bluuebunny/crossref_metadata_2025 huggingface dataset:
Sobrepeso em adolescentes de 14 a 19 anos em um município da região Sul do Brasil
Authors: Costa Marcia Cristina Dalla , Cordoni Junior Luiz , Matsuo Tiemi
Published: October 2007

OBJETIVOS: identificar a freqüência de sobrepeso em adolescentes, bem como os fatores ambientais, biológicos e socioeconômicos associados, no município de Toledo, Paraná. MÉTODOS: estudo transversal desenvolvido com adolescentes matriculados no ensino médio, de 14 a 19 anos, do período diurno da área urbana do município. Adotou-se o índice de massa corporal/idade para diagnosticar exposição ao risco de sobrepeso. Utilizou-se um questionário pré-testado para levantamento dos dados pessoais, antropométricos, biológicos e hábitos, como: usar TV, vídeo e computador, praticar esportes e freqüência das refeições. Para a situação socioeconômica, foi utilizado o critério de Classificação Econômica Brasil da Associação Nacional de Empresas de Pesquisa. RESULTADOS: dos adolescentes, 3,8% apresentaram baixo peso e 10,2% sobrepeso. Associação estatisticamente significativa foi encontrada para a freqüência de sobrepeso entre os adolescentes que realizavam quatro ou mais refeições/dia (5,5%) e entre aqueles que realizavam até três refeições/dia (16,3%). Ao estratificar o sobrepeso por classes econômicas, as freqüências mostram uma tendência de decréscimo de sobrepeso com a queda da classe econômica. CONCLUSÕES: a prevalência de sobrepeso é superior à de baixo peso, o qual se encontra abaixo dos índices identificados em outros municípios brasileiros. Menor número de refeições e classes econômicas mais elevadas apresentaram associação com o sobrepeso.
Fatores associados à ocorrência de cesárea e aborto em mulheres selecionadas em um centro de saúde no município do Rio de Janeiro, Brasil
Authors: Kac Gilberto , Silveira Erika Aparecida , Oliveira Lívia Costa de , Araújo Daniele Marano Rocha , Sousa Elton Bicalho de
Published: October 2007

OBJETIVOS: investigar fatores potencialmente associados à ocorrência de cesárea e aborto. MÉTODOS: foram analisados dados de uma coorte no pós-parto com 352 mulheres entre 15-45 anos. Os seguintes desfechos foram estudados: ocorrência de cesárea no último parto e ocorrência de aborto anterior à última gravidez. A análise estatística foi feita por meio de modelos de regressão logística multivariados e hierarquizados. RESULTADOS: as prevalências de cesárea e aborto foram de 36,3% e 34,0%, respectivamente. O modelo final revelou que as seguintes variáveis permaneceram estatisticamente associadas à ocorrência de cesárea: nível 1: cor de pele branca (OR=2,02; IC95%: 1,29-3,16); nível 2: ligadura (OR=19,68; IC95%: 5,77-67,15). As seguintes variáveis permane-ceram associadas à ocorrência de aborto: nível 1: idade >29 anos (OR=6,11; IC95%: 2,94-12,72), estado marital: vive em união (OR=4,22; IC95%: 2,03-8,78); solteira: (OR=3,70; IC95%: 1,59-8,61). CONCLUSÕES: a cor de pele branca e a prática de ligadura foram co-variáveis potencialmente associadas à ocorrência de cesárea, enquanto o estado marital em união ou solteira e a idade materna estiveram associadas à ocorrência de aborto, sendo maior a probabilidade para mulheres acima de 29 anos.
Morbidade hospitalar em crianças indígenas Suruí menores de dez anos, Rondônia, Brasil: 2000 a 2004
Authors: Orellana Jesem Douglas Yamall , Basta Paulo Cesar , Santos Ricardo Ventura , Coimbra Jr. Carlos E.A.
Published: October 2007

OBJETIVOS: analisar o perfil de morbidade hospitalar de crianças indígenas atendidas na rede de serviços do Sistema Único de Saúde. MÉTODOS: Foram investigados 380 registros de internação hospitalar de crianças indígenas Suruí menores de 10 anos de idade atendidas na rede hospitalar do município de Cacoal, Rondônia, a partir de dados coletados no Hospital Materno-Infantil, instituição pública, e no Hospital Infantil e Maternidade Menino Jesus, instituição particular, no período de 2000 a 2004. Esses dois hospitais concentram o atendimento a indígenas no município. Utilizou-se a Classificação Internacional de Doenças (CID), 10.ª revisão, para a classificação dos diagnósticos. RESULTADOS: as doenças do aparelho respiratório - Cap. X (58,2%) figuraram como o principal motivo de internação hospitalar. Doenças infecciosas e parasitárias (Cap I) apresentaram-se como a segunda maior causa (35,0%) e afecções originadas no período perinatal (Cap XVI) como a terceira (3,2%). Outras causas contribuíram individualmente com menos de 1,5% do total, que somadas não atingiram 4%. A maioria das internações (65,5%) foram de crianças <2 anos de idade. O tempo médio de internação foi significativamente superior no hospital público em relação ao privado. CONCLUSÕES: O perfil de morbidade hospitalar observado nas crianças Suruí evidencia não somente a precariedade das suas condições de saúde, como também problemas estruturais no que tange às ações de atenção básica. Recomenda-se a realização de estudos que visem aprofundar aspectos epidemiológicos relacionados às internações hospitalares em populações indígenas, fundamentais para o desenvolvimento de ações de saúde mais adequadas.
Percepção das mães sobre o cuidado do bebê de baixo peso antes e após implantação do Método Mãe-Canguru em hospital público da cidade de São Paulo, Brasil
Authors: Toma Tereza Setsuko , Venâncio Sonia Isoyama , Andretto Daniela de Almeida
Published: October 2007

OBJETIVOS: aumentar a compreensão sobre os diferentes modos que as famílias de baixa renda lidam com o nascimento de um bebê pré-termo, com vistas a aprimorar a implantação do Método Mãe-Canguru (MMC). MÉTODO: estudo qualitativo realizado em São Paulo, estado de São Paulo, em 2004, no qual foram entrevistadas 19 mães antes e 22 mães após implantação do MMC. O roteiro de entrevistas incluía questões abertas, das quais emergiram as informações sobre como as mães cuidaram de seus bebês de baixo peso, os arranjos domésticos e outras medidas a que recorreram. Para análise utilizou-se a abordagem da Grounded Theory. RESULTADOS: a necessidade de cuidar de outros filhos parece ser um dos principais limitadores para a opção ao MMC. Em comparação às mães entrevistadas antes da implantação do programa, as mães-cangurus eram mais jovens, mais escolarizadas, sem outros filhos, recebiam mais ajuda nas tarefas domésticas e relataram menos dificuldades na amamentação. CONCLUSÕES: a oferta do MMC em uma maternidade da periferia de São Paulo sugere efeitos positivos sobre a amamentação. A tendência à conformação de famílias nucleares dificulta a participação das mulheres no programa. Conhecer as limitações e possibilidades de cada família pode contribuir para o aperfeiçoamento do processo de implantação.
Studies on estrogen receptor (ER) α and β responses on gene regulation in peripheral blood leukocytes in vivo using selective ER agonists
Authors: Stygar Denis , Masironi Britt , Eriksson Håkan , Sahlin Lena
Published: October 2007

Major reproductive events such as menstruation, ovulation, implantation, and cervical ripening are characterized by an increased number of invading leukocytes in the tissues. Sex steroid hormones, particularly estrogens, play an important role in these dynamic changes in the female reproductive tract. Estrogens have also been implicated in the pathogenesis of many common pathological conditions associated with leukocyte infiltration and immunological dysfunction, such as auto-immune diseases and atherosclerosis. Although the two estrogen receptor (ER) subtypes, ERα and ERβ, have been found in different leukocyte populations in tissues and in peripheral blood, there is still very little known about functional activity and importance of ERs in blood cells. To elucidate the different roles for ERα and ERβ in peripheral blood leukocytes, we used microarray gene expression profiling of rat peripheral blood leukocytes subjected to in vivo treatment with estradiol (E2), the selective ERα agonist 4,4′,4″-(4-propyl-[1H]-pyrazole-1,3,5-triyl)trisphenol (PPT), and the selective ERβ agonist 2,3-bis(4-hydroxyphenyl)-propionitrile (DPN). We report the identification of genes that were commonly regulated by E2, PPT, and DPN, and genes that were regulated either by the ERα or ERβ agonist. Further confirmatory analyses of the selected regulated genes 12-lipoxygenase, fibulin-1, furin, and calgranulin B are also presented. These results were then compared with those from the uterine tissue of the same animals. Our study demonstrates that peripheral blood leukocytes are responsive to estrogens. E2 and selective ERα and ERβ agonists regulate a number of genes that may contribute to inflammation and remodeling of the extracellular matrix.
Spatial and temporal regulation of GH–IGF-related gene expression in growth plate cartilage
Authors: Parker E A , Hegde A , Buckley M , Barnes K M , Baron J , Nilsson O
Published: October 2007

Previous studies of the GH–IGF system gene expression in growth plate using immunohistochemistry and in situ hybridization have yielded conflicting results. We therefore studied the spatial and temporal patterns of mRNA expression of the GH–IGF system in the rat proximal tibial growth plate quantitatively. Growth plates were microdissected into individual zones. RNA was extracted, reverse transcribed and analyzed by real-time PCR. In 1-week-old animals, IGF-I mRNA expression was minimal in growth plate compared with perichondrium, metaphyseal bone, muscle, and liver (70-, 130-, 215-, and 400-fold less). In contrast, IGF-II mRNA was expressed at higher levels than in bone and liver (65- and 2-fold). IGF-II expression was higher in the proliferative and resting zones compared with the hypertrophic zone (P < 0.001). GH receptor and type 1 and 2 IGF receptors were expressed throughout the growth plate. Expression of IGF-binding proteins (IGFBPs)-1 through -6 mRNA was low throughout the growth plate compared with perichondrium and bone. With increasing age (3-, 6-, 9-, and 12-week castrated rats), IGF-I mRNA levels increased in the proliferative zone (PZ) but remained at least tenfold lower than levels in perichondrium and bone. IGF-II mRNA decreased dramatically in PZ (780-fold; P < 0.001) whereas, type 2 IGF receptor and IGFBP-1, IGFBP-2, IGFBP-3, and IGFBP-4 increased significantly with age in growth plate and/or surrounding perichondrium and bone. These data suggest that IGF-I protein in the growth plate is not produced primarily by the chondrocytes themselves. Instead, it derives from surrounding perichondrium and bone. In addition, the decrease in growth velocity that occurs with age may be caused, in part, by decreasing expression of IGF-II and increasing expression of type 2 IGF receptor and multiple IGFBPs.
Neonatal exposure to bisphenol A modifies the abundance of estrogen receptor α transcripts with alternative 5′-untranslated regions in the female rat preoptic area
Authors: Monje Lucas , Varayoud Jorgelina , Luque Enrique H , Ramos Jorge G
Published: October 2007

The xenoestrogen bisphenol A (BPA) is commonly ingested by humans. We examined the effects of neonatal exposure to low versus high doses of BPA over the control of estrogen receptor α (ERα) expression in the preoptic area (POA) of prepubertal female rats. Pups received s.c. injections every 48 h of BPA (high dose, 20 mg/kg and low dose, 0.05 mg/kg) or diethylstilbestrol (DES, 0.02 mg/kg) from postnatal day (PND) 1 to PND7 and were killed at PND8 or PND21. Relative expression of ERα transcripts containing alternative 5′-untranslated regions OS, ON, O, OT, and E1 in POA were evaluated by RT-PCR. Methylation status of ERα promoters was determined by bisulfited DNA restriction analysis and ERα protein by immunohistochemistry. In PND8, the high dose of BPA and DES diminished total ERα mRNA levels, mediated by the decreased expression of ERα-O and ERα-OT variants. In contrast, the low dose of BPA augmented total ERα mRNA by increasing the expression of the ERα-E1 variant. In PND21, both BPA doses increased total ERα mRNA by means of the augmented expression of ERα-O and ERα-OT variants. In PND21, the methylation status of the ERα promoters and the circulating levels of estradiol were similar in all experimental groups. At PND8 and PND21, DES and the high dose of BPA decreased, while the low dose of BPA increased ERα protein in the POA. These findings show that neonatal BPA exposure alters the abundance of hypothalamic ERα transcript variants and protein in a dose-dependent manner.
The effects of intrauterine undernutrition on pancreas ghrelin and insulin expression in neonate rats
Authors: Wang Xiumin , Liang Li , Du Lizhong
Published: October 2007

Ghrelin has a correlation with insulin secretion, β-cell development, and diabetes in crucial development period. The aim of this study was to compare the changes in plasma ghrelin, insulin, and glucose concentrations, and variation of ghrelin expression in the pancreas in response to intrauterine malnutrition in newborn rats. Pregnant rats at day 2 were randomly divided into two groups: nourished (fed ad libitum; NR) and undernourished rats (UR). The offspring of NR were defined as normal-birth-weight group (NBW, n = 79) and those of UR were defined as low-birth-weight group (LBW, n = 74). Plasma glucose, ghrelin, and serum insulin of both dams and their pups were analyzed at the first day after birth. The entire pancreas was collected for determination of ghrelin and insulin mRNAs, and quantification of pancreas ghrelin and insulin. Immunohistochemical double staining and confocal microscopy were performed on rat pancreas. Birth weight was 5.81 ± 0.64 and 4.76 ± 0.23 g in NBW group and LBW group respectively. Fasting plasma ghrelin concentrations in UR group (1382 (1287–1513) pg/ml) were higher than that of NR group (1072 (974–1205) pg/ml). Plasma ghrelin concentrations in the LBW group (2176 (2031–2384) pg/ml) were significantly lower than that of the NBW group (2493 (2311–2675) pg/ml). Undernutrition caused a decrease in plasma insulin concentrations in both UR dams and LBW pups (P < 0.001). Ghrelin mRNA and total ghrelin of pancreas were significantly affected by intrauterine nutrition state. Pancreas insulin concentrations were significantly affected by intrauterine nutrition (P = 0.007). The majority of ghrelin-producing cells were present at the periphery of islets in the NBW group. Ghrelin was colocalized with insulin in ß-cells in LBW group. The percentage of ghrelin-positive cells in the islets of LBW group was significantly higher than that of the NBW group (P < 0.01). Intrauterine undernutrition may affect the birth weight, plasma insulin and ghrelin levels, islet ghrelin expression, and ghrelin cell distribution. It will be interesting to investigate intrauterine nutrition which is involved in islet ghrelin expression and ghrelin cell distribution.
Alterations in myostatin expression are associated with changes in cardiac left ventricular mass but not ejection fraction in the mouse
Authors: Artaza Jorge N , Reisz-Porszasz Suzanne , Dow Joan S , Kloner Robert A , Tsao James , Bhasin Shalender , Gonzalez-Cadavid Nestor F
Published: October 2007

Myostatin (Mst) is a negative regulator of skeletal muscle in humans and animals. It is moderately expressed in the heart of sheep and cattle, increasing considerably after infarction. Genetic blockade of Mst expression increases cardiomyocyte growth. We determined whether Mst overexpression in the heart of transgenic mice reduces left ventricular size and function, and inhibits in vitro cardiomyocyte proliferation. Young transgenic mice overexpressing Mst in the heart (Mst transgenic mice (TG) under a muscle creatine kinase (MCK) promoter active in cardiac and skeletal muscle, and Mst knockout (Mst (−/−)) mice were used. Xiscan angiography revealed that the left ventricular ejection fraction did not differ between the Mst TG and the Mst (−/−) mice, when compared with their respective wild-type strains, despite the decrease in whole heart and left ventricular size in Mst TG mice, and their increase in Mst (−/−) animals. The expected changes in cardiac Mst were measured by RT-PCR and western blot. Mst and its receptor (ActRIIb) were detected by RT-PCR in rat H9c2 cardiomyocytes. Transfection of H9c2 with plasmids expressing Mst under muscle-specific creatine kinase promoter, or cytomegalovirus promoter, enhanced p21 and reduced cdk2 expression, when assessed by western blot. A decrease in cell number occurred by incubation with recombinant Mst (formazan assay), without affecting apoptosis or cardiomyocyte size. Anti-Mst antibody increased cardiomyocyte replication, whereas transfection with the Mst-expressing plasmids inhibited it. In conclusion, Mst does not affect cardiac systolic function in mice overexpressing or lacking the active protein, but it reduces cardiac mass and cardiomyocyte proliferation.
The emerging role of the fibroblast growth factor-23–klotho axis in renal regulation of phosphate homeostasis
Authors: Razzaque Mohammed S , Lanske Beate
Published: October 2007

Normal mineral ion homeostasis is tightly controlled by numerous endocrine factors that coordinately exert effects on intestine, kidney, and bone to maintain physiological balance. The importance of the fibroblast growth factor (FGF)-23–klotho axis in regulating mineral ion homeostasis has been proposed from recent research observations. Experimental studies suggest that 1) FGF23 is an important in vivo regulator of phosphate homeostasis, 2) FGF23 acts as a counter regulatory hormone to modulate the renal 1α-hydroxylase and sodium–phosphate cotransporter activities, 3) there is a trend of interrelationship between FGF23 and parathyroid hormone activities, 4) most of the FGF23 functions are conducted through the activation of FGF receptors, and 5) such receptor activation needs klotho, as a cofactor to generate downstream signaling events. These observations clearly suggest the emerging roles of the FGF23–klotho axis in maintaining mineral ion homeostasis. In this brief article, we will summarize how the FGF23–klotho axis might coordinately regulate normal mineral ion homeostasis, and how their abnormal regulation could severely disrupt such homeostasis to induce disease pathology.
Lack of vasoactive intestinal peptide reduces testosterone levels and reproductive aging in mouse testis
Authors: Lacombe Arnaud , Lelievre Vincent , Roselli Charles E , Muller Jean-Marc , Waschek James A , Vilain Eric
Published: October 2007

The neuropeptides vasoactive intestinal peptide (VIP) and pituitary adenylate cyclase-activating polypeptide have long been considered as putative regulators of testicular functions. In vitro evidence suggests that VIP could play an important role in testosterone biosynthesis. However, the endogenous role of VIP on testicular functions remained to be demonstrated. In C57BL/6 mice exhibiting a complete disruption of the VIP gene, we first observed here that serum testosterone levels were lower than those of WT littermates. At the age of 4 months, this phenotype was accompanied with a reduction of expression of StAR and 3-β-hydroxysteroid dehydrogenase (3β-HSD) in the testis. In addition, serum levels of FSH but not LH were reduced in young knock-out (KO) males. Testicular anatomy also revealed a higher percentage of degenerated seminiferous tubules in the 4-month-old VIP KO animals when compared with WT. In 15-month-old animals, control males showed typical testicular aging, including a severe degeneration of seminiferous tubules, a dramatic decrease in serum levels of testosterone, and a reduction in StAR and 3β-HSD gene expression. In age-matching VIP KO males, the levels of serum testosterone and steroidogenic enzymes were still very low. Interestingly, in contrast to that observed in young mice, testicular degeneration at 15 months was significantly less severe in VIP KO than WT mice. All together, these results suggest that 1) VIP is an important factor for regulating testosterone biosynthesis and FSH secretion and 2) VIP may influence testicular aging.
Meaning in Heart Disease: Measuring the Search for Meaning
Authors: Skaggs Brenda G. , Yates Bernice C. , Hertzog Melody , Barron Cecilia R. , Norman Joseph , Pozehl Bunny
Published: October 2007

The purpose of this study was to test the psychometric properties of a new measure, the Meaning in Heart Disease instrument (MHD), in persons who underwent percutaneous coronary intervention (PCI). Within 1 year of PCI, 232 persons completed the MHD and construct validity measures (SF-36v2™, Hospital Anxiety and Depression Scale). Study aims were examined using reliability analysis, factor analysis, and correlations. After factor analysis, four scales reflecting the theoretical concepts central to the conceptual framework of the instrument emerged—Disrupted Meaning (α = .93), Refocusing Global Meaning (α = .92), Searching for Answers (α = .82), and Ignoring Heart Disease (α = .77). Convergent and divergent validity was supported, in part, for all scales. The MHD had strong support for its validity and will be useful in testing nursing interventions aimed at helping individuals integrate heart disease into the life experience.
Utilization of EMDR in the Treatment of Grief and Mourning
Authors: Solomon Roger M. , Rando Therese A.
Published: October 2007

EMDR can be utilized within a comprehensive framework for the treatment of grief and mourning. EMDR can process the obstacles that can complicate the grief and mourning processes. This seems to facilitate the emergence of positive memories of the deceased, which aids the formation of an adaptive inner representation. The utilization of EMDR within six processes necessary for adaptive assimilation of the loss is described with case examples.
Reversing Reciprocal Suppression in the Anterior Cingulate Cortex: A Hypothetical Model to Explain EMDR Effectiveness
Authors: Kaye Bryce
Published: October 2007

A theoretical model is proposed to explain desensitization during Eye Movement Desensitization and Reprocessing (EMDR) as resulting from the reversal of reciprocal suppression of cognitive processing in the anterior cingulate cortex (ACC). Dual-attention and error monitoring are known to activate dorsal regions of the ACC that mediate metacognitive processing. Neuroimaging research has produced evidence that cognitive areas in the upper ACC may reciprocally suppress affective processing in the lower areas and vice versa. It is therefore proposed that the original eye-to-finger tracking task of EMDR may achieve its therapeutic effect by using error monitoring to reverse suppression of the upper ACC by the lower ACC. Contributions to EMDR effectiveness from resource installation and novelty-driven orienting reflexes may also influence ACC functioning. A distraction effect is proposed to be a negative and potentially disruptive by-product of very interactive stimulation tasks. A semantic priming procedure is suggested to limit distraction effects during more interactive forms of stimulation.
Trends in Preterm-Related Infant Mortality by Race and Ethnicity, United States, 1999–2004
Authors: MacDorman Marian F. , Callaghan William M. , Mathews T. J. , Hoyert Donna L. , Kochanek Kenneth D.
Published: October 2007

Trends in preterm-related causes of death were examined by maternal race and ethnicity. A grouping of preterm-related causes of infant death was created by identifying causes that were a direct cause or consequence of preterm birth. Cause-of-death categories were considered to be preterm-related when 75 percent or more of total infant deaths attributed to that cause were deaths of infants born preterm, and the cause was considered to be a direct consequence of preterm birth based on a clinical evaluation and review of the literature. In 2004, 36.5 percent of all infant deaths in the United States were preterm-related, up from 35.4 percent in 1999. The preterm-related infant mortality rate for non-Hispanic black mothers was 3.5 times higher and the rate for Puerto Rican mothers was 75 percent higher than for non-Hispanic white mothers. The preterm-related infant mortality rate for non-Hispanic black mothers was higher than the total infant mortality rate for non-Hispanic white, Mexican, and Asian or Pacific Islander mothers. The leveling off of the U.S. infant mortality decline since 2000 has been attributed in part to an increase in preterm and low-birthweight births. Continued tracking of preterm-related causes of infant death will improve our understanding of trends in infant mortality in the United States.
U.S. Medical Students' Knowledge about the Military Draft, the Geneva Conventions, and Military Medical Ethics
Authors: Boyd J. Wesley , Himmelstein David U. , Lasser Karen , McCormick Danny , Bor David H. , Cutrona Sarah L. , Woolhandler Steffie
Published: October 2007

The objective of this study was to ascertain how much U.S. medical students are taught about and know about military medical ethics, the Geneva Conventions, and the laws governing conscription of medical personnel. The authors developed an Internet-based questionnaire on these matters, and e-mail invitations to participate were sent to approximately 5,000 medical students at eight U.S. medical schools. Thirty-five percent of e-mail recipients participated in the survey. Of those, 94 percent had received less than one hour of instruction about military medical ethics and only 3.5 percent were aware of legislation already passed making a “doctor's draft” possible; 37 percent knew the conditions under which the Geneva Conventions apply; 33.8 percent did not know that the Geneva Conventions state that physicians should “treat the sickest first, regardless of nationality;” 37 percent did not know that the Geneva Conventions prohibit ever threatening or demeaning prisoners or depriving them of food or water; and 33.9 percent could not state when they would be required to disobey an unethical order.
Post-Apartheid Challenges: Household Access and Use of Health Care in South Africa
Authors: Gilson Lucy , McIntyre Di
Published: October 2007

This is the final part of the special section, edited by Professors Margaret Whitehead and Göran Dahlgren, on the equity impacts of different health care systems, which includes studies conducted within the framework of the Affordability Ladder Program.

Since 1994 the South African government has placed equity at the heart of its health policy goals. However, there has as yet been surprisingly little assessment of the success of policies in reducing inequity. This article provides insights on these issues by applying the Affordability Ladder conceptual framework in synthesizing evidence drawn from a series of household surveys and studies undertaken between 1992 and 2003. These data suggest that, despite policy efforts, inequities in access and utilization between socioeconomic groups remain. Underlying challenges include worsening community perceptions of the quality of publicly provided care and the influence of insurance status on utilization patterns. Further and more detailed evaluation of household-level policy impacts requires both improvements in the quality of South African survey data, particularly in enhancing consistency in survey design over time, and more detailed, focused studies.
Equity Impacts of Neoliberal Reforms: What Should the Policy Responses Be?
Authors: McIntyre Di , Whitehead Margaret , Gilson Lucy , Dahlgren Göran , Tang Shenglan
Published: October 2007

The final article in this special section draws together the lessons learned from the ALPS analyses and considers a range of potential policy responses. The country case studies highlight that health systems in many low- and middle-income countries are failing not only the poor but also other income groups, who are faced with wide-ranging barriers to accessing the health care they need. A key policy intervention to address these health system failures is that of challenging the status quo in relation to the public-private health care mix. There is an urgent need to strengthen public health services that have been systematically neglected over the past few decades while also regulating the worst excesses of the private health sector. Promoting a greater reliance on financing mechanisms that are progressive and that strengthen cross-subsidies in the overall health system is critical, as is ensuring that available financial and human resources are equitably allocated among geographic areas and groups. Finally, health system interventions of this nature should be supported by broader poverty-reduction strategies. Such interventions to fundamentally change ailing health systems are essential to break the vicious cycle of poverty, ill-health, and (further) impoverishment.
Corporate Colonization of Health Activism? Irish Health Advocacy Organizations' Modes of Engagement with Pharmaceutical Corporations
Authors: O'Donovan Orla
Published: October 2007

This article is based on a study that aimed to shed light on the “cultures of action” of Irish health advocacy organizations, and particularly their modes of engagement with pharmaceutical corporations. Debates about what some interpret as the “corporate colonization” of health activism provide the backdrop for the analysis. The empirical dimension of the study involved a survey of 112 organizations and in-depth study of a small number of organizations that manifest diverse modes of engagement with the pharmaceutical industry. The varying modes of interaction are plotted along a continuum and characterized as corporatist, cautious cooperation, and confrontational. Evidence is presented of a strong and growing cultural tendency in Irish health advocacy organizations to frame pharmaceutical corporations as allies in their quests for better health. The analysis of four constitutive dimensions of organizations' cultures of action can reveal the legitimating logics underlying their diverging positions around pharmaceutical industry sponsorship. While the research shows that pharmaceutical corporations have largely succeeded in defining themselves as a philanthropic force and rightful players in Irish health activism, it cautions against a simplistic conclusion that this is evidence of corporate colonization.
Is Australia's National Medicines Policy Failing? the Case of Cox-2 Inhibitors
Authors: Vitry Agnes , Lexchin Joel , Mansfield Peter R.
Published: October 2007

Australia has a National Medicines Policy with aims that include quality use of medicines, but policy stakeholders failed to protect Australia from the COX-2 (cyclo-oxygenase-2) inhibitor disaster. Drug regulators did not warn prescribers appropriately about potential cardiovascular risks. The Pharmaceutical Benefits Scheme did not limit unjustified drug expenditures on COX-2 inhibitors. Drug companies ran intense and misleading promotional campaigns on COX-2 inhibitors without adequate controls. Independent drug information was insufficient to counter the effects of the millions of dollars spent on advertising. Core elements of the National Medicines Policy—in particular the drug approval process, the post-marketing surveillance system, the control of drug promotion, and the quality of independent drug information—require major reappraisal if we want to avoid similar disasters in the future.
Press Report: Who Criticized for Neglecting Evidence
Authors: Cheng Maria , McMahon Jean
Published: October 2007

A study published in The Lancet reveals that when developing “evidence-based” guidelines, the World Health Organization routinely forgets one key ingredient: evidence. The study is based on interviews with senior WHO officials and analyses of various guidelines to determine how they were produced. The authors found a distinctly non-transparent process.
Computational Fracture Mechanics
Authors: Ingraffea Anthony R.
Published: October 2007

An overview of computational fracture mechanics (CFM) is presented in the framework of a taxonomy of methods of representation of cracks in computational models. This taxonomy has two main branches: geometrical and nongeometrical approaches to representation. Within each branch, there are numerous methods, each of which is described by way of example applications, and evaluated for its relative advantages and disadvantages with respect to computational difficulty and ability to support fundamental physics and mechanics of cracking processes.

The purpose of this chapter is to survey examples of historical and state‐of‐the‐art techniques of CFM for its role in determining crack driving forces, and in predicting material resistance to cracking. It is intended for the student of CFM trying to make sense of its vast literature and myriad methods. It is hoped that the chapter will provide a basis for deciding which of these methods would be better suited for providing support for improved physics or mechanics, or at least improved efficiency, whether research or practice oriented, the student is addressing.
Computational Geomechanics Including Consolidation
Authors: Carter John P. , Small John C.
Published: October 2007

A review is presented of the role of computational mechanics in geotechnical engineering. Discussions of the conventional deterministic techniques used for numerical modeling in geomechanics and a brief discussion of the stochastic techniques for dealing with the uncertainties encountered in geotechnical practice are included. Considerable emphasis is given to the methods commonly used for the solution of boundary and initial value problems. Significantly, the chapter also includes a discussion of the limitations of the various numerical modeling techniques. Constitutive modeling of soil and rock mass behavior and material interfaces is an essential component of this type of computing, and so a review of recent developments and capabilities of constitutive models for geomaterials is also included. Problems involving the interaction of the ground with other engineering structures are also addressed. Some of the concepts described in the paper are illustrated with examples taken from research and practice. Emphasis has been placed on the mechanical behavior of soil, but it is noted that many of the models and techniques described also have application in rock mechanics and rock engineering.
Multiscale and Stabilized Methods
Authors: Hughes Thomas J. R. , Scovazzi Guglielmo , Franca Leopoldo P.
Published: October 2007

This article presents an introduction to multiscale and stabilized methods, which represent unified approaches to modeling and numerical solution of fluid dynamic phenomena. Finite element applications are emphasized but the ideas are general and apply to other numerical methods as well. (They have been used in the development of finite difference, finite volume, and spectral methods, in addition to finite‐element methods.) The analytical ideas are first illustrated for time‐harmonic wave‐propagation problems in unbounded fluid domains governed by the Helmholtz equation. This leads to the well‐known Dirichlet‐to‐Neumann formulation. A general treatment of the variational multiscale method in the context of an abstract Dirichlet problem is then presented, which is applicable to advective–diffusive processes and other processes of physical interest. It is shown how the exact theory represents a paradigm for subgrid‐scale models and a posteriori error estimation. Hierarchicalp‐methods and bubble function methods are examined in order to understand and ultimately approximate the ‘fine‐scale Green's function’ that appears in the theory. Relationships among so‐called residual‐free bubbles, element Green's functions, and stabilized methods are exhibited. These ideas are then generalized to a class of nonsymmetric, linear evolution operators formulated in space–time. The variational multiscale method also provides guidelines and inspiration for the development of stabilized methods (e.g. SUPG, GLS, etc.) that have attracted considerable interest and have been extensively utilized in engineering and the physical sciences. An overview of stabilized methods for advective–diffusive equations is presented. A variational multiscale treatment of incompressible viscous flows, including turbulence is also described. This represents an alternative formulation of large eddy simulation (LES), which provides a simplified theoretical framework of LES with potential for improved modeling.
Residual Distribution Schemes: Foundations and Analysis
Authors: Deconinck Herman , Ricchiuto Mario
Published: October 2007

In this article, we introduce and analyze the class of numerical schemes known as residual distribution or fluctuation splitting schemes. The root of this family of discretizations is found mainly in works aiming at generalizing the finite volume techniques to a genuinely multidimensional upwinding context, as in, for example (Hall, Morton, Ni, Roe). However, the final result is a numerical method sharing a lot with other techniques, such as finite element schemes (Carette, Deconinck, Paillere and Roe, 1995).

Our aim is to look at fluctuation splitting/residual distribution methods from a generic theoretical point of view. We discuss in a general way the basic principles and the criteria used in the design of the schemes: positivity, k‐exacteness, energy stability, well‐balancedness. We also show similarities with known, more classical, discretization techniques, as well as the main distinguishing features that make residual distribution methods a valid alternative to these classical schemes.

Finally, we present some numerical applications and comparisons. Throughout the text, we give an extensive overview of the existing literature, and finally conclude the chapter by reviewing most of the ongoing research on the topic.
Explicit Finite Element Methods for Large Deformation Problems in Solid Mechanics
Authors: Benson David J.
Published: October 2007

Explicit finite methods are often the best choice for solving large deformation, high strain rate problems in solids mechanics. They are simple to implement, robust, efficient, and scale well on massively parallel computers. Their commercial applications include simulations of automobile crashes to the more prosaic drop testing of cell phones. This chapter presents an introduction of explicit finite element methods with an emphasis on the topics that distinguish the explicit formulation from the more traditional implicit one, including stable time step size estimation, energy conservation, shock viscosities, zero energy modes, and stress rotations.
Regulation of the Cell Cycle, Cell Cycle Checkpoints, and Cancer
Authors: Delia Domenico , Buscemi Giacomo
Published: October 2007

DNA damage response (DDR) pathways are triggered to ensure proper repair of DNA lesions and preserve genome integrity. Key intracellular transducers of the DNA damage are ataxia‐telangiectasia mutated kinase (ATM) and ataxia‐telangiectasia and Rad3‐related kinase (ATR). These nuclear proteins, through dynamic interaction with chromatin‐bound sensory components and phosphorylation at T/SQ residues of a multitude of substrates, including the checkpoint kinases Chk1 and Chk2, activate a network of pathways important for DNA repair, multiple cell cycle–phase arrest, transcription, and apoptosis. Interestingly, the DDR machinery is a key mediator of telomere‐dependent and telomere‐independent forms of cellular senescence, and provides a barrier to aberrant DNA replication induced by oncogenic stimuli. These findings and the constitutive activation of the DDR in human precancerous lesions, underscore the role of the DDR as a tumour suppressor constraining transformation by driving incipient tumour cells into apoptosis or senescence. Since genetic abnormalities of the DDR hypersensitize to genotoxic anticancer agents, this pathway represents a relevant target to increase tumour cell kill and possibly overcome drug resistance. The promising results with a number of chemical inhibitors of ATM, Chk1 and Chk2 are paving the way for new chemoradiation strategies that exploit the DDR machinery.
Tobacco Use and Cancer
Authors: Hecht Stephen S.
Published: October 2007

Although considerable advances have been achieved in tobacco control, the use of tobacco products continues to be an immense problem worldwide. There are about 1200 million smokers in the world and hundreds of millions of smokeless tobacco users. The link between tobacco use and cancer is unguestionable, with cigarette smoking causing about 30% of all cancer mortality in developed countries. Experimental studies have firmly established the cancer causing properties of tobacco products in laboratory animals. Carcinogens in tobacco products have been identified and their mechanisms of action are well understood. Biomarkers related to these carcinogens have been developed and widely applied. Collectively, the currently available data provide a strong framework for further mechanistic understanding leading to continued progress in tobacco control and prevention of tobacco‐induced cancer.
Multidisciplinary Team Management of Lung Cancer
Authors: Giaccone Giuseppe , Smit Egbert , Senan Suresh , Paul Rick
Published: October 2007

Lung cancer should preferably be managed within the context of a multidisciplinary team, especially for early lung cancer cases and cases where combined modality approaches are required. The treatment of limited‐disease small cell lung cancer (SCLC), resectable non‐small cell lung cancer (NSCLC), and stage III NSCLC all require a multidisciplinary approach. Chemotherapy represents the standard therapy for SCLC and a large proportion of NSCLCs, given either as the sole treatment modality for palliation or as part of a combined modality programme for less advanced cases.
Multidisciplinary Team Management of Gynaecological Cancers
Authors: Harrison Michelle L. , Ind Thomas , Blake Peter , Gore Martin E.
Published: October 2007

Gynaecological malignancies represent a highly specialized area of oncology and should be managed within the context of a multidisciplinary team (MDT). This model is becoming standard not only in gynaecology but also with all cancer types. In this chapter we discuss the benefits of this approach in terms of delivery of care, compliance with best practice, patient outcomes, and requirements for the establishment and running of an MDT.

An overview of the management for newly diagnosed gynaecological malignancies, including ovarian, fallopian tube, peritoneal, endometrial, cervical, vulval, and vaginal cancers is provided. Preoperative imaging is crucial for surgical and radiotherapy planning, in particular, magnetic resonance imaging (MRI), which is now an integral part of assessment. The role of surgery, radiotherapy, and chemotherapy is reviewed with an emphasis on the controversial issues and recent advances in each of the tumour types.
Melanoma
Authors: Kashani‐Sabet Mohammed
Published: October 2007

Melanoma is an increasingly common clinical problem, with few effective therapies available for advanced disease. The recent inroads into the molecular biology of melanoma have provided an important understanding of the molecular events that underlie melanoma progression, and will form the basis for the development of novel biomarkers as well as targeted therapies for this disease. In this chapter, we will review the current state of the art with respect to cutaneous melanoma epidemiology and molecular biology, and discuss recent advances in the prognostic assessment and therapy of melanoma.
Skin
Authors: Young Alison Z. , Murphy George F.
Published: October 2007

The skin is a large and complex organ composed of multiple cell types. From these various cell lineages a multiplicity of neoplasms may originate. There are numerous aetologic factors responsible for the genesis of malignant skin tumours, and these include exogenous (environmental) as well as endogenous (inborn and acquired) agents and mechanisms. Many cutaneous malignancies develop in the context of precursor lesions associated with cellular dysplasia. Specific examples of dysplasia/malignancy associations include actinickeratosis/squamous cell carcinoma and dysplastic melanocytic naevi/malignant melanoma. Examples of other representative cutaneous malignancies include basal cell carcinoma, mycosis fungoides, Kaposi's sarcoma, and angiosarcoma. These examples of cutaneous malignancy are discussed in detail in the context of aetiology, clinical features, correlative histopathology, prognosis, and clinical management.
Models for Prostate Cancer
Authors: Jain Anjali , Vashistha Surabhi , Gross Mitchell E. , Agus David B.
Published: October 2007

Translational research examining the progression and treatment of prostate cancer (PCa) is benefited significantly from the availability of models that faithfully mimic thein vivodisease. It is advantageous if the model system maximally recapitulates the myriad complex relationships that contribute towards prostate carcinogenesis. These include hormonal and genetic status of the host, immune response to the tumour, environmental and dietary influences, tumour epithelial and stromal interactions, local and systemic influences in the host including, the tumour tissue type, adjacent tissues, and metastatic preferences. The currently available models of prostate cancer have been divided as those that are influenced by, or are independent of, the immune systems of the hosts. The final section describes models that have specifically attempted to address bone metastasis in prostate cancer. These model systems are of paramount importance in the study of the biology of prostate cancer and to help develop new therapeutic strategies to fight the various “biologic states” of prostate cancer.
Endocrine Organs
Authors: Asa Sylvia L. , Ezzat Shereen
Published: October 2007

The endocrine organs represent groups of cells that have, as their primary function, the production and secretion of hormones into circulation. Tumours of these organs are characterized by widely ranging aberrant growth, hormone secretion, or both. The underlying molecular mechanisms involved in the pathogenesis of these distinct entities are now being utilized for diagnostic and therapeutic purposes with implications for non‐hormone‐producing cancers.
Male Genital Tract
Authors: Henley John D. , Ulbright Thomas M.
Published: October 2007

Tumours of the male genital tract, including those of the prostate gland, testis, and penis, are a significant cause of morbidity and mortality. In western culture, aside from skin tumours, prostate cancer is the most common type of cancer found in men. In male adolescents and young adults germ cell tumours of the testis are the most common type of solid tumour cancer. Carcinoma of the penis, although uncommon in the industrialized world, accounts for up to 20% of male malignancies in less developed parts of the world. The epidemiology and pathology of these diseases have become well characterized. Applied immunohistochemical andin situhybridization techniques continue to refine pathologic classification and diagnosis. Aetiologies, unfortunately, remain elusive. Undoubtedly, the accumulating wealth of data on genes and proteins will eventually unravel the molecular pathogenesis of these tumours. Continued progress will see application of these data to aid prevention, assessment of prognosis, and treatment.
Soft Tissues
Authors: Oliveira Andre M. , Nascimento Antonio G.
Published: October 2007

Soft tissue tumours comprise a group of rather distinct neoplasms of predominant mesenchymal differentiation. They are classified according to their line of differentiation and clinical behaviour. Specific cytogenetic and molecular genetic abnormalities have been identified in several of them, and the discovery of these abnormalities has not only allowed their better classification but also has opened avenues for the development of novel therapies. Soft tissue tumours are mainly treated with surgical procedures but radiotherapy and chemotherapy play a major role in the treatment of malignant tumours. Their prognosis vary widely and depend mainly on the line of differentiation, histologic grade and clinical stage.