Praxis
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WHO describes palliative care as the approach to patients with incurable illnesses. It covers identification and treatment of pain and other physical symptoms, psychological, social, and spiritual difficulties. A tight cooperation between the family doctor, the hospital (medical clinic with the subspecialists, geriatric and palliative care centre), the Spitex, the social, psychological, and the pastoral workers is needed. ⋯ The specific interventions may include irradiation, stenting of bile ducts, oesophagus or colon, hormonal treatment etc. A very important aspect is pain control and the correct handling of non-opioid analgesics, opioids, and co-analgesics. The terminal phase at home is a special challenge for the family doctor acting as a palliative physician.
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A recently observed decrease in the prevalence of cleft lip with or without cleft palate in the United States was associated with the folic acid fortification of enriched cereal grains, which became mandatory in 1998. Several case-control and one prospective study found an inverse association between intake of folic acid and/or multivitamins and the risk of cleft lip with or without cleft palate. ⋯ Until the results of carefully carried out cohort studies will be available, all women of childbearing age not under contraceptives should consume a diet rich in folate and take an additional daily dose of at least 0.4 (better 0.8) mg folic acid, preferably with a multivitamin, and until the end of the first twelve weeks after conception. With these recommendations for the prevention of neural tube defects, the risk of cleft lip with or without cleft palate may also be reduced.