CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
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There was much more to this summer's international AIDS conference in Vancouver than reports by researchers. Richard Cairney says the $15-million conference attracted a mix of activists, demonstrators, physicians and business representatives, and they coexisted somewhat uneasily.
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To recommend appropriate levels of calcium intake in light of the most recent studies. ⋯ Current recommended intakes of calcium are too low. Revised intake guidelines designed to reduce bone loss and protect against osteoporotic fractures are suggested. Canadians should attempt to meet their calcium requirements principally through food sources. Pharmaceutical calcium supplements and a dietician's advice should be considered where dietary preferences or lactase deficiency restrict consumption of dairy foods. Further research is necessary before recommending the general use of calcium supplements by adolescents. Calcium supplementation cannot substitute for hormone therapy in the prevention of postmenopausal bone loss and fractures. Adequate amounts of vitamin D are necessary for optimal calcium absorption and bone health. Elderly people and those who use heavy sun screens should have a dietary intake of 400 to 800 IU of vitamin D per day.
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To describe potential therapeutic uses of calcitonin in the prevention and treatment of osteoporosis. ⋯ Calcitonin in both intramuscular and intranasal forms can reduce the pain of acute osteoporotic vertebral fractures and may be effective in treating that associated with chronic vertebral osteoporotic fractures. Calcitonin may also prevent postmenopausal bone loss and increase bone density in those with established osteoporosis. Current evidence for long-term prevention of fractures is limited and does not support the use of calcitonin as a first-line treatment for established osteoporosis. Most side effects can be avoided with nasal administration. Further trials are needed to assess fracture prevention and effective dose ranges for treating pain and increasing bone mineral density and to determine the long-term efficacy of calcitonin in secondary osteoporosis, in premenopausal women, in men and in elderly people.
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"Coming out" remains a very major decision for a gay or lesbian medical student. Canadian students interviewed for this article say they have feared being ostracized by their peers or encountering bias among older faculty members. A recent survey by the US-based Gay and Lesbian Medical Association found that 59% of gay and lesbian physician and medical student respondents have experienced job-related discrimination because of their sexuality. However, other gay/lesbian physicians and students are finding that their coming out is being greeted with tolerance, acceptance and understanding.