Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2008
[Fortification of food with folic acid diminishes the number of neural tube defects].
A recent study from a research group from Quebec showed a strong decrease in the number of births affected by a neural tube defect since folic acid fortification was introduced in Canada. The prevalence decreased from 1.58 neural tube defects per 1000 births before the introduction of folic acid fortification to 0.86 per 1000 births in the period of complete fortification. ⋯ More research is needed to determine which population groups are at risk of possible negative effects of folic acid fortification and at which level of fortification. Until then, it is important to generate more attention and publicity in order to increase awareness and knowledge concerning folic acid and to promote its use before and after conception.
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Ned Tijdschr Geneeskd · Jan 2008
[The reporting of observational studies: useful and appreciable recommendations for improvement].
Much biomedical research is observational. Research should be reported in a way that enables the reader to comprehend the original objectives of the researchers, their subsequent actions and findings, and conclusions. ⋯ These 22 recommendations are summarised here with a commentary. These recommendations concern the title, the abstract, the introduction, the description of the methods and the results, the discussion and a list of the financiers of the study.
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--The incidence of type 2 diabetes mellitus is increasing, as is the rate of related long-term complications. --Increased body weight and lack of exercise are the major non-genetic factors that are responsible for the increased incidence of type 2 diabetes mellitus. --People predisposed to developing type 2 diabetes mellitus can be identified easily by taking a patient history (e.g. genetic predisposition, gestational diabetes, medication), performing a physical examination (e.g. body-mass index, fat distribution) and laboratory tests (e.g. impaired fasting and post-load blood glucose levels). --Intensive lifestyle modifications reduce the risk of type 2 diabetes mellitus by 42-58%. --Drug therapy is less effective than lifestyle modifications in the prevention of type 2 diabetes mellitus. Moreover, the disease course after treatment is discontinued is unknown. --Successful intervention resulting in a sustained effect is expected to have a preventive effect on the long-term complications of type 2 diabetes mellitus.
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Ned Tijdschr Geneeskd · Jan 2008
[Multi-detector CT screening for lung cancer is still to be discouraged for the time being].
Lung cancer is an important public health problem with almost no improvement in survival over the past decades. Although observational studies demonstrate that low-dose multi-detector spiral-CT screening is able to detect lung cancer in an early stage in 55-85% of all cancer cases detected, and that 5- and even 10-year survival rates close to 90% can be achieved, these studies do not answer the question whether CT screening is advisable. Excellent survival rates in a few individuals do not necessarily indicate that there is a lung cancer-specific reduction in mortality, since observational studies are subject to several biases: lead time bias, over-diagnosis bias, and length time bias. Therefore, there is a strong worldwide recommendation from various professional organisations not to adopt CT screening for lung cancer on a wide scale, but to await the results from large randomised studies such as the US 'National lung screening trial' and the Dutch-Belgian-Danish 'Netherlands-Louvain lung cancer screening study' (NELSON), which will provide more clarity as to the effectiveness and cost-effectiveness and possible negative effects of CT screening for lung cancer.
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Ned Tijdschr Geneeskd · Jan 2008
Review[Trigeminal autonomic cephalalgias: three forms of unilateral, short-lasting headache with facial autonomic symptoms].
--Trigeminal autonomic cephalalgias (TACs) include cluster headache, paroxysmal hemicranias and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCTs). --Because they are rare, it is often difficult to recognise TACs in practice. Hallmarks of TACs include the strictly unilateral pain near the eye or temple, the accompanying autonomic symptoms, and the specific pattern in the timing of the attacks. --The TAC subtypes differ in the duration and frequency of attacks. Differentiating TAC subtypes is important because it affects the treatment approach. --In rare cases, TAC results from an underlying structural disorder. Neuroimaging (cerebral MRI) is advised in all patients with TAC.