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Modeling pancreatic cancer in animals to address specific hypotheses.

Multiple experimental approaches have been employed to study exocrine pancreatic cancer, including the use of animals as surrogates for the human disease. Animals have the advantage that they can be manipulated to address specific hypotheses regarding mechanisms underlying this disease. Implicit in this opportunity is the necessity to match the question being asked with an appropriate animal model. Several approaches to modeling pancreatic cancer have been established that involve animals. First, xenogeneic cell transplantation, generally into immunocompromised rodent subcutis or pancreas, allows examination of (1) the effect of host environment on human or rodent pancreatic cancer cells, (2) whether specific genetic changes in donor cells correlate with certain cancer cell behaviors, and (3) novel approaches to cancer therapy or imaging of tumor growth. Second, carcinogen administration, typically to hamster or rat, allows examination of whether specific genetic, biochemical, cellular, and tissue phenotypic changes, including progression to neoplasia, accompany exposure to a particular chemical. Third, genetically engineered animals, usually transgenic or gene targeted mice, allow examination of (1) whether genetic changes, including oncogene overexpression/mutation or tumor suppressor gene loss, can increase the risk for neoplastic progression, (2) whether specific genetic changes can cooperate during pancreatic carcinogenesis, and (3) how the genetic signature of a neoplasm correlates with particular biological aspects of tumor initiation and progression. Collectively, these experimental approaches permit detailed exploration of pancreatic cancer genetics and biology in the whole animal context, thereby mimicking the environment in which human disease occurs.

Adenocarcinoma↗

Improving America's access to care: The National Institute of Dental and Craniofacial Research addresses oral health disparities.

BACKGROUND AND OVERVIEW: The National Institute of Dental and Craniofacial Research, or NIDCR, in 2001 sponsored the establishment of Centers for Research to Reduce Oral Health Disparities. The centers are based at Boston University; New York University; the University of Michigan; the University of Washington; and the University of California, San Francisco. Reflecting the importance of research to reduce disparities, the centers, along with related grants, represent one of the largest financial commitments ever made by the NIDCR. The centers are sponsored in part by the National Center on Minority Health and Health Disparities, or NCMHHD. Each of the five centers has forged partnerships that include ties with dental societies, state and local health agencies, community and migrant health centers, American Indian tribal nations and institutions that serve other diverse patient populations. CONCLUSIONS AND CLINICAL IMPLICATIONS: This network is attempting to address the needs of communities with poor oral health. A major part of the effort of these new centers is to build community networks and establish long-term relationships. Center investigators also recognize that solutions to these vexing problems must be built on an understanding of the social, economic, racial, educational, political and behavioral factors that affect most health care issues.

Adolescent↗

Anticipatory interpretations: addressing "cautionary tales" and the problem of premature termination.

This article explores the use of anticipatory interpretations early in the therapeutic process as a means of addressing the problem of premature termination with some patients. The author argues that emerging transference references, detected through a close attention to "cautionary tales" or derivative communications, should be used in early interpretive interventions. It is suggested that such transference references form a "template of intention" that help determine future difficulties in the therapeutic alliance. Being able to communicate these observations in a future-orientated way lays the groundwork for "thinking about" actions that threaten the therapeutic alliance when they occur, in turn curtailing the possibility of acting out through termination. The author uses two case examples to illustrate his observations and goes on to suggest that anticipatory interpretations involve: (1) isolating derivatives and underlying anxieties, (2) future-orientated transference references, and (3) an affirmation of difficulty.

Adult↗

Joining with resistance: addressing reluctance to engage in group therapy training.

Although research has documented the effectiveness of group psychotherapy, trainees are often reluctant to embrace this modality. This reluctance may reflect an informed choice based on knowledge, interest, and skill. Alternatively, reluctance may reflect misinformation or resistance due to conflicted feelings that arise from group dynamics. The latter are a major obstacle to the success of group therapy training and treatment programs. Understanding the origins of this reluctance and the developmental challenges of group therapy for trainees better equips supervisors to address this difficulty. This article uses case examples to illustrate how trainee reluctance emerges. It also provides strategies for working with hesitant trainees. The success of group therapy programs rests on the supervisor's ability to manage trainees' inhibitions to group therapy.

Adult↗

Addressing social and gender inequalities in health among seniors in Canada.

Although canadian seniors enjoy economic security and good health and have made substantial gains in recent decades, this well-being is not equally shared among socioeconomic groups and between men and women. As for younger age groups, income predicts health status in later life, but less powerfully. Potential alternative explanations include an overriding influence of the aging process, the subjective effects of income loss at retirement and the attenuation of the poverty gap owing to public retirement income. Older women are more likely to age in poverty than men, to live alone and to depend on inadequately resourced chronic health care and social services. These differences will hold as well for the next cohort of seniors in Canada. Addressing these disparities in health requires a comprehensive, multisectoral approach to health that is embodied in Canada's population health model. Application of this model to reduce these disparities is described, drawing upon the key strategies of the population health approach, recent federal government initiatives and actions recommended to the government by federal commissions.

Aged↗

Addressing the growing burden of trauma and injury in low- and middle-income countries.

Low- and middle-income countries suffer disproportionately from reduced life expectancy and quality of life. Injuries are overlooked as contributors to global inequities in health, yet the long-term disabilities they frequently produce represent a significant burden. The Fogarty International Center of the National Institutes of Health convened a panel of experts in trauma and injury from the United States and low- and middle-income nations to identify research gaps in this area and opportunities to create new knowledge. Panel members identified sustainable programs of research established through stable linkages between institutions in high-income nations and those in low- and middle-income nations as a priority. The resulting benefits of addressing the growing burden of trauma and injury to communities in resource-constrained settings around the world would be substantial.

Accidents, Traffic↗

The community action model: a community-driven model designed to address disparities in health.

The community action model is a 5-step, community-driven model designed to build communities' capacity to address health disparities through mobilization. Fundamental to the model is a critical analysis identifying the underlying social, economic, and environmental forces that create health and social inequities in a community. The goal is to provide communities with the framework necessary to acquire the skills and resources to plan, implement, and evaluate health-related actions and policies. The model was developed in the context of tobacco-related health disparities. Concrete policy outcomes demonstrate the model's potential application to a wide variety of grassroots policy development efforts.

California↗

Addressing health care disparities and increasing workforce diversity: the next step for the dental, medical, and public health professions.

The racial/ethnic composition of our nation is projected to change drastically in the coming decades. It is therefore important that the health professions improve their efforts to provide culturally competent care to all patients. We reviewed literature concerning health care disparities and workforce diversity issues--particularly within the oral health field--and provide a synthesis of recommendations to address these issues. This review is highly relevant to both the medical and public health professions, because they are facing similar disparity and workforce issues. In addition, the recent establishment of relationships between oral health and certain systemic health conditions will elevate oral health promotion and disease prevention as important points of intervention in the quest to improve our nation's public health.

Cooperative Behavior↗

Treating osteoporosis with bisphosphonates and addressing adherence: a review of oral ibandronate.

Osteoporosis is a common, chronic condition, affecting approximately half of all postmenopausal Caucasian women in the US. Vertebral fractures occur as a result of osteoporosis and lead to increased hospitalisation and mortality, and adversely affect patient quality of life. The burden of osteoporosis on healthcare systems is expected to rise as the elderly population continues to grow. Yet there are many medications for preventing and treating osteoporosis. Oral bisphosphonates are first-line treatment for osteoporosis, with demonstrated efficacy in increasing bone mineral density and reducing bone turnover, which reduces the incidence of fractures. However, adherence to medication is suboptimal, with approximately 40% of patients discontinuing treatment within 6 months. Recent reports have suggested simplifying the dosage regimen as a strategy to help address this issue. Ibandronate is a potent, nitrogen-containing bisphosphonate which is administered once-monthly. Preclinical studies initially revealed the feasibility of extending the between-dose interval. Subsequent clinical studies have provided further evidence of the positive effects of extended-interval ibandronate administration in reducing the risk of vertebral fractures through increasing bone mineral density and reducing bone turnover without compromising bone quality. These studies have also demonstrated that ibandronate has a safety profile similar to placebo. Ibandronate has recently been approved for use in the US to treat postmenopausal osteoporosis. This review summarises the efficacy and safety of once-monthly oral ibandronate and discusses the implications of such a treatment in primary care in the US.

Administration, Oral↗

Addressing the contradictions: health promotion and community health action in the United Kingdom.

Within mainstream health education/promotion in the United Kingdom, the last few years have witnessed an upsurge of interest in community development, sometimes coupled with an undermining of the fundamental principles of this approach. This article addresses some of the contradictions and dilemmas that this development has presented for the community health movement. Current trends in health promotion policy and practice are examined in relation to broader health and welfare policy of the 1980s, the history of community development in health, and the background to the World Health Organization's "Health for All by the Year 2000" and health promotion initiatives. The possibilities and limitations of utilizing the rhetoric, to support community health action, are explored with reference to recent attempts by the community health movement to "reclaim" Health for All.

Community Health Services↗

Simulation in medicine: addressing patient safety and improving the interface between healthcare providers and medical technology.

Medicine, as an industry in which human lives depend on the skill and performance of operators, must create and maintain a culture of safety, in addition to promoting the design of systems to mitigate errors. The use of medical simulation as a mechanism for training healthcare professionals in a safe environment is expanding rapidly. An important component of systems that ensure the safety of patients in the hospital setting is the interface between humans and technology in the hospital. The objective of this paper is to review: (1) the definition and a brief history of medical simulation, (2) examples of how current medical simulation centers are using simulation to address patient safety, and (3) examples of how simulation can be used to enhance patient safety through improvement of the interface between healthcare practitioners and medical technology. Medical simulation and human factors engineering can be used to examine and enhance the interface between healthcare practitioners and medical technology, with the potential to make a significant contribution to patient safety.

Biomedical Technology↗

Rehabilitation following surgical procedures to address articular cartilage lesions in the knee.

Knowledge of the structure and function of articular cartilage is important when considering rehabilitation following surgical procedures for articular cartilage lesions of the knee. Articular cartilage is avascular and derives its nutrition primarily from synovial fluid, resulting in a limited potential for regeneration. Basic science evidence has demonstrated that compressive loading may have a positive impact on articular cartilage healing; however, excessive shear loading may be detrimental. Rehabilitation following surgical procedures for articular cartilage lesions should include controlled range of motion exercises. Exercises to enhance muscle function must be done in a manner which minimizes shear loading of the joint surfaces in the area of the lesion. A period of protected weight bearing is often necessary and should be followed by progressive loading of the joint. This article will: 1) provide a brief review of the structure and function of articular cartilage lesions as it relates to rehabilitation; 2) describe common surgical procedures to address articular cartilage lesions; and 3) provide guidelines for rehabilitation following surgical management of articular cartilage lesions.

Animals↗

Group treatment approaches to address cognitive deficits.

Psychiatric rehabilitation services are primarily delivered using group modalities. Recent evidence points to the deleterious effects of poor cognitive functioning on group involvement, skill development and functional outcomes. This paper reviews the impact of individual cognitive deficits on group functioning, discusses the rationale for using a cognitive framework for group development, and presents multiple examples of group programming with compensatory and remediation techniques to improve group functioning. Examples include modifying groups to address cognitive limitations, as well as developing groups targeting specific cognitive functions. The groups described are suitable for persons with serious and persistent mental illness across hospital and community treatment settings.

Adult↗

Addressing challenging behaviour in children with Down syndrome: the use of applied behaviour analysis for assessment and intervention.

Children with Down syndrome are at an increased risk for engaging in challenging behaviour that may be part of a behavioural phenotype characteristic of Down syndrome. The methodology of applied behaviour analysis has been demonstrated effective with a wide range of challenging behaviours, across various disabilities. Applications to children with Down syndrome and the examination of behaviourally based strategies to specifically address the unique characteristics of children with Down syndrome are limited. However, there are several studies in which a subset of the participants did have Down syndrome. A handful of these studies are reviewed within the context of functional behaviour assessment and Positive Behavioural Supports. Drawing from these studies and the behavioural literature, as well as the authors' clinical experience and research, suggestions regarding early intervention for challenging behaviour with children with Down syndrome are provided.

Behavior Therapy↗

Thermal isoeffect dose: addressing the problem of thermotolerance.

A method of calculating a thermal isoeffect dose by converting thermal exposure into equivalent-minutes at 43 degrees C (EQ43) has been described previously by this investigator and others. Some investigators have suggested variations in the constants of this approach based on evaluations of the available in vivo data. The selection of these constants affect thermal dose calculations most at temperatures below 43 degrees C. Since treatment response appears to be most closely related to the dose in the coolest part of the tumour, the selection of appropriate constants may be quite important. The data suggest that these variations in constants are a consequence of thermotolerance. A more appropriate approach to address this problem is presented. The phenomena of thermotolerance complicates the practical application of this thermal isoeffect dose model. The dose modification caused by chronic thermotolerance which occurs during exposure at mild hyperthermic temperatures can be estimated by calculating the thermotolerance dose ratio (TTDR) between the equivalent-minute dose calculated with and without a transition temperature at 43 degrees C. The data suggest that the TTDR as a function of time can be mathematically described and used to correct for the dose modifying effect of thermotolerance. Using these results in a modification of the thermal isoeffect dose model causes a significant improvement in the fit for in vitro data below 43 degrees C.

Animals↗

Problems among youths entering the juvenile justice system, their service needs and innovative approaches to address them.

There is an urgent need to expand substance misuse and related services to address the multiple problems experienced by youths entering the juvenile justice system. In particular, innovative efforts are needed in which staff working with delinquent youths and their families are trained to provide treatment, and to link them with additional community services. We discuss a few of these programs and provide a focused bibliography for further use.

Adolescent↗

African-American women in an alcohol intervention group: addressing personal and political problems.

This paper describes a qualitative study in which African-American women met in a small group to discuss alcohol and drug problems. The goal was to expand the range of services available by creating an alternative intervention which provided a simultaneous focus on both the personal and the sociopolitical needs of Black women. Results suggest that the dual focus on individual and social issues, and the opportunity to simultaneously address racism, sexism, and classism in an African-American women-only alcohol recovery group was helpful.

Adult↗