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PubMedDate not supplied

Optimal calcium intake. Sponsored by National Institutes of Health Continuing Medical Education.

The National Institutes of Health Consensus Development Conference on Optimal Calcium Intake brought together experts from many different fields including osteoporosis and bone and dental health, nursing, dietetics, epidemiology, endocrinology, gastroenterology, nephrology, rheumatology, oncology, hypertension, nutrition and public education, and biostatistics, as well as the public, to address the following questions: 1) What is the optimal amount of calcium intake? 2) What are the important cofactors for achieving optimal calcium intake? 3) What are the risks associated with increased levels of calcium intake? 4) What are the best ways to attain optimal calcium intake? 5) What public health strategies are available and needed to implement optimal calcium intake recommendations? and 6) What are the recommendations for future research on calcium intake? The consensus panel concluded that: A large percentage of Americans fail to meet currently recommended guidelines for optimal calcium intake. On the basis of the most current information available, optimal calcium intake is estimated to be 400 mg/day (birth-6 months) to 600 mg/day (6-12 months) in infants; 800 mg/day in young children (1-5 years) and 800-1,200 mg/day for older children (6-10 years); 1,200-1,500 mg/day for adolescents and young adults (11-24 years); 1,000 mg/day for women between 25 and 50 years; 1,200-1,500 mg/day for pregnant or lactating women; and 1,000 mg/day for postmenopausal women on estrogen replacement therapy and 1,500 mg/day for postmenopausal women not on estrogen therapy. Recommended daily intake for men is 1,000 mg/day (25-65 years). For all women and men over 65, daily intake is recommended to be 1,500 mg/day, although further research is needed for this age group. These guidelines are based on calcium from the diet plus any calcium taken in supplemental form. Adequate vitamin D is essential for optimal calcium absorption. Dietary constituents, hormones, drugs, age, and genetic factors influence the amount of calcium required for optimal skeletal health. Calcium intake, up to a total intake of 2,000 mg/day, appears to be safe in most individuals. The preferred source of calcium is through calcium-rich foods such as dairy products. Calcium-fortified foods and calcium supplements are other means by which optimal calcium intake can be reached in those who cannot meet this need by ingesting conventional foods. A unified public health strategy is needed to ensure optimal calcium intake in the American population.

Absorption↗
PubMed1996

National Institutes of Health Consensus Development Conference Statement: cervical cancer, April 1-3, 1996. National Institutes of Health Consensus Development Panel.

OBJECTIVE: The objective was to provide physicians and the general public with a responsible assessment of current screening, prevention, and treatment approaches to cervical cancer. PARTICIPANTS: A non-Federal, nonadvocate, 13-member panel representing the fields of obstetrics and gynecology, gynecologic oncology, radiation oncology, and epidemiology participated. In addition, 28 experts in obstetrics and gynecology, gynecologic oncology, radiation oncology, gynecologic surgery, and psychology presented data to the panel and a conference audience of 500. EVIDENCE: The literature was searched through Medline, and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. CONSENSUS PROCESS: The panel, answering predefined questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. CONCLUSIONS: Carcinoma of the cervix is causally related to infection with the human papillomavirus (HPV). Reducing the rate of HPV infection by changes in sexual behaviors in young people and/or through the development of an effective HPV vaccine would reduce the incidence of this disease. Papanicolaou smear screening remains the best available method of reducing the incidence of and mortality from invasive cervical cancer. Persons with stage IA1 disease have a high cure rate with either simple hysterectomy or, where fertility preservation is an issue, by cone biopsy with clear margins. For patients with other stage I or stage IIA disease, radical surgery or radiation treatment is equally effective. These patients should be carefully selected to receive one treatment or the other but not both, because their combined use substantially increases the cost of and morbidity from treatment. Women with more advanced, nonmetastatic disease should be treated with radiation. Recurrent cervical cancer confined to the pelvis should be treated with the modality not previously received. Radiation therapy is recommended to palliate symptoms in patients with metastatic disease.

Female↗
PubMed1997

Tamoxifen's impact on the management of breast cancer: the oncologist's perspective.

Breast cancer treatment has evolved greatly within the last 25 years. Tamoxifen was first introduced for the treatment of metastatic breast cancer in the 1970s and later became accepted as standard adjuvant therapy. The emergence of tamoxifen as first-line hormonal therapy for metastatic disease and in the adjuvant setting occurred due to its efficacy in achieving prolonged overall survival as well as improved disease-free survival, the latter of which improves the psychological and physical quality of life of the patient. Tamoxifen is currently being studied for the prevention of breast cancer. Completion of this important trial is eagerly awaited.

Adjuvants, Pharmaceutic↗
PubMed1996

"Say it ain't so!".

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Consensus Development Conferences, NIH as Topic↗
PubMed1997

Orthodontic treatment and temporomandibular disorders: is there a relationship? Part 1: Clinical studies.

The relationship between orthodontic treatment and temporomandibular disorders (TMD) has long been of interest to the practicing orthodontist, but only during the last decade or so have a significant number of methodologically-sound clinical studies been conducted that have investigated this association. The aim of this paper is to critically review particularly those studies that have been published since 1989 and to answer the following questions: 1. Does orthodontic treatment with fixed or removable appliances lead to a greater incidence of TMD? 2. Does the extraction of premolars as part of an orthodontic treatment plan result in a greater incidence of TMD? 3. Does orthodontic treatment prevent or cure TMD? For this purpose, we conducted a MEDLINE search, complemented by a hand search in selected journals. We found 21 publications of studies related to the orthodontic-TMD interface. Based on these studies, the following statements can be made: 1. Orthodontic treatment performed during adolescence does not increase or decrease the chances of developing TMD later in life. There is no evidence of an elevated risk for TMD associated with any particular type of orthodontic mechanics. 2. The extraction of teeth as part of an orthodontic treatment plan does not increase the risk of TMD. 3. Thus far, there is no compelling evidence that orthodontic treatment prevents TMD, although the role of unilateral posterior crossbite correction in children may warrant further investigation. Likewise, there is no convincing evidence that TMD can be cured by orthodontic treatment.

Adolescent↗
PubMedDate not supplied

Physical activity and cardiovascular health.

OBJECTIVE: To provide physicians and the general public with a responsible assessment of the relationship between physical activity and cardiovascular health. PARTICIPANTS: A non-Federal, nonadvocate, 13-member panel representing the fields of cardiology, psychology, exercise physiology, nutrition, pediatrics, public health, and epidemiology. In addition, 27 experts in cardiology, psychology, epidemiology, exercise physiology, geriatrics, nutrition, pediatrics, public health, and sports medicine presented data to the panel and a conference audience of 600. EVIDENCE: The literature was searched through Medline and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. CONSENSUS PROCESS: The panel, answering predefined questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. CONCLUSIONS: All Americans should engage in regular physical activity at a level appropriate to their capacity, needs, and interest. Children and adults alike should set a goal of accumulating at least 30 minutes of moderate-intensity physical activity on most, and preferably, all days of the week. Most Americans have little or no physical activity in their daily lives, and accumulating evidence indicates that physical inactivity is a major risk factor for cardiovascular disease. However, moderate levels of physical activity confer significant health benefits. Even those who currently meet these daily standards may derive additional health and fitness benefits by becoming more physically active or including more vigorous activity. For those with known cardiovascular disease, cardiac rehabilitation programs that combine physical activity with reduction in other risk factors should be more widely used.

Adult↗