Puthapuan C 1994 ; Attitude and Risk Behavior Related to HIV infection in Health Science University Students in Chiang Mai. A research report. Faculty of Nursing, Chiang Mai University, Thailand. Royal Thai Ministry of Public Health, Division of Communicable Disease Control HIV AIDS Surveillance Data, Bangkok, 1994. Rugpao S 1995 ; Sexual Behavior in Adolescent Factory Workers. A final report to WHO. Research Institute for Health Sciences, Chiang Mai University, Thailand. Saiprasert S, Ford N 1993 ; Gender construction and changing nature of the sexual life-style of Thai youth. Qualitative Methods for Population and Health Research. Mahidol University, Nakornprathom, Thailand. Soonthorndhada A 1992 ; Adolescent role behavior, expectation and adaptation. In Changing Roles and Status of women in Thailand: a documentary Assessment. Institute for Population and Social Research, Mahidol University, Thailand. Srisupan V, et al 1990 ; Knowledge, Opinion, and Sexual Behavior of High School, Vocational College, and University Students in Chiang Mai Province. A research report. Faculty of Nursing, Chiang Mai University. Stedman Y, and Elstein M 1995 ; Rethinking sexual health clinics [editorial]. BMJ, 310, 342-343. Taneepanichskul S, and Phuapradit W 1995 ; Adolescent pregnancy with HIV-1 positive in Ramathibodi Hospital in 1991-1995. J Med Assoc Thai, 78: 688-91, 1995 Dec. Thevadithep K, et al 1992 ; Sexual Risk Behavior Related to STDs in University Students in Chiang Mai, A research report in the second health behavior conference, September 1992. Chiang Mai Orchid Hotel, Chiang Mai, Thailand. Wellings K, et al 1994 ; Sexual behavior in Britain. The National Survey of Sexual Attitudes and Lifestyles. Penguin Books. Wissarutrat S 2001 ; Unwanted Pregnancy among Teenagers in Chiang Mai. The Nation, August 9th, 2001. World Bank 1994 ; Integrated Approaches in Reproductive Health. Population and Development : Implication for the World Bank, Washington, DC. World Health Organization 1995 ; World Health Report Guiding the Gaps. World Health Report, Switzerland, WHO. Yoddumnern-Attig B 1992 ; Thai family structure and organization: changing roles and duties in historical perspective. In Changing Roles and Status of women in Thailand: a documentary Assessment. Institute for Population and Social Research, Mahidol University, Thailand.
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Eric D. Caine, M.D. Center for the Study and Prevention of Suicide tended to miss youth no longer in schools or men and women in early adulthood. Most have neglected adults in the middle years of life despite the fact that in the U.S. the greatest overall burden from suicide for both men and women accrues from ages 25-54 years. Nonetheless, local governments have the potential to integrate and implement actions that the Federal and State level of government can support but rarely can implement directly. In sum, creating both `vertical' and `horizontal' partnerships at and between each level of government is essential for longer term development and maintenance of effective suicide prevention efforts; this requires challenging and overcoming traditional agency boundaries in order to focus on both broader populations and symptomatic individuals immediately in need of care. Final Comments. The National Strategy for Suicide Prevention as well as past reports by the Surgeon General amply explain that the majority of people who will kill themselves either had never seen a mental health professional or did not see one at the time when their symptoms had spiraled out of control. The recently released UK national plan underscored the point further. Thus, one must define and carefully assess where potentially vulnerable individuals may be found and expand the spectrum of care to include sites well beyond the traditional healthcare delivery system. It will be essential in the future to creatively combine and utilize the diverse funding streams that presently flow to `critical sites' in a piecemeal, uncoordinated fashion to optimally develop a true "continuum of care" for reducing the burdens of suicide and suicidal behaviors by addressing the array contributing risk factors. There are ample published data regarding the influences of age, gender, ethnicity, psychopathology, and social circumstances that contribute to elevated risk and adverse outcomes. However, there is scant information guiding efforts to tailor programs to address the needs of diverse groups. For example, we know virtually nothing about `what it will take' to foster effective interventions for African-American men in their 20s and 30s relative to white men of the same ages. Nor do we have a clear understanding of how we will need to vary programs in urban and rural parts of our nation to enhance their effectiveness. A central element of any future national prevention effort must be built upon local action. No matter how much commitment there may be at the Federal level, actions that change the lives of people occur in smaller groups and one-to-one. These actions must be embedded in collaborating communities, which are defined not just by locale but also by common need and aspiration. It is essential to develop clear, understandable, readily acceptable mechanisms for drawing together communities and building coalitions to prevent suicide and its related spectrum of antecedent problems. As the latter share much in common with other pressing social needs, such as reducing domestic violence, treating and preventing chemical dependency, or reducing the impact of depression on work performance and productivity, it should be a central goal to draw together these efforts to enhance the overall health and well being of our communities. This `common risk' approach akin to identifying a common enemy among those with potentially disparate interests ; should be used to build alliances that have the possibility of fundamentally driving an array of critically important programs. Lasting success preventing suicide and related conditions will depend upon maintaining a well-coordinated array of national, state, and local activities that become `institutionalized' as part of the mandated roles of each, with expected accountability from both elected and appointed leaders. At the same time, it is critical to remember that rapid access to care remains a major barrier to those in need of preventive interventions; no prevention program in the United States will reach an optimal level of effectiveness as long as there substantial barriers remain, such as inadequate health insurance or a paucity of providers willing to provide care to currently underserved populations.
The pharmacists have been undertaking medication reviews in 22 out of the 57 practices in Bolton. To date 1276 patients have been reviewed and 3217 interventions made resulting in a monthly saving of 5, 500 for this number of patients. The chart below shows a breakdown of interventions made by category.
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FIG. 3. Effects of Go-6976 alone and in combination with Ro24-7429 A ; or PTX B ; on HIV-1 LTR-driven reporter gene expression. Jurkat cells were either untransfected or cotransfected with an equimolar concentrations of pHIV-1 LTR CAT and pSVTat 2 g of each ; , using the DEAE-dextran method. Cells were grown in either the absence or presence of the test drug for 48 h prior to harvesting of cell lysates. A ; Percent CAT activity in the presence of increasing concentrations of either Ro24-7429 nanomolar; E ; , Go-6976 nanomolar , or Ro24-7429 plus Go-6976 s ; . B ; Percent CAT activity in the presence of increasing concentrations of either PTX micromolar; E ; , Go-6976 nanomolar , or PTX plus Go-6976 s and imipramine.
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| Table 5 Characterization of the allosteric mechanism for hSERT mutants EC50 M ; hSERT WT hSERT ALI VFL hSERT II VT hSERT MS SN hSERT SI TT hSERT VFL-II-SN-TT hSERT ALI-VT-SN-TT hSERT VFL-VT-SN-SI hSERT VFL-VT-MS-TT hSERT VFL-VT-SN-TT hSERT VFL-II-SN-SI hSERT ALI-VT-MS-TT hSERT ALI-II-SN-TT hSERT VFL-II-MS-TT hSERT VFL-VT-MS-SI hSERT A505V hSERT L506F hSERT I507I hSERT I552V hSERT I553T hSERT M558S hSERT S559N hSERT S574T hSERT I575T 7.0 5.8-8.4 ; 45.2 32-64 ; 23.0 19-27 ; 15.4 14-17 ; 35.3 26-48 ; 216.3 126-372 ; 396.5 257-613 ; 193.0 146-255 ; 532.3 358-792 ; 208.2 169-256 ; 213.5 176-259 ; 207.7 120-359 ; 47.1 39-56 ; 483.8 369-634 ; 113.6 89-145 ; 34.9 24-51 ; 33.2 20-56 ; 6.2 5.2-7.3 ; 7.3 5.8-9.4 ; 21.4 14.6-31.4 ; 7.6 6.5-8.8 ; 16.1 11.6-22.4 ; 5.8 4.3-7.8 ; 23.4 19.7-27.9 ; Kd nM ; 6.7 5.4-8.0 ; n.d. 5.1 3.9-6.3 ; 4.6 3.9-5.2 ; 6.8 5.7-7.9 ; 11.3 8.3-14.4 ; 7.5 4.3-10.8 ; 6.6 3.3-10.0 ; n.d. 16.9 12.4-21.3 ; 10.2 6.7-13.7 ; 15.2 12.3-17.7 ; 10.8 8.4-13.2 ; 12.5 6.5-18.5 ; 14.1 10.5-17.8 ; n.d. n.d. n.d. n.d. n.d. n.d. n.d. n.d. n.d.
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Double-blind, placebo-controlled, multicenter trial Collaborators: the VA system, the NIH, and Merck Enrolled 38, 546 healthy subjects 60 years old Randomized: zoster vaccine vs. placebo Attenuated VZV with titer 14X higher than varicella vaccine Primary efficacy endpoints: Incidence of shingles Burden of illness BOI: zoster incidence X intensity X duration ; Incidence of PHN Monthly telephone follow-up to find cases and adverse events Median follow up about 3 years.
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The notion of legally protecting innovation is relatively new for some nations and decades-old for others. With such a wide range of rights management policies around the world--many of which are constantly evolving--multinational companies often face a dizzying array of legal, procedural, and financial decisions. For example, despite well established and stringent IP protections in the US, shifting legal precedents and changing competitive conditions constantly redefine the IP context in which businesses operate. Under such conditions, determining the most accurate method of damages valuation, developing cost-effective legal responses to patent infringement, or adjusting IP portfolio management strategies to reflect changing market conditions becomes all-themore complex. Elsewhere in the world, the movement to create or enhance intellectual property rights IPR ; protection policies has made important advances in recent years. In Japan, for example, IPR reforms instituted in 1998 have replaced old methods of calculating economic damages with revised methods based on economic principles--dramatically increasing a patent owner's chances of recovering damages in cases of infringement. These reforms have also resulted in higher patent damages awards and a more efficient court system to accommodate the increased number of IP-related lawsuits. Under the old system, damages awards were so low that, after accounting for litigation costs, even victorious plaintiffs frequently lost money when suing infringers in Japanese courts. But with Our experts are organized into global practices, linked by an efficient firm-wide communications and computing network that facilitates the international coordination of document and data production. We understand both the local issues and larger international concerns associated with each case and frequently collaborate with colleagues in our international network of economists to develop innovative, globally integrated approaches to complex and emerging intellectual property issues. Our excellence in data management and analysis makes the quantitative aspects of modern litigation manageable. NERA's capabilities are well-matched to the demands of a global market. With 11 offices in the US, six in Europe and one each in Tokyo and Sydney, our experts are well positioned to advise on IP matters or assist in economics-intensive litigation on any continent. Moreover, our economists' local language capabilities allow us to effectively explain the difficult economic issues underlying much of complex IP disputes to counsel and clients. The European Commission is working to combat counterfeiting and piracy through the alignment of national criminal laws of Member States. Meanwhile in China, a rapidly developing economy and intensifying external pressure from the US, Europe, and Japan have led to the establishment of intellectual property laws, courts, and enforcement processes. But although China is toughening its legal sanctions and pursuing counterfeiters with more gusto, the nation still accounts for nearly two-thirds of all counterfeit and pirated goods worldwide. In order to thrive, many multinationals--especially those in IP-sensitive industries such as consumer electronics, pharmaceuticals, and software--are becoming increasingly proactive in pursuing both legal tactics and operational strategies. the new system in place, Japanese businesses are now more aggressively defending their rights and more frequently resolving IP disputes in court and
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Chapter 6 Table 1: Characteristics of study population. Male n 43 ; Mean age at first psychosis yrs ; 24.41 n 15 4 % 34.9 9.3 Female n 24 ; 27.65 n 3 2 % 12.5 8.3 p 0.130.
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This study was supported by a grant from the New York State Department of Health to The Public Health Research Institute, New York, N.Y. We are grateful to Dennis Leung and Larry Leon for expert statistical assistance and to Timothy Kiehn, Susan Shuptar, Kathleen Gilhuley, Fitzroy Edwards, and May Wong for their support in the collection and analysis of Candida isolates.
MUSCULO SKELETAL SYSTEM Anti-inflammatory and anti-rheumatic products A Anti-inflammatory and anti-rheumatic products pre steroids B Combinations with corticosteroids Topical products for joint and muscular pain A Topical products for joint and muscular pain Muscle relaxants A Peripherally acting agents B Centrally acting agents C Directly acting agents Antigout preparations A Antigout preparations Other drugs for disorders of the musculo skeletal system A Other drugs for disorders of the musculo skeletal system CENTRAL NERVOUS SYSTEM Anaesthetics A Anaesthetics, general B Local anaesthetics, excl. dermatologicals Analgesics A Narcotics B Other analgesics and antipyretics C Anti-migraine preparations Anti-epileptics A Anti Parkinson drugs Psycholeptics A Neuroleptics B Tranquilizers C Hypnotics and sedatives Psychoanaleptics A Antidepressants B Psychostimulants C Psycholeptics and psychoanaleptics in combination Other CNS drugs, incl. Parasympathomimetics A Parasympathomimetics ANTI-PARASITIC PRODUCTS Antiprotozoals A Amoebicides and similar B Antimalarials X Other antiprotozoals and vasodilan.
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Clinicians from all disciplines and specialties require up-to-date information in order to deliver the best possible care to their patients. However, with around 20, 000 biomedical journals in print and limited time for reading, the ideal of large-scale critical appraisal Jonathan Underhill is assistant director, education and development, at the National Prescribing Centre Scott Pegler is principal pharmacist and medicines information manager at Swansea NHS Trust Correspondence to Jonathan Underhill e-mail jonathan.underhill npc.nhs.
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By Richard J. Beno CPCU Through the years, SCPIE has handled many cases involving allegations of physician failure to report patients with lapses of consciousness to the local health department. The three cases in this article illustrate the often-dire consequences of failing to follow through on this important step in a patient's medical treatment plan. Although all of these cases take place in California, each state has its own regulations. Physicians should check with their local health department on the reporting requirements for their particular state. In the following random sampling of three cases from our files, a total of four people died and eight were injured. These cases, which totaled more than .5 million in defense and indemnity expenses, illustrate instances where death and injury were wholly preventable. Case 1 The patient, a 30-year-old male with a history of juvenile diabetes, first presented to the insured internist in 1979. In 1986, the internist referred the patient to an insured nephrologist because of diabetes-induced renal failure. Later that year, the patient underwent a renal transplant. In 1990, the transplanted kidney was rejected and was subsequently removed. In December 1991, the insured nephrologist hospitalized the patient due to continued complications of diabetes, and requested a consult from a second insured internist. This second internist documented "periods of unconsciousness" in his consultation and sent copies of his report to the nephrologist and the original internist. No Confidential Morbidity Report CMR ; was filed with the local health department. [ Note: In California, pursuant to Health & Safety Code 103900, a CMR must be completed by the diagnosing physician to report patients with "lapses of consciousness." Once the CMR is filed with the local health department, the physician has complied with this statute. The local and
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GENERAL MEDICAL INPATIENT UNITS Both male and female ; . MALE INPATIENT UNIT . FEMALE INPATIENT UNIT . PEDIATRIC INPATIENT UNIT . HIV AIDS INPATIENT UNIT . DELIVERY INPATIENT UNIT . INPATIENT UNIT . UNIT COMBINES SPECIAL DIAGNOSES INCLUDING HIV AIDS . SURGERY INPATIENT UNIT Male and fema 29 MALE SURGICAL . FEMALE SURGICAL . OTHER 97 SPECIFY.
In Canada is somewhat problematic as it calls into question the often suggested role of exposure to environmental pollutants, usually associated with urban living, in the etiology of FM. Regarding our analyses of the socioeconomic factors of education and income, the findings not surprisingly indicate that the prevalence of FM declines with increasing income, consistent with what has been observed in other studies.2729 It is interesting to note that the prevalence of FM does not appear to be inversely related to education, despite the fact that education is usually strongly correlated with increased income. An attractive, but yet unproven explanation could be that lower income is not a predisposing condition for FM, but rather a result of developing the disorder. An additional, less straightforward explanation for these associations would be that high education and low income represent markers for other co-existing or correlating population characteristics, including emotional processes, which could be more common among individuals with FM. The results of the BMI, alcohol and smoking investigation raise both some interesting issues and present some unclear findings Table 4 ; . To our knowledge, this study demonstrates the first clear association between BMI and FM. A number of potential explanations for this association exist. First, increasing weight could predispose an individual to developing FM. For example, obesity may lead to a relative hormonal imbalance, similar to what occurs with.
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Spicer BV, Pike MC. "Hormone replacement after breast cancer." Lancet 342: 183-84, 1993. Class R ; Col NF, Eckman MH, Karas RH, et al. "Patient-specific decisions about hormone replacement therapy in postmenopausal women." JAMA 277: 1140-47, 1997. Class M ; History of Endometrial Cancer Most oncologists agree that women with past history of stage I endometrial cancer, which has been successfully treated, may safely use HRT if it is otherwise indicated. Creasman WT, Henderson D, Hinshaw W, et al. "Estrogen replacement therapy in the patient treated for endometrial cancer." Obstet Gynecol 67: 326-30, 1986. Class C ; Lee RB, Burke TW, Park RC. "Estrogen replacement therapy following treatment for Stage I endometrial carcinoma." Gynecol Oncol 36: 189-91, 1990. Class B ; American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. "Estrogen replacement therapy and endometrial cancer." ACOG Committee Opinion NO. 80. Washington, DC: American College of Obstetricians and Gynecologists. Class R ; History of Venous Thrombosis Women with a past history of venous thrombosis postoperatively or following prolonged immobilization do not seem to have an increased risk for recurrence while on HRT. It is not known whether women with a past history of venous thrombosis while taking OCPs have an idiosyncratic response to estrogen. Lobo RA. "Estrogen and the risk of coagulopathy." J Med 92: 282-85, 1992. Class R ; Devor M, Barrett-Connor E, Renvall M, et al. "Estrogen replacement therapy and the risk of venous thrombosis." J Med 92: 275-82, 1992. Class C ; Chronic Liver Disease If HRT is needed in women with chronic liver disease, use transdermal or intravaginal estrogen therapy avoiding the first pass hepatic effect of oral HRT. Hypertriglyceridemia Oral conjugated estrogens may significantly raise serum triglyceride levels potentially precipitating pancreatitis. Consider transdermal estrogen if baseline serum triglycerides are markedly elevated. Conditions for Which HRT is not Contraindicated Several conditions, such as hypertension, smoking, and obesity, which may be relative contraindications to the use of OCPs, are sometimes believed to be reasons not to consider HRT as well, by both patients and practitioners. However, these conditions may actually be indications for HRT use, because of its beneficial effects on cardiac risk factors. The effect of HRT on migraine headaches is often unpredictable. For management information, see Annotation #12, "Evaluate and Manage Side Effects.
Pakharenko-Anderson A. Building legislation and regulatory implementation environments: the Ukraine experience. Proceedings of the Global Forum on Pharmaceutical Anticounterfeiting; 2002 Sept. 22-25; Geneva, Switzerland. Greenwood Village: Reconnaissance Intl; 2002.
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