Endometriosis impairs HRQoL and work productivity across countries and ethnicities, yet women continue to experience diagnostic delays in primary care. A higher index of suspicion is needed to expedite specialist assessment of symptomatic women. Future research should seek to clarify pain mechanisms in relation to endometriosis severity.

Low serum vitamin D levels are associated with higher risk of active tuberculosis. Although more prospectively designed studies are needed to firmly establish the direction of this association, it is more likely that low body vitamin D levels increase the risk of active tuberculosis. In view of this, the potential role of vitamin D supplementation in people with tuberculosis and hypovitaminosis D-associated conditions like chronic kidney disease should be evaluated.

A targeted food tax combined with the appropriate subsidy on fruits and vegetables could reduce deaths from CVD and cancer.

BackgroundIncreased vegetable and fruit consumption is encouraged to promote health, including the maintenance of a healthy body weight. Population health strategies (e.g. 5-A-Day or similar campaigns and subsidies on vegetables or fruit) that emphasize increased consumption may theoretically lead to increased energy intake and weight gain.MethodsWe undertook a systematic review of trials that sought to increase vegetable and fruit consumption, in the absence of advice or specific encouragement to remove other foods from the diet, to understand the effect on body weight and energy intake. We included only randomised controlled trials. We pooled data using a random effects model for two outcomes: change in body weight and change in energy intake. Sensitivity and secondary analyses were also undertaken, including a one-study removed analysis and analysis by study sub-type to explore sources of heterogeneity.ResultsA total of eight studies, including 1026 participants, were identified for inclusion in the review. The mean study duration was 14.7 weeks (range four to 52 weeks). The mean difference in vegetable and fruit consumption between arms was 133 g (range 50 g to 456 g). The mean change in body weight was 0.68 kg (95% CI: 0.15-1.20; n = 8; I2 for heterogeneity = 83%, p = 0.01) less in the “high vegetable and fruit” intake arms than in the “low vegetable and fruit intake” arms. There was no significant difference in measured change daily energy intake between the two arms (368 kJ; 95% CI: -27 to 762, comparing high vs low; n = 6; I2 = 42%, p = 0.07).ConclusionPromoting increased fruit and vegetable consumption, in the absence of specific advice to decrease consumption of other foods, appears unlikely to lead to weight gain in the short-term and may have a role in weight maintenance or loss. Longer studies or other methods are needed to understand the long-term effects on weight maintenance and loss.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-886) contains supplementary material, which is available to authorized users.

ObjectiveTo generate and validate symptom-based models to predict endometriosis among symptomatic women prior to undergoing their first laparoscopy.DesignProspective, observational, two-phase study, in which women completed a 25-item questionnaire prior to surgery.SettingNineteen hospitals in 13 countries.Patient(s)Symptomatic women (n = 1,396) scheduled for laparoscopy without a previous surgical diagnosis of endometriosis.Intervention(s)None.Main Outcome Measure(s)Sensitivity and specificity of endometriosis diagnosis predicted by symptoms and patient characteristics from optimal models developed using multiple logistic regression analyses in one data set (phase I), and independently validated in a second data set (phase II) by receiver operating characteristic (ROC) curve analysis.Result(s)Three hundred sixty (46.7%) women in phase I and 364 (58.2%) in phase II were diagnosed with endometriosis at laparoscopy. Menstrual dyschezia (pain on opening bowels) and a history of benign ovarian cysts most strongly predicted both any and stage III and IV endometriosis in both phases. Prediction of any-stage endometriosis, although improved by ultrasound scan evidence of cyst/nodules, was relatively poor (area under the curve [AUC] = 68.3). Stage III and IV disease was predicted with good accuracy (AUC = 84.9, sensitivity of 82.3% and specificity 75.8% at an optimal cut-off of 0.24).Conclusion(s)Our symptom-based models predict any-stage endometriosis relatively poorly and stage III and IV disease with good accuracy. Predictive tools based on such models could help to prioritize women for surgical investigation in clinical practice and thus contribute to reducing time to diagnosis. We invite other researchers to validate the key models in additional populations.

The developed model estimates the impact of population-level dietary changes and is robust. Achieving UK dietary recommendations for fruit and vegetable consumption (five portions a day) would result in substantial health benefits-equivalent benefits would be achieved if salt intakes were lowered to 3.5 g per day or saturated fat intakes were lowered to 3% of total energy.

ObjectiveTo review published studies evaluating early menarche and the risk of endometriosis.DesignSystematic review and meta-analysis of case-control studies.SettingNone.Patient(s)Eighteen case-control studies of age at menarche and risk of endometriosis including 3,805 women with endometriosis and 9,526 controls.Intervention(s)None.Main Outcome Measure(s)Medline and Embase databases were searched from 1980 to 2011 to locate relevant studies. Results of primary studies were expressed as effect sizes of the difference in mean age at menarche of women with and without endometriosis. Effect sizes were used in random effects meta-analysis.Result(s)Eighteen of 45 articles retrieved met the inclusion criteria. The pooled effect size in meta-analysis was 0.10 (95% confidence interval −0.01–0.21), and not significantly different from zero (no effect). Results were influenced by substantial heterogeneity between studies (I2 = 72.5%), which was eliminated by restricting meta-analysis to studies with more rigorous control of confounders; this increased the pooled effect size to 0.15 (95% confidence interval 0.08–0.22), which was significantly different from zero. This represents a probability of 55% that a woman with endometriosis had earlier menarche than one without endometriosis if both were randomly chosen from a population.Conclusion(s)There is a small increased risk of endometriosis with early menarche. The potential for disease misclassification in primary studies suggests that this risk could be higher.

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