NTP-CERHR Expert Panel Report on the reproductive and developmental toxicity of 2-bromopropane.
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BACKGROUND: Over the past 25 years, African-Americans have experienced higher rates of emergency department (ED) visits, hospitalizations, and death due to asthma compared to other ethnic groups in the US. African-Americans of lower socioeconomic groups are particularly vulnerable to asthma morbidity and mortality. Few studies have investigated asthma-related healthcare services use by different age and gender groups within this sub-population. OBJECTIVES: The objectives of this study are to: (1) report rates of asthma among African-Americans who receive healthcare through a state government Medicaid program that provides medical coverage to low-income citizens; (2) report rates of asthma-related medical services and prescription utilization for these recipients; and (3) report the costs to the Medicaid program for asthma-related care for these recipients. METHODS: This was a cross-sectional descriptive analysis. West Virginia (WV) Medicaid administrative fee-for-service claims data from calendar year 2002 were the data source. Medical services claims with a primary diagnosis of asthma for recipients who were African-American less than 65 years of age were extracted. Matching prescription claims for these recipients for medications to treat asthma were extracted. Dollars reimbursed for medical services and prescription medications were from the perspective of WV Medicaid. RESULTS: There were 635 African-American recipients who had a primary diagnosis of asthma. Children under 21 years of age comprised the majority of the sample. Males under 21 years of age, and females 21 years and older had the highest rates of asthma. Although males 21 years and older accounted for the lowest proportion of age-gender groups, these recipients had the highest rates of hospitalizations and ED visits for asthma. Less than one-third of the recipients had a prescription claim for an inhaled corticosteroid. There were more claims paid by Medicaid for quick-relief medications vs. controller pharmacotherapy for the sample. A majority of the dollars paid by Medicaid for asthma care were for prescriptions and hospitalizations. CONCLUSION: Asthma prevalence and asthma-related medical services utilization rates among African-American recipients of Medicaid varied by age and gender groups. These recipients appeared to be underutilizing controller pharmacotherapy for asthma.
Acid mine drainage (AMD) is a widespread environmental problem associated with both working and abandoned mining operations. As part of an overall strategy to determine a long-term treatment option for AMD, a pilot passive treatment plant was constructed in 1994 at Wheal Jane Mine in Cornwall, UK. The plant consists of three separate systems; each containing aerobic reed beds, anaerobic cell and rock filters, and represents the largest European experimental facility of its kind. The systems only differ by the type of pre-treatment utilised to increase the pH of the influent minewater (pH<4): lime-dosed (LD), anoxic limestone drain (ALD) and lime free (LF), which receives no form of pre-treatment. The Wheal Jane pilot plant offered a unique facility and a major research project was established to evaluate the pilot plant and study in detail the biological mechanisms and the geochemical and physical processes that control passive treatment systems. The project has led to data, knowledge, models and design criteria for the future design, planning and sustainable management of passive treatment systems. A multidisciplinary team of scientists and managers from the U.K. universities, the Environment Agency and the Mining Industry has been put together to obtain the maximum advantage from the excellent facilities facility at Wheal Jane.
Following the announcement in 1949 in the USA that cortisone offered rheumatoid arthritis sufferers effective treatment for their crippling disease, the Ministry of Health came under considerable pressure from the medical profession and the public to make cortisone available in Britain. The Ministry, therefore, urged British companies to start manufacturing cortisone. Among the several pharmaceutical firms responding to the Ministry's request, Glaxo's expertise in the field of vitamins gave them a head start. This paper describes the varied and flexible strategy that enabled Glaxo to maintain this head start, and the scientific and technical capabilities which the company subsequently built up, enabling them to dominate the market for corticosteroids in Britain. Among the drugs to emerge out of the Glaxo project to manufacture cortisone, which began in 1950 and later became a wider R&D programme on steroids, was the topical steroid Betnovate, launched in 1963, which remains a best-seller today. However, although it led to successful new products, Glaxo's programme had limitations. The paper identifies a missed opportunity, in the shape of the biosynthetic route to steroid drugs, often considered as a milestone in the development of the new biotechnology. Whether or not this missed opportunity proved costly to the company is uncertain. However, it illustrates the role of technological path-dependence, and the importance of the integration between different scientific disciplines, in this case chemistry and biology, in pharmaceutical innovation.
Since adopting the National Biotechnology Strategy in 2001, the South African government has established several regional innovation centres and has put in place initiatives to encourage international partnerships that can spur internal development of life science ventures. This strategy seeks to capitalize on the high quality of research carried out in public research institutions and universities but is hampered, somewhat, by the lack of entrepreneurial culture among South African researchers due to, among other reasons, the expenses involved in registering foreign patents. Although private sector development is still relatively embryonic, start-ups are spinning out of universities and pre-existing companies. These represent a vital source of innovations for commercialization in the future, provided that the challenges facing the emerging South African biotechnology industry can be overcome.
This descriptive, comparative, cross-sectional, randomized community-based study was done to determine factors influencing drug compliance in the mass drug administration (MDA) programme against filariasis in selected urban and rural populations within the Western province of Sri Lanka. The study population was selected using the cluster sampling method. Factors influencing drug compliance were determined by administration of an interviewer-based pre-tested questionnaire eliciting information regarding drug compliance, socio-economic status, educational background, knowledge, attitudes and practices with regard to the 2004 MDA. A total of 2319 people aged between 10 and 90 years (median 40) responded to the questionnaire. The belief that the MDA programme was beneficial was the most important factor affecting drug compliance, as revealed by multivariate analysis of the combined populations (P<0.001). This was so even in the urban population (P<0.001), while the belief regarding the severity (danger) of filariasis was important in the rural population (P=0.013), when the areas were considered individually. Therefore, it is essential for awareness programmes to highlight the dangers (complications) of the disease and to influence the community to perceive the benefits of a filariasis-free community as well as 'beyond filariasis' benefits of having albendazole given in combination in the MDA programme.
Although technical constraints to eradication of bovine tuberculosis are well-recognised, non-technical constraints can also delay progress towards eradication, leading to inefficiency and increased programme costs. This paper seeks to analyse the main non-technical constraints that can interfere with the successful implementation of tuberculosis eradication plans, based on experiences from an area of high tuberculosis prevalence in Regione Piemonte, Italy. The main social and economic constraints faced in the past 20 years are reviewed, including a social reluctance to recognise the importance of seeking eradication as the goal of disease control, effective communication of technical issues, the training and the organization of veterinary services, the relationship between the regional authority and farmers and their representatives, and data management and epidemiological reporting. The paper analyses and discusses the solutions that were applied in Regione Piemonte and the benefits that were obtained. Tuberculosis eradication plans are one of the most difficult tasks of the Veterinary Animal Health Services, and non-technical constraints must be considered when progress towards eradication is less than expected. Organizational and managerial resources can help to overcome social or economic obstacles, provided the veterinary profession is willing to address technical, but also non-technical, constraints to eradication.
Bovine tuberculosis is endemic in Northern Ireland and a comprehensive eradication scheme has been in operation since 1959. The current programme involves annual testing, extensive computerized tracing, short-interval testing of herds contiguous to outbreaks and compulsory slaughter of positive cattle. Despite initial reductions in disease prevalence, eradication has proved elusive and potential explanatory factors include high cattle density and potential for between-herd contact, the impact of exotic diseases on resource priorities, and significant levels of bovine tuberculosis in a wildlife reservoir, the European badger (Meles meles). Both the role of the infected bovine and that of the badger in spreading disease have to be addressed to ensure progress towards eradication. Current measures are described and future options for enhancing the programme are outlined.
Of the approximately 374 million cattle in Latin America and the Caribbean, 70% are held in areas where rates of Mycobacterium bovis infection in cattle are higher than 1%. The remaining 30% are in countries where infection affects less than 1% of cattle, including 62 million in countries where bovine tuberculosis infection is virtually nil. Measures for controlling bovine tuberculosis are partially or extensively applied in most of the countries in the Region. These measures are based on test and slaughter, notification, post-mortem inspection and surveillance in slaughterhouses. A coordinated production, standardization and quality control of purified protein derivatives is urgently required for use in control and eradication campaigns in order to assure reliability of reagents and comparability of data on tuberculin testing within the Region. On the basis of information from Argentina, M. bovis is estimated to cause 2% of all human cases of tuberculosis in the Region. Slaughterhouse and dairy farms workers are most-frequently infected, with infection occurring via the respiratory tract. Various in vitro assays for the diagnosis of bovine tuberculosis have been developed and/or assessed in the Region, and DNA fingerprinting has been applied for a comprehensive understanding of the epidemiology of bovine tuberculosis at the local and regional level.
In the later stages of eradication of tuberculosis in cattle there is a need to take account of the fact that Mycobacterium bovis infection in cattle presents, not as cases of clinical disease but most commonly as apparently healthy animals showing an immunological response to tuberculin. This is an entirely different scenario to that seen when national eradication programmes were first devised, at a time when the protection of public health rather than animal health was the prime motivation. In countries with active programmes to eradicate bovine tuberculosis, it is critical for the programme's success that account is taken of this redefinition of tuberculosis, side by side with changes in modern animal production systems and their impact on the transmission of M. bovis. This paper highlights factors critical to the success of a national eradication programme, including a clear identification of the goals, of the policies that guide actions, and of the sequences of actions that are required within the programme to accomplish these goals. Experience has illustrated the adverse effects of compromise on outcome when the application of fundamental principles of disease control such as sound animal management, removal of known sources of infection, early diagnosis, quarantine, movement control and environmental hygiene are less than enthusiastically promoted and applied. The reality is that where these principles are applied in a sustained manner, the outcome is more likely to be successful. Therein lies the challenge for the risk manager.
Bovine tuberculosis is one of the most complex animal health problems that the farming industry in Great Britain faces today. In leading and facilitating the changes to policy required to reverse the long-term upward trend in the disease, Government is heavily reliant on evidence emerging from its wide-ranging bovine tuberculosis research programme. The paper outlines development of policy in Great Britain and its relationship to research findings.
Schistosomiasis japonica continues to remain a public health problem in the Philippines affecting 10 out of 16 regions with 6.7 million people at risk mostly farmers and fisher folks. Early efforts focused on snail control in the absence of an effective drug against the disease. Discovery of praziquantel shifted control focus from the expensive snail control to a more manageable one involving case detection and treatment. At present, the government's objective is to reduce morbidity by chemotherapy and supplemented with environmental sanitation, health education, and mollusciciding. In the past, external funds infused into government control programs helped a lot in bringing down prevalence rates of the disease in many highly endemic areas. The end of this foreign assistance has expectedly affected implementation of the programs bringing fears of a possible resurgence in many endemic areas. Such anxiety is also founded on the perennial problems of low disease awareness among people at risk, aggravated security problem, poverty and the negative effects of a devolved set-up in the health care delivery system. Experts suggest that the national health department should be more aggressive in dealing with the disease in terms of ensuring implementation and of continuously searching for better and more improved methods of control. Any new strategy should always consider the devolved set up of the health department.
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PURPOSE: Previous guidelines for the management of uncomplicated hypertension in elderly patients have recommended diuretic agents and then beta-blockers. We examined trends in the initial treatment choice for elderly people with hypertension and the effects of a government-sponsored program to publish and disseminate a simplified version of the national guidelines for the treatment of hypertension to all physicians in Ontario, Canada. SUBJECTS AND METHODS: Linked administrative databases containing information on the more than 1.2 million elderly residents in Ontario were used. Time series analysis was performed to determine prescribing trends from 1993 to 1998 for patients who began antihypertensive medication for the treatment of hypertension and to examine the effects of the simplified guidelines that were distributed in July of 1995. RESULTS: Diuretic agents were the most commonly prescribed medications, with annual rates from 35% to 38% (P = 0.59) throughout the study. Beta-blocker prescribing rose from 12% to 16% (P <0.01), whereas angiotensin-converting enzyme (ACE) inhibitor prescribing rose from 27% to 32% (P <0.01). Prescriptions for calcium channel blockers dropped significantly, from 23% to 14% (P <0.01). However, the publication and dissemination of the Ontario hypertension guidelines had no statistically significant effects on the proportion of patients who began treatment with a diuretic agent (P = 0.55), beta-blocker, (P = 0.32), ACE inhibitor (P = 0.09), or calcium channel blocker (P = 0.07). CONCLUSION: The dissemination of simplified practice guidelines for hypertension did not have notable effects on prescribing patterns in Ontario.