Medicare prevention: moving toward research-based policy.
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Aged↗
Biomedical subjects
D Haber
Publications and source records attributed to D Haber.
Roads leading to breast cancer.
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BRCA2 Protein↗
BRCA1: an emerging role in the cellular response to DNA damage.
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Animals↗
Health contract calendars: a tool for health professionals with older adults.
A modification of the health contract technique was applied by 4 geriatric fellows from the Center on Aging, University of Texas Medical Branch, and 3 family medicine residents from the Department of Family Medicine, University of Texas Medical Branch, to a diverse group of 48 older adults. The innovation, a calendar component to the health contract, allowed for the calculation of specific success rates. Fifteen clients had a 100% success rate, and 21 were highly successful, 8 not too successful, and 4 unsuccessful.
Aged↗
Violence prevention and young adolescents' participation in community youth service.
PURPOSE: To examine whether participation in a school-sponsored community youth service program reduces self-reported violent behaviors among young urban adolescents. METHODS: A total of 972 seventh- and eighth-grade students at two large, urban, public middle schools were surveyed at baseline and at 6-month follow-up. One school was assigned to interventions and the other served as a control. All students at the intervention school received the Reach for Health classroom curriculum that included a 10-lesson unit focusing on violence prevention. In addition, approximately half the students were randomly assigned by classroom to participate in the Reach for Health Community Youth Service program (CYS). Under the guidance of teachers and community nurses, these students spent several hours each week providing service in local health care agencies. Regression analyses were used to assess the influence of treatment condition on violent behavior outcomes. RESULTS: Comparing students in the curriculum-only and curriculum-plus-CYS interventions to the control group, there is a statistically significant interaction (p < .03) among grade, CYS participation, and violence at follow-up. Eighth-grade CYS students reported significantly less violence at follow-up than students in the control school, taking into account baseline level of risk behavior, gender, ethnicity, and social desirability (p < .04). There was no significant difference between controls and students in the curriculum-only condition. Comparing students in the CYS intervention to the curriculum-only condition within the intervention school, the grade by intervention interaction again is significant (p < .05). Eighth-grade CYS students-who received the broadest CYS experience-reported less violence at follow-up than their curriculum-only counterparts. CONCLUSION: When delivered with sufficient intensity, school programs which couple community service with classroom health instruction can have a measurable impact on violent behaviors of a population of young adolescents at high risk for being both the perpetrators and victims of peer violence. Community service programs may be an effective supplement to curricular interventions and a valuable part of multicomponent violence prevention programs.
Adolescent↗
The effectiveness of the Reach for Health Community Youth Service learning program in reducing early and unprotected sex among urban middle school students.
OBJECTIVES: This study evaluated the effectiveness of a community youth service (CYS) program in reducing sexual risk behaviors among African American and Latino urban young adolescents. METHODS: A total of 1061 students at 2 urban middle schools were surveyed at baseline and 6-month follow-up. Students at one school were randomly assigned by classroom to receive either the Reach for Health CYS program or the Reach for Health classroom curriculum only. Students at the other school served as controls. RESULTS: At follow-up. CYS participants reported significantly less recent sexual activity (P < .05) and scored lower on a sexual activity index than those in the control condition (P < .03). The greatest effect was among eighth graders, who received the most intensive service program (P < .03). The benefit of the curriculum-only intervention appeared greatest among students in special education classes. CONCLUSIONS: Well-organized CYS that couples community involvement with classroom health instruction can have a positive impact on the sexual behaviors of young adolescents at risk for HIV, sexually transmitted diseases, and unintended pregnancy. This study also suggests the importance of including students in special education classes in health education programs.
Adolescent↗
Haplotype analysis of two recurrent CDKN2A mutations in 10 melanoma families: evidence for common founders and independent mutations.
Germ-line mutations in CDKN2A have been shown to predispose to cutaneous malignant melanoma. We have identified 2 new melanoma kindreds which carry a duplication of a 24bp repeat present in the 5' region of CDKN2A previously identified in melanoma families from Australia and the United States. This mutation has now been reported in 5 melanoma families from 3 continents: Europe, North America, and Australasia. The M53I mutation in exon 2 of CDKN2A has also been documented in 5 melanoma families from Australia and North America. The aim of this study was to determine whether the occurrence of the mutations in these families from geographically diverse populations represented mutation hotspots within CDKN2A or were due to common ancestors. Haplotypes of 11 microsatellite markers flanking CDKN2A were constructed in 5 families carrying the M53I mutation and 5 families carrying the 24bp duplication. There were some differences in the segregating haplotypes due primarily to recombinations and mutations within the short tandem-repeat markers; however, the data provide evidence to indicate that there were at least 3 independent 24bp duplication events and possibly only 1 original M53I mutation. This is the first study to date which indicates common founders in melanoma families from different continents.
Cyclin-Dependent Kinase Inhibitor p16↗
Total hip arthroplasty in juvenile chronic arthritis: a consecutive series.
Twenty-nine total hip arthroplasties in 16 patients with juvenile chronic arthritis were performed by one surgeon and followed prospectively. The 9 female and 7 male patients averaged 21 years of age (range, 14-35). Height and weight averaged 160 cm (63 inches) and 53 kg (118 lb.), respectively. Preoperative planning used small or miniature components to accommodate the small anatomic proportions of the hip. The femoral component was cementless in the majority (20/29), but required cementing in 10 of 29 hips because of poor bone stock. The acetabula were reconstructed with a porous-coated cup with or without screws (27/29) or with a cemented cup (2/29). Follow-up periods averaged 53 months (range, 24-100 months). The average Harris hip score improved from 37 to 78 after surgery (P = .0001). Pain relief was excellent; 15 of 16 patients (27/29 hips) expressed a significant improvement in daily function and lifestyle, despite systemic involvement of their arthritis. The range of motion of the hip improved significantly in all planes (P = .001). Two of the 4 uncemented Muller CDH components (Protek, Bern, Switzerland) with a large offset have migrated into varus; both are pain-free. One cemented femoral component has been revised because of aseptic loosening. The use of a small or miniature, cemented or cementless femoral component and a porous-coated cup appears to provide an excellent method of hip reconstruction for patients with juvenile chronic arthritis and small anatomic proportions; however, a femoral component with too great an offset should be avoided, because this may result in varus migration of the stem.
Adolescent↗
Using hospital information systems to manage outcomes.
This article discusses techniques used at Staten Island University Hospital to help automate manual data collection for performance improvement reports and outcomes analysis. If data must be collected manually, it is time to take a look at information available in your hospital's information system.
Case Management↗
Orientation to community in a family practice residency program.
BACKGROUND: Family practice residencies are expected to include opportunities for trainees to learn about population-based approaches to health care delivery. METHODS: To prepare them for community projects later in training, first-year residents were introduced to a community-oriented primary care (COPC) curriculum by an interdisciplinary team with representatives from public health and academic family medicine. During their mid-year orientation month, the residents spent three afternoons in community settings, each year focusing on a different public health issue. The residents spent the first afternoon discussing principles of community medicine, the COPC model, and planning community interviews. The second afternoon, they interviewed in the community. The residents reported and evaluated on the third afternoon. RESULTS: During the 3 years described, most residents participated with enthusiasm, later reporting increased awareness and use of community resources. However, months after the third experience, a comparison of clinic records before and after the orientation showed no difference in the residents' inclusion of the health issue studied in managing their patients, although social workers and other non-physician faculty team members reported that residents consulted them more frequently following the community orientation. CONCLUSIONS: It is important to provide residents with an efficiently designed and attractive community orientation early in training. An interdisciplinary team should plan and coordinate their experiences, but all faculty should role model good community behavior. Although the 1996 residents described behavioral changes following this brief orientation, this was not documented by a chart review.
Adolescent↗
Detection of heterozygous truncating mutations in the BRCA1 and APC genes by using a rapid screening assay in yeast.
The detection of inactivating mutations in tumor suppressor genes is critical to their characterization, as well as to the development of diagnostic testing. Most approaches for mutational screening of germ-line specimens are complicated by the fact that mutations are heterozygous and that missense mutations are difficult to interpret in the absence of information about protein function. We describe a novel method using Saccharomyces cerevisiae for detecting protein-truncating mutations in any gene of interest. The PCR-amplified coding sequence is inserted by homologous recombination into a yeast URA3 fusion protein, and transformants are assayed for growth in the absence of uracil. The high efficiency of homologous recombination in yeast ensures that both alleles are represented among transformants and achieves separation of alleles, which facilitates subsequent nucleotide sequencing of the mutated transcript. The specificity of translational initiation of the URA3 gene leads to minimal enzymatic activity in transformants harboring an inserted stop codon, and hence to reliable distinction between specimens with wild-type alleles and those with a heterozygous truncating mutation. This yeast-based stop codon assay accurately detects heterozygous truncating mutations in the BRCA1 gene in patients with early onset of breast cancer and in the APC gene in patients with familial adenomatous polyposis. This approach offers a rapid and reliable method for genetic diagnosis in individuals at high risk for germ-line mutations in cancer susceptibility genes.
Base Sequence↗
Tumour-suppressor genes: evolving definitions in the genomic age.
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Genes, Tumor Suppressor↗
Community-oriented primary care in a family practice residency program.
BACKGROUND: The practice of medicine needs to include disease prevention, health promotion, community health, and clinical epidemiology. Community-oriented primary care (COPC) can be used as an educational strategy to develop competencies in these areas. METHODOLOGY: An interdisciplinary team that included public health representatives was created to teach COPC principles to family practice residents and supervise their community projects. Allied health and nursing graduate students were also involved in the process. Projects were implemented in collaboration with community representatives. RESULTS: Family practice residents and community representatives were positive about working together. The family practice residents appreciated the interdisciplinary experience and reported that the COPC model will be useful to them in the future. However, the program's didactic phase was insufficient to provide adequate skills for use of the COPC process. The program could benefit from more involvement of medical students and students in other health professions. CONCLUSIONS: The program encountered several significant obstacles such as competing clinical priorities, limited health education skills, and inadequate project evaluations. Despite the challenges, the family practice residents, as well as the interdisciplinary faculty, health science graduate students, and community representatives, reported a positive experience.
Clinical Competence↗
Differential effects of dietary diallyl sulfide and diallyl disulfide on rat intestinal and hepatic drug-metabolizing enzymes.
The chemopreventive properties of allyl sulfides on carcinogenesis may be related to the modulation of drug-metabolizing enzymes involved in carcinogen activation or detoxication. In order to investigate the effects of diallyl sulfide (DAS) and diallyl disulfide (DADS) on intestinal and hepatic drug-metabolizing enzymes, rats were fed a diet containing 0.2% of either allyl sulfide. The DADS enhanced intestinal epoxide hydrolase (EH) and cytochrome P-450 (P-450) 2B1/2 protein levels and the activities of pentoxy- and benzyl-oxyresorufin O-dealkylases, arylhydrocarbon hydroxylase, microsomal epoxide hydrolase, p-nitrophenol UDP-glucuronyl transferase and glutathione S-transferase, and decreased nitrosodimethylamine demethylase activity. In liver, DADS produced similar effects and, in addition, increased P-450 1A1/2 protein level and phenoxazone metabolizing activities (ethoxy- and methoxyresorufin O-dealkylases), p-hydroxybiphenyl UDP-glucuronyl transferase, and decreased P-450 2E1 level. The DAS enhanced only EH activity in the small intestine and induced P-450 2B1/2 and epoxide hydrolase protein levels. In liver, DAS produced similar effects as DADS. The different effects of DAS on intestinal drug-metabolizing enzymes, compared to liver, could be ascribed to less metabolism of this compound in small intestine. It is also suggested that DAS and DADS may not yield the same metabolites and therefore would have different effects on intestinal drug-metabolizing enzymes.
Allyl Compounds↗
Molecular genetics of Wilms tumor.
The study of Wilms tumor-predisposing congenital syndromes has led to the identification of one tumor-suppressor gene, WT1, and to the localization of WT2. Molecular genetic analyses of these and sporadic Wilms tumors have clarified the role of WT1 in Wilms tumor with aniridia, genitourinary malformations, and mental retardation (WAGR)-syndrome patients, but much remains unclear in the case of WT2 and the Beckwith-Wiedemann syndrome. Loci on chromosomes 16q and 1p have now been implicated in the progression of Wilms tumor and may serve as molecular prognostic markers. It is now clear that Wilms tumors are genetically heterogeneous and may be multigenic in origin. Molecular analyses can now be used for genetic counseling in some children and may become useful in individualizing therapy.
Chromosome Mapping↗
Identification of genetically aberrant cell lineages in Wilms' tumors.
Most Wilms' tumors contain several predominant cell types, of which a primitive blastemal population is often the most prominent. Other typical components include undifferentiated mesenchymal and epithelial cells, but it has not been demonstrated that these components are neoplastic. We used a combined cytogenetic and fluorescence in situ hybridization approach to determine the clonal relationship of different cell populations within six Wilms' tumors. Clonal numerical chromosome aberrations in three Wilms' tumors were found in blastemal cells, but not in mesenchymal cells. Loss of one WT1 allele in two other tumors was detected in both blastemal and mesenchymal cells. Tetrasomy 18 in a sixth case was observed in mesenchymal and epithelial cells; blastemal cells could not be evaluated in this tumor. These findings demonstrate that mesenchymal and epithelial cells in some Wilms' tumors are neoplastic. Different histologic components in some Wilms' tumors derive from a single chromosomally aberrant ancestor which is most likely to be the primitive blastemal cell.
Child↗
Modification of hepatic drug-metabolizing enzymes in rat fed naturally occurring allyl sulphides.
1. The effects of feeding allyl sulphides to rat (2000 ppm of the diet for 15 days) were investigated on various microsomal hepatic drug-metabolizing enzymes by their immunochemical detection and catalytic activity. 2. Allyl sulphides provoked a temporary dietary restriction, which enhanced the microsomal level of P450 and the activities of NADH-cytochrome c reductase and p-hydroxybiphenyl UDP-glucuronyltransferase (UDPGT 2), and lowered the activities of p-nitrophenol hydroxylase (PNPH), N-nitrosodimethylamine demethylase (NDMAD), laurate omega-hydroxylase (LAH) and glutathione S-transferase (GST). Therefore, pair-fed animals were used as a more relevant control for the dietary effects of allyl sulphides. 3. Diallyl sulphide (DAS) as well as diallyl disulphide (DADS) produced an enhancement of the microsomal level of P4501A2, 2B1/2 and 3A1/2, and epoxide hydrolase (EH) proteins, with an increase in the enzymatic activities they catalyse: ethoxyresorufin O-deethylase (EROD), aryl hydrocarbon hydroxylase (AHH), methoxyresorufin O-demethylase (MROD), ethoxycoumarin O-deethylase (ECOD), pentoxyresorufin O-depentylase (PROD), benzoxyresorufin O-debenzylase (BROD) and EH. Although P4502E1 proteins were lowered on treatment, NDMAD activity was not modified, and PNPH activity was even enhanced by allyl sulphides. Only DAS treatment raised erythromycin N-demethylase (ERDM) activity. 4. Both DAS and DADS increased the activity of GST and p-nitrophenol UDP-glucuronyltransferase (UDPGT 1), whereas UDPGT 2 activity was enhanced only by DAS.
Allyl Compounds↗
Characterization of three overlapping deletions causing X-linked lymphoproliferative disease.
Blot hybridization was used to find DNA sequences missing in a male who lacked two-thirds of Xq25. The probes were used to discover two additional males with deletions resulting in X-linked lymphoproliferative disease (XLP). All three deletions have a region in common, and DXS739 is within this candidate region. The new deletions were also detectable using chromosome banding, and the smallest removes only one-third of Xq25. XLP is the only consequence of the deletions.
Adult↗