Coping with Racial Discrimination: Coping Strategies, Critical Ethnic Awareness, and Psychosocial Resources for Asian Americans.

Despite rapid growth of the Asian Americans population in recent decades, less research exists on racial discrimination of Asian Americans than of other minority groups. Past studies have not explored how Asian Americans’ nativity status influences coping with racial discrimination. This study examined the protective roles of emotional support, critical ethnic awareness, and coping strategies on the impact of racial discrimination on depression among Asian Americans using four hypotheses in racial discrimination context. Four hundred ten Asian American adult respondents completed an online survey administered in June and July of 2010. The Center for Epidemiologic Studies Depression Scale (CES-D) served as the outcome measure to assess for respondents’ depressive symptom level. Five sets of factors were considered: 1) discrimination; 2) social support; 3) critical ethnic awareness; 4) general coping style; and 5) racism-specific coping strategies. Three hundred eighty four cases were available for hierarchical regression analyses, with each of the five factor sets added in successive analyses. The results reported were controlled for relevant socio-demographic factors. The results indicated that being perceived as a ‘perpetual foreigner’ was associated with depressive symptoms among Asian Americans in this study sample. The findings also indicated that emotional support from friends and family and thinking about self in social context were associated with the depression score. Additionally, general discrimination experience was associated with the depression score among the immigrant subgroup, while perception as a perpetual foreigner was associated with the depression score among the U.S.-born subgroup. The findings demonstrated that being perceived as a ‘perpetual foreigner’ is an independently significant stress beyond racial discrimination in general among U.S.-born Asian Americans. The results suggest that racial coping strategies may not buffer beyond general coping mechanisms in protecting Asian Americans from depressive symptoms. Future research must take into consideration nativity status when examining the relationship between racial discrimination and depressive symptoms in the Asian American population. Additionally, researchers and practitioners must examine what type of coping styles and/or strategies would best benefit Asian Americans in buffering the impact against racial discrimination experiences.Ph.D.Social Work & PsychologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/91377/1/kimisok_1.pd

Viiruse ja peremeesraku interaktsioonid inimese papilloomiviiruse elutsüklis

Väitekirja elektrooniline versioon ei sisalda publikatsioone.Papilloomiviirused on väga laialdase levikuga ning pea kõik inimesed nakatuvad mingil eluetapil selle viirusega. Üldiselt kulgeb HPV infektsioon üsna kergelt, põhjustades nahal või limaskestadel healoomulisi vohandeid, soolatüükaid (β-HPV) või kondüloome (α-HPV). Kliiniliselt oluliseks peetakse aga papilloomiviirusi seetõttu, et selle viiruse infektsiooniga on seotud enamik emakakaela vähi juhtumitest. Arvatakse, et emakakaela vähi tekke üks olulisemaid etappe on raku nakatumine kõrgesse riskigruppi kuuluva papilloomiviiruse subtüübiga. Kui soolatüükaid ja kondüloome põhjustavad madala riskiga inimese papilloomiviiruste subtüüpide infektsioon aja möödudes kaob, siis emakakaela vähki põhjustavate viiruste infektsioon muutub kergesti pikaajaliseks. Sellisesse faasi jõudnud nakkuse ravivõimalused on aga väga piiratud, mistõttu on HPV infektsiooni varajane avastamine eduka ravi seisukohalt ülioluline. Papilloomiviiruse infektsioon kulgeb tavaliselt läbi ekstrakromosomaalse rõngasmolekuli ning viiruse elutsükli edukaks lõpetamiseks ei ole integreerumine peremeesraku pärilikku materjali (DNA) tingimata vajalik. Vähirakkude geneetilisel uurimisel on aga muuhulgas HPV nakkuse tuvastamisele avastatud ka asjaolu, et väga paljudel juhtudel on papilloomiviiruse genoomi osad integreerunud peremeesraku kromosoomidesse, muutes HPV DNA üheks osaks peremeesraku pärilikust materjalist. HPV genoomi osaline integratsioon rikub ära aga mitmete viiruse jaoks oluliste valkude ekspressiooni (s.h. DNA replikatsiooniks ja virioni moodustamiseks vajalike valkude sünteesi). Seega peetakse integreerumist viiruse seisukohalt tupikteeks. Peremeesraku seisukohalt aga peetakse pahaloomuliseks kasvajaks arenenud rakkude DNAs tuvastatud suuri ja tagasipöördumatuid muutusi just viiruse integratsiooni tagajärjeks. Viiruse integratsioon võib toimuda mistahes kromosoomi piirkonda, ka nendesse piirkondadesse, mis on peremeesraku kasvu ja jagunemise kontrolli seisukohalt väga olulised. Kuna nakatunud rakk sisaldab keskmiselt 100 ekstrakromosomaalset viiruse genoomi koopiat ning massilist genoomide integratsiooni tavaliselt ei toimu, tekib olukord, kus ühes rakus eksisteerib kaks erinevat viiruse DNA vormi: üks, puudulike geenidega integreerunud vorm ja teine, täiesti funktsionaalne ekstrakromosomaalne vorm. Kuigi integreerunud viiruse DNAlt ei saa enam ekspresseerida DNA paljundamiseks vajalikke replikatsioonivalke, siis ekstrakromosomaalselt molekulilt replikatsioonivalkude sünteesiks mingeid takistusi ei ole. Selline olukord on aga peremeesraku genoomse stabiilsuse seisukohalt väga ohtlik, kuna integreerunud HPV järjestused sisaldavad viiruse DNA paljundamiseks vajalikku alguskohta (replikatsiooni origin-i), mis ei ole rakuliste regulatsiooni faktoritega kontrollitav. Sellelt järjestuselt alustatud DNA replikatsioon, põhjustab nii integreerunud HPV DNA kui ka sellega külgnevate peremeesraku genoomi osade kontrollimatut paljundamist (amplifikatsiooni). Olenevalt integratsiooni kohast, võivad integreerunud HPV järjestusega külgnevad alad sisaldada onkogeene või muid raku kasvu ja jagunemisega seotud regulatoorseid geene, mille amplifikatsioon võib põhjustada raku genoomset ebastabiilsust ning kontrollimatut kasvu ja jagunemist. Lisaks võib põhjustada HPV-dele omane litsentseerimata DNA re-replikatsioon replikatsiooni komplekside takerdumisi, mis viib ebatüüpiliste DNA replikatsiooni produktide kuhjumiseni raku tuumas. Rakulise DNA reparatsiooni radade võtmemolekulide lokalisatsioon HPV DNA replikatsiooni tsentritesse viitab rakuliste mehhanismide olulisele rollile tekkinud kaheahelaliste DNA katkete parandamisel. Kui enamik kaheahelalisi DNA katkeid parandatakse õigesti, siis antud väitekirjas kirjeldatud viiruse integratsiooni koha translokatsioon uude kromosoomi piirkonda viitab ebaõnnestunud katsele parandada DNA amplifikatsiooni tagajärjel tekkinud DNA produkte. Seega, integreerunud HPV järjestuste amplifikatsioon ja peremeesraku vastusena aktiveeritud DNA reparatsiooni mehhanismid võivad viia peremeesraku genoomse ebastabiilsuseni ja vähkkasvaja tekkeni. Inimese papilloomiviiruste uurimine nende looduslikes peremeesrakkudes on üsna keerukas just keratinotsüütide keeruka elutsükli tõttu, mis on aluseks nahkkoe kihistunud struktuuri moodustumisel. Kui diferentseerumata basaalsed keratinotsüüdid on pidevas jagunemises ja vastutavad basaalrakkude populatsiooni uuenemise eest, siis diferentsieerumisradadele suunatud rakud läbivad kontrollitud rakusurmaga lõppeva elutsükli. Mitmes eri diferentseerumisastmes olevate keratinotsüütide populatsioon tekitab nahkkoe kihistunud struktuuri, mille peamiseks ülesandeks on tagada tugev (ja läbimatu) barjäär sise- ja väliskeskkonna vahel. Kuna viirus nakatab diferentseerumata basaalseid keratinotsüüte ja pakib oma viiruspartiklid alles terminaalselt diferentseerunud rakkudes, on papilloomiviirused kohanenud kõikide peremeesraku eluetappidega. Lühidalt, papilloomiviirus nakatab basaalseid keratinotsüüte mikrovigastuste kaudu ning peale viiruse geneetilise materjali jõudmist raku tuuma, toimub esmalt aktiivne viirusgenoomi paljundamine. Peale optimaalse genoomi koopiaarvu saavutamist, lülitub viirus ümber stabiilsele genoomi säilimisele ning jääb ootama peremeesraku diferentseerumist. Sel ajal toimub HPV- ja peremeesraku geneetilise materjali sünkroonne paljundamine ning viiruse genoomide peaaegu ühtlane jaotumine tütarrakkude vahel. Terminaalselt diferentseerunud rakkudes toimub taaskord aktiivne genoomi paljundamine (amplifikatsioon) ning viimase etapina viiruspartiklite moodustumine. Laboritingimustes on keratinotsüütide kasvatamine ja elutsükli mimikeerimine tehniliselt keerukas, ajakulukas ja küllaltki kallis. Lisaks ei ole otstarbekas niigi kapriisset rakukultuuri kasutada laiamahuliseks kemikaalide skriinimiseks, et leida HPV elutsüklit pärssivaid komponente. Meie laboris välja töötatud sääreluu kasvaja rakuliiinil U2OS põhinev HPV uurimismudel osutus edukaks mitmete HPV subtüüpide (β-HPV5, β-HPV8, α-HPV6b, α-HPV11, α-HPV16, α-HPV18) transientse, stabiilse kui ka amplifikatsioonilise DNA replikatsiooni jälgimisel. Kuna U2OS rakud ei ole looduslikud papilloomiviiruse peremeesrakud, pidasime vajalikuks kaardistada viiruse geenide avaldumist, et tõsta U2OS rakusüsteemi usaldusväärsust HPV uuringutes. Antud töös kirjeldati HPV11 geenide ekspressiooni, kuid sarnane analüüs on läbi viidud ka HPV5 ning HPV18 subtüübiga. Kõiki saadud tulemusi on võrreldud viiruse loomulikest peremeesrakkudest, keratinotsüütidest, saadud tulemustega ning nende sarnasuse tõttu oleme arvamusel, et U2OS süsteem on sobiv keskkond papilloomiviiruste uurimiseks ning oma lihtsuse ja odavuse poolest ideaalne ka esialgsete ravimi kandidaatide skriinimiseks. Lisaks tuvastati U2OS süsteemis 1n HPV molekulide sünteesi kõrval ka suuremaid, 2n ja rohkem, järjestikku paigutunud HPV genoomi koopiatega rõngasmolekule (oligomeerid). Sarnaseid vaheprodukte on täheldatud nii varasemates kui ka antud töö raames kogutud HPV-positiivsetest kliinilistest koeproovidest. HPV-spetsiifiliste oligomeeride tekke täpsemal uurimisel tekkis hüpotees, et nende moodustumisel võib olla oma roll rakulise rekombinatsioonilise DNA replikatsiooni laadil. Oligomeersed HPV molekulid võivad osutuda kasulikeks, et tagada kiire HPV genoomi koopia arvu tõus vegetatiivses viiruse elutsükli faasis kui ka viiruse genoomi jagunemisel kahe tütarraku vahel. Kuna viiruspartiklisse pakitakse vaid üks HPV genoom, pole täpselt teada, milliseid mehhanisme kasutatakse oligomeersete DNA vormide konverteerimisel tagasi 1n HPV genoomideks.Human papillomaviruses (HPVs) are widely distributed and infect almost all people at some point. Generally, the viral infection does not cause significant illness but may generate benign warts on skin (β-HPVs) and condylomas on genitals (α-HPVs). The clinical importance of papillomaviruses is associated with the fact that HPV genomes (or parts of them) are found in almost all cervical cancer cases. It is believed that infection with the papillomaviruses that belong to the high-risk group of α-HPVs (e.g. HPV16, HPV18) is one of the most important steps in the development of cervical cancer. When infection with low-risk α-HPVs (e.g. HPV6, HPV11) is eventually eliminated by the immune system (usually taking up to 2 years), then infection with high-risk HPVs becomes more easily persistent. The limited treatment options to cure persistent HPV infection make the early detection of HPV infection highly important. Successful progression through the HPV life cycle is mediated through extrachromosomal molecules, and integration of the viral genome into host cell chromosomes is not essential. However, in cervical cancer cells, parts of HPV genomes are often found integrated into the host genetic material. This partial integration of HPV genomes disrupts the expression of many viral genes (including genes that encode proteins for DNA replication and capsid formation), and therefore, integration into host chromosomes is considered a dead end for the virus. On the other hand, as the integration site is not determined, the uncontrollable growth of cancer cells may result from viral integration into chromosome regions responsible for the regulation of cell growth. Additionally, the large-scale genetic changes found in cervical cancer cells are probably triggered by the viral integration event. Moreover, viral DNA integration encompasses only a few viral genomes, while the majority remains extrachromosomal molecules (cells carry approximately 100 copies of HPV genomes). The co-occurrence of two forms of viral DNA in one cell is a real threat to genomic stability, as HPVs integrate into the host genetic material in a way that the viral DNA replication origin that cannot be controlled by cellular checkpoint pathways is intact. The integration event usually disrupts the genes that encode the replication proteins; however, the expression of replication proteins from extrachromosomal molecules is still possible. Multiple replication initiations from the integrated DNA replication origin by episome-derived viral replication proteins lead to the amplification of not only the integrated viral DNA but also the flanking cellular sequences. Depending on the site of the integration, the flanking cellular sequences may contain oncogenes or other regulatory elements which amplification may lead again to uncontrollable cell growth or to genomic instability. In addition, the unlicensed DNA re-replication characteristic of HPVs often cause the collision of replication forks and the accumulation of aberrant DNA replication products. The co-localization of cellular DNA damage response (DDR) pathway key molecules to HPV DNA replication centers indicate to the generation of double-stranded DNA breaks by unlicensed DNA re-replication. It seems that the activation of cellular DDR pathways has an important role in repairing double-stranded DNA breaks that occur during viral DNA replication. While most of the double-stranded breaks are repaired properly, the cross-chromosomal translocations of viral integration locus detected within this thesis may result from failed attempt to repair the DNA damage. The generation of multiple modifications in host cell genomic material may eventually lead to the genomic instability and to the formation of malignancy. Keratinocytes, the native host cells for papillomavirus, are responsible for the continuous renewal of epithelial tissue and therefore have adapted a very complex life cycle. While undifferentiated basal keratinocytes are responsible for renewal of the basal cell compartment, they also undergo terminal differentiation and form the stratified structure of the epithelia. As papillomaviruses infect the basal layer of undifferentiated keratinocytes and pack their viral particles at terminally differentiated cell residues, the viral life cycle has adjusted to all stages of the host cell life cycle. The cultivation of keratinocytes in cell culture and mimicking their differentiation program is technically demanding, time-consuming and cost-intensive. In addition, keratinocytes are not suitable for the high-throughput screening of chemical compounds to find drugs that could reduce papillomavirus viability. The need for a simpler system to study the various aspects of the HPV life cycle has long inspired our research group to find a cell line that is easy to culture and where the replication of HPV genomes could be monitored. The development of a U2OS cell-based system provided a suitable environment for HPV, as the transient, stable, and amplificational genome replication of various types of HPV (β-HPV5, β-HPV8, α-HPV6b, α-HPV11, α-HPV16, and α-HPV18) was detected. Interestingly, while HPVs function through unit-sized (1n) extrachromosomal molecules and ultimately only one genome is packed into viral particles, analysis of replication intermediates detected larger than unit-sized HPV-specific molecules in addition to 1n molecules. Subsequent analysis of replication intermediates confirmed that the larger molecules were head-to-tail concatemers (further referred to as oligomers). Similar DNA replication products have also been described in previously analyzed clinical samples and were also detected in HPV16 and HPV18-positive patient probes collected within this thesis. Further analysis of the formation of oligomeric forms of HPV molecules suggested that recombination-dependent DNA replication is involved in this process. As the human osteosarcoma cell line U2OS is not the native host for papillomavirus, the suitability of this cell line in the study of papillomaviruses was further confirmed by the complete mapping of HPV11 transcripts. Similar analysis has also been carried out with HPV5 and HPV18 by other members in our research group. The similarity of gene expression of all three HPV types with previously reported results in native host cells or in clinical samples confirmed that U2OS cells are suitable for research of human papillomaviruses as well as for preliminary studies of anti-HPV drugs

Mechanism of Genomic Instability in Cells Infected with the High-Risk Human Papillomaviruses

In HPV–related cancers, the “high-risk” human papillomaviruses (HPVs) are frequently found integrated into the cellular genome. The integrated subgenomic HPV fragments express viral oncoproteins and carry an origin of DNA replication that is capable of initiating bidirectional DNA re-replication in the presence of HPV replication proteins E1 and E2, which ultimately leads to rearrangements within the locus of the integrated viral DNA. The current study indicates that the E1- and E2-dependent DNA replication from the integrated HPV origin follows the “onion skin”–type replication mode and generates a heterogeneous population of replication intermediates. These include linear, branched, open circular, and supercoiled plasmids, as identified by two-dimensional neutral-neutral gel-electrophoresis. We used immunofluorescence analysis to show that the DNA repair/recombination centers are assembled at the sites of the integrated HPV replication. These centers recruit viral and cellular replication proteins, the MRE complex, Ku70/80, ATM, Chk2, and, to some extent, ATRIP and Chk1 (S317). In addition, the synthesis of histone γH2AX, which is a hallmark of DNA double strand breaks, is induced, and Chk2 is activated by phosphorylation in the HPV–replicating cells. These changes suggest that the integrated HPV replication intermediates are processed by the activated cellular DNA repair/recombination machinery, which results in cross-chromosomal translocations as detected by metaphase FISH. We also confirmed that the replicating HPV episomes that expressed the physiological levels of viral replication proteins could induce genomic instability in the cells with integrated HPV. We conclude that the HPV replication origin within the host chromosome is one of the key factors that triggers the development of HPV–associated cancers. It could be used as a starting point for the “onion skin”–type of DNA replication whenever the HPV plasmid exists in the same cell, which endangers the host genomic integrity during the initial integration and after the de novo infection

Mental Health and Psychosocial Needs of Syrian Refugees: A Literature Review and Future Directions

Since 2011, the Syrian refugee crisis has resulted in a massive displacement of Syrians, inside and outside of Syria. The enormous psychosocial needs of displaced Syrians have been documented by various reports and studies. With expected arrivals of Syrian refugees resettling in the United States in the near future, the intensity of the challenges for both resettlement agencies and the Syrian refugees themselves are expected to increase. A literature review was conducted for publications produced between March 2011 and January 2017. Academic and grey literature were explored to provide an overview of the psychosocial well-being and cultural characteristics of Syrians. Additionally, current models were analyzed to identify future directions for social work practice. It is vital to understand the Syrian refugee crisis through a multidisciplinary lens. Responding to the challenges found among Syrians requires deliberate consideration for sociocultural, historical, and political issues that uniquely describe them and their contexts. Identifying psychosocial needs may facilitate other aspects of resettlement outcomes, such as employment, education, and social integration. Incorporating a holistic model that reflects trauma-informed and human rights perspectives into clinical as well as policy practices is critical for better overall resettlement outcomes for Syrian refugees, and refugee populations in general

Satisfaction with cognitive remediation therapy: its effects on implementation and outcomes using the cognitive remediation satisfaction scale

Cognitive Remediation (CR) improves cognition and functioning but is implemented in a variety of ways (independent, group and one-to-one). There is no information on whether service users find these implementation methods acceptable or if their satisfaction influences CR outcomes. We used mixed participatory methods, including focus groups, to co-develop a CR satisfaction scale. This was refined using three psychometric criteria (Cronbach's alpha, item discrimination, test-retest agreement) to select items. Factor analysis explored potential substructures. The refined measure was used in structural equation joint modelling to evaluate whether satisfaction with CR is affected by implementation method and treatment engagement or influences recovery outcome, using data from a randomised controlled trial. Four themes (therapy hours, therapist, treatment effects, computer use) generated a 31-item Cognitive Remediation Satisfaction scale (CRS) that reduced to 18 Likert items, 2 binary and 2 open-ended questions following psychometric assessment. CRS had good internal consistency (Alpha = 0.814), test-retest reliability (r= 0.763), and concurrent validity using the Working Alliance Inventory (r = 0.56). A 2-factor solution divided items into therapy engagement and therapy effects. Satisfaction was not related to implementation method but was significantly associated with CR engagement. Therapy hours were significantly associated with recovery, but there was no direct effect of satisfaction on outcome. Although satisfaction is important to therapy engagement, it has no direct effect on outcome. CR therapy hours directly affect outcome irrespective of which implementation model is used, so measuring satisfaction early might help to identify those who are likely to disengage. The study has mixed methods design

Cognitive Remediation Works But How Should We Provide It? An Adaptive Randomized Controlled Trial of Delivery Methods Using a Patient Nominated Recovery Outcome in First-Episode Participants

BACKGROUND AND HYPOTHESIS: Cognitive remediation (CR) benefits cognition and functioning in psychosis but we do not know the optimal level of therapist contact, so we evaluated the potential benefits of different CR modes. STUDY DESIGN: A multi-arm, multi-center, single-blinded, adaptive trial of therapist-supported CR. Participants from 11 NHS early intervention psychosis services were independently randomized to Independent, Group, One-to-One, or Treatment-as-usual (TAU). The primary outcome was functional recovery (Goal Attainment Scale [GAS]) at 15-weeks post randomization. Independent and TAU arms were closed after an interim analysis, and three informative contrasts tested (Group vs One-to-One, Independent vs TAU, Group + One-to-One vs TAU). Health economic analyses considered the cost per Quality Adjusted Life Year (QALY). All analyses used intention-to-treat principles. STUDY RESULTS: We analyzed 377 participants (65 Independent, 134 Group, 112 One-to-One, 66 TAU). GAS did not differ for Group vs One-to-One: Cohen's d: 0.07, -0.25 to 0.40 95% CI, P = .655; Independent vs TAU: Cohen's d: 0.07, -0.41 to 0.55 95% CI, P = .777. GAS and the cognitive score improved for Group + One-to-One vs TAU favoring CR (GAS: Cohen's d: 0.57, 0.19-0.96 95% CI, P = .003; Cognitive score: Cohens d: 0.28, 0.07-0.48 95% CI, P = .008). The QALY costs were £4306 for Group vs TAU and £3170 for One-to-One vs TAU. Adverse events did not differ between treatment methods and no serious adverse events were related to treatment. CONCLUSIONS: Both active therapist methods provided cost-effective treatment benefiting functional recovery in early psychosis and should be adopted within services. Some individuals benefited more than others so needs further investigation. TRIAL REGISTRATION: ISRCTN14678860 https://doi.org/10.1186/ISRCTN14678860Now closed

Satisfaction with cognitive remediation therapy:its effects on implementation and outcomes using the cognitive remediation satisfaction scale

Cognitive Remediation (CR) improves cognition and functioning but is implemented in a variety of ways (independent, group and one-to-one). There is no information on whether service users find these implementation methods acceptable or if their satisfaction influences CR outcomes. We used mixed participatory methods, including focus groups, to co-develop a CR satisfaction scale. This was refined using three psychometric criteria (Cronbach’s alpha, item discrimination, test-retest agreement) to select items. Factor analysis explored potential substructures. The refined measure was used in structural equation joint modelling to evaluate whether satisfaction with CR is affected by implementation method and treatment engagement or influences recovery outcome, using data from a randomised controlled trial. Four themes (therapy hours, therapist, treatment effects, computer use) generated a 31-item Cognitive Remediation Satisfaction scale (CRS) that reduced to 18 Likert items, 2 binary and 2 open-ended questions following psychometric assessment. CRS had good internal consistency (Alpha = 0.814), test-retest reliability (r= 0.763), and concurrent validity using the Working Alliance Inventory (r = 0.56). A 2-factor solution divided items into therapy engagement and therapy effects. Satisfaction was not related to implementation method but was significantly associated with CR engagement. Therapy hours were significantly associated with recovery, but there was no direct effect of satisfaction on outcome. Although satisfaction is important to therapy engagement, it has no direct effect on outcome. CR therapy hours directly affect outcome irrespective of which implementation model is used, so measuring satisfaction early might help to identify those who are likely to disengage. The study has mixed methods design

An Integrated marketing communications campaign for AxelMed Generics Philippines

This campaign proposal is for Axelmed Philippines. Axelmed Philippines is a new player entering the Philippine pharmaceutical industry functioning as a resource and trading corporation distributing generic medicines in the private and public sector. Axelmed operates on a business-to-business scale handling private accounts, and has recently tied up with several local government offices within the Central Visayas region, Mandaue, Cebu, organizing provincial medical missions to aid the less fortunate who have no access to high priced medicines. When Axelmed started its operations, there was no initial budget allotted for marketing because the company concentrated on customer relationship marketing and public relations to bring in select private accounts. Axelmed is now looking to progress operations and establish a significant share of market through increased marketing efforts that would communicate the companys uniquely economic position in the Pharmaceutical industry. This campaign will aim to generate more clients and prospects and communicate that the company ready to serve the people by providing quality medicines. Since Axelmed is a new player to the market, brand awareness should be pushed to drive trial and eventually, usage, of its products and build company equity. Given the exponential growth of generic medicines category in the Philippines, increased marketing and advertising efforts will open new opportunities that Axelmed can explore. The campaign proposal for Axelmed Philippines will have a business-to-business (B2B) scale concentrating on the four provinces within the Central Visayas Region 4 namely, Cebu, Negros Oriental, Bohol and Siquijor. Marketing efforts will be focused on the 556 Botika ng Bayan outlets within the said region. This campaign will define the recommended media channels and effective touch points, given the target markets media reach and consumption. Since the market is considered to be a niche or narrow market, the advertising materials will not be the traditional or above-the-line media channels, but instead utilizing other media channels that are more hardworking and not limiting, in terms of communication of messages and budget