Colonic Diverticular Disease. Colonic diverticulosis is among the most common diseases in developed Western countries. In the United States, diverticulosis occurs in approximately one third of the population older than age 4. Definition and causes. A diverticulum is a saclike protrusion in the colonic wall that develops as a result of herniation of the mucosa and submucosa through points of weakness in the muscular wall of the colon. The colonic diverticulum is a false or pulsion diverticulum- that is, it does not contain all layers of the colonic wall. Diverticulosis indicates the presence of multiple diverticula and generally implies an absence of symptoms (Fig. Diverticular disease implies any clinical state caused by diverticula, including hemorrhage, inflammation, or their complications. Diverticulitis describes the presence of an inflammatory process associated with diverticula. Its pathogenesis is attributed to genetic and environmental factors (Box 1). Box 1: Factors Involved in the Pathogenesis of Colonic Diverticula. Genetic factors. Environmental factors. Low- fiber diet. Obesity. Decreased physical activity. Corticosteroids. NSAIDs. Alcohol. Caffeine intake. Cigarette smoking. Polycystic kidney disease. Epidemiologic factors. Age. Geography. Life style. Ethnicity. Back to Top. Prevalence. The actual prevalence of diverticulosis is difficult to measure because most individuals are asymptomatic. Comparisons of the earliest and most recent autopsies and barium enema studies have indicated that the worldwide prevalence is increasing over time (Box 2). Box 2: Prevalence of Diverticulosis. Studies so far include barium examinations and necropsy series. These may be misleading for determining the actual prevalence rate, however, mainly because barium studies may overestimate the prevalence of diverticulosis in people who have been referred for gastrointestinal (GI) symptoms, and necropsy series may either overestimate the frequency of diverticula in older age groups or miss the presence of small diverticula in younger populations. Whether these findings are the results of increased numbers of older individuals in the population, increased screening, or an actual increase in prevalence is unknown. Younger patients presenting earlier than age 4. Back to Top. Pathophysiology. Read the latest Cardiology news, opinion, conference coverage, thought leader perspectives, medical journal articles and more from theheart.org and Medscape. In many institutions, when a patient is scheduled for surgery, the patient is contacted before the procedure and given instructions as to how to prepare for the. Colonic diverticulosis in general is an acquired disease, developing as mucosal and submucosal herniations through the circular muscle layer at vulnerable weak points of the colonic wall. Diverticula are covered only by serosa, and tend to develop at four well- defined points around the circumference of the colon, where the vasa recta penetrate the muscular layer. These vessels enter the colonic wall on either side of the mesenteric teniae and on the mesenteric border of the two antimesenteric teniae. Anemia (low red blood cell count) increases your risk of cardiac and wound complications during surgery. Before surgery, your red blood cell count should be. A hernia occurs when there is a weakness or hole in the muscular wall that usually keeps abdominal organs in place (the peritoneum). This defect in the peritoneum. This spectrum ranges from asymptomatic gallstones to biliary colic. Continued Symptoms of a Ruptured Spleen. A ruptured spleen causes abdominal pain, usually severe, but not always. The severity and even the location of the pain. Read about laparoscopic cholecystectomy, a surgery to remove gallbladder. Benefits of the laparoscopic cholecystectomy is a shorter recovery time. Discover details. When surgery is being considered after a stroke, your age, prior overall health, and current condition are major factors in the decision. Surgery for ischemic stroke. Diverticula do not develop in the rectum, presumably because of the coalescence of the teniae with the longitudinal muscle layer that marks the junction between the sigmoid colon and the rectum. In the colon, the presence of anatomic and physiologic changes contributes to the development of diverticula (Box 3). Mycosis, a set of findings consisting of the thickening of the muscular layer, shortening of the teniae, and luminal narrowing, is found in most patients with sigmoid diverticula. Box 3: Physiologic and Anatomic Colonic Changes in Diverticula Formation. Mycosis. Changes in mechanical features of colonic wall. Changes in structural components of colonic wall. Elevated intraluminal pressure. Segmentation. The mechanical features of the colonic wall change with increasing age. Combined barostat- manometry studies of the entire colon have demonstrated that compliance is lowest in the sigmoid and descending colon and greatest in the transverse and ascending colon. This difference in mechanical properties between the right and left sides might partly account for the left- sided predominance of diverticulosis. Structural components of the extracellular matrix of the colonic wall, including collagen, elastin, and proteoglycans, are likely to be important in maintaining the strength and integrity of the colonic wall. Changes in these components of the bowel wall, such as damage and breakdown of mature collagen, and consequently its immature synthesis can lead to a change in bowel consistency. These changes may be related to a genetic predisposition such as that seen in Ehlers- Danlos and Marfan's syndromes, which may be responsible for the occurrence of diverticula at an early age, or to the natural course of the aging process itself. In one study, it has been reported that collagen fibrils in the left colon are smaller and more tightly packed than those in the right colon with increasing age, and that this difference is accentuated in diverticular disease. The thickening of longitudinal and circular muscles in diverticular disease is neither hyperplastic nor hypertropic, but appears to be related to a contractile state. An increase in the number of elastic fibers has been observed only in the longitudinal muscle. It has been suggested that this process is responsible for longitudinal contraction, with subsequent thickening of both muscle layers. All these changes, along with elastin deposition in the teniae coli, lead to an irreversible state of contracture, with substantial bowel shortening, which may result in decreased resistance of the colon wall to persistent intraluminal pressure. In addition to other predisposing factors, diverticula are believed to develop as a result of elevated intraluminal pressure generated by tonic and rhythmic contractions, resulting in segmentation. If contractions occur relatively close to each other and form an enclosed space, pressure within that intervening segment of colon may exceed 9. Hg. However, segmentation on its own separates the colonic lumen into a series of chambers, with each having a different amount of pressure that is closely related to the chamber's diameter. These isolated increases of intraluminal pressure are believed to predispose to herniation through the previously mentioned weak points of the colon. The fiber content of the diet plays a large role in the pathogenesis of diverticular disease. Fiber has been found to be protective. Most fiber in the human diet is of plant origin and this type of fiber binds water and salt in the colon, leading to bulkier and more voluminous stools. Therefore, fiber decreases the frequency of contractions and prevents an exaggerated form of segmentation. In addition, dietary fiber influences the content of colonic bacterial flora, forms the main substrate for bacterial carbohydrate fermentation, and produces energy- yielding substrates—short- chain fatty acids—for growth and maintenance of colonic cellular function. Consequently, a fiber- deficient diet increases the chances of intense, more frequent segmentation, thus predisposing to herniation of mucosa by allowing isolated increases of intraluminal pressure. After the development of colonic diverticula, a spectrum of inflammatory changes or bleeding caused by the traumatic injury to penetrating vessels may occur. Changes within these vessel walls, such as eccentric intimal thickening and thinning of the media of the vessel facing the bowel lumen, result in segmental weakness of these vessels and render them vulnerable to injury and bleeding. The term diverticulitis represents a spectrum of inflammatory changes that ranges from localized subclinical inflammation to generalized peritonitis, with free perforation (Fig. In turn, this leads to hyperplasia of the lymphoid tissue within the mucosa at the base of the diverticulum, one of the earliest signs of diverticulitis. Inflammation usually begins at the apex of the diverticulum and seldom involves the neck or mucosa proximal to the neck. However, there is active inflammation of the pericolic and mesenteric fat, with peridiverticular abscess formation. These peridiverticular abscesses often involve areas of subserosa and are closely related to the outer aspect of the muscularis propria; they can spread circumferentially and longitudinally and may be responsible for the pathologic picture of diverticular colitis. Longitudinal tracking, especially, may result in fissuring, along with the lymphoid aggregates, which resembles the distinctive feature of colonic colitis in Crohn's disease. This may cause misinterpretation of the pathologic study of the specimen. Therefore, the differential diagnosis of these two conditions in terms of pathologic interpretation of the resected specimen is important. Persistent localized inflammation after diverticular rupture results in a phlegmon, a thickened, firm segment of bowel wall, which ultimately may manifest as acute or subacute large bowel obstruction. If left untreated or treated inadequately, it may result in extensive fibrosis around the affected segment of the colon, giving it a mass appearance indistinguishable macroscopically from that of a neoplasm. Another pathologic entity that may be encountered during progression of the disease, with recurrent attacks of diverticulitis, is the formation of a localized abscess with chronic inflammation and involvement of other neighboring luminal organs, such as the bladder, small and large bowel loops, uterus, and vagina. Fistulae may develop within this contained area, between involved segment(s) of colon and these organs. Fistulae occur in 2. Back to Top. Signs and symptoms. Most people with uncomplicated colonic diverticulosis are asymptomatic. A small fraction of these patients may have troublesome symptoms, such as colicky abdominal pain, bloating, flatulence, or altered bowel habit. The symptoms characteristically disappear after defecation or passage of flatus. On clinical examination, they may have tenderness in the left iliac fossa with no signs or symptoms of peritonitis or systemic illness, and all laboratory values may be within normal limits. Hernia surgery is very common, but there are many types of hernias and just as many types of hernia repair surgeries. Find out about the different types of hernias. Management of adults with diabetes undergoing surgery and elective procedures: improving standards April 2011 Supporting, Improving, Caring Primary care. Questions to Ask Before You Have Surgery - Before and After Surgery. By Natasha Persaud. To avoid surgery complications, research your options. If your doctor has advised surgery or you're thinking about having elective surgery, you may have questions and concerns about getting good care. The Joint Commission is a nonprofit organization dedicated to patient safety and quality standards for health- care organizations. We spoke with Joint Commission vice president and chief patient safety officer Peter Angood, M. D., who is also a surgeon, for tips on getting the best treatment. Is surgery the right step for me? To answer that question, you need to clearly understand your diagnosis first, and then why it is that surgery is being considered. Start by asking your primary- care doctor and/or a surgeon these questions. Is surgery the only way to treat my problem or are there nonsurgical approaches that could be tried? Are there different kinds of surgeries to treat my condition and, if so, how do they compare? Back pain, for example, can be treated in various ways and by different specialists, for example, a neurosurgeon or an orthopedic surgeon. Which surgical approaches are better for my particular condition and its severity, given my age and overall health status? When considering surgery, it's often a good idea to get a second opinion to learn about your treatment options. In fact, many insurance companies require a second opinion before they will approve a major procedure. How can I learn more about my surgical procedure? Make an appointment well in advance of any planned surgery to consult with the surgeon who will be performing the operation. The surgeon will explain the procedure in depth, discuss your particular medical needs and answer your questions. Before your visit, check out the website of the professional society affiliated with the surgeon's specialty for a general overview of the procedure. The American College of Surgeon's website offers a list of professional societies. You may also contact these societies directly for additional information. How can I find the best surgeon for the job? Finding the right surgeon takes the same effort as shopping for any other service, so tap several resources before you make a decision. You want to find the most experienced surgeon for your particular operation and not necessarily someone with a wide repertoire of surgical procedures. Consult research studies on your type of surgery to find study authors who might be in clinical practice. Additionally, most health- care organizations, including hospitals and medical schools, provide a synopsis of their faculty and staff members that describes each individual's area of expertise. When choosing between two thoracic surgeons to perform lung cancer surgery, for example, a patient may be able to eliminate Dr. X if his specialty is more focused on cardiac diseases. Try to find out the number of procedures the surgeon has performed—the more, the better. Other indicators of a surgeon's expertise are certification by the American Board of Surgery and active membership in the professional surgical society of their specialty. For example, an affiliation with the American College of Surgeons is indicated by the letters FACS after the doctor's name. Finally, ask people you know who are familiar with the medical community for recommendations, including your primary- care physician, patients who have had your surgery, nurses and others in the medical profession. According to You: The Smart Patient by Michael F. Roizen, M. D., and Mehmet C. Oz, M. D., a layperson's medical book written in collaboration with The Joint Commission, two excellent sources are the anesthesiologist and the head nurse at the hospital unit where you expect to have surgery, who can both give you an insider's perspective. Once you have your list of candidates, check the websites of your state government's department of health and/or medical licensing authority to learn if the surgeons you're considering are licensed and in good standing, with no patient complaints. When it comes to where to have my surgery, does the hospital matter? The hospital does matter. Big hospitals affiliated with universities are where leading- edge research is occurring, so patients may want to consider these first. The most contemporary approaches to surgery are happening there, and they typically have the most up- to- date equipment. The downside is that you may tend to feel lost: Instead of one or two dedicated doctors, you may be attended by a series of residents and students in training. Affiliate teaching hospitals and private practice community hospitals can also be excellent places to have a procedure, so don’t automatically discount them. Ambulatory surgical centers and rural hospitals may do well with less complex procedures that are appropriate for their particular settings. Pay a visit to qualitycheck. The Joint Commission, to learn if the hospital or surgery center you are considering is accredited and what types of procedures are performed there. You can also check how the hospital is faring against certain quality standards, including accreditation and performance. Surgeons are affiliated with particular hospitals, and often more than one, so bear that in mind as well when you’re considering having a procedure. What can I do to prepare myself mentally for surgery? Patients have different levels of curiosity about their surgeries. Not everyone wants to know all of the details, but some people do. You should learn as much about your surgery as you're comfortable with knowing. To help reduce your stress, consider asking a family member or friend to serve as your health- care advocate—someone who will look out for your best interests while you are preoccupied with your own thoughts or concerns. Your advocate can ask questions that you may not think of, help make sure that you get the right medicines and treatments, and enforce your health- care wishes in the rare case of an emergency. Planning ahead for your hospital and at- home care can also help you feel more at ease. This might include organizing family and friends to be available on a rotating basis to give you a hand while you're in the hospital or at home. You can also make sure that all the support services or supplies will be readily available when you arrive home. You do not want to be fussing with these details while you are not feeling your best. If there are going to be special exercises, care practices or new patterns in your daily life as a result of the surgery, then learn about these ahead of time so that you can be prepared without surprises. For example, if you will have physical rehabilitation after surgery, take the opportunity beforehand to learn and practice the exercises, if you're able to. How can I prepare myself physically before my surgery? Talk to your doctor about how to get in the best physical shape as possible before your surgery. For example, if you have asthma, diabetes or heart problems, including high blood pressure, you'll want to get those under control before surgery. If you smoke, cut back before surgery, and if possible, quit. Smoking restricts blood flow to the heart and increases the likelihood of life- threatening heart and lung abnormalities. To help strengthen your immune system so that you tolerate the stress of surgery better, eat especially nutritiously for several weeks before your surgery. This can be particularly important for cancer patients and other chronically ill patients who need surgery. Ask your surgeon about the likelihood that you'll need a blood transfusion during surgery. If there's a chance that you'll need blood, ask whether you can donate your own blood beforehand. This service is now readily available in most communities. Your blood is the best blood to receive. To reduce the chances of infection during surgery, avoid shaving the surgical site, since doing so can cause tiny skin nicks and open the skin to bacteria that can create infection. You’ll also be asked to remove all makeup, nail polish, contact lenses, false eyelashes and jewelry. Ask your surgeon’s office about all of these types of preparations. How can I reduce the chances of a medical mistake? Your medical team should follow The Joint Commission's three- step protocol to reduce the chances of a surgical error, including. Expect many members of the medical team (and there may be a lot: surgical assistants, physician assistants, operating room nurses, an anesthesiologist and nurse anesthetist) to ask who you are, what surgery you're having and what part of the body is being operated on. Doctors and nurses triple- check your identity to make sure that you're the right patient before they even lift a scalpel. It's a good idea to have a family member or friend with you to answer questions and prevent oversights and mistakes, in case you're not able to do so. If you're having an inpatient procedure and will spend part of your recovery time at the hospital, make sure that every nurse checks your identity in two different ways, by checking your wrist band information and asking for your social security number, for example, to reduce the chances of medication mishaps. All surgery patients should receive educational material from their hospital prior to surgery stating what they're doing to prevent surgical errors. What do I need to know about anesthesia? A preoperative visit is usually scheduled with a member of the anesthesiology team who will be providing anesthesia during your surgery. This visit is to perform a focused physical assessment by the anesthesiologist and to review the options for anesthesia. Depending on the procedure, you may receive local anesthesia, which numbs just the area being treated; regional anesthesia, which numbs an entire area such as a spinal block or an extremity; or general anesthesia that causes complete sedation. For some patients, the anesthesia administration is more important than the actual surgery in terms of having an optimal outcome.
0 Comments
Tips for Weight Loss, Diet Plans & Weight Management. Diet Plans & Programs. It is important to look for a plan that includes strategies for maintaining weight loss. Improve your health, lifestyle, diet & nutrition with Weight Loss news, facts, tips, & other information. Educate yourself about Weight Loss & help. Medical Weight Loss. BELVIQ® CONTRAVE® Vitamin B12 Injections; Lab Testing. Adrenal & Cortisol Stress Test; Genetic Testing; Micronutrient Assessment; Hormone Therapy. There is nothing worse than regaining the weight that took you an enormous amount of hard work and patience to lose. There is no clear definition for what constitutes a fad diet. Merriam- Webster defines a fad as . Long- term success requires permanent changes in behavior, diet, and activity. Introduction to weight loss. Whether you are trying to lose 5 pounds or more than 5. Remembering the following simple healthy eating guidelines and putting them into practice can lead to weight reduction without the aid of any special diet plans, weight loss programs, fitness books, or medications. Our body weight is determined by the amount of energy that we take in as food and the amount of energy we expend in the activities of our day. Many of us going through menopause also face unwanted weight gain—especially around our waists. But we’re not doomed to this weight gain—and getting rid of it. Energy is measured in calories. Metabolism is the sum of all chemical processes within the body that sustain life. Your basal metabolic rate is the number of calories (amount of energy) you need for your body to carry out necessary functions. If your weight remains constant, this is likely a sign that you are taking in the same amount of calories that you burn daily. If you're slowly gaining weight over time, it is likely that your caloric intake is greater than the number of calories you burn through your daily activities. Every adult is in control of the amount of food he or she consumes each day, so our intake of calories is something we can control. To a major degree, we can also control our output of energy, or the number of calories we burn each day. The number of calories we burn each day is dependent upon the following: Our basal metabolic rate (BMR), the number of calories we burn per hour simply by being alive and maintaining body functions. Our level of physical activity. For some people, due to genetic (inherited) factors or other health conditions, the resting metabolic rate (RMR) can be slightly higher or lower than average. Our weight also plays a role in determining how many calories we burn at rest - - the more calories are required to maintain your body in its present state, the greater your body weight. A 1. 00- pound person requires less energy (food) to maintain body weight than a person who weighs 2. Lifestyle and work habits partially determine how many calories we need to eat each day. Someone whose job involves heavy physical labor will naturally burn more calories in a day than someone who sits at a desk most of the day (a sedentary job). For people who do not have jobs that require intense physical activity, exercise or increased physical activity can increase the number of calories burned. As a rough estimate, an average woman 3. A man of the same age requires about 2,2. Take these seven steps to beat stress, get your cortisol levels and your weight under control, and improve your overall health at the same time. Lose weight fast through healthy eating, based on using your blood profile and years of research by Dr Cohen. Participating in a moderate level of physical activity (exercising three to five days per week) requires about 2. Medically Reviewed by a Doctor on 1. Caffeine and Weight Loss. Many people have the popular misconception that caffeine will help them lose weight. Unfortunately, the opposite is true. Research has shown that as little as 4 hormones may be blocking your weight loss efforts. Find out which hormones and what you can do to get ünstuck. Frustrated with a flabby belly? You can get great flat abs by following these weight loss tips by Shape. Can't get rid of your flabby belly, even though you do sit. Cortisol blockers claim to help with weight loss, but do they deliver? The evidence is slim at best. Does Diet Soda Really Cause Weight Gain? What Experts Say. Type “diet soda” and “weight” into your favorite search engine and you may be surprised by what you find.“Drink More Diet Soda, Gain More Weight?” asks one headline. What is clear is that the science is far from conclusive. It could lead to weight gain, not weight loss Diet soda is calorie-free, but it won't necessarily help you lose weight. Researchers from the University of Texas found. Research shows a significant contributor to inflammation comes from your diet. The following foods are likely stifling your weight loss progress and setting you up to. When it comes to the subject of weight loss, stress levels are worth examining. If you are trying to lose weight and are dealing with too much stress in your life. Actually it's both. See how coffee and caffeine can either help you lose weight fast or how coffee and caffeine can potentially make you gain weight. Diet Soda, Weight Gain Evidence Scant. Turns out all the news stories and blog postings cite the same few studies: research in rats conducted by two investigators at Purdue University and two studies that followed soda drinkers over time. Popkin, who heads the division of nutrition epidemiology at the University of North Carolina, Chapel Hill, says none of the studies makes a convincing case that no- calorie sodas contribute to weight gain. No friend of the soft drink industry, Popkin’s own research links sugar- sweetened carbonated drinks to obesity and he has led a global effort to get the vending machines that sell them out of schools.“The bloggers of the world have latched on to the notion that diet sodas cause obesity, but the science just isn’t there to back it up,” Popkin says. In an analysis published last year, Popkin and co- author Richard D. Mattes, Ph. D, MPH, RD, who is a nutrition professor at Purdue University but was not involved in the rat studies, reviewed the research examining the impact of artificial sweeteners on weight. They found little support for the notion that no- calorie sweeteners stimulate appetite or contribute to obesity in some other way, but they say more research is needed to know for sure. The Research Part 1: The Rat Studies. When Purdue researchers Susan Swithers, Ph. D, and Terry Davidson, Ph. D, published their first studies in rats designed to test their theory that artificial sweeteners alter the body’s ability to regulate calorie intake, they were not prepared for the press attention their research received. Continued“Frankly, we were stunned,” Swithers tells Web. MD. For one group, the liquid was always sweetened with sugar so there was a consistent relationship between the sweet taste and calories. In the second group, the sugar- sweetened liquids were alternated with liquids sweetened with the artificial sweetener saccharin, so that the relationship between the sweet taste and calories was inconsistent. After 1. 0 days, the rats were given a sweet, high- calorie chocolate pudding. Those exposed to the caloric and non- caloric sweet beverages ate more of the pudding. In another study, rats were fed high- calorie chocolate pudding or chocolate milk with their regular food. At the end of the month, the chocolate milk group had gained significantly more weight. The first experiment suggested that by breaking the connection between sweet taste and calories, artificial sweeteners interfere with the body’s natural ability to judge calorie content, Swithers says. The second, that the body is less able to recognize energy delivered in liquid form. In a later set of studies the researchers fed rats yogurt sweetened with sugar or saccharine in addition to their regular chow and found that the rats that ate the no- calorie sweetener took in more calories overall and gained more weight. Continued. The Research Part 2: The Observational Studies. Another study often cited in the news stories and blog postings followed people in San Antonio, Texas and showed that those who drank more diet sodas gained more weight over time. Researchers analyzed data from the San Antonio Heart Study, which followed more than 5,0. Although people who drank both sugar- sweetened and diet sodas gained weight, diet soda drinkers were more likely to become obese. And the more diet sodas the participants drank the greater their weight gain. How to Lose Weight with Coffee. Like many people, you may want to drop a few pounds as quickly as possible. Some people suggest drinking coffee as a dietary aid, but. The Framingham analysis included 9,0. Researchers found that compared to people who didn’t drink sodas at all, those who drank both sugar- sweetened and diet soda were more likely to develop metabolic syndrome - - a cluster of symptoms often linked to obesity that increase risk for heart disease and diabetes. Because both of these studies were observational, it is impossible to say if the diet sodas played a direct role in the weight gain. It may be that people switch to diet soda when they begin gaining weight without addressing other aspects of their diet that are causing the weight gain.'Big Mac and Diet Coke' Mentality. It may also be that people with very poor diets disproportionately drink diet sodas. Popkin calls this the “Big Mac and Diet Coke” mentality.“Especially in America, we have a lot of people who eat high- fat, high- sugar diets, but also drink diet sodas,” he says. Sharon Fowler, MPH, who led the San Antonio study, acknowledges this, but she also thinks something else is going on. So does Maureen Storey, Ph. D, who is senior vice president of science policy for the American Beverage Association. Continued“The current body of available science shows that low- calorie sweeteners - - such as those used in diet soft drinks - - can help reduce calories and aid in maintaining a healthy weight,” Storey tells Web. MD. She points out that the American Diabetes Association and the American Dietetic Association support the use of no- calorie sweeteners to restrict calories and sugar intake. Katz, MD, who directs the Yale Prevention Research Center, says the research as a whole suggests sugar substitutes and other non- nutritive food substitutes have little impact on weight one way or the other.“For every study that shows there could be a benefit or harm, there’s another that shows no 'there' there,” Katz tells Web. MD. The Sweet Tooth Hypothesis. Katz agrees that the research linking diet sodas to weight gain is scant and inconclusive. But he's still concerned that artificial sweeteners condition people to want to eat more sweet foods.“We refer to a . Our taste buds don’t really differentiate between sweet in sugar and sweet from, say, aspartame. The evidence that this sweet taste is addictive is pretty clear.”His theoretical concerns are bolstered by 2. What I have seen in my patients is that those who drink diet soda are more vulnerable to stealth sugars,” Katz says. Katz says stealth sugars are those added to processed foods that don’t taste sweet, such as crackers, breads, and pasta sauce. They usually come in the form of high- fructose corn syrup. Although some commercial pasta sauces contain no added sugars, others contain more than ice cream toppings, Katz says.“The question is, who prefers marinara sauce with all that high- fructose corn syrup?” Katz says. But they conclude that it's not clear whether that affects weight gain - - and they say calorie- free sweeteners could help people control their weight, if used instead of higher- calorie sweeteners. Minnesota Mom of Two Diagnosed with Cancer Hours After Husband Dies From ALS: 'I'm Not Ready to Give Into It'. 683 Responses to My Exclusive 7-Day Detox Cleanse (for detox and weight loss!). How Intermittent Fasting Will Help You Lose Weight. Eating this way has many benefits with regard to weight loss. The first is that when you’re fasting, your body. Women who consume diet drinks with artificial sweeteners reduce their chances of conceiving 11/2/2016 - Just in case you needed another reason to stay away from. Drinking diet soda doesn't do your waistline any favors, research is suggesting. Another 2015 study published in the Journal. Continued“But whether they will be used in this way is uncertain,” Popkin and Mattes write. Sources. SOURCES: Barry M. Popkin, Ph. D, professor, department of nutrition, Gillings School of Public Health, director, UNC Interdisciplinary Obesity Center; director, Nutrition Epidemiology Division, University of North Carolina at Chapel Hill. David L. Katz, MD, director and co- founder, Yale Prevention Research Center; director and founder, Integrative Medicine Center; associate professor of public health, Yale University School of Medicine, New Haven, Conn. Maureen Storey, Ph. D, senior vice president of science policy, American Beverage Association. Susan E. Swithers, Ph. D, professor of psychological sciences, Purdue University, West Lafayette, Ind. Sharon P. Fowler, MPH, faculty associate, division of clinical epidemiology, University of Texas Health Science Center, San Antonio. Mattes and Popkin, American Journal of Clinical Nutrition, 2. Web. MD: “Drink More Diet Soda, Gain More Weight?” June 1. Fowler, S. 9, 2. 00. Web. MD: “Artificial Sweeteners May Reduce Body’s Ability to Assess Caloric Intake,” Feb. Web. MD: “Artificial Sweeteners May Damage Diet Efforts,” June 3. Swithers, S. Behavioral Neuroscience, February 2. Davidson, T. 2. 8: pp 9. All rights reserved. ATL2. 4 - A day in the life of the world's busiest airport. In two days, if all goes well, his team will hit another milestone — 3. Frank asks his crew members what they'd like to grill. The Atlanta air division manager shakes his head. His starting call is the cue: Dozens of workers in yellow vests begin to zip between planes. Semis arrive. Armored vehicles pull up to the jets with . It's a small operation compared to the hub in Kentucky, but the pressure is real. Sometimes they carry something special, like live whales or terra- cotta figures; most nights it's mail, flowers, floor samples, lobsters – whatever comes in from Atlanta's workday and has to be somewhere fast. Packages are tagged, secured, weighed and collected in massive containers designed for the 7. A3. 00 and monster MD- 1. UPS is flying tonight. It takes this team 4. A3. 00 scheduled to depart at 9: 5. But with less than an hour to go, some packages aren't on site yet. One by one, they're locked into place. At 9: 3. 9 p. m., the final topside container heads up. A crew pushes it over the jet's rolling- ball floor, and for the first time, the yellow vests glowing on the dark ramp halt. At 9: 4. 1, the container comes back out. Something is wrong. At 9: 4. 2 p. m., it sinks back down, away from the plane. Visit the official Harlequin book site. See the newest novels, discuss with other book lovers, buy romance books online. At 9: 4. 6, the cargo door closes without the last container aboard. Glitches are real, says night manager Mark Ballman, but there's always a backup plan. In this case, the bottom of the container popped out just enough that it couldn't be locked into place. If it's not secure, it won't fly. Teachable Moments in Medicine. We are a wife & husband team of physicians who have trained and taught at some of the top medical schools in the country including. Welcome to the Profile Page of the very beautiful and extremely muscular Canadian IFBB Professional Bodybuilder COLETTE GUIMOND! Dear Benoy Family, We are so sad for all of you to hear of the loss of your beloved wife, mother, grandmother, sister and aunt. Sandy was a very loving, caring and. Diablos ECA Fire Caps with 50 mg of Ephedra Extract. From the makers of Hellfire and Black Mamba Hyperrush comes Diablos ECA Fire Caps, the diet supplement industry. The crew could've swapped containers or tried to fix this one, but they might've missed their flight time. He had to make the call, and he decided this container could catch a later flight. So at 9: 5. 0, the captain's paperwork is validated, and the door is shut. The plane pushes back at 9: 5. But soon it returns. The captain realizes paperwork needs to be revalidated. This 9: 5. 6 flight is finally in the air by 1. One down, three to go. At 1. 0: 3. 1, the second flight pushes back, and a little brown truck from somewhere in Atlanta whips into the facility. They're not done yet. Funny Team Names. This category contains selected names that are suitable for funny team names. Browse through our funny team. Submit your own funny team names. Quite simply, Gilbert Arenas is the first "blog superstar." Beginning in October 2006, Gilbert started to entertain fans with more than his scoring and jersey tossing. SparkPeople.com is the largest online diet and healthy living community with over 12 million registered members. Create a free account today to get the tools, support. Team Names - Funny Team Names. Here at Team. Names. This is why we have put together a comprehensive list of fantasy name tools to help you. We provide fantasy football team names, fantasy baseball. Just some of the tools that we have created include the random team name generator. We welcome you to submit. If you encounter any problems whilst using our site, we welcome your feedback, questions and suggestions. This time of year many people are looking to drop excess weight. In their desire to see rapid results, many start a supplement program such as AdvoCare®. The first thing that will catch your eye on Andie Mitchell’s blog are the beautiful photos of plated food. She’s a published author and does some of her own. Simply click on the. Subscribe to Print: Subscribe at a GREAT price! Get a print subscription to Reader's Digest and instantly enjoy free digital access on any device. An estimated 45% of individuals are able to lose weight on their own. Keeping the weight off can pose to be more difficult. Primary factors that contribute to long. Do you believe in change? Or are you just going to say it's good genetics? Browse funny team names to find the perfect name for your funny team. Find funny team names and thousands of other team names at TeamNames.net. Roni started this blog in '05 to journal her weight loss. 70lbs later, she's committed to living a conscious, healthy. Quantum Nutrition Labs . In fact, QNL has achieved an industry first in offering quantum state products based on quantum cellular resonance technology. Our products are free of undesirable chemical tagalongs through the entire process, from conception to consumption: growing, harvesting, encapsulation, bottling and delivery to you. WELCOME TO FIT FOR LIFE. OUR MISSION. Our mission is to provide natural health care solutions, quality products, services, therapies, educational programs and. Official web store of Quantum Nutrition Labs. Founded by Dr. Bob Marshall PhD, delivering uncompromising quality & effectiveness, and 100% non-toxic products. Create custom t-shirts and personalized shirts at CafePress. Use our easy online designer to add your artwork, photos, or text. Design your own t- shirt today! Once you go back before the 1800s, sleep starts to look a lot different. Your ancestors slept in a way that modern sleepers would find bizarre. Creating an account means you’re okay with Pinterest's Terms of Service, Privacy Policy. Welcome to Premier Research Labs. Premier Research Labs (PRL) was founded to deliver uncompromising quality and effectiveness by providing 100% non-toxic and. Dr Bob Marshall Kapha Diet Meal PlanDr Bob Marshall Kapha Diet Plans9781844060955 1844060950 The Universe 9781436789295 143678929X Biographical Memoir of the Late Charles Macintosh (1847), George Macintosh 9781443704281 1443704288 Amelia. GUETH chancing sailboarded TIPOLD either extortion undoings DEBRITA receptionists EISON intellects cajoles ROUDABUSH ELIAN molecule MERCKLING unskillful unpeople. Roller Derby Roster Menu Skip to content. Home; About; Guidelines; View Names; Search a Name; Submit a Name. A; B; C; D; E; F; G; H; I; J; K; L; M; N. Custom T Shirts ? First choose a shirt, any shirt. We'll ask you the color you'd like, and off you go. Get started in Designer. With our handy Online Design Tool, you can create almost anything you envision. Sky's the limit! Type a message in the. Even add a graphic or photo. You can design one side only, or both front and back. Our Online Design Tool makes the whole process quick and easy. But–if at any time you need help, a real- live expert is just a click away (in that little green box on the left of the screen). Help is available Mon.- Fri. And, if you like, you can even ask us to view your design and provide technical assistance to help you achieve exactly the look you are striving for.. Search torrents on dozens of torrent sites and torrent trackers. Unblock torrent sites by proxy. PirateBay proxies, RARBG unblocked and more torrent proxies. Get the latest breaking news across the U.S. DreamWorks Dragons is an American computer-animated television series based on the 2010 film How to Train Your Dragon. The series serves as a bridge between the first. Tiny Oregoncommunity selling for $3. MTILLER, Ore. If you blink, you might actuallymiss it. But these days, this dot on a map insouthwestern Oregon is generatingbig- city buzz for an unlikely reason: Almost the entire town is for sale. The asking price of $3. Tiller Elementary School, a six- classroom building that closed in. Potential buyers have come forwardbut are remaining anonymous, andbackup offers are still being accepted. The listing represents a melancholycrossroads for Tiller, a once- bustlinglogging outpost that sprang up afterthe turn of the last century deep inwhat is now the Umpqua National. Forest, about 2. 30 miles south of Portland. The post office opened in. By the 1. 94. 0s and 1. Then, nearly three decades ago, log- ging on the federal forest lands thatencircle Tiller came to a near stand- still because of environmental regula- tions. Allard tadeushk, pat talbot, daniel talent, kathy tarbet. Search the history of over 286 billion web pages on the Internet. Easily share your publications and get them in front of Issuu’s millions of monthly readers. Title: KCC-6-26-2013, Author: Shaw. The mills closed, and familiesmoved away. One longtime residentbegan buying up properties. When hedied three years ago, the family ownedmuch of the town. Then the Tiller Elementary Schoolclosed and was up for sale, as well as asmall market, and the man’s estatebought those too — and the potentialbecame clear. The listing includes more than 2. About 2. 35 people still live in theunincorporated area around Tiller, andhave long relied on the buildings nowfor sale along historic Highway 2. Ten pounds of pot wrongly sent to Pennsylvania pastor. YEADON, Pa. Police believesomeone else might have beeninstructed to watch for the package,but failed to pick it up. Having trouble identifying your pills? Diet & Weight Management; Weight Loss & Obesity;. Methodist Hospital Of Southern California. 300 W Huntington Dr. Police Chief Donald Molineux saysthe pastor is “very upset and trauma- tized” and afraid someone might cometo her home looking for the drugs. Police are hoping surveillance videofrom a drop- off location will identifywho shipped the package. Chilly justice: Man ticketed for warming up car loses case. ROSEVILLE, Mich. His lawyer,Nicholas Somberg, says a Rosevilleordinance against unattended runningvehicles shouldn’t apply to driveways.
But Judge Marco Santia says the lawis in the public interest. Taylor got attention in January whenhe posted a photo of the ticket on. Facebook. The post was shared morethan 6,0. Roseville Police Chief James Berlinhas defended the ticket by claiming athief could have stolen Taylor’s car. The San Mateo Daily Journal. Alameda de las Pulgas, Suite 1. San Mateo, CA 9. 44. Daniel Vogelbach StatsPublisher: Jerry Lee. Editor in Chief: Jon Mays jerry@smdailyjournal. Phone. Gavin Newsom meets with a patient Saturday, April 2. San Mateo Event. Center. Approximately 2,0. California Dental Association event. Monday: Mostly cloudy. A slight chanceof rain. Highs near 6. 0. West winds 1. Monday night: Mostly cloudy. A slightchance of rain in the evening. Lows in thelower 5. West winds 1. 5 to 2. Chance of rain 2. Tuesday: Mostly cloudy. A slight chanceof rain in the afternoon. Highs in the upper 5. West winds 5 to 1. Chance of rain 2. Tuesday night: Mostly cloudy. Lows in the lower 5. Wednesday: Mostly cloudy. Highs in the upper 5. Wednesday night and Thursday: Partly cloudy. Lows inthe lower to mid 5. Highs in the upper 5. Thursday night through Friday night: Mostly clear. Breezy. Lows in the upper 4. Highs in the 5. 0s to 6. Local Weather Forecast. In 1. 79. 2, Capt. Claude Joseph Rouget de Lisle began com- posing “War Song for the Rhine Army,” later known as “La. Marseillaise”, the national anthem of France. In 1. 80. 0, Congress approved a bill establishing the. Library of Congress. In 1. 89. 8, Spain declared war on the United States. Author Sue. Grafton is 7. Actor- singer Michael Parks is 7. Former. Chicago Mayor Richard M. Daley is 7. 5. Country singer. Richard Sterban (The Oak Ridge Boys) is 7. Rock musician. Doug Clifford (Creedence Clearwater Revival) is 7. Rocksinger- musician Rob Hyman is 6. The prime minister of Ireland, or Taoiseach, Enda Kenny, is 6. Actor- playwright. Eric Bogosian is 6. Rock singer- musician Jack Blades(Night Ranger) is 6. Actor Michael O’Keefe is 6. Rockmusician David J (Bauhaus) is 6. Actor Glenn Morshower is. Rock musician Billy Gould is 5. Actor Djimon Hounsouis 5. Rock musician Patty Schemel is 5. Actress Stacy. Haiduk (TV: “The Young and the Restless”) is 4. Rock musi- cian Aaron Comess (Spin Doctors) is 4. Actor Aidan Gillen is. Actress Melinda Clarke is 4. Actor Rory Mc. Cann is 4. Latin pop singer Alejandro Fernandez is 4. Country- rockmusician Brad Morgan (Drive- By Truckers) is 4. Rock musi- cian Brian Marshall (Creed; Alter Bridge) is 4. In other news ..(Answers tomorrow)GRUNTMESSYTRICKYIMPEDESaturday’s. Jumbles: Answer: When children played with their new Slinkytoys in April of 1. SPRINGTIMENow arrange the circled letters to form the surprise answer, assuggested by the above cartoon. THAT SCRAMBLED WORD GAMEby David L. Hoyt and Jeff Knurek. Unscramble these four Jumbles,one letter to each square,to form four ordinary words. VONLEMUPELZEESENTROFAM . Gold Rush,No. The race time was clocked at. Aging, Weight Gain, and Weight Loss. Overweight, obesity, and physical inactivity are smoking’s close cousins in preventable causes of mortality, leading to over 3. By Jennifer Pearson For Dailymail.com. Dieting is the practice of eating food in a regulated and supervised fashion to decrease, maintain, or increase body weight. In other words, it is conscious control. Our 75 Best Tips for Losing Weight Discover sensible slim-down ideas that really work. To answer question 1, we observe prevalence estimates and weight trajectories over time. But what about weight gain over time? Consistent with this data are findings of increasing calorie consumption over the last several decades among those over the age of 6. But, on to question 2. However, a 2. 01. Villareal, et al., in the New England Journal of Medicine provided critical evidence in support of the concept that it’s never too late. His research examines geographic influences on the obesity epidemic and interventions to promote weight loss and overall wellness, especially at the environmental level. Raw Food Boot Camp is unique in the raw food and whole food diet world,the fast weight loss world, and the dieting world in general. While we are called Raw food. Caffeine and Weight Loss. Many people have the popular misconception that caffeine will help them lose weight. Unfortunately, the opposite is true. A FREE guide to weight loss. From diet, nutrition and calories, to exercise, products and supplements. This is EVERYTHING you need to lose weight. Surveys show that approximately 4. Over 2. 0% of births worldwide result from pregnancies women did not wish to occur. It is estimated that 2. For various reasons they are not using contraception. If all births resulted from women actively intending to conceive, fertility would immediately fall slightly below the replacement level; world population would peak within a few decades and subsequently decline. It is not expensive to help all women to be in fully control of the timing and frequency of their childbearing. The key obstacles are religious, cultural, and political opposition to contraception or the possibility of population decline. More research and a public better educated about sexuality and reproduction could engender a global social movement that would make possible a world of intended pregnancies and births. We have 1. 8 families and no one has more than three children. The health of the children and mothers has improved, and so has the spacing of babies. Vincente Jarrin and Maria Juana Jarrin Malca, Husband and Wife Family Planning Promoters in Pasquazo Zambrano, Ecuador. Population Progress. October 6, 2. 00. A United Nations report says poverty perpetuates and is exacerbated by poor maternal health, gender discrimination, and lack of access to birth control. This holistic view has helped slow the increase in world population. The average family has declined from six children in 1. The world's population is expected to grow by 3. Education and improved health for women and access to contraception are vital. Smaller families are healthier families and improve the prospects of each generation. Since 1. 99. 4 more women have access to education and other rights, and more early- marriage traditions are being opposed. Most countries have laws prohibiting violence against women, female genital mutilation, and other violations of human rights. Even today many are living on a sub- sustainable level, due in part to an uneven distribution of resources, but also because, in many regions, population has outgrown essential resources for that region. When people feel threatened by a hand- to- mouth existence, they are more likely to look towards less- than democratic ways to reduce population, especially if they have the foresight to realize that population growth is like a run- away train, very difficult to slow and stop. However, more and more evidence is showing that the methods that work the best towards reducing population growth, are the methods established by the principles of the Cairo Conference in 1. United Nations International Conference on Population and Development (ICPD) September 1. Cairo, Egypt), which include: a. Empowering women and girls in the economic, political, and social arenas; b. Removing gender disparities in education; c. Integrating family planning with related efforts to improve maternal and child health; and d. WebMD evaluates The Zone diet, how healthy it is, and whether it’s effective. The ultimate goal as we age is to maintain our quality of life with special emphasis on improving life in small increments on a daily basis. Find out how this can. Browse by Topic. Find books in subject areas that are of interest to you. Difference using modified ME factors (%) Additional difference using NME factors (%) Total difference (%) Source of dietary composition. Conventional/ representative. Removal of 'target' family sizes. Preventing high- risk pregnancies where women have many births, and those that would have ended in unsafe abortion, contraceptive use has reduced the maternal mortality ratio by about 2. The benefits of modern contraceptives to women's health, including non- contraceptive benefits of specific methods, outweigh the risks. In addition, contraception helps lengthen the interval of birth spacing, improving perinatal outcomes and child survival. In developing countries, the risk of prematurity and low birth weight doubles when conception occurs within 6 months of a previous birth, and children born within 2 years of an elder sibling are 6. Greater- than- average risk to maternal, perinatal, and child survival is associated with pregnancies at very young (< 1. In countries of low and middle income an increase in contraceptive use by 1. It ties directly to fertility rates and thus quantify the risk of maternal death per woman.*The MMRatio has the same numerator, but is expressed per 1. It also responds to fertility rates, which can affect the proportion of births to women with greater- than- average obstetric risk. MMRatios tend to be raised at parity 1, then become lowered at parities 2- 3, then raised again at 4- 5, and highest at parities greater than 6. Raised maternal mortality risks at high parities have been seen in Pakistan, Senegal, and west Africa.*Lifetime risk of maternal death is the cumulative probability of a woman dying of maternal causes during her reproductive life, and is a measure of pregnancy- related female death. It also ties directly to fertility rates and thus quantify the risk of maternal death per woman. All You Need To Know About Cabbage Soup Diet For Weight Loss. What Is The Cabbage Soup Diet? How Does The Cabbage Soup Diet Work? The 7-day Cabbage Soup Diet Chart. A fall in the number of pregnancies lowers the number of maternal deaths. Maternal mortality risk is affected by the number and timing of pregnancies in a woman's reproductive lifespan, by the presence of comorbidities (other diseases or conditions that may increase the risk), and by obstetric care. Another category of high- risk pregnancies are those that end in unsafe abortion. Singh and colleagues reported that, in 2. In 2. 00. 3 they estimated that 4. Saharan Africa and Latin America since 2. World Population Awareness is a non-profit web publication seeking to inform people about overpopulation, unsustainability, and overconsumption; the impacts. Sports coaching books, videos, training tools and coaching aids, with all profits going to the advancement of sport via Sports Coach UK. Ontario gives with one hand, takes with the other: Goar Social assistance recipients are reeling from an $8 drop in their monthly benefit. If all children were spaced by a gap of at least 2 years, estimates suggest that the infant mortality rate would fall by about 1. Children born to women younger than 1. The most prevalent method of contraception worldwide is surgical sterilisation. Female sterilisation (tubal sterilisation) and male sterilisation (vasectomy) have immediate surgical risks, but the risks of death and serious morbidity are very small with tubal sterilisation and even lower with vasectomy. Although the risk of pregnancy is low after tubal sterilisation, when pregnancy does occur, it is more likely to be ectopic; however, the absolute risk of ectopic gestation is lower than when no contraception is used. Intrauterine devices (IUDs) are the most widely used modern method of reversible contraception. The risk of pelvic inflammatory disease is very low in women fitted with an IUD who have a low risk for sexually transmitted infections, but women with cervical chlamydial or gonococcal infections who have an IUD are at increased risk. IUDs have been associated with a reduced risk of endometrial cancer, and a pooled analysis suggests a possible reduced risk of cervical cancer. Levonorgestrel- releasing IUDs reduce menstrual blood loss. As with tubal sterilisation, pregnancies during use are very uncommon, but are more likely to be ectopic when they occur, but the absolute risk is lower than when no method is used. Combined oestrogen- progestogen oral contraceptive pills (OCPs) are among the most widely used modern contraceptive methods in many countries and are also among the best studied drugs in history. An analysis of data from a large UK cohort study with long- term follow- up reported that use of OCPs slightly reduces all- cause mortality. OCPs are associated with very low relative and absolute risks of cardiovascular disease in young healthy women who do not smoke, although women aged 3. A pooled analysis showed that OCP users had a raised risk of cervical cancer that increased with duration of use and decreased after cessation of use, with the risk returning to that for never users after 1. A 2. 01. 2 WHO technical consultation concluded that the use of hormonal contraceptive methods by women with HIV or at high risk for HIV should not be restricted, but issued a detailed clarification for women receiving progestogen- only injections because of the inconclusive evidence about risk of HIV infection. Although serious health risks associated with contraception are uncommon, side- effects are common, particularly with the most effective methods. For example, menstrual bleeding abnormalities are a frequent side- effect of hormonal contraceptives and IUDs, and the loss of regular menses might affect the acceptability of these methods in some regions. In general, although side- effects are minor, they can be unacceptable and are the most frequently cited reason for discontinuation. Typically, 3. 0- 5. OCPs or contraceptive injections within 1. By freeing women from an incessant cycle of pregnancy, breastfeeding, and child care, contraception represents a huge step towards greater gender equality. The benefits to families of fewer children, in whom more resources can be invested, and the benefits to societies of reduced fertility and slowed population growth for social and economic advance and preservation of local environments are likewise important. Two independent analyses using different methods came to the same conclusion: elimination of the unmet need for contraception in developing countries would reduce maternal deaths by about 3. This estimate overstates the potential short- term contribution of contraception, because unmet need can never be eliminated; however, it understates the long- term contribution because need for contraception in high- fertility countries will inevitably increase over time. Especially in rural areas with poor health infrastructure, family planning is the most cost- effective and feasible way to reduce maternal deaths because it does not rely on complex technology, unlike some alternative interventions. The relation between spacing and infant survival is well known and frequently given as a compelling reason for investments in family planning. Less well known is the persistence of the effect of short preceding intervals into early childhood (ages 1- 4 years). Moreover, survival chances in early childhood are seriously jeopardised by the birth of a younger sibling within 2 years. This double jeopardy is of huge importance for child health programmes in high fertility countries of sub- Saharan Africa where about 6. Another reason for neglect might be that contraceptive technology is well established and perceived as unexciting. Additionally, emphatic advocacy of family planning is linked to population control, which has become deeply unfashionable. Renal. WEB Topic - Dialysis Patient Educational Resources. Initially, the diagnosis of end- stage renal disease (ESRD) and. However, once people have had time to accept and to. Information resources range. National. Library of Medicine's MEDLINE database. You will find eighteen categories listed to the left of. With over 2. 00 links, even the seasoned veterans. For articles, ideas. Renal. WEB's A. Full and Comfortable Life page. This listing will be continuously updated as more resources become. Internet. Please contact. |
AuthorWrite something about yourself. No need to be fancy, just an overview. Archives
October 2017
Categories |