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1 Food in older men with somatic diseases Eating habits and approaches to food-related activities Kerstin Kullberg
2 Dissertation for the Degree of Licentiate of Philosophy (Faculty of Medicine) in Caring Sciences at Uppsala University Abstract Food in older men with somatic diseases: Eating habits and approaches to food-related activities. The overall aim was to improve the knowledge and understanding of eating habits of older men with somatic diseases, and the men's perceptions about managing food-related habits, such as grocery shopping and cooking. A total of 67 men between 64 and 89 years of age were visited in their homes on two occasions with 1-2 weeks in between. The participants were diagnosed with one of the three diseases Parkinson s disease, rheumatoid arthritis, or stroke. A food survey, with repeated 24-h recall, was used to assess food intake and meal patterns. Interviews with 18 participants were conducted with open-ended questions. The interviews were further analysed with a thematic framework approach. The findings showed that eating events were distributed over a 24-h period. Further, coliving men had a significantly larger number of eating events over the day (p=0.001). No differences in daily energy intake were observed between co-living and single-living men. Co-living men s hot eating events were compared with those of single-living men more often cooked from fresh ingredients (p=0.001), including a greater mix of vegetables/roots (p=0.003). Thematic analysis revealed three different approaches to food-related activities (FRA), namely Cooking as a pleasure, describing joy in cooking; Cooking as a need, indicating no habits or skills in cooking; and Food is served, that is, being served meals by a partner. The men's approaches to FRA were affected in particular by gender-related roles, but also by changed life circumstances, activity limitations, personal interests, and a wish to maintain continuity and independence. Further adaptive strategies were used among the men in attempts to maintain continuity and independence in FRA. In conclusion, single-living older men, especially those with activity limitations, were identified as being a vulnerable group from a nutritional perspective. Further, health care efforts in promoting FRA should preferably be individualised with respect to the older man s approach to these activities. Keywords: activities of daily living, arthritis rheumatoid, cookery, meal patterns, men, nutrition, older people, Parkinson disease, stroke Kerstin Kullberg, Uppsala University, Department of Public Health and Caring Sciences, Caring Sciences, Döbelnsgatan 2, SE Uppsala, Sweden. Kerstin Kullberg 2009
3 List of Papers This thesis is based on the following papers, which are referred to in the text by their Roman numbers. I Kullberg K, Åberg AC, Björklund A, Ekblad J, Sidenvall B. (2008). Daily eating events among co-living and single-living diseased older men. The Journal of Nutrition, Health and Aging, 12(3), , * II Kullberg K, Björklund A, Sidenvall B, Åberg AC. I start my day by thinking about what we re going to have for dinner : A qualitative study on approaches to food-related activities among older men with diseases. Submitted Reprint was made with permission of the publisher. * Serdi Publisher,
4 Abbreviations EI EE Hot EE Cold EE FRA Energy intake Eating event Hot Eating Event Cold Eating Event Food-related activities
5 Contents Introduction...7 Older people and food...8 Diseases, disability and food-related issues...9 Food-related activities...9 Aims...11 Methods and results...12 Inclusion and subjects...12 Data collection and analysis...14 Study I...15 Study II...16 Ethical considerations...17 Results...18 Summary of the results Study I...18 Methodological considerations, Study I...19 Summary of the results, Study II...20 Methodological considerations, Study II...22 Discussion...23 Food-related activities and gender...23 Nutritional aspects...24 Food-related activities and self-esteem...26 Conclusions...27 Acknowledgements...28 References...29
7 Introduction Sweden, like all Western countries, has a large proportion of older people. Out of 9.2 million inhabitants, approximately 1.6 million (18%) are 65 years of age or older (SCB 2008). Even though the proportion of older women is higher, about 36% of all single-living persons aged years are men (SCB 2008), which implies that men in this age group, as well as women, need to take responsibility for food-related activities (FRA) such as grocery shopping and cooking. This may give rise to a dilemma, however, as every-day cooking has traditionally been a woman s sphere (Donkin et al. 1998; Ekström Pipping, L'orange 2001). Differences between elderly co-living and single-living persons regarding food-related habits, e.g. the frequency of eating and specific food items included, have been examined in previous studies. It was found that persons living together more often ate two hot meals a day than those living alone (Kallio, Koskinen, Prättälä 2008). Further, coliving compared to single-living older persons used a wider range of fresh food in their cooking (Naska et al. 2006). Moreover, eating alone has been pointed out as a risk factor for a low energy intake (EI), especially among older men (Shahar, Shai, Vardi and Fraser 2003). In Sweden during the last decades, older people, even those with somatic diseases, have tended to continue living in their own homes (The National Swedish Board of Health and Welfare 2009). However, ill health may affect the ability to perform FRA and hence the ability to maintain healthy eating. Previous research has shown that the prevalence of a chronic disease increases the risk of having an inadequate energy intake (Schroll et al. 1996). Three diseases that may lead to disability and thus affect the capacity to perform FRA are Parkinson s disease, rheumatoid arthritis (RA) and stroke (Lorefält, Ganowiak, Wissing, Granéus and Unosson 2006; Pajalic, Karlsson and Westergren 2006; Westhoff, Listing and Zink 2000). It is therefore important to have knowledge about eating habits of older men with somatic diseases and these men's perceptions about how they manage FRA, an area which has rarely been investigated in research. 7
8 Older people and food In the Western world the conventional meal pattern consists of three meals a day breakfast, lunch and dinner (de Graaf 2000). Eating events that are not part of a meal have been designated snacks (de Graaf 2000; de Groot, Schlettwein-Gsell and Schroll-Björnsbo 1998). Previous research has shown that the energy intake from dinner decreases in higher age groups of men and women, while in men the energy derived from breakfast and snacks increases (Vincent, Lauque, Lanzman, Vellas, & Albarede, 1998). Further, older persons who have fewer snacks have been identified as having a lower daily energy intake (Shahar, Shai, Vardi and Fraser 2003). In an earlier study on Swedish older women and men it was found that meals and snacks, including beverages, were distributed all over the day (Rothenberg, Bosaeus and Steen 1994), and this was also found in a study compromising only Swedish older women (Andersson, Nydahl, Gustafsson, Sidenvall and Fjellström 2003). Eating habits have been compared between older women and men in previous studies. In a study on older persons a low fruit and vegetable consumption was associated with being a male (Johnson et al. 1998). It was also found that in particular single-living older men consumed fruit and vegetables less frequently, and that their eating included a less varied mix of vegetables (Donkin et al. 1998). Moreover, compared with older women, older men tended to have their meals more often outside their home (Rothenberg et al. 1994). In a study in the UK it was found that single-living older men are more likely than single-living older women to buy food that was easy to cook and to prepare (Donkin et al. 1998). Overall, men s cooking skills have been found to be less improved over the years compared with those of women (Donkin et al. 1998; Bennett, Hughes, Smith 2003; Keller, Gibbs, Wong, Vanderkooy, Hedley 2004). However, the perceived need for help with cooking among men of ages 65 and older has significantly declined since the end of the 1990s (The National Swedish Board of Health and Welfare 2005). This implies that older men of today are more involved in cooking compared to men of the same age group fifteen years ago. On the other hand, grocery shopping has been pointed out as being problematic, in particular among older women. About 37% of women 80 years and older had help with grocery shopping from the municipality, compared to about 24% of men in that age group (The National Swedish Board of Health and Welfare 2005). 8
9 Diseases, disability and food-related issues The present of chronic disease has been pointed out as a risk factor for low EI (Schroll et al. 1996). Furthermore, chronic diseases such as Parkinson's disease, RA, and stroke may affect the ability to perform FRA. Parkinson s disease is a progressive neurological disease with symptoms including tremor, fumbliness, rigidity, fatigue (Scott, Borgman, Engler, Johnels and Aquilonius 2000). These symptoms may affect the ability to eat and to perform food related activities (Andersson and Sidenvall 2001; Lorefält et al. 2006; Wressle, Engstrand and Granérus 2006). It was found in one study that even though energy intake and the time taken for resting increased, about 73% of the subjects diagnosed with Parkinson's disease lost body weight during one year (Lorenfält, Ganowiak, Pålhagen, Toss, Unosson and Granérus 2004). Rheumatoid arthritis is a chronic, usually progressive systemic inflammatory disease affecting the connective tissue in the whole body (Kent and Matteson 2004). Painful inflammation in the joints and reduced grip force may lead to difficulties in eating and in performing food-related activities (Nordenskiöld, Grimby 1997). Stroke causes neurological disabilities among adults and includes intracerebral or subachnoid haemorrhages, and cerebral infarctions (The National Swedish Board of Health and Welfare 2006). Eating difficulties, particularly at the onset of the disease, have been observed (Elmeståhl, Sommer and Hagberg 1996; Pajalic et al. 2006). Further, a need for assistance with FRA has frequently been reported among persons who have had a stroke (Hartman-Maeir, Soroker, Ring, Avni and Katz 2007; Pajalic et al. 2006). The importance of being able to prepare food for oneself has been found to increase in relation to the onset of stroke (Chiou and Burnett 1985). Food-related activities Food-related activities and eating can be regarded as essential components in the activities of daily living, as we eat several times a day and as over the years these activities provide structure and continuity to our everyday lives. Food activities are intimately connected with culture, expressed through norms, values and rituals (Fjellström, Sidenvall and Nydahl 2001). Further, every culture has it 9
10 own norms concerning what food is eaten, cookery, and rituals and behaviour in the meal situation. According to Fischler (1988), cookery is inseparable from culture, as it is in the culinary act that the passage from nature to culture is sanctioned. Hence, cookery helps to give food and its eaters a meaning, a place in the world. From this it follows that food is closely connected with an individual's sense of identity (Fischler 1988). The continuity theory of ageing (Atchley 1999) describes the continuous adaptation of individuals to altered life circumstances throughout the course of life. Although factors such as eating preferences and cooking habits are continuously altered at a detailed level, older persons usually show consistency in their activity profiles and patterns of thinking over time. Thus, in the frame of reference of the continuity theory, ageing is regarded as a process in which the individual constantly adapts to personal and environmental changes. This implies that adaptation is one of the central concepts in the continuity theory (Atchley 1999). In this thesis continuity refers to the elderly men's food-related habits, including factors over time such as preferences, self-perception, and social relations (Atchley 1989); and adaptation refers to the means by which the participants coped with altered life circumstances and activity limitations due to disease. 10
11 Aims The overall aim of this thesis was to improve the knowledge and understanding of eating habits of older men with somatic diseases and the perceptions of these men concerning management of food-related activities, such as grocery shopping and cooking. More specific aims were: To analyse the distribution and frequency of eating events and the associated energy intake, as well as specific food items, in older men with somatic diseases living in ordinary housing, in relation to their civil status (study I). To address the question of how older men with somatic diseases living in ordinary housing approach the question of food-related activities. Further, any food-related adaptations consequent to effects of diseases and of altered life circumstances were investigated. (Study II). 11
12 Methods Inclusion and subjects Between November 2002 and June 2004, men aged years, coliving and single-living, were invited to participate in the framework of the project 'Older men and food'. The men were identified from hospital registers and criteria for inclusion were: being diagnosed as having one of three diseases, namely Parkinson's disease, rheumatoid arthritis or stroke; living in ordinary housing; able to speak Swedish; and living in a specific county in central Sweden. Criteria for exclusion were: diagnosis of dementia; acute illness; severe aphasia. Three hundred and twenty-six identified presumptive participants (IPP) were systematically listed in a random order (Fig. 1). Case records were examined and to further ensure correct inclusion/exclusion the lists of participants were examined in cooperation with care staff. An invitation to participate in the project was consecutively sent by mail to 137 older men with the three somatic diseases mentioned above. After 3-7 days the participant was contacted by telephone, and the study was presented in greater detail. If the man was interested in participating in the study, the day and time for the first home visit was decided. The telephone call also served to assess whether the participant met the inclusion criteria. Fourteen of the invited participants were excluded on the basis of exclusion criteria, or had died or were not attainable. Hence, 123 older men with somatic diseases were invited to participate in the project, of whom 56 declined; reasons commonly mentioned were: not interested and/or lack of time and tiredness. Thus, 67 older men with diseases were included in the project Older men and food. The inclusion rate (67/123) in the project was 55% (45% among co-living men and 60% among single-living men). 12
13 123 IPP excluded due to exclusion criteria, and 66 IPP excluded due to completeness 326 identified presumptive participants (IPP) 14 PP excluded due to exclusion criteria 137 presumptive participants (PP) invited by mail 56 PP declined participation 123 PP invited in the project Older men and food 67 participants (P) included in the project 4 co-living men excluded because of missing data, 1 co-living and 1single-living man interrupted data collection. 61 P included in study I (35 co-living and 26 single-living men) 18 P included in study II (9 co-living and 9 single-living men). Figure 1. Flow chart of inclusion, exclusion, and drop-out of participants included in studies I and II. Study I was based on data from 61 participants (35 co-living and 26 single-living) (Table 1). From 51 participants data were collected by the first author, and data from 6 and 4 participants respectively were collected by two co-researchers. Study II was based on a purposeful sample of 18 participants (9 co-living and 9 single-living) included in study I (Table 1). The participants were recruited, on the basis of the following criteria: one of the three diseases, Parkinson s disease, RA or stroke; civil status; and location of residence (urban vs. rural). Data were collected by the author for 17 participants and by a co-researcher for one participant. 13
14 Table 1. Overview of the participants included in Studies I and II. The numbers of participants in Study II are given in brackets. Study I (II) Co-living men Single-living men Age (mean yrs) 73.5 (71.1) 74.9 (74.1) Diagnosis Parkinson's disease 12 (3) 5 (3) Rheumatoid arthritis 11 (3) 9 (3) Stroke 12 (3) 12 (3) All 35 (9) 26 (9) Location of residence Urban 26 (7) 22 (6) Rural 9 (2) 4 (3) All 35 (9) 26 (9) Besides the three diseases required for inclusion, 47 participants included in study I reported having additional diseases, such as diabetes, cardiovascular disease, prostate cancer, impaired vision, and chronic obstructive pulmonary disease (COPD). Data collection and analysis All participants were visited on two occasions in their home, usually with an interval of two weeks. Demographic data concerning civil status, age, and location of residence were collected with a protocol. Further, the participants were asked whether they had home help services with food-related activities. An overview of the data collection methods used in studies I and II is shown in Table 2. 14
15 Table 2. Overview of methods for data collection used in Study I and II. Data collection methods Study I Study II Demographic data x x Weight and height x Food survey, 24-h recall x Qualitative interviews x Study I At two visits to the participant's home, food recordings were made with the help of a 24-h recall, i.e. repeated 24-h recall (Gibson 2005). The participants were asked by the researcher, in as detailed a manner as possible, to describe everything, except for plain water, that they had eaten and drunk during the previous day and night. To help the participant to estimate portion sizes, a combination of household measures and The Meal Model was used (The Swedish National Food Administration 1997). The Meal Model is a picture book showing different dishes and portion sizes, including different types and sizes of bread. On a form, the researcher recorded the times of the eating events, their contents and components, and the amount of food eaten. Recipes and cooking methods were recorded, and in line with suggestions in earlier research (van Staveren, de Groot, Blauw and van der Wielen 1994), co-living participants were sometimes helped by a partner to recall and describe food consumed the previous day. A check-list of food items that are otherwise easy to forget was used, e.g., sweets, potato crisps, biscuits, alcoholic beverages. Thus home visits were made on weekdays; Fridays and Saturdays are not included in the material. Using weights and portion sizes estimated by the participants, food intake data were coded and registered in the MATs nutrient calculation system (version 4.06) (Nordin 2002), which is based on the database PC-kost (2002:1), including about 1800 food items (Arnemo and Ohlander 2002). When weights were missing standard portion sizes in accordance with weight tables were used (Swedish National Food Administration 1999; Provkök, KF och ICA 2000), and when a food item was not included in the PC-kost it was replaced by a similar food item. When ready-made meals were registered into the PC-kost, food and nutrient information given on the packages was used. 15
16 The concept eating event (EE) stands for an occasion on which the informant had eaten or drunk anything, except for plain water. Meal patterns refer to the order and rhythm of EE. In line with Kjaernes, Ekström, Gronow, Holm and Mäkelä (2001) all the registered EEs were classified into one of three categories: Breakfast, Cold eating events (Cold EE), or Hot eating events (Hot EE). Breakfast refers to the first EE of the day, including more than a single beverage. The concept Cold EE includes a range of various types of eating events, e.g. yogurts, fruit, and sweets. A cold EE could include a hot beverage. Regarding the preparation technique snacks has been defined in line with cold EEs (Roos, Quandt and De Walt 1993). Hot EEs consists of either a lunch or a dinner, but could also be a second breakfast, e.g. porridge. Energy intake was calculated as the mean of the two days of data collection for each participant. The percentage distributions of specific food items included in breakfast, hot EE and cold EE was calculated, as was the number of EE during the two days of data collection. The participant s body weight and height were measured at one of the home visits, without shoes but with light clothes on. The data were used in calculating body mass index (BMI) and estimated basal metabolic rate (BMR est ). BMR est was calculated with a formula for men >60 years (FAO/WHO/UNU, 1985). Besides this the ratio of the participant's reported energy intake (EI rep )/BMR est was calculated (Gibson 2005). The ratio can be useful in identifying the extent of underreporting at the group level (Gibson 2005). The Statistical Package for the Social Sciences for Windows (12.01 ed., SPSS Inc; Chicago, IL, USA, 2003) was used for analysing data. When analysing differences between normally distributed groups, a t-test was used. When the data were not normally distributed, a non-parametric test, the Mann-Whitney U-test, was applied. For comparing nominal data, the Pearson Chi-Square or Fisher s Exact Test, two-tailed, was used. A p value <0.05 was considered significant. Study II To gain a deeper understanding of the participants' approaches to FRA qualitative interviews were conducted. For this purpose an interview guide was used including questions about whether, when and how the men participated in and managed food preparation and grocery shopping, including planning for the shopping and transportation to 16
17 and from the store. Further, the participants were questioned regarding changes in these activities and any adaptations of FRA necessitated by the disease and/or altered life circumstances. Additionally, the interviews focused on the participants' perceived experiences in relation to these activities. The interviews, which lasted for 45 to 120 minutes, were conducted as a dialogue around the themes in the interview guide in the participant's home at the first home visit. The recorded audiotape was listened to shortly after this home visit. The second home visit gave opportunities to ask complementary questions and to confirm earlier statements. All the recorded audio taped interviews were transcribed verbatim, including complementary questions to eight participants. In line with a thematic framework approach described by Spencer, Ritchie, & O Connor (2003) and by Ritchie, Spencer, and O Connor (2003) the transcribed material was analysed with the purpose of becoming accustomed to the material, all interviews were listened to and attentively read several times. Subsequently the interviews were read one by one, and at the same time preliminary themes related to the aims of the study were noted in the transcripts. In the next step, similarities and differences within and between participants were identified and noted. In this process, described as analytical induction (Hammersley and Atkinson 1995), the analyses and interpretation moves forwards and backwards between the raw data and the preliminary themes. Hence, preliminary themes describing the participants' approaches to FRA are refined and distilled. In the final step, the whole data set was checked once again, with the aim of discovering patterns and explanatory factors (Ritchie et al. 2003) for change and maintenance in FRA approaches over time. Ethical considerations This research was designed and implemented in accordance with the ethical principles for research in humanities and social sciences (Swedish Research Council 2002). As the data collection took place in the participant's home, demands on integrity of the men's privacy had to be highly respected. The Committee of Research Ethics at the Medical Faculty, Uppsala University, Sweden approved the study on June 25,
18 Results Summary of the results Study I Sixty-one participants, older men with somatic diseases, were included in Study I, 35 co-living and 26 single-living. There were no differences between co-living and single-living men with respect to age, weight or BMI. The mean age of the co-living participants was 73.5(±5.4) years and that for single-living 74.9(±6.9) years. The group of co-living men had a mean weight of 78(±10)kg and a mean BMI of 25.4(±3.6), and the corresponding figures for single-living men were 79(±13) kg and 26.1(±3.8) respectively. Four single-living men received meals-on-wheels 2-7 days/week, and one co-living man and four co-living men received formal support with cooking or with heating up food. The reported mean EI/day was 8.5±2.8 MJ (2038±663 kcal) in co-living men and 7.5±1.9 MJ (1794±450 kcal) in single-living men. There were no differences 1 between co-living and single-living men with respect to EI/day, but nonetheless co-living men had a larger number of EE/day (5.1 ±1.4) compared to single-living men (3.9±1.1) (p=0.001) 2, including a larger number of hot EE (co-living men 1.5± 0.5 and single-living men 1.3± 0.4) (p=0.044) 2 and cold EE (co-living men 3.6± 1.4 and single-living men 2.7± 1.1) (p=0.010) 2. At almost all times of day both co-living and single-living men reported EE. Breakfast was mostly eaten at about 8 a.m. to 9 a.m. in both groups, and there was a hot EE between 9 a.m. and 8 p.m. Both co-living and single-living men could have a hot EE in the morning, i.e. a second breakfast, e.g. porridge. However, the distribution differed between co-living and single-living men in that co-living men had peaks of hot EE at lunchtime and at about 6 p.m. to 7 p.m., while single-living men had a hot EE peak around lunchtime and a more even distribution of hot EEs from 3 p.m. to 8 p.m. Both co-living and 1 2 Two sample T-test Mann-Whitney U-test 18
19 single-living men had cold EEs from early morning until late at night, and both groups had a peak of cold EE at about 8 p.m. With respect to EI, cold EE ranged from 4.2 KJ (1 kcal) to 6.13 MJ (1465 kcal). A cold EE at night often consisted of fruit or a sandwich. Co-living and single-living men had almost the same food items in their breakfast, i.e. spread/fatty sauce, cheese, milk products, bread, porridge/cereals, jam/marmalade, sugar, and coffee/tea. Food items often included in hot EE were spread/fatty sauce, milk products, bread, potatoes, vegetables/roots, meat, and alcoholic beverages. Regarding food items included in hot EEs it was found that compared with single-living men, co-living men more often (p=0.012) 3 ate porridge/cereals as a hot EE, i.e. a second breakfast or a light lunch. It was also clear that co-living men had a greater mix of vegetables in their hot EEs (p=0.003) 3. In both groups of men spread/fatty sauce, milk products, bread, fruit/juice, buns/biscuits, sugar and coffee/tea were often included in cold EEs. Single-living men had more often spread/fatty sauce (p=0.033) 3, milk products (p=0.049) 3, and bread (p=0.014) 3 in their cold EEs. Further, co-living men more often had their hot EE cooked from raw material (p=0.001) 3, while single-living men more frequently used convenience food in their cooking (p=0.001) 3. In addition single-living men more often (p=0.031) 3 had a hot meal outside their home, e.g. at a restaurant or at the home of a friend. Methodological considerations, Study I Although the sample size was relatively small from a statistical point of view, highly significant differences were found in respect to eating habits between the co-living and single-living groups of older men. It may be assumed that a larger sample size would have given the study more power and thus an opportunity to detect additional differences between the two groups. The data collection was conducted with a 24-h recall performed on two occasions. However, a disadvantage is that this type of data collection relies exclusively on the participant's memory and conceptual skills (van Staveren, et al., 1994; Gibson 2005). The interviews were conducted in the participants' homes, which improved the reliability by giving the researcher opportunities to validate their statements by for example by looking at glasses and cups. 3 Pearson Chi-Square 19
20 In the present study the calculated mean value for EI rep /BMR est was 1.31 for co-living and 1.15 for single-living men, indicating that low energy reporters were included. In an earlier study comprising home-dwelling elderly men the mean value for EI/BMR est was 1.50 (Rothenberg, Bosaeus, Steen, 1997). The present mean EI, however was in accordance with values from earlier studies comprising older healthy men living in their own homes (Schroll, et al., 1996; Vincent, Lauque, Lanzmann, Vellas, & Albarede, 1998; Sharkey et al., 2002; Nes, Sem, Pederson, & Trygg, 1992; Schlettwein-Gsell, & Barclay, 1996). Summary of the results, Study II Among the 18 older men included in study II, seven co-living and six single-living men drove a car. Mobility devices were used by four coliving and three single-living men. Three single-living men received help with FRA from the municipality home help services, one singleliving man had meals-on-wheels and two men were helped with grocery shopping. Three different themes, i.e. approaches to FRA, were identified among the participants: Cooking as a pleasure, Cooking as a need, and Food is served. The participant's approach was dependent on the individual's gender-related role to these activities, and the participant's skills and habits in performing FRA. Participants with the approach Cooking as a pleasure described themselves as having both an interest and skills in FRA, and they found cooking a joy. These participants often said that they had taken up cooking a long time ago, and at the time of the interview some participants cooked almost all hot meals in the family. The time spent on cooking had sometimes increased in connection with retirement, a partner's serious illness or a divorce. Further, the importance of shared responsibility in FRA was often emphasised by the men with the approach Cooking as a pleasure. It could be assumed that FRA performances contributed to overall well-being among the men with this approach. Participants with the approach Cooking as a need said that they had no skills or habits in FRA. These men looked for cooking alternatives, and convenience food was commonly used in their cooking. The men's inexperience and lack of competence in FRA sometimes appeared to be problematic, e.g. among widowed men. Participants with this approach did not usually plan a great deal before going to the grocery shop. Some men with the approach Cooking as a 20
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RERA Act will bring transparency in real estate sector, says MahaRera regulator Chatterji
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subset: commoncrawl


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Gag Order on Abuse Victims LiftedApr 25, 2002 | AP The Roman Catholic Archdiocese of New York has freed sex abuse victims from any legal promises they made to remain silent about their cases and the priests they accused.
"Victims are no longer gagged," said District Attorney Jeanine Pirro, who announced the decision after receiving a letter from archdiocesan lawyer James McCabe.
Joseph Zwilling, a spokesman for the archdiocese, confirmed Wednesday that any victim who agreed not to talk as part of a civil settlement in a case involving a priest would no longer be bound by that promise.
"In an attempt to cooperate with the district attorneys, we have voluntarily released people from the confidentiality agreements," he said.
In the past, the church has settled some sex abuse lawsuits with payments on the condition that victims not talk about the case. Such agreements "prevented victims from sharing any information about the sexual abuse and even the name of the abuser," Pirro said. "These are settled cases where there has been a finding of fault and I wanted very much to have the ability to talk with victims."
Mitchell Garabedian, who has represented alleged victims of priest sex abuse in Boston, said, "It's a very important step in preventing child abuse from occurring in the future and helping the victims regain some sort of dignity."
He said confidentiality agreements were "a way of revictimizing the victim, of silencing the victim unnecessarily and making the victim feel further guilt."
Jeffrey Anderson, a Minneapolis lawyer who has represented victims of sexual abuse involving Catholic priests for 20 years, said, "This would be the first clear and definitive relinquishment by a prelate of the confidentiality or gag provisions in settlements."
Other dioceses, he said, "have suggested they won't enforce them, but that's not exactly a proclamation."
Elsewhere in the child-molestation scandal that has rocked the nation's Catholic church:
_ Philadelphia District Attorney Lynne Abraham said she will convene a grand jury to investigate allegations of priest sex abuse and the response of church officials. She said church officials have agreed to turn over records on priests accused of abuse, whether they are "dead, dismissed or retired."
_ In Providence, R.I., attorneys for victims of alleged sexual abuse said they have asked a judge to schedule some of their cases for trial this fall after failing to settle with the Diocese of Providence. Thirty-eight lawsuits have been filed against the diocese, alleging abuse by 11 priests and one nun.
_ The head of the Roman Catholic diocese in Long Island, N.Y., appointed a former police commissioner to handle sex abuse allegations against priests. Bishop William Murphy of the Rockville Centre Diocese also added non-Catholics to two investigative panels for the first time.
_ A former bishop in the Diocese of Cheyenne, Wyo., was twice accused of sexual misconduct with boys while he was a priest in Kansas City in 1969 and the early 1970s. In a written statement, Father Joseph Hart said the allegations — made in 1989 and 1992 — were false. Hart retired in September at age 70. Both allegations in Missouri were handled before Rush became vicar general of Kansas City in 1994.


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Who's going to win tonight? The team that wins the majority of these battles:
No. 1: Pat and Kevin Williams vs. the Packers interior line — The Packers intend, when all are healthy, to have Scott Wells at center flanked by Mark Spitz and Daryn Colledge – a pair of up-and-down guards that have never really replaced Marco Rivera and Mike Wahle. There is a pretty good chance that the Vikings might end up facing Spitz at center and either backup tackle Tony Moll or backup left guard Allen Barbre at the right guard spot. This could be a domination of huge proportions if the Williams Wall can overpower players who are inexperienced and out of their natural positions.
No. 2: Jared Allen vs. Chad Clifton — Clifton has been battling pain in both of his knees and, in his ninth season, the game-to-game pounding is starting to take a toll. If the Vikings are to hurt the Packers offense, Allen schooling Clifton for a sack or two or perhaps a turnover is a must.
No. 3: The Packers defense vs. Adrian Peterson — We are likely to see a preview of how defenses plan to attack the Vikings and that plan starts (and may end) with the Packers putting eight men in the box when they're convinced Peterson will get the ball. We've seen that when Peterson gets the blocking he needs, there is no more explosive player in the open field.
No. 4: Artis Hicks vs. Cullen Jenkins and Kabeer Gbaja-Biamila — The Vikings were more than a little upset to hear that Bryant McKinnie got a four-game suspension, but even if it had been reduced, it wouldn't help the team this week. Hicks got moved to left tackle in a pinch while with the Eagles on a Monday night game against Miami, drawing the assignment of Jason Taylor. Hicks accounted for himself well in that game and the Vikings will need another step-up performance.
No. 5: Ryan Cook vs. Aaron Kampman — The Vikings wanted Kampman bad enough that they offered him a lucrative contract as a restricted free agent with an offer sheet the Packers matched. They have not been disappointed with that decision. Over the last two years, nobody in the NFC has more sacks than Kampman. Cook has been adequate at best at the right tackle spot and the kind of pressure Kampman can bring is the type that causes turnovers. If the Vikings are in the situation that they have to pass, if Cook can't hold his own against Kampman, the Vikings will have a difficult time winning.
No. 6: Ryan Grant vs. the Vikings defense — Grant was the only running back to gain 100 yards in a game against the Vikings defense last year. He had 25 carries for 119 yards in the 34-0 blowout Packers win at Lambeau Field last year. If the Vikings are to win, he can't have that kind of day again.
No. 7: Tarvaris Jackson vs. Aaron Rodgers — Jackson has been erratic in his short career and Rodgers is making his first career start. With the attention this game is garnering, both will likely be nervous and not wanting to make the critical mistake that costs his team the game. If either lacks confidence, it will be evident early on. Both players likely will be asked to manage the game rather than take it over. If one of them fails, it could easily turn the tide of the game.
No. 8: Bernard Berrian and Sidney Rice vs. Charles Woodson and Al Harris — The Packers have a pretty hard and fast rule defensively – Woodson and Harris play physical bump-and-run coverage and are often asked to take a receiver all the way down the field with little to no safety support. One blown coverage can result in huge plays. If the Vikings can isolate one or both of them and take a few shots deep downfield, the passing game could provide the big play needed for a tough road win.
No. 9: Antoine Winfield and Cedric Griffin vs. Greg Jennings — Donald Driver is a very good receiver, but Jennings is a home-run hitter. Much like when the Vikings faced the Bears aware that Berrian and Devin Hester were the two players they had to contend with concerning back-breaking big plays, the same is true for Jennings. He averaged 17.4 yards per reception and scored 12 TDs on just 53 catches. He can strike like a rattlesnake, and one mistake or bite on a double move could lead to an easy touchdown.
No. 10: Visanthe Shiancoe and Garrett Mills vs. Donald Lee and Jermichael Finley — Of all the cast of characters heading into this game, one seemingly lost element is that both teams run a West Coast Offense that is designed to get plays deep over the middle to tight ends with a linebacker in coverage. With defensive attention expected to be given to the running game and tight coverage to both teams' receivers, the tight ends that create a big play or two down the seam could be the key to victory.


text: Home > Medical > Diseases Updated 03 June 2015 Fibroids These are tumors/growths made up of muscle and other tissues that grow in the uterus. 0 BACKGROUNDUterine fibroids are tumors, or growths, made up of muscle and other tissues that grow in the uterus. They may develop in the uterine wall, inside the lining of the uterus, or outside of the uterus. They occur in 20-25% of women of childbearing age, and up to 80% of women will suffer from fibroids at some point in their lives. A single fibroid may develop or several may develop in groups. Fibroids range in size from less than one inch to larger than the size of a grapefruit. Other names for fibroids are uterine leiomyomata, fibromyomas, leiomyomas, and myomas.Many women with fibroids do not experience any symptoms and are unaware that they have fibroids. However, about one in four women may have heavy bleeding, pain, and urinary problems that require treatment. Fibroids are almost always benign (not harmful) and very rarely develop into cancer. Fewer than 0.1% of fibroid cases become cancerous. Other complications may include infertility, pregnancy problems, and anemia.Any woman can develop fibroids; they are most common among African American women. The cause is unknown and there are no known ways to prevent them.Fibroids are classified based on their location in the uterus and can be submucosal, intramural, subserosal, and pedunculated. Symptomatic fibroids can be treated with medications, surgeries, and other procedures. The most invasive surgery available, called a hysterectomy, completely removes the uterus and is the only treatment that completely prevents fibroids from growing back. One-third of hysterectomies in the United States are due to uterine fibroids.RISK FACTORSGeneral: There is ongoing research to find the cause of and risk factors for fibroids. Women of childbearing age are most likely to develop fibroids, but symptoms usually do not appear until a woman is between 35 and 50 years old. Even though fibroids tend to run in families, it is unclear if the condition is hereditary because no genetic patterns have been observed. A few risk factors have been identified.Diet: According to recent research, eating red meat, such as beef and ham, is associated with the presence of fibroids. Eating green vegetables, fruit, and fish, on the other hand, is associated with a reduced risk for fibroids.Hormone levels: Hormone levels may have an impact on the development of uterine fibroids. It is believed that estrogen and progesterone, two female hormones, may cause an increase in fibroid growth. When a woman is pregnant, fibroids grow more rapidly because of increased hormone levels, and the fibroids shrink after menopause because of decreased hormone levels.Obesity: Women who are overweight or obese also tend to have a slightly higher risk for fibroid growth.Ethnicity: African American women have an increased risk of developing fibroids, and they are 2-3 times more likely to develop symptomatic fibroids. They are also more likely to experience symptoms at an earlier age than other women, which could be due to the fact they usually have larger and more numerous fibroids. Asian women are least likely to have uterine fibroids, according to recent research.CAUSESGeneral: The cause of fibroids remains unknown. There are some theories, but researchers are continuing to study what exactly causes the growth. The cause may be genetic, hormonal, environmental, or a combination of all of these factors.Genetics: A specific gene causing fibroids has not been identified. However, if a person has a grandmother, mother, or sister who suffers from fibroids, she is twice as likely to develop them.Hormones: Researchers have observed that fibroids grow during pregnancy because there is an abundance of estrogen and progesterone, and shrink after menopause, when there are very low levels of estrogen and progesterone. Although hormones may contribute to the growth of fibroids, their exact role is not known.Growth factors: Growth factors are proteins that regulate a process known as angiogenesis, which is the growth of new blood vessels from pre-existing ones. The new blood vessels then allow blood to flow to any existing growth, including fibroids. Growth factors may play a role in fibroid development.SIGNS AND SYMPTOMSGeneral: It is estimated that about 80-90% of women who have fibroids do not have any symptoms. However 10-20% may experience menstrual problems, pain, urinary/bowel problems, and a feeling of fullness in the lower abdomen. The size, location, and number of fibroids also plays a role in the types of symptoms a woman experiences.Menstrual problems: A woman with fibroids may have heavy bleeding and periods that are more painful and longer than normal. Fibroids may cause blood to stay in the uterus long enough for clots to form, which may then cause severe menstrual cramping. Patients with fibroids may experience bleeding in between periods. These symptoms are more common with fibroids that grow inside the uterus (submucosal fibroids).Pain: Pain and pressure may be felt in the pelvis (lower abdomen) of women with fibroids. The pain is sometimes caused when the fibroid starts to die off due to lack of nutrients and its byproducts are absorbed into the tissues. Some women experience pain in their backs or legs as well as pain during sexual intercourse. Bleeding during sexual intercourse has also been reported.Urinary/bowel problems: If the fibroids are located on the outside of the uterus (subserosal fibroids), they may put pressure on the bladder and may cause urinary and bladder problems. Some women feel like they have to urinate frequently and some have urinary incontinence, which is the inability to hold urination. Other women may have constipation or develop hemorrhoids if the fibroids are putting pressure on the rectum.TYPES OF THE DISEASEGeneral: Fibroids are classified by where they grow in relation to the uterus. There are subserosal fibroids (outside the uterus), intramural fibroids (in the middle of the uterus), and submucosal fibroids (inside of the uterus, near the endometrial lining). Peduncles are stalks that can grow on the surface of the uterus, and they can develop fibroids themselves known as pedunculated fibroids. Pedunculated fibroids are sometimes a subclassification of subserosal or submucosal fibroids, but some doctors classify them as in their own group. A woman can have one type of fibroid, a couple of types, or all the types of fibroids.Subserosal fibroids: These fibroids grow on the outside of the uterus and, as they grow, they expand further out into the uterine cavity. Subserosal fibroids generally have no effect on menstrual flow, but they may cause lower back pain, pelvic pain, increased urination, and constipation if they push onto the surrounding tissues/organs. Subserosal fibroids account for about 20% of all fibroid cases.Intramural fibroids: In this type, the fibroids grow from within the uterine wall and they expand inward, causing the uterus to bulge. A doctor may suspect intramural fibroids if the uterus feels larger than normal during an examination. Intramural fibroids are the most common, accounting for about 70% of all fibroid cases, and they can potentially cause any of the symptoms associated with fibroids.Submucosal fibroids: Fibroids that grow just under the inner lining of the uterine cavity (called the endometrial lining) are called submucosal fibroids. They are the least common type of fibroid, accounting for only 5% of all cases. But even a small submucosal fibroid may cause symptoms of heavy bleeding and prolonged menstrual periods.Pedunculated fibroids: Peduncles are stalk-like growths on the inside or the outside of the uterus where a fibroid can grow and hang off. When a fibroid grows on a peduncle, it is called a pedunculated fibroid. If the fibroid is growing on the inside of the uterus, it is considered a pendunculated submucosal fibroid. If it is growing on the outside of the uterus, it is a pendunculated subserosal fibroid. The stalks on pedunculated fibroids have the ability to twist, which may cause severe or chronic pain or pressure on surrounding tissues.DIAGNOSISGeneral: Most fibroids are found during routine pelvic exams. The doctor is usually able to feel if the uterus is an irregular shape or size, which may indicate a fibroid. Imaging tests and a hysteroscopy are two ways to find fibroids and look at them in more detail.Imaging: An ultrasound uses sound waves to create a picture when a wand-like device (called a transducer) moves over the abdomen (transabdominal). A doctor may place the transducer inside the vagina (transvaginal) to get a more detailed picture of the uterus and the fibroids.Hysterosonography is another type of ultrasound in which saline is used in the uterine cavity in order to obtain inside images of the uterus. This ultrasound can be used when a transvaginal ultrasound is not sufficient.A hysterosalpingography is a type of X-ray image that uses a dye to highlight the uterus and fallopian tubes. A doctor uses this if it is suspected that the woman is infertile because it shows fibroids and whether the fallopian tubes are open.Other imaging tests that are used include X-rays, which use radiation to see inside the body; computerized tomography (CT) scans, which take many pictures at different angles; and magnetic resonance imaging (MRI), which uses magnets and radio waves to produce a picture.Hysteroscopy: A hysteroscopy is a procedure where a hysteroscope, or small telescope, is put into the uterus through the vagina. There is a tube that releases gas or liquid to expand the uterus to look at the uterine walls and the fallopian tubes. Unlike the other procedures, this procedure can be done at the doctor's office.COMPLICATIONSGeneral: Most fibroids are benign and may not cause any symptoms or complications. Some women may have problems with pregnancy. Pregnancy complications, like symptoms, depend on the size, location, and number of fibroids a woman has. It is even less likely that the fibroids will become cancerous.Anemia: Because heavy bleeding is a common symptom of fibroids, losing a lot of blood may lead to anemia. The most common anemia is a deficiency in iron. A doctor may recommend iron supplements to correct this anemia.Cancer: Cancer is not likely to develop in women with fibroids, with a rate of less than 0.1%. However, one in every 1,000 women with fibroids can develop a form of cancer called leiomyosarcoma. Leiomyosarcoma is a rare cancer of the smooth muscle, which is found in the uterus. A fibroid may be malignant if it is growing rapidly or growing after menopause. Having fibroids does not seem to increase the risk of developing other cancers.Infertility: Fibroids can cause infertility in some women. Fibroids may cause a distortion in the fallopian tubes or block them completely. This may also interfere with sperm passing into the fallopian tubes. Submucosal fibroids may prevent the embryo from implanting and growing by affecting the surrounding endometrial lining.Pregnancy problems: If a woman with fibroids becomes pregnant, a number of problems may occur. There may be an increased risk of miscarriage, premature labor, abnormal fetal position, and placenta abruption (placenta separating from the uterine wall). However, studies have not confirmed these associations. Localized, benign pain during the first and second trimesters is the most common pregnancy complication. This pain could be due to fibroids growing larger, putting pressure on surrounding tissues, or pedunculated fibroids twisting around their stalks.TREATMENTGeneral: Most women with fibroids do not have any symptoms or complications and therefore, do not need treatment. If symptoms do develop, doctors may recommend watchful waiting. A doctor and patient may consider treating fibroids depending on the symptoms, size of the fibroids, location of the fibroids, age, and whether a patient wants to get pregnant.Medications: Most medications are given to treat the symptoms of fibroids rather than the fibroids themselves. Over-the-counter medications, such as ibuprofen (Motrin©), an anti-inflammatory, or acetaminophen (Tylenol©), may be given to help relieve pain. Birth control pills may be prescribed to help alleviate symptoms and regulate the menstrual period.Gonadotropin releasing hormone (Gn-RH) agonists, such as leuprolide (Lupron©, Eliguard©), nafarelin (Synarel©), and goserelin (Zoladex©), may help decrease the size of fibroids. They are often given before surgery to make fibroids smaller and easier to remove. Gn-RH usually triggers a new menstrual cycle, while Gn-RH agonists do the opposite. Gn-RH agonists cause estrogen and progesterone levels to fall, which causes menstruation to stop and fibroids to shrink. Hot flashes and depression may occur because of the drop in estrogen.Mifepristone is an anti-hormonal agent that may help stop or slow the growth of fibroids. This agent only provides temporary relief of symptoms.Danazol is a man-made androgen, or male hormone, known to relieve fibroid symptoms. It may help decrease uterine size, stop menstruation, and reverse anemia. However, this is not commonly used among women because it can cause facial hair growth, weight gain, acne, headache, and deepening of voice.Myomectomy: Myomectomy is a surgery that removes the fibroids but keeps the uterus in place. This may be a good option for patients who plan on having children. The size, location, and number of fibroids a person has will determine whether the surgery will be minor, performed in an outpatient setting, or major, requiring a patient to stay in the hospital for a few days. Because the uterus is left intact, fibroids may eventually grow back with this treatment. There is a 10-30% chance that fibroids will grow back. Some studies saw a 50% re-growth rate in African American women.An abdominal myomectomy, in which the abdomen is opened up, is used in cases in which the fibroids are large and deep. A laparoscopic myomectomy, which uses a camera to locate the fibroids and a small instrument to remove the fibroids, is used for smaller fibroids and only requires small abdominal cuts. When fibroids are inside the uterus, a hysteroscopic myomectomy is conducted. The doctor places a hysteroscope through the cervix and removes the fibroids with the aid of a camera. About 20-40% of women have complications from myomectomies. Minor complications include bruising, mild infection, and fever. Bleeding and abdominal pain is expected after these procedures until a full recovery is made.Two variations of a myomectomy, myolysis and cyromyolysis, have also been used. These procedures do not remove the fibroid but cut off the blood supply causing the fibroid to shrink and die. Myolysis uses a needle and electrical currents to destroy the vessels of the fibroids, thereby cutting off their blood supply. Cryomyolysis is similar but uses liquid nitrogen to freeze the fibroids. There is a risk of uterine rupture, so this procedure is not recommended in patients that want to get pregnant. Fibroids may not shrink with these treatments, and in some cases, cryomyolysis may cause the fibroids to increase in size. The overall safety, effectiveness, and risk of recurrence have not been determined.Endometrial ablation: This surgery uses a hysteroscope and heat to destroy the inner lining of the uterus, known as the endometrial lining. This may help patients who have heavy bleeding, but it will not be effective for fibroids outside the uterine lining. Women are not able to have children after this procedure because the endometrial lining is needed to nourish a growing fetus.Hysterectomy: A hysterectomy is the complete removal of the uterus and the only complete and permanent cure for fibroids. It is an invasive surgery and should only be done when the patient is not planning on having children afterwards. Removal of the ovaries is uncommon for women with fibroids, but if the ovaries are removed, menopause will be induced and a patient may have to decide if she wants hormone replacement therapy. There are many side effects after a hysterectomy, including hot flashes, weight gain, urinary incontinence, osteoporosis, and low sex drive. It is important to consider the risks and benefits of a hysterectomy.Uterine fibroid embolization (UFE): UFE is a newer, non-surgical procedure that an interventional radiologist performs. A catheter is placed into the artery that supplies blood to the uterus and the fibroids. Tiny particles are released and the blood flow to the uterus is cut off, causing the fibroids to shrink. The procedure takes about an hour and most women stay one night in the hospital. The patient is conscious, but sedated, during the procedure and given narcotics for the pain. UFE treats all types of fibroids and is a good option for women who do not want to undergo surgery. A complication of this procedure is infection, which may affect the ovaries. Infections are typically treated with antibiotics. UFE is only suggested to those women that do not want children because the effect it has on fertility is not known. However, there have been women who have had successful pregnancies following UFE. There is some evidence suggesting that fibroids will not grow back, but more long-term data are needed.Focused ultrasound surgery: Focused ultrasound surgery (FUS) uses a special MRI scanner to guide the doctor to the location of the fibroid. Once the fibroids are found, high-frequency, high-energy sound waves destroy the fibroids, so no incision is needed. Women who wish to avoid surgery and to preserve their uterus may benefit from this option. One treatment may last up to several hours and the long-term effects are not known.INTEGRATIVE THERAPIESUnclear or conflicting scientific evidence:Traditional Chinese medicine: Chinese medicine is a broad term encompassing many different modalities and traditions of healing. These modalities share a common heritage of technique or theory rooted in ancient Chinese philosophy (Taoism) and date back more than 5,000 years. TCM practitioners may call upon a wide range of other modalities as well, from meditation and martial arts to feng shui. Human studies using TCM for fibroids have been conducted but have been of poor quality. Limited human data has shown that TCM was effective at shrinking fibroids or preventing them from growing.There have been reports of manufactured or processed Chinese herbal products being tainted with toxins or heavy metals or not containing the listed ingredients. There have also been reports of adverse effects. Chinese herbs can interact with drugs, interfering with or exaggerating their effects. In particular, ma huang should not be taken with caffeine. Certain modalities and herbs should be avoided in pregnancy and lactation. Consumers should consult with medical professionals, including pharmacists, for recommendations on safe herbal products, dosage, and interactions with other medications.Magnet therapy: The use of magnets to treat illness has been described historically in many civilizations and was suggested by ancient Egyptian priests and in the 4th Century BC by Hippocrates. Many different types, sizes, and strengths of magnets are available. Magnet therapy may be administered by a healthcare professional or used by individuals on their own. Constant (static) magnets or pulsed electromagnetic fields may be applied to areas of the body affected by illness or to the entire body. Early research reports reductions of pain in women with chronic refractory pelvic pain using magnet therapy. Well-designed studies are needed in this area before a conclusion can be drawn.People with implantable medical devices, such as heart pacemakers, defibrillators, insulin pumps, or hepatic artery infusion pumps, should avoid exposure to magnets, as magnets may affect the functioning of some equipment. Some publications discourage the use of static magnets or electromagnetic field therapy during pregnancy. Some publications also suggest that magnets may cause dizziness or nausea or may prolong poor wound healing or bleeding. Scientific research is limited in these areas.Traditional or theoretical uses lacking sufficient evidence:Acupuncture: The practice of acupuncture originated in China 5,000 years ago. Today, acupuncture is widely used throughout the world and is one of the main pillars of traditional Chinese medicine (TCM). Acupuncture has become integrated with Western medicine as well, and it is often referred to as medical acupuncture in that context. Acupuncture has been suggested as a possible treatment for fibroids, but research is currently lacking in this area.When performed by an experienced practitioner using standard sterile techniques, very few serious complications have been documented, despite millions of treatments conducted every year. Observational studies and randomized trials reviewing thousands of treatments have not noted any serious adverse reactions.American pennyroyal: American pennyroyal is an herb in the mint family. Although American pennyroyal has been suggested as a possible treatment for fibroids, research is lacking in this area.The essential oil of pennyroyal is toxic, and death has been reported after consumption of one half-ounce (15 milliliters) of the oil. Dangerous reactions may occur if pennyroyal is taken by mouth or is used on the skin. Avoid if allergic to pennyroyal or any of its components, including pulegone. Use cautiously with prescription drugs that control blood sugar levels.Black cohosh: Black cohosh is one of the highest selling herbs in the United States and is popularly used as an alternative to hormonal therapy in the treatment of menopausal (climacteric) symptoms such as hot flashes, mood disturbances, sweating, palpitations, and vaginal dryness. Several controlled trials and case series have reported that black cohosh improved menopausal symptoms for up to six months. Although these initial studies are suggestive, they have been few in number and have universally suffered from methodological weaknesses.Avoid if allergic to black cohosh or other members of the Ranunculaceae (buttercup or crowfoot) family. Reviews of the literature have reported black cohosh to be generally well tolerated in recommended doses for up to six months. The most common side effects seem to be gastrointestinal upset and rash. The potential effects of black cohosh on estrogen-sensitive conditions, such as breast cancer, uterine cancer, or endometriosis, are not known.Detoxification therapy: Detoxification is a broad concept that encompasses many different modalities and substances used in cleansing the body's systems and organs. Detoxification regimes primarily target heavy metals, chemical toxins, microbial compounds, and by-products of protein metabolism. Detoxification therapy has been proposed as a treatment for fibroids. However, human studies are currently lacking.Side effects and warnings depend on the specific therapy used. During some detoxification processes, toxins may be released from tissues and then build up in the bloodstream en route to being excreted, temporarily causing a worsening of symptoms before they are completely excreted. This is called the Herxheimer reaction and it is most often associated with die-off of toxin-producing organisms, such as yeasts, fungi, parasites, and bacteria, but it may theoretically occur with the release of other kinds of toxins.PREVENTIONCurrent research is focused on the cause of fibroids. Currently there is limited data available on how a woman can prevent fibroids.Weight control and diet may help to decrease the risk of fibroids. A diet that limits red meat and is rich in green, leafy vegetables, fruit, and fish may be beneficial. These are theoretical preventive measures because the exact cause of fibroids has not been reported in the available literature.AUTHOR INFORMATIONThis information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).American Pregnancy Association. www.americanpregnancy.org. Accessed February 29, 2008.Horne AW, Critchley HO. The effect of uterine fibroids on embryo implantation. Semin Reprod Med. 2007 Nov;25(6):483-9. View abstractNational Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH). www.nichd.nih.gov. Accessed February 29, 2008.National Uterine Fibroids Foundation (NUFF). www.nuff.org. Accessed February 29, 2008.National Women's Health Information Center. www.womenshealth.gov. Accessed February 29, 2008.Natural Standard: The Authority on Integrative Medicine. www.naturalstandard.com. Copyright © 2008.Raikhlin A, Baerlocher MO, Asch MR. Uterine fibroid embolization: CME update for family physicians. Can Fam Physician. 2007 Feb;53(2):250-6. View abstractReynolds A. Diagnosis and management of uterine fibroids. Radiol Technol. 2007 Nov-Dec;79(2):157-78; quiz 179-82. View abstractSchollmeyer T, Meinhold-Heerlein I, et al. Operative and interventional therapy of fibroids. Ther Umsch. 2007 Jul;64(7):353-63. View abstractSomigliana E, Vercellini P, et al. Fibroids and female reproduction: a critical analysis of the evidence. Hum Reprod Update. 2007 Sep-Oct;13(5):465-76. Epub 2007 Jun 21. View abstractUS Food and Drug Administration (FDA), Office of Women's Health. www.fda.gov. Accessed February 29, 2008.Wu T, Chen X, Xie L. Selective estrogen receptor modulators (SERMs) for uterine leiomyomas. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005287. View abstractCopyright © 2011 Natural Standard (www.naturalstandard.com) NEXT ON HEALTH24X Most teens who abuse ADHD meds get them from others 2016-03-30 13:52 More: MedicalDiseases advertisement Read Health24's Comments Policy Comment on this story 0 comments Comments have been closed for this article. Logout Comment 0 characters remaining Share on Facebook Loading comments... 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