aspiiAnti snoring pillows are constructed so that the head will be tilted back slightly and the airway is not blocked. Basically, a person snores because his airway is blocked by the soft palate. This is quite alarming considering that air that passes through the lungs, brain and other parts of the body is limited, which will later on lead to a number of health complications. Thus, wearing the anti snoring pillows upon sleeping can be a great help in correcting the anatomical position of the neck. However, when buying this kind of pillow in the internet, it is very important to be careful in choosing the right seller.

There are a number of scams present on the internet nowadays and you can be one of their victims if you do not take extra precaution. To make sure that you are dealing with the right seller, make sure that you research the credibility of the website. Take some time to read the product reviews and transaction histories of the seller. If they cannot provide any relevant information on their transactions, better find another one. The anti snoring pillows that you are going to buy should have the best quality, price and comfort.

Knowing How To Buy The Best Snoring Mouthpiece

When looking for the best snoring mouthpiece online, you should be ready on the potential risks that can occur. Companies will entice you with their product and provide the best guarantee that you can imagine. When you fall in their trap, your money will definitely be a waste. Hence, you should be careful in getting the best snoring mouthpiece online. As much as possible, you should know the credibility of the seller because this will give you an assurance whether they will deliver the product on time. Most reliable sellers will give you the pros and cons of their product, but it is still good to consider the opinions of their previous customers.

Check to see on how the product is made. Read some solid reviews. There are some sellers who will hide them from you but it is best to have a seller who honestly provides the details of the product he/she is selling. Take some time to read the features of the product and compare it with others. Through this process, you can be assured that you get the best snoring mouthpiece at a price that you can afford.

Buyer Beware

Everyone always wants to have the best quality on the things they purchase. No matter how big or small the amount is it should be equivalent to the quality that the material has. Thus, when you want to buy the best stop snoring mouthpiece, you should always take a look on its quality and price. Expensive does not always mean good quality. If you are wise to look through the material and you spend time researching, you can always have the right stop snoring mouthpiece at a price that does not hurt your pocket. There are a number of ways to do this but it takes a lot of research to successfully buy the best mouth piece.

The internet is a good platform for buying a mouthpiece because there are a lot of high quality review sites out there. For the Good Morning Snore Solution, a tongue retaining mouthpiece, there are quite a few comprehensive reviews such as this one. These reviews help you determine which device will work best for you, and will provide you with the piece of mind you need. Oh, that and the ability to get a good night’s sleep!

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ghmtadMore than 30 million Americans struggle with depression and anxiety. Reasons for that are numerous, but the most common ones are losing a job or having stress at work. It seems that working too much is not affecting Americans positively. Some of them are also having panic attacks. If you are one of them, try first with home remedies for panic attacks in order to solve your problem. First of all, sit down and think about what is causing your panic attacks. Get yourself a notebook and write all your worries down.

Then purchase herbal teas like chamomile or lemon balm that are soothing nerves. Some people that suffer from panic disorder also have problems with insomnia, so these teas may help in having good sleep. If you have addictions like smoking or drinking, quit them immediately. Addictions can make your condition even worse. Even smallest addictions like Facebook can make you feel awful. So quit with bad habits at once. Try making good habits instead. For instance, read books, exercise and learn some new craft like crocheting or pottery.  Go for short walks every day and listen to the music. Good habits and healthy routine can make your anxiety disappear.

Breathing Techniques Useful When Facing With Panic Attacks

To be relaxed when the stress comes is kind of art. But it can be practiced. When you feel normal and when you are sitting home in peace, you can use that opportunity and use specialized relaxing techniques that will help you when facing with panic attacks. You should learn how to deal with panic attacks when they come, but also how to prevent them. So, prevention lays in relaxing techniques.

Deep breathing will help you relax. But not all the people know how to breathe properly. That’s kind of ironic because we all breathe and we all need air to survive. But some of us are not using the high potential of their lungs. Our lungs should be filled with as much as possible if we want our body to be relaxed. So, if you can, lay down on a bed or on some rug and practice quality breathing. Put your legs straight and close your eyes. Put your left hand on your stomach, and your right hand on your chest. Breathe slowly and examine the way you breathe. If your chests are moving up when you breathe in and your shoulders too, then you do not breathe well. You should move with your diaphragm up when breathing in and the chests should be still.

Write A Diary And End Your Panic Attacks

When the panic attack comes, people are usually advised to breathe slow and relax muscles in order to calm down. But how does it sound to prevent the attack even before it comes? You can stop panic attacks before their symptoms start to occur. The symptoms are usually fast heart beat, sweating, shaking and hyperventilating. Since the cause is usually some fear or trauma, to cure the disease it is necessary to solve the problem in its root. A person who is suffering from irrational fears that lead to panic attacks should first admit that they have fears. The admitting is necessary in this process of healing. You can admit your fears to your friends, or you can write it down.

Many therapists suggest that people consider writing in journals or diaries in order to face their fears. When you feel bad and terrified, write it down. Describe your emotions and what you feel at the moment. Try to remember if there is anything in your life that is bothering you so much that it’s causing you stress. Writing about our thoughts and sufferings can help us to overcome the problems. Try to write it regularly, every evening before you go to bed.

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In an effort to provide a comprehensive picture of smoking, drinking, and substance abuse–including long-term trends, effects on society, media and cultural influences, approaches to and effectiveness of treatment, and future implications–the Robert Wood Johnson Foundation has published a report that incorporates more than three decades’ worth of data from several hundred public and private sources.

The report, “Substance Abuse: The Nation’s Number One Health Problem,” substantiates its title by documenting that tobacco, alcohol, and drug use cause more illnesses, deaths, and disabilities than any other preventable health problem. Of the more than two million deaths in the United States each year, one in four is attributable to tobacco, alcohol, or illicit substances.

The report looks at substance abuse from several different perspectives, including the following:

Early use. More than 40 percent of those who started drinking at age 14 or younger developed alcohol dependence, compared with 10 percent of those who began drinking at age 20 or older.

Media depictions. Alcohol appeared in 93 percent and tobacco in 89 percent of the 200 most popular movie rentals in 1996 and 1997.

Crime. At least half of all adults arrested for major crimes–including theft and assault–tested positive for drugs at the time of their arrest.

Treatment. Fewer than one-fourth of those in need receive treatment, although studies show that treatment is successful in up to 70 percent of alcohol patients and 80 percent of opiate users (with success defined as a 50 percent reduction in substance use after six months). Of the U.S. government’s drug control budget, three in five dollars are spent on criminal justice and interdiction, but fewer than one in five on treatment.

Education. People with more education are more likely to drink, but those with less education are more likely to drink heavily. Smoking is more common among people with less education, and heavy smoking is higher among those who lack a high school diploma.

Gender differences. Men are almost four times as likely as women to be heavy drinkers and one-and-a-half times as likely to smoke a pack or more of cigarettes each day

Costs. The economic cost of all substance abuse in the United States was estimated at $414 billion in 1995. The primary financial burden of alcohol abuse is productivity loss; the greatest implications of smoking are those related to health care costs; for drug abuse, the leading economic cost is from crime.

The report, which was prepared by the Schneider Institute for Health Policy at Brandeis University, is available at http://substanceabuse.rwjf.org, the Web site of the Substance Abuse Resource Center at the Robert Wood Johnson Foundation. The report can be found under the heading “Substance Abuse Chartbook.” Hard copies of the report can be obtained by calling (609) 452-8701.

Materials Available to Publicize Mental Health Month

The National Mental Health Association (NMHA) has developed a planning kit and several ancillary materials, including sample news releases and public service announcements, fact sheets, ad slicks, and posters, to help promote Mental Health Month in May 2001.

The Employee Assistance Professionals Association is one of more than 50 organizations partnering with NMHA to celebrate Mental Health Month, the purpose of which is to educate the public and policymakers about the importance of mental health and the reality of mental illness. EAPA members and chapters are encouraged to collaborate with partners in their area to organize activities and advocate for better mental health care and treatment.

The planning kit provides examples of how local Mental Health Associations have worked with the public, legislators, minority groups, religious leaders, the media, and partnering organizations to reinforce the message that “Mental Health Matters.” It also contains a variety of promotional materials and recommendations for communicating mental health information to diverse audiences.

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Hannah Hawkins, a Baptist who converted to Roman Catholicism, seems to relish breaking the mold and being difficult to pigeonhole. She started the Children of Mine Center for two reasons.

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First, she worked for eight years as an advisory neighborhood commissioner for Washington, D.C. In the District of Columbia, there are 37 Advisory Neighborhood Commissions, each composed of nine members. The groups advise the city government on issues such as zoning, streets, recreation, education, social services, sanitation, planning, safety, and health. Hawkins’ ANC work brought her into intimate contact with the ills besetting her community. She saw how crack cocaine was affecting the young people–and their children. She saw many young men being sent off to be warehoused in prison. She saw many young women jailed. She saw the despair.

In addition, her three sons–she has five children and is a grandmother of four–all became crack addicts. (Today, they have recovered and hold jobs. One is a chef at a halfway house. Another is a landscaper. Her daughters work in the computer field for the federal government.) Struggling with a heartbreaking situation so close to home moved her to become an activist.

Hawkins, who worked for 30 years as an administrative aide in the D.C. school system, being forced to retire on disability due to dangerously high blood pressure, was elected vice president of a group called Concerned Mothers Against Alcohol and Drug Abuse. Through her work there, she came in touch with a stream of wives and mothers and caring relatives in anguish because their loved ones had fallen prey to “this scourge.”

“JFK once said that he could not have empathy but he could have sympathy,” Hawkins says. “Because he was born with a silver spoon in his mouth, he didn’t know how it felt to be poor. But he could sympathize. I have sympathy and empathy [on the drug issue] because it was in my household as well.”

Drug abuse, she says, is a problem not only of poor people but of the well-to-do. “Rich folk are able to camouflage it a little bit more,” she says. According to Hawkins, they can keep their problems under wraps inside their homes better than poor people can. But the problems are still there.

“Sin is sin,” she says. “Addiction is addiction, fallen families are fallen families, separated parents are separated parents.”

Her sons’ drug problems started with marijuana, and before long, they were addicted to crack. Hawkins derides those who favor a liberalized marijuana policy, saying that the drug gets users in the habit of getting “high,” which inexorably opens the door to other and far more dangerous forms of drug intoxication. “I told a group [many years ago],” she recalls, “that from little acorns big oaks grow.”

Two things that vex Hawkins are jailing drug addicts instead of treating them and taking the right to vote away from those convicted of a felony.

TREATING VS. JAILING ADDICTS

On the treatment issue, she notes that most people characterize drug addiction as a sickness. Therefore, “why would you incarcerate a sickness?” she demands. “If you have cancer, which they have equated with chemical abuse, you treat it, don’t you? This is what [suspended New York Yankees outfielder] Darryl Strawberry is saying: ‘Why incarcerate me? I’m no harm to nobody but myself.’

“Why is it that so many of our brothers are incarcerated?” she concludes. “They need more long-term treatment centers for our sisters and brothers.”

The prisons are also taking so many women–some of whose kids frequent Children of Mine. Hawkins is staggered by the number of mothers flowing into America’s penal institutions. Most of their convictions are for crimes like prostitution, grand larceny, and check fraud, all of which stem from a single root–addiction to crack cocaine.

The neighborhood activist insists that far better than dealing with drug-related street crime through a failed policy centering on the prison revolving door would be to provide full-scale addiction treatment, which has been shown to be more effective and less costly in the long term.

On the subject of withdrawing a person’s voting rights, Hawkins is explosive. She describes how on Election Day she walked the streets to turn out the vote, speaking to young men lounging about. They would say to her, “Yo!” or “Hi, Mama!” And she would reply, “Hey, did you go vote today?” Some said yes, and some said no. And to those who said no, she asked, “Why?” And many would say it was because of a felony conviction and an incarceration.

Hawkins sees this as a problem not just for the poor but for the rich, for what’s involved are notions of justice, fundamental human rights, and cruel and unusual punishment. After all, she says, taking away a person’s vote is something that goes on punishing him–whether he’s rich or poor–not just for the duration of his sentence but for the rest of his life.

“So you need to deal with it,” she says. “James Brown told us that years ago: ‘You got to deal with it, baby.’ You got to deal with it, because it affects all of us.”

MURDER OF HER HUSBAND

In addition to what Hawkins had to handle with the predicament of her sons was the brutal 1969 murder of her husband, who was beaten to death by a robber.

This tragedy profoundly shook her soul. She was in denial for years, she admits, and wouldn’t talk about it. For a long time, she wouldn’t even throw out her husband’s clothes. Hawkins’ husband always smoked cigars–and the smell lingered, stirring excruciating nostalgia in her heart.

She never remarried, because, she says, although she likes men, to remarry would be to surrender a considerable chunk of her independence and free time, both of which are precious commodities to the activist and social-service volunteer.

Her parents taught her to “never look down on a man, unless you’re picking him up.” Her father, though not so religious, was caring. But her mother was both.

“I didn’t have to look outside my family for my heroes,” she says proudly. “This, today, unfortunately, is not the case in many homes, because a lot of the children are home alone and on their own. Even those who come from wealthy families are latchkey. It’s so important that we as parents take time out with our children, with our youth.”

She has seven sisters and two deceased brothers.

Hawkins unwinds by reading popular novels, history books, and the Bible–and by listening to spiritual audiotapes. She also likes to dance, even with the children she cares for.

“At the center, we are African dancers,” she says with enthusiasm. “I like calypso music, because it’s so rejuvenating. God tells us to always keep moving.”

Unlike many people she knows who are getting on in years, she enjoys roller-skating, bicycling, and motorcycling. “I like the excitement, you know?” she chuckles. “I want to be rejuvenated.”

Her heroes include Eleanor Holmes Norton, the D.C. delegate to the U.S. House of Representatives, and first lady and New York senator-elect Hillary Clinton.

Of Norton, Hawkins says she “is one of those energetic, don’t mind telling it like it is persons. She reminds me a lot of myself. She believes in telling the truth and shaming the devil.”

Of Clinton, the activist says: “I like her spunk. She went into a state where they said she was a foreigner, didn’t belong, and through the grace of God, she won it, in spite of the odds. I admire people like that.”

Summing up her sometimes sorrowful, sometimes joyful–but always full– life, she says: “I’ll tell you, life may not be fair, but God is good. And that’s whom I hold on to.”

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Once a brief guided tour of the dispensary, led by pharmacist Shafeeque Mohammed, was over,Mr Murdock’s first task of the day was to check the repeat prescriptions that had already been prepared by a dispenser.

Most of it was “pretty standard stuff” and, with the exception of one incomplete prescription, the job was finished without any major problems. The help of the BNF was only needed on a couple of occasions.

As the pharmacy is directly opposite a health centre and near a hospital, plenty of prescriptions soon started coming in and Mr Murdock and Mr Mohammed were suddenly extremely busy.

Getting into the swing

Mr Murdock seemed to find his bearings very quickly and was soon turning round prescriptions quite rapidly. There was some Calpol to be measured and poured into a bottle, and 84 Deltacortril tablets to be counted up.

“We used to do a lot more counting in my day; that has changed quite a lot with the introduction of patient packs, and rightly so,” said Mr Murdock.

He would like to see the introduction of patient packs speeded up, estimating that the current split is about 60 to 40 per cent in favour of packs. He put the blame for the delay firmly on the current Government.

“The last Tory Government was going to fund conversion to patient packs, but when Labour came into power they said `no way’ and insisted that the industry paid for it,” he explained, adding that no agreement on the subject had been reached with the Pharmaceutical Services Negotiating Committee either.

“It is a huge investment on industry’s part, but one that would allow us to automate a lot more,” he explained.

Mr Murdock seemed quite at ease counselling patients and explaining the medication, but acknowledged that it would be almost impossible to check and counsel every patient. “You tend to concentrate on the acute prescriptions where the patient is waiting. This is what makes it so difficult to see how pharmacists are going to manage all these new roles,” he said.

One particular customer certainly put Mr Murdock’s communication skills and imagination to the test. The lady in question, originally from Italy, did not speak any English, but was about to receive some antibiotics.

Having tried in vain to explain to her when and how she was supposed to take the tablets, and that she should avoid alcohol, it was time to resort to a different tactic.

Mr Murdock picked up a notepad and started drawing a clock showing 8 o’clock. Arrows pointed to a picture of either the sun or the moon with `1x’ written next to the two images.

This seemed to do the trick and the patient indicated that she had understood the instructions. Objective achieved!

“I think at the end she did understand how to take the medicine, but I cannot be quite as confident that she understood not to drink alcohol. It does highlight the problems associated with working in a multi- cultural area and shows how flexible pharmacists have to be in terms of their communication skills,” he said.

He felt that company educational promotions in foreign languages had an important role to play in this respect.

In the relatively quiet period that followed, and despite his initial hesitation, Mr Murdock took the opportunity to try out the PMR system.

While he was giving Mr Murdock a quick masterclass on using the Lloydspharmacy IT system, Mr Mohammed told him about problems with endorsing and various products being downgraded to zero stock-level whenever a pack is dispensed.

However, while trying his hand at the PMR system himself afterwards, Mr Murdock ran into problems of a different kind.

The prescription he wanted to endorse ran over two pages. Not recognising this fact the system endorsed all products on the first page. To his astonishment, Mr Murdock found that there was no option to introduce a page break. “There is certainly an issue regarding the dispensary IT system and in particularly the way it handles the endorsements,” he said, and promised to have the matter looked into.

To add a little variety to Mr Murdock’s day, Mr Mohammed asked him to check the NOMAD deliveries for a residential home. He seemed to recognise most of the drugs by their shape, markings and colour, but we decided to test his cognitive skills.

We gave him an unlabelled NOMAD box filled with nitrazepam, Adalat and atenolol 50 – and he identified them all correctly.

So what was it like to go back to the floor?

“It took a little while to get into it but once I started to hit my stride it was not as bad as you might think,” he said.

Relevant information

Having experienced a situation only too familiar to many locum pharmacists, Mr Murdock reiterated the importance of retaining as many records on the computer as possible. He also saw the urgent need for pharmacists to be given access to other relevant information in order to be able to make informed decisions.

“Pharmacy often works in isolation and this is absolutely ridiculous,” he said.

At no point had he felt uncomfortable and he would have been quite happy to supply EHC if it had been requested. He did admit, however, that if the store had offered diagnostic services, he would not have been entirely comfortable doing them.

Mr Mohammed was definitely impressed. “His counselling was very good, his knowledge seemed up to scratch and it was good to see him use the BNF as well,” he said

He was, however, very surprised to find that the superintendent pharmacist was not familiar with the Lloydspharmacy IT system.

While neither of the two pharmacists had been rushed off their feet, it had been a busy day, emphasising the difficulties pharmacists face in terms of finding time for any new roles.

“There is a shortage of pharmacists, the number of scripts is rising and there are all these new roles. We do need to address the skill- mixing issue and train technicians to take over some of the pharmacist’s roles under protocols. There is no reason why that time cannot be freed up,” said Mr Murdock.

His solution would be that community pharmacy follows the practice in hospitals, where technicians, rather than the pharmacist, are responsible for checking prescriptions.

Mr Murdock accepted that there would be a time gap and that it might take two to three years to train a checking technician.

“It is imperative that we start addressing this issue seriously now, otherwise we are holding those new roles back,” he said.

He was adamant that the cost issue should not come down to just the company or pharmacy proprietor.

“The paradox we have got is that the Government wants pharmacists to deliver a greater pharmaceutical service, but when it comes to funding it, they are unwilling for the NHS to provide the resources,” said he said. He added that the Government had got to recognise that the funding needed to run the new services may not be insubstantial and that some of it at least should come from the NHS.

So, how would he feel about going back to the dispensary full time?

Mr Murdock admitted that boredom might have played a not insignificant part in his decision to seek a career change. He insisted, however, that “if I had to go back I think I could. There is enough going on in pharmacy now for people to get involved in all the challenging things. I’d survive”.

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An announcement of unusual importance to every business owner

FOUR years ago, the Mechanical Contractors Association of Greater Kansas City adopted and implemented a Drug Abuse Policy following negotiations with Plumbers Local No. 8 and Pipe Fitters Local No. 533.

In announcing it to the public, MCA said:

 

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“It is our policy to provide a safe and healthful workplace for all employees. We understand that the construction industry is an inherently dangerous industry that is internally regulated by a variety of local, state and federal regulations. We recognize the problems and hazards associated with the use of drugs, alcohol and controlled substances.

“The purpose of this policy and program is to establish and promote a safe, efficient and productive working environment for all employees by providing a workplace and workforce free from illegal drugs, alcohol and controlled substances. This policy shall apply to all employees performing work covered by the Collective Bargaining Agreements. Each employer shall have in place a similar policy which shall apply to all other employees.”

If the contractors and two unions were starting to create an agreement and contract today, or asked to restate the policy, the parties involved would not change one sentence or one word of the original announcement. In plain, simple language, it gives the reason for the very existence of the Association and explains its membership growth.

MCA is still proud of the record of its proven drug policy. If the Association were not, it would not have continued to implement it for so long.

Just recently, for example, the fourth annual month-long drug screening was conducted in seven different area locations. The screening brought the total number of employees tested to nearly 6,900 in 22 counties throughout the metropolitan area. Again MCA scored a record low number of positive cases. Its 1.61 percent is dramatically below the construction industry national average between 17 and 22 percent.

Although the drug policy does not include random testing, it does mandate a rigorous annual testing during the month of June. This is required of all employees who are with the same contractor firm in the 12-month period. If the worker transfers to another firm, the testing is conducted semi-annually.

Drugs–the robber of all work efficiency

Substance abuse knows no season for the staggering hazards it presents. Compared with the average employee, a typical drug-using employee in today’s various work-places is 2.2 times more likely to request time off … 3 times more likely to be late for work … 3.6 times more likely to injure himself/herself or another person in an accident … 5 times more likely to be involved in an accident … 5 times more likely to file for worker’s compensation … 7 times more likely to have wage garnishments, and is 33 percent less productive.

MCA has conducted a policy to meet contemporary conditions

MCA realizes that conditions in the construction industry have so greatly deteriorated in the past few years that necessary correction in workforce performance is desirable. So the Association has crafted a policy that’s proven its effectiveness.

The cooperative involvement of MCA, Local 8, and Local 533 working together led to a unified effort with Lockton Companies, Inc.; CorporateCare Occupational Medicine Network, a division of the Saint Luke’s Shawnee Mission Health System; management; and counselors.

Sensible clear guidelines and workable procedures

The proven drug policy is more than a blueprint for today. It goes further. It anticipates the needs of 2001, of 2002, of 2003.

The proven drug policy is strikingly different than previous efforts to deal with the serious health, financial, and societal problems of substance abuse.

In developing the program, numerous requirements were specified. These included Drug Testing Cards, Annual Billing Program, Medical Review Officer (a licensed physician), Employee Assistance Program Training for Employer Review Officers, Confidentiality of Employees, Project Management, and Probable Cause Record-Keeping.

Careful guidelines are built into the testing program. For example, if Probable Cause is cited, two persons–union and contractor–must observe and document. If there is an OSHA-related accident, the contractor has a right to request a test.

There are some consequences for those who test positive. One is suspension. Another is counseling. If a person tests positive twice in a year, he/she will be dropped from the union. Ten different substances and an alcohol level are followed as determined by the federal government.

Time and effort devoted to preparing policy

The proven drug policy has not been planned and made in a day. The MCA contractors began work on it several years ago. In May, 1996, committees were assigned by the MCA and both unions. A preliminary committee of the contractors took three meetings in one month to review eight to ten policies in place around the country. The committee also studied the policy of the U.S. Government and reviewed a draft of its own. Then a committee was formed by MCA to present the draft to committees of Local 8 and Local 533.

The first joint session of Locals 8 and 533 plus MCA met on December 23, 1996. Thereafter, the joint group met weekly. On January 8, 1997, the group convened to examine the MCA draft and the union draft, reviewing each article one by one. On April 1, the group completed the reviews, 60 days before its target date. The unions now had 60 days to educate their workers. The contractors themselves had 60 days to review the steps required by management.

What all this means to you as a business owner

The effort described above means that if you are planning to have a building constructed, you no longer have to worry about creating and implementing your own drug policy for workers who are hired on the job to follow. That’s because MCA contractors now have one in place for you. It’s a process the MCA does annually. Even the service workers are drug tested.

That’s not all.

If you are a building owner or facilities manager, you are assured of quality, skilled performance by the contractors who use the highly trained, drug-free workers of Plumbers Local 8 and Pipe Fitters 533. This translates into your project being completed on time and within budget.

If you are a business enterprise leasing or renting offices or manufacturing space, you have the confidence of knowing you’ll be utilizing physical quarters that meet the rigid, high standards of safe, healthful, and contamination-free construction.

Because MCA strongly adheres to a philosophy of value, we consider it our most important contribution to the construction industry and business community.

IF YOU would like more information on The Proven MCA Drug Policy, the Association has available a 23-Point Checklist of what to look for regarding Attendance, Behavior, and Job Performance plus a valuable 18-Step Flow Chart that will let you see clearly the sequence of every phase in the program.

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Various groups and individuals representing animal agriculture and the animal health industries feel FDA has failed to substantiate, on a scientific basis, a human health hazard resulting from fluoroquinolone use in poultry. In written comments filed with the agency, industry has told FDA it believes its action was based on unfounded assumptions, selective data and inappropriate risk assessments.

The issue of antibiotic resistance, including that being associated with fluoroquinolone use in poultry, is definitely a sensitive and far-reaching matter. It is an issue that concerns those producing meat products as well as those consuming them. Nevertheless, the points industry raises should not be ignored or simply brushed aside, for if they hold true, FDA could actually be putting more consumers at risk by banning fluoroquinolone use in poultry then by allowing the antimicrobial to remain on the market. There’s no question poultry producers and the birds they raise will suffer from the product’s removal.

Much of the difference of opinion that exists between FDA and industry surrounds the assessment of risk in regard to fluoroquinolone use in chickens and fluoroquinolone-resistant campylobacter in humans. Both sides believe the use of antibiotics in humans or animals could eventually result in the development of resistance or the creation of conditions that allow the expression and recognition of resistance genes that existed prior to antibiotic use. The unknown is the degree to which this has already occurred with campylobacter in poultry and whether an unacceptable risk is created when compared with the risks resulting from the withdrawal of therapeutic uses of enrofloxacin in poultry. As pointed out by the American Veterinary Medical Assn. (AVMA) and others, these risks include reduced animal health and welfare as well as a less economical and wholesome food supply.

Also being called into question is the National Antimicrobial Resistance Monitoring System (NARMS) classification of campylobacter isolates from chickens classified as fluoroquinolone “resistant” and studies reporting “resistant” campylobacter in retail samples of chicken. AVMA and others have pointed out that the scientific data do not clearly demonstrate the “resistant” campylobacter are truly resistant in terms of clinical outcomes. Seeing that neither the laboratory methods used to test for susceptibility of the campylobacter nor the interpretations of resistance were validated by the National Committee for Laboratory Standards or FDA’s Center for Drug Evaluation & Research, industry makes a very good point. From a scientific standpoint, it just doesn’t make sense for the breakpoint used to classify campylobacter as resistant to not be directly correlated with clinical effectiveness. Doing so brings to question whether the “resistant” campylobacter is in fact resistant, particularly when one considers th at several studies have shown “resistant” campylobacter to respond to treatment with fluoroquinolones.

Like with the NARMS data, FDA’s risk assessment also does not compare well with data from the Centers for Disease Control & Prevention’s (CDC) FoodNet, which is interesting, seeing that human illness data used in the risk assessment are based on CDC’s FoodNet data. Substantial improvements in food safety between 1998 and 1999 appear substantially understated by FDA’s risk assessment model, industry has said.

Another area of concern is directly related to FDA’s premise that fluoroquinolone-resistant campylobacter is transferred to humans and is a significant cause of infections in humans. Of particular interest is the influence of international travel by U.S. consumers and how that corresponds to campylobacter incidents. According to industry, data exist that show the greatest association with human campylobacter infections is, in fact, human travel, followed distantly by drinking raw milk, eating of meat cooked outside the home, having contact with farm animals, living on or visiting a farm, contact with puppies, eating undercooked poultry and eating raw seafood.

In the interest of public health, FDA should focus on determining where the real risks lie and then concentrate its efforts on those factors.

Making such determinations are especially important considering the National Chicken Council’s (NCC) claim that the risk to human health may actually be increased with the withdrawal of fluoroquinolones from poultry. According to NCC, the loss of enrofloxacin to the chicken industry — in addition to resulting in the unnecessary suffering of millions of birds, including death — would result in a significant increase in the risk of poultry products purchased by consumers being contaminated with enteric foodborne pathogens. If public safety is truly the motivating factor for FDA in its action against fluoroquinolone use in poultry, then it only makes sense that the agency would be concerned about any potential correlation between enrofloxacin used in chickens and intestinal wall strength.

Considering the unanswered questions and valid concerns that exist with the proposed withdrawal of enrofloxacin use from poultry, FDA has little choice but to grant an opportunity of hearing to Bayer sponsor company of enrofloxacin, and give the company the opportunity to present its case.

If, following re-evaluation, the science shows fluoroquinolone use in poultry presents a human health risk, FDA has an obligation to prohibit the antimicrobial’s use by poultry integrators.

FDA owes it to consumers, as well as the poultry and animal health industries, to thoroughly examine all scientific data and alternative risk assessment models submitted in response to its proposal to remove enrofloxacin from the poultry market. Only by doing so will the agency be able to say with confidence that the action it took was based on sound scientific principles and not simply perceived risk.

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