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391. A nursing home in Arab-Israeli society: Targeting utilization in a changing social and economic environment - Suleiman K. and Walter-Ginzburg A. [Dr. A. Walter-Ginzburg, Mavoh Ganigar 4, Tel Aviv 69359, Israel] - J. AM. GERIATR. SOC. 2005 53 1 ; - summ in ENGL This article is a case study of the first 10 years of operation 19922002 ; of the Dabouriya Home for the Aged, the first publicly funded culturally adapted nursing home for Israeli citizens of Arab descent. Although 44% of Arab Israelis and 26% of Jewish Israelis aged 65 and older are disabled, in 1999, 4.3% of the Jewish population but only 0.7% of the Arab-Israeli population aged 65 or older lived in long-term care institutions; disabled Arab-Israeli elderly were mainly cared for by families. As Arab-Israeli society modernizes and traditional caregiving is reduced, alternatives must be found for this growing, disabled population. Medical and administrative records of 404 people admitted consecutively to a 136-bed facility over 10 years were analyzed. Two distinct segments of the needy population were served: people with independent activity of daily living ADL ; function but little or no family to provide help with intermediate ADLs and those dependent in ADLs and with health problems, especially dementia. Economic, demographic, and social changes in Arab-Israeli society may mean that traditional caregivers will not be able to adequately care for this highly disabled population. Administrators of the public health system in Israel should be aware of the underutilization of publicly funded long-term care by disabled Arab Israelis and the lack of care alternatives for the population that does use nursing homes, because there may be severe consequences in terms of caregiver burden and social stress when disabled elderly people remain in unsuitable environments. 2005 by the American Geriatrics Society. 392. Development and initial validation of the Falls Efficacy Scale-International FES-I ; - Yardley L., Beyer N., Hauer K. et 79, because periactin for cats.
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Baseline characteristics include: Genotype 1-85%, African Americans-17%, and advanced liver disease42%. Three hundred and seventeen combination therapy nonresponders Combo NR ; , 75 interferon monotherapy nonresponders Mono NR ; and 68 combination therapy relapsers Combo Relapser ; have reached week 72. Results are seen in the table below. Therapy was terminated early in 20% of fixed dose and 21% of induction participants. Conclusion: Interim results suggest the use of induction dosing does not improve the sustained response rates in the three groups evaluated. Previous combination nonresponders achieve a sustained response in 5-10% of participants. Complete sustained response data including an analysis of partial responders to previous therapy will be presented at the annual meeting.
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And the code of ethics of the medical profession. Truth in lending and family values should be there too. Well, the Internet has no brain, conscience, heart or master. It is a tool that can till the fertile ground of human potential, play to the basest human motives or do great harm as a mindless weapon in criminal hands. Our patients are increasingly seeking information about their illnesses, health, and their physicians on the Internet. There are thousands of web sites devoted to every imaginable disease or treatment. Medical societies, journals, consumer groups and medical groups have moved rapidly to the Internet in response to the public demand for information. However, as the search engines plow through the servers around the planet, little distinction is made among a shameless promotion by a drug company, a scurrilous self serving advertisement by an unprincipled practitioner, or the latest in medical practice from the National Library of Medicine or the Centers for Disease Control. Perhaps concern about the gullibility of the public or its susceptibility to abuse is too patronizing toward patients. Perhaps the public needs no guardian. However, as the medical community we must be concerned about our integrity as reflected on the World-Wide Web. Perhaps we should be most concerned about the quality of content, the presumed imprimatur.
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'From the Division of Cardiology, Roosevelt Hospital and Department of Medicine, Columbia University, College of Physicians and Surgeons, New York City. Reprint requests: Dr. Dwyer, Roosevelt Hospital, 428 W s et 59th Street, New Yosk City 10019.
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ET-17. SMALL MOLECULE INHIBITOR OF TRANSFORMING GROWTH FACTOR BETA TGF-BETA ; RECEPTORS BLOCKS TGF-BETA-MEDIATED SIGNAL TRANSDUCTION AND INHIBITS CELLULAR PROLIFERATION M.D. Hjelmeland, S. Sathornsumetee, H.S. Friedman, N.J. Laping, D.D. Bigner, X.-F. Wang, and J.N. Rich; Duke University Medical Center, Durham, NC; and GlaxoSmithKline Pharmaceuticals, NJ; USA Transforming growth factor beta TGF-beta ; is a multifunctional cytokine that is frequently expressed in multiple types of malignant brain tumors. TGF-beta exerts a complex set of effects in cancers with an early tumor suppressive effect through growth inhibition but later effects in cancer development that are tumorigenic, including increased tumor cell motility and invasion, induction of angiogenesis, and immune suppression. We have previously characterized the TGF-beta signal transduction pathway components in several malignant glioma cell lines and phenotypic consequences of TGF-beta treatment in these same lines. Most glioma cell lines have largely intact TGF-beta receptor and intracellular mediator expression, but the response to exogenous TGF-beta treatment varies widely between lines. Some glioma lines are growth inhibited by TGF-beta treatment while others are resistant or growth stimulated by TGF-beta. Recently, small molecule inhibitors of the type I TGF-beta receptor have been developed. We have now examined the impact of one of these inhibitors SB431542 ; on TGF-beta signaling in these same glioma lines. The activation of the intracellular messenger, SMAD2, was inhibited by pretreatment with the small molecule inhibitor; however, the glioma cell lines tested exhibited a wide range of doses at which the inhibition was complete, suggesting a significant difference in the activation potential of the TGF-beta pathways. Of note, a cell line growth stimulated by TGF-beta treatment exhibited no activation of SMAD2 in response to TGF-beta treatment yet retained other TGF-betamediated cellular effects denoting a likely SMAD-independent signaling mechanism. SB431542 treatment caused growth inhibition of glioma cell lines at moderate doses. This effect could be partially overcome through the treatment of cultures with high doses of TGF-beta. We are currently investigating other cellular effects, including cellular invasion and angiogenesis with this and one other small molecule TGF-beta receptor inhibitor in preclinical evaluation. Conclusion: The TGF-beta pathway offers a novel therapeutic target to which new small molecule inhibitors have been directed. These therapies may offer an ability to target cellular proliferation, invasion, angiogenesis, and immune escape and piroxicam.
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Drug Safety - January 1997 - Issue No. 3 Correspondence Comments should be marked for the attention of: The Pharmacovigilance Unit, Irish Medicines Board, Earlsfort Centre, Earlsfort Terrace, Dublin 2. Tel: 676 4971-7 Fax: 676 7836 1.
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Tion of their sex-offending cycles and the development of strategies to implement when the cycle is triggered and or in the context of situations identified as high risk.48 Although the efficacy of treatment practices for sex offenders has been questioned and viewed at best as equivocal in the past, more recent research using improved methodologies suggests that even in its broad application, current sex offender treatment approaches appear to have positive effects in reducing sex-offending recidivism.49 52 Though exact sexual recidivism rates have not been established, and it is difficult to eliminate fully the self-selection biases, the recidivism literature indicates that those sexual perpetrators who forego or discontinue treatment have higher rates of recidivism than those who participate and complete treatment.53 Berlin and colleagues54 conducted a 5-year recidivism study, surveying a cohort of 626 male sex offenders 406 pedophiles, 111 exhibitionists, and 109 sexually aggressive men ; . At the time of study enrollment, subjects were patients at a community-based sexual disorders clinic. Sexual recidivism rates for the entire cohort were less than 9.7 percent. In particular, and as noted earlier, treatment compliance was associated with significantly lower sexual recidivism rates than treatment noncompliance. In a meta-analytic review of 43 studies on the effectiveness of psychological treatment with sexual offenders, Hanson et al.55 found that recidivism rates were lower in treated groups 12.3% ; than in the comparison groups 16.8% ; . In a 25-year follow-up study of over 7, 000 sexual offenders, Maletzky and Steinhauser56 presented outcome data on a cognitive behavioral treatment program. Limitations in research methodology, such as the retrospective nature of this study, the lack of a control group, and potential problems with self-selection bias, prohibited them from drawing definitive conclusions about treatment efficacy. However, overall results within the limits of their research methodologies indicated that "treatment techniques employed in a cognitive behavioral program generated long-lasting, positive results by reducing recidivism and risk to the community" Ref. 56, p 143 ; . In addition, their findings suggest that improvements over time in cognitive behavioral techniques and applications itself contribute to improved outcomes for patients. To date, the broad-brush approach to sex offender treatment has largely been based on research on in488.
PATRICIA L. BRUBAKER, PHD1, 2 with the ascents of longer duration, and or the lack of experience of these climbers. One other difference between these studies may involve the selection of subjects because the individuals who climbed Cho Oyu were free of diabetes complications, with an average HbA1c A1C ; of 7.0%, whereas the Kilimanjaro climb included some subjects with background retinopathy and or microalbuminuria A1C levels were not given ; 4, 10 ; . However, it seems unlikely that the very dramatic differences in success rates are consequent to differences in metabolic control because the success rate of the Kilimanjaro expedition for the control subjects was also very low compared with other treks on this route; the author of this review, who also has type 1 diabetes, recently summitted Kilimanjaro along with all seven of her nondiabetic colleagues, and success rates on Kilimanjaro of 60% are routinely claimed on various websites. Finally, consistent with a normal ability to climb to altitude, analysis of aerobic capacity at sea level in subjects with complication-free type 1 diabetes has demonstrated no differences from paired fit or sedentary control subjects, although the fit individuals had a higher VO2max than the sedentary subjects 12 ; . However, A1C levels were inversely correlated with VO2max when both fit and sedentary individuals with type 1 diabetes were examined, suggesting that the fit subjects had better glycemic control. Furthermore, as might be predicted, the presence of cardiac autonomic neuropathy in fit subjects with type 1 diabetes was associated with a reduced VO2max that was similar to that found in the sedentary subjects 12 ; . Nonetheless, cardiovascular performance in healthy subjects with type 1 diabetes is similar to that of normal control subjects at altitudes of up to 5, 800 m 8, 10 ; . Thus, the available data suggests that people with type 1 diabetes can successfully undertake the physical challenges of high and extreme altitude expeditions with reasonable rates of success compared with normal individuals. ACUTE ALTITUDE SICKNESS -- Acute mountain sickness AMS ; occurs unpredictably, consequent to a recent in2563.
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