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Unintentional Weight Loss Causes

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121. An update to the Greig Health Record: Preventive health care visits for children and adolescents aged 6 to 17 years ? Technical report

and in school. Parents and children need to know the basic rules for safer Internet use. The periodic health visit is an ideal opportunity to talk with patients about protecting their hearing during especially loud activities (e.g., a rock concert) and by keeping the volume down on personal music devices. Permanent hearing loss is caused by loudness and length of exposure to noise. Rock concerts and personal music players can reach an intensity of 110 to 120 dB. Using appropriately fitting earbuds (...) . Sequelae of sleep deprivation Getting inadequate sleep may be harmful. Insomnia is common, affecting an estimated 10% of U.S. adolescents and 6% of European adolescents. Chronic sleep loss in adults is associated with a greater risk of mortality. There is fair evidence that short sleep duration over time is associated with subsequent weight gain and increased risk of concurrent and adult obesity. - The combination of short sleep duration and variable sleep patterns is associated with adverse metabolic

2016 Canadian Paediatric Society

122. Physical activity: walking and cycling

- motorised transport an easier option.) National actions to support walking and cycling, such as fiscal measures and other policy interventions to alter the balance between active and motorised travel in terms of cost and convenience. Measures to reduce the risk of unintentional injuries from walking and cycling. (See NICE's guidance on strategies to prevent unintentional injuries among under-15s.) Who is this guidance for? The guidance is for commissioners, managers and practitioners involved (...) with limited mobility. The Chief Medical Officers' 2011 report notes: 'there is a clear causal relationship between the amount of physical activity people do and all-cause mortality. While increasing the activity levels of all adults who are not meeting the recommendations is important, targeting those adults who are significantly inactive (that is, engaging in less than 30 minutes of activity per week) will produce the greatest reduction in chronic disease' (Chief Medical Officers of England, Scotland

2012 National Institute for Health and Clinical Excellence - Clinical Guidelines

123. Lumark - lutetium, isotope of mass 177

will be given with a few weeks intervals. Using this value a PECsurfacewater is calculated to be 0.1 ng/l, falling below the action limit of 0.01 µg/l. A Phase II assessment is therefore not deemed necessary. The Expert has stated that concentrations of lutetium in surface waters worldwide have previously been reviewed (Weltje, 2003) with figures varying from 0.25 pmol/l to 5.5 pmol/l. This would correspond to lutetium chloride concentrations equal to 70 – 1545 pg/l based on its molecular weight of 281 (...) or conduction. Effects of the respiration were slight and variable. No gross differentiating changes were found of the tissues demonstrating no evidence of acute damage resulting from the experiment. The studies suggest that the intravenous toxicity of the ionic compounds of the rare earth elements would decrease with atomic weight resulting in Lutetium ( 177 Lu) being the least toxic of the series. Its main risk derives from the emission of energy ß radiations. No data on chronic toxicity studies were

2015 European Medicines Agency - EPARs

124. Cariprazine HCl (Vraylar)

with/or without cholesterol clefts) in humans based on relatively low safety margin (4.2 fold) for this adverse effect at the MRHD of 6 mg/day; therefore, as indicated above, some concerns with regard to pulmonary toxicity caused by cariprazine in nonclinical studies and their relevance to humans remain. The Division of Pulmonary, Allergy and Rheumatology Products (DPARP) completed an assessment of pulmonary safety consult based on nonclinical and clinical cariprazine data (see DPARP review of August 23, 2013 (...) , didesmethylcariprazine (DDCAR), with a very long half-life that causes it to accumulate for at least 3-4 weeks (there is continuing discussion of the relevant half-life and insufficient data to determine when a blood level plateau is reached but it is almost certainly at least 4 weeks). The total active moiety (mostly cariprazine plus DDCAR) also continues to accumulate, again with a plateau at least 4 weeks. Drugs with such a long half-life would usually be at least considered for administration using a loading

2015 FDA - Drug Approval Package

125. Health Equity: School-Based Health Centers

%, unfavorable (3 studies that did not separately report outcomes for female and male students Becoming pregnant or causing pregnancy: Females only: median decrease of 40.0% (5 studies) Males only: increase of 21.5% in causing pregnancy, unfavorable (1 study) Specific to pregnancy: Pregnancy complications: median increase of 25%; unfavorable (3 studies) Percent low birth weight: median decrease of 58.3% (3 studies) Prenatal care: median 27.8% increase in the number of prenatal visits (2 studies); 2 (...) : Delivery of vaccinations and other recommended preventive services Asthma morbidity Emergency department and hospital admissions Contraceptive use among sexually active females Prenatal care and birth weight Other health risk behaviors If targeted to low-income communities, SBHCs are likely to reduce gaps in education and improve health equity. Intervention School-based health centers must provide primary health care on-site (school-based) or off-site (school-linked). They may also provide mental

2015 Community Preventive Services Task Force

126. Hypersalivation: oral glycopyrronium bromide

production of saliva. This presents as drooling in children, young people and adults with a neurological condition, such as cerebral palsy or Parkinson's disease. Hypersalivation can also be an adverse effect of drug treatment (for example, clozapine). Chronic drooling can be defined as the unintentional loss of saliva from the mouth. Zeller et al. (2012a) reported that although drooling is normal in infants, it usually stops by 15–18 months of age, and is considered pathological if present after 4 years (...) ) therapy and with concomitant oral potassium chloride. The most commonly reported adverse effects listed are dry mouth, vomiting, constipation, flushing and nasal congestion. P Patient factors atient factors Glycopyrronium bromide tablets and oral solution or suspension are imported or prepared by 'specials' manufacturers. Dosage varies: generally given 3 times daily, titrated and dependent on weight in children (Cuvposa labelling advises to give either 1 hour before, or 2 hours after, meals). Oral

2013 National Institute for Health and Clinical Excellence - Advice

127. The Role of Bariatric Surgery in Improving Reproductive Health

banding (LAGB), silastic ring gastroplasty (SRG), vertical banded gastroplasty (VBG) and sleeve gastrectomy (SG). An example of a malabsorptive bariatric procedure is biliopancreatic diversion (BPD); Roux-en-Y gastric bypass (RYGB) is both a restrictive and malabsorptive procedure. Bariatric surgery results in a loss of up to 15–25% of body weight that is sustained in the long term, as well as significant reductions in healthcare costs and comorbidities associated with obesity, such as diabetes (...) . 24 Complications include bleeding, anastomotic leak with peritonitis, deep vein thrombosis and internal hernias. In SG, a partial gastrectomy is performed to reduce stomach volume while maintaining the normal anatomy of the rest of the gastrointestinal tract. Originally performed to aid initial weight loss prior to a duodenal switch, it has gained popularity as a stand-alone operation. The metabolic effects and weight loss appear similar in the first few years to RYGB surgery, 25–28 but RYGB

2015 Royal College of Obstetricians and Gynaecologists

128. Bipolar disorder

except that a diagnosis only requires that symptoms have lasted for 4 days, the episode is not severe enough to cause marked impairment in social or occupational functioning or necessitate hospitalization, and there are no psychotic features. A depressive episode is a period of at least 2 weeks during which there is either depressed mood or loss of interest or pleasure in nearly all activities (or irritability in children and adolescents), accompanied by at least four additional symptoms (...) is severe enough to cause marked impairment in social or occupational functioning or necessitate hospitalization, or which includes psychotic features. A hypomanic episode is similar to a manic episode except that a diagnosis only requires that symptoms have lasted for 4 days, is not severe enough to cause marked impairment in social or occupational functioning or necessitate hospitalization, and there are no psychotic features. A depressive episode is a period of at least 2 weeks during which

2019 NICE Clinical Knowledge Summaries

129. Bariatric Surgery in Improving Reproductive Health, The Role of

banding (LAGB), silastic ring gastroplasty (SRG), vertical banded gastroplasty (VBG) and sleeve gastrectomy (SG). An example of a malabsorptive bariatric procedure is biliopancreatic diversion (BPD); Roux-en-Y gastric bypass (RYGB) is both a restrictive and malabsorptive procedure. Bariatric surgery results in a loss of up to 15–25% of body weight that is sustained in the long term, as well as significant reductions in healthcare costs and comorbidities associated with obesity, such as diabetes (...) . 24 Complications include bleeding, anastomotic leak with peritonitis, deep vein thrombosis and internal hernias. In SG, a partial gastrectomy is performed to reduce stomach volume while maintaining the normal anatomy of the rest of the gastrointestinal tract. Originally performed to aid initial weight loss prior to a duodenal switch, it has gained popularity as a stand-alone operation. The metabolic effects and weight loss appear similar in the first few years to RYGB surgery, 25–28 but RYGB

2015 Royal College of Obstetricians and Gynaecologists

130. UnderNutrition and the Older Person

appetite and recent unintentional weight loss. The interrater reliability of the tool was high (93-97%). A positive screening will lead to action plan that include referral to dietitian 54 . The Malnutrition Universal Screening Tool (MUST) Widely used in the United Kingdom. Can be used in all health care settings 55 . Linked to a generic care plan. Simplified Nutritional Assessment Questionnaire (SNAQ) Simple 4-item appetite assessment tool 56 . Detecting risk of poor nutritional health prior to weight (...) in a randomized trial. Am J Clin Nutr. 2014;100: 1108-1115. [38] Simmons SF, Patel AV. Nursing home staff delivery of oral liquid nutritional supplements to residents at risk for unintentional weight loss. J Am Geriatr Soc. 2006;54: 1372-1376. [39] Milne AC, Potter J, Vivanti A, Avenell A. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev. 2009: CD003288. [40] Stephen AI, Avenell A. A systematic review of multivitamin and multimineral supplementation

2015 Australian and New Zealand Society for Geriatric Medicine

131. Genetics of Breast and Gynecologic Cancers (PDQ®): Health Professional Version

), (associated with Cowden syndrome), (associated with diffuse gastric and lobular breast cancer syndrome), and (associated with Peutz-Jeghers syndrome), confer a risk to either or both of these cancers with relatively high penetrance. Inherited endometrial cancer is most commonly associated with , a condition caused by inherited pathogenic variants in the highly penetrant mismatch repair genes MLH1 , MSH2 , MSH6 , PMS2 , and EPCAM . Colorectal cancer (and, to a lesser extent, ovarian cancer and stomach (...) pathogenic, or pathogenic (disease causing). Throughout this summary, we will use the term pathogenic variant to describe a disease-causing mutation. Refer to the summary for more information about variant classification. ] [ Note: Many of the genes and conditions described in this summary are found in the Online Mendelian Inheritance in Man (OMIM) catalog. Refer to for more information. ] Among women in the United States, breast cancer is the most commonly diagnosed cancer after nonmelanoma skin cancer

2018 PDQ - NCI's Comprehensive Cancer Database

132. 2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation Full Text available with Trip Pro

(Strong Recommendation, High-Quality Evidence). 2. When OAC is indicated in the presence of CAD, we suggest a NOAC in preference to warfarin for NVAF (Conditional Recommendation, Low-Quality Evidence). Values and preferences. The suggestion for use of a NOAC rather than warfarin places relatively greater weight on the ease of use of NOACs vs warfarin and on the data from RCTs of NOACs vs warfarin for NVAF, showing equal or greater reduction of stroke, equal or less major bleeding, less intracranial (...) bleeding, and no net increase in CAD outcomes. It places relatively less weight on the absence of long-term data on the effect of NOACs on coronary outcomes as opposed to the data for efficacy of warfarin. Practical tip. When CAD is present, some expert clinicians prefer a combination of a NOAC and ASA rather than a NOAC alone in preference to warfarin alone for patients perceived to be at higher risk of coronary events and low risk of major bleeding and might choose a NOAC alone as a reasonable option

2016 Canadian Cardiovascular Society

133. Dyspepsia - proven peptic ulcer

and when to consult their GP. Statement 2. Adults presenting with dyspepsia or reflux symptoms are referred for urgent direct access endoscopy to take place within 2 weeks if they have dysphagia, or are aged 55 and over with weight loss. Statement 3. Adults with dyspepsia or reflux symptoms have a 2-week washout period before a test for Helicobacter pylori if they are receiving proton pump inhibitor therapy. Statement 4. Adults aged 55 and over with dyspepsia or reflux symptoms that have not responded (...) -existent H. pylori infection, further increasing the risk of peptic ulceration. Smoking, alcohol consumption, and stress — the evidence is conflicting in studies. Zollinger-Ellison syndrome (rare) — this hypersecretory state may be associated with multiple peptic ulcers, diarrhoea, weight loss, and hypercalcaemia. Prevalence How common is it? The exact prevalence of peptic ulcer disease is difficult to establish, as the definitions used vary between studies, and endoscopy is needed to make a formal

2018 NICE Clinical Knowledge Summaries

134. Towards a better managed off-label use of drugs

to which it could reasonably be expected that the product would be put”. It is unlikely, however, that the producer will be held liable if the patient was sufficiently informed on the possible risks by the package leaflet and by the physician and if the injury was not caused by a defect inherent to the product or an error in the leaflet. ? Pharmacists can be held liable for damage caused by a defective magistral formula. They are responsible for the quality of the magistral formula: correct weighing (...) for a (too) limited treatment duration or because the authorised alternative is in short supply (e.g. insufficient stocks) or because the treating physician feels that it is less suitable than the off-label product. The use of generic drugs can also lead to unintentional off-label use. Often, generics of one and the same molecule list different applications on the leaflet. Even between countries, applications for one and the same generic can differ. Doctors are usually not aware of this. In countries

2015 Belgian Health Care Knowledge Centre

135. Daily iron supplementation in postpartum women

in which there is too little haemoglobin, which is carried by red blood cells, thereby decreasing the capacity of the blood to carry sufficient oxygen to meet physiological needs. There are a number of causes of anaemia, including blood loss, iron deficiency and other micronutrient deficiencies (e.g. vitamin A, folate, vitamin B 12 and riboflavin), inherited haemoglobin disorders (e.g. sickle-cell disease and thalassaemias), parasitic infections and other acute and chronic infections that cause (...) little iron is excreted through breast milk (9, 10). Nevertheless, one of the strongest predictors of postpartum anaemia is anaemia during pregnancy, as iron stores tend to remain low for several months after childbirth, especially if there is significant blood loss during the delivery and additional iron is not consumed in sufficient quantities (11–13). Worldwide, there are limited data on the prevalence of postpartum anaemia. Studies conducted in high-income countries have reported that 10–30

2016 World Health Organisation Guidelines

136. Map of NICE guidanace realting to inequalities

at socioeconomic disadvantage. For example: ? Smoking is the largest single cause of health inequalities. A socioeconomic gradient is observed for smoking and cardiovascular disease with rates of risk factor and disease both increasing with increasing disadvantage ? Obesity is related to social disadvantage, especially in children, as is weight retention after birth. Physical activity has a complex relationship with socioeconomic status ? Alcohol-related problems have a disproportionate effect on disadvantaged (...) groups ? Children and young people from lower socioeconomic groups are more likely to be affected by unintentional injuries. The social gradient is noted to be particularly steep in relation to deaths caused by household fires, cycling and walking ? Conduct disorders exhibit a steep social class gradient. This document does not signpost to policy and other documents proposing social reform to address the extent of social gradient arising from income inequality, differences in social status

2016 Public Health Wales Observatory Evidence Service

137. The Impact of the Welfare Reform and Work Bill

: These are the commonest cause of death in children aged 5-9 in the UK and a major area of socioeconomic inequality. Children from disadvantaged backgrounds are more likely to experience unintentional injury. 44 Road traffic accidents are the main cause of death in this age-group and are strongly related to socioeconomic status. For example, child pedestrians in the lowest socioeconomic group are five times more likely to be killed on the roads than those in the highest group. For deaths due to fire this differential (...) in that year (and every year thereafter). 8 It also included a further duty on the Secretary of State to publish a child poverty strategy triennially. 13. In the Conservative Manifesto 2015, a commitment to “work to eliminate child poverty and introduce better measures to drive real change in children’s lives by recognising the root causes of poverty: entrenched worklessness, family breakdown, problem debt, and drug and alcohol dependency” was included. 9 14. The Welfare Reform and Work Bill will repeal

2016 Faculty of Public Health

138. Muscle mass, BMI, and mortality among adults in the United States: A population-based cohort study. Full Text available with Trip Pro

unchanged after excluding unintentional weight loss, chronic illness, early mortality, and participants performing muscle-strengthening exercises or recommended levels of physical activity.Muscle mass mediates associations of BMI with adiposity and mortality and is inversely associated with the risk of death. After accounting for muscle mass, the BMI associated with the greatest survival shifts downward toward the normal range. These results provide a concrete explanation for the obesity paradox. (...) Examination Survey 1999-2004. Low muscle mass was defined using sex-specific thresholds of the appendicular skeletal muscle mass index (ASMI). Proportional hazards models were created to model associations with all-cause mortality.At any level of BMI ≥22, participants with low muscle mass had higher body fat percentage (%TBF), an increased likelihood of diabetes, and higher adjusted mortality than other participants. Increases in %TBF manifested as 30-40% smaller changes in BMI than were observed

2018 PLoS ONE

139. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

predictive equation or a simplistic weight-based equation (25–30 kcal/kg/day) be used to determine energy requirements. (See section Q for obesity recommendations.) Rationale: Clinicians should determine energy requirements in order to establish the goals of nutrition therapy. Energy requirements may be calculated either through simplistic formulas (25–30 kcal/kg/day), published predictive equations, or IC. The applicability of IC may be limited at most institutions by availability and cost. Variables (...) , such as weight, medications, treatments, and body temperature. The only advantage of using weight-based equations over other predictive equations is simplicity. However, in critically ill patients following aggressive volume resuscitation or in the presence of edema or anasarca, clinicians should use dry or usual body weight in these equations. Additional energy provided by dextrose-containing fluids and lipid-based medications such as propofol should be accounted for when deriving nutrition therapy regimens

2016 Society of Critical Care Medicine

140. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

. Question: What is the best method for determining energy needs in the critically ill adult patient? A3a. We suggest that indirect calorimetry (IC) be used to determine energy requirements, when available and in the absence of variables that affect the accuracy of measurement. [Quality of Evidence: Very Low] A3b. Based on expert consensus, in the absence of IC, we suggest that a published predictive equation or a simplistic weight‐based equation (25–30 kcal/kg/d) be used to determine energy requirements (...) and underweight patients. ‐ Equations derived from testing hospital patients (Penn State, Ireton‐Jones, Swinamer) are no more accurate than equations derived from testing normal volunteers (Harris‐Benedict, Mifflin St Jeor). The poor accuracy of predictive equations is related to many nonstatic variables affecting energy expenditure in the critically ill patient, such as weight, medications, treatments, and body temperature. The only advantage of using weight‐based equations over other predictive equations

2016 American Society for Parenteral and Enteral Nutrition

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