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The Complex Cancer Care Coverage Environment — What is the Role of Legislation?: A Case Study from Massachusetts
- Christine Leopold, Rebecca L. Haffajee, Christine Y. Lu, Anita K. Wagner
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- Journal:
- Journal of Law, Medicine & Ethics / Volume 48 / Issue 3 / Fall 2020
- Published online by Cambridge University Press:
- 01 January 2021, pp. 538-551
- Print publication:
- Fall 2020
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Over the past decades, anti-cancer treatments have evolved rapidly from cytotoxic chemotherapies to targeted therapies including oral targeted medications and injectable immunooncology and cell therapies. New anti-cancer medications come to markets at increasingly high prices, and health insurance coverage is crucial for patient access to these therapies. State laws are intended to facilitate insurance coverage of anti-cancer therapies.
Using Massachusetts as a case study, we identified five current cancer coverage state laws and interviewed experts on their perceptions of the relevance of the laws and how well they meet the current needs of cancer care given rapid changes in therapies. Interviewees emphasized that cancer therapies, as compared to many other therapeutic areas, are unique because insurance legislation targets their coverage. They identified the oral chemotherapy parity law as contributing to increasing treatment costs in commercial insurance. For commercial insurers, coverage mandates combined with the realities of new cancer medications — including high prices and often limited evidence of efficacy at approval — compound a difficult situation. Respondents recommended policy approaches to address this challenging coverage environment, including the implementation of closed formularies, the use of cost-effectiveness studies to guide coverage decisions, and the application of value-based pricing concepts. Given the evolution of cancer therapeutics, it may be time to evaluate the benefits and challenges of cancer coverage mandates.
Interfacility Spread of OXA-23–Producing Carbapenem-Resistant Acinetobacter—Connecticut, 2018–2019
- Sydney Jones, Meghan Maloney, Anu Paranandi, Dana Pepe, Elizabeth Nazarian, Shannon Morris, Wagner Christine, Janine Bodnar, Kailee Cummings, Vivian Leung
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, p. s304
- Print publication:
- October 2020
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Background: Carbapenem-resistant Acinetobacter baumannii (CRAB), a multidrug-resistant gram-negative bacterium, can cause difficult-to-treat infections with mortality in approximately half of CRAB cases. CRAB can spread among healthcare facilities after transfer of an infected or colonized patient. Strategies to limit CRAB spread include adherence to contact precautions, environmental cleaning with bleach, and screening to identify colonized patients. During July–September 2018, the Connecticut Department of Public Health (DPH) worked with an acute-care hospital (hospital A) to contain an outbreak of OXA-23–producing CRAB (OXA-23 is an enzyme that confers resistance to carbapenems). During November 2018–March 2019, statewide CRAB surveillance identified additional cases of related OXA-23–producing CRAB at other healthcare facilities. DPH, Connecticut State Public Health Laboratory (SPHL), and the Antibiotic Resistance Laboratory Network (ARLN) investigated to prevent additional cases. Methods: Since January 2017, CRAB isolates have been routinely sent to SPHL and ARLN for carbapenemase gene detection and whole-genome sequencing (WGS) to determine isolate relatedness. During November 2018–March 2019, DPH collected patient healthcare history for patients with CRAB isolates to identify outbreaks and provide assistance in infection control and prevention to healthcare facilities reporting CRAB cases. Beginning May 2019, DPH and ARLN offered facilities screening to identify patients colonized with OXA-23–producing CRAB. Results: Of 10 OXA-23–producing CRAB isolates reported to DPH during November 2018–March 2019, 3 were closely related to the 9 isolates from hospital A’s outbreak by WGS (single-nucleotide polymorphism difference range, 1–16). One isolate was from a patient who had been admitted to hospital A during July 2018. All 3 patients with CRAB isolates shared a history of residence at long-term–care facility A (LTCF A). Two patients received a CRAB infection diagnosis upon admission to hospital B after transfer from LTCF A. Both LTCF A and hospital B performed environmental cleaning with bleach and placed CRAB-identified patients on contact precautions. LTCF A declined screening patients for CRAB, whereas hospitals B and C, which receive frequent transfers from LTCF A, screened all patients on admission from LTCF A. During May–September 2019, among 6 patients screened, 1 was colonized with OXA-23–producing CRAB and was placed on contact precautions. Conclusions: Transfer of patients who are infected or colonized with CRAB among hospitals and LTCFs can facilitate the regional spread of CRAB. Strategies for containing the spread of carbapenemase-producing organisms include adherence to contact precautions, colonization screening, interfacility communication, and collaboration with public health.
Funding: None
Disclosures: None
Mental Disorders in Firefighters Following Large-Scale Disaster
- Shannon L. Wagner, Nicole White, Christine Randall, Cheryl Regehr, Marc White, Lynn E. Alden, Nicholas Buys, Mary G. Carey, Wayne Corneil, Trina Fyfe, Lynda R. Matthews, Alex Fraess-Phillips, Elyssa Krutop
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- Journal:
- Disaster Medicine and Public Health Preparedness / Volume 15 / Issue 4 / August 2021
- Published online by Cambridge University Press:
- 27 May 2020, pp. 504-517
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Firefighting service is known to involve high rates of exposure to potentially traumatic situations, and research on mental health in firefighting populations is of critical importance in understanding the impact of occupational exposure. To date, the literature concerning prevalence of trauma-related mental disorders such as posttraumatic stress disorder (PTSD) has not distinguished between symptomology associated routine duty-related exposure and exposure to large-scale disaster. The present systematic review synthesizes a heterogeneous cross-national literature on large-scale disaster exposure in firefighters and provides support for the hypothesis that the prevalence of PTSD, major depressive disorder, and anxiety disorders are elevated in firefighters compared with rates observed in the general population. In addition, we conducted narrative synthesis concerning several commonly assessed predictive factors for disorder and found that sociodemographic factors appear to bear a weak relationship to mental disorder, while incident-related factors, such as severity and duration of disaster exposure, bear a stronger and more consistent relationship to the development of PTSD and depression in cross-national samples. Future work should expand on these preliminary findings to better understand the impact of disaster exposure in firefighting personnel.
Raising Awareness and Appreciation: Employee Perspectives on Disability Management in Swiss Companies
- Thomas Geisen, Benedikt Hassler, Shannon Wagner, Nicholas Buys, Christine Randall, Henry Harder, Alex Fraess-Phillips, Ignatius TS Yu, Caroline Howe, Liz Scott
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- Journal:
- International Journal of Disability Management / Volume 14 / 2019
- Published online by Cambridge University Press:
- 06 May 2019, e1
- Print publication:
- 2019
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In Western countries, an increasing number of companies has difficulties with recruiting and retaining employees, along with growing employer responsibilities in the workplace. Therefore, companies’ interest in disability management programs has increased. This article examines employee perspectives of disability management and how it is related to job satisfaction, physical and mental health, workplace morale and sickness absence. Employees from seven Swiss companies (N=482), from the private and public sector, participated in either an online and paper-and-pencil survey for this present study. The survey asked employees to report their views of how disability management is related to job satisfaction, mental health, physical health, workplace morale and absenteeism. The Swiss employees participating in the study knew about disability management and related programs, which are implemented in their company. They valued them as moderately helpful for a variety of factors related to workplace wellbeing, and regarded the programs generally as high quality and wanted them to continue, because they contribute to job satisfaction, mental health, physical health, workplace morale and reduced sickness absence. However, employees also saw more value in disability prevention (DP) and stay at work (SAW) programs than in return to work (RTW) programs. Male employees and those working for public organisations saw more benefit in disability management programs than female employees and those working in the private sector.
Canadian Employee Perspectives on Disability Management
- Shannon Wagner, Henry Harder, Liz Scott, Nicholas Buys, Ignatius Yu, Thomas Geisen, Christine Randall, Karen Lo, Dan Tang, Alex Fraess-Phillips, Benedikt Hassler, Caroline Howe
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- Journal:
- International Journal of Disability Management / Volume 12 / 2017
- Published online by Cambridge University Press:
- 18 September 2017, e3
- Print publication:
- 2017
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A Canadian sample was collected as an aspect of a large international project, with representation from Australia, Canada, China, and Switzerland. In each country, interview and survey data were collected using team-created research tools. Canadian survey data on disability management (DM) perceptions were collected from 218 employees in both public and private organisations. Our Canadian employee sample reported perceived influence of disability prevention on job satisfaction, physical health, mental health, and morale for both themselves and their coworkers. Return to work programs were seen as valuable for job satisfaction of both the employee and coworkers, as well as the physical health of coworkers. Similarly, stay at work programs were seen as valuable for mental health and morale of coworkers. There was no relationship between perceived influence of DM interventions and reduction of sickness absence. The influence of DM was perceived as more positive for private and/or nonunionised workplaces. No gender differences were evident.
Australian Employee Perspectives on Disability Management in Relation to Job Satisfaction, Physical and Mental Health, Workplace Morale and Reduced Sickness Absence
- Nicholas Buys, Shannon Wagner, Christine Randall, Ignatius Yu, Thomas Geisen, Henry Harder, Alex Fraess-Phillips, Benedikt Hassler, Caroline Howe
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- Journal:
- International Journal of Disability Management / Volume 11 / 2016
- Published online by Cambridge University Press:
- 20 October 2016, e2
- Print publication:
- 2016
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Disability management is now recognised as an effective means of managing the increasing global costs of injury and disability. However, research on disability management particularly employee perceptions of its value, are sparse. This paper reports on the Australian findings of a large international project that included Canada, China, Switzerland and Australia, which examined employee perspectives of disability management related to job satisfaction, physical and mental health, workplace morale and reduced sickness absence. Data was collected from 365 employees in 10 large private and public companies using an online survey tool that focused on three components of a disability management program — disability prevention (DP), stay at work (SAW) and return to work (RTW) programs — in relation to the dependent variables of job satisfaction, physical and mental health, workplace morale, sickness absence. Multivariate regression was used to predict disability management's influence on the dependent variables. Results demonstrated positive perceptions regarding the perceived benefits of disability management to both individual employees and their perceptions of coworkers. It was apparent that each component of a disability management program (DP, SAW, and RTW) is positively related to job satisfaction, physical and mental health, workplace morale and reduced sickness absence Disability management programs were perceived as more beneficial in private, as opposed to public, workplaces; however, no differences were evident according to union status or gender of the respondent. It is possible disability management may impact on organisational productivity via variables associated with workplace culture, as well as through the direct benefits flowing from preventing and managing injury. Given the significant costs associated with absenteeism, an outcome of interest to many employers was the finding that employees perceived SAW programs as the most beneficial in terms of reducing absenteeism for both themselves and their coworkers.
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- By Phillip L. Ackerman, Soon Ang, Susan M. Barnett, G. David Batty, Anna S. Beninger, Jillian Brass, Meghan M. Burke, Nancy Cantor, Priyanka B. Carr, David R. Caruso, Stephen J. Ceci, Lillia Cherkasskiy, Joanna Christodoulou, Andrew R. A. Conway, Christine E. Daley, Janet E. Davidson, Jim Davies, Katie Davis, Ian J. Deary, Colin G. DeYoung, Ron Dumont, Carol S. Dweck, Linn Van Dyne, Pascale M. J. Engel de Abreu, Joseph F. Fagan, David Henry Feldman, Kurt W. Fischer, Marisa H. Fisher, James R. Flynn, Liane Gabora, Howard Gardner, Glenn Geher, Sarah J. Getz, Judith Glück, Ashok K. Goel, Megan M. Griffin, Elena L. Grigorenko, Richard J. Haier, Diane F. Halpern, Christopher Hertzog, Robert M. Hodapp, Earl Hunt, Alan S. Kaufman, James C. Kaufman, Scott Barry Kaufman, Iris A. Kemp, John F. Kihlstrom, Joni M. Lakin, Christina S. Lee, David F. Lohman, N. J. Mackintosh, Brooke Macnamara, Samuel D. Mandelman, John D. Mayer, Richard E. Mayer, Martha J. Morelock, Ted Nettelbeck, Raymond S. Nickerson, Weihua Niu, Anthony J. Onwuegbuzie, Jonathan A. Plucker, Sally M. Reis, Joseph S. Renzulli, Heiner Rindermann, L. Todd Rose, Anne Russon, Peter Salovey, Scott Seider, Ellen L. Short, Keith E. Stanovich, Ursula M. Staudinger, Robert J. Sternberg, Carli A. Straight, Lisa A. Suzuki, Mei Ling Tan, Maggie E. Toplak, Susana Urbina, Richard K. Wagner, Richard F. West, Wendy M. Williams, John O. Willis, Thomas R. Zentall
- Edited by Robert J. Sternberg, Oklahoma State University, Scott Barry Kaufman, New York University
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- Book:
- The Cambridge Handbook of Intelligence
- Published online:
- 05 June 2012
- Print publication:
- 30 May 2011, pp xi-xiv
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. Deichmann Edwards, Miguel A. De La Torre, George E. Demacopoulos, Thomas de Mayo, Leah DeVun, Beatriz de Vasconcellos Dias, Dennis C. Dickerson, John M. Dillon, Luis Miguel Donatello, Igor Dorfmann-Lazarev, Susanna Drake, Jonathan A. Draper, N. Dreher Martin, Otto Dreydoppel, Angelyn Dries, A. J. Droge, Francis X. D'Sa, Marilyn Dunn, Nicole Wilkinson Duran, Rifaat Ebied, Mark J. Edwards, William H. Edwards, Leonard H. Ehrlich, Nancy L. Eiesland, Martin Elbel, J. Harold Ellens, Stephen Ellingson, Marvin M. Ellison, Robert Ellsberg, Jean Bethke Elshtain, Eldon Jay Epp, Peter C. Erb, Tassilo Erhardt, Maria Erling, Noel Leo Erskine, Gillian R. Evans, Virginia Fabella, Michael A. Fahey, Edward Farley, Margaret A. Farley, Wendy Farley, Robert Fastiggi, Seena Fazel, Duncan S. Ferguson, Helwar Figueroa, Paul Corby Finney, Kyriaki Karidoyanes FitzGerald, Thomas E. FitzGerald, John R. Fitzmier, Marie Therese Flanagan, Sabina Flanagan, Claude Flipo, Ronald B. Flowers, Carole Fontaine, David Ford, Mary Ford, Stephanie A. Ford, Jim Forest, William Franke, Robert M. Franklin, Ruth Franzén, Edward H. Friedman, Samuel Frouisou, Lorelei F. Fuchs, Jojo M. Fung, Inger Furseth, Richard R. Gaillardetz, Brandon Gallaher, China Galland, Mark Galli, Ismael García, Tharscisse Gatwa, Jean-Marie Gaudeul, Luis María Gavilanes del Castillo, Pavel L. Gavrilyuk, Volney P. Gay, Metropolitan Athanasios Geevargis, Kondothra M. George, Mary Gerhart, Simon Gikandi, Maurice Gilbert, Michael J. Gillgannon, Verónica Giménez Beliveau, Terryl Givens, Beth Glazier-McDonald, Philip Gleason, Menghun Goh, Brian Golding, Bishop Hilario M. Gomez, Michelle A. Gonzalez, Donald K. Gorrell, Roy Gottfried, Tamara Grdzelidze, Joel B. Green, Niels Henrik Gregersen, Cristina Grenholm, Herbert Griffiths, Eric W. Gritsch, Erich S. Gruen, Christoffer H. Grundmann, Paul H. Gundani, Jon P. Gunnemann, Petre Guran, Vidar L. Haanes, Jeremiah M. Hackett, Getatchew Haile, Douglas John Hall, Nicholas Hammond, Daphne Hampson, Jehu J. Hanciles, Barry Hankins, Jennifer Haraguchi, Stanley S. Harakas, Anthony John Harding, Conrad L. Harkins, J. William Harmless, Marjory Harper, Amir Harrak, Joel F. Harrington, Mark W. Harris, Susan Ashbrook Harvey, Van A. Harvey, R. Chris Hassel, Jione Havea, Daniel Hawk, Diana L. Hayes, Leslie Hayes, Priscilla Hayner, S. Mark Heim, Simo Heininen, Richard P. Heitzenrater, Eila Helander, David Hempton, Scott H. Hendrix, Jan-Olav Henriksen, Gina Hens-Piazza, Carter Heyward, Nicholas J. Higham, David Hilliard, Norman A. Hjelm, Peter C. Hodgson, Arthur Holder, M. Jan Holton, Dwight N. Hopkins, Ronnie Po-chia Hsia, Po-Ho Huang, James Hudnut-Beumler, Jennifer S. Hughes, Leonard M. Hummel, Mary E. Hunt, Laennec Hurbon, Mark Hutchinson, Susan E. Hylen, Mary Beth Ingham, H. Larry Ingle, Dale T. Irvin, Jon Isaak, Paul John Isaak, Ada María Isasi-Díaz, Hans Raun Iversen, Margaret C. Jacob, Arthur James, Maria Jansdotter-Samuelsson, David Jasper, Werner G. Jeanrond, Renée Jeffery, David Lyle Jeffrey, Theodore W. Jennings, David H. Jensen, Robin Margaret Jensen, David Jobling, Dale A. Johnson, Elizabeth A. Johnson, Maxwell E. Johnson, Sarah Johnson, Mark D. Johnston, F. Stanley Jones, James William Jones, John R. Jones, Alissa Jones Nelson, Inge Jonsson, Jan Joosten, Elizabeth Judd, Mulambya Peggy Kabonde, Robert Kaggwa, Sylvester Kahakwa, Isaac Kalimi, Ogbu U. Kalu, Eunice Kamaara, Wayne C. Kannaday, Musimbi Kanyoro, Veli-Matti Kärkkäinen, Frank Kaufmann, Léon Nguapitshi Kayongo, Richard Kearney, Alice A. Keefe, Ralph Keen, Catherine Keller, Anthony J. Kelly, Karen Kennelly, Kathi Lynn Kern, Fergus Kerr, Edward Kessler, George Kilcourse, Heup Young Kim, Kim Sung-Hae, Kim Yong-Bock, Kim Yung Suk, Richard King, Thomas M. King, Robert M. Kingdon, Ross Kinsler, Hans G. Kippenberg, Cheryl A. Kirk-Duggan, Clifton Kirkpatrick, Leonid Kishkovsky, Nadieszda Kizenko, Jeffrey Klaiber, Hans-Josef Klauck, Sidney Knight, Samuel Kobia, Robert Kolb, Karla Ann Koll, Heikki Kotila, Donald Kraybill, Philip D. W. Krey, Yves Krumenacker, Jeffrey Kah-Jin Kuan, Simanga R. Kumalo, Peter Kuzmic, Simon Shui-Man Kwan, Kwok Pui-lan, André LaCocque, Stephen E. Lahey, John Tsz Pang Lai, Emiel Lamberts, Armando Lampe, Craig Lampe, Beverly J. Lanzetta, Eve LaPlante, Lizette Larson-Miller, Ariel Bybee Laughton, Leonard Lawlor, Bentley Layton, Robin A. Leaver, Karen Lebacqz, Archie Chi Chung Lee, Marilyn J. Legge, Hervé LeGrand, D. L. LeMahieu, Raymond Lemieux, Bill J. Leonard, Ellen M. Leonard, Outi Leppä, Jean Lesaulnier, Nantawan Boonprasat Lewis, Henrietta Leyser, Alexei Lidov, Bernard Lightman, Paul Chang-Ha Lim, Carter Lindberg, Mark R. Lindsay, James R. Linville, James C. Livingston, Ann Loades, David Loades, Jean-Claude Loba-Mkole, Lo Lung Kwong, Wati Longchar, Eleazar López, David W. Lotz, Andrew Louth, Robin W. Lovin, William Luis, Frank D. Macchia, Diarmaid N. J. MacCulloch, Kirk R. MacGregor, Marjory A. MacLean, Donald MacLeod, Tomas S. Maddela, Inge Mager, Laurenti Magesa, David G. Maillu, Fortunato Mallimaci, Philip Mamalakis, Kä Mana, Ukachukwu Chris Manus, Herbert Robinson Marbury, Reuel Norman Marigza, Jacqueline Mariña, Antti Marjanen, Luiz C. L. Marques, Madipoane Masenya (ngwan'a Mphahlele), Caleb J. D. Maskell, Steve Mason, Thomas Massaro, Fernando Matamoros Ponce, András Máté-Tóth, Odair Pedroso Mateus, Dinis Matsolo, Fumitaka Matsuoka, John D'Arcy May, Yelena Mazour-Matusevich, Theodore Mbazumutima, John S. McClure, Christian McConnell, Lee Martin McDonald, Gary B. McGee, Thomas McGowan, Alister E. McGrath, Richard J. McGregor, John A. McGuckin, Maud Burnett McInerney, Elsie Anne McKee, Mary B. McKinley, James F. McMillan, Ernan McMullin, Kathleen E. McVey, M. Douglas Meeks, Monica Jyotsna Melanchthon, Ilie Melniciuc-Puica, Everett Mendoza, Raymond A. Mentzer, William W. Menzies, Ina Merdjanova, Franziska Metzger, Constant J. Mews, Marvin Meyer, Carol Meyers, Vasile Mihoc, Gunner Bjerg Mikkelsen, Maria Inêz de Castro Millen, Clyde Lee Miller, Bonnie J. Miller-McLemore, Alexander Mirkovic, Paul Misner, Nozomu Miyahira, R. W. L. Moberly, Gerald Moede, Aloo Osotsi Mojola, Sunanda Mongia, Rebeca Montemayor, James Moore, Roger E. Moore, Craig E. Morrison O.Carm, Jeffry H. Morrison, Keith Morrison, Wilson J. Moses, Tefetso Henry Mothibe, Mokgethi Motlhabi, Fulata Moyo, Henry Mugabe, Jesse Ndwiga Kanyua Mugambi, Peggy Mulambya-Kabonde, Robert Bruce Mullin, Pamela Mullins Reaves, Saskia Murk Jansen, Heleen L. Murre-Van den Berg, Augustine Musopole, Isaac M. T. Mwase, Philomena Mwaura, Cecilia Nahnfeldt, Anne Nasimiyu Wasike, Carmiña Navia Velasco, Thulani Ndlazi, Alexander Negrov, James B. Nelson, David G. Newcombe, Carol Newsom, Helen J. Nicholson, George W. E. Nickelsburg, Tatyana Nikolskaya, Damayanthi M. A. Niles, Bertil Nilsson, Nyambura Njoroge, Fidelis Nkomazana, Mary Beth Norton, Christian Nottmeier, Sonene Nyawo, Anthère Nzabatsinda, Edward T. Oakes, Gerald O'Collins, Daniel O'Connell, David W. Odell-Scott, Mercy Amba Oduyoye, Kathleen O'Grady, Oyeronke Olajubu, Thomas O'Loughlin, Dennis T. Olson, J. Steven O'Malley, Cephas N. Omenyo, Muriel Orevillo-Montenegro, César Augusto Ornellas Ramos, Agbonkhianmeghe E. Orobator, Kenan B. Osborne, Carolyn Osiek, Javier Otaola Montagne, Douglas F. Ottati, Anna May Say Pa, Irina Paert, Jerry G. Pankhurst, Aristotle Papanikolaou, Samuele F. Pardini, Stefano Parenti, Peter Paris, Sung Bae Park, Cristián G. Parker, Raquel Pastor, Joseph Pathrapankal, Daniel Patte, W. Brown Patterson, Clive Pearson, Keith F. Pecklers, Nancy Cardoso Pereira, David Horace Perkins, Pheme Perkins, Edward N. Peters, Rebecca Todd Peters, Bishop Yeznik Petrossian, Raymond Pfister, Peter C. Phan, Isabel Apawo Phiri, William S. F. Pickering, Derrick G. Pitard, William Elvis Plata, Zlatko Plese, John Plummer, James Newton Poling, Ronald Popivchak, Andrew Porter, Ute Possekel, James M. Powell, Enos Das Pradhan, Devadasan Premnath, Jaime Adrían Prieto Valladares, Anne Primavesi, Randall Prior, María Alicia Puente Lutteroth, Eduardo Guzmão Quadros, Albert Rabil, Laurent William Ramambason, Apolonio M. Ranche, Vololona Randriamanantena Andriamitandrina, Lawrence R. Rast, Paul L. Redditt, Adele Reinhartz, Rolf Rendtorff, Pål Repstad, James N. Rhodes, John K. Riches, Joerg Rieger, Sharon H. Ringe, Sandra Rios, Tyler Roberts, David M. Robinson, James M. Robinson, Joanne Maguire Robinson, Richard A. H. Robinson, Roy R. Robson, Jack B. Rogers, Maria Roginska, Sidney Rooy, Rev. Garnett Roper, Maria José Fontelas Rosado-Nunes, Andrew C. Ross, Stefan Rossbach, François Rossier, John D. Roth, John K. Roth, Phillip Rothwell, Richard E. Rubenstein, Rosemary Radford Ruether, Markku Ruotsila, John E. Rybolt, Risto Saarinen, John Saillant, Juan Sanchez, Wagner Lopes Sanchez, Hugo N. Santos, Gerhard Sauter, Gloria L. Schaab, Sandra M. Schneiders, Quentin J. Schultze, Fernando F. Segovia, Turid Karlsen Seim, Carsten Selch Jensen, Alan P. F. Sell, Frank C. Senn, Kent Davis Sensenig, Damían Setton, Bal Krishna Sharma, Carolyn J. Sharp, Thomas Sheehan, N. Gerald Shenk, Christian Sheppard, Charles Sherlock, Tabona Shoko, Walter B. Shurden, Marguerite Shuster, B. Mark Sietsema, Batara Sihombing, Neil Silberman, Clodomiro Siller, Samuel Silva-Gotay, Heikki Silvet, John K. Simmons, Hagith Sivan, James C. Skedros, Abraham Smith, Ashley A. Smith, Ted A. Smith, Daud Soesilo, Pia Søltoft, Choan-Seng (C. S.) Song, Kathryn Spink, Bryan Spinks, Eric O. Springsted, Nicolas Standaert, Brian Stanley, Glen H. Stassen, Karel Steenbrink, Stephen J. Stein, Andrea Sterk, Gregory E. Sterling, Columba Stewart, Jacques Stewart, Robert B. Stewart, Cynthia Stokes Brown, Ken Stone, Anne Stott, Elizabeth Stuart, Monya Stubbs, Marjorie Hewitt Suchocki, David Kwang-sun Suh, Scott W. Sunquist, Keith Suter, Douglas Sweeney, Charles H. Talbert, Shawqi N. Talia, Elsa Tamez, Joseph B. Tamney, Jonathan Y. Tan, Yak-Hwee Tan, Kathryn Tanner, Feiya Tao, Elizabeth S. Tapia, Aquiline Tarimo, Claire Taylor, Mark Lewis Taylor, Bishop Abba Samuel Wolde Tekestebirhan, Eugene TeSelle, M. Thomas Thangaraj, David R. Thomas, Andrew Thornley, Scott Thumma, Marcelo Timotheo da Costa, George E. “Tink” Tinker, Ola Tjørhom, Karen Jo Torjesen, Iain R. Torrance, Fernando Torres-Londoño, Archbishop Demetrios [Trakatellis], Marit Trelstad, Christine Trevett, Phyllis Trible, Johannes Tromp, Paul Turner, Robert G. Tuttle, Archbishop Desmond Tutu, Peter Tyler, Anders Tyrberg, Justin Ukpong, Javier Ulloa, Camillus Umoh, Kristi Upson-Saia, Martina Urban, Monica Uribe, Elochukwu Eugene Uzukwu, Richard Vaggione, Gabriel Vahanian, Paul Valliere, T. J. Van Bavel, Steven Vanderputten, Peter Van der Veer, Huub Van de Sandt, Louis Van Tongeren, Luke A. Veronis, Noel Villalba, Ramón Vinke, Tim Vivian, David Voas, Elena Volkova, Katharina von Kellenbach, Elina Vuola, Timothy Wadkins, Elaine M. Wainwright, Randi Jones Walker, Dewey D. Wallace, Jerry Walls, Michael J. Walsh, Philip Walters, Janet Walton, Jonathan L. Walton, Wang Xiaochao, Patricia A. Ward, David Harrington Watt, Herold D. Weiss, Laurence L. Welborn, Sharon D. Welch, Timothy Wengert, Traci C. West, Merold Westphal, David Wetherell, Barbara Wheeler, Carolinne White, Jean-Paul Wiest, Frans Wijsen, Terry L. Wilder, Felix Wilfred, Rebecca Wilkin, Daniel H. Williams, D. Newell Williams, Michael A. Williams, Vincent L. Wimbush, Gabriele Winkler, Anders Winroth, Lauri Emílio Wirth, James A. Wiseman, Ebba Witt-Brattström, Teofil Wojciechowski, John Wolffe, Kenman L. Wong, Wong Wai Ching, Linda Woodhead, Wendy M. Wright, Rose Wu, Keith E. Yandell, Gale A. Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- The Cambridge Dictionary of Christianity
- Published online:
- 05 August 2012
- Print publication:
- 20 September 2010, pp xi-xliv
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Antioxidant responses to an acute ultra-endurance exercise: impact on DNA stability and indications for an increased need for nutritive antioxidants in the early recovery phase
- Oliver Neubauer, Stefanie Reichhold, Lukas Nics, Christine Hoelzl, Judit Valentini, Barbara Stadlmayr, Siegfried Knasmüller, Karl-Heinz Wagner
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- Journal:
- British Journal of Nutrition / Volume 104 / Issue 8 / 28 October 2010
- Published online by Cambridge University Press:
- 19 July 2010, pp. 1129-1138
- Print publication:
- 28 October 2010
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Antioxidant requirements have neither been defined for endurance nor been defined for ultra-endurance athletes. To verify whether an acute bout of ultra-endurance exercise modifies the need for nutritive antioxidants, we aimed (1) to investigate the changes of endogenous and exogenous antioxidants in response to an Ironman triathlon; (2) to particularise the relevance of antioxidant responses to the indices of oxidatively damaged blood lipids, blood cell compounds and lymphocyte DNA and (3) to examine whether potential time-points of increased susceptibility to oxidative damage are associated with alterations in the antioxidant status. Blood that was collected from forty-two well-trained male athletes 2 d pre-race, immediately post-race, and 1, 5 and 19 d later was sampled. The key findings of the present study are as follows: (1) Immediately post-race, vitamin C, α-tocopherol, and levels of the Trolox equivalent antioxidant capacity, the ferric reducing ability of plasma and the oxygen radical absorbance capacity (ORAC) assays increased significantly. Exercise-induced changes in the plasma antioxidant capacity were associated with changes in uric acid, bilirubin and vitamin C. (2) Significant inverse correlations between ORAC levels and indices of oxidatively damaged DNA immediately and 1 d post-race suggest a protective role of the acute antioxidant responses in DNA stability. (3) Significant decreases in carotenoids and γ-tocopherol 1 d post-race indicate that the antioxidant intake during the first 24 h of recovery following an acute ultra-endurance exercise requires specific attention. Furthermore, the present study illustrates the importance of a diversified and well-balanced diet to maintain a physiological antioxidant status in ultra-endurance athletes in reference to recommendations.
Closed-Hub Systems with Protected Connections and the Reduction of Risk of Catheter-Related Bloodstream Infection in Pediatric Patients Receiving Intravenous Prostanoid Therapy for Pulmonary Hypertension
- D. Dunbar Ivy, Michelle Calderbank, Brandie D. Wagner, Susan Dolan, Ann-Christine Nyquist, Michael Wade, William M. Nickels, Aimee K. Doran
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 30 / Issue 9 / September 2009
- Published online by Cambridge University Press:
- 02 January 2015, pp. 823-829
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- September 2009
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Background.
Intravenous prostanoids (epoprostenol and treprostinil) are effective therapies for pulmonary arterial hypertension but carry a risk of catheter-related bloodstream infection (CR-BSI). Prevention of CR-BSI during long-term use of indwelling central venous catheters is important.
Objective.To evaluate whether using a closed-hub system and waterproofing catheter hub connections reduces the rate of CR-BSI per 1,000 catheter-days.
Design.Single-center open observational study (January 2003-December 2008).
Patients.Pediatric patients with pulmonary arterial hypertension who received intravenous prostanoids.
Methods.In July 2007, CR-BSI preventive measures were implemented, including the use of a closed-hub system and the waterproofing of catheter hub connections during showering. Rates of CR-BSI before and after implementing preventive measures were compared with respect to medication administered and type of bacterial infection.
Results.Fifty patients received intravenous prostanoid therapy for a total of 41,840 catheter-days. The rate of CR-BSI during the study period was 0.51 infections per 1,000 catheter-days for epoprostenol and 1.38 infections per 1,000 catheter-days for treprostinil, which differed significantly (P < .01 ). CR-BSIs caused by gram-negative pathogens occurred more frequently with treprostinil than with epoprostenol (0.91 infections per 1,000 catheter-days vs 0.08 infections per 1,000 catheter-days; P <.01). Patients treated with treprostinil after the implemented changes had a significant decrease in CR-BSI rate (1.95 infections per 1,000 catheter-days vs 0.19 infections per 1,000 catheter-days; P <.01).
Conclusion.The closed-hub system and the maintenance of dry catheter hub connections significantly reduced the incidence of CR-BSI (particularly infections caused by gram-negative pathogens) in patients receiving intravenous treprostinil.
Malnutrition and depression in the institutionalised elderly
- Christine Smoliner, Kristina Norman, Karl-Heinz Wagner, Wolfgang Hartig, Herbert Lochs, Matthias Pirlich
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- Journal:
- British Journal of Nutrition / Volume 102 / Issue 11 / 14 December 2009
- Published online by Cambridge University Press:
- 22 July 2009, pp. 1663-1667
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- 14 December 2009
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Malnutrition and depression are highly prevalent in the institutionalised elderly and can lead to unfavourable outcomes. The aim of the present study was to assess associations between nutritional status and depressive symptoms and to explore their impact on self-caring capacity and quality of life (QoL) in elderly nursing-home residents (NHR). We conducted a cross-sectional study with 114 NHR (eighty-six female) with a mean age of 84·6 (sd 9·1) years. Nutritional status was assessed with the Mini Nutritional Assessment (MNA). Depressive symptoms were rated with the Geriatric Depression Scale (GDS). Self-caring capacity was measured with the Barthel index (BI) and QoL was assessed with the short-form thirty-six-item (SF-36) questionnaire. Of the NHR, twenty-six (22·8 %) were malnourished according to the MNA and sixty-six (57·9 %) were at nutritional risk. Of the residents, seventy-five could be assessed with the GDS, whereof sixteen (21·3 %) had major and twenty-six (34·7 %) had minor depressive symptoms. GDS scores tended to be higher in patients with impaired nutritional status (5·4 (sd 3·6) in well-nourished subjects and 6·9 (sd 3·2) in residents with malnutrition or at risk of malnutrition). The MNA correlated significantly with the GDS (r − 0·313; P = 0·006) and the GDS emerged as the only independent risk factor for malnutrition in a multiple regression analysis, whereas age, sex, care level, number of prescriptions and self-caring capacity had no influence. The BI was not reduced in patients with a high GDS. QoL was affected in malnourished residents as well as in study participants with depressive symptoms. The results of the present study point towards an association between malnutrition and depressive symptoms. However, the relationship is complex and it remains unclear whether depression in NHR is the cause or consequence of impaired nutritional status. Further studies are needed to identify the direction of this relationship and to assess the effect of depression treatment on nutritional and functional status as well as on QoL.
Use of conventional and -omics based methods for health claims of dietary antioxidants: a critical overview
- Siegfried Knasmüller, Armen Nersesyan, Miroslav Mišík, Christopher Gerner, Wolfgang Mikulits, Veronika Ehrlich, Christine Hoelzl, Akos Szakmary, Karl-Heinz Wagner
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- Journal:
- British Journal of Nutrition / Volume 99 / Issue E-S1 / May 2008
- Published online by Cambridge University Press:
- 01 May 2008, pp. ES3-ES52
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- May 2008
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This article describes the principles and limitations of methods used to investigate reactive oxygen species (ROS) protective properties of dietary constituents and is aimed at providing a better understanding of the requirements for science based health claims of antioxidant (AO) effects of foods. A number of currently used biochemical measurements aimed of determining the total antioxidant capacity and oxidised lipids and proteins are carried out under unphysiologcial conditions and are prone to artefact formation. Probably the most reliable approaches are measurements of isoprostanes as a parameter of lipid peroxidation and determination of oxidative DNA damage. Also the design of the experimental models has a strong impact on the reliability of AO studies: the common strategy is the identification of AO by in vitro screening with cell lines. This approach is based on the assumption that protection towards ROS is due to scavenging, but recent findings indicate that activation of transcription factors which regulate genes involved in antioxidant defence plays a key role in the mode of action of AO. These processes are not adequately represented in cell lines. Another shortcoming of in vitro experiments is that AO are metabolised in vivo and that most cell lines are lacking enzymes which catalyse these reactions. Compounds with large molecular configurations (chlorophylls, anthocyans and polyphenolics) are potent AO in vitro, but weak or no effects were observed in animal/human studies with realistic doses as they are poorly absorbed. The development of -omics approaches will improve the scientific basis for health claims. The evaluation of results from microarray and proteomics studies shows that it is not possible to establish a general signature of alterations of transcription and protein patterns by AO. However, it was shown that alterations of gene expression and protein levels caused by experimentally induced oxidative stress and ROS related diseases can be normalised by dietary AO.
Bilingual children with language impairment: A comparison with monolinguals and second language learners
- VERA F. GUTIÉRREZ-CLELLEN, GABRIELA SIMON-CEREIJIDO, CHRISTINE WAGNER
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- Journal:
- Applied Psycholinguistics / Volume 29 / Issue 1 / January 2008
- Published online by Cambridge University Press:
- 01 January 2008, pp. 3-19
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The purpose of this study is twofold: (a) to examine whether English finite morphology has the potential to differentiate children with and without language impairment (LI) from Spanish-speaking backgrounds and different levels of English proficiency in comparison to Hispanic English speakers and (b) to investigate the extent to which children who are bilingual exhibit differences in their grammatical performance because of cross-linguistic influence from their first language. Seventy-one children between the ages of 4 years, 5 months and 6 years, 5 months were distributed into the following five groups: English as a first language (EL1) speakers with typical language development (TLD), EL1 speakers with LI, Spanish–English bilinguals with TLD, Spanish–English bilinguals with LI, and English as a second language (EL2) learners with TLD were compared on regular verb finiteness and nominative subject use using spontaneous narrative samples. The EL1 children with LI had significantly lower verb accuracy rates than the EL1 controls with TLD. Verb finiteness marking was also a significant discriminator for the bilinguals with LI. There was no evidence of cross-linguistic influence, however. The analysis indicated no significant differences between EL1 and bilingual children on subject or verb use. The EL2 group only presented difficulties with finite verb use. The typological differences between English and Spanish for overt subject use did not seem to affect the performance of either typical or atypical bilingual learners. The findings underscore the need for addressing language dominance in future bilingual studies.
Stress and First Responders: The Need for a Multidimensional Approach to Stress Management
- Christine A. Reynolds, Shannon L. Wagner
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- Journal:
- International Journal of Disability Management / Volume 2 / Issue 2 / 01 May 2007
- Published online by Cambridge University Press:
- 23 February 2012, pp. 27-36
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- 01 May 2007
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First responders are exposed to traumatic, nontraumatic and organisational stressors that conspire to create stress, potentially leading to emotional issues and/or physical or psychological illness. In addition to individual consequences, stress also takes a toll on the function of emergency departments and their communities. Fortunately, police, fire and ambulance agencies have initiated various preventive measures in an effort to mitigate the ill-effects of continued exposure to stressors by their personnel. However, combating stress effectively requires more than offering individual coping skills and access to counseling for first responders. To best preserve the wellbeing of their workers, emergency service administrators must recognise the impact of stress from a variety of sources, including organisational factors, and approach stress prevention in a multi-staged and comprehensive manner, paying special attention to primary stage interventions. When agencies embrace and act on a broad, holistic view of stress management that includes instituting cultural and organisational changes to support stress prevention, significant improvements in the stress level and health of first responders will be possible.
The Role of the Physician in Disability Management: Assessing Family Physicians' View of Discrepancies Between Practice and Canadian Medical Association Guidelines
- Christine A. Reynolds, Shannon. L. Wagner, Henry. G. Harder, Lela Zimmer
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- Journal:
- International Journal of Disability Management / Volume 2 / Issue 2 / 01 May 2007
- Published online by Cambridge University Press:
- 23 February 2012, pp. 57-72
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- 01 May 2007
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Purpose: This research project aimed to explore the views and perspectives of family physicians in regards to fulfilling their role in disability management (DM) — specifically, to examine the discrepancies between physicians' practice in DM and their professional guidelines, with special attention to physicians' experience in collaborating with key stakeholders. Methods: Seven family physicians were interviewed using a semi-structured interview format (8 evidence-based questions and 2 case examples). Interviews were recorded and transcribed. A content analysis of the interview data was conducted in addition to a thematic review of participant responses. Results: Data revealed that in accordance with previous literature, physicians' practice does not typically emulate Canadian Medical Association policy, and the participant physicians described several barriers as the reason for this discrepancy. This study revealed a multitude of frustrations encountered by physicians when interacting with other parties in DM. Participant physicians also reported potential solutions to these frustrations and other related issues. Conclusion: This qualitative study yields valuable insight into barriers, as well as facilitating factors, for physicians in the fulfillment of their DM role. Some practical recommendations for the DM community are presented, while noting that more research should be conducted, including input from key DM stakeholders, to both gain further understanding of physicians' DM function, and to identify viable interventions aimed at optimising their role.
Diet and physical activity profiles in French preadolescents
- Carine Platat, Anne-Elisabeth Perrin, Mohamed Oujaa, Aline Wagner, Marie-Christine Haan, Jean-Louis Schlienger, Chantal Simon
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- Journal:
- British Journal of Nutrition / Volume 96 / Issue 3 / September 2006
- Published online by Cambridge University Press:
- 19 February 2008, pp. 501-507
- Print publication:
- September 2006
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Dietary patterns have been identified in adults, but less is known about children and adolescents. For the first time, we have investigated lifestyle patterns combining diet and physical activity in 12-year-old French preadolescents and examined their association with sociodemographic factors. Physical activity, sedentary activities and dietary habits were assessed by questionnaires given to 2724 students in 2001. Family income tax and parents' educational level, as indicators of socio-economic status, and the size of the residence commune were obtained from parents. After adjusting for socio-economic status, physical activity was positively associated with a consumption of frui/egetable/ruit juice on more than four occasions in the previous 24h (P<0·001). Sedentary activities were positively associated with the consumption of French fries or potato chips (P<0·001), with sweetened drink as the most usual drink (P<0·001) and with nibbling while watching television (P<0·001), and inversely associated with a high consumption of frui/egetable/ruit juice (P=0·04). Multiple correspondence analysis identified two independent axes and specific combinations of behaviour: one axis characterised by sedentary activity, sweetened drink as the most usual drink, the consumption of French fries or potato chips and nibbling while watching television; a second one associating physical activity and the consumption of frui/egetable/ruit juice. Both socio-economic proxies were associated with the former axis (P<0·001). The size of the residence commune was associated with the latter (P<0·1). Combinations of diet and physical activity habits were identified in adolescents, indicating that prevention programmes targeting both behaviours may have an enhanced outcome.
3 - Estrogen receptor mRNA: neuroanatomical distribution and regulation in three behaviorally relevant physiological models
- Edited by Paul E. Micevych, University of California, Los Angeles, Ronald P. Hammer, Jr, Tufts University, Massachusetts
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- Book:
- Neurobiological Effects of Sex Steroid Hormones
- Published online:
- 15 October 2009
- Print publication:
- 26 May 1995, pp 57-84
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Summary
Introduction
Gonadal steroid hormone receptors are ligand-activated transcription factors that are part of a complex superfamily of such factors (Evans 1988). These receptors alter the transcription of genes containing specific promoter or enhancer sequences. In this way, estrogen, acting through the estrogen receptor (ER), alters the transcription of genes in the cells where the receptors are found.
Neurons that contain gonadal steroid hormone receptors are a key to the mechanisms through which these hormones govern the behavioral and neuroendocrine processes underlying reproduction (Morrell et al. 1975; Morrell and Pfaff 1983). A complex and only partly understood cascade of events occurs subsequent to the genomic regulation initiated by these ligand-activated transcription factors (Yamamoto 1985). The presence of gonadal steroid hormone receptors in neurons has been documented by means of steroid hormone autoradiography, biochemical assays for binding, and immunocytochemistry (Blaustein and Olster 1989; DonCarlos et al. 1991; Giordano et al. 1991; Morrell et al. 1992). Now the tools of molecular biology provide a means of investigating the mRNA from which gonadal steroid hormone receptors are translated.
The differential sensitivity of brain regions to steroid hormones is based on the combination of the regional location of neurons containing these receptors, the number of neurons containing the receptors per brain region, and the number of receptors per neuron. The degree of sensitivity to steroid hormones is not a static property of the brain as there is increasing evidence that the endocrine and behavioral status of the adult mammal can govern the sensitivity of brain regions to steroid hormones by regulating either the number of neurons expressing the receptors or the amount of receptor per neuron (Hnatczuk et al. 1994; Koch and Ehret 1989; Pearson et al. 1993; Simerly and Young 1991).