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Selected AbstractsThe Audit Commission review of diabetes services in England and Wales, 1998,2001DIABETIC MEDICINE, Issue 2002B. Fitzsimons Abstract Aims of the Audit Commission The Audit Commission has a statutory duty to promote the best use of public money. It does this through value for money studies, such as that reported in Testing Times[1]. This work has been followed with a review of innovative practice in commissioning. These initiatives aim to support the implementation of the diabetes national service framework. The Audit Commission also appoints external auditors to NHS organizations who assess probity and value for money in the NHS; the latter by applying national studies locally and by carrying out local studies. Methods Research for Testing Times consisted of structured visits to nine acute trusts, a telephone survey of 26 health authorities and a postal survey of 1400 people with diabetes and 250 general practitioners. Local audits used a subset of the original research tools. Case studies were identified through a cascade approach to contacts established during Testing Times and through self-nomination. Results Rising numbers of people with diabetes are placing increasing pressure on hospital services. Some health authorities and primary care organizations have reviewed patterns of service provision in the light of the increasing demands. These reviews show wide variations in patterns of routine care. In addition, there is a widespread lack of data on the delivery of structured care to people with diabetes. People with diabetes report delays in gaining access to services, and insufficient time with staff. There are insufficient arrangements in place for providing information and learning opportunities to support self-management. Conclusion As the number of people with diabetes continues to rise, the potential for providing more care in a primary care setting needs to be explored. This will enable specialist services to focus more effectively on those with the most complex needs. [source] Screening for the 21st century: learning from the pastCYTOPATHOLOGY, Issue 1 2000A. E. Raffle Introduction In 1986 I took on the public health responsibility for the cervical screening service in Avon. Like many others, I understood screening to be a simple, highly effective, and inexpensive way of stopping people getting cancer. The only problem so far as I was aware was in making sure those most at risk took up the opportunity to be screened. The more involved I became with screening, however, the more I was obliged to modify this view. In summary, I was confronted with two problems. The Avon cervical screening service,thanks to contributions from many individuals over the previous two decades,was already well organized and population coverage was already high. Why then were women still dying from cancer of the cervix? Why also was there a substantial and rising number of women requiring colposcopic investigation for screen-detected abnormality when, according to screening theory, the ,prevalence' pool should have been cleared and the rate of newly detected ,incident' abnormalities should equate to the incidence of serious disease? [source] Experimental design comparison of studies evaluating doxorubicin nanoparticles in breast cancer therapyHUMAN FACTORS AND ERGONOMICS IN MANUFACTURING & SERVICE INDUSTRIES, Issue 3 2008Farman A. Moayed Background The unique properties of nanoparticles (NP) qualify these colloidal systems for a wide range of medical applications, including diagnosis and treatment. Particularly in cancer therapy, NP have significantly enhanced the potential of conventional imaging, radiotherapy, and chemotherapy and, consequently, offered new avenues for early interventions. So far, breast cancer has been one of the most studied cancer types with NP research, which can benefit the occupational breast cancer for the increasing number of women in the labor force in industry. Objectives The objective of this study is to compare the experimental designs of preclinical studies that assessed the effect of doxorubicin NP (DOX-NP) on the estrogen-dependent MCF-7 breast cancer cell line using a recently established quantitative Experimental Appraisal Instrument (ExpAI). Methods A systematic review of research articles published between August 2004 and August 2005 on NP and breast cancer treatment with doxorubicin was performed using various online databases and indexes available through the University of Cincinnati. Restrictive inclusion and exclusion criteria were defined leading to selection of four relevant articles that used comparable experimental designs. Critical appraisal of those studies was performed by five independent assessors using the ExpAI version 2.0 and the results were summarized in a table of evidence. Results The study design in the selected articles was either between groups or mixed, with sample sizes varying from n = 3,6, and the evaluation of the effect of DOX-NP either in vitro or in vivo. The cytotoxic drug doxorubicin was the input variable in all studies, whereas different end points such as pharmacokinetic parameters, cytotoxicity surrogates (e.g., growth inhibition, mitochondrial activity), and quantitative analysis of messenger RNA were used as output variables. Conclusions Although the articles assessed in this article were preclinical experimental studies, the results showed that doxorubicin NP drugs can be used effectively to enhance the delivery process in MCF-7 breast cancer cells by increasing the circulation time and targeting the tumor tissues. Considering the rising number of women in the labor force and the risk of occupational breast cancer, it can be concluded that DOX-NP may potentially be used as an effective anticancer drug on humans, but further research and studies are required to understand how DOX-NP drugs might react in the human body before using it on breast cancer patients. © 2008 Wiley Periodicals, Inc. [source] Children in Foster Care: A Nursing Perspective on Research, Policy, and Child Health IssuesJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 2 2001Mary Margaret GottesmanArticle first published online: 23 FEB 200 ISSUES AND PURPOSE. To examine the roles of public policy and poverty on the rising number of children in family foster care, and to examine the impact of different types of family foster care on children's well-being. CONCLUSIONS. Recent changes in welfare legislation increase the likelihood of family poverty, with a subsequent increase in the number of children in out-of-home care. Greater emphasis needs to be placed on preventing entry into out-of-home care, improving the quality of foster care, and giving children a voice in care decisions. PRACTICE IMPLICATIONS. Nurses have important roles to play in the prevention of family dissolution, the design of healthcare delivery systems for children in foster care, in evaluating and educating all types of foster families, and as advocates in legal and legislative proceedings. [source] Vanishing Trials: The Bankruptcy ExperienceJOURNAL OF EMPIRICAL LEGAL STUDIES, Issue 3 2004Elizabeth Warren The federal bankruptcy system provides two critical points of comparison with data about the overall trends of federal lawsuits and trials. The first is the rising number of bankruptcy filings, which indicates that a growing number of collection actions and debtor-creditor disputes are funneled into the bankruptcy system for relatively quick, cheap resolution. The second point of comparison focuses on adversary proceedings, the lawsuit-like subset of disputes that sometimes are resolved within a bankruptcy. The trend lines here suggest that the number of adversary proceedings filed is climbing, while the number of such disputes that are actually resolved by trial is declining. Like the data about the federal court system generally, these data suggest that the trial is quietly vanishing from the bankruptcy system. Data about the number of judges and about business and nonbusiness bankruptcy cases make it possible to explore two competing hypotheses,a Judicial Workload Hypothesis and a Cost Hypothesis,to explain the overall findings. The data are not conclusive, but they are consistent with the view that judicial workloads explain less of the decline in the number of trials than an increase in litigants' costs of resolving disputes in bankruptcy. The data are also consistent with a vision of bankruptcy as an evolving process that is increasingly standardized (and cheaper) for nonbusiness debtors, while it is highly individualized (and more costly) for business cases. If that vision is right, it has implications both for understanding the changing role of the trial and for considering various statutory proposals to differentiate further the treatment of large business, small business, and nonbusiness cases. [source] Unresolved issues relating to the Shaking Palsy on the celebration of James Parkinson's 250th birthdayMOVEMENT DISORDERS, Issue S17 2007Andrew J. Lees MD Abstract James Parkinson's Essay on the Shaking Palsy published in 1817 provided the first clear clinical description for the disorder now known throughout the world by his name. His primary reason for publishing his monograph shortly before his retirement from medical practice was to draw the medical profession's attention to a malady, which had not yet been defined as a nosological entity. He also hoped that the eminent anatomists of the day would be stimulated to elucidate the pathological lesion responsible for the clinical picture and that this in turn might lead to a rational cure. The concept of Parkinson's disease remains clinically based and successive generations of neurologists have refined and embellished Parkinson's seminal descriptions. Narrative accounts by affected individuals have also helped physicians understand what it is like to live with Parkinson's disease. For many years, the pathological hallmarks of Parkinson's disease were disputed and there were few clinico-pathological reports with adequate clinical description. However, most neurologists now link severe loss of nigral cells in the ventrolateral tier of the pars compacta of the substantia nigra with bradykinesia and the presence of Lewy bodies in a number of discrete brain stem and cortical regions with Parkinson's disease. There are many unanswered clinical questions relating to Parkinson's disease including the striking heterogeneity and frequent limb asymmetry. It also remains somewhat uncertain whether Parkinson's disease is ever truly unilateral by the time of clinical presentation and whether the hand rather than the foot is the most common site of onset. Hyposmia and visual hallucinations are helpful pointers in distinguishing Parkinson's disease from atypical Parkinsonism and should be specifically enquired about in the history. Simple reliable cultural-specific smell identification batteries are an urgent need and target of clinical research. It remains to be determined whether Alzheimer type dementia as opposed to a dysexecutive syndrome should be considered a part of Parkinson's disease and further detailed clinico-pathological correlative studies are needed. It is also unclear whether autosomal dominant monogenetic Parkinsonism due to synuclein or LRRK-2 mutations will prove to be identical clinically with Parkinson's disease and for the present it is wiser to regard Parkinson's disease as a sporadic disorder. Parkinson was an active political reformer and if alive today would certainly be campaigning to translate more effectively the rich seam of neuroscientific research of the last decade into therapeutic benefits for the rising number of people who are developing the shaking palsy as a result of increasing longevity in the developed world. © 2007 Movement Disorder Society [source] Negotiating Multiple Roles in the Field: Dilemmas of Being an Employee/ResearcherNORTH AMERICAN DIALOGUE (ELECTRONIC), Issue 2 2007Ashley Spalding More North Americanists must consider the implications of combining paid work with research since funding for our projects is not keeping up with the rising number of anthropologists conducting research in North America. In this article, I reflect on my own paid work and dissertation research in a divided "mixed income" neighborhood in Tampa, Florida. I negotiated multiple roles conducting research with both middle-class homeowners and low-income renters while working as an employee in one of the neighborhood's low-income apartment complexes. Paid work has advantages beyond making research financially possible. For instance, it enables greater access and insight into particular issues. It can also complicate a researcher's role/s in numerous ways, including how she is perceived by different members of the communities in which she works, and the practical and ethical issues that result. [source] Increasing deaths from opioid analgesics in the United States,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 9 2006Leonard J. Paulozzi MD Abstract Purpose Since 1990, numerous jurisdictions in the United States (US) have reported increases in drug poisoning mortality. During the same time period, the use of opioid analgesics has increased markedly as part of more aggressive pain management. This study documented a dramatic increase in poisoning mortality rates and compared it to sales of opioid analgesics nationwide. Methods Trend analysis of drug poisoning deaths using underlying cause of death and multiple cause of death mortality data from the Centers for Disease Control and Prevention and opioid analgesic sales data from the US Drug Enforcement Administration. Results Unintentional drug poisoning mortality rates increased on average 5.3% per year from 1979 to 1990 and 18.1% per year from 1990 to 2002. The rapid increase during the 1990s reflects the rising number of deaths attributed to narcotics and unspecified drugs. Between 1999 and 2002, the number of opioid analgesic poisonings on death certificates increased 91.2%, while heroin and cocaine poisonings increased 12.4% and 22.8%, respectively. By 2002, opioid analgesic poisoning was listed in 5528 deaths,more than either heroin or cocaine. The increase in deaths generally matched the increase in sales for each type of opioid. The increase in deaths involving methadone tracked the increase in methadone used as an analgesic rather than methadone used in narcotics treatment programs. Conclusions A national epidemic of drug poisoning deaths began in the 1990s. Prescriptions for opioid analgesics also increased in this time frame and may have inadvertently contributed to the increases in drug poisoning deaths. Copyright © 2006 John Wiley & Sons, Ltd. [source] Food Safety Regulation and the Conflict of Interest: The Case of MeatSafety and E. Coli 0157PUBLIC ADMINISTRATION, Issue 3 2000Richard Schofield The Food Standards Agency (FSA) aims to remove the longstanding conflict of interest between producers and consumers which is thought to lie at the heart of the rising number of food safety problems of recent years, to restore consumer confidence, and to protect public health. This paper sets out firstly to understand what the conflicts are, how they arise and their implications for food safety, and secondly to provide some means of evaluating the proposals for the Food Standards Agency. It does this by examining the current food safety regulatory regime as it relates to e. coli 0157, one of the problems that gave rise to the FSA and an exemplar of the problems of meat safety, and places it in its wider economic context. The results show that the financial pressures on the food industry were such that food hygiene was largely dependent upon external regulation and enforcement. But the deficiencies in the conception, design and implementation of the Food Safety Act, which was fundamentally deregulatory and privileged producer interests, permitted the food safety problems to grow. The case also, by illustrating how the interests of big business predominate in the formulation of public policy at the expense of the public, reveals how the class nature of the state affects public policy and social relations. Without addressing these issues, the problems they give rise to will remain. While the case is based on experiences in Britain, the problem of food safety and the issues raised have an international significance. [source] Trends and determinants of caesarean sections births in Queensland, 1997,2006AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 6 2009Stuart HOWELL Background:, The determinants of Queensland's rising caesarean section (CS) rate remain poorly understood because of the historical absence of standard classification methods. Aims:, We applied the Robson Ten Group Classification System (RTGCS) to population-based data to identify the main contributors to Queensland's rising CS rate. Method:, The RTGCS was applied retrospectively to the Queensland Perinatal Data Collection. CS rates were described for all ten RTGCS groups using data from 2006. Trends were evaluated using data for the years 1997,2006. Public and private sector patients were evaluated separately. Results:, In Queensland, in 2006, CS rates were 26.9 and 48.0% among public and private sector patients, respectively. Multiparous women with a previous caesarean birth (Group 5) made the greatest contribution to the CS rate in both sectors, followed by nulliparous women who had labour induced or were delivered by CS prior to the onset of labour (Group 2) and nulliparous women in spontaneous labour (Group 1). CS rates have risen in all RTGCS groups between 1997 and 2006. The trend was pronounced among multiparous women with a previous caesarean delivery (Group 5), among women with multiple pregnancies (Group 8) and among nulliparous women who had labour induced or were delivered by CS prior to the onset of labour (Group 2). Conclusions:, The CS rate in Queensland in 2006 was higher than in any other Australian state. The increase in Queensland's CS rates can be attributed to both the rising number of primary caesarean births and the rising number of repeat caesareans. [source] Migration Control and Migrant Fatalities at the Spanish-African BordersINTERNATIONAL MIGRATION REVIEW, Issue 2 2007Jørgen Carling This article addresses the dynamics of migration control along the Spanish-African borders and the associated problem of migrant deaths. The past decade and a half has seen rising numbers of migration attempts, large investments in control measures, and resulting geographical and organizational responses on the part of smugglers. Advanced surveillance and interception infrastructure on the border is a necessary but far from sufficient element in controlling unauthorized migration. The growth in the number of migrant deaths seems to result from an increased number of migration attempts. The risk of dying in the attempt appears to be constant or slightly falling. [source] Thinking about ageing issuesINTERNATIONAL SOCIAL SECURITY REVIEW, Issue 1 2002Dalmer D. Hoskins Advances in longevity and falling birth rates have a profound impact on our societies, in both the industrialized and developing worlds. Demographic ageing is causing considerable concern, if not alarm, in many circles. Yet the public debate about the future of social security is often lacking in accurate and objective information. It is easier to focus on the "burden" of ageing on society than attempt to better understand the complex, interrelated nature of the issues involved, especially the rising numbers of persons of working age who are inactive and contributing neither taxes nor social security contributions. Whether the mode of pension financing is public or private, retirement income of the non-active older population must be paid out of the economic gains of the younger working population. Social security policy is all about making plans now for future generations. This means more carefully defining the terms of the public debate, articulating more clearly the desired objectives and policies. [source] | |||||||||||||