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PubMedDate not supplied

The impact of endocrine disrupters on the female reproductive system.

Over the last decades, many tonnes of man-made chemicals have been produced and released into the environment. Many of these chemical substances have the ability to modulate the action of hormones and are called endocrine disrupters. Cell receptors that have been pure receptors for thousands of years have (due to industrialization), become susceptible to the action of exogenous chemicals. The balance of the endocrine system is very important in the human body especially in females because the menstrual cycle and fertility are very sensitive to hormone imbalances. This review considers the mode of exposure and action of endocrine disrupters and focuses on their impact on the female reproductive system, including female hormone concentrations, menstrual cycle, fertility, spontaneous abortion and the development of endometriosis. An attempt is made to elucidate the impact of endocrine disrupters on the female reproductive system, while admitting that most scientific data come from experimental animals and the conclusions cannot be applied to humans easily. The aim is to present available information, highlighting the impact of endocrine disrupters on the female reproductive system, in order to stimulate reevaluation in identifying hormone disorders.

Abortion, Spontaneous↗
PubMed2005

Issues related to the use of animals in biocontainment research facilities.

The expansion and improvement of high-containment animal facilities has been driven by terrorism, economics, the emergence of new pathogens, and the re-emergence of other pathogens in new areas. Working with highly infectious viral agents requires a team of trained scientists, laboratory technicians, veterinarians, animal care staff, biological safety officers, engineers, and physical plant staff to ensure safety, biocontainment, and the animals' well being, while providing essential scientific data. The challenges of working with infectious disease agents in high levels of containment, and some solutions to these challenges, are described from an animal care point of view.

Animal Experimentation↗
PubMed1995

The physician's authority to withhold futile treatment.

The debate over futility is driven, in part, by physicians' desire to recover some measure of decision-making authority from their patients. The standard approach begins by noting that certain interventions are futile for certain patients and then asserts that doctors have no obligation to provide futile treatment. The concept of futility is a complex one, and many commentators find it useful to distinguish 'physiological futility' from 'qualitative futility'. The assertion that physicians can decide to withhold physiologically futile treatment generates little controversy. The claim that they can withhold qualitatively futile treatment runs afoul of standard objections to medical paternalism. There is reason to believe that the conceptual distinction will not be maintained in clinical practice. This paper contends that the scientific data which would support a physician's unilateral decision to withhold physiologically futile treatment also provide support for an institutional policy restricting access to the treatment. The data the doctor uses to take decision-making power out of the hands of the patient can be used by the administrator to take power out of the hands of the doctor. While this loss of power is unproblematic, there is reason to believe that the ambiguity in the term 'futility' will allow a much greater loss of physicians' power.

Attitude to Health↗
PubMed1994

Vitamins: the tortuous path from needs to fantasies.

The discovery of vitamins in the early 1900s, their chemical characterization and the clarification of their metabolic functions are sequential aspects of a brilliant chapter in the history of modern nutritional science. Despite our current knowledge about vitamins, inadequate vitamin status still abounds in the less industrialized world. With some vitamins, toxicity also poses a problem. The average daily amounts of dietary vitamins needed to maintain physiological functions in generally healthy persons is fairly well known. Nonetheless, new indicators of vitamin status and in vivo kinetic analysis should allow refinement of these values. The dietary intake of fruits and vegetables has been associated with a decreased risk of major chronic diseases, including cancer and cardiovascular diseases. The specific contributions of different components of the diet, including several vitamins, to this apparent protective effect is still uncertain. Factors besides diet that affect chronic diseases are lifestyle, genetics, medical awareness, and habits like smoking. Fantasies among generally healthy persons that large supplements of any single vitamin or combination of them, like some magical amulet, will significantly stave off ill health have captivated a sizable percentage of our population. Such beliefs can only be changed, if at all, by appropriate educational messages based on convincing scientific data.

Chronic Disease↗
PubMed2004

The basis for setting the upper range of adequate intake for regulation of macronutrient intakes, especially amino acids.

The comparison of actual intakes of essential amino acids to the dietary reference intakes indicates that amino acid supply is likely not a public health concern in industrialized countries. This fact does not preclude the interest in specific amino acid intake in some physiological or pathological situations in targeted subgroups of the population. Thus, the addition of amino acids to some food vehicles to create functional foods will be regulated by public authorities in different ways according to the regulatory contexts specific to each country. The main issues to be considered are, however, the same: safety of the product and justification of the health claim accompanying the product's promotion. In addition to classical scientific data, the use of Monte Carlo simulations can be a useful tool to support the choice of the food vehicle and the amounts added to this food, and to demonstrate both safety and possible efficacy of the functional food in the targeted population.

Amino Acids↗
PubMed1996

Molecular epidemiology: insights into cancer susceptibility, risk assessment, and prevention.

Recent molecular epidemiologic research provides compelling new evidence that environmental factors are major contributors to human cancer and that their risks are strongly influenced by genetic and acquired susceptibility. In particular, molecular epidemiology has demonstrated substantial variability in biologic response to carcinogens and suggests that certain groups-such as the very young, those with predisposing genetic traits or nutritional deficits, and even certain ethnic groups-are likely to have greater risk from selected exposures than other members of the population. This work implies that major gains in prevention of cancer, which will claim more than 554 000 American lives this year, will necessitate health and regulatory policies that protect these more susceptible groups and individuals from risks of man-made and naturally occurring environmental carcinogens. The specific implication from this research is that, to be effective in prevention, risk assessments developed in support of these policies by regulatory bodies, such as the Environmental Protection Agency, should reflect the available scientific data on individual variability in both exposure and susceptibility.

DNA Repair↗
PubMed1998

Trends and outcomes of outpatient mastectomy in elderly women.

BACKGROUND: Considerable public attention has focused on the use of outpatient mastectomy and has resulted in numerous legislative proposals to mandate a minimum hospital stay following mastectomy. To date, only limited scientific data are available regarding the use and the outcomes of outpatient mastectomy. The purpose of this study was to provide population-based information on trends and outcomes for outpatient mastectomy in elderly women. METHODS: Medicare data for elderly women with fee-for-service coverage were examined for trends and regional variation in the use of outpatient mastectomy. Logistic regression was used to identify patient and provider characteristics associated with having an outpatient mastectomy, and outcomes were assessed by calculating the risk of being rehospitalized and the reasons for rehospitalization. RESULTS: From 1986 through 1995, the proportion of mastectomies performed on an outpatient basis increased from virtually 0% to 10.8%. Outpatient mastectomies were more likely to be performed on women with no coexisting health problems in hospitals that were for-profit or non-teaching or in large metropolitan statistical areas. Women undergoing outpatient mastectomy had substantially higher rates of rehospitalization within 30 days than women with a 1-day stay in the hospital. Both groups had comparable rates of rehospitalization for complications definitely related to their surgery. The percentage of women who required rehospitalization was low, and the actual number of women rehospitalized was relatively small. CONCLUSIONS: We conclude that the risks from outpatient mastectomy are modest, although ongoing monitoring of outcomes and assessment of patient satisfaction are needed.

Aged↗
PubMed2004

ORFDB: an information resource linking scientific content to a high-quality Open Reading Frame (ORF) collection.

The ORFDB (http://orf.invitrogen.com/) represents an ongoing effort at Invitrogen Corporation to integrate relevant scientific data with an evolving collection of human and mouse Open Reading Frame (ORF) clones (Ultimate ORF Clones). The ORFDB serves as a central data warehouse enabling researchers to search the ORF collection through its web portal ORFBrowser, allowing researchers to find the Ultimate ORF clones by blast, keyword, GenBank accession, gene symbol, clone ID, Unigene ID, LocusLink ID or through functional relationships by browsing the collection via the Gene Ontology (GO) Browser. As of October 2003, the ORFDB contains 6200 human and 2870 mouse Ultimate ORF clones. All Ultimate ORF clones have been fully sequenced with high quality, and are matched to public reference protein sequences. In addition, the cloned ORFs have been extensively annotated across six categories: Gene, ORF, Clone Format, Protein, SNP and Genomic links, with the information assembled in a format termed the ORFCard. The ORFCard represents an information repository that documents the sequence quality, alignment with respect to public protein sequences, and the latest publicly available information associated with each human and mouse gene represented in the collection.

Animals↗
PubMed1990

Toxic tort litigation: medical and scientific principles in causation.

A definition and an explanation of the legal standard for imposition of legal liability in a toxic tort case are set forth. The focus is on how expert witnesses utilize the applicable medical and scientific data in order to provide opinion evidence of the causal relation between exposure to a toxic substance and disease in an individual case. The author concludes that policy considerations are present in both the legal standard and the basis for establishing a cause and effect relation.

Causality↗
PubMed2003

Science to services: consumers need "real-world" science.

Over the past decade there has been a revolution in pharmacotherapy for schizophrenia and related disorders. The second generation, or atypical, antipsychotic medications have demonstrated efficacy and generally better side-effect profiles. However, from the perspective of policy makers the higher costs associated with these newer medications leads to tough decisions regarding their continued use in light of an escalating fiscal crisis. For consumers, both persons with the illness and their family caregivers, the budgetary cutbacks leave many scrambling for answers to questions that most treatment (efficacy) studies were never designed to answer. "Should we oppose formulary restrictions on principle alone, or is there scientific data that can be relied on to inform our position?" On a more personal note, many are asking whether or not to switch to one of the newer medications and which medication would be best for them. Unlike CATIE, efficacy studies were never designed to answer such questions. In this article, we start by highlighting how CATIE will fill important gaps in translating the results of efficacy studies to effectiveness in the real world. Both the development of the CATIE methodology and the study design itself reflect what we will refer to as "real-world science": i.e., science that sheds light on effectiveness in vivo and can inform decisions consumers, clinicians, and policy makers are faced with day-to-day. We discuss CATIE in the context of the fiscal crisis hitting MEDICAID programs leading many policy makers to take the more expensive, atypical antipsychotics off the list of medications made available to patients. We argue that studies like CATIE will be highly informative and ultimately vital to policy makers wishing to create mental health policies that will succeed. Throughout, we highlight how CATIE, and real-world science more generally, are vital to consumers striving to find the medication(s) that works best for them. Given the organic research design process, which arguably relies on a fuller range of stakeholders than any study of its kind before, we remain hopeful that CATIE can succeed in generating an unprecedented amount of real-world science that consumers can use.

Consumer Advocacy↗
PubMed2006

Nitrogen emissions from broilers measured by mass balance over eighteen consecutive flocks.

Emission of nitrogen in the form of ammonia from poultry rearing facilities has been an important topic for the poultry industry because of concerns regarding the effects of ammonia on the environment. Sound scientific data is needed to accurately estimate air emissions from poultry operations. Many factors, such as season of the year, ambient temperature and humidity, bird health, and management practices can influence ammonia volatilization from broiler rearing facilities. Precise results are often difficult to attain from commercial facilities, particularly over long periods of time. Therefore, an experiment was conducted to determine nitrogen loss from broilers in a research facility under conditions simulating commercial production for 18 consecutive flocks. Broilers were reared to 40 to 42 d of age and fed diets obtained from a commercial broiler integrator. New rice hulls were used for litter for the first flock, and the same litter was recycled for all subsequent flocks with caked litter removed between flocks. All birds, feeds, and litter materials entering and leaving the facility were quantified, sampled, and analyzed for total nitrogen content. Nitrogen loss was calculated by the mass balance method in which loss was equal to the difference between the nitrogen inputs and the nitrogen outputs. Nitrogen partitioning as a percentage of inputs averaged 15.29, 6.84, 55.52, 1.27, and 21.08% for litter, caked litter, broiler carcasses, mortalities, and nitrogen loss, respectively, over all eighteen flocks. During the production of 18 flocks of broilers on the same recycled litter, the average nitrogen emission rate was calculated to range from 4.13 to 19.74 g of N/ kg of marketed broiler (grams of nitrogen per kilogram) and averaged 11.07 g of N/kg. Nitrogen loss was significantly (P < 0.05) greater for flocks reared in summer vs. winter. Results of this experiment have demonstrated that the rate of nitrogen volatilization from broiler grow-out facilities varies significantly on a flock-to-flock basis.

Air Pollutants↗
PubMed2005

21st century challenges in radiation protection and shielding: draft 2005 recommendations of ICRP.

The International Commission on Radiological Protection regularly examines the status of its recommendations and reviews the increasing knowledge of the effects of exposure to ionising radiation in order to decide whether new recommendations are needed. The Commission strives to make its system more coherent and comprehensible, while recognising the need for stability in international and national regulations, many of which have, only fairly recently, implemented the 1990 Recommendations. However, new scientific data have been produced since 1990 and there have been societal developments in that more openness or transparency is expected in developing new recommendations and, in addition, there has been a move from the utilitarian approach of 'the greatest good for the greatest number', to one with more concern for the 'individual', all of which have inevitably led to some changes in the formulation of the recommendations. This paper outlines the proposals for the 2005 Recommendations.

Guidelines as Topic↗
PubMed1986

Thoughts on the treatment of schizophrenia.

The author contends that the clinical relationship is the foundation for treating the person with schizophrenia. However, the models and scientific data available to the clinician have been limited by prevailing ideologies. Despite important contributions from interpersonal, pharmacologic, and rehabilitation treatment perspectives, each has curtailed the range of clinical observation and the capacity for integration of treatments. Even recent advances in clinical science methodology have contributed to a short fall in treatment knowledge. The author espouses a broad medical model for defining the range of data and integration of techniques relevant to therapeutics. He views phenomenology as the crucial concept for clinical exploration, and contrasts this approach with the shallowness of purely descriptive approaches on the one hand and the distortion imposed by theoretical presentiments of psychotherapy on the other. Continuity of care and integration of therapies can emerge from phenomenology in the context of the clinical relationship.

Antipsychotic Agents↗
PubMed1995

Review of regulations and guidelines for commercial and noncommercial drivers with sleep apnea and narcolepsy.

Studies show that persons with sleep disorders, such as sleep apnea and narcolepsy, have an increased incidence of automobile accidents. The goal of this study was to review any regulations or guidelines dealing with fitness to drive of persons with sleep disorders in all the 50 states and countries around the world. Several authorities in the United States and abroad in fact have produced guidelines or regulations stating that certain of these persons are not fit to drive. As of March 1994, only four states in the United States (Maryland, North Carolina, Oregon and Utah) had guidelines for narcolepsy, while two had guidelines for both narcolepsy and sleep apnea (California and Texas). In Maine, guidelines had been proposed for sleep apnea. In contrast, almost all Canadian provinces have guidelines for both sleep apnea and narcolepsy, as does the United Kingdom. There are, however, considerable variations in the nature of the regulations used in different states, Canadian provinces and countries. These variations are not based on scientific data. Currently the impact of these regulations on crash rates or on the practice of sleep medicine has not been assessed.

Accidents, Traffic↗
PubMed1983

Agent Orange. Update.

Review of the available literature on dioxin over the last several years is reported. There has been considerable writing on the subject, but extraction of true scientific data from emotionalism and sensationalism remains difficult. We must continue to remain alert to potential hazards stemming from this herbicidal chemical and await more definitive and conclusive studies than have been published to date.

2,4,5-Trichlorophenoxyacetic Acid↗
PubMed2004

Antiretroviral therapy in drug-naive patients infected with human immunodeficiency virus.

A vast amount of knowledge has accumulated since the discovery of the immunodeficiency diseases caused by human immunodeficiency virus-1 (HIV-1) in the early 1980s. An expert panel of HIV researchers and clinicians produced the first set of treatment guidelines in 1997. Since then, these guidelines have been updated based on available clinical information and supplemented by expert opinion when scientific data were incomplete. The latest version of the HIV treatment guidelines are summarized here, with attention focused on the rationale for treatment of asymptomatic as well as symptomatic individuals, including when and what to start as a first regimen of highly active antiretroviral therapy (HAART). Components of initial and follow-up evaluations are detailed, with attention given to available HIV viral load tests and their use. Because adherence to HAART is critical to immune recovery and stabilization, data on predictors of both good and poor medication compliance, as well as strategies to maximize medication adherence are presented. Lastly, recommendations for the use of HIV genotypic and phenotypic resistance testing in antiretroviral naive patients are presented.

Adolescent↗
PubMed2002

Tissue response to N-butyl-2-cyanoacrylate after percutaneous injection into cutaneous vascular lesions.

Despite the fact that cyanoacrylates, a group of rapidly polymerizing adhesives, are used widely in general surgery, neuroradiology, otolaryngology, and plastic surgery, scientific data on histopathological changes resulting from the deposition of -butyl-2-cyanoacrylate (NBCA), a new-generation cyanoacrylate derivative, in human tissues is based largely on experimental observations in animals and sporadic postmortem studies in humans. The authors report the consecutive pathological findings of a patient who underwent surgery for facial hemangioma after percutaneous injection of NBCA for devascularization of a lesion, and underwent additional surgery 1 and 6 months after the initial operation for the removal of the residual NBCA cast from the injection site. Acute inflammatory findings after injection of NBCA and the development of a chronic granulomatous foreign body reaction support the histological findings of experimental animal studies and postmortem examinations on humans. Additionally, their findings support the proposed hypothetical sequence of events for the recanalization of cyanoacrylate-embolized vascular structures.

Arteriovenous Malformations↗
PubMed2001

The role of Helicobacter pylori in paediatrics.

Helicobacter pylori is a bacterium that colonizes the human stomach, especially during childhood. Although it has been studied intensively during the past decade, many controversies still exist on many important issues, including the clinical relevance of virulence factors, indications for treatment, recommended procedures for diagnosis and the typical symptom profile, among others. The lack of double-blind, placebo-controlled studies in children illustrates the paucity of hard scientific data, and is the major reason for differences in opinion. Therefore, the present review of literature published during the past 2 years raises many questions.

Adolescent↗