By W. Frithjof. Life Pacific College.
Several types of studies have shown a relationship between fiber intake and diverticular disease buy cheap super viagra 160 mg. The data showed that the inverse relationship was particularly strong for the nonviscous Dietary Fiber buy 160 mg super viagra amex, particularly cellulose (Aldoori et al generic super viagra 160 mg without prescription. Case-control studies have consistently found that patients with diverticula consumed less Dietary Fiber than did nonpatients super viagra 160mg cheap. For example, Gear and coworkers (1979) reported on the prevalence of symptomless diverticular disease in vegetarians and nonvegetarians in England. Twelve percent of the vegetarians had diverticular disease compared with 33 per- cent of the nonvegetarians. Similarly, Manousos and coworkers (1985) reported a lower prevalence of diverticular disease in rural Greece compared with that found in urban areas. In addition, those individuals with diverticular dis- ease consumed fewer vegetables, brown bread, potatoes, and fruit. In an intervention trial, Findlay and coworkers (1974) showed a protective effect of unprocessed bran. In another study, Brodribb (1977) treated 18 patients with diverticular disease by providing either a high fiber, bran-containing bread (6. Relief of symptoms was significantly greater in the high fiber group compared with the low fiber control group. Although the mechanism by which fiber may be protective against diverticular disease is unknown, several hypotheses have been proposed. For example, some scientists report that it is due to decreased transit time, increased stool weight, and decreased intracolonic pressure with fiber supplementation (Cummings, 2000). The majority of the studies cited above show a relationship between Dietary Fiber and gastrointestinal health. There are data that show the benefits of certain Dietary and Functional Fibers on gastro- intestinal health, including the effect of fiber on duodenal ulcers, consti- pation, laxation, fecal weight, energy source for the colon, and prevention of diverticular disease. For duodenal ulcer and diverticular disease, the data are promising for a protective effect, but insufficient data exist at this time upon which to base a recommended intake level. It is clear that fiber fermentation products provide energy for colonocytes and other cells of the body, but again this is not sufficient to use as a basis for a recommen- dation for fiber intake. With regard to the known fecal bulking and laxative effects of certain fibers, these are very well documented in numerous studies. Epidemiological Studies Thun and coworkers (1992) found a significant inverse relation between the intake of citrus fruits, vegetables, and high fiber grains and colon cancer, although Dietary Fiber intake was not specifically analyzed. Fuchs and colleagues (1999) prospectively examined the relationship between Dietary Fiber intake and the risk of colon cancer in a large cohort of women. The same study group found a minimal nonsignificant inverse association in an earlier report that was based on 150 cases of colon cancer reported during 6 years of follow-up (Willett et al. Likewise, in six large, prospective studies, inverse associations between Dietary Fiber intake and the risk of colon cancer were weak or nonexistent (Giovannucci et al. Inverse relationships have been reported between Dietary Fiber intake and risk of colon cancer in some case-control studies (Bidoli et al. A critical review of 37 observational epide- miological studies and a meta-analysis of 23 case-control studies showed that the majority suggest that Dietary Fiber is protective against colon cancer, with an odds ratio of 0. Furthermore, a meta-analysis of case-control studies demonstrated a combined relative risk of 0. Lanza (1990) reviewed 48 epidemiological studies on the relationship between diets containing Total Fiber and colon cancer and found that 38 reported an inverse relationship, 7 reported no association, and 3 reported a direct association. In the Netherlands, Dietary Fiber intake was reported to be inversely related to total cancer deaths, as the 10-year cancer death rate was approximately threefold higher in individuals with low fiber intake compared with high fiber intake (Kromhout et al. Intervention Studies There have been a number of small clinical interventions addressing various surrogate markers for colon cancer, primarily changes in rectal cell proliferation and polyp recurrence. Generally, the small intervention trials have shown either no effect of fiber on the marker of choice or a very small effect. There was no overall decrease in rectal cell proliferation as a result of fiber supple- mentation unless the groups were divided into those with initially high and those with initially normal labeling indices. With this statistical division, there was a significant decrease in cell proliferation as a result of the fiber supplementation in six of the eight patients with initially high labeling indices and three of the eight patients with initially low indices, which suggests that wheat-bran fiber is protective against colon cancer. In a sepa- rate trial from the same group, supplemental dietary wheat-bran fiber (2.
By sending to the clipboard without selecting citations discount super viagra 160mg on-line, PubMed will add up to 500 citations of the search results to the clip- board super viagra 160 mg sale. Printing and saving When ready to save or print clipboard items it is best to change them to ordinary text to simplify the printout and save paper so it will not print all the PubMed motifs and icons discount 160mg super viagra fast delivery. To do this order 160 mg super viagra visa, click on “clipboard” on the features bar, which will show only the articles placed on the clipboard. From the send menu select “text” and a new page will be displayed which resembles an ordinary text document for printing. This “send to text” option can also be used for single references and will omit all the graphics. To save the entire set of search results click the display pull-down menu to select the desired format and then select “send to file” from the send menu. To save specific citations click on the check-box to the left of each citation, including other pages in the retrieval process, and when finished making all of the desired selections, select “send to file. It can also be used to send e-mail alerts, apply filters, and other customization features. General searching in PubMed The general search page in PubMed is useful to find evidence that is not coming up on the Clinical Queries search, or when looking for multiple papers by a single author who has written extensively in a single area of interest. Begin by clicking on the PubMed symbol in the top left-hand corner of the screen to display the general search screen (Fig. Simply type the search terms in the query box and your search results will be displayed as before. The search can then be refined by clicking on the term to bring up the detailed display (Fig. Clicking “search PubMed” will execute the search, which will automatically explode the term unless restricted by selecting the “do not explode this term” box. This will probably result in retrieval of about one-quarter of the articles retrieved in the previous search. A simple way to do this is that once a relevant citation has been found, click on the author link to view the abstract and then go to the “display” box and open it as shown in Fig. Linking to “related articles” will find other relevant citations, but the selected limits are not applied to this retrieval. If there was a search limited 46 Essential Evidence-Based Medicine Fig. These can be selected by lim- iting the search to one study design type in PubMed under the limit feature for publication types in the pull-down menu. An appropriate methodological filter may help confine the retrieved studies to primary research. For example, if searching whether a screening intervention reduces mortality from colorectal cancer, confine the retrieved studies to con- trolled trials. The idea of methodological terms as filters may be extended to Searching the medical literature 47 multiple terms that attempt to identify particular study types. Field searching It is possible to shorten the search time by searching in a specific field. This works well if there is a recent article by a particular author renowned for work in the area of interest or if a relevant study in a particular journal in the library has recently been published on the same topic. To search for an article with “colorectal cancer” in the title using PubMed, select the title field in the limits option using the fields pull-down menu in the “Tag Term” default tag for the selected search term. As with truncation this turns off the automatic mapping and exploding features and will not get articles with the words “colorectal neoplasms” in the article title. The most commonly used field labels are abstract (ab), title (ti), source (so), journal (jn), and author (au). The difference between source and journal is that “source” is the abbreviated version of the journal title, while “journal” is the full journal title. In PubMed the journal or the author can be selected simply by using the journals database located on the left-hand side bar or by typing in the author’s last name and initials in the query box. Remember, when searching using “text words,” the program searches for those words in any of the available fields. For example, if “death” is one search term then articles where “death” is an author’s name as well as those in which it occurs in the title or abstract will be retrieved.
Reactivations have also been reported to occur with other types of immunosuppressives buy super viagra 160 mg otc, notably anti–tumor- necrosis factor therapy for rheumatoid arthritis and infammatory bowel disease (Esteve et al discount 160 mg super viagra free shipping. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www cheap 160 mg super viagra fast delivery. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www safe 160 mg super viagra. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Research to develop a vaccine for hepatitis C continues although it is unlikely that a vaccine will be developed and licensed in the near future. Given the com- plexity of the issues surrounding vaccination of children and adults, this report devotes a separate chapter (Chapter 4) to immunization. Support for abstinence is an element of harm reduction but is not a requirement for participation in harm-reduction programs. Harm reduction focuses on providing information about safer practices (for ex- ample, how to inject without exposing oneself to contaminated blood), providing materials for engaging in safer practices (such as needle syringes and condoms), and offering hepatitis B vaccination. Because harm reduc- tion does not condemn illicit-drug use and instead seeks practical solutions to mitigate its harmful consequences, these programs can be controversial (Des Jarlais et al. The guidelines are updated regularly to refect advances in care and should be referred to as the basis of appropri- ate medical management. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. In addition, any pa- tient who has stigmata of liver disease—ascites, enlarged spleen, jaundice, or encephalopathy—or a platelet count below 100,000 (which is a sign of possible splenomegaly) should be referred immediately to a specialist. The primary care provider should take a his- tory and perform a physical examination with emphasis on symptoms and signs of liver disease. Patients found to have signs or symptoms of liver disease or a low platelet count (below 100,000) should be referred to a specialist who has experience in managing persons with advanced hepatitis C. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. For genotype 1 patients, it may be preferable frst to do a liver biopsy to determine the degree of liver involvement and scarring before making a decision about whether treatment should be considered sooner rather than later. Finally, primary care providers should counsel patients to abstain from, or at least limit, alcohol consumption be- cause heavy alcohol use is the greatest contributor to the rate of progressive liver fbrosis. Because patient characteristics that are associated with not responding to treatment generally are associated with not receiving treatment, it is diffcult to ascertain from available research fndings the degree to which lower up- take into treatment represents discrimination against minority populations or appropriate implementation of treatment guidelines. For example, in another study of veterans, less treatment was received by minority-groups members and by persons who were older, who had a history of drug and alcohol use, or who had comorbid illnesses (Butt et al. However, researchers found that in a large national cohort of veterans less than one-fourth of the patients who began treatment for chronic hepatitis C completed a 48-week course. The major predictors of treatment noncompletion were pretreatment anemia and depression (Butt et al. For example, a study found that Hispanic patients were more likely to be candidates for treatment but were Copyright © National Academy of Sciences. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Another study found that blacks and Hispanics were 24–27% less likely than whites to receive surgi- cal therapy (Sonnenday et al. Once researchers controlled for receipt of treatment, the difference in mortality in black patients was no longer signifcant (Davila and El-Serag, 2006). Those data on racial and ethnic disparities in the outcomes of and treatments for chronic hepatitis underscore the need for additional research to understand the biologic and societal basis of the disparities.