Bowels: Beliefs and Behaviour

A postal questionnaire about knowledge, beliefs, and experiencesof bowel function was returned by 171 patients aged 55 yearsand over from a group general practice in London. Of the respondents,10% reported no predictable frequency of movement, a higherproportion being women than men; 79% believed that a daily movementis important and 90% that ‘regularity’ is necessaryfor good health; 14% were dissatisfied with their bowel habitsand 16% regularly self-treated; 95% gave reasonable definitionsof ‘regular’ and ‘diarrhoea’; a tenthwere unsure about the definition of ‘constipation’.Although 76% believed there were bowel symptoms which requireimmediate medical attention, 98% would in the first instancetreat themselves for constipation, 90% for diarrhoea, and 25%for rectal bleeding. To reduce delay in the diagnosis of colorectal cancer, it issuggested that consultations for disturbance of bowel functionbe encouraged among the middle-aged and the elderly. Doctorsshould examine such patients with the diagnosis of malignancyin mind.     

Peer Reviewed: Healthy Maine Partnerships: Policy and Environmental Changes

Background

Tobacco settlement funds were used to establish the Healthy Maine Partnerships (HMPs) to reduce tobacco use, increase physical activity, and improve nutrition through local policy and environmental change.

Context

The HMP model is a progressive approach to public health. It provides for coordinated efforts between state and local partners for health promotion and disease prevention. Community coalitions, supported with funding and guidance by the state, are the basis for policy and environmental change.

Methods

The state awarded contracts and provided program guidance to foster policy and environmental change at the local level. The partnerships'' efforts were assessed with a retrospective evaluation that consisted of 2 data collection periods conducted using the same tool. A survey booklet containing lists of possible environmental and policy changes was developed and mailed — once in 2005 and once in 2006 — to all 31 local partnership directors and school health coordinators who completed it. Additional data were collected from the local partnerships in the form of narrative reports required by their funder (Maine Center for Disease Control and Prevention).

Consequences

All local partnerships implemented policy or environmental interventions to address tobacco use, physical activity, and nutrition during the period covered by the surveys (July 2002-June 2005 [fiscal years 2003-2005]). Cumulatively, more than 4,600 policy or environmental changes were reported; tobacco use policies represent most changes implemented. A second round of HMP funding has since been secured.

Interpretation

Although the survey methodology had limitations, results suggest that much work has been accomplished by the local partnerships. Plans are to share success stories among partnerships, provide training, and continue to improve the public health infrastructure in Maine.     

Acute Epididymitis: Etiology and Therapy

Fifty patients with acute epididymitis were evaluated prospectively by history, examination, and microbiologic studies, including cultures for aerobes, anaerobes, N. gonorrhoeae, Chlamydia trachomatis, and Ureaplasma urealyticum. E. coli was the predominant pathogen isolated from the urine of men over 35 years old and C. trachomatis and N. gonnorrheae were the predominant pathogens isolated from the urethra of men under 35. The etiologic role of E. coli and C. trachomatis was confirmed by isolation from epididymal aspirates from a high proportion of men with positive urine of urethral cultures for these agents. C. trachomatis epididymitis accounted for two thirds of “idiopathic epididymitis” in men, and was often associated with oligozoospermia. Of nine female sexual partners of men with C. trachomatis infection, six had antibody to C. trachomatis, of whom two had positive cervical cultures for this organism, and the others had nongonococcal pelvic inflammatory disease. Antibiotic therapy with tetracycline was effective for the treatment of men with C. trachomatis epididymitis, and should be offered to their female sex partner.     

Work and Well-Being: Realities and Aspirations

This article summarizes research on the quality of working lifeand the effects of unemployment, and presents policy proposalsin both areas. Research findings on the quality of working lifeare discussed in terms of six major determinants: variety andchallenge; autonomy and control; resources and supervision;relations with coworkers; wages and promotion; and conditionsof work. Effects of unemployment are demonstrated in four areas— mental health, physical symptoms, physiological indicators,and economic well-being. Suggestions for future research and for social policy are madein two domains, socio-technics and reallocation of work. Thefirst, socio-technics revisited, is a proposal for interdisciplinarycollaboration in which engineering, architecture, and medicineas well as the social sciences address the problems of qualityof employment. This contrasts with the earlier research in whichthe technology of work is taken as given and the task of socialscience is adaptation to it. The proposal for the reallocationof work is based on a four-hour work module and on individualchoice, compatible with organizational requirements, on thenumber and pattern of modules to be worked. Both proposals areurged as subjects for experimental trial and revision, beforeenactment as social policy.     

Tuberculosis and AIDS: European and worldwide perspectives

Summary To examine the possible influence of AIDS and HIV infection on the epidemiology of tuberculosis in Europe and worldwide in the coming decades an analysis of the available data on the two diseases and on the transmission of the two infections in relation to the demographic structure of the population was conducted, including projections for up to the year 2025. Globally, the effects of the AIDS pandemic on the tuberculosis situation will problably be very serious, adding some 1.5 million new cases of tuberculosis annually by the year 2025 as a result of HIV infection. However, this effect for Europe in the year 2025 may be in the range of 15000 additional cases only. The main factor determining the scale of aggravation of Tb is the age structure of the population infected, or at risk of being infected, with tubercle bacilli and HIV. Although the influence of HIV infection on tuberculosis in Europe may not be very high due to the fact that HIV infection involves mainly younger age groups it may, however, substantially postpone the elimination of tuberculosis from Europe. Therefore it seems necessary to monitor constantly all the changes in the epidemiological situation of both tuberculosis and AIDS/HIV.

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Zusammenfassung Um in den kommenden Jahrzehnten den Einfluss der AIDS- und HIV-Infektionen auf die Tuberkuloseepidemie in Europa und weltweit zu untersuchen, wurde eine Analyse der vorhandenen Daten über die beiden Krankheiten und über die übertragung dieser infektionen in Beziehung zur demographischen Struktur der Bev?lkerung durchgeführt, einschliesslich Prognosen bis ins Jahr 2025. W?hrend weltweit der Effekt der AIDS-Pandemie auf die Tuberkulose von bis zu 1,5 Millionen neuer Tuberkulosef?lle bis ins Jahr 2025 als sehr ernst bezeichnet werden kann, werden in Europa bis dahin nur etwa 15000 zus?tzlicher F?lle auftreten. Hauptfaktor, verantwortlich für diesen Unterschied, ist die Altersstruktur der infizierten Bev?lkerung oder der Bev?lkerung mit dem h?chsten Ansteckungsrisiko für Tuberkulose oder HIV. Obschon der Einfluss der HIV-Infektion auf die Tuberkulose in Europa nicht so stark sein wird, weil HIV haupts?chlich die jungen Altersgruppen betrifft, wird sie dennoch die Elimination der Tuberkulose in Europa betr?chtlich verz?gern. Aus diesem Grunde ist es wichtig, dass die epidemiologische Situation der beiden Krankheiten Tuberkulose und AIDS/HIV weiterhin sorgf?ltig über-wacht wird.

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Résumé La situation créée par l'interaction entre l'infection VIH et l'infection tuberculeuse est inquiétante tant par son ampleur que par la menace pour l'avenir de la situation mondiale de la tuberculose. L'effet de cette interaction a été étudié dans plusieurs pays européens et pour plusieurs décennies à venir, en relation avec les changements démographiques de la population infectée par M. tuberculosis. On peut prévoir qu'en 2025, à l'échelle mondiale, l'effet de la pandémie de SIDA se traduira par une augmentation du nombre des cas de tuberculose d'environ 1.5 millions. Dans les pays européens, en 2025, le SIDA n'aura pas une grande influence sur l'élimination de la tuberculose en raison de la prévalence faible de l'infection tuberculeuse chez les sujets agés de 0 à 50 ans, chez lesquels la fréquence de l'infection par le VIH est la plus élevée. L'augmentation du nombre des cas de tuberculose en 2025 sera d'environ 15000 cas. Néanmoins, cette augmentation peut prolonger l'élimination de la tuberculose dans la plupart des pays européens, et il est nécessaire d'étudier constamment tous les changements de la situation épidémiologique du SIDA et de la tuberculose.

     

Rehabilitation: Concept and Practice

The word “Rehabilitation” has been used in many contexts and in many different ways. In the medical field its interpretation has changed considerably in the period from the years before the first world war to that after the second and the ensuing extensive social legislation which followed the Beveridge Report. Changes in definition, although usually enlarging the scope, do not necessarily mean increased application. The multiplicity of statutory and other agencies which have a part in the method and means of returning patients to full industrial and social contact has contributed to the failure to progress with the changes in definition.

Any review of rehabilitation services in this country shows many gaps which are due primarily to a failure by the medical profession as a whole to accept the dynamic philosophy of treatment demanded by rational schemes of rehabilitation and secondarily to the failure of effective co-ordination and integration between government departments, hospitals, general practitioners, public health services, and industry.

The prevailing tendency to isolate rehabilitation in the sphere of physical medicine is criticized as an attempt to evade a responsibility which the whole practising profession must accept. The fundamental function of industry in the process and the importance of the role of the Industrial Medical Officer are emphasized. Resettlement in employment is the crux of the whole process of rehabilitation.

     

Beliefs and behaviours: understanding chiropractors and immunization

Background:Concerns have been raised about the beliefs and behaviours of chiropractors related to immunization; however, none have systematically examined the relationships between beliefs and behaviours.Purpose:We examine the immunization-related behaviours and beliefs of chiropractors in Alberta, Canada, and explore the relationship of beliefs to immunization-related behaviours with patients.Methods:Data were collected in 2002 from a postal survey of Alberta chiropractors. The questionnaire inquired about six behaviours of interest in the six months prior to survey (gave information about risks/benefits of vaccination; advised patients in favour/against have self/children immunized; counselled on freedom of choice; directed to sources of information on immunization). It included items addressing beliefs and norms related to immunization.Results:The response rate was 78.2% (503/643). Immunization arose with patients at least monthly for 36.5% of respondents, and at least weekly for 9.2%. One quarter advised patients in favour and 27% against having themselves/their children immunized. A parsimonious model of chiropractor pro/anti-vaccination behaviours included beliefs about the efficacy/safety of vaccination, chiropractic philosophy and individual rights.Conclusions:Similar proportions of chiropractors advise patients in favour or against immunization. A small minority deals with immunization issues frequently. Behaviours can be understood in the context of beliefs.     

Chemotherapy-Induced Nausea and Vomiting: Optimizing Prevention and Management

Background

Nausea and vomiting are serious side effects of cancer chemotherapy that can cause significant negative impacts on patients’ quality of life and on their ability to tolerate and comply with therapy. Despite advances in the prevention and management of chemotherapy-induced nausea and vomiting (CINV), these side effects remain among the most distressing for patients.

Objective

To discuss CINV and the current pharmacologic approaches to its management.

Discussion

This article outlines the mechanism of CINV followed by a review of current approaches to pharmacologic therapy and current practice guidelines from national cancer organizations. This information will help providers and payers understand the optimal management of patients with CINV including practical considerations and value-based decision-making that considers cost issues.

Conclusion

Numerous preventive and treatment options are available to manage CINV Addressing antiemetic regimens requires ongoing patient evaluation to determine the best approach for each individual patient.Nausea and vomiting are 2 serious and related side effects of cancer chemotherapy. These adverse effects can cause significant negative impacts on patients’ quality of life and on their ability to comply with therapy. Also, nausea and vomiting can result in anorexia, decreased performance status, metabolic imbalance, wound dehiscence, esophageal tears, and nutritional deficiency.1,2 Despite advances in the prevention and management of chemotherapy-induced nausea and vomiting (CINV), these side effects remain among the most distressing for patients. The use of emerging antiemetic medications has reduced the incidence of vomiting substantially, but evaluations show that approximately 30% to 60% of patients still experience either acute or delayed nausea after chemotherapy.3 Serial evaluations throughout the 1980s and into the 2000s show that, although vomiting has fallen further down on the list of side effects that patients perceive as being their most severe, nausea remains either the first or second most severe side effect of chemotherapy.4–8Risk factors for CINV can be divided into patient-specific and treatment-specific risk factors. Female sex and history of motion or morning sickness are clear risk factors for nausea and vomiting.5,6 Younger age has also been correlated with increased risk, although this may be explained by the more aggressive chemotherapy regimens that tend to be administered to younger patients who have more aggressive diseases.5–7 Finally, alcohol intake tends to be inversely correlated with the risk of developing CINV. Many factors contribute to the treatment-specific risk, including (1) the emetogenicity of the agents being used, (2) the dose and schedule of each agent, and (3) in the case of radiation-induced or postoperative nausea, the site of radiation or surgery.“Emetogenicity” refers to an agent''s tendency to cause nausea and/or vomiting. Initially described in 1997, the emetogenicity scale, also known as the Hesketh scale, divided chemotherapy agents and doses into 5 levels, based on their likelihood to cause CINV.9 Since then, the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) have modified this scale to be divided into the following 4 categories10,11:

• Highly emetogenic: medications or doses that cause CINV in >90% of patients
• Moderately emetogenic: medications that induce CINV in 30% to 90% of patients
• Low emetogenic: medications that are associated with CINV rates of 10% to 30%
• Minimally emetogenic: medications that cause CINV in <10% of patients.

“CINV” is a broad term used to describe the many types of nausea and vomiting that can occur in patients with cancer. The major subtypes of nausea and vomiting associated with chemotherapy are12–16:

• Acute: onset of nausea and vomiting within minutes to hours after administration of chemotherapy and resolving within 24 hours
• Delayed: occurs 24 hours or later after administration of chemotherapy
• Anticipatory: occurs before chemotherapy administration; thought to be an indicator of previous poor control of nausea and vomiting
• Breakthrough/refractory: nausea and vomiting that occur despite appropriate prophylaxis; requires the use of rescue medications.

Because there are so many independent and variable risk factors that can influence the risk for CINV in any particular patient, it becomes paramount for providers to individualize the approach to the prevention and treatment of CINV in every patient case.     

Health Capability: Conceptualization and Operationalization

Current theoretical approaches to bioethics and public health ethics propose varied justifications as the basis for health care and public health, yet none captures a fundamental reality: people seek good health and the ability to pursue it. Existing models do not effectively address these twin goals.The approach I espouse captures both of these orientations through a concept here called health capability. Conceptually, health capability illuminates the conditions that affect health and one''s ability to make health choices. By respecting the health consequences individuals face and their health agency, health capability offers promise for finding a balance between paternalism and autonomy.I offer a conceptual model of health capability and present a health capability profile to identify and address health capability gaps.VARIOUS ETHICAL approaches provide different justifications that underlie health care and public health. Some models assert consumer rationality in health behaviors and a willingness to forgo care beyond the individual''s means. Other approaches focus on fair processes, equality of opportunity, utilitarianism, or equal distribution of goods. Libertarians emphasize autonomy. However, none of these approaches captures a fundamental reality in the health ethics realm: people seek both good health and the ability to pursue it. Existing models cannot effectively address these twin goals because they typically favor either a consequentialist (outcome-oriented) or a proceduralist (procedure-oriented) perspective.The approach I develop captures both these intuitions in a concept I call health capability. Health capability integrates health outcomes and health agency. Why is it so difficult for some populations or individuals to translate health resources into health outcomes? Why have health literacy efforts been only moderately successful? Why do some individuals have such difficulty adhering to specific treatment regimens? Why are some individuals harmed or helped by cultural norms about health behaviors? Conceptually, health capability enables us to understand the conditions that facilitate and barriers that impede health and the ability to make health choices. It offers a more accurate evaluation of the aim and success of social policies and change.Health capability is comprised of both health functioning and what I call health agency. I define health agency as individuals'' ability to achieve health goals they value and act as agents of their own health; health agency achievement represents what one''s realized actions are compared with potential actions.¹ Health functioning is the outcome of the action to maintain or improve health. It is comprehensive, inclusive of mental and physical health functioning and more. Health is constitutive of, but different from, well-being or quality of life. These theoretical distinctions and others have been discussed extensively elsewhere.² By respecting both the health consequences individuals face and their health agency, health capability offers promise for striking the delicate balance between paternalism (the practice of an individual or state interfering with the choices of another individual with the justification that the individual or population will be better off or protected from harm) and autonomy (to live one''s life according to one''s own reasons and motivations). Health capability allows the assessment of a wider range of injustices, beyond the distribution of resources or liberties, to include attributes and conditions affecting individuals'' freedoms: self-management, decision-making ability, skills, knowledge and competence, and social norms and relations, as well as structures within which resource distribution takes place.This approach seeks to enable individuals to exercise personal responsibility for their health through health agency. Rather than justifying health, health care, or public health through equality of opportunity, this approach rests on human flourishing as the philosophical justification for enabling all to be healthy. It holds that health functioning and health agency are the ultimate ends of justice, not equality of opportunity. A more comprehensive analysis of the theoretical foundations and framework for health and social justice based on the “health capability paradigm” is provided elsewhere.²Bioethics and public health ethics aid in the understanding of ethical reasoning as it applies to health, health care, and public health. Bioethics evolved to establish individual autonomy, the right to refuse care, and the right to voluntary and informed consent as preeminent moral principles.³ Public health ethics places priority on principles of necessity, effectiveness, proportionality, public justification, and least infringement.⁴ But for much of the past several decades, these principles have focused too narrowly on issues surrounding the allocation of material and financial resources to solve problems.⁵ Moreover, some approaches have overemphasized individual autonomy and procedural processes in judging the rightness of health care delivery. Others have focused on utility or health maximization or even broader forms of well-being.⁶The health goals of a just society, however, are to ensure all individuals the ability to be healthy.^7,8 Despite considerable progress in bioethics and public health ethics, neither field has successfully developed a theoretical paradigm for achieving this aim. Building on a theoretical framework² that advances the health capability paradigm, I aim to illuminate what individuals are actually able to be and do in an optimal environment (health capability) versus their current environment (health achievement). Assessing and understanding the gap between these 2 states of affairs will improve our ability to foster health capability.A comparison between other ethical approaches—such as equality of opportunity, equality of resources, or even equality of welfare or dimensions of well-being—and a health capability paradigm raises some important distinctions. One such distinction concerns social obligation. Unlike other approaches, the health capability paradigm purports that the fundamental societal obligation is to ensure conditions for all to be able to be healthy, not to ensure equal welfare, or happiness, or employment opportunities. And unlike libertarianism, it does not support individuals opting out of social guarantees and their responsibilities to help pay for those guarantees. Thus, under universal health insurance, one cannot opt out of paying premiums or taxes for premiums, although one may opt to abstain from using health care or public health measures oneself.Another contrast is between the health capability paradigm and the narrow focus of disease diagnosis and epidemiology, which does not necessarily take into account individuals'' ability to navigate the health system and the broader environment to access needed health care and public health services. Nor does that narrow focus help us to adequately understand the constraints individuals face in their ability to be healthy. Additionally, these approaches are more positivist than normative in their orientation.The health capability paradigm recognizes that health capability gaps for individuals and populations can be reduced by both individual-level interventions to improve health functioning and health agency and policies to improve the broader social and physical environment. A health capability profile can analyze the impact of individual interventions and social policies by explicitly measuring categories of individual health functioning, health agency, and the more general social factors enhancing or inhibiting health capability.I offer a conceptual model of health capability,^7,8 define the concepts and domains basic to health capability, and, for its operationalization, present a prototype health capability profile. I identify key indicators for each health capability domain and begin to illustrate how to use these indicators to develop measures of health capability.As a first sketch of these ideas, this article opens up an opportunity to discuss, refine, and develop valid and reliable components of such a profile. Although grounded in capability theory, which has roots in Aristotelian notions of human flourishing, the conceptualization of health capability I develop creates an intellectual space at the intersection of a number of different disciplines, including public health, health policy, medicine, health psychology, decision theory, behavioral economics, theories of addiction, social epidemiology,⁹ and broader social scientific theory. Despite the location of this work at this interdisciplinary nexus, I argue that the concept of health capability is distinctive and unique in a number of critical aspects from what these other disciplines have brought forth for our edification and consumption.The principles guiding the content and measurements of the health capability profile are rooted in capability theory; the theory of health capability and its uniqueness as a concept in bioethics and public health ethics has been developed in further depth elsewhere.^7,10,11     

Human and Ecosystem Health:

Agricultural productivity and the health of farming populations are both influenced by environmental change. Farming activities also affect the environment. Six principal dimensions of this agriculture/environment interrelation are explored: pesticides and fertilizers; deforestation; population pressures; and biodiversity. Changes in these environmental dimensions are critical to the health of rural populations in developing countries. National and international policies and incentives for the protection of agricultural environments are described.     

Cognitive psychology and self-reports: Models and methods

This article describes the models and methods that cognitive psychologists and survey researchers use to evaluate and experimentally test cognitive issues in questionnaire design and subsequently improve self-report instruments. These models and methods assess the cognitive processes underlying how respondents comprehend and generate answers to self-report questions. Cognitive processing models are briefly described. Non-experimental methods – expert cognitive review, cognitive task analysis, focus groups, and cognitive interviews – are described. Examples are provided of how these methods were effectively used to identify cognitive self-report issues. Experimental methods – cognitive laboratory experiments, field tests, and experiments embedded in field surveys – are described. Examples are provided of: (a) how laboratory experiments were designed to test the capability and accuracy of respondents in performing the cognitive tasks required to answer self-report questions, (b) how a field experiment was conducted in which a cognitively designed questionnaire was effectively tested against the original questionnaire, and (c) how a cognitive experiment embedded in a field survey was conducted to test cognitive predictions.     

Rekindling reform: principles and goals

Members of the Rekindling Reform Steering Committee collaborated over a period of several months in early 2002 to develop a set of principles and goals to help guide and define the group’s efforts for comprehensive health care reform in the United States.

The next step is to circulate this document to the sponsoring organizations for their approval. This document is, then, a work in progress, subject to revision as the process of discussion and review continues.

These principles provide a sense of the lessons members of the Rekindling Reform Steering Committee have learned from their study of other countries’ universal health care systems, and how those lessons have informed their thinking about the nature of the health care reform needed in United States.

     

Frailty and Malnutrition: Related and Distinct Syndrome Prevalence and Association among Community-Dwelling Older Adults: Singapore Longitudinal Ageing Studies

Objective

The association between frailty and malnutrition is widely noted, but the common and distinct aspects of this relationship are not well understood. We investigated the prevalence of prefrailty/frailty and malnutrition/nutritional risk; their overlapping prevalence; compared their sociodemographic, physical, and mental health risk factors; and assessed their association, independently of other risk factors.

Personality factors and eating disorders: Self-uncertainty

The International Personality Disorder Examination interview (IPDE) was used to examine common features of personality amongst eating disorder (ED) patients. Female inpatients (N = 155), aged 18 to 45, BMI < 30 kg/m², were interviewed. Items present in ≥ 25% of patients were analysed by factor analysis. Five factors emerged — ‘interpersonal anxiety’, ‘instability’, ‘self-uncertainty’, ‘obsessionality’ and ‘perfectionism’ accounting for 62% of the variance. Patients with BMI, < 18.5 kg/m² had significantly greater ‘interpersonal anxiety’ factor scores. Patients who purged had higher ‘interpersonal anxiety’, ‘instability’, and ‘perfectionism’ factor scores. Differences between ED diagnostic groups were accounted for by body weight and purging. Increasing age was weakly associated with improvement in ‘self-uncertainty’ and ‘instability’ scores. This study separates obsessionality and perfectionism, possibly reflecting ED patients' ‘need for control’, and introduces a new factor ‘self-uncertainty’ which reflects their poor self-concept. The contribution of this factor structure to development and duration of illness should be studied.     

Health and Poverty: Global Health Problems and Solutions

Poor outcomes from behavioral treatments of severe obesity have led to a dependence on invasive medical interventions, including surgery for morbidly obese individuals. Improved methods to self-regulate eating will be required to reduce obesity. The use of self-regulation methods for completing physical activity may carry over to increased self-regulation for eating through improved feelings of competence (self-efficacy) and mood. The study recruited women (Mean_age = 43 years) with morbid obesity (Mean_BMI = 44 kg/m²) to participate in 26 weeks of cognitive-behavioral support of physical activity paired with either nutrition education (n = 51) or cognitive-behavioral nutrition (n = 51) methods. Data collected were from 2011 and 2012. Significant improvements in self-regulation for physical activity, self-regulation for eating, overall mood, and self-efficacy for eating, with greater improvement in self-regulation for eating, were observed in the cognitive-behavioral nutrition group. Changes in mood and self-efficacy for eating significantly mediated the relationship between changes in self-regulation for physical activity and self-regulation for eating. When subscales of overall mood and self-efficacy were entered into separate regression equations as mediators, the only significant mediators were vigor, and controlling eating when socially pressured and when increased cues to overeat were present.     

The Internet and HIV study: design and methods

Background  

The Internet provides a new meeting ground, especially for gay men, that did not exist in the early 1990s. Several studies have found increased levels of high risk sexual behaviour and sexually transmissible infections (STI) among gay men who seek sex on the Internet, although the underlying processes are not fully understood. Research funded by the UK Medical Research Council (2002–2004) provided the opportunity to consider whether the Internet represents a new sexual risk environment for gay and bisexual men living in London.     

Honey and cancer: A mechanistic review

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Fiber and Prebiotics: Mechanisms and Health Benefits

The health benefits of dietary fiber have long been appreciated. Higher intakes of dietary fiber are linked to less cardiovascular disease and fiber plays a role in gut health, with many effective laxatives actually isolated fiber sources. Higher intakes of fiber are linked to lower body weights. Only polysaccharides were included in dietary fiber originally, but more recent definitions have included oligosaccharides as dietary fiber, not based on their chemical measurement as dietary fiber by the accepted total dietary fiber (TDF) method, but on their physiological effects. Inulin, fructo-oligosaccharides, and other oligosaccharides are included as fiber in food labels in the US. Additionally, oligosaccharides are the best known “prebiotics”, “a selectively fermented ingredient that allows specific changes, both in the composition and/or activity in the gastrointestinal microflora that confers benefits upon host well-bring and health.” To date, all known and suspected prebiotics are carbohydrate compounds, primarily oligosaccharides, known to resist digestion in the human small intestine and reach the colon where they are fermented by the gut microflora. Studies have provided evidence that inulin and oligofructose (OF), lactulose, and resistant starch (RS) meet all aspects of the definition, including the stimulation of Bifidobacterium, a beneficial bacterial genus. Other isolated carbohydrates and carbohydrate-containing foods, including galactooligosaccharides (GOS), transgalactooligosaccharides (TOS), polydextrose, wheat dextrin, acacia gum, psyllium, banana, whole grain wheat, and whole grain corn also have prebiotic effects.