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At least 1,783 records · Page 99Linked to original sources
PubMed2005

Quality management for clinical trials within the German Competence Network Paediatric Oncology and Haematology.

The German 'Competence Network Paediatric Oncology and Haematology' aims at improving the structure of paediatric oncology and haematology as a whole, focussing in particular on the quality of clinical trials and study co-ordinating centres. This comprises the following measures: (1) Employment of research and trial assistants in order to improve the quality of documentation and study management in the participating hospitals. (2) Development of an internet portal to provide medical information for non-professionals, for patients and their families as well as for health professionals. (3) The project group 'Central Trial Support' supports study centres during the process of writing and examining new treatment protocols so that they are in compliance with the Good Clinical Practice criteria, formal criteria, legal requirements and statutory provisions. This group currently produces a structural standardisation of study protocols and case record forms in order to improve their usability. The 'Competence Network Malignant Lymphomas' is a project with similar aims and will be outlined for comparison.

Child↗
PubMed2004

Nuclear receptor signaling in the control of cholesterol homeostasis: have the orphans found a home?

Cholesterol is essential for all mammalian cells. Cellular cholesterol requirements are met through de novo synthesis and uptake of plasma lipoproteins, homeostatic responses that are transcriptionally regulated by the sterol regulatory element-binding proteins (SREBPs). To prevent cytotoxicity attributable to accumulation of excess cholesterol, liver X receptors (LXRs) and the farnesoid X receptor (FXR), together with other members of the nuclear receptor superfamily, promote the storage, transport, and catabolism of sterols and their metabolites. Members of this metabolic nuclear receptor family include receptors for oxysterols (LXRs), bile acids (CAR, FXR, and PXR), and fatty acids (PPARs). Through coordinated regulation of transcriptional programs, these nuclear receptors regulate key aspects of cellular and whole-body sterol homeostasis, including cholesterol absorption, lipoprotein synthesis and remodeling, lipoprotein uptake by peripheral tissues, reverse cholesterol transport, and bile acid synthesis and absorption. This review focuses on the nuclear receptors that are central to the lipid metabolic signaling cascades, communication between lipid metabolites and their receptors, and the role of nuclear receptors in orchestrating the complex transcriptional programs that govern cholesterol and bile acid metabolism.

ATP-Binding Cassette Transporters↗
PubMed2004

Nkx2-5 mutation causes anatomic hypoplasia of the cardiac conduction system.

Heterozygous mutations of the cardiac transcription factor Nkx2-5 cause atrioventricular conduction defects in humans by unknown mechanisms. We show in KO mice that the number of cells in the cardiac conduction system is directly related to Nkx2-5 gene dosage. Null mutant embryos appear to lack the primordium of the atrioventricular node. In Nkx2-5 haploinsufficiency, the conduction system has half the normal number of cells. In addition, an entire population of connexin40(-)/connexin45(+) cells is missing in the atrioventricular node of Nkx2-5 heterozygous KO mice. Specific functional defects associated with Nkx2-5 loss of function can be attributed to hypoplastic development of the relevant structures in the conduction system. Surprisingly, the cellular expression of connexin40, the major gap junction isoform of Purkinje fibers and a putative Nkx2-5 target, is unaffected, consistent with normal conduction times through the His-Purkinje system measured in vivo. Postnatal conduction defects in Nkx2-5 mutation may result at least in part from a defect in the genetic program that governs the recruitment or retention of embryonic cardiac myocytes in the conduction system.

Animals↗
PubMedDate not supplied

Special education in Russia: historical aspects.

Tracing the history of special education services in Russia from its beginnings in the early nineteenth century through the rapid expansion of both private and government-supported programs and institutions until the restrictive Soviet period provides both understanding and appreciation of current Russian special education services and institutions. Theoretical principles guiding special education formulated by L. Vygotsky, and sources outside the USSR, were officially suppressed, as were testing and statistical data on handicapped individuals. Official mandates to bring students with handicaps up to state-approved standards resulted in the development of creative, effective approaches. The framework of special education changed little until the breakdown of the USSR. The new Russian Federation ratified UN resolutions protecting the rights of children. Categorical language is a recent development, and terms such as defective, retarded and pedologist are gradually being replaced. The final decade of this century is witnessing rapid change at the initiation of the Ministry of Education that is beginning to produce needed reform. One of the major initiatives is to provide LD specialists in all schools so that students will not need to be a great distance from home to receive needed services.

Child↗
PubMed2002

Drug prescribing pattern of interns at a government healthcare centre in northern India.

Prescribing habits of interns posted at a primary health centre for a period of 2 months (January 1994 and February 1994) were studied. Among the 1457 prescriptions collected, the average number of drugs per prescription was 2.47. The commonest groups of drugs prescribed were antibiotics (33.9%), analgesics and anti-inflammatories (17.0%), vitamins (13.0%), cough syrups (10.5%) and antihistamines (8.6%). The use of injectables was uncommon (0.9%). Most of the drugs prescribed were from the local drugs list of the centre (84.2%) consisting of 36 drugs. The list contained 20 drugs with proprietary names of which six were fixed-dose combinations. The local drug list needs modification. The proportion of drugs prescribed by generic name was 49.5%. As per Kunin's criteria, 57.9% of the antibiotics used were appropriate. Interns often forget to write the diagnosis (43%), signs and symptoms (50.2%), dosages and frequency of treatment. The result of this baseline study may be useful in promoting the education necessary in order to achieve the objectives of good prescribing.

Adult↗
PubMed2001

The state of the Innocenti Declaration targets in Italy.

If Italy is to meet the operational targets of the Innocenti Declaration, there will need to be changes in the way that breastfeeding is not only promoted but also protected and supported. During the celebration of World Breastfeeding Week in October 2000, a resolution was passed in the parliamentary Commissione per l'infanzia (Commission on Childhood) that committed the government to promoting, protecting, and supporting breastfeeding in a more active manner; to including breastfeeding as a health indicator; and to establishing national and regional goals for breastfeeding prevalence and duration. A next step that must be taken by the government is that of creating a national committee to coordinate the work. Progress toward accrediting a baby-friendly hospital needs to continue and must use the international standards as criteria. Recent action taken by the Ministry of Health and the court system is promising; however, full compliance of the International Code of Marketing of Breast-Milk Substitutes should be a goal for Italy and the rest of the European Union. The one area in which Italy seems to have fulfilled all of its obligations is the one concerning "imaginative legislation"; however, this shows that although legislative protection is important, it is not enough to ensure breastfeeding success.

Breast Feeding↗
PubMed2000

Privatizing indigent health services in Los Angeles County: understanding the effects on community-based providers.

Faced with imminent financial collapse of its public healthcare system, the Los Angeles County Department of Health Services solicited community-based providers to supply primary care health services to the medically indigent. This study highlights the effects that participation in the programme has had on these community providers. While strongly committed to the programme's objectives, community providers tended to overextend themselves financially, putting their organizations at substantial risk of failure should contractual expectations or patient demand forecasts not be met. Because of this risk, policymakers involved in public-private partnerships with community-based providers must exercise extreme caution owing to the unique status many of these providers hold as centrally positioned actors in their communities. On the positive side, we found evidence of increased levels of co-operation and innovation between community providers outside their formal roles in the county-sponsored public-private partnership programme.

Community Health Centers↗
PubMed1997

Programme budgeting revisited: special reference to people with learning disabilities.

The recent reorganization of community care in the UK removed many of the perverse incentives identified in the previous system. However, the organization of care for many people is still divided across several agencies in the public and independent sectors. As purchasing and providing agencies in both the National Health Service and local authority personal social services attempt to coordinate policy objectives and the means to achieve them, the total resources available and their allocation across different care groups and among people in the same care groups from a consistent focus of attention. The principles and practice of programme budgeting provide important lessons for planning and monitoring expenditure. This paper rehearses such principles in the specialized area of policies for people with learning disabilities and draws on the experience of mapping expenditure on relevant services in a survey over 10 local authorities in England.

Budgets↗
PubMed2000

Current status of iodine deficiency in Mongolia in 1998-1999.

In 1992, the Mongolian government conducted a nationwide palpation study of the thyroid glands, and the study showed an overall goiter rate of 30%. As a result of this, the Mongolian Government launched its Iodine Deficiency Disorders (IDD) Elimination Programme in 1996 and its primary strategy was salt iodization. In 1998 and 1999, we carried out programme monitoring studies in 11 provinces. The results showed: among schoolchildren, a goiter rate was 22.8% (n = 6,535), median values of urinary iodine excretion ranged from 11 micrograms/l to 256 micrograms/l (n = 1,930), and usage rates of iodized salt (> 20 PPM iodine content) in their households ranged from 3% to 82%. We concluded that severe iodine deficiency in 1992 was improved from moderate to mild severity a few years later by salt iodization. However, stronger official commitments and community participation are needed to improve the programme so that iodized salt will be made more widely available.

Child↗
PubMed2001

Promoting the health and social care of older people: gaining a perspective from outside the UK.

With people living longer, getting sicker and entering nursing home care later in their lives, the global trends point to preventing premature institution as a major public health and social care goal. Compared with the UK--Australia, Canada and the USA have a longer track record for introducing government Acts, policies and strategies which contribute to supporting older people in maintaining their health, safety and independence. They also have government Ministers for the Aged. In the UK, it is only very recently that we are witnessing new Government programmes such as the NHS Plan and Modernizing Social Services that begin to demonstrate its more determined approach to improve the life of the older person. An ageing population brings new challenges to policy-makers and planners in the statutory sectors. Various international conferences have been held to address ways in which countries are providing or developing their services, and their research regarding older people. Yet, whatever country one considers, nursing home care continues to give rise to many concerns. Developments in the USA managed care programmes have recently come under even more scrutiny from the Federal and State governments, insurance agencies, nursing home owners and, of course, older people themselves. This article raises issues that still need to be addressed in the UK. It reports briefly on an international conference (attended during the undertaking of a Winston Churchill Fellowship) which had some forward-thinking presentations addressing existing and future care needs of older people. It then concentrates on highlighting some of the current developments in the USA care system that might be learning lessons for UK policy-makers. It concludes with some additional considerations for delivering a National Service Framework for Older People in order that "The needs of older people are at the heart of the reform programme for health and social services."

Aged↗