Asunto(s)
Factor VIII/uso terapéutico , Lenalidomida/uso terapéutico , Gammopatía Monoclonal de Relevancia Indeterminada/diagnóstico , Enfermedades de von Willebrand/diagnóstico , Factor de von Willebrand/uso terapéutico , Anciano , Hemorragia Gastrointestinal , Humanos , Inmunoglobulina M/genética , MasculinoRESUMEN
A questionnaire survey on simulated ill-health retirement decisions was performed at a scientific conference for local authority medical advisers. Respondents were asked to make decisions based on ten case scenarios drawn from real life. The overall agreement amongst 35 physicians was low, with a kappa statistic of 0.241. There were wide variations amongst respondents, with two physicians accepting all ten cases for retirement while another accepted only one. The survey suggests that there is great potential for inconsistency and inequity in such decisions. An improvement in agreement between physicians might be achieved by training, consensus guidelines and audit. This issue should be addressed by occupational physicians and trustees of superannuation schemes.
Asunto(s)
Evaluación de la Discapacidad , Determinación de la Elegibilidad , Medicina del Trabajo/métodos , Jubilación , Conocimientos, Actitudes y Práctica en Salud , Humanos , Variaciones Dependientes del Observador , Medicina del Trabajo/educación , Encuestas y CuestionariosRESUMEN
Recent studies show that u-3 polyunsaturated fatty acids (PUFAs) have the capacity to modulate cancer outcomes. The body responds to cancer in the same way that it responds to inflammation and wound healing. Nutrients with anti-inflammatory effects could therefore be expected to play a role in cancer treatment. This review focuses on the role of u-3 PUFAs in tumourigenesis and cancer cachexia. Studies indicate that eicosapentaenoic acid (EPA) supplementation may promote arrest of tumour growth and reduce cell proliferation. Patients need to consume at least 2 g of EPA per day for it to have a therapeutic effect. Positive outcomes related to cachexia include diminished weight loss; increased appetite; improved quality of life and prolonged survival; although there is controversy regarding these clinical outcomes. The effects of u-3 PUFAs on tumourigenesis and cachexia are viewed in the context of altered lipid and protein metabolism. This altered metabolism usually experienced by cancer patients results in increased formation of proinflammatory eicosanoids and cytokines. Cytokines play an indirect role by stimulating the production of arachidonic acid-derived eicosanoids; which support inflammation; cell proliferation and angiogenesis; and inhibit apoptosis. It can be concluded that u-3 PUFA supplementation offers a means of augmenting cancer therapy; inhibiting tumouri- genesis and possibly contributing to cachexia alleviation