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PubMedDate not supplied

Following the pioneers. Addressing tobacco in chemical dependency treatment.

Traditionally, tobacco has been ignored as an issue in the treatment of addictions to alcohol and other drugs. Beginning in 1985, and especially since the publication of the 1988 Surgeon General's Report on nicotine addiction, a handful of treatment programs have worked at coming to terms with tobacco. This article explores the reasons for addressing nicotine in the course of managing other addictions and summarizes the lessons learned from the programs which have done pioneering work in this area. The reasons for addressing nicotine are compelling, and the accumulated experiences among the pioneering programs are consistently encouraging. Regional projects to help alcohol and drug treatment programs come to terms with tobacco are an appropriate next step.

Aftercare↗
PubMed1994

Mechanism of delta-opioid receptor selection by the address domain of dermenkephalin.

Dermenkephalin (Tyr-D-Met-Phe-His-Leu-Met-AspNH2) is a highly potent and selective delta-opioid peptide isolated from frog skin. It was recently recognized that the C-terminus His4-Leu5-Met6-Asp7NH2 of dermenkephalin was responsible for the addressing of the peptide towards the delta-opioid receptor. In order to investigate the role played by residues 4, 5 and 6 in this 'delta address', we synthesized and evaluated 20 new analogues for their ability to displace tritiated ligands from mu- and delta-opioid sites. Results showed that position 4 of dermenkephalin contributes to delta selectivity independently of delta-opioid receptor binding by preventing a high affinity mu binding. Position 5 requires a hydrophobic side chain to enhance delta affinity. A high delta affinity was obtained with any amino acids introduced in position 6 suggesting that residue 6 serves as a neutral spacer. Thus, the main features responsible for the high delta-opioid selectivity of dermenkephalin are electrostatic repulsions with the mu-opioid receptor, additional hydrophobic interactions with the delta-opioid receptor and folding of the C-terminal domain.

Amino Acid Sequence↗
PubMed1993

Detection of sub-nanogram quantities of Mojave toxin via enzyme immunoassay with light addressable potentiometric detector.

Sensitive detection of Mojave toxin (MoTX), a potent neurotoxin isolated from the venom of Crotalus scutulatus scutulatus, was developed using an enzyme immunoassay (EIA) and light addressable potentiometric detection. This EIA utilizes both biotin- and fluorescein-labeled anti-MoTX antibodies to immobilize and detect sub-nanogram to nanogram quantities of toxin. Labeled mono- and polyclonal anti-MoTX antibodies were used alone and/or in combination to determine maximum assay sensitivity. Assays performed using a combination of biotinylated poly- and fluoresceinated monoclonal antibodies produced an assay with a lower detection limit near 2.5 ng. Assays performed using labeled polyclonals alone, or in combination with biotinylated mono- and fluoresceinated polyclonal antibodies, indicated increased sensitivity with a detection limit near 300 pg. In conclusion, we describe an enzyme immunoassay using different labeled antibody schemes which detects sub-nanogram quantities of MoTX via light addressable potentiometric detection.

Antibodies↗
PubMed2005

A stromal address code defined by fibroblasts.

To navigate into and within tissues, leukocytes require guidance cues that enable them to recognize which tissues to enter and which to avoid. Such cues are partly provided at the time of extravasation from blood by an endothelial address code on the luminal surface of the vascular endothelium. Here, we review the evidence that fibroblasts help define an additional stromal address code that directs leukocyte behaviour within tissues. We examine how this stromal code regulates site-specific leukocyte accumulation, differentiation and survival in a variety of physiological stromal niches, and how the aberrant expression of components of this code in the wrong tissue at the wrong time contributes to the persistence of chronic inflammatory diseases.

Dendritic Cells↗
PubMedDate not supplied

Using community-partnered participatory research to address health disparities in a Latino community.

Working in collaborative partnership with communities experiencing health disparities has been identified as a successful strategy to address population health disparities. This article illustrates a collaborative outreach program designed to address health disparities in a poor Latino community in Los Angeles County, California, by training community members to function as lay health advisors (LHAs) to provide health education to members of their own community. The study consisted of three phases, each accomplished in a collaborative partnership among researchers, community residents, community-based organizations, and health officials. In Phase 1, a community needs assessment was conducted to identify a community with demonstrated health disparities and agencies within that community willing to become partners in providing health education. In Phase 2, community members were recruited and trained to function as LHAs. Phase 3 consisted of implementation of community outreach and education activities by the LHAs in their community. This article describes how the study changed over time through responding to challenges that arose in the process of conducting the project, the participatory or collaborative methods used, and feedback received. Strategies for successful research using community partners are presented and implications discussed for future research efforts using community-partnered participatory methods for reducing health disparities.

Community Health Workers↗
PubMed1997

National survey of Clerkship Directors in Internal Medicine on the competencies that should be addressed in the medicine core clerkship.

PURPOSE: To prioritize competencies that should be addressed in the medicine core clerkship, assess factors influencing this prioritization, and estimate the percentage of clerkship time that should be devoted to inpatient versus outpatient care. METHODS: A national survey of the Clerkship Directors in Internal Medicine (CDIM) was used. Using explicit criteria, respondents assigned priority scores, on a 1 to 5 scale, to 17 general competencies and 60 disease-specific clinical competencies pertinent to care of adult patients in inpatient. ambulatory, intensive care, and emergency settings. RESULTS: Ninety-three (75%) of 124 CDIM members responded. The highest mean priority scores were assigned to 6 general competencies: case presentation skills (4.65), diagnostic decision-making (4.64), history and physical diagnosis (4.61), test interpretation (4.47), communication with patients (4.35), and therapeutic decision-making (4.12). Disease-specific clinical competency areas receiving the highest mean priority scores were: hypertension (4.57), coronary disease (4.53), diabetes mellitus (4.45), heart failure (4.42), pneumonia (4.39), chronic obstructive pulmonary disease (4.26), acid-base/electrolyte disorders (4.19), and acute chest pain (4.08). Priorities for general competencies were moderately correlated with importance to the practice of general internists (mean Spearman rho 0.49) and with importance to students pursuing careers outside internal medicine (mean Spearman rho 0.45), but only weakly correlated with the adequacy with which a competency was addressed in other parts of the curriculum. Respondents' mean recommended allocation of clerkship time was: 52% inpatient, 33% ambulatory care, 8% intensive care, and 7% emergency medicine. This time allocation did not differ by any characteristics of respondents. CONCLUSION: There is consensus among medicine clerkship directors that the medicine core clerkship should emphasize fundamental competencies and devote at least one third of the time to clinical competencies pertinent to ambulatory care.

Clinical Clerkship↗
PubMed2003

Other high-risk factors for young drivers--how graduated licensing does, doesn't, or could address them.

PROBLEM: Young drivers, particularly those who are newly licensed, have a very high crash risk. This paper examines the risk factors underlying their high crash rates and assesses the extent to which existing graduated licensing programs address these risks and whether improvements to these programs should be considered. METHOD: Review and synthesis of the literature. RESULTS: The elevated risk among young drivers of being in an injury crash is the result of a number of factors found alone or in combination, such as risky driving, alcohol use, seat belt nonuse, driver distraction, fatigue, and vehicle choice. Nighttime and passenger restrictions, adopted widely in the United States, work by keeping drivers out of hazardous situations rather than by addressing risk factors directly. However, the risk factors remain in play in driving situations not specifically restricted by law. Although other graduated licensing components adopted around the world-more stringent exit tests (i.e., you need to pass a test to move to the next stage), hazard perception tests, and restrictions on speed, vehicle power, and roadway access-make sense based on the identified risk factors, they are not yet supported by research. Should research findings warrant it, consideration should be given to providing guidance to parents about how to keep their beginning drivers safe, including information on vehicle choice. IMPACT ON RESEARCH, PRACTICE, AND POLICY: Researchers should continue to monitor and to evaluate innovative approaches to reduce the crash risk of young drivers. The effectiveness of new approaches should be established before adoption on a wider scale takes place.

Accidents, Traffic↗
PubMed2002

The moral tollbooth: a method that makes use of the patent system to address ethical concerns in biotechnology.

Patents granted for biotechnological innovations continue to cause social and ethical dilemmas. For example, much controversy surrounds the patenting of genes that predispose to breast-cancer, and in the USA the debate continues about whether or not stem-cell technology should be accessible to all. In this report, we argue that some of these concerns can be addressed within national patent systems. In particular, we examine the "order public or morality" clause that exists in most national patent procedures. Furthermore, we propose that patents for inventions that present social and ethical questions should be subject to suspension by an independent, transparent, and responsible tribunal made up of specialists in ethics, research, and economics. This suspension should be reversible so that, when the social or ethical concerns have been addressed in an appropriate manner, the suspension can be lifted. Although controversial, such a flexible mechanism would assist governments and industry in enhancing public support for patents in the biotechnology area.

Animals↗
PubMed2001

Activities to address antimicrobial resistance in the United States.

Antimicrobials are essential for the prevention and treatment of bacterial infections in humans and animals. Subtherapeutic antimicrobials have been used as growth promoters for >40 years. The subject of antimicrobial resistance is not new but has gained increasing attention due to public-health concerns about multi-resistant pathogenic organisms. Numerous United States' activities do exist to address antimicrobial resistance. A surveillance system (the National Antimicrobial Resistance Monitoring System) was established in 1996 to monitor changes over time in resistance for 17 antibiotics in humans and animals. Educational campaigns have been created to promote the judicious therapeutic use of antimicrobials. Producer groups are developing guidelines for judicious therapeutic antimicrobial use for their prospective species. Basic and applied research programs are being expanded to answer many of the unsolved questions regarding development, persistence, and transmission of antimicrobial resistance. This paper focuses on a federal inter-agency public-health action plan to combat antimicrobial resistance; the plan was released for public comment in 2000. This plan addresses goals and actions to combat antimicrobial resistance in humans and agriculture in four areas: surveillance; research; prevention and control; product development.

Animals↗
PubMedDate not supplied

Addressing the challenges of transforming laboratory advances into Alzheimer's Disease treatments.

This essay addresses the challenges of clinical trials to develop treatments for Alzheimer's Disease (AD). The issues covered are enrolling subjects, defining clinically meaningful endpoints, and making the claim that a drug slows the progression of the disease. The perspective to address these challenges is that dementia research should embrace a biopsychosocial model for drug development. In this model, the patient and caregiver are seen as interrelated subjects of both treatment and research and outcome measures reflect biomarkers of the disease, the functional morbidity of AD and the distress of caregiving.

Alzheimer Disease↗
PubMed1999

Addressing birth in Gaza: using qualitative methods to improve vital registration.

The use of anthropological qualitative methods to validate and improve health surveillance data is demonstrated through an examination of the process of birth registration in Gaza. Theoretically, the importance of understanding the link between historical events and microlevel decision-making is emphasized both in general terms and specifically in the context of the Gaza Strip today. In the course of interviewing a sample of mother/infant pairs selected from a register of births in the Gaza Strip it became evident that 100% of the addresses were incomplete. Using qualitative methods in the form of field visits and interviews with physicians, clerks and nurses, an understanding of the information pathway for birth registration data was developed. It was also established that there was some erroneous recording of birthweight. An intervention was designed which failed to improve the accuracy of addresses but did improve the recording of birthweight.

Adolescent↗
PubMed1998

Building a feminist theoretical framework for screening of wife-battering: key issues to be addressed.

The purpose of this paper is to identify key questions which must be addressed in developing a woman-centred, that is feminist, theoretical framework for screening for wife battering in health settings. The health sector has not had a positive history in addressing women's health holistically or in terms of the social context of women's lives. This is notable in relation to the issue of wife battering, where attention is recent but growing and responses have been varied. On the other hand, violence against women is one of the greatest threats to their health and, therefore, it can be argued that the health sector has a major role to play in ending this violence. With the recent efforts within the health sector, a great deal has been accomplished; we have some consensus on what is an appropriate protocol for and the roles of health care providers. We are also making progress in developing training programs. Several things are still lacking an understanding of the systemic barriers to promotion of and participation in screening; sufficient program evaluations; sufficient attention to issues of diversity among women; and, a theoretical framework for practice which links these together.

Adult↗
PubMedDate not supplied

Addressing women's concerns about weight gain due to smoking cessation.

Specific concerns about weight gain following smoking cessation inhibit attempts to quit smoking, especially in women. However, adjunct interventions to prevent weight gain after cessation have generally been successful only in attenuating, rather than preventing, weight gain. More aggressive weight control adjuncts may be necessary to prevent cessation-induced weight gain. On the other hand, weight control programs have not been found to improve long-term smoking abstinence and, in fact, may actually impede abstinence, necessitating a search for alternative approaches to addressing weight concerns. Since the typical amount of weight gain is essentially trivial from a health standpoint, particularly when compared with the health benefits of quitting smoking, the most appropriate clinical strategy may be to combat the weight concerns themselves rather than the weight gain. A second alternative approach is to focus all treatment efforts on smoking cessation alone, to avoid placing excessive burdens on participants resulting from attempting simultaneous changes in multiple health behaviors (i.e., smoking and those related to weight). The rationales for these three clinical approaches to addressing concerns about weight gain-more effective weight control, direct reduction in weight concerns by cognitive-behavioral treatment, and smoking cessation only-are presented, followed by descriptions of the adjunct treatments based on these approaches currently being evaluated in a clinical outcome study with women trying to quit smoking.

Body Image↗
PubMed2000

Rapid identification of biological warfare agents using an instrument employing a light addressable potentiometric sensor and a flow-through immunofiltration-enzyme assay system.

An instrument employing a light addressable potentiometric sensor and a flow-through immunofiltration-enzyme assay system has been developed for the rapid and specific identification of biological warfare (BW) agents. The system has been designed to assay for up to eight agents simultaneously and provides an indication of the absence or presence of a threat within 15 min. Parameters affecting the mixing of the reagents within the instrument's fluidic lines were investigated and optimized. Measurements of blank samples and samples containing Bacillus subtilis spores in the concentration range of 10(4) to 10(6) cfu/ml indicate the limit of detection (LOD) is 3 x 10(3) cfu/ml for B. subtilus. Although the LOD is higher than that of several technologies currently under development, this instrument offers an immediate interim approach for addressing the need to rapidly detect biological warfare agents in the field.

Bacillus subtilis↗
PubMed2001

Derivatives of 17-(2-methylallyl)-substituted noroxymorphone: variation of the delta address and its effects on affinity and selectivity for the delta opioid receptor.

In an effort to establish the importance of the N-(2-methylallyl) substituent in the noroxymorphone series, several derivatives have been synthesized, retaining that N-substituent and modifying the delta address moiety. A few compounds showed moderate binding affinity and selectivity for the delta receptor; none displayed a pharmacological profile as exceptional as N-(2-methylallyl)noroxymorphindole. A second study showed that 3-O-methylation of all derivatives decreases binding affinity. The present results indicate that only a combination of the N-(2-methylallyl) group and an indole delta address provided high selectivity for the delta receptor.

Oxymorphone↗
PubMed2001

Addressing semen loss concerns: towards culturally appropriate HIV/AIDS interventions in Gujarat, India.

A situation analysis of sexual networking and sexual health in an industrial area of Gujarat, India, identified anxiety about masturbation and other semen loss concerns as major preoccupations among young men. This paper describes how the Deepak Charitable Trust addressed these concerns in their HIV prevention programme for young men aged 15 to 30. Flowcharts were used as participatory learning tools and to obtain data on the perceived consequences of masturbation, both before and after intervention activities. Research was also done on the relation between semen-related anxieties and sexual risk behaviour by DCT and two other NGOs among young men engaging in unsafe sexual behaviour. DCT advocates addressing masturbation and other semen loss concerns in all sexual health campaigns in South Asia, based on the magnitude of these concerns, their potential to confound syndromic management of STIs and their significance as an idiom of psychosocial distress. Masturbation and associated anxieties about sexual performance are seen as health issues and discussed as such by the programme. There is immediate identification among young men, whether or not they are already sexually active, and it provides an excellent entry point for sexual health and safer sex education. The community response to these efforts has been entirely positive.

Adolescent↗
PubMed2001

Will the pill make me sterile? Addressing reproductive health concerns and strategies to improve adherence to hormonal contraceptive regimens in adolescent girls.

UNLABELLED: PAPER OBJECTIVE: This paper is designed to help clinicians understand the relationship between hormonal contraceptive side effects and the potential development of general and reproductive health concerns that can impact on adherence to hormonal contraception. By understanding the concerns raised by young women, we can then make our counseling more specific to the factors that affect compliance in this population. DESIGN: Studies that specifically addressed hormonal contraceptive compliance, side effects, and method selection in adolescents and young women were chosen for this paper. All articles were from peer-reviewed journals. Medline-Ovid articles from 1980-2000 were used with the following search keywords: Contraception, Patient Compliance, Hormonal Contraception, Oral Contraceptive Pills, Norplant, Depo Provera, and Adolescents. DATA SYNTHESIS: The general public has many concerns about the safety of hormonal contraception. The development of side effects, especially those that are menstrual-related, seem to cause adolescents and young women to feel that their general and reproductive health is being threatened. CONCLUSIONS: Hormonal contraceptive counseling should include 1) explaining, in a nontechnical manner, how these methods work; 2) addressing negative information the patient has heard about the methods; 3) providing factual information about cancer risks, blood clots, and other general health concerns; 4) discussing the potential side effects and what each means to her health; 5) asking specifically about possible reproductive health worries, especially in light of the menstrual irregularities that may occur; and 6) assuring the patient that she should always feel free to share her concerns and worries with you, the provider.

Adolescent↗