0.003 0.008 0.001 0.001Discussion This survey highlights the need to standardise post CS pain management in Nigeria. Poorly managed post CS pain is now a recognised risk factor for chronic post surgical pain. 2 T h e R o y a l C o l l e g e o f A n a e s t h e i s t s g u i d e l i n e recommends that 100 of women should be prescribed regular non steroidal antiinflammatory drugs unless contraindicated. On this score alone two hospitals had 0 compliance. Yet paracetamol and diclofenac are available and affordable even in resource poor countries. In 2013 the IMPRACSE team plans to audit post CS outcomes. This will include pain scores and actual analgesia received. References1. EziheEjiofor JA. Obstetric anaesthesia in Nigeria a coming of age ceremony Pencilpoint 2012 33 14 15. 2. Kainu JP, Sarvela J, Tippana E et al. Persistent pain after caesarean section and vaginal birth. Int J Obstet Anesth 2010 19 4 9.Data are number P values MannWhitney u test Discussion Chronic pain after CS in this study was more prevalent than published evidence suggests. 1 The possible reasons for this include a false elevation due to a low response rate, a high wound infection rate and differences in anaesthetic technique between this and other published studies. It is known that a past history of chronic pain and acute severe postoperative pain can predispose to chronic postoperative pain. 2 However, this study has found the first reported significant association between caesarean wound infection and persistent postoperative pain. Evidence shows that antibiotic prophylaxis given pre incision instead of post umbilical cord clamping reduces the prevalence of wound infection following CS. 3 T h e r e f o r e , w e s u g g e s t t h a t introducing such a policy could reduce the risk of developing chronic pain after caesarean delivery. References1. Vermelis JM, Wassen MM, Fiddelers AA, et al.. Prevalence and predictors of chronic pain after labor and delivery. Curr Opin Anaesthesiol 2010 23 295 9. 2. Niraj G, Rowbotham D. Persistent post operative pain Where are we now Br J Anaesth 2011 107 25 9. 3. Lamont RF, Sobel J, Kusanovic JP et al. Current debate on the use of antibiotic prophylaxis for caesarean section. BJOG 2011 118 193 201.International Journal of Obstetric AnesthesiaS43section and vaginal birth. Int J Obstet Anesth 2010 19 4 9.of antibiotic prophylaxis for caesarean section. BJOG 2011 118 193 201.
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20063552012 20S40P57 Postnatal codeine prescription a survey of UK practice N Thiagarajan, P Mackie, G Dickinson, J Bain Anaesthetics, Queen Alexandra Hospital, Portsmouth, UK, Anaesthetics, University Hospital Southampton NHS Foundation Tru, Southampton, UK, Anaesthetics, Royal Hampshire County Hospital, Winchester, UK Introduction Codeine is a commonly prescribed opioid for acute pain following caesarean section. Its use in different forms in UK, such as codeine phosphate, co dydramol, cocodamol, dihydrocodeine, is widespread. We were prompted to carry out this survey in light of recent evidence of adverse reactions, including one neonatal death, in breastfed infants whose mothers were prescribed codeine phosphate, 1,2,3 and new guidelines issued by NICE and the FDA. The aim of this survey is to establish the prevalence of codeine use in UK obstetric units, the circumstances in which it is used and what information the mother is given about its use. Methods F o l l o w i n g a p p r o v a l f r o m t h e O b s t e t r i c Anaesthetists Association , an electronic mailing survey was sent to all UK lead obstetric anaesthetists with specific instructions as to answer the survey questions as per their protocol rather than their own opinion. Results We had a response rate of 79. 69 of units prescribe codeine to breastfeeding mothers. Only 36 of the units have guidance on prescription of codeine for postnatal analgesia. Codeine is not prescribed by 22 of units and factors that influence codeine prescription include constipation, concerns with baby, increased side effects, allergy, not in guidelines and not a good analgesic. Codeine has been prescribed in 14 of units for specific groups like post caesarean section, post perineal tear and post instrumental delivery. Codeine was prescribed regularly in 33 of the units and as required in 67. 64 were prescribed by anaesthetists and 14 by obstetricians. Prescription doses varied between 30 mg43 and 60 mg57. 35 of the units discharge women with codeine and only 24 give information about its use. Out those, 68 gave verbal advice and 24 used leaflets. Key messages given to patients include constipation and sleepy baby. Discussion Are we taking into account the genetic factors and the physiological alterations in pregnancy in relation to opioid metabolism and response The use of codeine in breastfeeding mothers should be at the lowest effective dose and for the shortest duration as per NICE recommendations. There is a need for continued vigilance when patients are prescribed codeine. Practice has changed significantly following the case report. Some units have stopped prescribing codeine whereas others prescribe it as required. References1. Madadi P, Shirazi F,Walter FG et al. Establishing causality of CNS depression in breastfed infants following maternal codeine use. Paediatric Drugs 200810399 404 2. Koren G, Cairns J, Chitayat G Leeder SJ. Pharmacogenetics of morphine poisoning in a breastfed neonate of a codeine prescribed mother. Lancet 2006368704 3. Madadi P, Ross CJ, Hayden MR et al. Pharmacogenetics of neonatal opioid toxicity following maternal use of codeine during breastfeeding a casecontrol study. Clin Pharmacol Ther 20098531 5International Journal of Obstetric AnesthesiaP58 Efficacy of transversus abdominis plane block as part of multimodal analgesia for management of pain following caesarean delivery an institutional experience W D H Lakshman, K Gardner, V Annam Anaesthetics, ColchesterHospital University NHS Foundation Trust, Colchester, UK Introduction The transversus abdominis plane TAP block as part of multimodal analgesia for postoperative pain relief following caesarean delivery CD has shown to be effective when performed in combination with intrathecal fentanyl, 1 but not with morphine. 2 There are no randomised controlled trials, of TAP blocks in combination with intrathecal diamorphine, a drug widely used in the UK. An audit conducted in our unit in 2008 showed only 12.5 of women had a pain score in the first 24 h of 3 VAS 010 against a national best practice standard of 90. 3 This figure improved to 45 in 2009 with addition of TAP blocks to a multimodal analgesic regimen that included paracetamol, NSAIDS and opioids. We then introduced a staff and patient education programme on postoperative pain management along with self administration of oral analgesia SAM. We reaudited our practice in 2010. Methods After obtaining hospital audit committee approval, we collected data prospectively from women having a CD over a 6 week period. We collected patient demographic details, category of caesarean section, anaesthetic technique and the amount and type of postoperative rescue analgesia administered by midwives. We also collected the worst pain scores on movement VAS 010 and PONV scores for the first 3 postoperative days or until discharge, which ever was earlier. We also obtained data on postoperative length of hospital stay from the hospital records. Results There were 60 women who had a CD during this time, 53 elective and 47 nonelective 46 spinal, 8 epidural and 6 general anaesthesia. 90 of women who had a spinal anaesthetic with intrathecal diamorphine also had TAP blocks. No TAP blocks were performed on women who had an epidural top up. All women were entered into the SAM programme. A total of 40 did not require any rescue analgesia. The median total oral morphine used in the first 24 h was 10 mg IQR 020. The median worst pain score in the first 24 h was 0 IQR 03 this had been 4 in 2009 and 6 in 2008. 90 of women had a worst pain score of 3 12.5 in 2008 no TAP blocks and no SAM, 45 in 2009 TAP blocks but no SAM. The median length of stay was 2 days IQR 12 it was also 2 in 2008 and 2009 IQR 23. Discussion The quality of postoperative pain relief following CD has improved significantly in our unit following the addition of TAP blocks to a multimodal analgesic regimen. Further improvements have been achieved with the introduction of SAM, patient education and staff training . References1. McDonnell JG, Curley G, Carney J et al. The analgesic efficacy of transversus abdominis plane block after caesarean delivery. Anesth Analg 2008 106 186 92 2. Abdallah FW, Halpern SH, Margarido CB. Transversus abdominis plane block for postoperative analgesia after caesarean delivery performed under spinal anaesthesia A systematic review and meta analysis. Br J Anaesth 2012 109 679 87 3. Pickering E, Holdcroft A.Pain relief after caesarean section. In Colvin JR, ed. Raising the standard A compendium of audit recipes for continuous quality improvement in anaesthesia. Royal College of Anaesthetists,London. 2nd edition 2006168 9International Journal of Obstetric AnesthesiaS41International Journal of Obstetric AnesthesiaP59 Incidence of pelvic girdle pain in Peterborough Hospital M Morosan, R Kare, R Abulamagd, M Weisz Anaesthesia, Peterborough and Stamford Hospitals NHS Trust, Peterborough, UK Introduction We conducted a prospective survey to establish the incidence of pelvic girdle pain PGP in our population, in order to better stratify its severity and to facilitate an early referral to the anaesthetic clinic. Methods After gaining clinical governance approval from our hospital, we prospectively collected data from the obstetric antenatal clinic. We devised a questionnaire based on a validated pelvic girdle pain collection tool, looking at a 20item activity scale and 5 item pain related scale permission for usage being granted by original researchers. 1 Between March and July 2012 we collected 502 completed questionnaires. 20 were excluded from the final analysis, due to difficulty in data interpretation. Demographic data were collected on age, smoking and working status. Further data were collected on gestational age, parity, history of inflammatory or chronic pain conditions, presence of PGP in previous pregnancies and time frame for improvement, onset in current pregnancy and treatment received. Results In the 482 analysed questionnaires, we found an incidence of 9.5 severe and 26.1 moderate PGP. In 19 patients affected in a previous pregnancy it took between 6 months to 2 years to notice an improvement in their symptoms. The majority of patients informed the midwives and GPs about symptoms and few received treatment or physiotherapy referral despite an increased severity. As a result, we started a new PGP pathway in our hospital. Patients with mild and moderate disease will be brought to exercise classes, while severely affected patients will attend anaesthetic antenatal clinic and receive physiotherapy. Discussion Pregnancy associated PGP is a source of disability and distress to the mothers and their families. These patients are more likely to require an anaesthetic intervention for delivery. There are few evidence based interventions related to this condition. 2 Recent animal studies report a protective effect of oxytocin at spinal level in the development of postpartum chronic pain. 3 References1. Studge B, Garratt A, Krogstad Jenssen H, Grotle M. The Pelvic Girdle Questionnaire a condition specific instrument for assessing activity limitations and symptoms in people with pelvic girdle pain. Physical Theraphy 2011911 12. 2. Vleeming A, Albert HB, Ostgaard HC, et al. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J 200817794 819. 3. Gutierrez S, Liu B, Hayashida K, et al. Reversal of peripheral nerve Injuryinduced hypersensitivity in the postpartum period role of spinal oxytocin.Anesthesiology.2013118152 9.S41P60 Patient survey regarding enhanced recovery interventions for elective caesarean sections at a tertiary obstetric unit. S Aluri, R Bhosale, C R Anderson, I Wrench Anaesthetics, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK Introduction In our unit the median length of stay following elective caesarean section is two days 60 of patients. We are planning to adopt the principles of enhanced recovery programmes 1 to allow some patients to be discharged the day following surgery currently 2.5 of patients. To support this initiative we distributed a questionnaire to patients, based on these interventions to know their views and to assist with pathway design. Methods This project was registered with the Trust Clinical Effectiveness Unit as a service evaluation. In total 58 patients who had undergone elective caesarean section were seen on the first or second postoperative day and asked to complete a questionnaire. Results The proportion of patients who would like to have gone home at least a day earlier was 46. In terms of discharge medication, 59 of patients felt that regular paracetamol and diclofenac with or without codeine would be sufficient with the remainder preferring something stronger such as oramorph.Figure Patient responses in percentage to the questionnaire. Discussion A significant minority of patients would like earlier discharge following elective caesarean section. As a group they also welcome preoperative high calorie drinks and early skintoskin contact in theatre. There are concerns about getting out of bed at 8 h and in terms of warming, many patients do not perceive this as a problem at all despite evidence from our own unit that many are cold postoperatively. Our data suggest that interventions for enhanced recovery following elective caesarean section will be welcomed by patients. We also believe that they will result in significantly more being discharged the day following surgery. Reference1. Varadhan KK, Neal KR, Dejong CHC et al. The enhanced recovery after surgery ERAS pathway for patients undergoing major elective open colorectal surgery A meta analysis of randomised controlled trials. Clin Nutr 201029434 40.S42International Journal of Obstetric AnesthesiaS42P61 The state of post caesarean section pain management services in tertiary hospitals in Nigeria in 2012 J A EziheEjiofor, E OgboliNwasor, C O Imarengiaye, S FynefaceOgan, C C Makwe, A O Lawal Anaesthetics, Conquest Hospital, Hastings, UK, Anaesthesia, Coordinator, The IMPRACSE Team, Nigeria, Obstetrics and Gynaecology, Coordinator, The IMPRACSE Team, Nigeria Introduction In September 2011 the League of Obstetric Anaesthetists of Nigeria LOAN was inaugurated. This was a significant milestone in the evolution of obstetric anaesthesia as a subspecialty in the country. In a bid to improve the standard of obstetric anaesthesia services LOAN has embarked on the IMPRACSE IMproved Pain Relief After CaeSarean sEction project. This multicentre obstetric anaesthesia project aims to develop a blueprint for improving post caesarean section CS pain management in a way that is practical and sustainable in an economically challenged environment. 1 We found no previous report on similar multicentre obstetric anaesthesia research in Africa. This survey was necessary to obtain baseline data. Methods An electronic questionnaire was sent to tertiary hospitals having an identified consultant with a subspecialty interest in obstetric anaesthesia. We received responses from all five hospitals. Two hospitals are located in Lagos and one each in Benin, Port Harcourt and Zaria. We sought information on the number of caesarean sections for 2009 2011, drugs and techniques available for post CS analgesia and who wrote the analgesic prescription . Results In 45 hospitals 80 the obstetrician was solely responsible for the post CS analgesic prescription. Only in one hospital was the anaesthetist jointly involved. There was no preservative free morphine or diamorphine in any hospital. However, intrathecal fentanyl was used in three 60 hospitals. In one hospital there was no opioid available for intrathecal use. Pentazocine was the commonest drug used for post CS analgesia but prescription practice varied widely.Drugs used for post CS analgesia 1st 48 h Drug Hosp 1 Hosp 2 Hosp 3 Paracetamol no no yes Diclofenac no yes yes Tramadol no no no Codeine no no no Pentazocine yes yes yes Pethidine no no no Hosp 4 no no yes no no no Hosp 5 no yes no no yes yesInternational Journal of Obstetric AnesthesiaP62 Wound infection is significantly associated with chronic pain after caesarean section YM Nawaz, L Parks, PF Bell Anaesthesia, Craigavon Area Hospital, Portadown, UK Introduction Chronic pain after caesarean section CS is a debilitating condition which affects a mothers ability to care for herself and her new baby. The prevalence of this condition is estimated to be between 6 18. 1We report a study of chronic pain after CS in a maternity unit with approximately 4000 deliveriesyear and a CS rate 35. Methods Following Regional Ethical and Trust Governance approval, a postal patient questionnaire was sent to 300 consecutive women who had a CS between August and October 2011. Data were collected on patient demographics, past medical history, perioperative care, duration of postoperative pain and characteristics of chronic pain. The primary aim was to identify the prevalence of chronic pain lasting two months after CS and until the time of survey in the study cohort with calculated 95 confidence intervals CI. The secondary aim was to identify the factors which were significantly associated with this condition. Results Six patients were excluded due to wrong address details. 124294 potential participants returned a completed questionnaire and consent form giving a 42 response rate. Postoperative pain lasting two months was present in 29 95CI 21.8 to 37.6 and lasting for a mean of 363 days was present in 22.6 95CI 16.1 to 30.7 of respondents. The overall wound infecton rate was found to be 22 and the most common sites of pain persisting until the time of survey were the wound 57 and back 43. Several factors were significantly associated with chronic postoperative pain. Table Factors associated with chronic pain CP after CSAssociated Factor Past history of chronic pain General anaesthesia Severe acute post operative pain Wound infection CP n36 7 20 4 11 18 50 15 42 No CP n88 3 3 2 2 15 7 11 12.5 P Value 0.003 0.008 0.001 0.001Discussion This survey highlights the need to standardise post CS pain management in Nigeria. Poorly managed post CS pain is now a recognised risk factor for chronic post surgical pain. 2 T h e R o y a l C o l l e g e o f A n a e s t h e i s t s g u i d e l i n e recommends that 100 of women should be prescribed regular non steroidal antiinflammatory drugs unless contraindicated. On this score alone two hospitals had 0 compliance. Yet paracetamol and diclofenac are available and affordable even in resource poor countries. In 2013 the IMPRACSE team plans to audit post CS outcomes. This will include pain scores and actual analgesia received. References1. EziheEjiofor JA. Obstetric anaesthesia in Nigeria a coming of age ceremony Pencilpoint 2012 33 14 15. 2. Kainu JP, Sarvela J, Tippana E et al. Persistent pain after caesarean section and vaginal birth. Int J Obstet Anesth 2010 19 4 9.Data are number P values MannWhitney u test Discussion Chronic pain after CS in this study was more prevalent than published evidence suggests. 1 The possible reasons for this include a false elevation due to a low response rate, a high wound infection rate and differences in anaesthetic technique between this and other published studies. It is known that a past history of chronic pain and acute severe postoperative pain can predispose to chronic postoperative pain. 2 However, this study has found the first reported significant association between caesarean wound infection and persistent postoperative pain. Evidence shows that antibiotic prophylaxis given pre incision instead of post umbilical cord clamping reduces the prevalence of wound infection following CS. 3 T h e r e f o r e , w e s u g g e s t t h a t introducing such a policy could reduce the risk of developing chronic pain after caesarean delivery. References1. Vermelis JM, Wassen MM, Fiddelers AA, et al.. Prevalence and predictors of chronic pain after labor and delivery. Curr Opin Anaesthesiol 2010 23 295 9. 2. Niraj G, Rowbotham D. Persistent post operative pain Where are we now Br J Anaesth 2011 107 25 9. 3. Lamont RF, Sobel J, Kusanovic JP et al. Current debate on the use of antibiotic prophylaxis for caesarean section. BJOG 2011 118 193 201.International Journal of Obstetric AnesthesiaS43section and vaginal birth. Int J Obstet Anesth 2010 19 4 9.of antibiotic prophylaxis for caesarean section. BJOG 2011 118 193 201.


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Tina8543

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HI, I just tried to move one of the spam emails manually into spam, rather than clicking the SPAM button and this is the error message I got:

1. 08-26-2014 12:08 GMTAn error occurred inside the server which prevented it from fulfilling the request. (MSG-0021, -1130387244-45379087)
 
Date: Tue Aug 26 2014 13:08:42 GMT+0100 (GMT Daylight Time)
Host: https://emailmg.homestead.com/ox6/ox.html
Version: 6.22.6 Rev13 (UI), 7.4.2-Rev20 (Server)
Browser: Mozilla/5.0 (Windows NT 6.1) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/36.0.1985.143 Safari/537.36
 
Module: mail, View: mail/hsplit/unthreaded, Folder: default0/INBOX, Default folders: infostore=282tasks=281eas=truecontacts=280calendar=279, Landing page: portal, Tree: New, Expert: Yes, Language: en_US
 
Loaded modules: caldav, calendar, com.openexchange.eas.provisioning.ui, com.openexchange.extras, com.openexchange.group, com.openexchange.oxupdater, com.openexchange.publish, com.openexchange.resource, com.openexchange.secret.recovery, com.openexchange.subscribe, com.openexchange.upsell.multiple.gui, com.openexchange.user.passwordchange, com.openexchange.user.personaldata, com.openexchange.usm, com.openexchange.usm.eas, com.openexchange.usm.json, com.openexchange.wizard, contacts, folder, infostore, interfaces, mail, mailaccount, messaging, olox20, portal, tasks, themes, uwaWidge
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Mike F., Alum

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Hi Tina8543,  Those messages have all been submitted as spam so you should not longer see them.  As far as the ability for you to flag them as spam and move them into a junk/spam folder, we are expecting some updates to the email platform that will allow you to do this on your own. Unfortunately I do not have any eta for this.

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Tina8543

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Hi thank you, I used to be able to click the SPAM button to move an email to spam, but I was then also receiving non spam emails into my spam folder - and emails I was sending to our suppliers were landing in their spam folders.... since you removed the option for me to click the SPAM button, all my emails received and sent are working... but I just cant now click an item as SPAM when it is received ?
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Mike F., Alum

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Hi Tina8543,  One think you might do if  you are getting a lot of spam is use a 3rd party email client such as Outlook or Thunderbird which have the ability to flag items as spam. Thunderbird for example is free, and has a very good learning filter built right into it.

Mike
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Tina8543

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HI, All I want is the SPAM button to be enabled again like it always has been then I can click anything that is spam as spam :)
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Mike F., Alum

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Thanks.  It's high on our wish list but I don't have any eta on when it may be added/activated again.

Mike

This conversation is no longer open for comments or replies.