Recommended Adult Immunization Schedule - 2011

 

1. Influenza vaccination
Annual vaccination against influenza is recommended for all persons aged 6 months and older, including all adults. Healthy, nonpregnant adults aged less than 50 years without high-risk medical conditions can receive either intranasally administered live, attenuated influenza vaccine (FluMist), or inactivated vaccine. Other persons should receive the inactivated vaccine. Adults aged 65 years and older can receive the standard influenza vaccine or the high-dose (Fluzone) influenza vaccine. Additional information about influenza vaccination is available at http://www.cdc.gov/vaccines/vpd-vac/flu/default.htm.
2. Tetanus, diphtheria, and acellular pertussis (Td/Tdap) vaccination
Administer a one-time dose of Tdap to adults aged less than 65 years who have not received Tdap previously or for whom vaccine status is unknown to replace one of the 10-year Td boosters, and as soon as feasible to all 1) postpartum women, 2) close contacts of infants younger than age 12 months (e.g., grandparents and child-care providers), and 3) healthcare personnel with direct patient contact. Adults aged 65 years and older who have not previously received Tdap and who have close contact with an infant aged less than 12 months also should be vaccinated. Other adults aged 65 years and older may receive Tdap. Tdap can be administered regardless of interval since the most recent tetanus or diphtheria-containing vaccine.
Adults with uncertain or incomplete history of completing a 3-dose primary vaccination series with Td-containing vaccines should begin or complete a primary vaccination series. For unvaccinated adults, administer the first 2 doses at least 4 weeks apart and the third dose 6–12 months after the second. If incompletely vaccinated (i.e., less than 3 doses), administer remaining doses. Substitute a one-time dose of Tdap for one of the doses of Td, either in the primary series or for the routine booster, whichever comes first.
If a woman is pregnant and received the most recent Td vaccination 10 or more years previously, administer Td during the second or third trimester. If the woman received the most recent Td vaccination less than 10 years previously, administer Tdap during the immediate postpartum period. At the clinician’s discretion, Td may be deferred during pregnancy and Tdap substituted in the immediate postpartum period, or Tdap may be administered instead of Td to a pregnant woman after an informed discussion with the woman.
The ACIP statement for recommendations for administering Td as prophylaxis in wound management is available at http://www.cdc.gov/vaccines/pubs/acip-list.htm.
3. Varicella vaccinationAll adults without evidence of immunity to varicella should receive 2 doses of single-antigen varicella vaccine if not previously vaccinated or a second dose if they have received only 1 dose, unless they have a medical contraindication. Special consideration should be given to those who 1) have close contact with persons at high risk for severe disease (e.g., healthcare personnel and family contacts of persons with immunocompromising conditions) or 2) are at high risk for exposure or transmission (e.g., teachers; child-care employees; residents and staff members of institutional settings, including correctional institutions; college students; military personnel; adolescents and adults living in households with children; nonpregnant women of childbearing age; and international travelers).
Evidence of immunity to varicella in adults includes any of the following: 1) documentation of 2 doses of varicella vaccine at least 4 weeks apart; 2) U.S.-born before 1980 (although for healthcare personnel and pregnant women, birth before 1980 should not be considered evidence of immunity); 3) history of varicella based on diagnosis or verification of varicella by a healthcare provider (for a patient reporting a history of or having an atypical case, a mild case, or both, healthcare providers should seek either an epidemiologic link with a typical varicella case or to a laboratory-confirmed case or evidence of laboratory confirmation, if it was performed at the time of acute disease); 4) history of herpes zoster based on diagnosis or
verification of herpes zoster by a healthcare provider; or 5) laboratory evidence of immunity or laboratory confirmation of disease.
Pregnant women should be assessed for evidence of varicella immunity. Women who do not have evidence of immunity should receive the first dose of varicella vaccine upon completion or termination of pregnancy and before discharge from the healthcare facility. The second dose should be administered 4–8 weeks after the first dose.
4. Human papillomavirus (HPV) vaccination
HPV vaccination with either quadrivalent (HPV4) vaccine or bivalent vaccine (HPV2) is recommended for females at age 11 or 12 years and catch-up vaccination for females aged 13 through 26 years.
Ideally, vaccine should be administered before potential exposure to HPV through sexual activity; however, females who are sexually active should still be vaccinated consistent with age-based recommendations. Sexually active females who have not been infected with any of the four HPV vaccine types (types 6, 11, 16, and 18, all of which HPV4 prevents) or any of the two HPV vaccine types (types 16 and 18, both of which HPV2 prevents) receive the full benefit of the vaccination. Vaccination is less beneficial for females who have already been infected with one or more of the HPV vaccine types. HPV4 or HPV2 can be administered to persons with a history of genital warts, abnormal Papanicolaou test, or positive HPV DNA test, because these conditions are not evidence of previous infection with all vaccine HPV types.
HPV4 may be administered to males aged 9 through 26 years to reduce their likelihood of genital warts. HPV4 would be most effective when administered before exposure to HPV
through sexual contact.
A complete series for either HPV4 or HPV2 consists of 3 doses. The second dose should be administered 1–2 months after the first dose; the third dose should be administered 6 months after the first dose.
Although HPV vaccination is not specifically recommended for persons with the medical indications described in Figure 2, “Vaccines that might be indicated for adults based on medical and other indications,” it may be administered to these persons because the HPV vaccine is not a live-virus vaccine. However, the immune response and vaccine


Source:
http://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm

Recommended Immunization Schedule for Persons Aged 7 - 18 Years— 2011

This schedule includes recommendations in effect as of December 21, 2010. Any dose not administered at the recommended age should be administered at a subsequent visit, when indicated and feasible. The use of a combination vaccine generally is preferred over separate injections of its equivalent component vaccines.
Considerations should include provider assessment, patient preference, and the potential for adverse events. 

1. Tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap).
(Minimum age: 10 years for Boostrix and 11 years for Adacel))
• Persons aged 11 through 18 years who have not received Tdap should receive a dose followed by Td booster doses every 10 years thereafter.
• Persons aged 7 through 10 years who are not fully immunized against pertussis (including those never vaccinated or with unknown pertussis vaccination status) should receive a single dose of Tdap. Refer to the catch-up schedule if additional doses of tetanus and diphtheria toxoid–containing vaccine are needed.
• Tdap can be administered regardless of the interval since the last tetanus and diphtheria toxoid–containing vaccine.

2. Human papillomavirus vaccine (HPV). (Minimum age: 9 years)
• Quadrivalent HPV vaccine (HPV4) or bivalent HPV vaccine (HPV2) is recommended for the prevention of cervical precancers and cancers in females.
• HPV4 is recommended for prevention of cervical precancers, cancers, and genital warts in females.
• HPV4 may be administered in a 3-dose series to males aged 9 through 18 years to reduce their likelihood of genital warts.
• Administer the second dose 1 to 2 months after the first dose and the third dose 6 months after the first dose (at least 24 weeks after the first dose).

3. Meningococcal conjugate vaccine, quadrivalent (MCV4). (Minimum age: 2 years)
• Administer MCV4 at age 11 through 12 years with a booster dose at age 16 years.
• Administer 1 dose at age 13 through 18 years if not previously vaccinated.
• Persons who received their first dose at age 13 through 15 years should receive a booster dose at age 16 through 18 years.
• Administer 1 dose to previously unvaccinated college freshmen living in a dormitory.
• Administer 2 doses at least 8 weeks apart to children aged 2 through 10 years with persistent complement component deficiency and anatomic or functional asplenia, and 1 dose every 5 years thereafter.
• Persons with HIV infection who are vaccinated with MCV4 should receive 2 doses at least 8 weeks apart.
• Administer 1 dose of MCV4 to children aged 2 through 10 years who travel to countries with highly endemic or epidemic disease and during outbreaks caused by a vaccine serogroup.
• Administer MCV4 to children at continued risk for meningococcal disease who were previously vaccinated with MCV4 or meningococcal polysaccharide vaccine after 3 years (if first dose administered at age 2 through 6 years) or after 5 years (if first dose administered at age 7 years or older).

4. Influenza vaccine (seasonal).
• For healthy nonpregnant persons aged 7 through 18 years (i.e., those who do not have underlying medical conditions that predispose them to influenza complications), either LAIV or TIV may be used.
• Administer 2 doses (separated by at least 4 weeks) to children aged 6 months through 8 years who are receiving seasonal influenza vaccine for the first time or who were vaccinated for the first time during the previous influenza season but only received 1 dose.
• Children 6 months through 8 years of age who received no doses of monovalent 2009 H1N1 vaccine should receive 2 doses of 2010-2011 seasonal influenza vaccine. See MMWR 2010;59(No. RR-8):33–34.

5. Pneumococcal vaccines.
• A single dose of 13-valent pneumococcal conjugate vaccine (PCV13) may be administered to children aged 6 through 18 years who have functional or anatomic asplenia, HIV infection or other immunocompromising condition, cochlear implant or CSF leak. See MMWR 2010;59(No. RR-11).
• The dose of PCV13 should be administered at least 8 weeks after the previous dose of PCV7.
• Administer pneumococcal polysaccharide vaccine at least 8 weeks after the last dose of PCV to children aged 2 years or older with certain underlying medical conditions, including a cochlear implant. A single revaccination should be administered after 5 years to children with functional or anatomic asplenia or an immunocompromising condition.

6. Hepatitis A vaccine (HepA).
• Administer 2 doses at least 6 months apart.
• HepA is recommended for children aged older than 23 months who live in areas where vaccination programs target older children, or who are at increased risk for infection, or for whom immunity against hepatitis A is desired.

7. Hepatitis B vaccine (HepB).
• Administer the 3-dose series to those not previously vaccinated. For those with incomplete vaccination, follow the catch-up schedule.
• A 2-dose series (separated by at least 4 months) of adult formulation Recombivax HB is licensed for children aged 11 through 15 years.

8. Inactivated poliovirus vaccine (IPV).
• The final dose in the series should be administered on or after the fourth birthday and at least 6 months following the previous dose.
• If both OPV and IPV were administered as part of a series, a total of 4 doses should be administered, regardless of the child’s current age.

9. Measles, mumps, and rubella vaccine (MMR).
• The minimum interval between the 2 doses of MMR is 4 weeks.

10. Varicella vaccine.
• For persons aged 7 through 18 years without evidence of immunity (see MMWR 2007;56[No. RR-4]), administer 2 doses if not previously vaccinated or the second dose if only 1 dose has been administered.
• For persons aged 7 through 12 years, the recommended minimum interval between doses is 3 months. However, if the second dose was administered at least 4 weeks after the first dose, it can be accepted as valid.
• For persons aged 13 years and older, the minimum interval between doses is 4 weeks.

Providers should consult the relevant Advisory Committee on Immunization Practices statement for detailed recommendations: http://www.cdc.gov/vaccines/pubs/acip-list.htm. Clinically significant adverse events that follow immunization should be reported to the Vaccine Adverse Event Reporting System (VAERS) at http://www.vaers.hhs.gov or by telephone, 800-822-7967.

Sources:

Immunization Schedules http://www.cdc.gov/vaccines/recs/schedules/default.htm

http://www.cdc.gov/vaccines/who/teens/downloads/parent-version-schedule-7-18yrs.pdf

10 Habits for a Stronger Heart

Men's Health .The smartest plan for attacking a heart attack is, of course, preventing one from ever happening. Choose three of the following strategies and make them a habit. The closer to the top, the more you reduce your risk of heart disease.

1. Convince Your Wife to Stop Smoking
Nonsmoking husbands of smoking wives face a 92 % increase in their risk of heart attack. Breathing secondhand smoke boosts bad cholesterol levels, decreases good cholesterol, and increases your blood's tendency to clot.

2. Work Out for 30 Minutes, Four Times a Week
Middle-aged men who exercise vigorously for 2 or more hours cumulatively per week have 60 percent less risk of heart attack than inactive men do.

3. Lose 10 - 20 Pounds
If you're overweight, dropping 10 to 20 pounds lowers your risk of dying from a heart attack. A 10-year study found that overweight people had heart attacks 8.2 years earlier than normal-weight victims.

4. Drink 5 Glasses of Water a Day
Men who drink that many 8-ounce glasses are 54 % less likely to have a fatal heart attack than those who drink two or fewer. Researchers say the water dilutes the blood, making it less likely to clot.

5. Switch from Coffee to Tea
A recent study found that people who drink three cups of tea a day have half the risk of heart attack of those who don't drink tea at all. Potent antioxidants, called flavonoids, provide a protective effect.

6. Eat Salmon on Saturday, Tuna on Tuesday
Researchers at the Harvard School of Public Health say that eating fish at least twice a week lowers heart-disease risk by more than 30 percent. The magic ingredient is the omega-3 fatty acids.

7. Ask Your Doctor About Vitamin E and Aspirin
Men who take both cut the plaque in clogged arteries by more than 80%, according to a recent University of Pennsylvania study.

8. Eat a Cup of Total Corn Flakes for Breakfast
This cereal contains one of the highest concentrations of folate (675 micrograms) of any cereal. Taking in that much folic acid daily cuts your risk of cardiovascular disease by 13 percent, according to researchers.

9. Count to 10
Creating a 10-second buffer before reacting to a stressful situation may be enough to cool you down. Men who respond with anger are three times more likely to have heart disease and five times more likely to have a heart attack before turning 55.

10. Eat Watermelon
It contains about 40 % more lycopene than is found in raw tomatoes, and a new study shows that your body absorbs it at higher levels due to the melon's high water content. Half a wedge can boost heart-disease prevention by 30%.

Northern Ethiopia declare an end to Female Genital Cutting

Female genital cutting (FGC), also known as female genital mutilation (FGM), female circumcision, or female genital mutilation/cutting (FGM/C), is any procedure involving the partial or total removal of the external female genitalia or other injury to the female genital organs "whether for cultural, religious or other non-therapeutic reasons."

• The term is almost exclusively used to describe traditional or religious procedures on a minor, which requires the parents' consent because of the age of the girl.

When the procedure is performed on and with the consent of an adult, it is generally called clitoridectomy, or it may be part of labiaplasty or vaginoplasty. It also generally does not refer to procedures used in sex reassignment surgery, and the genital modification of intersexuals.
FGC is predominantly practiced in Northeast Africa and parts of the Near East and Southeast Asia,although it has also been reported to occur in individual tribes in South America and Australia.Opposition is motivated by concerns regarding the consent (or lack thereof, in most cases) of the patient, and subsequently the safety and long-term consequences of the procedures. In the past several decades, there have been many concerted efforts by the World Health Organization (WHO) to end the practice of FGC. The United Nations has also declared February 6 as "International Day of Zero Tolerance to Female Genital Mutilation".


 Because the term female genital mutilation has been criticized for increasing the stigma associated with female genital surgery, some groups have proposed an alteration, substituting with the word "cutting" the one of "mutilation." According to a joint WHO/UNICEF/UNFPA statement, the use of the word "mutilation" reinforces the idea that this practice is a violation of the human rights of girls and women, and thereby helps promote national and international advocacy towards its abandonment. They state that, at the community level, however, the term can be problematic; and that local languages generally use the less judgmental "cutting" to describe the practice. They also state that parents resent the suggestion that they are "mutilating" their daughters. In 1999, the UN Special Rapporteur on Traditional Practices called for tact and patience regarding activities in this area and drew attention to the risk of "demonizing" certain cultures, religions, and communities. As a result, the term "cutting" has come to be used when trying to avoid alienating communities.In 1996, the Uganda-based initiative REACH (Reproductive, Educative, And Community Health) began using the term "FGC", observing that "FGM" may "imply excessive judgment by outsiders as well as insensitivity toward individuals who have undergone some form of genital excision." The UN uses "FGM" in official documents, while some of its agencies, such as the UN Population Fund, use both the terms "FGM" and "FGC".

Procedures: World Health Organization categorization

FGC consists of several distinct procedures. Their severity is often viewed as dependent on how much genital tissue is cut away. The WHO—which uses the term Female Genital Mutilation (FGM)—divides the procedure into four major types(see Diagram 1), although there is some debate as to whether all common forms of FGM fit into these four categories, as well as issues with the reliability of reported data.

Diagram 1:This image shows the different types of FGM and how they differ to the uncircumcised female anatomy.

• Type I

The WHO defines Type I FGM as the partial or total removal of the clitoris (clitoridectomy) and/or the prepuce (clitoral hood); see Diagram 1B. When it is important to distinguish between the variations of Type I cutting, the following subdivisions are proposed: Type Ia, removal of the clitoral hood or prepuce only (which some view as analogous to male circumcision and thus more acceptable); Type Ib, removal of the clitoris with the prepuce. In the context of women who seek out labiaplasty, there is disagreement among doctors as to whether to remove the clitoral hood in some cases to enhance sexuality or whether this is too likely to lead to scarring and other problems.

• Type II

The WHO's definition of Type II FGM is "partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora". When it is important to distinguish between the major variations that have been documented, the following subdivisions are proposed: Type IIa, removal of the labia minora only; Type IIb, partial or total removal of the clitoris and the labia minora; Type IIc, partial or total removal of the clitoris, the labia minora and the labia majora.

• Type III: Infibulation with excision

The WHO defines Type III FGM as narrowing of the vaginal orifice with creation of a covering seal by cutting and repositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation)." It is the most extensive form of FGM, and accounts for about 10% of all FGM procedures described from Africa.Infibulation is also known as "pharaonic circumcision".
In a study of infibulation in the Horn of Africa, Pieters observed that the procedure involves extensive tissue removal of the external genitalia, including all of the labia minora and the inside of the labia majora. The labia majora are then held together using thorns or stitching. In some cases the girl's legs have been tied together for two to six weeks, to prevent her from moving and to allow the healing of the two sides of the vulva. Nothing remains but the walls of flesh from the pubis down to the anus, with the exception of an opening at the inferior portion of the vulva to allow urine and menstrual blood to pass through; see Diagram 1D. Generally, a practitioner recognized as having the necessary skill carries out this procedure, and a local anesthetic is used. However, when carried out "in the bush", infibulation is often performed by an elderly matron or midwife of the village, without sterile procedure or anesthesia.
A reverse infibulation can be performed to allow for sexual intercourse or when undergoing labor, or by female relatives, whose responsibility it is to inspect the wound every few weeks and open it some more if necessary. During childbirth, the enlargement is too small to allow vaginal delivery, and so the infibulation is opened completely and may be restored after delivery. Again, the legs are sometimes tied together to allow the wound to heal. When childbirth takes place in a hospital, the surgeons may preserve the infibulation by enlarging the vagina with deep episiotomies. Afterwards, the patient may insist that her vulva be closed again.
Women who have been infibulated face a lot of difficulty in delivering children, especially if the infibulation is not undone beforehand, which often results in severe tearing of the infibulated area, or fetal death if the birth canal is not cleared (Toubia, 1995). The risk of severe physical, and psychological complications is more highly associated with women who have undergone infibulations as opposed to one of the lesser forms of FGM. Although there is little research on the psychological side effects of FGM, many women feel great pressure to conform to the norms set out by their community, and suffer from anxiety and depression as a result (Toubia, 1995). "There is also a higher rate of post-traumatic stress disorder in circumcised females" (Nicoletti, 2007, p. 2). 
A five-year study of 300 women and 100 men in Sudan found that "sexual desire, pleasure, and orgasm are experienced by the majority (nearly 90%) of women who have been subjected to this extreme sexual mutilation, in spite of their being culturally bound to hide these experiences."

• Type IV: Other types

There are other forms of FGM, collectively referred to as Type IV, that may not involve tissue removal. The WHO defines Type IV FGM as "all other harmful procedures to the female genitalia for non-medical purposes, for example, pricking, piercing, incising, scraping and cauterization." This includes a diverse range of practices, such as pricking the clitoris with needles, burning or scarring the genitals as well as ripping or tearing of the vagina.Type IV is found primarily among isolated ethnic groups as well as in combination with other types.

Reasons for Female Genital Mutilation

Cultural, religious and social causes
The causes of female genital mutilation include a mix of cultural, religious and social factors within families and communities.

• Where FGM is a social convention, the social pressure to conform to what others do and have been doing is a strong motivation to perpetuate the practice.

• FGM is often considered a necessary part of raising a girl properly, and a way to prepare her for adulthood and marriage.

• FGM is often motivated by beliefs about what is considered proper sexual behaviour, linking procedures to premarital virginity and marital fidelity. FGM is in many communities believed to reduce a woman's libido, and thereby is further believed to help her resist "illicit" sexual acts. When a vaginal opening is covered or narrowed (type 3 above), the fear of pain of opening it, and the fear that this will be found out, is expected to further discourage "illicit" sexual intercourse among women with this type of FGM.

• FGM is associated with cultural ideals of femininity and modesty, which include the notion that girls are “clean” and "beautiful" after removal of body parts that are considered "male" or "unclean".

• Though no religious scripts prescribe the practice, practitioners often believe the practice has religious support.

• Religious leaders take varying positions with regard to FGM: some promote it, some consider it irrelevant to religion, and others contribute to its elimination.

• Local structures of power and authority, such as community leaders, religious leaders, circumcisers, and even some medical personnel can contribute to upholding the practice.

• In most societies, FGM is considered a cultural tradition, which is often used as an argument for its continuation.

• In some societies, recent adoption of the practice is linked to copying the traditions of neighbouring groups. Sometimes it has started as part of a wider religious or traditional revival movement.

• In some societies, FGM is being practised by new groups when they move into areas where the local population practice FGM.

Medical consequence

• Among practicing cultures, FGC is most commonly performed between the ages of four and eight, but can take place at any age from infancy to adolescence. Prohibition has led to FGC going underground, at times with people who have had no medical training performing the cutting without anesthetic, sterilization, or the use of proper medical instruments. The procedure can lead to death through shock from excessive bleeding. The failure to use sterile medical instruments may lead to infections.

Other serious long term health effects are also common. These include urinary and reproductive tract infections, caused by obstructed flow of urine and menstrual blood, various forms of scarring and infertility.

• Epidermal inclusion cysts may form and expand, particularly in procedures affecting the clitoris. These cysts can grow over time and can become infected, requiring medical attention such as drainage.The first episode of sexual intercourse will often be extremely painful for infibulated women, who will need the labia majora to be opened, to allow their partner access to the vagina. This second cut, sometimes performed by the partner with a knife, can cause other complications to arise.

• A June 2006 study by the WHO has cast doubt on the safety of genital cutting of any kind. This study was conducted on a cohort of 28,393 women attending delivery wards at 28 obstetric centers in areas of Burkina Faso, Ghana, Kenya, Senegal and The Sudan. A high proportion of these mothers had undergone FGC. According to the WHO criteria, all types of FGC were found to pose an increased risk of death to the baby (15% for Type I, 32% for Type II, and 55% for Type III). Mothers with FGC Type III were also found to be 30% more at risk for cesarean sections and had a 70% increase in postpartum haemorrhage compared to women without FGC. Estimating from these results, and doing a rough population estimate of mothers in Africa with FGC, an additional 10 to 20 per thousand babies in Africa die during delivery as a result of the mothers having undergone genital cutting.

In cases of repairing the damage resulting from FGC, called de-infibulation when reversing Type III FGC, this is usually carried out by a gynecologist. See also Pierre Foldes, a French surgeon, who developed modern surgical corrective techniques.

• A 12-year-old Egyptian girl, Badour Shaker, died in June 2007 during or soon after a circumcision, prompting the Egyptian Health Ministry to ban the practice. She died from an overdose of anaesthesia. The girl's mother, Zeinab Abdel Ghani, paid the equivalent of US$9.00 (£4.60 pounds sterling, €6.82 euro) to a female doctor, in an illegal clinic in the southern town of Maghagh, for the operation. The mother stated that the doctor tried to give her $3,000 to withdraw a lawsuit, but she refused.

Sexual effects

• The effect of FGC on a woman's sexual experience varies depending on many factors. FGC does not eliminate all sexual pleasure for all women who undergo the procedure, but it does reduce the likelihood of orgasm. Stimulation of the clitoris is not solely responsible for the sexual excitement and arousal of a woman during intercourse; this involves a complex series of nerve endings being activated and stimulated in and around her vagina, vulva (labia minora and majora), cervix, uterus and clitoris, with psychological response and mindset also playing a role.

• Lightfoot-Klein (1989) studied circumcised and infibulated females in Sudan, stating, "Contrary to expectations, nearly 90% of all women interviewed said that they experienced orgasm (climax) or had at various periods of their marriage experienced it. Frequency ranged from always to rarely." Lightfoot-Klein stated that the quality of orgasm varied from intense and prolonged, to weak or difficult to achieve.

Psychological and psychiatric consequences

In February 2010, a study by Pharos, a Dutch group which gathers information on health care for refugees and migrants,found that many women who have undergone FGC suffer psychiatric problems. This was the first study into the psychiatric and social complaints associated with female circumcision. In the study 66 questioned Dutch African women, who had been subjected to the practice, were found to be "stressed, anxious and aggressive". It also found that they were more likely to have relational problems or in some cases had fears of establishing a relationship. According to the study, an estimated 50 women or girls are believed to be circumcised every year in the Netherlands. The report was published to mark the International day against female genital mutilation.
A study by anthropologist Rogaia M. Abusharaf, found that "circumcision is seen as 'the machinery which liberates the female body from its masculine properties'  and for the women she interviewed, it is a source of empowerment and strength

The Starchild Skull

The Starchild skull is an abnormal human skull allegedly found in Mexico. It is primarily notable due to claims by paranormal researchers that it is the product of extraterrestrial-human breeding. DNA recovered from the skull establishes it as human.

Introduction

        In the 1930's, in a small rural village 100 miles southwest of Chihuahua, Mexico, at the back of a mine tunnel, two mysterious remains were found: a complete human skeleton and a smaller, malformed skeleton
         In late February of 1999, Lloyd Pye was first shown the Starchild skull by its owners. Nameless then, it was a highly anomalous skull. He initially felt it would prove to be a rare genetic deformity of some kind. This skull’s symmetry was astonishing, even more so than the average human. In fact, all of its bones—most of which had human counterparts—were beautifully shaped. But shaped like what? Solving many questions that this unusual skull presented became his challenge. 

Skull Discovery

Sixty to seventy years ago an American girl of Mexican heritage in her late teens (15 to 18) was taken by her parents to visit relatives living in a small rural village 100 miles southwest of Chihuahua, Mexico. The girl was forbidden to enter any of the area's numerous caves and mine tunnels, but like most teenagers, she went exploring. At the back of a mine tunnel she found a complete human skeleton lying on the ground's surface. Beside it, sticking up out of the ground, was a malformed skeletal hand entwined in one of the human skeleton's upper arms. The girl proceeded to scrape the dirt off a shallow grave to reveal a buried skeleton smaller than the human one and also malformed. She did not specify the type or degree of any of the "malformations."

 The girl recovered both skulls and kept them for the remainder of her life. Upon her death they were passed to an American man, who maintained possession for five years before passing them to the American couple who now control them. 

Analysis

The skull is abnormal in several respects. A dentist determined, based on examination of the upper right maxilla found with the skull, that it was a child's skull, 4.5 to 5 years in age. However, the volume of the interior of the starchild skull is 1,600 cubic centimeters, which is 200 cm³ larger than the average adult's brain, and 400 cm³ larger than an adult of the same approximate size. The orbits are oval and shallow, with the optic nerve canal situated closer to the bottom of the orbit than to the back. There are no frontal sinuses. The back of the skull is flattened. The skull consists of calcium hydroxyapatite, the normal material of mammalian bone.

Dating

Carbon 14 dating was performed twice, the first on the normal human skull at the University of California at Riverside in 1999, and on the Starchild skull in 2004 at Beta Analytic in Miami. Both tests provided results of 900 years ± 40 years since death.

Front view of the Starchild skull (on the left) and the human skull (on the right).
Compare striking differences between depth of eye sockets and shape of temporal
area just behind outer edges of eyes.

DNA testing

            DNA testing in 1999 at BOLD, a forensic DNA lab in Vancouver, British Columbia found standard X and Y chromosomes in two samples taken from the skull, "conclusive evidence that the child was not only human (and male), but both of his parents must have been human as well, for each must have contributed one of the human sex chromosomes".Further DNA testing at Trace Genetics, which specializes in extracting DNA from ancient samples, in 2003 recovered mitochondrial DNA from both skulls. The child belongs to haplogroup C. Since mitochondrial DNA is inherited exclusively from the mother, it makes it possible to trace the offspring's maternal lineage. The DNA test therefore confirmed that the child's mother was a Haplogroup C human female. The adult female belongs to haplogroup A. Both haplotypes are characteristic Native American haplogroups, but the different haplogroup for each skull indicates that the adult female was not the child's mother. Trace Genetics obtained nuclear DNA, which contains chromosomes from both the father and the mother, from the adult female, but was not able to recover useful lengths of nuclear DNA or Y-chromosomal DNA of the father from the Starchild skull, despite conducting six consecutive tests. The founders of Trace Genetics stated that "[t]he inability to analyze nuclear DNA indicates that such DNA is either not present or present in sufficiently low copy number to prevent PCR analysis using methods available at the present time."

Explanations

Potential explanations for the skull's unusual features, apart from the alien-hybrid hypothesis, include the use of cradle boarding on a hydrocephalic child,brachycephaly and Crouzon syndrome.

 

The Importance of Antioxidants

The prefix "anti" means against, in opposition to, or corrective in nature. In order to understand antioxidants, it helps to learn what exactly these agents oppose and correct. Within the human body, millions of processes are occurring at all times. These processes require oxygen. Unfortunately, that same life giving oxygen can create harmful side effects, or oxidant substances, which cause cell damage and lead to chronic disease. Oxidants, commonly known as "free radicals," are also introduced through external sources such as exposure to the sun or pollution. Other mediums include stress, as well as things that people put into their bodies, such as alcoholic beverages, unhealthy foods, and cigarette smoke. In much the same way as oxidation creates rust, causing a breakdown on the surface of inanimate objects, oxidation inside the body causes a breakdown of cells. Free radicals produced by this breakdown attack healthy cells, usually DNA as well as proteins and fats. This chain of events weakens immunological functions as well as speeding up the aging process, and is also linked to several diseases such as cataracts, various forms of cancer, and heart disease. Some studies indicate possible links to arthritis and several other chronic conditions.

15 Houseplants for Improving Indoor Air Quality

In the late '80s, NASA and the Associated Landscape Contractors of America studied houseplants as a way to purify the air in space facilities.

• They found several plants that filter out common volatile organic compounds . Lucky for us the plants can also help clean indoor air on Earth, which is typically far more polluted than outdoor air. 
• Other studies have since been published in the Journal of American Society of Horticultural Science further proving the science.

      Aloe (Aloe vera)

This easy-to-grow, sun-loving succulent helps clear formaldehyde and benzene, which can be a byproduct of chemical-based cleaners, paints and more. Aloe is a smart choice for a sunny kitchen window. Beyond its air-clearing abilities, the gel inside an aloe plant can help heal cuts and burns.

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          Spider plant (Chlorophytum comosum)

Even if you tend to neglect houseplants, you’ll have a hard time killing this resilient plant. With lots of rich foliage and tiny white flowers, the spider plant battles benzene, formaldehyde, carbon monoxide and xylene, a solvent used in the leather, rubber and printing industries.

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Gerber daisy (Gerbera jamesonii)

This bright, flowering plant is effective at removing trichloroethylene, which you may bring home with your dry cleaning. It’s also good for filtering out the benzene that comes with inks. Add one to your laundry room or bedroom — presuming you can give it lots of light.

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Snake plant (Sansevieria trifasciata 'Laurentii')

Also known as mother-in-law’s tongue, this plant is one of the best for filtering out formaldehyde, which is common in cleaning products, toilet paper, tissues and personal care products. Put one in your bathroom — it’ll thrive with low light and steamy humid conditions while helping filter out air pollutants.

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Golden pothos (Scindapsus aures)

Another powerful plant for tackling formaldehyde, this fast-growing vine will create a cascade of green from a hanging basket. Consider it for your garage since car exhaust is filled with formaldehyde. (Bonus: Golden pothos, also know as devil’s ivy, stays green even when kept in the dark.)

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Chrysanthemum (Chrysantheium morifolium)

The colorful flowers of a mum can do a lot more than brighten a home office or living room; the blooms also help filter out benzene, which is commonly found in glue, paint, plastics and detergent. This plant loves bright light, and to encourage buds to open, you’ll need to find a spot near an open window with direct sunlight.

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Red-edged dracaena (Dracaena marginata)

The red edges of this easy dracaena bring a pop of color, and the shrub can grow to reach your ceiling. This plant is best for removing xylene, trichloroethylene and formaldehyde, which can be introduced to indoor air through lacquers, varnishes and gasoline.

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Weeping fig (Ficus benjamina)

A ficus in your living room can help filter out pollutants that typically accompany carpeting and furniture such as formaldehyde, benzene and trichloroethylene. Caring for a ficus can be tricky, but once you get the watering and light conditions right, they will last a long time.

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Azalea (Rhododendron simsii)

Bring this beautiful flowering shrub into your home to combat formaldehyde from sources such as plywood or foam insulation. Because azaleas do best in cool areas around 60 to 65 degrees, they’re a good option for improving indoor air in your basement if you can find a bright spot.

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English ivy (Hedera helix)

A study found that the plant reduces airborne fecal-matter particles. It has also been shown to filter out formaldehyde found in some household cleaning products.

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Warneck dracaena (Dracaena deremensis 'Warneckii')

Combat pollutants associated with varnishes and oils with this dracaena. The Warneckii grows inside easily, even without direct sunlight. With striped leaves forming clusters atop a thin stem, this houseplant can be striking, especially if it reaches its potential height of 12 feet.

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Chinese evergreen (Aglaonema Crispum 'Deborah')

This easy-to-care-for plant can help filter out a variety of air pollutants and begins to remove more toxins as time and exposure continues. Even with low light, it will produce blooms and red berries.

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Bamboo palm (Chamaedorea sefritzii)

Also known as the reed palm, this small palm thrives in shady indoor spaces and often produces flowers and small berries. It tops the list of plants best for filtering out both benzene and trichloroethylene. They’re also a good choice for placing around furniture that could be off-gassing formaldehyde.

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Heart leaf philodendron (Philodendron oxycardium)

This climbing vine plant isn’t a good option if you have kids or pets — it's toxic when eaten, but it's a workhorse for removing all kinds of VOCs. Philodendrons are particularly good at battling formaldehyde from sources like particleboard.

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Peace lily (Spathiphyllum 'Mauna Loa')

Shade and weekly watering are all the peace lily needs to survive and produce blooms. It topped NASA’s list for removing all three of most common VOCs — formaldehyde, benzene and trichloroethylene. It can also combat toluene and xylene.

Creative Ads: Toronto Plastic Surgery

Thanks to the success of US television shows like Extreme Makeover, plastic surgery is fast becoming the norm. The latest advertising campaign for Canadian surgery ‘Toronto Plastic Surgery’ takes it one step further. Ad agency DDB Canada dreamed up this clever idea - allowing consumers to test-drive a new nose shape while drinking their coffee. We love it. 

#Ad. : Do You Know First Aid?

To raise awareness around World First Aid Day,  ad agency 'Downtown Partners' placed life size realistic decals of a person at the bottom stairwells in Cineplex Odeon Theatres in Toronto. At first, the decal generates the impression that someone is lying down unconscious and needs help, but as you get closer, you'll realize it's just a picture on the floor with a call to action to visit www.redcross.ca for a first aid training course. Let's hope it doesn't freak someone out and give them a heart attack first.

Medical Abortion : What is the Abortion Pill?

When a woman becomes pregnant, she is posed with a question. She must decide whether or not she is ready to bring new life into the world. It is one of the most monumental moments in a woman’s life and a decision that brings together her past, her present and her future dreams.

For many women, the answer is crystal clear: No, it is not time. Or, yes, she is ready to become a mother. For others, the answer is far less certain. There are many questions that must be answered, many emotions that must be explored. Ultimately, the choice should come from a loving heart and a clear head. You know your life situation best and will make the decision that is not only best for yourself but for those who already depend on you.

If you are pregnant and unsure of your path, i encourage you to involve someone – a relative, partner, friend, religious advisor, a physician or someone you trust to talk about the options in front of you. 

Making a choice about your pregnancy can be a gift of learning and growth. It is an invitation for you to develop a larger vision of yourself. It’s a way to practice compassion and loving kindness toward yourself.” from “Abortion: Finding Your Own Truth” by Corrintha Rebecca Bennett, Religious Coalition for Reproductive Choice


Decisions
If you are having a hard time, you will probably need to spend time identifying and sorting out your feelings about this experience. When pregnancy occurs, you may feel as if your entire past, present and future are up for examination. So, feelings about abortion may also have a great deal to do with other issues in your life that have not been addressed.

• Write a list of why you want an abortion and why you do not. Some of your reasons will be emotional, some will be more rational. Seeing these reasons on paper often helps you “see” the path towards a more clear decision.
• Write a letter to yourself. If there are people who oppose your decision or if you are worried about regretting it later, take some time now to write about why you would make the choice of abortion and how you feel about ending this pregnancy. Save this to read at a later date if you need to.
• “Pregnant? Need Help? Pregnancy Options Workbook” This great booklet was developed by Margaret Johnston, Director, Southern Tier Women’s Services in Binghamton, NY. Here, you will get help seeing the realistic picture of all your choices–abortion, adoption and parenthood. Included are exercises and rituals which help the decision-making process. This workbook is available, free of charge, at Northland Family Planning Centers or go to Pregnancy Options Workbook.

Women who are willing to explore how they feel and what they think can come to a peaceful resolution about their pregnancy. To get there, you must be willing to work at it. The exercises offered by the counselors at Northland Family Centers or in the workbook, mean you must do some soul searching and do some “homework.” It may be the most important assignment you ever do.

Listen to your heart and your own voice to find the right answer.

Medical abortion treatment

Medical abortion or the abortion pill (also known as ‘early abortion’) is an alternative to surgical abortion . This type of abortion means taking two sets of pills (orally) over two visits (this can be on the same day or separate days) which causes the passing of the pregnancy.

You may experience discomfort, very strong cramps and heavy bleeding with medical abortion (the abortion pill). This normally lasts for a few days until the pregnancy has passed.
The abortion starts within 4-5 hours after taking the second set of tablets and is usually completed within one to two days of taking the tablets. Very occasionally it can take up to two weeks to pass the pregnancy.

Visit 1: During your first visit you will have your consultation, be given your first tablet and an appointment will be made for you to return to the clinic (either later that day or at some point over the next 48 hours) for the second set of tablets.

Visit 2: During your second visit you will take your second set of tablets and will be given detailed aftercare advice and information.

Two different types of medication are used for medical abortion Mifegynae and Misoprostol which have been found to be effective in causing a pregnancy to pass.

Not all women are suitable for medical abortion and you will not be able to choose this method if you:

• Are over 35 and smoke more than 10 cigarettes a day

• Have a suspected ectopic pregnancy

• Have a history of heart disease, high blood pressure, liver or kidney disease

• Are taking long term anti corticosteroids

• Have an IUD in place which will not be removed

• Have adrenal failure

• Are taking anti-coagulants or have any hemorrhagic disease or porphyria

• Have a poorly controlled inflammatory bowel disease

The failure rate for early medical abortion is between 2 to 3% (2-3 women out of 100)

Abortion aftercare Before you leave a  clinic after your second visit a team member will check how you are feeling and talk you through any specific aftercare information that you need to know. You will also be given a booklet with aftercare information in to take away with you and it is important that you read this. Should you have any worries or concerns about anything after your abortion treatment please call our specialist nurse advisors on 1 who will be on hand to offer advice and support 24 hours.

Read More:
 http://www.earlyoptionpill.com/
 http://www.emedicinehealth.com/abortion/article_em.htm
http://www.plannedparenthood.org/health-topics/abortion/abortion-pill-medication-abortion-4354.asp
http://www.fwhc.org/abortion/medical-ab.htm

Is Abortion a Medical issue or is it a Moral issue or a Legal issue?

Click the link below to view the question and/or answer it:
http://www.medpedia.com/questions/2420-is-abortion-a-medical-issue-or-is-it-a-moral-issue-or-a-legal-issue

Consequences of 'Foot Binding' among Women in China

               Foot binding  was a custom practiced on young girls and women for approximately one thousand years in China, beginning in the 10th century and ending in the first half of 20th century.
Foot-binding resulted in lifelong disabilities for most of its practitioners. As the practice waned in the early 20th century, "some girls' feet were released after initial binding, leaving less severe deformities," according to a study conducted by the University of California, San Francisco. However, some effects of foot-binding were permanent, especially if a girl's arches or toes had been broken or other drastic measures taken in order to achieve the desired smallness. In the 1990s and early 2000s, some elderly (born until mid-1940s) Chinese women still suffered from disabilities related to bound feet.


Legend has it that the origins of footbinding go back as far as the Shang dynasty (1700-1027 B.C.). The Shang Empress had a clubfoot, so she demanded that footbinding be made compulsory in the court.
But historical records from the Song dynasty (960-1279 A.D.) date footbinding as beginning during the reign of Li Yu, who ruled over one region of China between 961-975. It is said his heart was captured by a concubine, Yao Niang, a talented dancer who bound her feet to suggest the shape of a new moon and performed a "lotus dance."

During subsequent dynasties, footbinding became more popular and spread from court circles to the wealthy. Eventually, it moved from the cities to the countryside, where young girls realized that binding their feet could be their passport to social mobility and increased wealth.

• However, there is little strong textual evidence for the custom prior to the court of the Southern Tang dynasty in Nanjing, which celebrated the fame of its dancing girls, renowned for their tiny feet and beautiful bow shoes. What is clear is that foot binding was first practised among the elite and only in the wealthiest parts of China, which suggests that binding the feet of well-born girls represented their freedom from manual labor and, at the same time, the ability of their husbands to afford wives who did not need to work, who existed solely to serve their men and direct household servants while performing no labor themselves.
  
  
  • When the Manchu nobility came to power in 1644, they tried to ban the practice, but with little success. The first anti-footbinding committee was formed in Shanghai by a British priest in 1874.
            But the practice wasn't outlawed until 1912, when the Qing dynasty had already been toppled    by a revolution. Beginning in 1915, government inspectors could levy fines on those who continued to bind their feet. But despite these measures, footbinding still continued in various parts of the country.
  
  
  • A year after the Communists came to power in 1949, they too issued their own ban on footbinding. According to the American author William Rossi, who wrote The Sex Life of the Foot and Shoe, 40 percent to 50 percent of Chinese women had bound feet in the 19th century. For the upper classes, the figure was almost 100 percent.
  
  Some estimate that as many as 2 million Chinese women broke and bound their feet to attain this agonizing ideal of physical perfection. Author Yang Yang says that women with tiny feet were a status symbol who would bring honor upon the entire clan by their appearance.
• The economic and social attractions of such women may well have translated into sexual desirability among elite men.

And 86-year-old Zhou Guizhen says, "At that time everybody had bound feet. If you didn't, you'd only be able to marry a tribesman from an ethnic minority."

• These women disfigured their feet to guarantee their own future, but according to Yang Yang, this act ultimately consigned them to tragic lives. Most of Liuyicun's bound-feet women were forced to perform hard physical labor in the late 1950s, digging reservoirs, for example — work which was punishing enough for ordinary women, but agonizing for those with tiny, misshapen feet.
  Their families also suffered food shortages as they were often unable to fulfill their production quotas at work, or walk into the mountains to pick vegetables and fruit like other mothers.
  "Their tiny feet sealed their tragic fates," Yang says

Consequences of foot binding among women in China

A case study of Chinese bound feet: application of footprint analysis:  Foot print patterns of the bound feet of a 90-year-old Chinese female were made to obtain insight into the ergonomic consequences of a Chinese custom that caused significant disabilities for many women throughout history. Pressure patterns were evaluated using the techniques applied to standard thumb print analysis. 

A digital summary of the pressure patterns were compared to the patterns obtained from a normal subject. The outcomes indicated that the bound foot produced greater plantar tissue pressures than the non-bound foot. These observations help explain the discomfort, gait abnormalities, and disabilities exhibited by many older women with bound feet living in China today. Although foot-binding is no longer practiced, this study offers an ergonomic perspective on a custom practiced in China for centuries.

Sources:
Case: More Pictures http://fabulously40.com/article/id/honey-i-shrunk-your-feet-2360
http://www.sfmuseum.org/chin/foot.html
http://www.npr.org/templates/story/story.php?storyId=8966942
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1381134/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1381134/pdf/amjph00509-0103.pdf

Support a Charity Just by Watching YouTube

• Do Something - Thumb Wars PSA

BroadbandTV Corp. recently launched a YouTube destination to get your social good on. The site, named VISO Give, aggregates pre-existing video content from non-profits, sorts it by company name and type of cause, and lets you watch or search for your favorites.

VISO Give features videos from celebrities like the cast members of Community asking you not to text while driving, Usher speaking about getting out the vote and Nick Jonas promoting music education outreach on behalf of DoSomething.org. However, the channel also gives equal billing to smaller non-profits like a bobcat rescue or regional homeless job centers that might not have the same exposure or celebrity backing.


What makes the site interesting is its emphasis on providing a service not just to users looking for videos, but to the non-profits looking for help. Charities usually have to fight for two things: exposure and funding. VISO Give helps with both. VISO, the consumer branch of BroadbandTV, already rakes in more than 1 billion impressions through YouTube, via its video game and movie trailers channels. That built-in fan base will hopefully convert to the new channel and send new eyeballs to non-profits of all sizes.

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• Big Cat Rescue - Bobcat Kittens!

The channel also aims to help with funding by giving 60% of the non-profits’ associated ad revenue. The other 40% will be reinvested in the channel. While YouTube ad revenue is notoriously low (think: pennies per view), that number can quickly add up with enough views. Essentially, every time you watch a video on VISO Give, you’re indirectly donating to that charity. To help, there will be additional direct donation links posted with each video.

          There’s always the worry that big brands with aggregation services will end up co-opting content from their smaller content providers — using the videos to drive traffic to their own sites. However, it’s free for non-profits to sign up and VISO Give has intelligently made the channel non-exclusive, meaning non-profits can post or place their videos on rival sites or keep them native. It’s a nice move by VISO and BroadbandTV and reinforces the idea that the channel is there to help.
VISO Give has already partnered with a number of non-profits, including Livestrong and the United Way, but hopes to expand and grow its catalogue.
What do you think? Is VISO Give something you’d check out? What’s the merit of potentially passive philanthropy like this, as opposed to direct fundraising or awareness campaigns? Let us know in the comments below.

Causes of Amenorrhea

What is Amenorrhea?
Amenorrhea is the absence of menstrual bleeding. Amenorrhea is a normal feature in :

• prepubertal, 
• pregnant,
• postmenopausal females.

In females of reproductive age, diagnosing amenorrhea is a matter of first determining whether pregnancy is the etiology. In the absence of pregnancy, the challenge is to determine the exact cause of absent menses. This article reviews the physiologic aspects of menstruation and presents an approach for ascertaining the etiology of amenorrhea. Only the main components of amenorrhea are highlighted. Many minor components of physiology are important but are beyond the scope of this article.

Pathophysiology

The menstrual cycle is an orderly progression of hormonal events in the female body that results in the release of an egg. Menstruation occurs when an egg released by the ovary remains unfertilized; subsequently, the soggy decidua of the endometrium (which was primed to receive a fertilized egg) is sloughed in a flow of menses in preparation for another cycle.

The menstrual cycle can be divided into 3 physiologic phases: follicular, ovulatory, and luteal. Each phase has a distinct hormonal secretory milieu. When one diagnoses the disease processes responsible for amenorrhea, consideration of the target organs of these reproductive hormones (hypothalamus, pituitary, ovary, uterus) is helpful.

Primary and Secondary Amenorrhea

Primary amenorrhea is defined either as absence of menses by age 14 years with the absence of growth or development of secondary sexual characteristics (eg, breast development) or as absence of menses by age 16 years with normal development of secondary sexual characteristics.

Secondary amenorrhea is defined as the cessation of menstruation for at least 6 months or for at least 3 of the previous 3 cycle intervals. Because only 3 diagnoses are unique to primary amenorrhea and never cause secondary amenorrhea, differentiating primary from secondary amenorrhea does little to enhance the clinician's understanding of the etiology.

The causes of amenorrhea are listed below. Organize clinical evaluation on the basis of sexual development and basic developmental physiology. With such a vast differential diagnosis, one way to organize and memorize the causes of amenorrhea can be in its relationships with generalized pubertal delay, normal pubertal development, or abnormalities of the genital tract.

Causes of amenorrhea

Amenorrhea can be caused by any number of changes in the organs, glands, and hormones involved in menstruation.

Possible causes of primary amenorrhea (when a woman never gets her first period) include:

• Failure of the ovaries (female sex organs that hold eggs).
• Problems in the central nervous system (brain and spinal cord) or the pituitary gland (a gland in the brain that makes hormones involved in menstruation).
• Poorly formed reproductive organs.

In many cases, the cause of primary amenorrhea is not known.

Common causes of secondary amenorrhea (when a woman who has had normal periods stops getting them) include:

• Pregnancy
• Breast feeding
• Stopping the use of birth control
• Menopause
• Some birth control methods, such as Depo-Provera

Other causes of secondary amenorrhea include:

• Stress
• Poor nutrition
• Depression
• Certain drugs
• Extreme weight loss
• Over-exercising
• Ongoing illness
• Sudden weight gain or being very overweight (obesity)
• Hormonal imbalance due to polycystic ovarian syndrome (PCOS)
• Thyroid gland disorders
• Tumors on the ovaries or brain (rare)

A woman who has had her uterus or ovaries removed will also stop menstruating.

 Sources:

http://www.mayoclinic.com/health/amenorrhea/DS00581/DSECTION=causes 

http://emedicine.medscape.com/article/953850-overview

http://www.medicinenet.com/amenorrhea/article.htm