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Description of study design Systematic review with homogeneity ; of randomized clinical trials Individual randomized clinical trials with narrow confidence interval ; All or none all patients died before the drug became available, but some now survive on it; or when some patients died before the drug became available, but none now die on it. ; Systematic review with homogeneity ; of cohort studies Individual cohort study including low quality randomized clinical trial ; "Outcomes" research Systemic review with homogeneity ; of case-control studies Individual case-control study Case series, single case reports and poor quality cohort and case control studies ; Expert opinion without explicit critical appraisal or based on physiology or bench research Abstracts.
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European Commission's work in the field of nutrition. I will also present some of the background and the reasons that put nutrition higher on the political agenda of the European Union, before I move on to talk more in detail about the process leading to the development of a Status report on the European Commission's work in the field of nutrition. I will also talk a bit about other developments in the field of nutrition before I finalise by saying some words about the possible developments an actions in the nutrition field in the future. I will mainly talk about public health nutrition issues, leaving food safety and food security issues aside this time. Not because I do not think these are important, but because time is limited, and I have been working mostly with public health nutrition. Since I no longer work for the European Commission, the statements below should be taken as such, representing my personal perspective on these issues, and not necessarily the European Commission's official view on the subject matter. The Community is currently experiencing a high prevalence of non-communicable diseases, such as cancer, cardiovascular disease, diabetes, and obesity, to mention a few. This is due to the interaction of various genetic, environmental and lifestyle factors including smoking, unhealthy diets and a lack of physical activity. Nutrition and physical activity are thus key determinants for several of the public health problems of significance in Europe, among these, obesity. The legal base for action in the field of public health is article 152 of the Amsterdam Treaty. By the Amsterdam Treaty, the legal base for public health was strengthened, and in particular, the responsibility for other Directorates-General to take health issues into account when defining and implementing their policy, was stressed. However, nutrition has been dealt with in the Commission before the Amsterdam treaty was adopted in 1999, since the Maastricht Treaty gave public health a legal base for the first time. New elements in article 129 of this Treaty were "contributing to a high level of health", "encouraging cooperation among Member States", "prevention of diseases", and incentive measures". No harmonisation of laws and regulations was included. To respond to these new obligations, the Commission presented its Communication on the Framework for Action in the Field of Public Health. Key elements were the establishment of eight Public Health Programmes, which together would represent such a Framework. Thus, nutrition was already dealt with both under the health promotion programme, the health monitoring programme, and under the cancer programme, where several projects on nutrition were funded. Among these projects, Eurodiet, the French initiative and the EPIC study on cancer and nutrition. The Eurodiet project 19982000.
SIC 3953: Marking Devices Establishments primarily engaged in manufacturing rubber and metal hand-stamps, dies, and seals; steel letters and figures; and stencils for use in painting or marking. Establishments primarily engaged in manufacturing felt tip markers are classified in Industry 3951.
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In 1995, the largest epidemiological study on sjs and ten, partially funded by drug companies was published in the new england journal of medicine by the severe cutaneous adverse reaction study group scar ; , which was an international case-control study to evaluate the relative risks of drugs associated with sjs and ten and clonazepam.
Study of the first line chemotherapy comparing AC adriamycin and cyclophosphamide ; and docetaxel in metastatic breast cancer patients. 441 patients were accrued and now are on following-up. Three neoadjuvant trials are active and DNA microarray is analyzed as ancillary study respectively. In the field of gynecological cancer, multi-institutional trials of chemotherapy are actively conducted. For the frontline chemotherapy against ovarian cancer, randomized trial of conventional paclitaxel and carboplatin vs. dose-dense weekly paclitaxel and carboplatin is activated. In addition to these active trials, a phase III trial of cisplatin and paclitaxel vs. carboplatin and paclitaxel for metastatic cervical cancer, and a phase II trial for sarcoma patients as a investigator initiated IND Investigational New Drug ; trial are prepared for activating in 2004.
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Information on quality comes mostly from observations of the actual delivery of FP services, supplemented with information from provider interviews and client exit interviews. The Bruce-Jain model of six dimensions of quality that is widely used in the field of FP provides conceptual guidance for the review of quality Bruce 1990 ; . These critical dimensions are client-provider relations, information exchange, choice of method, provider competence, follow-up mechanisms, and an appropriate constellation and integration of services. Observations are limited to clients who are new, restarting, or switching methods because the Bruce-Jain model is more clearly relevant to these clients, who are expected to have full counseling. The evaluation of services to continuing clients is more complex and difficult to compare to a standard. This is because these clients' counseling needs vary greatly, since services to them depend on how long they have been using services, whether they have had problems with their contraceptive method, whether they may want to switch or stop their method, or whether they only want a resupply of their method.
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ABSTRACTS of others especially Burger, Talbott ; the technical characteristics of a new "floating" table ballistocardiograph are described. The ballistocardiograms obtained with this instrument are illustrated. The 3 main deflections, corresponding to the H, I, and J deflections of other instruments, are interpreted on the basis of differences in volume and time of blood movements to the supra- and infra-cardiae segments of the body, and therefore of displacement of the center of gravity, projected on the longitudinal axis. The physical principles of ballistocardiography are briefly reviewed. CALABRESI.
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Figure 1.2 provides visualizations of the parameters a, b ; of the procedures Qa, b left ; and of the corresponding points S 0, Qa, b ; , S 1, Qa, b right ; . Table 1.3 gives details about the following specific points. Point A The naive procedure Q1 3, 1 2 has already been discussed at the beginning of the previous section. It corresponds to the idea that the probabilities q2 2 ; q2 have to be assigned if x 2 because 2, 4 and 6 are equiprobable if Strategy 3 1 is chosen ; and that the probabilities q3 3 ; q3 have to be assigned if x 3 because 3 and 6 are possible and equiprobable if Strategy 0 is used ; . The snake in the grass is that if x 2, and Strategy 0 would have been chosen in case y 6, then 2, 4 and 6 are not equiprobable at all, because y 6 is impossible. A similar argument holds for x 3, if Strategy 1 would have been chosen in case y 6. It very difficult for some probabilists to accept that the information `the die is fair, the number of eyes is even' does not imply that the outcomes 2, 4 and 6 are equiprobable. In the present context such a probabilist will be less unwilling to deviate from that what he regards as the foundations of Probability Theory than in, e.g., the quiz-master's problem. The reason is that we can present a precise analysis of the situation. The crux is, of course, that the source of the information `the number of eyes is even' ; has to be made part of the probabilistic model. In the present Fisher-Neyman-PearsonWald approach this is done by referring to the true but unknown number i of the strategy which Player I would apply if he would have been confronted by y 6. follows from the discussion that the naive procedure Q1 3, 1 2 represented by A is not appropriate: a should be larger than 1 and b larger than 1 . How much larger, that 3 2 is the question.
There is much clinical interest and considerable research activity in developing effective local applications of vasoactive agents to the penis to produce good quality erections without systemic side-effects in the patient or his partner. Locally applied, rapidly absorbed preparations will probably have a role to play. Combination therapy has to date not been studied extensively. The potential of using centrally acting drugs and peripherally acting agents delivered orally in combination with locally applied preparations in the more clinically challenging patient is potentially an exciting therapeutic opportunity. Much has already been achieved in the field of andrological research and it is highly likely that further preparations will become available in the very near future. It is important that general practitioners overcome their inhibitions and question their patients about their sex lives, particularly in the presence of common predisposing factors, including cardiovascular disease, hypertension, diabetes, depression and the use of a variety of medications and depakote.
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Info Dr. F.A.M. Redegeld, Utrecht Institute for Pharmaceutical Sciences, Department of Pharmacology and Pathophysiology, PO Box 80082, 3508 TB Utrecht, The Netherlands. tel 31 30 253 f.a.m.redegeld pharm.uu.nl and detrol.
Pharmacol ther 64 : 127-5 1994.
TABLE 3. Summary of ANOVA results and diazepam and climara.
62 HEALTH AFFAIRS even relatively small groups. At the core of all these matters is the question of how and to whom access shall be accorded. It is here that the French government has moved to stake out its role. In his review of the French report, Joseph Coates nearly begged for some American center of power to take on the task of developing an American policy. It does not now seem possible to develop any policy in the health field that fails to develop telematics policy as well. How access to the emerging telematic nets in the health field are organized and assured is an important area of concern. Some Future Applications Five different telematic technologies chosen essentially at random from the growing field ; in the health area offer illustrations of how they might be used as well as the issues they raise. The Videodisk PPI. Joseph Coates has suggested that the patient package insert PPI ; problem being debated for the second decade by the Food and Drug Administration FDA ; might be solved by creating a special low-priced market ten to fifty cents per piece ; for a videodisc the size of a quarter or smaller that could be sold with, or separately from, any drug. This would explain in sound and visual images how the drug is expected to work, its potential side effects, and how to monitor these side effects. If this were voluntary and a significant number of consumers bought such devices, the competition among drug companies, publishing houses, and recording studios to produce the most effective information would enrich the policy debate, and the level of medical knowledge provided to the public would be far more than has been provided by the patient package insert debate of the last twelve years. The Home Computer Health Adviser. International Resource Development, Inc., provides the following image of computer-aided health information: Good morning and congratulations. This is your friendly computer again, with the news that you have increased your life expectancy by a full two years since you bought me. This morning I recommend that you jog steadily for 3.7 miles, and I would advise against having 14 more than one egg for breakfast. Personal health software that combines diet, exercise, and stress monitoring will allow users to establish their own biochemical profiles. Consumers would have a better idea of the efficacy and side effects of particular drugs for themselves, as well as the ways in which nutrition and other factors interact with those drugs.
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Menopause, or cessation of menses due to ovarian failure, typically occurs between 41-59 years of age, with 51 years as the median age. The menopausal transition period is typically associated with irregular and heavy bleeding, vasomotor symptoms such as hot flashes and night sweats, and or urogenital symptoms such as dysuria, urgency, urge incontinence, urinary frequency, and nocturia.1 For most women, these symptoms are usually mild and of short duration, subsiding within five years.2 Hormone replacement therapy HRT ; with estrogens, alone or in combination with progestins, is the most effective treatment for the relief of these menopausal symptoms. HRT has been shown to reduce the frequency of hot flashes and other symptoms of menopause by more than 70%.3 Long-term use of HRT greater than five years ; has been used for the past two decades for the prevention of chronic diseases, such as coronary heart disease CHD ; and osteoporosis. This is based on over 40 observational studies which showed a risk reduction of CHD by 35%-50%, vertebral fracture by 50%, hip fracture by 25%-30%, colorectal cancer by 20%, and an increase in bone mineral density by 2%-5% with the use of hormone therapy.3 However, recently, randomized controlled trials failed to show a cardioprotective effect with estrogens. On the contrary, the estrogen plus progestin substudy of the Women's Health Initiative WHI ; was stopped early due to findings of increased incidences of coronary heart disease CHD ; , stroke, venous thromboembolic disease, and invasive breast cancers.4 The estrogen alone substudy of the WHI was also stopped early due to findings of an increased risk of stroke and no reduction in risk of CHD.5 The Heart and Estrogen Progestin Replacement Study HERS ; also showed an increased relative risk of gallbladder disease by 1.4 and venous thromboembolism by 2.7.3 Many medical associations and authorities now recommend using HRT to treat menopausal symptoms only and at the lowest effective dose of hormone for the shortest duration of treatment, while weighing the benefits versus the risks for each individual woman. HRT is not recommended for the prevention of chronic diseases such as CHD or osteoporosis.6-17 Table 1 lists the single entity estrogens included in this review. This review encompasses all dosage forms and strengths. Estradiol and estropipate are available generically as oral tablets and estradiol is also available generically by the transdermal route. In accordance with Preferred Drug Legislation, this review does not include information on Enjuvia synthetic conjugated estrogens, B ; because it has not been on the market for at least 6 months. This medication will be reviewed at a future time. Table 1. Single Entity Estrogens Included in this Review Generic Name Formulation s ; Example Brand Name s ; chlorotrianisene capsule Tace dienestrol vaginal cream Ortho-Dienestrol diethylstilbestrol tablet, injection Stilphostrol estradiol tablet, topical emulsion, Alora, Climara * , topical gel, transdermal Esclim, Estrace * , patch, vaginal cream, Estraderm, Estrasorb, vaginal ring, vaginal Estring, Estrogel, 1.
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However, it is important to remember that the long-term effects of this class of drugs on cardiovascular disease are unknown and that side effects such as weight gain, fluid retention and unfavourable effects on lipids limit their use in some patients.
The pure and clear form of classic mania is typified by at least a week of dramatically decreased need for sleep, decreased need for eating, being too energized with fabulous new ideas or creative projects to pursue to have time to waste on such mundane tasks as eating or sleeping, thoughts that come so fast “ racing” that the mouth or writing can’ t keep up, talking so fast “ pressured” others can’ t get a word in edgewise, the ideas though seeming logical to the manic are expressed and change so quickly that others can’ t follow the “ flight of ideas” , the manic is so overwhelmed by urges and thoughts that he or she is very easily distracted, social judgment is lost, the person becomes overly sexual, spends money excessively and unwisely, the manic’ s mood is euphoric and elated “ happier than happy” or very very irritable, the view of self is now “ grandiose” such that he or she believe the normal rules of life no longer apply to him or her.
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Time-limited group behavioral treatment leads to significant improvement in OC symptoms, as measured by the YBOCS, in patients who complete the group either alone or as an adjunct to pharmacotherapy. However, the patients who were on medication showed a greater improvement than those who were medication-free. This finding stands in contrast to recent preliminary findings of Foa et al., 18 who noted no extra benefit from adding medication to a behavioral therapy regimen. Confidence in our finding of greater improvement in group participants who were on medication, however, must be tempered by the comparatively small sample size of the unmedicated group n 15 ; . Although our results about combined medication and behavioral treatment are interesting, unfortunately no specific measures of the adequacy of the pharmacotherapy, in terms of either duration or dose, were made. Thus, it is not possible to determine whether.
In the intervening years doctors continued to prescribe a drug to tens of thousands of vulnerable children, ignorant of the fact that it had not been shown to work and was harmful to some.
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Healthy lifestyle A systematic review of exercise health promotion strategies concluded that public health strategies aimed at changing the environment to encourage walking and cycling would reach a greater proportion of the inactive population than strategies aimed at increasing use of exercise facilities.202 While eating more fresh fruit and vegetables has been shown to be associated with a lower risk of stroke, 203 health effects of changes in consumption have not been demonstrated through trials. Public health strategies to reduce salt consumption such as reducing salt content in processed foods may have an impact on blood pressure see chapter on hypertension ; .204.
Lia Boldt is supportedby an amicus brief from Doctors Opposinp Circumcision "DOC" ; who similarly arguethat a custodial parent should not be allowed to authorize routine circumcision for his child if his motivations are religious. They arguethat children possess rights to protect them from all medical intervention on the part of the parents. They arguethat theserights are derived from a ; the statutesfOrbidding female genital mutilation, which should be extendedto cover routine male circlrmcision so that they do not discriminate againstmales; b ; the International Covenanton Civil and Political Rights; c ; the guidelines of the Bioethics committee of the Arherican Academy of Pediatricsand a Bioethics Textbook; and d ; ill-defined due processrights. They also arguethat the child in this circumstanceis an unreliable sourcefor determining his own true intentions and, as a result, they requestthe appointmentof a guardian ad litem. Amici submit that the decision by a custodialparent to conduct a religiouslymotivated circumcision cannot, in and of itself, be the basis for denying custody, changinga custody order, appointing a guardian ad litem for a child, ot even holding a hearing on theseissues. The record revealsthat in a different proceedingnot on appeal here, the Circuit Court conducteda fulI custody hearing where it appropriately considered the best interestsof the child and determinedthat the father was to have sole custody. That decision was upheld on appeal. The issue of who is the more capableor fit parent, basedon any considerationother than the questionof the circumcision, is thereforenot before this Court.u It ir the position of amici that routine male circumcision is precisely the extent the Court deemsthe questionof who is the more appropriateparent to have custody to be at issuein this appeal, amici take no position on that question. 6 To.
On the basis of limited and conflicting evidence on the use of beta blockers in non-q wave infarction, the american college of cardiology has given beta blockers a class iib designation usefulness efficacy is less well established by evidence opinion ; in the setting of non-q wave infarction.
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