7,226 research outputs found

    A Research and Practice Brief: Measuring Compliance with the Indian Child Welfare Act

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    This research and practice brief by Casey Family Programs is a useful resource for states that seek to document compliance with ICWA. We document different approaches for measuring compliance and make some recommendations including increased resources to support and to develop training mechanisms for child protective services and judicial staff. Standard measures for compliance across jurisdictions would be beneficial

    Mutation analysis of HIF prolyl hydroxylases (PHD/EGLN) in individuals with features of phaeochromocytoma and renal cell carcinoma susceptibility

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    Germline mutations in the von Hippel–Lindau disease (VHL) and succinate dehydrogenase subunit B (SDHB) genes can cause inherited phaeochromocytoma and/or renal cell carcinoma(RCC). Dysregulation of the hypoxia-inducible factor (HIF) transcription factors has been linked to VHL and SDHB-related RCC; both HIF dysregulation and disordered function of a prolyl hydroxylase domain isoform 3 (PHD3/EGLN3)-related pathway of neuronal apoptosis have been linked to the development of phaeochromocytoma. The 2-oxoglutarate-dependent prolyl hydroxylase enzymes PHD1 (EGLN2), PHD2 (EGLN1) and PHD3 (EGLN3) have a key role in regulating the stability of HIF-a subunits (and hence expression of the HIF-a transcription factors). A germline PHD2 mutation has been reported in association with congenital erythrocytosis and recurrent extra-adrenal phaeochromocytoma. We undertook mutation analysis of PHD1, PHD2 and PHD3 in two cohorts of patients with features of inherited phaeochromocytoma (nZ82) and inherited RCC (nZ64) and no evidence of germline mutations in known susceptibility genes. No confirmed pathogenic mutations were detected suggesting that mutations in these genes are not a frequent cause of inherited phaeochromocytoma or RCC

    A global framework for action to improve the primary care response to chronic non-communicable diseases: a solution to a neglected problem.

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    BACKGROUND: Although in developing countries the burden of morbidity and mortality due to infectious diseases has often overshadowed that due to chronic non-communicable diseases (NCDs), there is evidence now of a shift of attention to NCDs. DISCUSSION: Decreasing the chronic NCD burden requires a two-pronged approach: implementation of the multisectoral policies aimed at decreasing population-level risks for NCDs, and effective and affordable delivery of primary care interventions for patients with chronic NCDs. The primary care response to common NCDs is often unstructured and inadequate. We therefore propose a programmatic, standardized approach to the delivery of primary care interventions for patients with NCDs, with a focus on hypertension, diabetes mellitus, chronic airflow obstruction, and obesity. The benefits of this approach will extend to patients with related conditions, e.g. those with chronic kidney disease caused by hypertension or diabetes. This framework for a "public health approach" is informed by experience of scaling up interventions for chronic infectious diseases (tuberculosis and HIV). The lessons learned from progress in rolling out these interventions include the importance of gaining political commitment, developing a robust strategy, delivering standardised interventions, and ensuring rigorous monitoring and evaluation of progress towards defined targets. The goal of the framework is to reduce the burden of morbidity, disability and premature mortality related to NCDs through a primary care strategy which has three elements: 1) identify and address modifiable risk factors, 2) screen for common NCDs and 3) and diagnose, treat and follow-up patients with common NCDs using standard protocols. The proposed framework for NCDs borrows the same elements as those developed for tuberculosis control, comprising a goal, strategy and targets for NCD control, a package of interventions for quality care, key operations for national implementation of these interventions (political commitment, case-finding among people attending primary care services, standardised diagnostic and treatment protocols, regular drug supply, and systematic monitoring and evaluation), and indicators to measure progress towards increasing the impact of primary care interventions on chronic NCDs. The framework needs evaluation, then adaptation in different settings. SUMMARY: A framework for a programmatic "public health approach" has the potential to improve on the current unstructured approach to primary care of people with chronic NCDs. Research to establish the cost, value and feasibility of implementing the framework will pave the way for international support to extend the benefit of this approach to the millions of people worldwide with chronic NCDs

    Eating with a smaller spoon decreases bite size, eating rate and ad libitum food intake in healthy young males

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    There is a paucity of data examining the effect of cutlery size on the microstructure of within-meal eating behaviour or food intake. Therefore, the present studies examined how manipulation of spoon size influenced these eating behaviour measures in lean young men. In study one, subjects ate a semi-solid porridge breakfast ad libitum, until satiation. In study two, subjects ate a standardised amount of porridge, with mean bite size and mean eating rate covertly measured by observation through a one-way mirror. Both studies involved subjects completing a familiarisation visit and two experimental visits, where they ate with a teaspoon (SMALL) or dessert spoon (LARGE), in randomised order. Subjective appetite measures (hunger, fullness, desire to eat and satisfaction) were made before and after meals. In study one, subjects ate 8 % less food when they ate with the SMALL spoon (SMALL 532 (SD 189) g; LARGE 575 (SD 227) g; P=0·006). In study two, mean bite size (SMALL 10·5 (SD 1·3) g; LARGE 13·7 (SD 2·6) g; P<0·001) and eating rate (SMALL 92 (SD 25) g/min; LARGE 108 (SD 29) g/min; P<0·001) were reduced in the SMALL condition. There were no condition or interaction effects for subjective appetite measures. These results suggest that eating with a small spoon decreases ad libitum food intake, possibly via a cascade of effects on within-meal eating microstructure. A small spoon might be a practical strategy for decreasing bite size and eating rate, likely increasing oral processing, and subsequently decreasing food intake, at least in lean young men.
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