In the past, celiac disease was believed to be a chronic enteropathy, almost exclusively affecting people of European origin. The availability of new, simple, very sensitive and specific serological tests (anti-gliad...In the past, celiac disease was believed to be a chronic enteropathy, almost exclusively affecting people of European origin. The availability of new, simple, very sensitive and specific serological tests (anti-gliadin, anti- endomysium and anti-transglutaminase antibody assays) have shown that celiac disease is common not only in Europe and in people of European ancestry but also in the developing countries where the major staple diet is wheat (Southern Asia, the Middle East, North West and East Africa, South America), both in the general population and in the groups at risk. Gluten intolerance thus appears to be a widespread public health problem and an increased level of awareness and clinical suspicion are needed in the New World where physicians must learn to recognize the variable clinical presentations (classical, atypical and silent forms) of celiac disease. In the developing countries, both serological screening in the general population and serological testing in groups at risk are necessary for an early identification of celiac patients. The gluten-free diet poses a challenging public health problem in the developing countries, especially since commercial gluten-free products are not available.展开更多
Breast cancer is defined as a chronic disease.Increasing amounts of attention have been paid to the healthmanagement of breast cancer survivors. An important issue ishow to find the most appropriate method of follow-u...Breast cancer is defined as a chronic disease.Increasing amounts of attention have been paid to the healthmanagement of breast cancer survivors. An important issue ishow to find the most appropriate method of follow-up in orderto detect long-term complications of treatment, local recurrenceand distant metastasis and to administer appropriate treatmentto the survivors with recurrence in a timely fashion. Differentoncology organizations have published guidelines for followingup breast cancer survivors. However, there are few articles onthis issue in China. Using the published follow-up guidelines,we analyzed their main limitations and discussed the content,follow-up interval and economic benefits of following up breastcancer survivors in an effort to provide suggestions to physicians.Based on a large number of clinical trials, we discussed the roleof physical examination, mammography, liver echograph, chestradiography, bone scan and so on. We evaluated the effects ofthe above factors on detection of distant disease, survival time,improvement in quality of life and time to diagnosis of recurrence.The results of follow-up carried out by oncologists and primaryhealth care physicians were compared. We also analyzed thecorrelation factors for the cost of such follow-up. It appears thatfollow-up for breast cancer survivors can be carried out effectivelyby trained primary health care physicians. If anything unusualarises, the patients should be transferred to specialists.展开更多
文摘In the past, celiac disease was believed to be a chronic enteropathy, almost exclusively affecting people of European origin. The availability of new, simple, very sensitive and specific serological tests (anti-gliadin, anti- endomysium and anti-transglutaminase antibody assays) have shown that celiac disease is common not only in Europe and in people of European ancestry but also in the developing countries where the major staple diet is wheat (Southern Asia, the Middle East, North West and East Africa, South America), both in the general population and in the groups at risk. Gluten intolerance thus appears to be a widespread public health problem and an increased level of awareness and clinical suspicion are needed in the New World where physicians must learn to recognize the variable clinical presentations (classical, atypical and silent forms) of celiac disease. In the developing countries, both serological screening in the general population and serological testing in groups at risk are necessary for an early identification of celiac patients. The gluten-free diet poses a challenging public health problem in the developing countries, especially since commercial gluten-free products are not available.
文摘Breast cancer is defined as a chronic disease.Increasing amounts of attention have been paid to the healthmanagement of breast cancer survivors. An important issue ishow to find the most appropriate method of follow-up in orderto detect long-term complications of treatment, local recurrenceand distant metastasis and to administer appropriate treatmentto the survivors with recurrence in a timely fashion. Differentoncology organizations have published guidelines for followingup breast cancer survivors. However, there are few articles onthis issue in China. Using the published follow-up guidelines,we analyzed their main limitations and discussed the content,follow-up interval and economic benefits of following up breastcancer survivors in an effort to provide suggestions to physicians.Based on a large number of clinical trials, we discussed the roleof physical examination, mammography, liver echograph, chestradiography, bone scan and so on. We evaluated the effects ofthe above factors on detection of distant disease, survival time,improvement in quality of life and time to diagnosis of recurrence.The results of follow-up carried out by oncologists and primaryhealth care physicians were compared. We also analyzed thecorrelation factors for the cost of such follow-up. It appears thatfollow-up for breast cancer survivors can be carried out effectivelyby trained primary health care physicians. If anything unusualarises, the patients should be transferred to specialists.