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PubMed1984

Sexual abuse in the National Incidence Study of Child Abuse and Neglect: an appraisal.

The National Incidence Study of Child Abuse and Neglect was a major, government sponsored effort to collect data on reported and unreported child abuse. It used a systematic representative sample methodology and very precisely developed definitions of child abuse. This paper review some of the main limitations of the study in regard to findings on sexual abuse. First, there is probably less "new" data in the study on sexual abuse than on other forms of abuse, since so many of the study cases of sexual abuse were "officially reported' cases. In addition, the study limited its definition of sexual abuse only to cases where a caretaker was the perpetrator , a definition that is much more restrictive than what is used in many treatment programs. Finally, the data on perpetrators has a number of problems that stem from the study's definitions of sexual abuse. The paper makes suggestions for future incidence type studies of sexual abuse.

Adolescent↗
PubMed1993

Rehabilitation innovations in Central America.

In an extensive qualitative research project sponsored by the Partners of the Americas (32 professional and lay people from Panama, Costa Rica, Nicaragua, Honduras, El Salvador, Guatemala, Belize, the United States and the Dominican Republic) employment opportunities were examined for disabled youth in Central America. Despite economic and attitudinal barriers field researchers found innovations in financing, special education and rehabilitation programming, job development and job placement alternatives for those who live with disability in Central America.

Agriculture↗
PubMed2001

A basin-wide approach to dredged material management in New York/New Jersey Harbor.

In the last decade, an area of increasing estuarine research in the New York/New Jersey Harbor has been the identification of toxic contaminant sources, mapping of contaminant levels in water and sediments, and assessment of contaminant accumulation in biota. The accumulation of anthropogenic contamination in the harbor's sediments has occurred for centuries, primarily from land-based municipal and industrial sources. Contaminants from land-based sources introduced into surface waters rapidly become scavenged by suspended particles that then tend to settle to the bottom, primarily in deep areas, such as berths and navigation channels. Several million cubic meters of sediments must be dredged annually to clear navigation channels. In the past, the dredged material was disposed in a designated ocean site. However, in1992, new testing procedures were implemented, and much of the harbor's dredged material was determined to be unsuitable for ocean placement. It is ironic that these restrictions came at a time when the quality of harbor sediments is improving, largely because of pollution controls implemented as a result of the Clean Water Act and other environmental measures put in place by government and industry. For example, the harbor-wide concentration of mercury has decreased to 0.7-0.8ppm, a level that is approaching the pre-industrial background level. Nevertheless, in certain areas of the harbor, there remain sufficiently high concentrations of contaminants to merit concern and to create serious problems for sponsors of dredging projects. Development of a basin-wide sediment management strategy is necessary to guide port decision-makers in their efforts to clean-up contaminant sources, to dredge regional waterways, and to ameliorate the contaminated sediment disposal problem. The backbone of this strategy is the integration of the data from an ongoing field monitoring and modeling program with a parallel investigation of watershed and airshed sources and sinks using industrial ecology methodology.

Decision Making↗
PubMed2002

Community-directed treatment with ivermectin in two Nigerian communities: an analysis of first year start-up processes, costs and consequences.

OBJECTIVES: To determine the start-up processes, costs and consequences of community-directed treatment with ivermectin (CDTI) in two onchocerciasis endemic rural towns of Southeast Nigeria; namely Achi and Nike. The other objectives were to discover the community-financing mechanisms, local ivermectin distribution strategies and communities' organisational capacity to handle the programme. METHODS: Structured questionnaires, informal interviews, observations, discussions with community members at general village assemblies and community outreach lectures were used at different stages of the study. RESULT: The towns had the organisational capacity to implement the programme. Coverage with ivermectin was between 31-73% in Achi (mean = 58.6%), and 36.6-72% in Nike (mean = 61.95%). The unit financial costs were $0.17 in Nike and $0.13 in Achi, but the unit aggregate cost was $0.37 in Nike and $0.39 in Achi. When research costs were removed, the unit aggregate cost was $0.22 in Achi and $0.20 in Nike. Provider's financial costs and communities' non-financial costs were the biggest contributors to the aggregate cost. The cost would decrease in subsequent years since the research cost and parts of the mobilisation and training costs would not be incurred after the first year. CONCLUSION: Governments and sponsors of CDTI should find means of continuously strengthening the programme and providing technical support to the communities. As both CDTI and communities are dynamic entities, continuous health education campaigns are needed to keep reminding the people of the benefit of long-term ivermectin distribution, together with the need for community ownership of the programme.

Anthelmintics↗
PubMed1995

Brief of the Canadian Society for Clinical Investigation to the science and technology review.

In the context of new realities, perceptions, and concerns, it is fitting that the government has undertaken this Science and Technology Review, questioning not only how much to spend but also the justification and the best ways to carry out federally-funded research. We share the government's concern about the lack of economic competitiveness of our industries and agree that government-sponsored research should make a bigger contribution to the nation's global economic position. The CSCI, which represents the clinical investigators/scientists in this country, is grateful for having been given the opportunity to make this "tour d'horizon" of Canadian clinical research. In this brief, we have attempted to articulate the needs for, and the benefits of, basic biomedical research because it is the only type of research which will provide us with final answers. However, it should be more closely articulated with applied research, as well as with epidemiological, evaluative, and operational approaches which have been neglected. This brief has emphasized that CSCI is committed to PUTTING MORE SCIENCE INTO MEDICINE by encouraging a greater flow of discoveries from the laboratory research bench to the bedside and the community. We made the point that there is a crisis in patient-oriented research and a decrease of young physicians opting for research careers. The Royal College of Physicians and Surgeons of Canada and the MRC are responsive to this situation, which may compromise our capacity to discharge our broader mission. The MRC has given itself valid instruments to foster the creation of wealth through special programs such as the NCE, the University/Industry program, and the MRC-PMAC partnership. Some refining is in order, and close scrutiny of outcome is essential. Both the academic community and industry have their share of responsibility for the less-than-optimal transfer of knowledge to the market place. Lack of venture capital is also a serious issue. A unified science-industry policy will be helpful, but the government must also act as a broker between academia and industry. There is a growing dependence on the health care industry (drugs, testing devices, equipment) for the funding of clinical research. Current legislation and incentives should be maintained but the CSCI would also like to see the funding of more phase I and phase II studies by the drug industry in Canada. We see favorably the increasing role of provincial governments in biomedical and health research and we pay tribute to disease-related foundations and to CHR.(ABSTRACT TRUNCATED AT 400 WORDS)

Canada↗
PubMedDate not supplied

Quality control for biomarker determination in oncology: the experience of the Italian Network for Quality Assessment of Tumor Biomarkers (INQAT).

Biomarker analysis and evaluation in oncology is the product of a number of processes (including managerial, technical and interpretation steps) which need to be monitored and controlled to prevent and correct errors and guarantee a satisfactory level of quality. Several biomarkers have recently moved to clinical validation studies and successively to clinical practice without any definition of standard procedures and/or quality control (QC) schemes necessary to guarantee the reproducibility of the laboratory information. In Italy several national scientific societies and single researchers have activated -- often on a pilot level -- specific external quality assessment protocols, thereby potentially jeopardizing the clinical reality even further. In view of the seriousness of the problem, in 1998 the Italian Ministry of Health sponsored a National Survey Project to coordinate and standardize the procedures and to develop QC programs for the analysis of cancer biomarkers of potential clinical relevance. Twelve QC programs focused on biomarkers and concerning morphological, immunohistochemical, biochemical, molecular, and immunoenzymatic assays were coordinated and implemented. Specifically, external QC programs for the analytical phase of immunohistochemical p53, Bcl-2, c-erb-2/neu/HER2, and microvessel density determination, of morphological evaluation of tumor differentiation grade, and of molecular p53 analysis were activated for the first time within the project. Several hundreds of Italian laboratories took part in these QC programs, the results of which are available on the web site of the Network (www.cqlaboncologico.it). Financial support from the Italian Government and the National Research Council (CNR) will guarantee the pursuit of activities that will be extended to new biomarkers, to preanalytical phases of the assays, and to revision of the criteria of clinical usefulness for evaluating the cost/benefit ratio.

Autoradiography↗
PubMedDate not supplied

Cell sources and support programs for stem cell research and cell-based therapy in the USA.

In August 2002, the Health & Human Services Secretary Tommy Thompson and National Institutes of Health (NIH) Director Elias Zerhouni announced the creation of a new NIH Task Force to advance stem cell research. The National Heart, Lung, and Blood Institute (NHLBI), with a long history of sponsored research programs for stem cell biology, is participating in the NIH Stem Cell Task Force to facilitate stem cell and embryonic stem (ES) cell research including programs to improve access to cell sources. Programs being implemented include infrastructure enhancement awards to develop eligible human ES cell lines into distribution-quality cell lines, grant supplements for human ES cell line research, an educational program to provide laboratory courses on human ES cell culture techniques, and a new training program to assist investigators wishing to re-direct their laboratories into stem cell research.

Cell Line↗
PubMed2001

Measuring the direct costs of graduate medical education training in Minnesota.

PURPOSE: To demonstrate the usefulness of self-reported cost-accounting data from the sponsors of training programs for estimating the direct costs of graduate medical education (GME). The study also assesses the relative contributions of resident, faculty, and administrative costs to primary care, surgery, and the combined programs of radiology, emergency medicine, anesthesiology, and pathology (REAP). METHOD: The data were the FY97 direct costs of clinical education reported to Minnesota's Department of Health by eight sponsors of 117 accredited medical education programs, representing 394 sites of training (both hospital- and community-based) and 2,084 full-time-equivalent trainees (both residents and fellows). Average costs of clinical training were calculated as residency, faculty, and administrative costs. Preliminary analysis showed average costs by type of training programs, comparing the cost components for surgery, primary care, and REAP. RESULTS: The average direct cost of clinical training in FY97 was $130,843. Faculty costs were 52%, resident costs were 26%, and administrative costs were 20% of the total. Primary care programs' average costs were lower than were those of either surgery or REAP programs, but proportionally they included more administrative costs. CONCLUSIONS: As policymakers assess government subsidies for GME, more detailed cost information will be required. Self-reported data are more cost-effective and efficient than are the more detailed and costly time-and-motion studies. This data-collection study also revealed that faculty costs, driven by faculty hours and base salaries, represent a higher proportion of direct costs of GME than studies have shown in the past.

Accounting↗
PubMed2005

The Manganese Health Research Program (MHRP): status report and future research needs and directions.

The manganese (Mn) research health program (MHRP) symposium was a full day session at the 22nd International Neurotoxicology Conference. Mn is a critical metal in many defense and defense-related private sector applications including steel making and fabrication, improved fuel efficiency, and welding, and a vital and large component in portable power sources (batteries). At the current time, there is much debate concerning the potential adverse health effects of the use of manganese in these and other applications. Due to the significant use of manganese by the Department of Defense, its contractors and its suppliers, the Manganese Health Research Program (MHRP) seeks to use the resources of the federal government, in tandem with manganese researchers, as well as those industries that are involved with manganese, to determine the exact health effects of manganese, as well as to devise proper safeguard measures for both public and private sector workers. Humans require manganese as an essential element; however, exposure to high levels of this metal is sometimes associated with adverse health effects, most notably within the central nervous system. Exposure scenarios vary extensively in relation to geographical location, urban versus rural environment, lifestyles, diet, and occupational setting. Furthermore, exposure may be brief or chronic, it may be to different types of manganese compounds (aerosols or salts of manganese with different physical and/or chemical properties), and it may occur at different life-stages (e.g., in utero, neonatal life, puberty, adult life, or senescence). These factors along with diverse genetic composition that imposes both a background and disease occurrence likely reflect on differential sensitivity of individuals to manganese exposure. Unraveling these complexities requires a multi-pronged research approach to address multiple questions about the role of manganese as an essential metal as well as its modulation of disease processes and dysfunction. A symposium on the Health Effects of Manganese (Mn) was held on Wednesday, September 14, 1005, to discuss advances in the understanding on role of Mn both in health and disease. The symposium was sponsored by the Manganese Health Research Program (MHRP). This summary provides background on the MHRP, identifies the speakers and topics discussed at the symposium, and identifies research needs and anticipated progress in understanding Mn health- and disease-related issues.

Biomedical Research↗
PubMedDate not supplied

Growth and progression of head and neck cancer: a report of the Upper Aerodigestive Cancer Task Force Workshop.

Factors governing the initiation, growth, and progression of squamous cell carcinoma were the focus of a recent Upper Aerodigestive Cancer Task Force workshop sponsored by the National Cancer Institute. The goal of the daylong workshop was to identify critical research concepts in head and neck cancer biology. Discussed were the multistep processes potentially involved in tumor evolution, including the role of carcinogens, viral promotors, host and tumor karyotypes, microenvironment growth factors and growth factor receptors, as well as host/tumor components inherent to the metastatic process. Concepts developed from research in other neoplastic processes but potentially relevant to head and neck cancer were emphasized. The process of identifying critical research directions is the first step by the National Cancer Institute in program development designed to advance the treatment of head and neck cancer.

Carcinogens↗
PubMed1997

Endocrine disruptors and reproductive development: a weight-of-evidence overview.

It is clear that the endocrine system presents a number of target sites for the induction of adverse effects by environmental agents (Fig. 1). There are numerous examples demonstrating that reproductive and developmental processes may be exquisitely sensitive to exposure and there are clear effects induced by presumed endocrine-disrupting chemicals in a variety of species. The concerns raised by studies of wildlife and humans place added significance on a better understanding of the myriad of effects attributed to endocrine disruptors. But there remains a large void between the study of relatively high exposure levels used in laboratory settings versus the relatively low levels found in the general environment. It is also equally clear that the term "endocrine disruption' has been applied to situations where the biological basis is far from conclusive. This may be a moot point in situations where populations are experiencing adverse effects on reproduction, but as scientists we must be vigilant of the appropriate use of descriptive terminology, particularly in cases where public awareness and concern are as great as this. Not only is there a need for better test procedures (both in vivo and in vitro) to characterize the potential of environmental agents to disrupt endocrine function in laboratory species, but there is also a need for a more comprehensive understanding of the normal physiological processes associated with reproduction and development in those wildlife species studied. At the same time, obtaining better information on the transport, fate and bioavailability of chemicals released into the environment remains an important but imposing task. The goals of risk characterization are to carefully delineate cause-and-effect relationships, define the dose-response relationships, and determine whether environmental exposures exceed acceptable levels. A concerted research effort is needed to fill the voids in our knowledge and reduce the large uncertainties that exist today. Only then can regulatory actions take place within the confines of legislative mandates, remediation strategies and considerations of international use and transport. Towards this end, the US Environmental Protection Agency (EPA) sponsored two workshops in 1995 (Ankley et al. 1996, Kavlock et al. 1996) at which groups of international scientists began the process of identifying research needs. Similar efforts also took place in several European countries at about the same time (Danish Environmental Protection Agency 1995, Medical Research Council 1995, Umweltbundesamt 1995). More recently, a Working Group on Endocrine Disruptors has been established within the Committee on the Environment and Natural Resources of the US Government's National Science and Technology Council. The objectives of this Working Group are to (1) formulate a framework for identifying research needs related to the health and ecological effects of endocrine-disrupting chemicals; (2) conduct an inventory of on-going federal research programs; and (3) identify research gaps and facilitate a co-ordinated research plan to address them. These efforts were largely completed in the Fall of 1996 and the information will be made available via the Internet (http;@www.cpa.gov/endocrine). The group also plans to work more broadly with other governments and private industry and public interest groups conducting research on this tissue to co-ordinate research and disseminate scientific information. Persons wishing to know more about this effort should contact the authors. The issue of endocrine disruption has raised the consciousness of many researchers, both within and outside the toxicology community, and has attracted considerable public and political interest. We now have the beginnings of international co-operation to identify the most important scientific uncertainties and to dedicate resources to address the critical gaps. (ABSTRACT TRUNCATED)

Adolescent↗
PubMed1993

Hawaii's near-universal health insurance--lessons learned.

To date, Hawaii is the only state to have implemented near-universal health insurance. The cornerstone of this program is the country's only requirement that employers provide health insurance for all employees who work at least 20 hours per week. Combined with low unemployment, voluntary modified community rating by health insurers, and expanded Medicaid and Medicare, this employer mandate has been part of a patchwork mechanism that insures upwards to 95 percent of the state's population. Indeed, by adding a state-sponsored gap group-insurance program, Hawaii may now insure in excess of 95 percent of its population. The program has generated good health outcomes, good consumer satisfaction, and relatively modest overall health care expenditures. But for all that near-universal insurance provides, there is still a great need for community-based preventive and primary care programs with outreach and family support services. In addition, traditionally underserved populations continue to be at increased risk. Both funding reform and continued infrastructure development must occur to achieve universal access to care.

Cost-Benefit Analysis↗
PubMedDate not supplied

Orienting new trustees to their role.

Since trustees come from various backgrounds, their learning needs reflect both diversity and commonality. Those from the business sector, for example, may be adept at interpreting financial statements yet unable to assess the physician credentialing process. All new trustees, of course, need to become acquainted with the Church's role in health care, the sponsoring group's mission, and current ethical and legal issues in health care. In an actual educational needs assessment for board members with one to three years' service, the need for education was identified in such areas as program planning, quality of care assessment, personnel policies, selection and evaluation of administrators, and third-party payment methods. The administrator, as well as the sponsoring group and the board itself, should encourage new trustees to identify their learning needs and suggest activities to meet those needs. Group discussion, role playing, case studies, and the critical incident approach can be useful in encouraging the learner's active participation. Throughout the educational process, trustees should share responsibility for defining learning goals and for planning, conducting, and evaluating learning activities.

Catholicism↗
PubMed2003

State-sponsored research on creatine supplements and blood doping in elite Soviet sport.

The former Soviet Union began participating in international sport after World War II and soon achieved a dominant position in the Olympic Games and other competitions. The success of Soviet athletic programs led to charges of unfair practices but, because of secrecy surrounding Soviet research in exercise biochemistry, it has been difficult to substantiate these charges. This article presents previously restricted information regarding the development and use of creatine supplements and blood doping in the USSR. Early work by Olexander Palladin established the role of creatine in muscle function. In the 1970s, Soviet scientists showed that oral creatine supplements improved athletic performance in short, intense activities such as sprints. Subsequent studies in the West substantiated these investigations and have led to the widespread acceptance and use of creatine supplements to enhance muscle function and athletic performance. In addition, however, the Soviet government supported the development of blood doping, which is banned by the International Olympic Committee. Blood doping was pervasive in the USSR in the 1970s and 1980s, and was used by many Soviet athletes in the 1976 and 1980 Olympic Games. Open publication and discussion may help to prevent the abuses that can come from secret scientific research.

Creatine↗
PubMed2006

Crowd-in: the effect of private health insurance markets on the demand for Medicaid.

OBJECTIVE: To investigate the effects of local labor market conditions and the availability of employer-sponsored health insurance on exits from the Medicaid program. DATA SOURCE: Data for this project come from a unique administrative database containing a 2 percent sample of all cases on California's Medicaid program in 1987 and a 2 percent sample of all new cases starting each year between 1987 and 1995. STUDY DESIGN: The results are estimated using a discrete duration model where the monthly exit probability is a function of demographic characteristics, local labor market variables, the probability of having employer-sponsored insurance, and fixed year and county effects. PRINCIPAL FINDINGS: Improvements in labor market opportunities (i.e., employment growth, wage growth, and increases in the availability of employer-sponsored health insurance) promote exits off the Medicaid program. A 2.5 percentage point increase in the availability of employer-sponsored insurance leads to a 6 percent increase in the probability that a completed spell lasts no more than 2 years. It would take a 2 percentage point decrease in unemployment rates or a 10 percent increase in average quarterly earnings to yield an equivalent increase in the likelihood of exiting Medicaid within 2 years. These effects are robust to the inclusion of county-level fixed effects and time effects. CONCLUSIONS: Medicaid expenditures and caseloads are sensitive to local economic fluctuations and secular trends in the availability of health insurance. Continued decreases in employer-based health insurance coverage will greatly increase the demand for public insurance coverage and the financial pressures on state governments.

Adolescent↗
PubMed1970

Development of methodologic tools for planning and managing library services. IV. Bibliography of studies selected for methods and data useful to biomedical libraries.

This selective bibliography is intended to serve as a guide to empirical studies reporting data and methods that can be used by medical librarians to assess their own efforts objectively and to improve the effectiveness and efficiency of services they offer. The decision rules that governed selection of items for the bibliography are specified in detail. A total of 178 items published between 1915 and mid-1968 met the selection criteria. The list of items is supplemented by a keyword index derived from titles. Half the items are journal articles; a third of these articles appeared in the Bulletin, and most of the remainder in thirteen other library and information science journals. Most of the non-journal items are technical reports issued by the organization that conducted or sponsored the work. The characteristics of this literature suggest that few medical libraries, unless they are part of a university system that includes the collection of a library or information science school, are likely to have quick access to the literature base needed to support a comprehensive program of self-evaluation studies and the continuing education of their own staff. Regional medical libraries might well undertake to ensure both ready access to, and awareness of, literature on the scientific aspects of librarianship.

Bibliographies as Topic↗
PubMed1998

Failure-as-success: multiple meanings of eradication in the Rockefeller Foundation Sardinia project, 1946-1951.

In the history of malaria control programs there were important tensions between proponents of the concept of eradication and those of malaria control. In this debate the concept of eradication has had multiple meanings. This paper concerns the post-hoc interpretations of the outcomes of the Rockefeller International Health Foundation-sponsored project conducted in Sardinia between 1946 and 1951. The Ente Regionale per la Lotta Anti-Anofelica in Sardegna (regional agency for the anti-Anopheles struggle in Sardinia) (ERLAAS) project was conceived as a large-scale, field-based pilot demonstration project to test the feasibility of the strategy of "species eradication" in an area with an endemic malaria vector. Species eradication, a strategy championed by Soper, was aimed at the total annihilation of an anopheline vector from an area. Under the leadership of the Rockefeller Foundation, the ERLAAS project used postwar UNRRA funds to purchase local labor and imported DDT, oil-suspension, and war-surplus equipment in an "all-out" campaign against Anopheles labranchiae, even in sparsely populated areas. The original aim was entirely entomological; species eradication was expected to be completed in two years for a cost of $2.7 million. Ironically, malaria mortality on the island had already been lowered before WWII by a series of public health interventions. The ERLAAS project encountered severe technical and logistical difficulties; its ultimate failure was foreshadowed in the resignation of the first American director who doubted the feasibility of species eradication. Ultimately, the ERLAAS project was ended after four and a half years and an expenditure of $11.2 million. Although new malaria transmission on the island ended the project failed to eliminate A labranchiae. Finally, the regional government was counselled to continue mosquito control efforts; the continuation of a substantial mosquito control program for fifty years after this famous "malaria eradication" project runs contrary to the basic cost/benefit logic of the eradication concept. Nevertheless, in the popular press both in the U.S. and Italy, the project was presented and heralded as a major success in liberating the island from the age-old stranglehold and misery of malaria. In the course of the project, the goals of ERLAAS became transformed from species eradication to malaria eradication; this was an important political spin that was put on the evaluation of the program. The consequences of this tactical change in discourse included two important facts: the contribution of the Rockefeller Foundation to the island was exaggerated, and the legitimacy of the concept of global eradication was maintained. In the framework of the World Health Organization and the agreement for a global malaria eradication program, the "failure" of the Sardinia project was seldom recognized or mentioned. The technical, economic, and logistical problems faced by ERLAAS were very similar to the problems associated with the end of the WHO global malaria eradication policy in 1972. The Sardinia project is presented as a case of "failure-as-success"; an ideological transformation was made, not simply for local political expediency, but more importantly because of the predominance of the modernist cultural model of "progress through technology" that characterized international Public Health in the postwar era.

Animals↗