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PubMed2000

Amifostine: mechanisms of action underlying cytoprotection and chemoprevention.

Amifostine is an important drug in the new field of cytoprotection. It was developed by the Antiradiation Drug Development Program of the US Army Medical Research and Development Command as a radioprotective compound and was the first drug from that Program to be approved for clinical use in the protection of dose limiting normal tissues in patients against the damaging effects of radiation and chemotherapy. Its unique polyamine-like structure and attached sulfhydryl group give it the potential to participate in a range of cellular processes that make it an exciting candidate for use in both cytoprotection and chemoprevention. Amifostine protects against the DNA damaging effects of ionizing radiation and chemotherapy drug associated reactive species. It possesses anti-mutagenic and anti-carcinogenic properties. At the molecular level, it has been demonstrated to affect redox sensitive transcription factors, gene expression, chromatin stability, and enzymatic activity. At the cellular level it has important effects on growth and cell cycle progression. This review focuses on relating its unique chemical design to mechanisms of action that underlie its broad usefulness as both a cytoprotective and chemopreventive agent for use in cancer therapy.

Adolescent↗
PubMed1994

The cost of hyperthermia: nine years experience at the Radiation Therapy Department of the Turin University.

BACKGROUND: In this paper the authors try to quantify the expenditure for the equipment, staff, treatment per patient and research, sustained at the Radiation Therapy Department of the University of Turin for the treatment of cancer with hyperthermia, METHODS: Two hyperthermic computerized devices are available: the SAPIC SVO3 multifrequencies system (915, 434 and 2-30 MHz) for external hyperthermia, and the SACEM system. working only with the frequency of 915 MHz, for interstitial and intracavitary heating. From September 1983 to December 1991, 408 patients have been treated with hyperthermia, for a total number of treated sites of 483; 2960 heating sessions were performed, with a average of six sessions per patient. RESULTS: The overall cost of our "hyperthermia project" was about 2,000,000,000 Italian liras; the equipment cost was estimated at 1,258,650,000 Liras (839,100 US$), and the cost per treatment and per heat session at about 3,985,200 (2676 US$) and 664,200 liras (443 US$), respectively. The cost of the research program can be estimated in 175,000,000 liras (116,666 US$). The National Health System provides for a partial reimbursement of 2,000,000 liras (1,333 US$) for each course of hyperthermia. Taking into account the mean expected life expectancy and increasing purchases for replacement of equipment, these costs increase 10% each year. As regards the cost-benefit problem, using the Rees formula it varies from 1112 US$ when hyperthermia is used as elective treatment to 3380 US$ when hyperthermia is used as palliative treatment. CONCLUSIONS: Hyperthermia is, in our experience, an expensive therapy.

Hospitals, University↗
PubMed1996

The role of cytokines in cancer.

The role of cytokines was intensively discussed over the course of a two and a half day meeting sponsored by the US-JAPAN Cancer Cooperative Research Program of the Office of International Affairs, National Cancer Institute and held at The National Institutes of Health, Bethesda, Maryland on 15-17 January 1996. Most of the first day was devoted to a discussion of the role of cytokines in modulating angiogenesis and the consequent effect of this on tumor growth and metastases. This was followed by sessions on the effect of various cytokines in enhancing or suppressing immunological responses to tumors. Several presentations focused on the direct inhibitory or growth promoting effects of cytokines on tumor growth. The final session consisted of a comparison of the efficacy of different approaches to tumor vaccination including gene therapy, enhanced antigen presentation, use of polymeric carriers or of DNA vectors. For background information the reader is referred to appropriate chapters on the role of cytokines in neoplastic diseases (Oppenheim JJ, Rossio JL, Gearing AJH, eds. In Clinical Application of Cytokines: Role of Pathogenesis, Diagnosis and Therapy. Oxford University Press, New York, 1993 [1]).

Acquired Immunodeficiency Syndrome↗
PubMed1996

Controlling hypertension. A research success story.

In the past 2 decades, deaths from stroke have decreased by 59% and deaths from heart attack by 53%. An important component of this dramatic change has been the increased use of antihypertensive drugs. This remarkable success resulted from broad-based and diverse research programs supported by the federal government, pharmaceutical companies, voluntary health agencies, and private foundations. It included basic research, drug development programs, epidemiologic studies, health surveys of US citizens, clinical research, and large-scale drug trials. Four of the categories of antihypertensive drugs in wide use--diuretics, beta-blockers, calcium antagonists, and angiotensin-converting enzyme inhibitors--emerged from widely different areas of investigation. In the beginning, the major breakthroughs that led to the development of these drugs were impossible to forecast, and their ultimate applications were impossible to predict. Although decreases in hypertension-related mortality are impressive, enthusiasm must be tempered because the mechanisms of hypertension are still incompletely understood and prevention is not yet possible. Continued research is needed to extend these advances.

Antihypertensive Agents↗
PubMedDate not supplied

Incorporating health services research into nursing doctoral programs.

Despite the successes of the US health care system, problems associated with access, affordability, and quality of care remain to be solved. Health services research (HSR) has the potential to aid nurses in addressing these issues; yet the importance of its inclusion in the academic preparation of nurse researchers has not been consistently recognized. This article discusses the relevance of HSR to nursing, provides a brief review of the history of HSR and its imperatives, and presents rationale for nursing's involvement in HSR. Problems identified by the Re-envisioning PhD project conducted by the University of Washington are assessed for relevance to HSR and nursing doctoral preparation. Recommendations are included for integrating HSR into nursing doctoral programs and meeting HSR capacity building needs for the future.

Curriculum↗
PubMed2002

Evaluation of practical sessions in clinical anatomy: a strategy for educational improvement.

We have evaluated the students' response to the practical teaching sessions in Clinical Anatomy in our Medical School using an action-research method. The aim was to identify problems and to introduce changes that might improve both the program and the performance of the teaching staff. At the end of each section of the program, each student completed a "target type" questionnaire with eight different components. As each one quarter of the whole class had its own teacher, we used an analysis of variance to evaluate the target questions in the various sections of the program, and the performance of the four teachers. This research method gave us feedback on the students' responses while the program was in progress. The results emphasize the importance of action-research in assessing and improving a developing program in a basic discipline of the medical curriculum.

Anatomy↗
PubMed2003

Introduction: the Traumatic Brain Injury Model Systems of Care.

The Traumatic Brain Injury Model Systems of Care (TBIMS) is a program that has been funded by the National Institute on Disability and Rehabilitation Research (US Department of Education) since 1987. The program is a collaborative effort of rehabilitation centers across the United States to further knowledge about the natural history of recovery and outcomes over the life course of individuals with traumatic brain injury, as well as to provide comprehensive services across the continuum of care and to foster innovative research programs. This introduction describes the underlying principles of the TBIMS program and the research initiatives carried out in the 1997/1998-2002 funding cycle.

Brain Injuries↗
PubMedDate not supplied

Evaluation of training designed to prevent and manage patient violence.

This study was designed to determine whether the test responses of mental health care workers (n = 118) showed significant improvement after attending a training session about managing violence. Four variables (knowledge, attitude, self-efficacy, and behavioral intention) were measured before and after staff attended a training program that consisted of two commercial programs: the Nonviolent Crisis Intervention (CPI) and Handle with Care. The Nonviolent Crisis Intervention is designed to teach staff how to prevent and control disruptive behavior of clients. "Handle with Care" is a combination of lecture and demonstration of self-defense skills and restraining methods for staff who work with potentially assaultive patients. The research team used a one group, pretest/posttest study design for the evaluation. The study location was an acute care psychiatric hospital located in the southwestern United States. Hospital staff completed a pretest, participated in a 12-hour intervention, and completed a posttest immediately after the intervention. The evaluation of staff responses demonstrated improvements in posttest scores that were significant for knowledge, attitude, self-efficacy, and behavioral intention to use the training techniques. More research is needed regarding evaluation of programs that train mental health care workers to prevent and manage patient violence. Such research can help us develop more effective programs.

Adolescent↗
PubMed2004

Resolving conflict and building cooperation in the National Estuary program.

Since its beginning in 1987, researchers and policymakers have touted the US Environmental Protection Agency National Estuary program (NEP) as one of the leading examples of collaborative institutions designed to resolve conflict and build cooperation at the watershed level. Using the NEP as an example, I summarize the advantages and disadvantages of collaborative institutions. Using data gathered from focused surveys of policy elites in 22 estuaries, I estimate statistical models that show the NEP does a better job of resolving conflict and building project-level cooperation than similar estuaries without the NEP. I also describe the activities of the NEP mentioned by respondents as contributing to this outcome.

Conflict of Interest↗
PubMedDate not supplied

Patterns of sexual commerce among women at US Syringe Exchange Programs.

In the USA, the majority of research on sex work has examined the experiences of women recruited from social locations commonly referred to as the 'sex industry', such as street strolls or escort services. This paper presents data from female syringe exchange participants who had sold sex in the last 30 days. The women interviewed for this study report a much broader array of commercial transactions than found in previous US studies, including selling sex to women, paying men for sex, and considerable role fluidity between buying and selling. In addition, approximately one-third of the women report only selling sex 1 day per week or less, and appear to be more socio-economically stable than women who sell sex more often. We argue that this data suggests the existence of an array of commercial sexual transactions outside of the socially recognized sex industry, and that social location may affect condom use.

Adult↗
PubMed2006

The length of perimenopausal menstrual cycles increases later and to a greater degree than previously reported.

OBJECTIVE: To demonstrate that the perimenopausal increase in menstrual cycle length presented by Treloar et al. was biased by misidentified menopause dates, mean values classified by calendar year, and exclusion of menstrual cycles straddling two calendar years; and to use the revised data to investigate women's experiences of longer perimenopausal cycles. DESIGN: Secondary analysis of prospectively collected menstrual cycle data. SETTING: Center for Population and Health, Georgetown University. PATIENT(S): One hundred twenty white, college-educated, US women in the Tremin Research Program on Women's Health. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Mean cycle length and time spent in >40-day cycles, by year before menopause. RESULT(S): Mean estimates for each of the 4 years before menopause were 30.48, 35.02, 45.15, and 80.22 days, respectively, compared with the original analysis: 33.60, 43.91, 55.87, and 54.58 days. In the year before menopause, the majority of women spent >or=75% of their time in cycles >40 days long. CONCLUSION(S): Treloar's estimates of mean cycle length were biased. Long cycles occurred throughout perimenopause, but the largest increase in mean cycle length did not occur until the final year before menopause. New estimates of the time spent in cycles >40 days may be useful clinically as well as epidemiologically for assessing menopausal onset and symptomatology.

Adult↗
PubMed2002

What's the relative risk? A method to directly estimate risk ratios in cohort studies of common outcomes.

PURPOSE: In cohort studies of common outcomes, odds ratios (ORs) may seriously overestimate the true effect of an exposure on the outcome of interest (as measured by the risk ratio [RR]). Since few study designs require ORs (most frequently, case-control studies), their popularity is due to the widespread use of logistic regression. Because ORs are used to approximate RRs so frequently, methods have been published in the general medical literature describing how to convert ORs to RRs; however, these methods may produce inaccurate confidence intervals (CIs). The authors explore the use of binomial regression as an alternative technique to directly estimate RRs and associated CIs in cohort studies of common outcomes. METHODS: Using actual study data, the authors describe how to perform binomial regression using the SAS System for Windows, a statistical analysis program widely used by US health researchers. RESULTS: In a sample data set, the OR for the exposure of interest overestimated the RR more than twofold. The 95% CIs for the OR and converted RR were wider than for the directly estimated RR. CONCLUSIONS: The authors argue that for cohort studies, the use of logistic regression should be sharply curtailed, and that instead, binomial regression be used to directly estimate RRs and associated CIs.

Cohort Studies↗
PubMed1999

The involvement of genome researchers in high school science education.

The rapid accumulation of genetic information generated by the Human Genome Project and related research has heightened public awareness of genetics issues. Education in genome science is needed at all levels in our society by specific audiences and the general public so that individuals can make well-informed decisions related to public policy and issues such as genetic testing. Many scientists have found that an effective vehicle for reaching a broad sector of society is through high school biology courses. From an educational perspective, genome science offers many ways to meet emerging science learning goals, which are influencing science teaching nationally. To effectively meet the goals of the science and education communities, genome education needs to include several major components-accurate and current information about genomics, hands-on experience with DNA techniques, education in ethical decision-making, and career counseling and preparation. To be most successful, we have found that genome education programs require the collaborative efforts of science teachers, genome researchers, ethicists, genetic counselors, and business partners. This report is intended as a guide for genome researchers with an interest in participating in pre-college education, providing rationale for their involvement and recommendations for ways they can contribute, and highlighting a few exemplary programs. World Wide Web addresses for all of the programs discussed in this report are given in Table 1. We are developing a database of outreach programs offering genetics education () and request that readers submit an entry describing their programs. We invite researchers to contact us for more information about activities in their local area.

Adolescent↗
PubMed2004

A preliminary investigation of balint and non-balint behavioral medicine training.

BACKGROUND AND OBJECTIVES: Despite inclusion of Balint training in US family medicine residency programs, little research exists about the effectiveness of this training in improving residents' behavioral medicine skills. This study compared the outcomes for residents who did and did not undergo Balint training to increase residents' psychological medicine skills in two rural training programs. METHODS: Fourteen residents from two rural community-based training programs were assessed using the Psychological Medicine Inventory, following standard first-year behavioral medicine training. At one residency program, residents then participated in 9 months of Balint training during the second year of residency training, while at the other program they did not. Both groups were reassessed at the end of the second year of residency. RESULTS: Only Balint-trained residents showed gains in self-reported psychological medicine skills, abilities, and confidence beyond levels developed in year 1. CONCLUSIONS: Balint training enhances the levels of residents' self-reported psychological medicine skills, when compared to standard behavioral medicine curriculum for first- and second-year family medicine residents.

Adult↗
PubMed1993

The importance of the continued use of fluoride in the reduction of dental caries in children.

Fluoride continues to be a safe and effective public health measure. In spite of a recent decline in caries reduction in the US due to the large number of supplemental fluorides available, water fluoridation remains a cost-effective method to prevent decay in children. Also, a review of the literature shows a lack of ill effects associated with fluoride use in children. Most recently, the United States Public Health Service continues to support fluoridation in terms of policy and research. In 1990, the US toxicology Program concluded there were no detrimental effects including cancer risk from fluoride use.

Child↗