It has been 20 years since the concepts that are now embraced in the term recombinant DNA technology were first described. The technology has been used to design new vaccines, and one product — that for hepatitis B — has been in widespread use for almost a decade. Several other engineered vaccines have shown considerable promise in laboratory trials. Nevertheless, the potential of the approach is still to be realized. This article describes the principles that are involved in the design of these new vaccines, focusing on those for hepatitis B and rabies.

Can the world respond to the demands of the Children's Vaccine Initiative (CVI) to produce large quantities of affordable vaccines that have never been manufactured previously? Vaccines for the world's birth cohort of 150 million will continue to be produced in the countries that use the greatest part of the global vaccine supply. Thus, the CVI will rely on increased self sufficiency in vaccine production in the developing world and “shared development” of new and improved vaccines. The CVI's goal is to direct product development to meet the needs of immunization programs, but it must not neglect production. Thus, from the start, investment at the front end of the development and production sequence requires attention to the ultimate production capacity.

Not only is the number of computed tomography (CT) units relative to population in Japan the highest in the world, that of magnetic resonance imaging (MRI) units is second only to the United States. This study examines the diffusion pattern of MRI in Japan, as well as the factors that influence it. The number of MRI units has increased sharply, closely following CT, as has been the case in the United States. This pattern of diffusion in Japan was determined mainly by the following factors: the technological attributes of MRI; the market situation of the medical engineering industry; the reimbursement system of health insurance; and Japan's sociocultural background. However, the introduction of MRI in Japan was not linked to any formal assessment of its efficacy or effectiveness.

Computer networks serve as convenient, efficient, and enduring vehicles for delivering nursing services to patients at home. The ComputerLink, a specialized computer network, provided nurse-supervised information, decision support, and communication services to home-dwelling persons living with AIDS (PWAs). During a 26-week randomized field experiment, 26 PWAs accessed the ComputerLink on more than 8,664 occasions. The communications area was used most often; the public communication area functioned like a support group. Multiple behavioral measures of use provide a rich picture of how these PWAs, none of whom had had prior computer experience, adopted and adapted to this innovative nursing care delivery system. Meeting the needs of a rapidly growing and diverse population of home-care clients demands that nurses make effective use of existing technologies such as cable television and telephone triage systems. Computer networks combine the best features of cable television and telephone systems—broadcast distribution and interaction; therefore, computer networks represent an ideal technology for the delivery of certain nursing services to the home.

Prognostic factors were analyzed among women with ovarian cancer. Stage, histologic subtype and grade, age, performance status, residual tumor size, and platinum-based chemotherapy were factors that significantly influenced the survival rate. Based on these findings, we performed maximal cytoreductive surgery and gave dose-intensified platinum-based chemotherapy to patients with advanced disease and were able to improve survival rate significantly.

Technological advances by developed countries are producing safer, more potent vaccines. In addition, the transfer of the technology of vaccine production to some developing countries has been taking place during the past five decades, thereby making possible the participation of developing countries in the production and supply of the essential biologicals that are required for immunization programs. Examples of successful transfers of technology, the decisive elements and factors that contribute to the transfers, and the major obstacles to such transfers are presented.

New medical technologies are often developed and diffused in health care without societal assessments or setting of priorities. This article discusses the driving forces behind the development of new technologies and asks how women as users and providers of health services can gain influence on the process. Technologies used in pregnancy and childbirth are discussed to reveal different interests in their development and use and to discuss the role of industry in the development of new medical technologies in general.

Recent advances in genetic identification and characterization of a number or hereditary disorders have led to increased possibilities for genetic testing and screening. The context and methods of screening are important given that identification of otherwise healthy persons as being presymptomatic or at increased risk for genetic diseases may have serious consequences for their future lifestyle, employment, and insurability. This article examines general principles for genetic screening, including goals, delivery issues, and professional and lay responses to screening and counseling, and recommends areas in which social psychological research on screening is needed.

Currently, myringotomy is widely used in the routine initial treatment of acute otitis media in Japan. In an attempt to evaluate the validity of this strategy, a number of issues that demand reassessment or clarification have been identified. These issues and factors contributing to the persisting uncertainty about myringotomy are examined.

Invasive and noninvasive medical technology are employed frequently in the health care of women, particularly childbearing women, often without any demonstrable benefit. Nurses are in a position to be advocates for their childbearing patients and to define and implement a realistic balance between supportive or facilitative caring and technical interventions.

Prenatal diagnosis is now offered to the majority of pregnant women in Europe and the United States. Advances in obstetric and laboratory techniques mean that increasing numbers of conditions can be diagnosed prenatally; indeed, gene carriers can be identified before pregnancy in some cases. Current obstetric and laboratory techniques for prenatal screening and diagnosis of genetic disorders are discussed.

The Children's Vaccine Initiative (CVI) will result in profound changes in immunization practice. Before the CVI is fully developed, it will present numerous challenges to regulatory practice that will require new applications of existing ideas and innovative solutions to practical issues, especially in combining existing vaccines.

Prenatal diagnosis has been performed more frequently in Japan recently, but is still less popular than in the United States or Europe. Legal arrangements, insufficient economic support, and insufficient medical information provided to future parents may explain this difference. The acceptability of prenatal diagnosis, based on the concept of the cost of side effects and elective abortion, was found to be similar when examined through decision analysis and direct survey. Amniocentesis was considered useful for more than half of couples in Japan when the incidence of chromosomal abnormality is more than 0.5% and proper information about the decision to undergo this examination is provided to the pregnant woman and her family.

Patterns of the diffusion of laparoscopic cholecystectomy in Canadian hospitals were determined by a telephone survey of 153 randomly selected hospitals over two years. Results were analyzed by region, hospital size, and type of hospital. Laparoscopic cholecystectomy has diffused very quickly compared with other technologies, before any comprehensive evaluation to consider its potential impact could take place.

Several routine procedures are available for diagnosis of diseases caused by an alteration in a single gene. These techniques include Southern analysis, the polymerase chain reaction, allele-specific oligonucleotide screening, automated DNA nucleotide sequencing, and linkage analysis. DNA testing procedures can be used for diagnosis of disease, determination of carrier status in affected families, or general screening of the population. Some of the more commonly used techniques and their applications are described in this article.

Although the vaccination initiatives undertaken during the past decade are the cornerstones for protecting the world's children and helping to ensure their survival and development, the vaccines currently being employed may become obstacles for further disease reduction or eradication. Their characteristics complicate or increase the burden on health care infrastructures to maintain or expand vaccine delivery systems. This paper examines an experience with the vaccine technologies that currently are being used by immunization programs in developing countries, illustrating the field problems and obstacles associated with their use. It discusses the advantages and benefits that would accrue if new or improved, heat-stable, multi-antigen vaccines that require only one or two, preferably oral, doses were to become available.

Our understanding of the genetic changes that transform normal cells into malignant cells is increasing at a remarkable pace. Some of the changes involve detectable cytogenetic aberrations, whereas others are identifiable only at the molecular level. Many of the structural cytogenetic changes have also been defined molecularly because the genes involved have been cloned. Thus, we are approaching the stage in which the DNA obtained from tumor tissue can be analyzed to detect the presence of a series of chromosomal and molecular alterations. These studies provide important information regarding the precise diagnosis of the tumor type as well as prognostic information about the likely response to therapy and survival.

Japanese surgeons have performed only one heart transplant in the quarter century since the procedure was developed. Possessing the requisite training and technology, transplant surgeons have been stymied by several factors that elude professional and political solution. Most critically, the lack of a brain death standard limits the availability of transplantable organs. Mistrust of the medical profession, traditional outlooks on death, and the primacy placed on consensual decision making have fueled debate about brain death and transplantation. Volatile and value laden, these issues have overwhelmed the discussion of health care resources, equal access to high-technology medical procedures, and insurance coverage for transplantation.

This study assessed a joint protection education program and investigated the costs and effects of assistive devices. Fifty-three women with seropositive rheumatoid arthritis, whose ages ranged from 29 to 65 years, attended a standardized joint protection course (13 hours). A self-report questionnaire was constructed listing the most common devices, and the subjects were asked to check which devices they had received, which ones they used and did not use, and why. Pain during activities of daily living and when using assistive devices was measured using the visual analogue scale. Results show that the subjects reported great benefits from the joint protection course, assistive devices, and wrist orthosis. The women had tried 663 devices, 91 % of which were still being used. Pain decreased significantly (p < .001) when using assistive devices. The utility of 11 devices at a cost of SEK 1,683 per person can be described as increased capacity and ability to work at home, work outside the home, and perform leisure activities with less pain.

The efficacy of vaccines for prophylactic use is a function of the immune response elicited by activated lymphocytes. Based on the current understanding of these responses, their induction, and the most effective ways to obtain long-lived immunity, a novel protocol for the vaccination of children against seven childhood diseases, involving only two visits for vaccine administration, is proposed.