CRIME IN THE UAE !!!!

So if anyone thought that the UAE is a really safe place think again.... Besides this you hear of rape cases, killings and people committing suicide on a daily basis....
=================================================================
Police and The Courts
Published: 28/12/2006 12:00 AM (UAE)
The men carried out robberies during night in Bur Dubai and Al Mamzar neighbourhoods.

Two held for villa thefts as police recover some loot
Staff Report
Dubai: Two men were arrested for committing a series of burglaries in villas in Bur Dubai and Al Mamzar.
Brigadier Khamis Mattar Al Mazeina, Director of Dubai Police's Criminal Investigation Department (CID), yesterday said Bur Dubai and Al Muraqqabat police stations had received several complaints from worried residents.
He said the thefts were carried out by an Arab man and an African. They operated at night when residents were sleeping.
Brigadier Al Mazeina said investigating teams arrested one of the suspects on December 6 and one of the stolen items was also recovered.
Probe led to the man's aide who denied any link with the first suspect.
"The items were sent to the suspects' countries through a cargo company. Officers working on the case were able to recover the items, which included a TV, a microwave and some bags," Brigadier Al Mazeina said. He said the suspects had hidden some of the expensive items inside the TV to misguide customs.
"The two suspects carried out similar crimes in Northern Emirates. Coordination between Dubai Police and police in the concerned emirates is going on to find out similar cases," Brigadier Al Mazeina said.

" Merry Christmas " to you from Me in the world different languages

Afrikaans: Gesëende Kersfees
Afrikander: Een Plesierige Kerfees
African/ Eritrean/ Tigrinja: Rehus-Beal-Ledeats
Albanian:Gezur Krislinjden
Arabic: Milad Majid
Argentine: Feliz Navidad
Armenian: Shenoraavor Nor Dari yev Pari Gaghand
Azeri: Tezze Iliniz Yahsi Olsun
Bahasa Malaysia: Selamat Hari Natal
Basque: Zorionak eta Urte Berri On!
Bengali: Shuvo Naba Barsha
Bohemian: Vesele Vanoce
Brazilian: Feliz Natal
Breton: Nedeleg laouen na bloavezh mat
Bulgarian: Tchestita Koleda; Tchestito Rojdestvo Hristovo
Catalan: Bon Nadal i un Bon Any Nou!
Chile: Feliz Navidad
Chinese: (Cantonese) Gun Tso Sun Tan'Gung Haw Sun
Chinese: (Mandarin) Kung His Hsin Nien bing Chu Shen Tan (Catonese) Gun Tso Sun Tan'Gung Haw Sun
Choctaw: Yukpa, Nitak Hollo Chito
Columbia: Feliz Navidad y Prَspero Aٌo Nuevo
Cornish: Nadelik looan na looan blethen noweth
Corsian: Pace e salute
Crazanian: Rot Yikji Dol La Roo
Cree: Mitho Makosi Kesikansi
Croatian: Sretan Bozic
Czech: Prejeme Vam Vesele Vanoce a stastny Novy Rok
Danish: Glوdelig Jul
Duri: Christmas-e- Shoma Mobarak
Dutch: Vrolijk Kerstfeest en een Gelukkig Nieuwjaar! or Zalig Kerstfeast
English: Merry Christmas
Eskimo: (inupik) Jutdlime pivdluarit ukiortame pivdluaritlo!
Esperanto: Gajan Kristnaskon
Estonian: Ruumsaid juulup|hi
Ethiopian: (Amharic) Melkin Yelidet Beaal
Faeroese: Gledhilig jol og eydnurikt nyggjar!
Farsi: Cristmas-e-shoma mobarak bashad
Finnish: Hyvaa joulua
Flemish: Zalig Kerstfeest en Gelukkig nieuw jaar
French: Joyeux Noel
Frisian: Noflike Krystdagen en in protte Lok en Seine yn it Nije Jier!
Galician: Bo Nada
Gaelic: Nollaig chridheil agus Bliadhna mhath ùr!
German: Froehliche Weihnachten
Greek: Kala Christouyenna!
Haiti: (Creole) Jwaye Nowel or to Jesus Edo Bri'cho o Rish D'Shato Brichto
Hausa: Barka da Kirsimatikuma Barka da Sabuwar Shekara!
Hawaiian: Mele Kalikimaka
Hebrew: Mo'adim Lesimkha. Chena tova
Hindi: Shub Naya Baras
Hausa: Barka da Kirsimatikuma Barka da Sabuwar Shekara!
Hawaian: Mele Kalikimaka ame Hauoli Makahiki Hou!
Hungarian: Kellemes Karacsonyi unnepeket
Icelandic: Gledileg Jol
Indonesian: Selamat Hari Natal
Iraqi: Idah Saidan Wa Sanah Jadidah
Irish: Nollaig Shona Dhuit, or Nodlaig mhaith chugnat
Iroquois: Ojenyunyat Sungwiyadeson honungradon nagwutut. Ojenyunyat osrasay.
Italian: Buone Feste Natalizie
Japanese: Shinnen omedeto. Kurisumasu Omedeto
Jiberish: Mithag Crithagsigathmithags
Korean: Sung Tan Chuk Ha
Lao: souksan van Christmas
Latin: Natale hilare et Annum Faustum!
Latvian: Prieci'gus Ziemsve'tkus un Laimi'gu Jauno Gadu!
Lausitzian:Wjesole hody a strowe nowe leto
Lettish: Priecigus Ziemassvetkus
Lithuanian: Linksmu Kaledu
Low Saxon: Heughliche Winachten un 'n moi Nijaar
Macedonian: Sreken Bozhik
Maltese: IL-Milied It-tajjeb
Manx: Nollick ghennal as blein vie noa
Maori: Meri Kirihimete
Marathi: Shub Naya Varsh
Navajo: Merry Keshmish
Norwegian: God Jul, or Gledelig Jul
Occitan: Pulit nadal e bona annado
Papiamento: Bon Pasco
Papua New Guinea: Bikpela hamamas blong dispela Krismas na Nupela yia i go long yu
Pennsylvania German: En frehlicher Grischtdaag un en hallich Nei Yaahr!
Peru: Feliz Navidad y un Venturoso Aٌo Nuevo
Philipines: Maligayan Pasko!
Polish: Wesolych Swiat Bozego Narodzenia or Boze Narodzenie
Portuguese:Feliz Natal
Pushto: Christmas Aao Ne-way Kaal Mo Mobarak Sha
Rapa-Nui (Easter Island): Mata-Ki-Te-Rangi. Te-Pito-O-Te-Henua
Rhetian: Bellas festas da nadal e bun onn
Romanche: (sursilvan dialect): Legreivlas fiastas da Nadal e bien niev onn!
Rumanian: Sarbatori vesele
Russian: Pozdrevlyayu s prazdnikom Rozhdestva is Novim Godom
Sami: Buorrit Juovllat
Samoan: La Maunia Le Kilisimasi Ma Le Tausaga Fou
Sardinian: Bonu nadale e prosperu annu nou
Serbian: Hristos se rodi
Slovakian: Sretan Bozic or Vesele vianoce
Sami: Buorrit Juovllat
Samoan: La Maunia Le Kilisimasi Ma Le Tausaga Fou
Scots Gaelic: Nollaig chridheil huibh
Serb-Croatian: Sretam Bozic. Vesela Nova Godina
Serbian: Hristos se rodi.
Singhalese: Subha nath thalak Vewa. Subha Aluth Awrudhak Vewa
Slovak: Vesele Vianoce. A stastlivy Novy Rok
Slovene: Vesele Bozicne Praznike Srecno Novo Leto or Vesel Bozic in srecno Novo leto
Spanish: Feliz Navidad
Swedish: God Jul and (Och) Ett Gott Nytt إr
Tagalog: Maligayamg Pasko. Masaganang Bagong Taon
Tami: Nathar Puthu Varuda Valthukkal
Trukeese: (Micronesian) Neekiriisimas annim oo iyer seefe feyiyeech!
Thai: Sawadee Pee Mai or souksan wan Christmas
Turkish: Noeliniz Ve Yeni Yiliniz Kutlu Olsun
Ukrainian: Srozhdestvom Kristovym
Urdu: Naya Saal Mubarak Ho
Vietnamese: Chung Mung Giang Sinh
Welsh: Nadolig Llawen
Yugoslavian: Cestitamo Bozic
Yoruba: E ku odun, e ku iye'dun!

!!!!! CONGRATULATION !!!!

€850,000.00 EMAIL SELECTION AWARD WINNING PRIZE 2006

THE PROMOTION AWARD COMITEE

LOTTERY NATIONAL OF BURKINA

AVENUE CHARCE DU GUILE

OUAGADOUGOU BURKINA FASO

DATE : 18TH/DECEMBER/ 2006

!!!!!CONGRATULATION!!!!

Dear Lucky Winner,

We are pleased to inform you of the result of the E-MAILS LOTTERY RAFFLE DRAW an International program held on the 1st of September, 2006.Your e-mail address was attached to the following informations

(1) TICKET NUMBER: 857-58-34-001-6358

(2) SERIAL NUMBER: BATCH/548500023

(3) LUCKY DRAW NUMBER: 2006/2589-630/14501

which consequently won in the 2nd category, you have therefore been approved for a lump sum payment of €850,000.00 (Eight Hundred and fifty Thousand Euros).

NOTE: Due to mix up of some numbers and names, we ask that you keep your winning information confidential until your claim has been processed and your money remitted to you. This is part of our security protocols to avoid double claiming and unwarranted abuse of this program by some participants. All participants were selected through a computer ballot system drawn from over 20,000 company and 30,000,000 individual email addresses from all over the world. This promotional program takes place every year. This lottery was promoted and sponsored by International software organization committee, we hope with part of your winning you will take part in our next coming (1million euro) international lottery.

To file for your claim, please contact our claim agent

CONGRATULATIONS: Contact your claim agent for due processing and remittance of your prize money to a designated account of your choice. Remember, you must contact your claims officer not later than 27th of December, 2006. After this date, all funds will be returned as unclaimed.

NOTE: In order to avoid unnecessary delays and complications, please remember to quote your reference numbers in every one of your Correspondences with your officers. Furthermore,should there be any change of your address, do inform your claims officer as soon as possible. Congratulations again from all our staff and thank you for being part of our Promotions program.

We wish you continued good fortunes.

Best regards.

Mr William Brams

I don't know whay is this **it :S

I LOVE YOU

I You

I'll just take it as a hint if I don't get this back. How many people actually
have 8 true friends?
Hardly anyone I know! But some of us have all right friends and good friends!!!
You have been tagged by the Friendship Angel which means you are a great friend!! You will have
good luck for two years if you send this to 8 people or more and if it is sent
back to you then you know that you are a true friend.

I would rather live one day knowing you are my bud than live forever without you
by my side.

Delete this if we are not friends

Of all the
friends I've ever met,
You're
the one I won't forget.
And
if I die
Before you do
I'll go to heaven
And wait for you
I'll
give the angels
Back
their wings
And
risk the loss
Of everything
Just to prove
My friendship is
true.

Tomorrow can be too late ( special for my best friends )

The Messege is

really nice!!!

If you're mad with someone , and nobody's there to fix the situation... You fix it .

Maybe today, that person still wants to be your friend . And if u don't, tomorrow can be too late .

If you're in love with somebody , but that person doesn't know... tell her/him.

Maybe today, that person is also in love with you .

And if you don't say it, tomorrow can be too late .

If you still love a person that you think has forgetten you... tell her/him.

Maybe that person have always loved you. And if you don't tell her/him today , tomorrow can be too late.

If you need a hug of a friend... ask her/him for it.

Maybe they need it more than you do. And if you don't ask for it today, tomorrow can be too late.

If you really have friends who you appreciate... tell them.

Maybe they appreciate you as well. That if you don't and they leave or go far away today , tomorrow can be too late.

If you love your parents, and never had the chance to show them... do it .

Maybe you have them there to show them how you feel. That if you don't and they leave today , then tomorrow can be too late.

SEND THIS MAIL TO EVERY PERSON YOU CARE ABOUT , INCLUDING THE ONE WHO SENT IT TO YOU. YOU'LL SEE HOW YOU'RE GOING TO KNOW THAT THERE ARE PEOPLE WHO CARES ABOUT YOU , THAT YOU DIDN'T KNEW .

Forward it today... coz tomorrow can be too late...

Malaria fanning spread of AIDS in Africa

Lauran Neergaard
The Associated Press
Friday, December 08, 2006

Malaria is fuelling the spread of AIDS in Africa by boosting the HIV in people's bodies for weeks at a time, says a study that pins down the deadly interplay between the dual scourges.
It's a vicious cycle as people weakened by HIV are, in turn, more vulnerable to malaria.
University of Washington researchers, who estimated the impact of the overlapping infections, concluded that the interaction could be blamed for thousands of HIV infections and almost a million bouts of malaria over two decades in just one part of Africa.
The research, published in Friday's edition of the journal Science, highlights the need for a joint attack on both epidemics.
"It's an important paper," said Dr. Anthony Fauci of the National Institutes of Health, the government's leading infectious disease specialist. "We really need to be much more serious about what we do about malaria at the same time we're serious about what we do about HIV."
Anti-malaria programs, such as a $1.2 US billion initiative in its early stages, "assume a much, much greater imperative when you realize not only are you going to have an impact on one disease, but you might impact another disease," Fauci added.
Malaria sickens up to half a billion people annually and kills more than one million, mostly young children and mostly in Africa -- which also bears the biggest HIV burden. Sub-Saharan Africa is home to 24.7 million HIV-infected people; about two million died this year, according to the latest UN update.
Scientists long have suspected the two diseases fuel each other. The new study created a mathematical model to figure out just how much they do.
HIV is most easily spread when patients have high virus levels in their blood. A bout of malaria causes a temporary surge -- a stunning sevenfold increase -- in those levels, said lead researcher Laith Abu-Raddad, a scientist at the University of Washington.
The surge may last six weeks to eight weeks. That is longer than it takes adults in intense malaria areas, where people get the parasitic disease once or twice a year, to recover from a typical bout and feel up to sexual activity again, he said.
Moreover, HIV patients are more susceptible to malaria reinfection because of their weakened immune systems.
Armed with that information, Abu-Raddad turned to parts of Africa , a region w here he found good data tracking HIV and malaria prevalence over decades, and even information on sexual behaviour such as average number of partners and volume of sex workers.
In regions where both diseases are common, malaria may be responsible for almost five per cent of HIV infections, and HIV may be behind 10 per cent of malaria episodes. In Africa , that translated into 8,500 extra HIV infections and 980,000 extra malaria bouts over two decades, he concluded.
© The Calgary Herald 2006

Malaria helps spread AIDS: study
New research suggests malaria may be helping to spread the AIDS virus across Africa.
Scientists in the US and Africa say the diseases are likely to spread more quickly when they interact.
Researchers studying the rapid spread of HIV/AIDS in one region of Africa were puzzled when risky sexual behaviour was not in itself sufficient to explain the rate of transmission.
Their research, based in on the Various towns shores of Lake Regions, led them to look at the interaction of AIDS and malaria.
The scientists concluded that when people with HIV are attacked by the malaria parasite, the HIV viral load in their bodies increases, raising the risk that the virus will be passed on.
Dr James Kublin says that at the same time, people with HIV are more susceptible to malarial infection because of their weakened immune systems.
"At times, this seems like a significant complication in efforts to control either of these," he said.
"I'm even more inclined to look at it as an opportunity in which we can better focus our efforts on the direction of how to strategically address these two scourges."
The research has been published in the American Science journal.

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I dont Know I will not buy any of this

YOU KNOW YOU'RE ARAB WHEN...

YOU KNOW YOU'RE ARAB WHEN...................................

*you refer to your dad's friends as Amoo

*you have an endless supply of pistachios, dates, and
pumpkin seeds(bizzer)

*you curse at your teachers or strangers in Arabic

*after a family meal, the women fight to the death over Who should wash dishes, while the men sit on there asses and Discuss politics waiting for there tea (shi)

*your parents want you to become a doctor, engineer or a lawyer

*you use your forehead and eyebrows to point something out

*your mother yells at the top of her lungs to call you to dinner, even if you're in
the next room

*you arrive one or two hours late to a party and think it's normal

*you are standing next to the largest suitcase at the
airport

*you talk for an hour at the front door when leaving
someone's house

*you say bye 17 times on the phone

*your parents don't realise phone connections to foreign countries have Improved in the last 2 decades and still scream at the top of their lungs when making long distance calls

*your mother does everything for you if you are male, you do all the housework and cooking if you're female

*your relatives alone could populate a small city

*you still come back home to live with your parents after you graduate

*you always say "open the light" instead of "turn the light on"

*your parents drink 6 cups of tea a day

*you've had a shoe thrown at you by your mother YOU'RE PROUD

TO BE AN ARAB - AND YOU PASS THESE JOKES
ON TO ALLYOUR ARAB FRIENDS
:-)

Romance maths

SHOPPING MATH
A man will pay $2 for a $1 item he needs.
A woman will pay $1 for a $2 item that she doesn't need.


GENERAL EQUATIONS & STATISTICS
A woman worries about the future until she gets a husband.
A man never worries about the future until he gets a wife.
A successful man is one who makes more money than his wife can spend.
A successful woman is one who can find such a man.


HAPPINESS
To be happy with a man, you must understand him a lot
and love him a little.
To be happy with a woman, you must love her a lot
and not try understand her at all.


MEMORY
Any married man should forget his mistakes,
there's no use in two people remembering the same thing.


APPEARANCE
Men wake up as good-looking as they went to bed.
Women somehow deteriorate through the night.


PROPENSITY TO CHANGE
A woman marries a man expecting he will change, but he doesn't.
A man marries a woman expecting that she won't change, and she does.


DISCUSSION TECHNIQUE
A woman has the last word in any argument.
Anything a man says after that is the beginning of a new argument.

Forward-Thinking Investors ye

OF INTEREST PAY ATTENTION VITAL
Watch it go DEC 4th
This advisory is based on exclusive insiders/agents information. (TERX.OB)
Terax Energy Inc. (TERX.OB)

Terax Energy, Inc. operates as an independent gas exploration, development, and production company in the United States. The company focuses on exploring the gas reserves

located in the Barnett Shale formations of the Fort Worth Basin. Its principal properties consist of 2 blocks of oil and gas leases, 1 covering approximately 11,300 gross acres

in Erath County, Texas; and 1 covering a block of approximately 16,200 gross acres in Comanche County, Texas. Terax Energy was founded in 2000 as Royal Phoenix and changed its

name to Terax Energy, Inc. in 2005. The company is headquartered in Austin, Texas.

AT 18 cents its a STEAL

Find out more about Terax Energy from your brokerage, get in for an easy doubler
The key to any tade is buying low and selling high, WELL the energy market has bottomed out and time to get in is now. We specialise in calling market bottom and when it comes

to energy THIS IS THE BOTTOM, SO GET IN FOLKS
THIS ONE IS A SHOE IN
THIS ONE IS A SHOE IN

What is this :D

hi it's Denton

We have brought you winner after winner this year and things are only
become better!

The XXI century house is one in which broadband is available in every room.
Video streams to wherever you choose to watch it. Home appliances are seamlessly
integrated into a comprehensive network. This is already a reality for
the wealthy, and is just now becoming a booming
business as it spreads to the middle class house.
Our next feature makes this all possible, and is bringing it to the world!

Advanced Powerline Technologies

Symbol: APWL
Price: 0.100
Short Term Target: 0.27
Long Term Target: 1.10

An incredible info is expected out of the company very soon.
This will be backed up by a PR blitz and I'm sure you can guess what will
happen to the price of this share!
Tech companies blast off on news like this. Get in before this one takes
off and ride it all the way to the bank!
---
DES MOINES, Iowa (AP) -- He may be Iowa's governor, but Tom Vilsack's home-field advantage isn't enough to force rivals for the Democratic presidential nomination to cede him the game -- far from it.
ANKARA, Turkey (CNN) -- Pope Benedict XVI on Tuesday began his visit to Turkey -- his first to a Muslim country -- with a message urging "dialogue" between Christians and Muslims as he moved to ease anger over his perceived criticism of Islam.
PERU, Indiana (AP) -- A 12-year-old girl set fire to her sleeping mother's bed and took off in the family car to fake the abduction of herself and her two younger siblings, police said.
WASHINGTON (AP) -- A Dubai-owned company will accept final bids within two weeks for the sale of all $700 million worth of its U.S. port operations to an American buyer, a plan forced by concerns over terrorism security.

please Forward and help her!!

Hi, my name is Amy Bruce. I am 7 years old, and I have severe lung cancer.. I also have a large tumor in my brain, from repeated beatings. Doctors say I will die soon if! this isn't fixed, and my family can't pay the bills.

The Make A Wish Foundation, has agreed to donate 7 cents for every time this message is sent on.

For those of you who send this along, I thank you so much, but for those who don't send it, what goes around comes around. Have a Heart, please send this.

Please, if you are a kind person, send this on. PLEASE HIT FORWARD BUTTON NOT REPLY BUTTON.

YOUR'S FAITHFULLY,

AMY BRUCE


I recive the same words for others people they are well

Cooperate Representative

From The Desk of:
Mr. Peter Chang, Ms. Linda Guo,
3001, Unit F, Zhongyi City Garden,
Linhe East Road, Guangzhou City,
Guangdong Province. China

Dear Sir/Madam,
It is my pleasure to write you in respect of our Company Walmat Industrial Co., Ltd. China. Base in No 3001, Unit F, Zhongyi City Garden, Linhe East Road, Guangzhou City, Guangdong Province. China.Established in 1997.

Walmat Industrial Co., Ltd.is a specialized manufacturer of household appliances, such as fan heaters, electric water kettles and party grills.
With an annual production capacity of 1,800,000 pieces,we have become one of the leading manufacturers of small appliances in China. Having focused on research and development of innovative products, we are able to
advance into the global market drastically by meeting customers' changing needs effectively.

Furthermore, We produce our molds based on American and European quality standards. we are capable of undertaking. Our products have been sold all over the world, including materials; we export into the North America, South
America, Western Europe, Eastern Europe, Eastern Asia, Mid East and Africa.

We are searching for a representatives who can work with us to help us establish a medium of getting our funds from our costumers in these areas as well as making payments through you to us. Please if interested in
transacting business in view helpings us, so our clients could make payment to you being a representative for us we will be very glad and compensations will be given and as well as other benefits.
Subject to your satisfaction you will be given the opportunity to negotiate your mode of which we will pay for your services as our representative/agent in North America, South America, Western Europe, Eastern Europe, Eastern Asia, Mid
East, Africa.

If you are interested in becoming part of our team or require more information, please do not hesitate to contact us with the information below at e-mail address: ***********@yahoo.com.hk

1 Your Full Name/ Age and Marital Status
2 Residence address/ Company Address
3 Phone Number/ Fax (if any)
4 Occupation, Company Name
6 Any valid identification acceptable
7 Present Country/ State/ Province and Zip Code

Selected Products

Grill, Fan Heater
Kettle, Fan Heater
Cordless Kettle
Fan Heater

On your receipt of the above details we shall forward only your contact infomation to our customer/clients to immediately contact you with the mode of payment.

Kindest Regards,
Company Director.
Mr. Peter Chang, Ms. Linda Guo.

That is a big RUBBER

*SPAM* Hunter wrote:

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Company: Nano Superlattice Technology, Inc.
Sym: NSLT
Current Price: $0.22(+37%)
Short-Term Target: $0.58
Long-Term Target: $5.50

With the increased miniaturization of personal
electronics devices current tools are reaching their
limits.
Nano Superlattice Technology Inc. is a nanotechnology
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with nano structured PVD coatings for high-tech
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NSLT uses Superlattice technology to apply multi-ayers
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An amazing revelation is set to come out of the Nano
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Hello

Hello
I've found pills you have asked for. It took some time to say that you should buy medications at MyCanadianPharmacy
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I don't know who is antony and I don't need to know

I think you have a wrong Number

Rrriiiiinnnnggg,
rrriiiinnnngg,
"Hello?"
"Hi honey. This is Daddy.
Is Mommy near the phone?"
"No, Daddy. She's upstairs in the bedroom with Uncle Paul."
After a brief pause, Daddy says,"But honey,you haven't got an
Uncle Paul." "Oh yes I do, and he's upstairs in the room with
Mommy, Right now."
Brief Pause.
"Uh, okay then, this is what I want you to do.Put the phone down on the
table, run upstairs and knock on the bedroom door and shout to Mommy that
Daddy's car just pulled into the driveway."
"Okay, Daddy, Just a minute."
A few minutes later The little girl comes back to the phone.
"I did it, Daddy."
"And what happened, honey?" He asked.
"Well, Mommy got all scared, jumped out of bed with no clothes on and ran
around screaming. Then she tripped over the rug, hit her head on the
dresser And now she isn't moving at all!"
"Oh my God!!!
What about your Uncle Paul?"
"He jumped out of the bed with no clothes on, too.
He was all scared and he jumped out of the back window and into the
swimming pool. But I guess he didn't know that you took out the water
last week to clean it.He hit the bottom of the pool and I think he's
dead."
***Long Pause***
***Longer Pause***
***Even Longer Pause***
Then Daddy says,
"Swimming pool? ............
Is this 486-5731?"
No, I think you have the wrong number.......

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Meeting Finder

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Ivory

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Don't Ask me what is this ↑

*SPAM* necessary AQFU

But if 2NR says it's so, grab that extinguisher and be ready to put out some flamesThat's a lot of protection

Everyone here in Miami is talking about the Heat.Aluminum is a lightweight, highly effective alternativeIt can alter outward camber up to 25mm to fine-tune your suspension
There aren't any moving parts or bolts that will come loose or flex under loadWe suggest you get to her next HIN appearance and get an up close and personal for yourself before she becomes untouchable
At the same time, the valvetrain team was evaluating the Revolution-modulated Valve-control (REV) technology used in the 1983 Honda motorcycle, the CBR 400FThe stock core was 18mm thick and had a capacity of 2 litersWhen I'm in front I'm physically tired-like standing for a long time on my tippy-toes

About 15 minutes into the shoot these guys from next door slowly started coming out to see what was going onUsing an adjustable front pillow ball, the Ueo Style lower arm completely replaces the factory

If you don't have access to one, the road should be level, straight, unobstructed and, obviously, Which pictures were they?

I didn't know how to pose eitherThe system is quite simple: The OBD-II interface cable and interface box, which are included in the kit, plug into your OBD-II diagnostics port on one end and your laptop on the other


I'm always recieve some mails like this spamsssssssss @#$$%$#$

I love him..do you?

IF SOMEONE HAD
A GUN HELD IN FRONT OF YOUR FACE AND ASKED YOU IF YOU BELIEVED IN GOD,
WHAT WOULD YOU DO?

SAY NO AND FEEL
ASHAMED THE REST OF YOUR LIFE?
OR SAY YES,
I DO, AND DIE STANDING UP FOR GOD?
IF YOU'D SAY NO, THEN DELETE THIS E-MAIL.
IF YOU WOULD SAY YES,
PASS THIS ON.

Funny, isn't it?

Funny how simple
it is for people to trash God and then wonder why the world's going to hell.

Funny how we
believe what the newspapers say, but question what the God says.

Funny how everyone
wants to go to heaven provided they do not have to believe, think, say, or do anything
the God says. (Or is it scary?)

Funny how someone
can say "I believe in God" but still follow Satan (who, by the way, also "believes"
in God).

Funny how you
can send a thousand 'jokes' through e-mail and they spread like wildfire, but when
you start sending messages regarding the Lord, people think twice about sharing.

Funny how when
you go to forward this message, you will not send it to many on your address list
because you're not sure what they believe, or what they will think of you for sending it to them.

Funny how I
can be more worried about what other people think of me than what God thinks of
me. (Are you thinking?)

Pass this on
only if you mean it.

Yes,

I

do

Love

God!

How to Treat People with Down Syndrome ?

Introduction:
The glib answer to the question "how do I treat people with Down syndrome?"
is: "The same as you treat everybody else". There is nothing really unusual
about people with Down syndrome or their medical problems and managing them
is not particularly difficult. The reality is, however, that general
practitioners will be called upon to provide medical care to people who have
Down syndrome through their lives and unfamiliarity with the syndrome may
compromise the quality of that care. This article, published in Australia
during Down Syndrome Week in 1993, aims to assist general practitioners in
the provision of quality medical care to people with Down syndrome and their
families from diagnosis to old age.

Background:
There is evidence in ancient art of people with trisomy 21 being part of the
human race for thousands of years but it was not until 1866 that Dr John
Langdon Down first remarked on the facial similarities of a group of his
mentally retarded patients. Unfortunately, he used racial descriptors such
as "mongol" to describe their appearance which led to a century of
inaccurate and misleading terminology. People who have Down syndrome and
their advocates are understandably sensitive about the words used to
describe this chromosomal condition. With the identification of the
chromosomal basis of Down syndrome in 1959, a gradual process of acceptance
of trisomy 21 as being a variation of normal has done a lot to remove some
of the handicap and end uninformed debates over the "humanity" of people
with Down syndrome.

Apart from using the term "mongol", another way to get into a heated
discussion is to refer to a person as "suffering from Down syndrome". This
is a nonsensical statement as the syndrome in itself is not painful or
distressing. The phrase "a person with Down syndrome" is accurate,
non-pejorative and reminds us that the patient is, indeed, a person first.

Down syndrome is the commonest identifiable cause of intellectual
disability, accounting for almost one third of cases. It occurs equally in
all races with an overall incidence of approximately 1 in 800 births. This
is much lower than the actual conception rate due to a high incidence of
spontaneous and surgical abortion. The increase in incidence with advancing
maternal age is well-known but what is not commonly realised is that most
children with Down syndrome are born to mothers who are less than 30. This
is due to a greater number of pregnancies in this age group compared to the
older group.

Ninety five percent of cases of Down syndrome are caused by trisomy 21, with
unbalanced translocations of chromosome 21 and mosaicism accounting for the
remainder. The extra chromosome is maternal in origin in at least 90% of
cases.

Prenatal screening:
The medical profession has been criticised for allowing technical advances
to outstrip our ability to deal with the ethical issues which they raise. It
is heartening, therefore, to see paternalism being replaced by a conscious
effort on the part of doctors to act as expert informers who allow parents
to make their own decisions based on accurate facts. While the technical
procedures require a high level of skill to be performed well, an even
higher level of skill is required to handle the results appropriately.

Amniocentesis:
Amniocentesis of "high-risk" pregnancies at 16 weeks remains the commonest
method of detecting those which are affected by trisomy 21. Such pregnancies
are selected on the basis of maternal age being greater than 35 years or a
previously affected pregnancy. The risk of having a second pregnancy with
Down syndrome is 1% unless a translocation was the cause in which case the
risk may be much higher. The procedure is not without its problems, however,
which include an accidental miscarriage rate of 0.5 - 1% and the potential
need to perform a mid-trimester abortion if that is the option selected by
the parents.

Despite being extremely sensitive this test will still miss the majority of
trisomy 21 pregnancies due to the restriction of its use to the older age
group, whereas most babies with Down syndrome are born to mothers less than
30 years old. The use of mass maternal serum screening (ideally measuring
alphafetoprotein, hCG and oestriol) at 16 weeks gestation is now routine in
some states and allows the detection of 60% of trisomy 21 affected
pregnancies with a false positive rate of 5%. Women who are detected in this
way (1-2% of the tested population) are then offered amniocentesis, allowing
a reduction in the number of unnecessary invasive procedures while
maintaining high rates of detection. As with all screening tests, however,
adequate pre-test discussions must take place to ensure parental
understanding and consent. The technical aspects are far less challenging
than the counselling issues.

Chorionic Villus Sampling:
This procedure involves the transvaginal biopsy of the developing placenta
at 10 to 12 weeks gestation. It has the advantage of earlier detection of
chromosomal abnormalities than is possible with amniocentesis but it is
associated with a higher rate of post-procedure miscarriage (2-5% depending
on the operator). Concerns have been raised over limb and jaw defects in
foetuses which have undergone the procedure but hard data is lacking.

Ultrasound:
Multiple foetal characteristics have been studied as possible indicators of
trisomy 21. These include posterior fossa size, nuchal skinfold thickness,
hand posture and bone lengths. Although this technology offers promise for
the future, it is not reliable enough for use as a screening test at
present. The same can be said of detecting and karyotyping fetal cells in
maternal circulation, although this technology is imminent.

WHEN DOWN SYNDROME IS DIAGNOSED:
Giving the diagnosis of Down syndrome to a couple, either antenatally or in
the immediate postpartum period, requires all of the doctor's communication
and counselling skills. It is the general practitioner to whom most parents
would prefer to turn for this information.

Giving the prenatal diagnosis:
Although parents should have been prepared for the diagnosis of Down
syndrome before the test took place, even the best pre-test counselling does
little to offset the shock of an unexpected diagnosis. Initial shock and
denial can be anticipated as part of a sudden shift in parental
expectations. Most parents experience a need for concise, accurate and non-judgemental
information on which to base their decision. Contact with the Down Syndrome
Association might be helpful if the parents are agreeable.

One of the great challenges for doctors when trisomy 21 is detected
prenatally is to give a balanced and complete explanation of the options
available to the parents so that they can come to an informed decision
whether to continue with the pregnancy or not. This includes giving accurate
information about Down syndrome and the range of expectations they could
have for the child, while not trying to be impossibly predictive.

If termination of pregnancy is selected after adequate discussion, the full
impact of that procedure must be explained. Careful follow up should be
arranged to ensure that an appropriate grieving process for the loss of the
pregnancy takes place. Insensitive statements such as "Forget this one and
start again" are cruel and ignorant.

The detection of trisomy 21 prenatally does not always result in the
termination of that pregnancy. During pre-test discussions with the parents,
when information is given about the conditions being sought, it might become
apparent that the couple would not choose to abort an affected pregnancy but
just want to know of any defects so that they can be prepared for the baby's
arrival. It is vital that all couples be adequately prepared for any
screening tests so that they understand what the test is for, what its
dangers are and what options are available should the test be positive for
the condition being sought.

Giving the postnatal diagnosis:
The way in which the diagnosis of Down syndrome is communicated is another
area where the consumers of our medical services have expressed
dissatisfaction.

The firm diagnosis of Down syndrome on phenotypic grounds is usually
possible immediately after delivery. The doctor who tries to avoid making
the diagnosis for a few days until the karyotype is known will only be
pre-empted by a grandparent. It is essential to inform the parents, at least
of your suspicions, as soon as possible after delivery.

The Delivery Suite diagnosis of Down syndrome should follow this plan:
As soon as the baby is delivered congratulate the parents on the birth of their child.

Advise them whether the baby is healthy or not and explain any immediate
resuscitative procedures you are performing.

As soon as third stage is complete and the baby is stabilised, ensure that
you can have some time alone with both parents and the baby. Many parents
will already have sensed an apprehensive atmosphere in these few minutes. A
midwife who has been involved with the delivery may be an invaluable
support.

State your clinical diagnosis and, if necessary, your degree of certainty.
An opening statement could be: "She looks very healthy but I have some news
for you that you might not have been expecting. Your baby has Down
syndrome." You should be touching the baby as you say this and using her
name, indicating your acceptance of the child. No new parent wants their
doctor to treat their baby with repugnance.

After dealing with any immediate denial statements from the parents, it is
necessary to evaluate their understanding of the diagnosis ("What do you
understand by the term Down syndrome?"). It may become evident that they
have little knowledge about the condition or they are weighed down with
myths and misunderstandings. These should be corrected carefully.

It is impractical to fully educate the parents of a baby with Down syndrome
immediately after delivery. Enough information should be given so as to
answer their immediate questions and support them until later in the day
when more detailed discussions can take place. Immediate information should
include a synopsis of the aetiology of the syndrome, a defusing of either
parent "blaming" the other, and a description of investigations and
procedures which are necessary to fully evaluate the child's health.

A complete discussion of the diagnosis should take place once the parents
are at least partially recovered from the immediate stress of delivery,
usually within twenty four hours. By this time there will be a barrage of
questions which will need to be answered accurately and adequately. Every
effort should be made to have both parents at this meeting. Again the child
should be present as the focus of the discussions and should be held by the
parents. It is still too early to overload the parents with every minute
fact so there is a need to be sensitive to their particular rate of uptake
of these new and complex concepts.

Don't try to be to predictive. It is nonsense to try to foresee the future
for any child with accuracy. Perpetuating myths such as "at least he'll
always be loving and enjoy music" is inexcusable. A "broad brush" picture
should be painted which recognises every child's capacity to develop
individually.

Family and friends can be a source of great support but they may also need
information and education. Each state has a Down Syndrome Association which
offers in-hospital and ongoing support to parents of babies with Down
syndrome by people who have been in that situation themselves. Contact
numbers are listed at the end of this article.

It may be helpful for relations to bring in photos of the parents as
neonates. This allows the parents to compare the baby's facial
characteristics with their own and see that it is their baby, not a "Down's
baby".

Most doctors understand the parents' need to have time alone but also to
feel confident in approaching the doctor at any time for more information.
An open-door policy is essential.

When a case of Down syndrome is delivered, a child is born. This simple fact
is so often overlooked in the storm of emotional upheaval that the new
mother and father are rarely congratulated on becoming parents. One
Melbourne mother was even sent an "In Sympathy" card the day after she
delivered a healthy baby who had Down syndrome . Less than thirty years ago
some Australian doctors used to advise their patients to place their Down
syndrome babies in institutions and tell their relations they had been
stillborn. Although this sort of approach no longer exists, very
occasionally the parents of a newborn with Down syndrome will decide that,
for whatever reason, they are unable to accept the child. In this situation
the options include foster care or adoption and it is obviously not a
decision to be taken lightly. The doctor's role is again that of an informed
counsellor, not a judge.

The process of coming to terms with having given birth to a child with Down
syndrome has been likened to the well-known grief reaction which occurs
after the death of a child. Stages such as denial, anger, acceptance et
cetera are recognisable and the parents are said to be grieving for the loss
of their expected "perfect" child. While this view has some small merit, it
fails to address the long term and varying nature of the readjustment
process in the case of the family of a child with Down syndrome. After all,
the child has not died.

MEDICAL CARE OF PEOPLE WITH DOWN SYNDROME:
Although Down syndrome is not a medical illness, there are a number of
pathological processes which are more common in people who have the
condition. These associations will necessarily bring people with Down
syndrome into frequent, and at times intensive, contact with doctors.

Neonatal period:
Immediately after delivery the child should be fully examined to confirm the
diagnosis and to identify any immediate medical problems. Paediatric
consultation is appropriate in most situations.

Cardiac: Congenital heart disease, usually in the form of endocardial
cushion defects, affects 40% of babies and should be screened for by
echocardiography soon after birth as it may well be difficult to detect.
Septal defects and Fallot's tetralogy also occur. The discovery of severe
congenital malformations often raises the issue of how interventive to be.
It must be emphasised that exactly the same medical and surgical treatment
should be instituted for a child with Down syndrome as for a child without a
chromosomal disorder.

Severe congenital heart disease remains a major killer of children with Down
syndrome, despite advances in surgical treatments. In the absence of a
congenital heart defect, however, the majority of children can expect to
live into their sixth decade.

Gastrointestinal: The commonest congenital abnormality of the
gastrointestinal tract associated with Down syndrome is duodenal atresia,
although pyloric stenosis, Hirschsprung's disease and tracheo-oesophageal
fistulae have all been reported. Again, surgical intervention should be
evaluated without reference to the chromosomal disorder. The total incidence
of GIT malformations is approximately 12%.

Vision: Three percent of newborns with Down syndrome will have dense
congenital cataracts which should be removed early. Glaucoma is also more
common.

Feeding: Hypotonia is a constant feature of neonates with Down syndrome.
This floppiness can interfere with breastfeeding and an experienced
lactation consultant may need to be involved to ensure that the process is
successful. Feeding tends to take longer and there may be attachment
problems due to a protuberant tongue. Some babies experience difficulty
maintaining temperature and may need extra swaddling during feeding.
Constipation is more common due to hypotonic gut musculature.

Congenital Hypothyroidism: This condition is slightly more prevalent in
babies with Down syndrome. It should be detected by the routine heelprick
screen performed on all neonates.

Congenital dislocation of the hips: Joint laxity and hypotonia can combine
to increase the incidence of hip dislocation, although true congenital
dislocation is quite rare. Extra care should be taken during the usual
neonatal examination.

Infancy:
Once any urgent medical conditions have been addressed and feeding has been
successfully established, the parents will take their new baby home. If the
general practitioner has not been involved during the in-patient stay, early
contact is important to allow an assessment of the child's baseline medical
condition. This "well child check" means that the doctor need not be
confronted for the first time by an unfamiliar and obviously sick child
several months later.

Medical care in the first year of life will include the continued management
of any problems identified in the neonatal period as well as surveillance
for acquired problems such as hearing or visual impairments. Early and
regular contact with appropriately-experienced consultants should begin in
the first year.

Seizure disorders are more common in children with Down syndrome
(approximately 10%) and can occur from an early age. They are usually tonic
clonic in nature.

People with Down syndrome have reduced cell-mediated immunity and so babies
in particular are likely to suffer more respiratory infections. Upper airway
obstruction is also more common due to hypertrophy of tonsils and adenoids.
This alteration in immunity has also been implicated in the observed
increase in incidence of leukaemia in people with Down syndrome, although
the link is not clear.

In practical terms the decrease in immunity has little impact. The normal
childhood immunisation program should be commenced at the usual time.

The philosophy of "early intervention" is now well accepted as having
benefits for the child and family. This refers to home-based or centre-based
treatment of a disabled child by a variety of health professionals such as
occupational therapists, physiotherapists and speech therapists from a very
early age. The parents are also involved as therapists. These recognised,
government-sponsored programs tend to be preferable to the so-called
"fringe" therapists who can be exhausting of parental resources without
producing many results.

Childhood:
As the child grows through the preschool years it will become evident that
development is globally delayed. Physical milestones will be delayed due to
hypotonia and joint laxity, speech is likely to be difficult and
socialisation may be delayed. Psychometric evaluation shows that most
children with Down syndrome have intellectual functioning in the moderately
disabled range but the range is enormous. At this time it is useful to
assist the parents in recognising that a different set of milestones is
relevant for this child, and that comparing its progress to that of siblings
is not much help. Comparing notes with other parents of children with Down
syndrome is helpful but it must be remembered that each child will follow
their own path. It is important not to make too many predictions as to how
far and how fast the child will develop but the mood should be one of
optimism and reasonable expectations, as for all children.

The general practitioner's lifelong relationship with the child should be
developing well at this point. Familiarity with what is normal for that
child will allow the early recognition of any health problems, as will an
awareness of which medical conditions are more common. Beyond that, however,
the astute GP will remember that the child with Down syndrome is susceptible
to the same range of childhood problems as any other and that not all
symptoms will be due to the syndrome.

The GP's approach to a child with Down syndrome should be the same as to any
other child: friendly, non-threatening and interactive. The parents are
usually invaluable sources of information about the child and, after several
years of hard work, will have become staunch advocates and
"bureaucracy-busters". Their concerns should be treated with due
consideration.

Having been involved in early intervention and preschool programs, most
children with Down syndrome are well-equipped for entry to mainstream
schooling at the usual time. There remains a lot of debate over the relative
merits of mainstreaming versus special schooling which is outside the scope
of this article. The doctor's role is generally to support the parents in
their decision making and to address any medical issues which may arise when
selecting a school.

Congenital Heart Disease: Severe malformations which cannot be definitively
treated remain a major cause of morbidity and mortality throughout
childhood. Close liaison with a paediatric cardiologist should be
maintained.

Sensory deficits: Significant hearing impairments occur in the majority of
children with Down syndrome. Annual audiometry and specialist consultation
is recommended.

Visual impairment due to refractive errors or strabismus is also common and
should be checked annually. Cataracts often develop but are usually outside
the visual axis.

Hypothyroidism: With a lifetime incidence of anything up to 30%,
hypothyroidism must be screened for on a regular basis. Although most cases
develop in teenage years, biannual biochemical screening of younger children
is recommended. If any symptoms of thyroid disease are detected, early
investigation and treatment are essential.

Atlantoaxial instability: There has been a lot of controversy as to the
correct approach to this problem. Up to 15% of children with Down syndrome
will have radiological evidence of instability of the atlantoaxial joint but
in only a handful of cases will this instability result in an impingement on
the spinal cord with resultant neurological signs. The controversy arises
over whether to screen radiologically all people with Down syndrome and if
so, when. If instability is detected, is it fair to limit a person's
sporting and recreational pursuits in an attempt to prevent the rare
complication of damage to the spinal cord? Subtle neurological signs are
sometimes difficult to detect in people with Down syndrome and the surgery
involved in stabilising the joint is major.

The current consensus is marginally in favour of radiological screening
before school entry, mainly to reassure the parents of the large majority of
children who will be found to have stable AA joints. If instability or
anatomical abnormalities are detected, careful counselling should ensure
that activities are modified appropriately without restricting the child
unnecessarily. Neurological surveillance is essential. Some authorities
recommend a second set of screening radiographs before entry to high school
for all children with Down syndrome although there is little evidence to
support the concept of development of instability.

Physical growth: Physical development is invariably delayed in children with
Down syndrome and modified percentile charts are available for accurate
monitoring (). A tendency towards obesity requires special attention to
healthy diet and exercise habits in this group.
Dental care: The teeth of children with Down syndrome tend to be small,
irregularly spaced and misshapen. Early and frequent dental care is required
to ensure adequate dentition for adult life.

Adolescence
Having Down syndrome does not protect against the hormonal maelstrom which
usually accompanies adolescence. All the usual trials and torments of this
potentially difficult phase of development have to be negotiated. This
includes the adolescent trying to establish his or her own identity, find
some private space and pursue their own interests.

People with disabilities are sexual beings and those with Down syndrome are
no exception. It is a grave injustice to hold a stereotype of people with
Down syndrome as being "happy eternal children", as any parent will agree.
Teenagers with Down syndrome are subject to the same tempers, desires and
emotions as anyone else, although they are often more frustrated in their
expression.

Some specific medical conditions need attention:
Menstruation & sexuality: Menarche is usually only slightly delayed in girls
with Down syndrome. Menstruation usually settles into a regular pattern and,
although many cycles will be anovulatory, fertility should be presumed.
There are approximately thirty cases in the world literature of women with
Down syndrome becoming pregnant.

There is a long history of women with Down syndrome having their
menstruation and fertility controlled through the use of medications such as
progesterone or surgical intervention. Little attention was paid to the
woman's needs and even less to providing appropriate education on menstrual
hygiene, relationships and contraception. A hysterectomy does not protect
against sexual abuse, particularly when women with Down's syndrome are seen
by many as compliant and helpless. More enlightened thinking has allowed
these women to successfully manage their own menses and to make decisions
about contraception, based on appropriate information from expert
counsellors.

It is hard to justify involuntary menstrual suppression or sterilisation
unless there are major medical indications. A recent High Court decision has
given the Family Court responsibility for consenting to sterilising
procedures on children. Most states have legislation giving intellectually
disabled adults the same protection through Guardianship Boards.

Adolescent males with Down syndrome usually experience the same sexual
drives and frustrations as their peers. The genitals are usually small and
underdeveloped although this is by no means invariable. Some men have
difficulty attaining a full erection and ejaculation is not always possible.
Although the semen of males with Down syndrome shows decreased sperm numbers
and motility with increased abnormal shapes, there is at least one recorded
case of a child being fathered by a man with Down syndrome.

Education about appropriate sexuality is essential. One of the great
obstacles to developing healthy sexual expression for people with Down
syndrome is the lack of information which other teenagers have access to
through a variety of community sources. Family Planning clinics and women's
health resource centres can often be of assistance to families and general
practitioners in this area.

Hypothyroidism: As most cases of hypothyroidism in people with Down syndrome
develop during the teen years, surveillance should be increased to yearly
thyroid function tests along with an increasing index of suspicion as to
whether this condition could be behind unusual clinical presentations.

Skin: The skin of children with Down syndrome tends to be dry and
susceptible to eczema. During adolescence, folliculitis and boils become
more common. Alopecia areata is a common manifestation of the disordered
autoimmunity which may accompany Down syndrome.

Adulthood
Changes in the approach to people with Down syndrome in the latter part of
this century has resulted in a threefold increase in their life expectancy.
Better and more active medical care coupled with community living have been
largely responsible. It is only in the last few decades that people with
Down syndrome could reasonably expect to reach adulthood. If the first five
years of life (when most cardiac deaths occur) are survived a person with
Down syndrome has an 80% chance of reaching the third decade and a 60%
chance of living beyond fifty. The average age of death for a person with
Down syndrome is in the mid-fifties. All this means that general
practitioners need to employ the same preventive health skills as they do
for the rest of the community so that people with Down syndrome can be
healthy into old age.

People with Down syndrome still complain about the way they are perceived by
some doctors. A man of twenty five should not be called a "boy". He has
usually moved out of the family home and is working in an adult centre. He
is probably able to answer questions about his health and should be given
the opportunity to do so. He is an adult and should be treated as such.
Medical procedures should be explained to him in appropriate language (see
figure 3) and consent should be gained in the usual way.

If there is any likely controversy over a medical treatment or procedure for
an adult with Down syndrome, a guardian may need to be appointed to make
decisions on behalf of that person. This only applies if the person is not
competent to give informed consent and it is one of the few areas of the law
where common sense has a large role to play. Usually a parent or concerned
friend can be seen to be clearly capable of making decisions which are in
the best interests of the disabled person. Uncertainties about the need for
a guardian can usually be cleared up by a telephone call to the Guardianship
Board or Attorney General's Department in each state.

Preventive care: The usual range of preventive health activities should be
offered to adults with Down syndrome. The usual protocols apply for cervical
cytology, breast screening and cardiovascular risk factor monitoring. Diet
and exercise advice should be realistic, comprehensive and adapted for the
person's living and employment situation where necessary.

Hypothyroidism: Throughout the adult years vigilance for thyroid dysfunction
should be maintained with annual thyroid function tests. Sensory deficits:
On going contact with eye and ear specialists is advisable during adult life
due to a high prevalence of acquired problems such as cataracts, keratoconus
and sensorineural hearing loss.

Behavioural problems: One of the most difficult challenges confronting a GP
in treating a person with an intellectual disability is the assessment and
management of difficult behaviours. Our predecessors seem to have relied
heavily on the use of major tranquillisers as a way of quelling angry
outbursts or destructive behaviour but this approach does nothing to
identify the root cause of the problem. People with disabilities rarely
behave in a destructive or violent way unless there is a reason. It may be
something intrinsic to the person, such as depression or a tooth ache. It
may be due to a change in that person's life situation, such as a change of
residence or employment. Or it may be due to interpersonal conflict. The
doctor's role is to seek the underlying cause of the problem through a full
assessment rather than just to suppress the symptoms.

Psychiatric disorders: Psychiatric illnesses occur in people with Down
syndrome with much the same frequency as in the rest of the population. This
is a difficult area for psychiatrists, however, and there are few in
Australia who have risen to the challenge of providing comprehensive mental
health services to people with intellectual disabilities.

Dementia: Much recent attention has been focussed on the association between
Down syndrome and Alzheimer's disease. There appears to be a gene-dose
effect where having an extra chromosome 21 gives an individual a higher
chance of developing the neuropathological changes of Alzheimer's disease,
which are coded for on that chromosome. The association is so strong that
some authorities are advocating the inclusion of Alzheimer's disease as one
of the invariable features of the syndrome, although it is always a
diagnosis of exclusion after other, reversible causes of dementia have been
excluded. Late onset epilepsy is often seen in association with Alzheimer‚s
disease in this group.

From a practical point of view it is helpful to be aware of this
association. Due to the increased life expectancy of people with Down
syndrome, most of our patients can be expected to show signs of dementia as
they age. The recognition of declining intellectual functioning and loss of
some social skills may assist the GP in suggesting appropriate strategies to
help the patient and family. These may include a move to more appropriate
accommodation, involvement in generic geriatric services and contact with
specialised support agencies.

Summary:
People with Down syndrome are part of our community and as such are part of
the GP's patient population. While there are some medical conditions which
are more common in people with an extra chromosome 21, there is nothing
which is unique to this group or which is totally outside the scope of
general practitioner involvement. The key to good quality care is to be
familiar with the syndrome but, more importantly, to know the person who has
the syndrome.

The advocacy efforts of people with Down syndrome and their families have
resulted in huge improvements in life quality and expectancy. The medical
profession is attempting to match these developments by becoming more
sophisticated in its approach to ethical issues, more energetic in its
provision of care and more cooperative in its interactions with people who
have Down syndrome and their families.