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Molecular portrait of cisplatin induced response in human testis cancer cell lines based on gene expression profiles.
No full textBACKGROUND: Testicular germ cell tumors (TGCTs) respond well to cisplatin-based chemotherapy and show a low incidence of acquired resistance compared to most somatic tumors. The reasons for these specific characteristics are not known in detail but seem to be multifactorial. We have studied gene expression profiles of testicular and colon cancer derived cell lines treated with cisplatin. The main goal of this study was to identify novel gene expression profiles with their functional categories and the biochemical pathways that are associated with TGCT cells' response to cisplatin. RESULTS: Genes that were differentially expressed between the TGCT cell lines vs the (somatic) HCT116 cell line, after cisplatin treatment, were identified using the significance analysis of microarrays (SAM) method. The response of TGCT cells was strikingly different from that of HCT116, and we identified 1794 genes that were differentially expressed. Functional classification of these genes showed that they participate in a variety of different and widely distributed functional categories and biochemical pathways. Database mining showed significant association of genes (n = 41) induced by cisplatin in our study, and genes previously reported to by expressed in differentiated TGCT cells. We identified 37 p53-responsive genes that were altered after cisplatin exposure. We also identified 40 target genes for two microRNAs, hsa-mir-372 and 373 that may interfere with p53 signaling in TGCTs. The tumor suppressor genes NEO1 and LATS2, and the estrogen receptor gene ESR1, all have binding sites for p53 and hsa-mir-372/373. NEO1 and LATS2 were down-regulated in TGCT cells following cisplatin exposure, while ESR1 was up-regulated in TGCT cells. Cisplatin-induced genes associated with terminal growth arrest through senescence were identified, indicating associations which were not previously described for TGCT cells. CONCLUSION: By linking our gene expression data to publicly available databases and literature, we provide a global pattern of cisplatin induced cellular response that is specific for testicular cancer cell lines. We have identified cisplatin-responsive functional classes and pathways, such as the angiogenesis, Wnt, integrin, and cadherin signaling pathways. The identification of differentially expressed genes in this study may contribute to a better understanding of the unusual sensitivity of TGCT to some DNA-damaging agents
Expression of NDRG2 is down-regulated in high-risk adenomas and colorectal carcinoma.
No full textBACKGROUND: It has recently been shown that NDRG2 mRNA is down-regulated or undetectable in several human cancers and cancer cell-lines. Although the function of NDRG2 is unknown, high NDRG2 expression correlates with improved prognosis in high-grade gliomas. The aim of this study has been to examine NDRG2 mRNA expression in colon cancer. By examining affected and normal tissue from individuals with colorectal adenomas and carcinomas, as well as in healthy individuals, we aim to determine whether and at which stages NDRG2 down-regulation occurs during colonic carcinogenesis. METHODS: Using quantitative RT-PCR, we have determined the mRNA levels for NDRG2 in low-risk (n = 15) and high-risk adenomas (n = 57), colorectal carcinomas (n = 50) and corresponding normal tissue, as well as control tissue from healthy individuals (n = 15). NDRG2 levels were normalised to beta-actin. RESULTS: NDRG2 mRNA levels were lower in colorectal carcinomas compared to normal tissue from the control group (p < 0.001). When comparing adenomas/carcinomas with adjacent normal tissue from the same individual, NDRG2 expression levels were significantly reduced in both high-risk adenoma (p < 0.001) and in colorectal carcinoma (p < 0.001). There was a trend for NDRG2 levels to decrease with increasing Dukes' stage (p < 0.05). CONCLUSION: Our results demonstrate that expression of NDRG2 is down-regulated at a late stage during colorectal carcinogenesis. Future studies are needed to address whether NDRG2 down-regulation is a cause or consequence of the progression of colorectal adenomas to carcinoma
Rusmiddelmisbruk og spiseforstyrrelser. Sammenfall og sammenhenger : en litteraturstudie
No full textNORSK SAMMENDRAG: Det første temakapittelet refererer studier av ungdom og sammenfallende atferd, både i den generelle ungdomsbefolkningen og i behandling for henholdsvis spiseforstyrrelser og rusmiddelmisbruk. De epidemiologiske studiene viser sammenhenger mellom slankeatferd, bulimisk atferd og kroppsmisnøye, – og bruk av tobakk, alkohol og narkotika, blant både gutter og jenter i alderen 10 til 20 år. De kliniske studiene viser at ungdom i behandling for bulimi bruker rusmidler i større grad enn ungdom i behandling for anoreksi. Ungdom i behandling for rusmiddelproblemer ser ut til å vise større grad av spiseforstyrret atferd enn annen ungdom.\ud
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Samvariasjon\ud
Befolkningsstudier av voksne omfatter kvinner i alderen 16 til 59 år. Studiene ser på spiseforstyrrelser/spiseforstyrret atferd i forhold til bruk/misbruk av henholdsvis tobakk, alkohol og narkotika/flere rusmidler. Røyking ser ut til i en viss grad å samvariere med spiseforstyrrelser/spiseforstyrret atferd, misnøye med kroppen, vektfobi, lav selvfølelse samt sosial utrygghet. Kvinner med diagnostisert bulimi eller med bulimisk spiseforstyrret atferd misbruker og/eller opplever negative konsekvenser av alkohol i større grad enn andre kvinner. Det samme gjelder for bruk av narkotiske stoffer.\ud
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Bulimi og rusmidler\ud
Studier av voksne i behandling for enten spiseforstyrrelser eller rusmiddelproblemer viser at kvinner i behandling for bulimi røyker, drikker og bruker mer narkotika og legemidler utover det foreskrevne, enn kvinner i behandling for anoreksi. Sammenlignet med prevalenstall for befolkningen for øvrig, ser det ut til at kvinner i behandling for bulimi viser en høyere frekvens enn kvinner generelt når det gjelder bruk av tobakk, alkohol, narkotika og legemidler utover det foreskrevne. Blant kvinner og menn i behandling for rusmiddelmisbruk kan det synes som om fullt utviklede spiseforstyrrelser (spesielt av typen bulimi) eller spiseforstyrret atferd er mer utbredt enn i den øvrige befolkningen.\ud
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Kjønnsfordeling\ud
Når det gjelder kjønnsfordelingen, ser vi at for voksne utgjør kvinner majoriteten av utvalget med komorbide lidelser, i likhet med utvalg med spiseforstyrrelser. Når det gjelder ungdom ser vi imidlertid en økt hyppighet av spiseforstyrret atferd blant gutter, slik at den sammenfallende problematferden er likere fordelt mellom kjønnene. Sammenhenger mellom spiseforstyrret atferd og bruk av rusmidler er til dels like sterke eller sterkere for guttene.\ud
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Kvinner og menn, jenter og gutter, som lider av både spiseforstyrrelser og rusmiddelmisbruk ser ut til å utvikle spiseforstyrrelser først og rusmiddelproblemer senere. Dette er i tråd med det vi vet om debutalder for de to lidelsene hver for seg.\ud
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Årsaker til samvariasjon\ud
Det siste kapittelet gjengir mulige årsaksforklaringer til samvariasjoner mellom rusmiddelmisbruk og spiseforstyrrelser. Vi deler forklaringene inn i biologiske, psykologiske og kulturelle årsaksforklaringer, der de biologiske inkluderer forklaringer med utgangspunkt i hjernens impulser og nervebaner, genetisk arv og kroppslig utvikling. De psykologiske forklaringstypene berører temaer som selvfølelse, mestring, impulsivitet, psykologisk avhengighet, traumatiske erfaringer, samt andre psykiske lidelser (særlig depresjon, angst, personlighetsforstyrrelser). Kulturelle forklaringer omfatter her jevnaldrene og massemedia.\ud
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Hjernefysiologi, impulsivitet, selvfølelse og flere psykiske lidelser ser ut til å være forklaringstyper som samler støtte. Gjennomgangen antyder også at mange faktorer synes å virke sammen i utvikling av sammenfallende spiseforstyrrelser og rusmiddelmisbruk, for eksempel i form av disponerende, utløsende og vedlikeholdende faktorer. Det er imidlertid få studier som beveger seg inn i de komplekse relasjonene mellom forklaringstyper.\ud
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De inkluderte artiklene inneholder i liten grad håndgripelige råd om forebygging og behandling, bortsett fra en sterk anbefaling av kartlegging. I norsk sammenheng står vi overfor store utfordringer når det gjelder både kartlegging og dokumentasjon av de sammensatte lidelsene, forebygging, utvikling av behandlingsmodeller og forskning. Mangelen på kvalitative forskningsbidrag og fenomenologisk kunnskap på dette området, også internasjonalt, er iøyenfallende.ENGLISH SUMMARY: This is a literature study of co-occurence and connections between eating disorders and substance abuse. The object of this report is to give a presentation of relevant international studies of co-occurence and co-morbidity between eating disorders or disordered eating and use or abuse of various substances.\ud
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We have reviewed 55 clinical and community studies from 1986 to 2005, mainly from North America and Western Europe, as well as five reviews/reports and a number of theme articles. This report consists of eight chapters, including an introductory chapter. Chapter two describes substance abuse and eating disorders providing definitions, prevalence and instruments for measurement. The next five chapters are based on types of studies, all with introductory information about the studies, the samples, and the use of tests.\ud
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Chapter three includes studies of co-occurring problem behaviours among youth, focusing both on youth in general and on youth residing in treatment for either eating disorders or substance abuse. According to the community studies, there are links between dieting, bulimic behaviour and body dissatisfaction, on one side, and the use of cigarettes, alcohol and drugs (illegal substances) on the other among both boys and girls ages 10 to 20. The clinical studies demonstrate that young people in treatment for bulimia nervosa use more substances than young people in treatment for anorexia nervosa. Young people in treatment for substance abuse show more disordered eating than young people in general.\ud
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Community studies of adults include women aged 16 to 59. The topic is eating disorders/disordered eating in relations to tobacco, alcohol and drugs. Smoking shows some co-occurrence with eating disorders/disordered eating, body dissatisfaction, drive for thinness, ineffectiveness and social insecurity. To a larger extent than women in general, women with diagnostic bulimia or with bulimic disordered eating abuse alcohol and/or experience negative consequences of alcohol. The pattern is similar for the use of drugs.\ud
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Studies of adults in treatment for either eating disorders or substance abuse show that women in treatment for bulimia smoke more cigarettes, drink more alcohol and use more drugs and psychotropics (by self-prescription), than women in treatment for anorexia. Compared to prevalence numbers for women in general, women in treatment for bulimia seem to show a higher prevalence concerning use of tobacco, alcohol, drugs and psychotropics (by self-prescription). Among men and women in treatment for substance abuse, full-blown eating disorders (especially bulimia) or disordered eating is more prevalent than in others.\ud
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The included studies demonstrate that for adults, women constitute the majority of those with comorbid eating disorders and substance abuse, as they constitute the majority of those with eating disorders only. For youngsters we find an elevated frequency of eating disorders among boys, making the comorbid problem behaviours more equally distributed among the sexes. The connections between disordered eating and use of substances seem to a certain extent to be equally strong or stronger among boys than girls.\ud
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Women and men, girls and boys, suffering from both eating disorders and substance abuse, predominantly develop eating disorders first and substance abuse later. This is congruent with what we know about age of onset for each of the two disorders.\ud
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The last chapter of this report looks at various possible risks or reasons for the co-occurence between substance abuse and eating disorders. Dividing them into biological, psychological and cultural explanations, the biological explanations include brain impulses and circuits, genetics and physical development. The psychological explanations concern self-esteem, coping, addiction, traumas, and psychiatric diagnoses (especially major depression, anxiety and personality disorders). Cultural explanations include influence from peers and mass media. Brain physiology, impulsivity, self-esteem and additional psychopathology seem to be the most common type of explanations. The review of the articles also suggests that various factors can play together in the development of comorbid eating disorders and substance abuse, for instance as predisposing, eliciting and maintaining factors.\ud
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The included articles offer little advice on prevention and treatment but strongly recommend screening/testing for substance abuse when dealing with eating disorders, and vice versa. In Norway we face great challenges regarding documenting and prevention, developing of treatment models, and further research. There is an obvious scarcity of qualitative research and phenomenological knowledge in the field
Klagesaker – pest, plage eller inspirasjonskilde?
No full textFra 1980-årene og framover har behandlingen av klagesaker vært brukt som en del av arbeidet for å sikre kvaliteten i helsetjenesten. Det har imidlertid vist seg at hvis dette skal fungere etter ønske som rettledning og inspirasjon til forbedring, og ikke bare som en sanksjon mot de personer som berøres, fordres en god del kulturforandring også innen helseprofesjonene
Symbols were superior to numbers for presenting strength of recommendations to health care consumers: a randomized trial.
No full textOBJECTIVE: To compare health care consumers' understanding, evaluations, and preferences for symbols vs. numbers and letters for the representation of strength of recommendations (SOR) and quality of evidence (QOE). STUDY DESIGN AND SETTING: Questionnaire study in a randomized controlled design in the setting of a community health education program. RESULTS: Eighty-four participants completed the questionnaire. For the presentation of the SOR, participants had better objective understanding of symbols than numbers (74% vs. 14%, P<0.001). They also scored symbols positively, and numbers negatively for ease of understanding (mean difference [md]=1.5, P=0.001), clearness and conciseness (md=1.5, P<0.001), and conveyance of the degree of uncertainty (md=0.7, P=0.092). About half (48%) preferred symbols over numbers. For the presentation of the QOE, objective understanding of symbols and letters was similar (91% vs. 95%, P=0.509). Participants scored both symbols and letters positively; the scores for symbols were however lower for ease of understanding (md=-0.7, P=0.019), clearness and conciseness (md=-0.6, P=0.051), and conveyance of the QOE (md=-0.4, P=0.24). CONCLUSION: Symbols were superior to numbers for the presentation of the SOR. Objective understanding was high for both symbols and letters for the presentation of the QOE, but letters conveyed the QOE better than symbols
Samhandling om pasienter med alvorlige psykiske problemer i allmennpraksis.
No full textKey messages\ud
The Norwegian Knowledge Centre for the Health Services (NOKC) was asked to perform\ud
a systematic review of effects of enhanced collaboration initiatives to improve\ud
the management of serious mental illness in primary care settings. The request came\ud
in autumn 2006 from the Norwegian Directorate for Health and Social Affairs in autumn\ud
2006. The review was conducted by NOKC staff as well as a group of experts\ud
from the field.\ud
We searched electronic databases: EPOC, Medline, Psych info, Cochrane Library\ud
and EMBASE. We selected 19 studies, nine systematic reviews and ten primary studies.\ud
Outcomes relating to changes in process of care and patient-related outcome of\ud
treatment were sought together with costs and cost- effectiveness data.\ud
Methodological details and outcomes were extracted and checked by two reviewers.\ud
Most primary studies were conducted in the US primary health-care system, often in\ud
Health Maintenance Organizations (HMOs) or at university clinics. We did not find\ud
any Norwegian or Nordic effect studies which satisfied our inclusion criteria.\ud
A narrative synthesis was conducted.\ud
Multifaceted collaborative care treatment for major depression or/and anxiety disorders\ud
which combine educative and organizational initiatives improve patient outcomes\ud
and increase the quality of treatment compare to usual care. The intervention\ud
group had greater reduction in symptoms and remission rates along with better adherence\ud
to treatment. The effect size was moderate.\ud
Following factors seem vital for the effect: integration of collaborative care initiatives\ud
at all organizational levels, coordinate and patient-focused health services, integrated\ud
specialist mental health care in primary care, clinician and patient education,\ud
active monitoring of patients with feedback to primary care physician. Collaborative\ud
care across organizational levels and professions seems to increase total costs\ud
for health services and to consume more resources. Transferability of these models\ud
of collaborative care in the Norwegian health care system has to be evaluated from\ud
case to case.\ud
We did not identify any effect studies of collaboration initiatives between general\ud
practitioner and professions outside the health care system. There is a sparse evi7\ud
For ord\ud
dence for the effect of collaborative treatment care for patients with schizophrenia,\ud
psychosis or other personality and behavioral disorders
Regionprosjektet – Nyttig forebygging? Evalueringen av et pilotprosjekt om lokalbasert rusforebygging
No full textNORSK SAMMENDRAG: Rapporten er en evaluering av Regionprosjektet, et statlig styrt, lokalt basert forebyggingsprosjekt som ble initiert av Bondevik II-regjeringen. Ingeborg Rossow, Bergljot Baklien, Hilde Pape og Elisabet E. Storvoll står bak evalueringen, som er gjort på oppdrag av det tidligere Sosialdepartementet. Analysene bygger på et omfattende datamateriale der bl.a. intervjuer med aktører på sentralt og lokalt nivå, observasjon av møter og iverksetting av tiltak, spørreskjemaundersøkelser av 40 000 skoleungdommer og kjøpsforsøk i butikker som selger øl inngår.\ud
Ingen kortsiktige effekter\ud
Regionprosjektet hovedmålsetting om å redusere rusmiddelbruk og begrense rusrelaterte skader blant ungdom ble ikke innfridd i løpet av den perioden som evalueringen dekker (2004-2006). Prosjektet bidro heller ikke til å begrense ungdoms tilgang på alkohol.\ud
Rapporten peker på flere mulige forklaringer på de manglende resultatene. Bare et fåtall av tiltakene som kommunene ble anbefalt av Sosial- og helsedirektoratet hadde dokumentert effekt på rusmiddelbruk og rusrelaterte skader. Mange av tiltakene hadde et langt tidsperspektiv og noen ble satt i gang i ufullstendige "light"-versjoner.\ud
Samarbeid og ny kunnskap\ud
Regionprosjektet har derimot ført til at en del av kommunene har etablert nye tverrfaglige samarbeidsformer både internt og seg i mellom. Når det gjelder tilpasning og videreutvikling av forebyggingstiltak, har dessuten den lokale kompetansen økt. Organiseringen i kommunene har vært funksjonell, og prosjektet har hatt god politisk og administrativ forankring lokalt. Samarbeidet med Sosial- og helsedirektoratet på sentralt nivå opplevde derimot mange av de involverte kommunene som problematisk.\ud
Framtidig forebygging\ud
Rapporten peker på at ingen av kommunene i Regionprosjektet har tatt i bruk de mest virksomme strategiene i rusforebygging. Forskning viser at det å begrense tilgjengeligheten på alkohol har effekt. Strengere håndheving av salgs- og skjenkebestemmelsene kan også være virksomme forebyggingstiltak.\ud
Fakta om Regionprosjektet\ud
Regionprosjektet var en del av Bondevik II-regjeringens Handlingsplan mot rusmiddelproblemer (2003-2005). Hovedmålsettingen var å utvikle gode forebyggende tiltak og å videreutvikle eksisterende tiltak med sikte på å begrense rusmiddelbruk og rusmiddelrelaterte skader, med hovedfokus på barn og unge.\ud
Seks kommuner/regioner ble valgt ut til å delta i prosjektet: Larvik, Haugesund, Narvik, Os, Nesodden og fire kommuner på Ytre Søre Sunnmøre. De mottok til sammen 20 millioner kroner over en periode på tre år, og fikk i tillegg faglig veiledning fra de regionale kompetansesentrene for rusmiddelspørsmål. Sosial- og helsedirektoratet sto for den sentrale styringen av prosjektet.ENGLISH ABSTRACT: This report deals with the evaluation of the Regional Project. This project was part of the Plan of Action to Prevent Alcohol and Drug Problems (2003-2005) of the Norwegian Government under Prime Minister Bondevik (II). As we interpret the Plan of Action, the main aim of the project was to develop effective preventive measures and to develop further existing measures with a view to limiting the use of alcohol and drugs, and harms related to substance use, with the main focus on children and young people.\ud
Six municipalities / regions (called test municipalities) were chosen to participate in the Regional Project. Altogether they were granted NOK 20 million over a period of three years; the amount per municipality reflected the population size. In addition they were given professional guidance from the Regional Resource Centres for Alcohol and Drug Issues. The Norwegian Directorate for Health and Social Affairs was responsible for the central management of the project.\ud
The aims of the evaluation were:\ud
• to assess how the intentions of the Plan of Action were translated and interpreted by the Norwegian Directorate for Health and Social Affairs, and subsequently by the test municipalities\ud
• to find out how the extra allocation of funding for preventive work in the field of alcohol and drug problems, together with central management and professional follow-up from the Regional Resource Centres, were transformed into measures at the local level\ud
• to investigate how organization of the Regional Project, both centrally and locally, influenced the implementation and accomplishment of the measures\ud
• to identify whether there were indications that the activities had resulted in reduced use of alcohol and drugs, fewer alcohol-related problems, and more limited availability of alcohol for young people under the age-limit\ud
• to find out whether the use of resources had had other positive effects in the local community, for example in the form of increased skills or new structures for cooperation\ud
• to highlight positive experiences that can be developed in other locally-based measures.\ud
We carried out both process and effect evaluation of the Regional Project. The analyses were based on a comprehensive data material, which included documents, videos, observations of meetings and implementation of measures, a large number of interviews with key persons at the central and local levels, questionnaire surveys of almost 40 000 school children in the test and control municipalities before and after implementation of the measures, attempts to buy beer in shops before and after the measures, and a survey of preventive activities in all the lower secondary and upper secondary schools in all the test and control municipalities during the project period.\ud
A central working group for the project was appointed with representatives from all the seven Regional Resource Centres and the central project leader in the Norwegian Directorate for Health and Social Affairs. In addition to professional follow-up of the test municipalities, the Regional Resource Centres acted as coordinators between the central and local levels. This organization meant that the test municipalities had limited influence on the central management of the project.\ud
The Norwegian Directorate for Health and Social Affairs operationalized the Plan of Action, and developed a list of twelve recommended preventive measures. However, only a few of these measures had documented effect on substance use and related harms. This recommendation of preventive measures reduced the sense of ownership of the intervention at the local level\ud
Follow up from the Regional Resource Centres varied between the municipalities both in extent and content. The local conditions for implementation also varied, both with regard to continuation of established projects and cooperation, and with regard to organization of the project.\ud
At the start of the project, the management of the project by the Directorate was fairly strong and detailed. Moreover, communication from the central to the local level was unclear, both with respect to the time scale for the project, how much funding each test municipality would receive, and whether the municipalities could choose measures that were not on the list. The unclear signals from the central level led to frustration as well as a delay in implementation of measures the local level.\ud
The test municipalities’ own considerations (regarding factors such as whether the measures were easy to implement) were of primary importance when the test municipalities chose preventive measures. In addition to the measures on the Directorate’s list, most of the municipalities also chose a range of other interventions. In several cases this involved continuation of projects that were already underway. Children and young people were the most important target groups, and many of the measures had a long-term perspective. Not all the measures were implemented according to the plan. Several of the municipalities implemented more measures than they had originally committed themselves to, and we saw much enthusiasm and drive in the test municipalities.\ud
Effect evaluation was primarily based on questionnaire surveys of 13-19 year old school children in the test municipalities and in seven control municipalities. The results gave no indication that the Regional Project had led to reduced alcohol use, drug use or related harms. There was also nothing to indicate that the project had contributed to limiting the availability of alcohol to young people. The analyses also did not give any indication that the Regional Project had contributed to improving young people’s knowledge or changing their attitudes to alcohol and drugs, or to the limits set by parents with regard to alcohol and drugs, or parents’ communication about this. We also evaluated the effect of one measure, for which the aim was to limit sale of alcohol to young people under the age-limit, and found no effects.\ud
There are several possible explanations for the discouraging results of the effect evaluation: The measures had very limited potential for prevention, several measures had long-term perspectives and some of them were implemented as incomplete “light versions”. It is also worth mentioning that background figures indicate that the number of establishments for selling and serving alcohol in the test municipalities was relatively stable during the project period.\ud
However, the Regional Project seems to have had other positive effects. Local coordination and local ownership were central concepts in the Plan of Action. The project’s only example of inter-municipal cooperation and coordination showed that this is both demanding and productive. Some municipalities had their own coordination measures, and they all succeeded in improving multi-sectoral and inter-agency cooperation. In addition, local skills in adaptation and development of measures were improved.\ud
The local organization in the test municipalities was generally good and functioned well, and led to coordination of personnel resources between agencies and departments. The Regional Project had a sound political basis in most of the test municipalities, as a result of both the involvement and active commitment of the chairperson of the municipal council and the chief municipal executive. Personal factors such as enthusiasm and competence, legitimacy and ability to find room to manoeuvre, were important for the project at all levels.\ud
Another important experience gained was related to the time-scale. Several of the municipalities regarded prevention of alcohol and drug problems as long-term work. Both building the foundation and implementing the work take time, but the centrally-determined time-scale took little account of long-term ambitions.\ud
In conclusion, we found that the Regional Project achieved the aims of the Plan of Action only in some areas. This was primarily in the areas of local coordination and cooperation. We found no evidence that the main aims of limiting use of alcohol and drugs, limiting alcohol related harms, and limiting availability of alcohol to young people, were achieved. This is probably related to the fact that none of the municipalities implemented measures that are most likely to be effective; - i.e. limiting the availability of alcohol (number and opening hours of outlets), and increased enforcement of alcohol sales regulations (controls and sanctions)
Factors influencing the utilization of research findings by health policy-makers in a developing country: the selection of Mali's essential medicines.
No full textBACKGROUND: Research findings are increasingly being recognized as an important input in the formation of health policy. There is concern that research findings are not being utilized by health policy-makers to the extent that they could be. The factors influencing the utilization of various types of research by health policy-makers are beginning to emerge in the literature, however there is still little known about these factors in developing countries. The object of this study was to explore these factors by examining the policy-making process for a pharmaceutical policy common in developing countries; an essential medicines list. METHODS: A study of the selection and updating of Mali's national essential medicines list was undertaken using qualitative methods. In-depth semi-structured interviews and a natural group discussion were held with national policy-makers, most specifically members of the national commission that selects and updates the country's list. The resulting text was analyzed using a phenomenological approach. A document analysis was also performed. RESULTS: Several factors emerged from the textual data that appear to be influencing the utilization of health research findings for these policy-makers. These factors include: access to information, relevance of the research, use of research perceived as a time consuming process, trust in the research, authority of those who presented their view, competency in research methods, priority of research in the policy process, and accountability. CONCLUSION: Improving the transfer of research to policy will require effort on the part of researchers, policy-makers, and third parties. This will include: collaboration between researchers and policy-makers, increased production and dissemination of relevant and useful research, and continued and improved technical support from networks and multi-national organizations. Policy-makers from developing countries will then be better equipped to make informed decisions concerning their health policy issues
Implementation of the Obligations of the Convention on Nuclear Safety in Norway. The Fourth Norwegian Report in Accordance with Article 5 of the Convention
No full textBasert på rapporteringen under de relevante artikler i kjernesikkerhetskonvensjonen for en part\ud
uten nukleære installasjoner på sitt territorium, konkluderes det med at Norge overholder sine\ud
forpliktelser under konvensjonen.The fourth Norwegian report in accordance with Article 5 of the Convention on Nuclear Safety\ud
concludes that Norway is in compliance with its obligations under the convention
Introduction of a novel magnetic resonance imaging tenosynovitis score for rheumatoid arthritis: reliability in a multireader longitudinal study.
No full textOBJECTIVES: To describe a novel scoring system for the assessment of tenosynovitis by magnetic resonance imaging (MRI) in patients with rheumatoid arthritis, and assess its intra- and inter-reader reliability in a multireader, longitudinal setting. METHODS: Flexor and extensor tenosynovitis were evaluated at the level of the wrist in 10 different anatomical areas, graded semi-quantitatively from grade 0 to 3 (total score 0-30), based on the maximum width of post-contrast enhancement within each anatomical area on axial T1-weighted MR images. Ten sets of baseline and 1-year follow-up MR images of the wrists of patients with rheumatoid arthritis with early and established disease were scored independently by four readers twice on 2 consecutive days. Intra- and inter-reader agreements were evaluated. RESULTS: The intrareader intraclass correlation coefficients (ICCs) were high for status scores (median ICCs 0.84-0.88) and slightly lower for change score (0.74). The smallest detectable difference (SDD) in % of the maximum score was 11.2-11.5% for status scores and 13.3% for change scores. Inter-reader single-measure ICCs were acceptable for both status scores (median 0.73-0.74) and change scores (0.67), while average-measures ICCs were very high for both status and change score (all > or =0.94). The median scoring time per patient (baseline and follow-up images) was 7 min (range 3-10). CONCLUSIONS: The introduced tenosynovitis scoring system demonstrates a high degree of multireader reliability, is feasible, and may be used as an adjuvant to the existing OMERACT RAMRIS score, allowing improved quantification of inflammatory soft tissue changes in patients with rheumatoid arthritis