By W. Tom. Bay Path College.

According to a comparison of men’s and wom- going a break-up of a marriage or partnership goes on en’s health in Norway1 there is reason to believe that sick leave after the break-up cheap 15mg actos fast delivery. In 1999 purchase cheapest actos, a special committee women report various health ailments and see a doc- published the frst report on women’s health buy 15 mg actos with amex, point- tor more often than men. One chapter in the report is dedicated to Ô Distributing health information that reaches both men’s lifestyle and health. Thus the authori- Ô Gender perspectives to be embedded in health and ties are aware that men and women have different ex- care services and in research on health periences of health and sickness, and that a masculin- Ô Increasing our knowledge on gender differences ity perspective is important in this context. The Ministry of Health and Care Services has sure that health information reaches both women and men. The report also states that in some cases, men and women should be provided with health informa- tion that is adapted to each gender, just as other social background variables must be taken into consideration when developing communication measures and when patients encounter medical staff. The “Klara Klok” (Ask provision of information suited to the life experiences of Abby) website is an example of this. Studies show that boys know much less is another possible channel that is suggested. The Ministry states that the lack of adult men who boys, and newsletters and information brochures fo- can serve as mentors and advisers for young boys is a cusing on boys. Health clinics for young persons are an arena authorities to develop the school health service to dominated by women, both on the user and the health- make it just as attractive for boys as for girls. We urge the authorities to arrange for a public Ô Men’s life expectancy across the world, including report on men and health, including a focus on in Norway, is unnecessarily low, and too many men men’s mental health. The reason why more men die too early from causes that might have been are put on full disability pensions than women prevented. We urge the Government to increase funding (particularly prostate and testiclular cancer) is ris- of research on men’s health within a gender ing rapidly. General practitioners must be instructed to call suicide, while men’s mental health problems ap- in male patients for regular checkups. Focus on health, well-being and mental health is important dur- A male perspective on health and quality of life will in- ing such checkups. We propose that the school health service should be improved and should have better in- ties have made a great step ahead in pointing out the formation for boys. Awareness-raising activi- necessity of specifc focus on men’s quality of life, their ties are crucial in school when it comes to men health and male specifc diseases and in identifying the and health, lifestyle and prevention. Experience shows that men avail them- Bekkemellem, initiated the “Men’s Panel” as a part of the selves of such programmes when they exist. We call for a report on a life-phase-based re- About Men the Male Role and Equality. The panel was form of working hours which takes into consid- set up to discuss men’s role in a gender equality per- eration the fact that parents of young children spective in the public debate, and consisted of 30 men are under the greatest pressure when it comes chosen for this purpose in particular. The “Men’s Panel” to the balance between working life, home (care/ household) and leisure time. Extensive information measures must be intro- taken for including men in the gender equality work. A plan must be drawn up to raise the compe- the “Men’s Panel” conclusion note, especially focus- tence of all general practitioners when it comes ing on men’s health. Reform offers low threshold services for men at the local level such as counselling and anger management courses, initiates several projects focused on men, and collects and disseminates knowledge on men and boys in the general public. He has been working at Reform since 2002 with issues related to masculinity, health and fa- therhood. His competence is mainly within men’s ability to manage/cope with stress, men’s health issues and what creates individual change. In short the health and well conform to its expectations of masculinity plays a large being of the Scottish male could be much improved. The desir- able male ideals of being strong and independent run Ô Life expectancy for males, in Scotland , at 74. Attitudes towards men’s health and work in the feld of improving Ô Numbers of men in Scotland dying from alcohol it are moving ahead at a very encouraging rate. Many committed individuals within the health compared with a 6% increase in females while 3 out of 4 suicides in Scotland are by men. Currently, 2500 men are diagnosed as having prostate cancer each year There are a number of specifc pieces of work in Scot- in Scotland, of whom 750 to 800 die. The social and personal costs of this are signifcant in terms of health and economics across our communities. Since opening in September 2001, the Camelon Ô To raise the profle of men’s health in Scotland Centre has offered comprehensive, individualised health assessments and health promotion activity Ô To provide a major focus for National Men’s Health Week designed specifically for men (www. The “men only” aspect of the Stop Violence Against Women centre is highlighted in the advertisements. Men’s Health Forum Scotland have been involved in a range of conferences and campaigns to challenge male The service has proved popular with 3604 men violence, particularly against women. It has proved effective in achieving its main hosted by Men’s Health Forum Scotland in partnership target of engaging with men regarding their health. The convenient time of the service (in the We are currently developing a programme of work to sup- evening out with normal working hours) has been port violent men to change their behaviour, and hope to es- cited as a major reason for attendance. Not least of these has been around us, how we relate to it, and how it impacts upon the opportunity to engage directly with politicians, our health and lifestyle. Men’s ples are experienced throughout life by both men and Health Forum Scotland works closely with the Scot- women, but in different ways. It is these differences tish Government and has seen real infuence coming which need to be recognised from the outset when de- to bear on their approach to men’s health issues. A crucial element ever, much remains to be done and the struggle to keep is that gender sensitive health policy on its own is not men’s health on the political agenda is not always easy. Effective responses to is an obligation on public bodies not only to take gender the needs associated with that experience can then into account, but to publish Gender Equality Schemes be considered. This will have ing the Equality Duties in relation to gender, race, age, an impact on the nature of services required, and disability, faith and sexual orientation. This clearly has implications for service planning generic and gender-specifc service provision. In order for health promotion to develop in all areas of health care a recognition of the have the fullest impact, it requires to be resourced and value of a social model of health, alongside a clinical valued within the wider public health agenda. While effective and accessible clinical services Recent changes that have seen health promotion activity are imperative, it is also essential that we recognise the within Scottish Health Boards move to a community other social determinants of health. As has been said level within Community Health Partnerships may have many times, health is not just about the absence of advantages, but there is also a need to maintain a disease, but about well being and the experience of the central focus and critical mass of expertise at a Health individual in relation the world around them. In specifc areas, such as sexual health, it From a gender perspective, this is greatly infuenced may not always be appropriate to coordinate resources by the role of men in society and the family.

To understand this abnormal condition requires some knowledge of normal bone structure and physiology order actos. Microscopically order generic actos line, bone consists of a mixture of connective tissue safe actos 30 mg, blood vessels, specialized cells, and the crystals of calcium salts, which give hardness and strength. At about the age of 30 or 35 we will possess all the bone-mass we shall ever have, and from then on, there is a slow overall loss, because bone 7-6 formation does not keep pace with bone loss. When bone is being absorbed faster than it is being deposited, the skeleton is weakened. Some of this research may prove to be helpful in reducing the risk of osteoporosis, or perhaps preventing it altogether: (1) in women, administering estrogen before bone loss becomes severe to prevent the progress of the disease; (2) exercising to prevent bone loss; (3) taking calcium supplements and vitamin D, in order to limit excessive bone loss; and (4) for both men and women, giving up smoking and alcohol. Regular exercise and adequate dietary calcium are important to prevent osteoporosis. Management of Recurrent Urinary Tract Infection The best-known symptoms of bladder infection are pain or burning on urination, frequent and urgent urination, and blood in the urine. The female urethra, the tube leading from the bladder to the outside of the body, is only about one-half inch long in women, a short distance that makes it easy for bacteria to travel upward to reach the bladder. Most bacteria that cause bladder infections come from the rectal area, and sometimes bladder infection is related to sexual activity. Drink acidic fruit juices, since putting more acid into the urine may help bring relief. If relief is not substantial within 24 hours and complete in 48 hours, seek medical attention. If you are experiencing vomiting, back pain, or chills, this is not typical of bladder infection but more likely indicates kidney infection. This requires immediate evaluation and more vigorous treatment by a medical professional. Many female contraceptives are available including birth control pills and patches, intrauterine devices and vaginal diaphragms. These require a physician’s prescription so they must be obtained (and used) before they are needed. One in four women report that they have been victims of family violence or stalking. These acts of violence take several forms, including child abuse, intimate partner violence, sexual assault and abuse, rape, incest, and elder abuse. Women who have been assaulted or who are victims of abuse often feel too ashamed and afraid to report the incident. Violence against women in any form is a crime, regardless of who committed the violent act. It is always wrong, whether the perpetrator is a family member, colleague, acquaintance, or stranger. If you or someone you know has been sexually, physically, or emotionally abused, seek help from other family members and friends or the employee assistance program. Learn how to minimize your risk of becoming a victim of sexual assault or sexual abuse before you find yourself in an uncomfortable or threatening situation. Violence among crew requires involvement of the chain of command, and should be reported to legal authorities when appropriate. Calcium Both women and men need enough calcium to build maximum bone mass during their early years of life. Low calcium intake appears to be one important factor in the development of osteoporosis. Osteoporosis is a condition in which progressive loss of bone occurs with aging, leaving the bones susceptible to fracture. The most important time to get a sufficient amount of calcium is when bone growth and consolidation are occurring. The foods that top the calcium charts including milk, cheese, and ice cream are not lightweights in calories and fat, so choose the low-fat or fat-free versions. Other good sources of calcium include salmon, tofu, certain vegetables including broccoli, legumes such as peas and beans, seeds, and nuts. Iron For pre-menopausal women, the recommended daily allowance for iron is 15 to 18 mg per day, more than the recommended daily allowance of 0-10 mg for men. Pre-menopausal women need more of this mineral because they lose iron during menstruation. Dietary iron from plant sources is found in peas and beans, spinach and other green leafy vegetables, and iron fortified cereal products. The addition of even relatively small amounts of foods containing Vitamin C substantially increases the total amount of iron absorbed from a meal. After menopause, a woman’s need for iron is lower and unlikely to require supplementation. Calories and Weight Control Cutting back on calories is not always the answer to losing weight. You cannot cut back on calories and eat all the necessary nutrients if you are taking in fewer than 1500 calories per day. The fewer the calories you eat, a harder it is to meet 7-9 your daily nutritional requirements. Look to eliminate any sources of “empty” calories from your diet, such as sodas and other sweetened beverages, sugary snack foods, added fats, and alcohol. If you find you are gaining weight, you need to think of not only cutting calories, but also about increasing physical activity. Physical activity burns calories, increases the proportion of lean to fat body mass, and raises your metabolism. Eating Disorders Two common types of eating disorders are anorexia nervosa and bulimia. Some behaviors associated with these conditions are starvation, self-induced vomiting, excessive exercise, and the misuse of laxatives or diuretics. Symptoms of eating disorders are fear of gaining weight, food obsessions, avoidance of meals, rigid dieting and fasting, rigorous exercise, weight loss, unusual mood states (such as confusion, lethargy, and depression), swollen salivary glands, erosion of dental enamel (from stomach acid dissolving teeth during vomiting), dark circles under the eyes, low self-esteem, declining performance, and lack of menstrual periods. Eating disorders are extremely damaging to the mind and body, and can be fatal if untreated. The female athlete triad is found among female athletes trying to balance the pressures of body image and peak physical performance. The triad is marked by inadequate food intake, menstrual abnormalities (irregular or absent cycles), and bone loss (weak bones at increased risk for fractures). In well-nourished women, heavy physical training may not result in amenorrhea (three or more missed menstrual cycles), which may reflect malnutrition. It is key to establish a healthy relationship between food, body image and performance. Resources to help with eating disorders are found at: National Institute of Mental Health http://www. Choose a diet low in animal fat and sodium, and rich in fruits, vegetables, whole grains, and 7-10 low-fat or nonfat dairy products. Be aware that sexual activity can transmit disease, and modify behavior accordingly. Medical experts agree that good health depends on use of preventive services and good personal lifestyle habits.

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These incidences of water contamination still examples of waterborne illnesses highlight remain a problem in many developed the need for rapid actos 45mg on line, sensitive and inexpensive countries buy cheap actos 15 mg line. For example order actos with paypal, an outbreak in 1988 methods to assess water quality to mitigate in Sweden affected 11,000 people when a such costly outbreaks of waterborne disease chlorination failure occurred at a water- in developing and developed countries. The treatment plant (Andersson, 1991), and 2300 quality of drinking water, wastewater individuals in Walkerton, Ontario, Canada, treatment and recreational-use waters must were affected by a waterborne outbreak of constantly be assessed due to their potential Escherichia coli O157 when exposed to to serve as a vehicle for spreading disease. In contaminated drinking water from a well that some instances, untreated wastewater is used had most likely been contaminated by surface for the irrigation of crops, creating a potential runoff water (Hrudey et al. Steiner can thus serve as a source for transmission of and Okabe, 2006; Yates, 2007), based on the pathogens, becoming important from a food- rationale that these indicator organisms are safety standpoint (see Niu et al. Thesting for these micro- of these various issues can be crucial from a organisms in particular is necessary because public health perspective. A number of testing for the numerous bacterial, viral and methods for such assessment exist and can be parasitical pathogens that can cause water- differentiated into chemical, physical or borne illness is generally considered to be biological approaches (as well as their use in impractical, particularly as doing so can combination). The purpose of this chapter, require extensive laboratory knowledge, however, is to describe the scientific literature specialized equipment and a large quantity of surrounding the use of coliphages and phages time and other resources (Havelaar and that infect other bacterial species as indicators Hogeboom, 1983; Yates, 2007). For additional reading, there In addition to testing for the presence of are a number of earlier reviews of phage use gross faecal pollution, it is also useful to as faecal indicators of water quality (Leclerc develop methodology that can evaluate the et al. We begin with an overview of the the basic criteria for a good index organism of concept of the use of indicator organisms in water quality as the following: (i) the general for assessment of water quality. The detection, treatment strategies as the pathogens it isolation and identification of waterborne indicates; and (v) the organism should be pathogens can be expensive, difficult and both easily assayed and non-pathogenic. To addition to these criteria, the ideal indicator/ alleviate these issues with waterborne index organism would also be able to pathogen testing, indicator microorganisms discriminate between contamination sources (organisms used to determine the presence of (animal or human), also known as microbial faecal pollution) and index microorganisms source tracking, and would have the ability to (organisms used to indicate the presence predict the presence of waterborne viral of specific groups of pathogenic micro- pathogens (Scot et al. Historically, coliforms, the thermo- total coliforms, then further analyses for faecal tolerant coliform group, enterococci and coliforms or E. Another issue standard for recreational water is much more to consider is the fact that the bacterial liberal and utilizes E. These criteria are identifies the source of the pollution, which based on the rationale that the absence of enables containment and a decrease in the faecal coliforms, E. Many rapid detection, it is clear that there remains of these bacteria, however, are routinely an acute need to identify beter indicators of isolated from soil and water environments microbial quality that would determine faecal that have not been impacted by faecal contamination in a rapid manner and also pollution. For example, faecal coliforms and determine the source of that pollution so that E. In an propagate within pristine and tropical effort to find indicators and index organisms environments, meaning that assessment of that fit the criteria previously described, their initial numbers can be exaggerated novel alternatives to total coliform and E. Bacteriophages as indicators of microorganisms and the full range of water quality, and as index organisms for pathogens they are intended to represent is enteric viruses, have been proposed as a not clearly understood, nor are the dynamics substitute for bacteria. Bacteriophages as Indicator and There are other difficulties in using these Index Microorganisms bacteria as markers of faecal contamination. The bacteria are able to grow in biofilms Bacteriophages were recognized as being within drinking-water distribution systems. The use of water supplies during outbreaks of water- phages to indicate the possible presence of borne disease. Also, while the persistence of pathogenic enteric bacteria was an idea that these bacteria in water-distribution systems is subsequently developed in the 1930s, and comparable to that of some bacterial direct correlations between the presence of pathogens, the relationship between bacterial certain types of bacteriophages and the index organisms and the presence of enteric presence of faecal contamination were viruses and protozoa is poor, which is reported (Scarpino, 1978). Finally, the methods used to detect the pathogens, the approach to monitoring for indicators/index bacteria are problematic. In addition, candidate index microorganisms for the enteric viruses are ofen present in low enteric viruses including somatic coliphages concentrations, requiring the analysis of at (Kot, 1966; Hilton and Stotzky, 1973; Kot et least 10 litres of water, and while diagnostic al. The similarities between phages and Somatic Coliphages enteric viruses begin with the simple fact that phages are viruses themselves. Bacteriophage The somatic coliphage group includes all assay conditions, however, are much simpler phages that require the presence of a receptor- and cheaper than any of the enteric virus binding protein for infection of their host E. For example, phages can coli and comprise bacteriophages from the be identified and quantified using several families Myoviridae, Siphoviridae, Podoviridae methods ranging from standard micro- and Microviridae (Muniesa et al. Somatic coliphages have these methods of detection can suffer the been proposed as indicators of faecal same limitations as bacterial detection, in contamination and guidelines currently exist some cases requiring even more laboratory for their detection and analysis via enrichment expertise. The researchers tested water samples multiply in the environment and should be for the presence of somatic coliphages, and present in greater numbers than the enteric any water samples that contained phages viruses. Additionally, they should be at least were subsequently tested for the enteric as long-lived as the enteric viruses present in viruses. Of the 68 surface-water samples the environment, and their survival kinetics positive for somatic coliphages, only two throughout the water-treatment process were positive for enteric viruses when should be similar to that of enteric viruses detected by culturable methods, while 60 (Keswick et al. For instance, there is present in wastewater and other faecally evidence that somatic coliphages may contaminated waters in numbers at least multiply in other species of Enterobacteriaceae, equal to the enteric viruses. Somatic phages which are part of the total coliform group and also persist in wastewater and surface waters ofen found associated with vegetation and for longer time periods that enteroviruses biofilms. Somatic coliphages have been detected that some coliphages might be produced that in sewage-contaminated waters but were not are not only unrelated to faecal contamination found in pristine waters (Toranzos et al. Coliforms that can colonize contaminated waters has been reviewed by biofilms may be present anywhere in the Gerba (1987), the International Association on water collection treatment or distribution Water Pollution Research and Control system. Nevertheless, shellfish-growing waters showed that coli- detractors of the use of somatic coliphages as phages are not adequate index micro- indicators of faecal contamination cite data organisms of enteric viruses. This was due to showing that propagation within the the replication of coliphages, the presence of environment could occur whenever a host more than one dominant phage type in bacterium is present, causing their numbers estuarine and fresh waters making the results to be over-represented, and somatic of a test for any one phage type not definitive coliphages have been reported to replicate at (Vaughn and Metcalf, 1975; Seeley and temperatures as low as 15°C (Seeley and Primrose, 1980; Parry et al. In addition, studied environmental bacterial host strains inconsistent occurrence of coliphages in raw and found that, although environmental sewage samples with the simultaneous somatic coliphages could be propagated on isolation of enteroviruses has been observed, laboratory E. These results suggested that environ- mental replication of somatic coliphages is not a significant problem and therefore Male-specific Coliphages would not cause over-representation of somatic coliphages. Male-specific coliphages from the families Other potential limitations exist that are Inoviridae and Leviviridae are defined by their relevant to the use of somatic coliphages as requirement for the expression of F pili on 158 L. Steiner their host bacteria for successful infection water-quality indicators during different (Long and Sobsey, 2004). Therefore, detection of indicators of faecal contamination has been these phages indicates a recent contamination widely disputed as they are not as well event. They are Phage Detection as an Indication of Faecal Contamination 159 also similar to enteric viruses with respect to (Furuse et al. Unlike were incubated with antisera from each phages from the genus Levivirus, Allolevivirus group and then grown on their respective E. If the phage was neutralized, host-cell lysis (Bollback and Huelsenbeck, then it belonged to the same group as the 2001; Stewart et al. The and physiochemical properties (Havelaar serotyping method can be used in a source and Hogeboom, 1984). The serotyping method as agglutination and nucleic acid hybridization described by Furuse et al. Phages in bold represent the type phage for each particular serotype or genogroup. The genotyping method showed strongly associated with harvest area faecal excellent agreement with the serotyping pollution and with shellfish-associated method (P<0. Samples were the known increased virus risk associated tested at the point of sale following commercial with shellfish harvested at this time of year in processing and packaging.

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Y N Do you require all visitors and vehicles to park near the entrance to the farm in established parking areas away from all animals purchase actos us, barns generic 30mg actos with visa, and livestock areas? Y N Do you provide clean coveralls and disposable or disinfected rubber boots for visitors if they have had contact with livestock from other farms in the previous 72 hours? Y N Do you require any vehicles entering the farm to be disinfected prior to entry and upon exiting? Y N Do you require that visitors avoid livestock areas purchase actos now, pens, and barns unless absolutely necessary? Y N Do you restrict close contact or handling of animals by visitors (unless necessary for the health of the animal)? Cleaning and Disinfection Y N Do you clean and disinfect any non-disposable items that come in contact with eye or nasal discharges, manure, urine, saliva, or milk from an infected animal? Y N Do you dispose of bedding and manure from isolation areas so that livestock or wildlife do not have access to it? Y N Do you remove dirt and organic material (bedding, manure) before applying disinfectants? Y N Are boot baths properly maintained (proper concentration used, changed frequently to keep clean)? Conclusion Total number of: Yes responses ________ No responses ________ If you have 1 or more No responses, you have identifed areas for improvement on your farm. Not all questions are equal in their risk of disease transmission, so it is important to work with your veterinarian to develop a management plan addressing the biggest risks frst. This will help minimize the chance of foot-and-mouth disease from entering your farm. Each farm will be unique in their ability to prevent disease transmission because management styles, herd sizes and fnances vary. Overview of Parkinson’s Disease Parkinson’s disease is a progressive and chronic neurodegenerative brain disorder that affects approximately 1 million people in the United States. Parkinson’s disease affects both men and women; however, men are one and a half times more likely than women to have the disease. The condition is generally characterized by primary motor symptoms of resting tremor, bradykinesia, rigidity, and postural instability. Non-motor symptoms experienced by Parkinson’s disease patients may include cognitive impairment, mood disorders, and sleep disturbances. The progression of Parkinson’s disease may differ markedly from patient to patient following diagnosis. There is no cure for Parkinson’s disease; therefore, the goals for treatment are to improve quality of life and manage the signs and symptoms of the disease. Several treatment options for Parkinson’s disease are currently available and involve a wide range of administration routes including tablets, capsules, patches, subcutaneous injections, intramuscular injections and intrajejunal infusions. Carbidopa-levodopa remains the mainstay of treatment for the signs and symptoms of Parkinson’s disease. Over the course of their disease, almost all patients with Parkinson’s disease will take carbidopa-levodopa. Deep brain stimulation is also a potential therapeutic option for patients with advanced Parkinson’s disease. Non-pharmacological management approaches include exercise, yoga, meditation, diet, and lifestyle modification. Discussion focused on two key topics: (1) the effects of Parkinson’s disease that matter most to patients, and (2) patients’ perspectives on treatments for Parkinson’s disease. The discussion questions (Appendix 1) were published in a Federal Register notice that announced the meeting. For each topic, a panel of patients and patient representatives (Appendix 2) shared comments to begin the dialogue. Panel comments were followed by a facilitated discussion inviting comments from other patients and patient representatives in the audience. Participants who joined the meeting via live 3 webcast (referred to in this report as web participants) were also able to contribute comments. In addition, in-person and web participants were periodically invited to respond to polling questions (Appendix 3), which provided a sense of the demographic makeup of participants and of how many participants shared a particular perspective on a given topic. Approximately 45 Parkinson’s disease patients and patient representatives attended the meeting in- person, and approximately 10 patients or patient representatives provided input through the live webcast. According to their responses to the polling questions, in-person and web participants represented an even distribution of gender. A majority of meeting participants identified themselves as having received a Parkinson’s disease diagnosis less than ten years ago. To supplement the input gathered at the meeting, patients and others were encouraged to submit 2 comments on the topic to a public docket, which was open until November 23, 2015. A few patient groups and healthcare providers also submitted surveys and patient group responses to the public docket. More information, including the archived webcast and meeting transcript, is available on the meeting website: http://www. To the extent possible, the terms used in this report to describe specific Parkinson’s disease symptoms, impacts, and treatment experiences reflect the words used by in-person participants, web participants, or docket commenters. The report is not meant to be representative in any way of the views and experiences of any specific group of individuals or entities. There may be symptoms, impacts, treatments, or other aspects of Parkinson’s disease that are not included in this report. The input from the meeting and docket comments underscore the debilitating effect that Parkinson’s disease has on patients’ lives and the challenges patients face in finding therapy to manage the multiple challenges caused by their condition. Several key themes emerged from this meeting: • Parkinson’s disease is a progressive, devastating disease. Participants emphasized the difficulty of living with the unexpected onset and progression of symptoms. Many described living with daily motor symptoms which included bradykinesia, dyskinesia, tremor and dystonia. In addition to motor symptoms, participants also highlighted sleep disturbances, cognitive impairment, fatigue, and constipation. Participants described severe limitations in performing at work, caring for self and family, and maintaining relationships. Participants described the burden of selecting the best available treatments to address their symptoms, the complexity of managing proper timing of medications in addition to pill burden (number and frequency of pills taken throughout the day), and the need for adjustment of their medication regimen because of unpredictable symptoms, changes in daily demands leading to increases in symptoms, as well as disease progression. Participants emphasized that the side effects of treatments were often as debilitating as the underlying disease symptoms. Many participants highlighted the benefits of incorporating non- drug therapies, such as exercise and diet modifications, with prescription regimens for optimal symptom management. For example, Appendix 4 shows how this input may directly support our benefit-risk assessments for products under review.

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