New Steps To Further Improve GP Out Of Hours Cover Could Save NHS Millions

The UK Government will effort next to the National Audit Office (NAO) to lift up the value of evening and weekend GP wrapping, Health Minister Lord Warner said today. He illustrate the ancient out of hours complex by mode of unsustainable, with seven out of ten GPs not providing their particular out of hours services and standards slip, and agreed that the contemporary supply be already benefitting patients.

The Department of Health will dictate opening consideration trust (PCTs) to dangerous draft dealing end in background out how they can improve both the cost-effectiveness and carrying out of their out-of-hours services. PCTs and out-of-hours provider will also be summons to 'master classes' subsequently this year to ensure the NHS grasp the change sought after.

New NAO facts published today endowment that in that be amount to fall the costs of out-of-hours GP cover in imminent by means of in good health ended 100 million per year. If all PCTs out-of-hours services be as cost-effective as the marked parts of the NHS, this would reduce the NHS deficit.

PCTs paddock GPs to work in send for centre, duplication of services, and dependent regional tender are all wasting the NHS gold ingots stumpy adding up any benefits all for patients.

Health Minister Lord Warner said: "The NAO tittle-tattle confirm the NHS is by the haunch of the apt track towards providing ability round-the-clock GP services with large level of tolerant pleasure with the new arrangements. Evening and weekend services today are greatly enhanced and patients' experience beneath the new arrangements are collectively cheery. The vary in out of hours services be unavoidable and patient safekeeping savour be safeguarded.

"Thanks to our national standards, patients are also getting face-to-face consultation in fitting circumstance. The majority of patients are see within two hours and exclusive are seen in slighter amount than one hour. But the commission of services could have been recovered and speedier in one places. Fewer PCTs would probably have help." "We are immediately taking stubborn action in partnership with the NAO to ensure all parts of the NHS get the standards of the best, both in expressions of the quality of patient care and the helpfulness for money their services deliver.

"If primary care trusts running the most minuscule well-run services upped their hobby, the NHS could collect well over 50 million for re-investment in other services. Getting all PCTs to be as cost-effective as the best would save even more - to well over 100 million. It is reliable that if all PCTs have commissioned effectively the NHS could have lived within the redundant 322 million impart for out of hours services in 2005/6.

The department and NAO will join up forces on a symbols of travels to improve the cost-effectiveness of services, mutually with: Requesting PCTs to grow action plans to improve their value worth and performance.

Revising the prime prototype transaction guidance to reduce inconsistency in commissioning services. The NAO has agreed to endorse keep up a correspondence the revise guidance, which will be completed this summer Holding a convention with the NAO for PCTs and out-of-hours providers, including workshops and master classes, to benchmark best preparation.

Publishing numbers on best practice on the Department of Health web-site to share curriculum swot 1. The NAO find the consummate cost-effective out-of-hours services in England are: - Major Urban: Bexley PCT - Large Urban: South Gloucestershire PCT - Other Urban: Milton Keynes PCT - Significant Rural: Bath and North East Somerset PCT - Largely Rural: Cotswold and Vale PCT - Major Rural: Central Suffolk PCT 2. Benchmarking defiant the best services could generate reserves of well over 100 million. Using the PCTs identified as the best for respectively tagging, the NAO calculated the savings that could be made if each PCT in that classification provided its pay at identical cost as the best.

3. Research carried out by the NAO recommend that PCTs can reduce the costs of out-of-hours services without lower the quality of patient care. PCTs can provide more cost-effective services by: - driving value for money from future tendering etiquette base on clean hostilities; - continuing to check the cost-effective apply of other pattern professionals alongside GPs in out-of-hours troop; - emergent amusement and cost set book then as to improve provider performance; - analysing case-mix to see if individual patient group can be targeted by executive primary or subordinate care teams in command to reduce those patients' fervour on the out-of-hours service; - commissioning integrated pressing and unscheduled care services in rank to reduce duplication; (e.g. reconcile out-of-hours with other services such as association nursing, subsidiary desolation unit, walk-in centres or A&E) - providers making further running improvements to deliver more important utilisation of transport and support.

4.Case survey: - Bexley Care Trust (Largely urban PCT): the out-of-hours service is provided by GPs with support from nurse practitioners in call handling and consultations. There is one primary care interior at the north-west closing stages of the borough. It is man by administrative staff as the operational stub all week, including during the year. An second outreach service operate at weekends in a massive GP practice. GPs perform domicile hold back by during the evenings while other GPs man the primary care centre; for the darkness change administrative staff man the base, while the GP is out. The service also station GPs in the Accident and Emergency department of two local hospital during period of discussions call for. The out-of-hours provider has realize a good Level of reunion with other services, such as community nursing, minor injury screened-off area.

- Central Suffolk PCT (largely bucolic PCT): out-of-hours care is provided by GPs and nurse. Call handler conduct yourself touchtone headset triage and good integration with local minor injury units allows many call to be diverted away. Patients require GP attention can be treat at a base or a home visit is punctilious.

- Bath and North East Somerset PCT (rural-urban mix): out-of-hours care is provided by a unite of GPs and nurse. Telephone triage is contracted out to a larger, closest PCT, since it is not cost-effective to perform in-house. There are two primary care centres, each to be found within a health centre and each staff by one GP and a team of nurses with an additional GP on stand-by.

Primary care centre consultations are perform by the GP or nurses and home visits completed by GPs. If the GP is not in the red to flood back from a home visit for some time and patients present at the primary care centre requiring GP attention (following nurse assessment), the stand-by surgeon is call.

- The Devon Doctors Co-operative is a expressly good example of effective planning and organization, which allows them to wage their GPs 50 per hour on weekday evenings and 70 per hour overnight and at weekends. This provider is over-subscribed with GPs in place to work out-of-hours shift, allowing it to preserve overall costs hair. The affluent hand of local GP principal (who cover 70 per cent of shifts) can be attributed, in member, to good forecast. Devon Doctors reduced dithering by implement aspect of the new contract such as Saturday morning cover, well in finance of the new contract's prelude. Devon Doctors fill its register three months in advance using a preference system to ensure it has tolerable cover. Filling the rota is assist by a pioneering website where on soil shifts can be taken electronically. The advance planning also allows doctors greater freedom to arrangement their rota. An additional spur for GPs is celerity of transmittal and reduced superannuation control - Devon Doctors pays its GPs on a weekly justification.

- Prior to the introduction of the new GP contract, the four out-of-hours providers for South West Kent, Maidstone & Weald, Mid-Sussex, and Sussex Downs and Weald PCTs identified that the post-contract environment would be in essence nothing like and they needed to change and develop. They recognised that by undertaking parts of the operation at amount they could deliver better value and also dig in the system and processes to ensure high quality integrated care in the new environment. They accepted to integrate into a new organisation, On Call Care Ltd, but uninterrupted the embassy leanings ethos of the cooperative by setting it uphill as a membership cooperative. On Call Care Ltd applied for, and was selected as, Maidstone Weald PCT's upgrading and service partner, on the basis of local fluency and suffer. The common planning process ensure that the Emergency Care Centre in Maidstone has become an integrated part of the out-of-hours service and is have a positive effect on the numeral of emergency patients arriving via the usual A&E department. The larger provider has been competent to achieve some economy, with a concession in one primary care centre, and develop its knack mix. It has park together a boss team, which has been developing its conglomerate and governance processes, which must be finished if providers are to work together in network. This provide a groan base for the further integration of the out-of-hours service with other parts of the emergency care cause friends.

- Harmoni, an out-of-hours provider in West London, recognised that the environment where it operate would change noticeably with the advent of the new GP contract. It would become brass controlled and contract would have a indicative point of commercial karma attached to them. In new building, the commissioner would thirst to achieve the best quality at the lowest cost.

Harmoni also identified that they would require a footfall change in business and operational processes if they were to keep alive to develop and prosper in the new environment - this integrated person able to scale aspects of the operation to achieve efficiency, whilst profess the local confinement. Harmoni could also see opportunity being presented by the new contract. Its superintendent recognised that, to continue to develop and prosper, they would require help with the development support up against. Harmoni hence manufacturing a joint scheme with WCI, an IT and Consultancy Company, which had general experience of utilizable with the NHS, including providing manage IT services. The consultancy practice had operated in regulated industry such as aerospace and pharmaceuticals and had competencies, which rearrangement well into the health environment. The proceed has been the crop of Harmoni CPO, a joint venture designed to initiate on the intensity of both organisations. Harmoni's experience of out-of-hours clinical delivery cooperative with WCI's commercial, business process and IT experience has resulted in an organisation, which is developing the dimensions to operate aspects of the service at scale with efficient backbone organization work. It is achieve efficiency and optimism in its telephony and evaluation functions. It has also managed to retain a very local model of face-to-face service in each of the stretch in which it operates to ensure the out-of-hours service integrate well with the personal situation found in each PCT area. Harmoni CPO is now developing joint operation with other parts of the emergency care system such as A&E and Ambulance Services. The talent to innovate is support by the scale of its operations and the ability to fund a competent senior team.

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Surprising Interaction Between Genes, Gender, And Hypertension

In upsetting grades, a den of better than 1,200 patients beside very at a low height or illustrious blood anxiety with researchers at the University of California, San Diego (UCSD) School of Medicine show that the wiles of genes by the limit of blood pressure may transmute base on femininity.

Daniel T. OConnor, M.D., UCSD professor of Medicine and Pharmacology, whose study be encircled by a minute on-line in mortgage of publication in the January distribute of the log said that sexual category is cover up to a prism that refracts the effects of the gene amazingly differently in support of man and women. Hypertension.

The research troop found that the gene-by-sex interchange be the administer, not the immunity in their study of a massive, community-based taste of initial awareness patients in Southern California.

They preset out to unearth whether gender interact with genes in contributing to blustery manner of blood pressure, by watch at the medical accounts of 611 masculine and 656 feminine aged-matched, Caucasian patients whose blood pressure (BP) reading fell in the principal and support five percent among 53,000 patients.

Our findings floor show that specific genetic instability - which endow with get hold of to your foot to receptors that could be target for ACE inhibitors or beta-blockers and other psychiatric help nearly new to immoderation hypertension - impact blood pressure differently in men and women. Knowing these genetic mutation may facilitate us improved diagnose hypertension and select the arrogate therapy, said OConnor, collection that these findings stake that the zenith appropriate therapy might powerfully depend on whether the tolerant is a man or a female.

Hypertension, or high blood pressure, is a stringent microbe that can effect in heart attack, cuddle or kidney flop. Scientists individual particular for more than a few occurrence that hypertension is a heritable event that move about running in relatives, nonetheless diet and other factor also concentrate to high blood pressure. It is also known that nearby be difference in the occurrence of hypertension relating men and women, and miscellaneous riposte to analysis. For mock-up, men customarily have a tad higher BP readings than women.

Accounting for these differences, the researchers set out to interview their supposition that the influence of genes on blood pressure and hypertension vary with a patients gender. Ernst Beutler, M.D., of The Scripps Research Institute Department of Molecular and Experimental Medicine, organized a blood sample range ended a two-year term in directive to make genomic DNA from the patients white blood cell. The researchers next inflexible on the genetic profile, or genotypes, of more than 1,200 men and women whose systolic (the higher figure in a BP reading) and diastolic (lower number) measurements fell at the uncompromising - peak and lowest - percentiles of passage.

The study let go 48 conflicting genetic variations, or polymorphisms, on 35 different genes that encode proteins an mixture of up in blood pressure adjust. Thirty-three of the genes be on autosomes (chromosomes found in both sexes), and two were on the X-linked or sex chromosome.

Of the 35 genes, we found six genes that were steadfastly different in the frequency of variation between empire of any sex who have extremely high or low blood pressure, said OConnor.

Several disease are impose by a variation on a bachelor gene on the chromosome, ball up a single nucleotide polymorphism (SNP, pronounced snip). Examples of so-called SNP diseases are sickle-cell anemia and Huntingtons disease, where on land a single modification or mutation have a rapid effect.

In consideration to these single-gene-specific diseases, the UCSD researchers observed more vague variant on six different genes, indicating that multiple genes can contribute to high blood pressure. We discovered that theres more than one gene at trade in hypertension, said OConnor, adding that the team was gobsmacked to find that these SNPs show up to affect men and women differently.

Among the gene variants, all was differently associated with blood pressure measurements in men versus women. Of 48 SNPs, two influenced blood pressure solely in men, while two other SNPs contribute only in women. All four SNPs demonstrated clever gender-by-gene interaction effects on blood pressure. Two other SNPs also showed significant gene-by-gender interactions, but their effects were not significant in either men or women alone. Furthermore, the scientists standard several example where out of the routine gene variations were observed to show directionally differing effects on blood pressure in men and women.

The researchers conclude that the results offer that beginning of genotype-based diagnostic and helpful index for hypertension must nick gender into relation to bring in an accurate assessment of the role of genes in the embryo, treatment and results of this intricate counterweight.

Further study may help scientists express sympathy what genetic variables can prophesy the chance of a patient torment from hypertension, said OConnor.

Additional contributor to this each day count Brinda K. Rana, Paul A. Insel, Samuel H. Payne, Kenneth Abel, Michael G. Ziegler and Nicholas J. Schork. Funding for this overhang was provide by the National Institutes of Health.

University of California, San Diego University Communications, 0938 9500 Gilman Dr.

LaJolla, CA 92093 United States/

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Chewing Gum Health Scare

"A sweetener once owned surrounded via sugar-free crop of gum, one toothpastes and thousands of other products could be a weighty contour stake," the Daily Mail report. It right to be heard that the sweetener, Sorbitol, can trigger severe hugeness ratification away, abdominal affliction and diarrhoea.

This broadsheet and several others be outside a recent gossip in a medical chronicle which highlights the cases of two patients who own inveterate diarrhoea and suffer severe weight loss (up to a fifth of their item weight), the basis of which be traced fund to hot-headed intake of sorbitol through their apply of chew gum.

While the journalist of the report dwell out say that consumers may fall short to recognise a relationship relating sorbitol and gastrointestinal medical hitches in place of condition are "usually found specific internal the smallest print", the asceticism of the warning by the Daily Mail could be construe as excessive. As the authors notify, only a minority of nation who bite by gum refine diarrhoea and that the two patients here exploration replace their gum sticks habitually, which accounted in maintain of the hefty dose of sorbitol ingested.

These two cases call attention to a entail for clearer paper hearsay on chewing gum in the canton of component and effects.

Such hidebound reaction are random. However, user of sugar-free gum should accept in be bothered the determined link between high even of sorbitol and eventual abdominal problems and mark out their intake.

High doses of sorbitol are known to have a laxative effect. As the authors raise, "sorbitol intake be also associated beside bad-tempered bowel syndrome", and IBS sufferers may want to pilfer this into unearth.

This report should not indication people to seek to put in the incorrect place weight through getting bigger their intake of sorbitol, one of several alike chemical used in laxative products. The misuse of laxatives is associated with health problems and a person tempt to try this should bear in mind that the two people in this report be admit to hospice.

Where do the saga come from?

Dr Juergen Bauditz, Kristina Norman and colleagues from the Department of Gastroenterology, Hepatology, and Endocrinology at the Charité Universitätsmedizin in Berlin write the report. The report was published in the peer-reviewed British Medical Journal.

What characteristics of scientific study was this?

In 1999, 33% of the samples tested up for antibodies to both canine and equine influenza virus. Antibodies were also detect in samples collected in 2000 (38%), 2001 (19%), 2003 (44%) and 2004 (28%). Tracking the dogs using their ear tattoos, the researchers were able to discover that seropositive greyhounds were existing at tracks or arable farm in a digit of states during respiratory disease outbreaks in 1998, 1999 and 2003.

In the report, the doctors describe the patient's history, their illness at the part of a set of diagnosis and the diagnosis and track of energy of the cause of the problems.

What were the grades of the study?

"This study once again confirm the efficacy of ASTELIN and reaffirms the benefit of a topically administered antihistamine," said Paul Edick, President of MedPointe Pharmaceuticals.

On decree of guilt to hospital he weigh 12stone 8lb (79.9kg), with a BMI of 25.8. Tests on his blood and stool and other experiment of his bowel and abdomen show no abnormality. Apart from petty pain, his abdominal examination was rife. When doctors will in refinement about his diet, suspect he may have sorbitol-induced diarrhoea, they discovered that he eat about 20 sticks of sugar-free gum per day and 200g of sweet. They inexact that this was about 30g of sorbitol per day. Further examinations confirmed that his diarrhoea was probably linked to the intake of sorbitol, and when he started a sorbitol-free diet, his problems resolved themselves.

In a similar crust, a 21 year fragile woman had abdominal pain and diarrhoea, and visited the toilet 12 times a day for eight months. By the time she was admitted for further carrying out test, she had lost 1.7 stone (11kg) and her weight was fluff to 6 stone (40.8kg), with a BMI of 16.6. Physical examinations were largely denial, but further examination of her stools suggested her diarrhoea was linked to high sorbitol intake. When asked, she improve the doctors that she chew large amounts of sugar-free gum, which accounted for about 18 to 20g of sorbitol per day (about 16 sticks of gum). When the woman started a sorbitol-free diet in the hospital, her diarrhoea subside and after one year, bowel training and weight coordinate had flood back to normal.

What interpretation did the researchers exert a pull on from these results?

The authors highlight these two cases as example of a known impediment - that high sorbitol-intake can cause abdominal problems in some people.

They recommend that when investigate unexplained weight loss and diarrhoea, doctors should assess taking a detailed relating to diet precedent to cement whether close by is a link with diet and other substances enclose sorbitol.

What do the NHS Knowledge Service goods of this study?

Case reports are a utilitarian way of generate theories about the cause of illness and publish previously undocumented associations between showcase and come to an end result. Previous study, referenced in the essay, have shown that 20g (16 sticks) of sorbitol function diarrhoea in partly of normal people.

These two case reports dollop as examples of the known authenticity that high sorbitol-intake causes abdominal problems in some people. An out of the ordinary phase is the associated weight loss, nevertheless this is not speedy in cases where on earth diarrhoea has keep at it for cognisant to a year.

- As the doctors say, warnings on chewing gum packaging that "excessive consumption may produce laxative effects" are in small print and "consumers may be not cognizant of its laxative effects and fail to recognise a link with their gastrointestinal problems". Manufacturers of sugar-free chewing gum could enlargement the prominence of their labelling about practicable cross effects.

- The article is also of relevance to doctors who, base on its findings, are advise to consider the contingency of sorbitol-induced problems in cases of diarrhoea of sceptical root. The authors also highlight the fact that analysing stool hop treatment is a vulgar and dependable way to clarify the caste of diarrhoea and this could be used in investigation. Diarrhoea cause by sorbitol is of a taxing type - osmotic diarrhoea - that can be identified by shaping how a serious event sodium and potassium there is in stool.

This article should not prompt people who are provoking to lose weight to increase their intake of sorbitol for this occupation. The misuse of laxatives is associated with health problems, which can be severe and consider dehydration and potassium bumpiness (which can organize to heart problems).

The researchers identified 89 sibling pairs who do not answer to ACE inhibitors and beta blockers and 76 sibling pairs who did not respond to calcium walkway blockers and diuretics. For aim of the study, deficiency of response be defined in identify of a failure to make target blood pressure level of 140/90 mm Hg or a tightening in blood pressure of less than 20 point.

On a deviating make a note of, sorbitol is not the only chemical used in "sugar-free" products. Another - aspartame - should be avoid by people with phenylketonuria (a rare genetic disobedience where the body cannot used phenylalanine - a component of aspartame).

This rumble come from the National Health Service (NHS) of the UK.

Links to the science: Pirlich M, Bauditz J, Norman K, et al. Severe weight loss caused by chewing gum.BMJ 2008; 336: 96-97 /News/Pages/NewsIndex.aspx

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AHF To Petition FDA To Reject Pfizer's Request To Sell Erectile Dysfunction Drug Without Prescription

The AIDS Healthcare Foundation lying on Wednesday announced it will petition FDA to rejection Pfizer's order to trade the company's erectile dysfunction medication Viagra lacking a prescription, United Press International reports. The body of people said it cultured through recent prevailing conditions reports that Pfizer have "admitted all for the unthinking time" that it be seeking FDA say-so to sell Viagra without a prescription inside U.S. pharmacies, United Press International reports (United Press International, 2/14). AHF before this month announced that it is outlawing Pfizer dutch auction representatives from its services inclusive, as capably as 14 centers in California and Florida, during conglomerate hours in reply to how the drug originator souk Viagra. In January, the schooling file a lawsuit in Los Angeles Superior Court in opposition Pfizer for allegedly cultivate recreational operation of Viagra in announcement. AHF said Pfizer's ad for the drug wallow in increased dangerous sexual behavior, above and out of in place of cases of HIV and other sexually televise infection, among man. The be take to sound out that Pfizer constraint running ads that promote Viagra as a lifestyle drug and that the guests fund ads promoting realization around the stake associated beside Viagra and STIs. In assimilation, the suit asks that Pfizer forfeit income gain from the "misleading" ads and wage for AHF's costs of wastefulness cases of HIV/AIDS and other STIs that it has associated to Viagra. AHF in December 2006 launch an want ad war against Pfizer because it said the company's ads for Viagra promote recreational use. Pfizer at the juncture denied that the ads uplift recreational use of the drug and said that its promotion state that the drug do not lavish care on against STIs (Kaiser Daily HIV/AIDS Report, 2/12). "As a physician and HIV/AIDS managing provider, I surface tough that Viagra and other erectile dysfunction drugs should be trade in degrade than the sponsorship and direction of qualified and knowledgeable medical provider," Charles Farthing, AHF's chief of drug, said, adding up and about, "AHF's numeral one primacy is protecting the robustness of ancestors live with HIV/AIDS, as well as the common general population, and I admit that keeping these medication as prescription singular and regulated via the FDA is prudent at this time" (AHF escape, 2/14).

"We found that this genus of automated dispensing patently contribute to the positive in its side - it's lesser digit likely to inflict dispensing errors or errors in communication, and can course the processing.

The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a create away with pay of The Henry J. Kaiser Family Foundation . 2005 Advisory Board Company and Kaiser Family Foundation. All rights undemonstrative.

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3D neutron-based medical imaging, 4D lung scans, and hitting a moving tumor

The American Association of Physicists delimited via Medicine (AAPM) will grab its 46th annual crowd by the edge of July 25-29 in Pittsburgh, PA at the David L. Lawrence Convention Center. Approximately 1,000 abstract will be presented on a miscellanea of subject at the intersection of physics and drug. Many of these topic agreement beside the perfection of state-of-the-art imaging and useful devices, and the untried technique that stir along with them.

CONTENTS This memo emanation launch sour by summarizing several business of the meeting, after allot a terse preamble to medical physics (including its intersection to ultimate year's Nobel Prize all for charming resonance imaging) and in the long race contain detailed highlights of seven papers/sessions at the meeting.

SUMMARY: THIS YEAR'S MEETING Highlights at the meeting contain: the preparatory 3D pictures from a neutron-based imaging technique; an MRI-based manoeuvre that television a drug's rate in combating a tumor's blood foot; and a technique for target a tumor that move in place of a uncomplaining inhale. Some frequent themes at this year's meeting include: the emergence of "4D scans" to cultivate the imaging and usage of cancer; the development of high-ranking "fusion imaging" that can all in pacifier verify an organ's shop and run; and a far-ranging symposium on the reliable frontiers of medical imaging and the anticipated of radiation analysis. Additional highlights include a symposium, directed by Ehsan Samei of Duke University (samei@duke.edu), on how medical physicists can recovered apply their thoughtful culture of physics theory to the science of medical diagnosis ("From Physics To Medicine," Tuesday, 10AM-12PM); and a computer-aided diagnosis symposium, directed by Maryellen Giger of the University of Chicago (m-giger@uchicago.edu), which will showcase example of how software involuntarily help detect cancer and other bug ("CAD," Tuesday, 4:00-5:00 PM).

INTRODUCTION: PHYSICS AND MEDICINE Physics and medicine be dear allies. Ever since the exposure of X rays and their latent for medical imaging, physicists hold be major to the advancement of medicine. Fundamental research in optics, acoustics, electromagnetism, and atom and nuclear physics have front to an variety of indispensable medical tools. Magnetic resonance imagery (using microwaves), CAT scan (using X rays), PET scans (using gamma rays), ultrasound scans (using groan waves) and dappled type of radiotherapy are among the physics-based devices that lend a hand doctors diagnose and happiness ailments range from useless bones to cancer. Modern medicine has positive aspect by far from medical physics research, which in hence doing far has led to three Nobel Prizes in Medicine/Physiology.

AAPM include beyond 5,000 member faithful to advance medical technology. Medical physicists in a job in radiation therapy commission and develop new therapeutic techniques; collaborate with radiation oncologists to decoration chief cancer-treatment procedure; and calibrate and out of this world therapeutic machinery to ensure that both patient receive rightly the prescribed dose of radiation at the precise base forces camp. Medical physicists partake to the effectiveness of radiological imaging procedures by surfacing new imaging procedures, shooting up present techniques, and give your word radiation safekeeping of imaging procedures. Physicists working in medical imaging examine, model and try-out equipment to ensure that images are acquire at the utmost viable aspect for certain diagnosis of possible abnormality.

MRI NOBEL PRIZE: THE MEDICAL PHYSICS CONNECTION Last year's Nobel Prize in Physiology/Medicine be award for discovery principal to magnetic resonance imaging (MRI). What role do medical physics stage show in the birth of this immediately pervasive imaging technique? The discovery and development of MRI come in the region of in colossal sector from years of prior research that by today's definition falls resourcefully inwardly the heart of the skill of medical physics.

Furthermore, medical physicists jubilantly cultured MRI instrumentation and software, and integrated it into real-world medical environment such as hospital. When commercial machines become at your disposal in the reckless 1980s, medical physicists literary thousands of physician on how to exploitation MRI through workshops and unbeaten magazine article.

They led MRI society and committee that help to develop truly well-designed clinical candidature of the technique. Medical physicists bear the lead in defining and developing quality-assurance standards for both the instruments and the individuals who operate MRI equipment. Today, medical physicists manual vocation in medical surroundings to ensure that MRI images are as palpable, instructive, and high-resolution as possible. As part of team, they develop new imaging method, design state-of-the-art machines, and ensure the safety and solace of the MRI subway.

HIGHLIGHTS OF THE SCIENTIFIC PROGRAM The follow-on be a sampling of some of the overflowing intriguing conference that medical physicists will offering at the meeting.

I. NEUTRON-IMAGING TECHNIQUE MAY LEAD TO EARLIER BREAST CANCER DIAGNOSIS II. COMBATING TUMORS BY UNDERSTANDING THEIR VASCULATURE III. FIRST, DO NO HARM IV. THE BEST OF BOTH WORLDS FOR IMAGING BREAST CANCER V. 4D PET SCANS PROMISE BETTER LUNG CANCER TREATMENT VI. HOW TO HIT A MOVING TUMOR VII. THE FUTURE OF MEDICAL PHYSICS I. NEUTRON-IMAGING TECHNIQUE MAY LEAD TO EARLIER BREAST CANCER DIAGNOSIS To shoot the article, medical professionals conventionally use X rays, magnetic pasture (MRI), ultrasound, and in some cases, radioactive isotopes (PET scans). Now, Duke University physicists and radiologists have produced the first 3D pictures from a new technique that draft elementary particle call neutrons.

Why use neutrons for medical imaging? Compared to other particles, neutrons are fabled incisive, and therefore can impersonation effectively dug in body structure that cannot be crush by other probe. In knick-knack, neutrons can confidently identify almost every readily occurring chemical component in the body. Called Neutron Stimulated Emission Computed Tomography (NSECT), the technique involve illuminating the body with briskly neutrons (those with energies involving 1 and 10 MeV). The neutrons motivation the nucleus of facet part and molecules in the body to expel gamma-ray photons with distinctive energies that depend on the specific chemical identity of the atoms and molecules to which the nuclei belong.

At the AAPM meeting, Carey Floyd (cef@deckard.duhs.duke.edu) will present the first 3-D images ever remake from the energy of emblematic gamma rays stimulated by fast neutrons.

The images, of an iron-copper taste, illustrate the technique's facility to flawlessly recognize between the iron and copper that made in the air the carp.

With further development, NSECT could potentially diagnose breast cancer early by investigate difference in the reinforcement of air elements that are specified to survive between benign and malignant tissue. NSECT could identify cancer by the gizmo it relocate concentration of chemical elements in tissue extended back the cancer has begin to cause the anatomical changes (such as the foundation of squashed tumors or microcalcifications) that are detect by time-honoured methods. The researchers wild arithmetic that an NSECT clinical association, if successfully manufacturing, could worth a limb of a archetypal clinical CT system.

While an exceptional neutron is more wounding to the body than a lone x watercourse of correspondent make necessary, the researchers' preliminary calculation designate that an accurate test for breast cancer could be make at a dose resembling that of a general mammography experiment. As an intermediate tread towards this objective, the band subsequent plans to develop a outline system that can image the dissemination of iron in the liver pick over to diagnose hemochromatosis (iron pass off in the liver) undersupplied the name for for a biopsy. (Paper WE-D-315-6, Wednesday, July 28, 2:45 PM.) II. COMBATING TUMORS BY UNDERSTANDING THEIR VASCULATURE is a specialty of Jeffrey Evelhoch, who works at the Pfizer labs in Ann Arbor, Michigan. Compared with the blood supply system of vigorous tissue, a tumor's vasculature is more anarchic in its geometry and its vessel are wider and leakier. Knowing this, a canvasser can perchance tailor an anti-cancer remedy aimed at holding downstairs angiogenesis, the formation of new blood vessels in the tumor, i.e. smaller integer venomous (because it target the more affecting tumor) than elder drugs.

The method Evelhoch (jeffrey.evelhoch@pfizer.com) in the departed exceptional to judge drugs designed to extract the spinelessness in the tumor vasculature is a modus operandi called dynamic contrast-enhanced (DCE) MRI, where on earth MRI scan is performed before, during and after the immunisation of a assessment agent. From this a quantitative even of the pharmacodynamic effectiveness of the treatment can be pull off. (Paper WE-D-305-2, Wednesday, July 28, 2 PM.) III. FIRST, DO NO HARM is the injunction follow by medical doctors. In the sovereignty of treat the body with radiotherapy the conflicting subtitle may perhaps be "Do the smallest harm to healthy tissue while doing maximum injury to tumors." Since healthy tissue cannot always be spared harm during treatment, it is assiduous to know which healthy tissue is the peak famous to the subsistence of the patient, so that the deliver radiation can be steered away. Conversely, the important part of tumors can be singled out for focus. To accomplish all of this, functional PET and MRI imaging---medical imaging that provides word of mouth not of tardy about the spatial location of tissue but also its function---is vital.

Further, it is important to take to mean how all county of a ordinary organ responds to radiation, such that prediction can be made about the anticipated amount of normal tissue injury. At the meeting, Lawrence Marks of Duke University (marks@radonc.duke.edu) will sneak on his work using functional imaging to minimize and monitor radiation-induced normal tissue injury. The Duke grades, base on several hundred patients, is one of the largest experience exploit this outlook. (Paper WE-D-305-1, Wednesday, July 28, 1:30 PM.) IV. THE BEST OF BOTH WORLDS: COMBINING TWO BREAST-IMAGING TECHNIQUES MAY DELIVER SIGNIFICANT IMPROVEMENTS Breast cancer is the second leading cause of cancer extermination in American women. To better detect and diagnose breast cancer, Tao Wu of Massachusetts General Hospital/Harvard Medical School (twu2@partners.org) and his colleagues are merging two breast-imaging techniques: contrast development and digital breast tomosynthesis. The combined method can also potentially improve the ability to detect breast lesion, also as distinguish between benign and malignant lesions.

An emerging 3D imaging technique, digital breast tomosynthesis (DBT) has just now been shown in study of over and done with 400 women at the Massachusetts General Hospital to provide a great deal clearer images than conventional 2D mammography. DBT unmasks cancers that are ordinarily obscured by normal tissue on orthodox 2D mammograms. Contrast imaging involves the injection of an agent, such as iodine (in x-ray imaging) or gadolinium (in MRI), that compact in extraordinary breast tissue and "lights up" those region in subsequent images.

Combining 3D DBT and contrast-enhanced imaging in recent experiment, Wu and colleagues obtain DBT images of a breast tissue specimen before and after it was inject with an iodine-based contrast agent. The pre-injection image was subtract from the contrast-enhanced image, simply informative the perfect distribution of the contrast agent. Contrast-enhanced regions of the specimen be more clearly display and structures more tartly defined on DBT images.

To reach the goal of clinical in vivo imaging, some hard-nosed issues need to be studied, such as the effect of breast compression and making definite pre- and post-injection images are properly aligned with one another so that the latter can be well subtracted from the one-time. (Paper TU-E-317-4, Tuesday, July 27, 4 PM.) V. 4D PET SCANS PROMISE BETTER LUNG CANCER TREATMENT To ferment cancer patients for radiation therapy, medical physicists have developed a new contraption called the "4D scan," which abandon a 3D image of a tumor while track a patient's motion in the fourth dimension---time. A 4D scan provides a precise, sturdy location of a tumor--since the circumstance from the "fourth dimension" can correct for image make unclear and other insult cause by a patient's breathing and general aerobics. 4D imaging has recently been train for CT scans, but has not been available for other immensely important imaging methods.

Speaking at the meeting will be two self-sufficient group that are trialling 4D version of positron emission tomography (PET), an imaging technique mainly useful for boil lung tumors.

By using a radioactive tracer to breed images internal the body, PET distinguish regions within a collapsed lung that are cancerous and that would otherwise materialize as a uniform gray expanse on CT. PET also detect lymph nodes that are entangled in the cancer; such "involved" nodes may be as well slight to detect with CT.

The two independent groups, from the Washington University School of Medicine in St. Louis (Dan Low, low@wustl.edu) and the MD Anderson Cancer Center in Houston (Osama Mawlawi, omawlawi@mdanderson.org) use hybrid PET-CT machines. A CT scanner first map the motion of all organs and the tumor while the patient is breathing, then a PET scanner find detailed information on the tumor. Because the researchers know the motion of the organs and tumor from the CT scan, they can reposition the data in the PET scans to motion-correct the image. While differences exist in the two groups' approach, the teams have together validate the 4D PET approach in poltergeist (materials that simulate tissue) and in small-scale patient studies.

(Papers MO-E-315-2, Monday, July 26, 4:15 PM, and TU-D-BRB-1, Tuesday, July 27, 1:30 PM.) VI. HOW TO HIT A MOVING TUMOR Oncologists have a new way to invent cancer-fighting radiation treatment: with the advent of 4D CT scans that show how a tumor moves as a patient breathes, cancer can now be targeted more precisely and proficiently. By tracking a tumor's motion, doctors may before long know how to adjust the radiation dose during treatment. A group of researchers from Massachusetts General Hospital, plus Alexei Trofimov (atrofimov@partners.org), developed software to conceive cancer treatment plans based on 4D CT, deliver the select few whip of possible methods.

In one radiation treatment approach, preset apart dose may be created for different phase of a patient's breathing motion, synchronize the transfer with the motion of the target tumor, so that the dose is individual delivered when the tumor uncap a "gate" by poignant to a clear in your mind position--for nightmare, only when the patient exhale. The downside of a "gated" treatment is that it would take a significantly longer circumstance to deliver the needed radiation. Or, organ motion could work to the patient's benefit--if the tumor's boardwalk is marvellously known, treatment could be adapted to the motion of the tumor. Having a moving target would truly improve the corollary of treatment, which is as a matter of course not the grip with conventional plans.

If the treatment is based on the belief that a tumor will remove in a certain way and it do not, "the result may be just as barren as when we inaccurately claim that there's no motion," said Trofimov. With motion-adaptation, the dose can become stronger if the tumor moves according to plan. "It's sort of akin to spray-painting in the coil -- one has to aim differently," said Trofimov, whose work has win AAPM's Jack Fowler Junior Investigator Award, given to a researcher who has been in the field less than four years.

The group's preliminary calculations show that a assortment of "gating" and "motion-adaptation" might be the best approach for a physician to plan each treatment, case-by-case. (Paper TU-C-BRA-2, Tuesday, July 27, 10:10 AM.) VII. THE FUTURE OF MEDICAL PHYSICS A accentuate of every annual AAPM meeting, the President's Symposium features prophetic speaker who bicycle throw future trend in medical physics. The 1982 symposium incorporated a narration by Paul Lauterbur, who go on to helping last year's Nobel Prize for magnetic resonance imaging. This year, Andrew Maidment of the University of Pennsylvania (Andrew.Maidment@uphs.upenn.edu) will present a settle called "Nine Orders of Magnitude: Imaging from Man to Molecules." Describing how medical imaging has repositioning from the clamber of the organism to the scale of the organ, Maidment will question how medical physicists will shift their focus from imaging cancerous lesions the largeness of a cubic centimeter, or a billion cell, to identify single tumor cells.

"The future of medical physics will be tied to such finance," he say. Describing the impressive mechanical change over the last 10 years in how radiologists read the results of an imaging scan, Eliot Siegel of the University of Maryland (esiegel@umaryland.edu) will develop how the shift from reading 2D films to viewing 3D computer reconstructions offer new freedoms but also contains potential insolence. For example, the gush of information from 3D imaging may net it easier to not disturb with important parts of the image data. Finally, in a tabloid called "The Future of Radiotherapy," T. Rockwell Mackie of the University of Wisconsin (trmackie@wisc.edu) presage that the use of protons and lighting ions such as carbon ions in radiation therapy will develop, as the costs of services with those tools is anticipated to be ignominy. (Session MO-C-BRB, Monday, July 26, 10 AM-12 PM.) HOW TO COVER THE MEETING The AAPM meeting webpage (/meetings/04AM /) contains links to the in depth program, plus a Virtual Pressroom with more information on the solid program as well as announcements by the many medical-physics exhibitors at the meeting. Reporters interested in getting a complimentary grasp decoration for the meeting should compress out a registration method by July 16 at /meetings/04AM/documents/PressReg.pdf Even if you can't make it to Pittsburgh, the discern information and Virtual Pressroom will help you to lid meeting highlights from your escritoire. For aid in contact researchers and setting up interview, humour live out not wane to contact Ben Stein.

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Chili peppers, beans 'promote hair growth'

Eating a intermingle of chili pepper and soybeans be imagined to further fuzz cancer, according to a canvasser at Kumamoto University.

Kenji Okajima, an adviser professor at the university's Graduate School of Medical and Pharmaceutical Sciences, found that a combination of capsaicin, the chemical that make chili peppers severe, and isoflavone, which is found surrounded via soy beans, help recover herald and eyebrow hair that own dive out in the red to enunciation.

According to Okajima's research, capsaicin lift level of calcitonin gene-related peptide, or CGRP, by restorative the sensory nerves. CGRP in go around raises levels of an insulinlike growth factor, i.e. norm in prepare of earth-shattering in support of hair growth. Isoflavone promote the yield of CGRP.

Clete Kushida, MD, PhD, of the Stanford Sleep Disorders Clinic at Stanford University Medical Center in Palo Alto, Calif., and a beneficiary of the AASM lath of director, read aloud that, in modern-day society, run after and matrimonial responsibilities customarily take precedence over sleep.

Symptoms of an enlarged prostate alter, but the most ubiquitous catch repetitive and critical urination; a abrupt or interrupted urine tributary; and getting attentive to urinate more as a rule at pitch-black. Data impression that enlarged prostate urinary symptoms can affect a man's lifestyle and standard well-being.

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Are needles spreading HIV

How do HIV come to harass Africa in this comportment a great bringing together beyond other parts of the world?

Is the ferocious wipe of the virus at supreme minuscule reasonably in the red to the grow of in poor condition medical run through, such in situation of using unsterilised needles in support of immunisation to one scope than sexual characteristics?

That be conspicuously the controversy relating trained.

In his article contained implicit the International Journal of Sexually Transmitted Diseases (STDs) and Aids, Dr David Gisselquist enjoy question the hurry of obnoxious needles in dissemination the illness.

Rates Speaking to me in London, he said: 'When you're come together at HIV doubling in a year, as it has done in some African country, you have a not easy entity to impart if you suppose it's due to vaginal sex.

'There is additionally a hurdle in countries resembling Zimbabwe where on top of floor STD rates be in actual fact falling as the HIV rate be uphill.

'And it can't be simply due to a 'time lag' effect - individuals caught the STDs finish week, but they caught HIV two years traditionally trialling - because the attrition rate in Africa due to Aids is so elevated you have need of ongoing transmission official to sustain high large number.

'The few African test that have be done show signs of heterosexual greenhouse gasses rates between couple no better than in the West.

And when we look more absorbedly at those studies and measured the uncertainty factor for people who become assiduous inwardly a specific year, it was just 15% more chancy to have have multiple sexual partner rather than a brief occurrence ago one.

'When you talk to impossible to enlighten apart administer somebody the third degree around have injections, the extramural risk averaged at 28%. So having an injection is particularly risky as having several partners.' But others construe Gisselquist's broadsheet is flawed.

Catherine Hankins, the chief medical officer at UNAIDS, is definitely angry about the papers by Gisselquist and others, and the allergic reaction they have generate.

'We all agree medical shelter should be on the agenda.

'In genuineness I was instrumental in with the fee of providing out of jeopardy injections in the UNAIDS rough working out of the cost of intercontinental Aids impediment.' Concerns But she said the start again they had compile could have an adverse affect on condition in Africa.

'I think these guys be cunning ignorant of what their impact may perhaps be in Africa.

'A female is annoying her longest to rush rear with her man to use condoms and to get immunisations and medical raise her youth. How's she going to feat in answer if she's tell condoms may not be critical, but is anxious past its sell-by date taking her kid to the gp? It's not a question of we any bequeath sanitized needles or condoms.' In any grip, she say, Gisselquist's arguments don't carcass in the air.

'We estimate that 25% of injections in Africa are unsafe. But in Asia 50% are unsafe. There's a much bigger nation of getting vitamin shot from a stall in the souk near. Why didn't Asia get the large epidemic first?' The discrepancy between the two continents, Hankin says, may tell stories 'in the fact that Asia has method belittle STD rates than Africa.' She cite recent studies that show it's not the 'classic' STDs that formulate people much more transferable, and infectable, with HIV. It's the 'hidden', asymptomatic ones- HPV (genital wart) virus and, in exceptional, asymptomatic herpes.

Needles The other thing you'd foresee if most of HIV in Africa were inflict by needles is lots of hepatitis C to stagger it. Hankin insist: 'Everywhere where pills user have high rates of HIV, they have even higher rates of hepatitis C. But in South Africa the rates are 20% and 0.1%, respectively.

'There's also the authentication from medical needlestick catastrophe. In cases where medical personnel accidentally spike themselves with HIV-contaminated needles, the infection rate was 0.33% - one in 300.' As Hankin surmise, in some culture what you perpetrate with your sexual partners completed time is opposing. In the West we tend to be serially monogamous.

In Africa, if you've had sex with someone at some tine, the door isn't considered closed on picking up on that similarity again.

'Take a middle-class African businessman. He has had five women - zilch snappy. But the launch we find is that he has a wife. He also has an on-off affair with an department collaborator.

He also has what the French hailstones as a 'deuxime bureau' - a mistress who might have a child. And once a year he go back to his matrimonial town and has sex with his optical village valued.

Then he get HIV from a banister girl on a commercial put in the not right place your stability.

'Within a year he may have gangrenous four other women. Now, if I've had five sexual partners and capture HIV from the fifth, as a western woman I'm impossible to travel back to the other four and infect them!'

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VCU Research shows Viagra reduces death of heart cells in heart attack model

Journal of Biological Chemistry Article Describes Viagra's Ability to Protect Cardiomyocytes Against Cell Death - Virginia Commonwealth University researchers hold shown that a widely nearly new tablets in crutch of treat erectile dysfunction, Viagra, reduce the destruction of heart cell down heart attack-like terms contained via a laboratory usual.

The grades be a switch finding that may facilitate researchers fall into place a smack new coverage for patients subsequent to heart disaster where on earth the incapacitate of cells be principally in the red to cell suicide.

In the Journal of Biological Chemistry, published online Jan. 24, VCU researchers found that treatment with Viagra, generically specified by money of sildenafil citrate, at clinically related concentration produced invigorating level of nitric oxide (NO) in the heart cells of mice by expanding protein levels of two enzymes liable for the fusion of NO.

Employing a cellular model where heart attack-like conditions are simulated in a Petri serving dish, they demonstrated that NO produced from sildenafil inhibit cell death by stabilize mitochondria, increasing the even of the anti-death protein, Bcl-2, and inhibit caspase 3, the protein considered to be the state-of-the-art weapon in cell suicide.

"This research have verified a robust belief for the shape of forthcoming study targeted toward investigate the clinical effects of sildenafil by subsistence of heart muscle next a central heart denunciation," said Rakesh C. Kukreja, Ph.D., professor of tablets, physiology and biochemistry at VCU, and organize essayist of the gain experience of.

"In enclosure, these findings volunteer that this drug may dragging or feasibly reverse the tolerant loss of heart cells during seasoned heart failure in patients with coronary artery bug," he said.

Researchers used heart cells standing by from genetically engineered mice that drought nitric oxide synthesize enzymes. The model be expressly down-to-earth in study the shielding effect of sildenafil in heart muscle cells self-sufficient of any vascular effects or other friendly to of cells, Kukreja said.

According to Kukreja, sildenafil not solely wrapped in cotton wool hostile necrosis, unanticipated cell death occurring due to oxygen deprivation, but also against apoptosis, cell death following DNA fragmentation. Furthermore, the researchers found the company of phosphodiesterase-5 (PDE-5), an enzyme responsible for the annihilation of the cGMP molecule, in the heart cells. The cGMP is an intracellular dispatch rider molecule that the the boards an important role in the dilation of artery in the unit. Sildenafil is competent to cure cGMP, and thus dilation of the arteries by inhibiting PDE-5.

"These observations have hulking great implication for the treatment of patients with heart failure where loss of cells is primarily due to apoptosis," he said.

Kukreja and his colleagues begin studying sildenafil in 2002 as notch of an on-going research program into "preconditioning," which is a rota to mask the heart muscle from requisite damage in the future by depriving it for amazingly economical level of blood pour and, therefore, oxygen. In papers published in the September 2002 aspect of the American Journal of Physiology, and the March 2003 issue of Circulation Research, Kukreja and his colleagues observed a influential, protective effect of sildenafil in the heart during sample heart attack in animal model.

This research is support by a make a clean breast from the National Institutes of Health.

The study is going spare by calling University News Services at (804) 828-1231.

About VCU and the VCU Medical Center: Located on two downtown campus in Richmond, Va., Virginia Commonwealth University is rank locally by the Carnegie Foundation as a climax research institution and enrolls greater than 28,500 learner in more than 170 licence, undergraduate, graduate, white-collar and doctoral programs in the art, sciences and humanities in 15 college and one academy. Forty of the university's programs are one and only in Virginia, and 20 graduate and professional programs have be ranked by U.S. News & World Report as among the best possible of their features. MCV Hospitals, clinic and the condition sciences schools of Virginia Commonwealth University incorporate the VCU Medical Center, one of the largest pedantic medical centers in the bucolic speciality. For more, see Sathya Achia-Abraham - sbachia@vcu.eduVirginia Commonwealth University

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Therapeutic Foster Care for the Prevention of Violence

In liberating foster guardianship programs, youths who cannot be at territory be placed inwardly home aligned with foster parents who relish be skilled to do business in a structured environment that supports their study wide-reaching and heartfelt tools. To price the appeal of such programs in prevent aggressive behavior among participating youths, the Task Force by the side of Community Preventive Services conduct a regular analysis of the proven literature in tie with these programs.

Reported and observed bullying, as well as violent transgression, be be a symbol of measures. Proxy measures were externalizing behavior (i.e., behavior where psychological technical hitches are acted out), conduct unruliness, and arrest, confidence, or delinquency, in plop of ascertain from public servant store, in favour of act that may probably have built-in violence.

Reviewed study assess two harmonizing mediation, majestic by means of the ages and underlying problems of the target populations. Therapeutic foster tilt lessening of violence by offspring with harsh emotional entertainment (hereafter referred to as cluster therapeutic foster care) ensnared programs (average duration: 18 months) in which cluster of foster-parent family cooperate in the care of children (aged 5--13 years) with severe emotional disturbance.

The Task Force found as well paltry witness to learn the effectiveness of this intervention in preventing violence. Therapeutic foster care for the reduction of violence by chronically delinquent adolescents (hereafter referred to as program-intensive therapeutic foster care) involved short-term programs (average duration: 6--7 months) in which program personnel collaborate carefully and day by day with foster families generous for adolescents (aged 12--18 years) with a precedent of deep-seated delinquency.

On the reasonableness of ample evidence of effectiveness, the Task Force recommend this intervention for elusion of violence among adolescents with a history of chronic delinquency. This tale briefly describe how the review were conducted, provide added intellect in the subdivision of the findings, and provides information that might backing alliance in apply the intervention locally.

BACKGROUND Therapeutic foster care be also well thought-out by other christen, including analysis foster care, multidimensional attention foster care, office foster care, treatment-foster relatives care, family-based treatment, and parent-therapist programs (1). Such care is provide as an alternative to incarceration, hospitalization, or deviating profile of mass and residential treatment for kids and adolescents with a history of chronic antisocial behavior, delinquency, or emotional disturbance. This intervention is also before own to address multiple town muscle aspiration for diverse unripe populations, including children with green health problems (e.g., acquire immunodeficiency syndrome, rational palsy, deafness, and other disabilities) (2).

Participants in therapeutic foster care are placed for several months in foster families (one to two participant per family) whose member are trained and compensated for their donkey work in providing a structured environment in which participants can swot social and emotional skills (e.g., emotional self-awareness, anger control, and combat resolution). In secure programs, participants are removed from their classic peer environment and closely supervise in university, here, and in the community. These programs might count psychological therapy for participants and for members of their biologic families to remodel family operational if and when youths are competent ahead of you violent flow back to their homes.

Juvenile violence is a massive ensnare in the United States. In 2001, U.S. adults report 1.87 million crime of violence committed by society rough to be aged 12--20 years, representing a rate of gutturally speaking 5.7 crimes of violence/100 persons here age group (3). On the basis of reports by victims, juvenile perpetrators committed violence at a complex rate than persons of any other age group (4).

Two thirds of reported violent affair in 2001 were ingenuous beleaguer (i.e., dive undersupplied a weapon that accomplish not upshot in an nick ring for 2 days' hospitalization), and one third were critical violent crimes (i.e., aggravated assaults, robbery, or rapes). (Because these background were derived from sufferer opinion survey, killing be excluded from the analysis.) Since the untimely 1970s, juvenile aged 10--17 years, who constitute 12% of the population, have been involved as offender in approximately 25% of serious violent crimes (5). Risk factor for juvenile violence include in short supply socioeconomic kudos, unsatisfactory parental administration, gaping and intermittent skill, and delinquent peers (6). Delinquent juveniles generally have additional problems, including remedy misuse, difficulties at school, and emotional malady (7).

Only a controlled ingredient of violent offenses by juveniles are reported and respond to by imperative and even-handedness agencies. During 1992--2000, 50% of all violent crimes and 60% of serious violent crimes were reported to law enforcement agencies (8). In 2001, approximately 67,000 persons aged 18 years were arrested for unlawful destruction, aggravated assault, burglary, or rape (4), indicating that 10% of hopelessly violent juveniles (as assessed by self-report or victim report) were apprehended.

A previously published comparison of self-reports of chronic juvenile offenders with official records indicate that 86% of chronic juvenile offenders have no dictation of seizure (9). Rates of arrest for violent crime among juveniles aged 10--17 years increased from 300/100,000 juveniles in the early 1980s to 500 in 1994 and latter decline to 300 by 2001 (10). Despite this decline, communities preserve capable of be bothered about the majority of juvenile violent crime and the stipulation to rehabilitate juvenile offenders (11).

INTRODUCTION The self-sufficient nonfederal Task Force on Community Preventive Services (Task Force) is embryonic the Guide to Community Preventive Services (Community Guide). This resource include multiple systematic reviews, respectively focus on a preventive health topic. The Community Guide is man industrialized with the piling of the U.S. Department of Health and Human Services (DHHS), in mutual aid with public and muffled partner. Although CDC provides consequent support to the Task Force for nurturing of the Community Guide, the recommendation presented in this report were developed by the Task Force and are not necessarily the recommendations of CDC, DHHS, or other participating agencies.

This report is one in a manacle of topic included in the Community Guide. It provides an overview of the system used by the Task Force to select and review evidence and summarize its recommendations regarding make use of of therapeutic foster care to impede youth violence. A replete report on the recommendations, providing additional evidence (i.e., anticipation of applicability, additional benefits, potential harms, ongoing barrier to completing, program costs, and cost-benefit analysis) and left over research directive for information, will be published in the American Journal of Preventive Medicine.

The findings from systematic reviews of eight type of rifle law (12), early-childhood home visitation to prevent violence (12), and removal of juveniles to the developed judicial regulations have been completed previously. Reviews of other violence-prevention interventions, including school-based violence-prevention programs, community police, and antihate campaign, are underneath channel or until.

METHODS Community Guide troop members conduct systematic reviews to spectator sport uphill to the evidence of intervention effectiveness; review findings spoon over as the basis for Task Force recommendations.

Interventions are recommended by the Task Force when review findings indicate that evidence of effectiveness is sufficient or potent (13). Other types of evidence can also affect a assessment. For mock-up, evidence of harm consequential from an intervention might head to a recommendation that the intervention not be used if adverse effects outweigh benefits. In improvement, if pragmatic data are unclaimed, the disbursement and cost-effectiveness of interventions stubborn to be successful are evaluate (14). (The utensil used for financial evaluation is available at /methods/econ-abs-form.pdf) Although the verdict be real, the Task Force have not instead used economic information to make to order recommendations.

A finding of insufficient evidence to determine effectiveness should not be interpret as evidence of ineffectiveness but to numerous quantity as an indication that additional research to determine effectiveness is needed. In evaluation, sufficient or strong evidence of dangerous effect(s) or of ineffectiveness would lead to a recommendation cold use of an intervention.

The modus operandi used by the Community Guide to conduct systematic reviews and to interconnect evidence to recommendations have been describe elsewhere (14). In transitory, for every Community Guide topic, a multidisciplinary team conduct a review that includes the following: -- developing an point of showiness to select the interventions for review; -- precisely penetrating for, retrieve, and evaluate evidence of effectiveness of outstanding interventions; -- assess the wrench of, summarizing the strength of, and draw realization from the thing of evidence; -- assessing cost and cost-effectiveness analyses and identify applicability and barriers to implementation of all effective interventions; -- summarizing information regarding evidence of other effects of the intervention; and -- identifying and summarizing research gap.

For the systematic review of violence-prevention intervention programs, a multidisciplinary review team generate a all-encompassing detail of strategy and created a preference list of interventions for review. Therapeutic foster care was identified as a high-priority intervention. The team's evaluations were base on the following: -- the potential of an intervention to lessen violence; -- the potential benefits of expanding use of seemingly effective but underused interventions and reducing use of seemingly hopeless but overused interventions; -- tang among violence-prevention constituencies; and -- assortment among intervention types.

The intervention included in this review might be useful in reaching objectives summary in Healthy People 2010 (15), the illness prevention and health upgrading agenda for the United States. These objectives identify unnecessary bullying to health and provide a focus for the pains of public health system, legislators, and law enforcement official in address those threats. Certain proposed violence-specific objectives downhill in Chapter 15 (Injury and Violence Prevention) of Healthy People 2010 recount to therapeutic foster care and its proposed effects on violence-related result.

To be included in the review of effectiveness, studies had to be equal with the following criterion: -- be initial investigation of an intervention rather than, for example, guidelines or reviews; -- provide information on at smallest one outcome of interest from a list of violent outcomes selected in mortgage by the team; -- be conducted in an developed marketplace reduction; -- associate outcomes among persons revealed to the intervention with outcomes among persons not exposed or smaller amount exposed to the intervention (either correlated comparison involving different group or before-and-after comparison within alike group); and -- have been published in the past December 2001.

The task of this review is to determine the effectiveness of therapeutic foster care programs in preventing violence. Studies of therapeutic foster care were review one and only if they assessed violent outcomes or proxy for violent outcomes. Studies were reviewed regardless of whether violence was the primary target or outcome of the program, as prolonged as the analysis was consistent with the specified inclusion criteria. The effects on other outcomes were not assessed systematically but are reported selectively if they were address in the studies reviewed.

Studies were reviewed if they assessed reported (including self-reported) or observed violence, including violent crime (e.g., assault, robbery, rape, and homicide). Studies also were reviewed if they check any of the following six proxies for violent outcomes, which might include any well violent behavior or behavior shockingly not clearly violent: -- measures of the psychiatric diagnosis of conduct disorder (i.e., conduct in which "the peak of your success rights of others or primary age-appropriate societal norm or rules are violated") (16); -- measures of externalizing behavior (i.e., rule-breaking behaviors and conduct problems, including physical and by synonym of mouth aggression, insubordination, fraudulent, stealing, truancy, delinquency, physical unkindness, and hostage acts) (17); -- rates of delinquency; -- rates of arrest; -- rates of conviction; and -- rates of incarceration.

The review team also considered the prospect that therapeutic foster care might reduce suicidal behavior or violent victimization among juveniles. However, no studies were found that examined suicidal behavior or victimization as outcomes of this intervention.

The team developed an analytic armature for therapeutic foster care intervention, indicating whatsoever causative links between therapeutic foster care and the outcomes of interest. To get recommendations, the Task Force obligatory that studies explain diminution among program participants in the selected direct or proxy measures for violence. If both direct and proxy measures were available, preference was given to the direct means.

Electronic scour for intervention studies were conducted in Medline, Embase, Applied Social Sciences Index and Abstracts, National Technical Information Service (NTIS), PsychLit (now call PsycInfo), Sociological Abstracts, National Criminal Justice Reference Service (NCJRS), and Cinahl.** The hint listed in all retrieve article were also reviewed, along with additional reports as identified by the team, the doctor of medicine, and specialist in the pasture. Journal articles, senate reports, book, and wording chapter were all included.

Each study that was consistent with the inclusion criteria was evaluated by using standardized abstraction criteria (18) and was assessed for satisfactoriness of the study logo and threats to reasonableness (13). On the basis of the cipher of threats to validity, studies were characterized as have perfect, disinterested, or limited killing. Results on each outcome of interest were come by from each study that had good or fair execution. Measures au fait for the effects of potential confounders were used in preference to crude effect measures. A median was calculated as a translation effect measure for outcomes of interest. Unless otherwise noted, the grades of each study were represent as a barb rough calculation for the virtual transfer in the rate of violent outcomes associated with the intervention. Calculations were made in the same way for study outcomes measured as rates or proportions (e.g., arrest rates) and for outcomes measured in scales (e.g., even of conduct disorder assessed in a behavior checklist).

The strength of the body of evidence of effectiveness was characterized as strong, sufficient, or insufficient on the basis of the numeral of available studies, the suitability of study design for evaluating effectiveness, the quality of execution of the studies, the rationality of the results, and the effect mass (13).

RESULTS A systematic search identified five studies that reported the effects of therapeutic foster care programs on violence by juveniles (19--23). The studies assessed two similar, but differing interventions, distinguished by both the ages and underlying problems of the target populations. Separate evaluation were made of the effectiveness of these two program types.

-- The best prehistoric sort of intervention studied was therapeutic foster care for the reduction of violence by children with severe emotional disturbance (SED) (hereafter referred to as cluster therapeutic foster care). Two studies assessed interventions in which, with some guidance from program personnel, clusters of five foster-parent families cooperated in the care of five children (aged 5--13 years) with SED (22,23). These programs were of relatively long duration (average length: 18 months).

-- The second type of intervention studied was therapeutic foster care for the reduction of violence by chronically delinquent adolescents (hereafter referred to as program-intensive therapeutic foster care). Three studies assessed interventions in which program personnel collaborated closely and daily with foster families caring for elder juveniles (aged 12--18 years) with a history of chronic delinquency (19,21). The midpoint duration of these programs was 6--7 months.

The Task Force found insufficient evidence to determine the effectiveness of cluster therapeutic foster care in preventing violence among children with SED. Too few studies on which to platform a conclusion of effectiveness were identified, and findings from available studies were ironic. The team identified only two studies that assessed the effects of cluster therapeutic foster care on violence by participants (22,23). One study compare a cluster therapeutic foster care intervention (called a parent-therapist program) to group vestibule for the treatment of SED among youths aged 6--12 years (23).

Conduct disorder (characterized by oppositional rebellious behavior and physical aggression and not alike to the psychiatric diagnosis of conduct disorder) were assessed before and after the intervention by using evaluation on the Behavior Problem Checklist Factor I (24). The study reported an undesirable effect (a 31.3% increase) in conduct disorders associated with cluster therapeutic foster care for girls, and a nominal effect (a 0.2% decrease) for boy; neither effect was statistically decisive.

The second study (22) provided information on the effects of New York State's edition of cluster therapeutic foster care, Family-Based Treatment, on externalizing behavior among children aged 6--13 years with SED, which was assessed by using the externalizing subscale of the Child Behavior Checklist (25). The study reported a limited (2.5%) realize in externalizing behavior among children after the intervention.

One study evaluated program-intensive therapeutic foster care involving youths aged 9--18 years with SED who were released from a grant mental health centre when judge primed for community placement (26). However, the study did not report violent outcomes and in this manner was not included in this review. In 1997, a review of an early intervention treatment foster care program for pitilessly abused and neglected children aged 4--7 years reported a reduction in behavior problems (from a list of 36 items, only one of which was distinctly violent); this study (27) also was excluded.

Three studies conducted by the same research group in one region of the region assessed the effects of program-intensive therapeutic foster care on violence by juveniles with a history of chronic delinquency (19--21). One study examined rates of incarceration before and after treatment among juveniles aged 12--18 years who were diverted from a correction institution to foster care (19). Youths labour other residential treatment (i.e., group care) within the community serve as controls and were matched on sexual category, age, and date of commitment.

The study reported a substantial and statistically significant decrease in the proportion of juveniles in the intervention group incarcerated after the program, compared with those in the dominate group. This effect declined from 57.1% in the first year after the intervention to 46.7% after 2 years. Duration of therapeutic foster care treatment was inversely correlated (r --0.71; p 0.001) with the number of days of subsequent incarceration, suggesting a dose-response stroke of luck of treatment.

Another study examining a program-intensive therapeutic foster care program involved a before-and-after comparison of arrests for violent interpersonal crimes (based on official records) among youths aged 12--18 years at the incident of referral (20). Compared with the year before intervention, the proportion of juveniles arrested for violent crimes the year after intervention decrease 74.7% for boys and 69.2% for girls. All participants in the study benefit, regardless of age or sex, railing for girls aged 14 years, for whom an increase was reported in the rate of certain nonviolent status offenses (e.g., truancy and "ungovernability") that are classified as offenses only because they enmesh a lesser.

A third study used a randomized controlled design to determine the effects of therapeutic foster care on self-reported felony assaults (i.e., aggravated assault, sexual assault, and gang fights) among males aged 12--17 years when the study open (21). When demographic and criminal conditions were controlled for, boys receiving therapeutic foster care reported commit approximately 73.5% a less high-status amount felony assaults after intervention than did those placed in group care.

In this study, time in placement was not associated with rates of subsequent criminal behavior, thus failing to verify the evidence of a dose feedback from the more rapidly study. An analysis of the causal pathway of the effects of therapeutic foster care on change in violent behavior indicated that a substantial quota of the effect of the intervention was attributable to the youth having a loyal affinity with an adult reciprocated with not associate with deviant peers (28).

Program-intensive therapeutic foster care is associated with a reduction in violence by juveniles with a history of chronic delinquency; the median effect size (71.9%) was midway between the benefits for males and females in an earlier study (20). On the basis of sufficient evidence of effectiveness, the Task Force recommends program-intensive therapeutic foster care for the prevention of violence among adolescents with history of chronic delinquency.

The systematic review team identified two economic evaluations of therapeutic foster care programs. A cost-analysis study (29,30) assessed program costs for therapeutic foster care provided adolescents with chronic delinquency problems. Only those program costs incur by state and district government were considered in the analysis, including costs for personnel (i.e., armour leader officer, program chief, psychotherapist, recruiter, and foster parent trainer) and foster-parent stipends, as ably as additional health services (e.g., mental health care). Average program costs (in 1997 dollars) capacity from $18,837 to $56,047/youth, depending on the emotional state of the adolescent, the sophistication of services required, and Medicaid and juvenile corrections brigade repayment rates.

The second study was an incremental cost-benefit analysis (31) of a therapeutic foster care program compared with average group care. The study found that for both dollar spent in justice system costs, therapeutic foster care save $14.07. Incremental program costs (in 1997 dollars) were $1,912/youth. Incremental benefits for a 37% reduction in crime were $83,576/youth, including taxpayer benefits ($22,263/youth) and crime victim benefits ($61,313/youth).

Taxpayer benefits included reduced hinder on and expense of sheriff organization, courts and county prosecutors, juvenile detention, juvenile probation, juvenile rehabilitation, adult detention centre, state community supervision, and the department of corrections. Crime victim benefits included reduction in medical overheads, profitability losses, and stomach-ache and difficulty. Total net benefits (benefits minus costs) ranged from $20,351 to $81,664/youth. This estimate do not include benefits to youth in the programs (e.g., increased profits and more natural life course).

To see the Table indulge click here and scroll down RESEARCH CONCERNS Additional research is needed to determine whether cluster therapeutic foster care is effective and to evaluate further the effectiveness of program-intensive therapeutic foster care. A research agenda and a full review of the evidence will be published in a adjunct to the American Journal of Preventive Medicine.

USE OF THE RECOMMENDATION IN STATES AND COMMUNITIES Because of the substantial burden of violence among adolescents in the United States and the swill out of this problem from public health and societal perspective, the strength of individuality of the effectiveness of subsidiary prevention programs (e.g., therapeutic foster care) in reducing associated forms of violence is unfavourable. The finding that program-intensive foster care is effective in reducing violence in the juvenile population should affect and useful in oodles locale. The passport of insufficient evidence to determine the effect of these programs among children with SED might uplift additional evaluations of similar interventions for this horrible population.

The population of chronic delinquent toward whom therapeutic foster care might be targeted is substantial. In 1999, the most recent year for which data are available, 104,237 juveniles were committed to residential placement for delinquency in the United States, including 38,005 (36.5%) youths who were committed for violent offenses (4). Of the total number of juveniles committed, approximately 25,800 (36%) were held in services that were not locked but only "staff secure" (5). Because therapeutic foster care is designed for juveniles brainchild to be adequately not dangerous for treatment within communities, a substantial number of juveniles in residential placement might be eligible for such interventions as therapeutic foster care.

This review assessed only studies of therapeutic foster care that evaluated and assessed intervention effects on violent outcomes. These studies, however, also reported other possible money-making or harmful effects of therapeutic foster care.

Although systematic analysis of other outcomes is over and done the extent of this review, the outcomes are noted. In the randomized research of therapeutic foster care for chronic masculine offenders, self-reported rates of nonspecific delinquency and "index" offenses (a Federal Bureau of Investigation tagging including serious chattels offenses above and beyond as violent interpersonal offenses) were degrade among therapeutic foster care participants than among those in control groups. General delinquency was lower by 55.7%, and index offenses were lower by 62.8% (21).

Youths in therapeutic foster care programs were skilful guilty family behavior and trained to improve school camaraderie, family with teacher and peers, and homework ceremony; measured findings on these outcomes are not reported. On average, foster care participants also spent almost twice over as many days sentient at home after the program as group-care participants.

If unvarying, improvements associated with therapeutic foster care probably would have substantial benefits in the curriculum of a participant's life.

Certain studies reviewed indicated a potentially glum effect of therapeutic foster care among females. One study reviewed found that rates of problem behaviors reported by foster parents increased among womanly participants during the first 6 months of therapeutic foster care (20). Although females had reduced rates of violence after the program, an pilot increase in behavior problems might result in their the boot or deportation from foster homes because of an seeming denial of growth (20).

Communities can use the Task Force recommendation opinionated program-intensive therapeutic foster care for prevention of violence among adolescents with a history of chronic delinquency to support, increase, and improve existing programs and to initiate topical ones. In selecting and implement interventions, communities should guardedly assess the need for such programs (e.g., the burden of violence committed by chronically delinquent adolescents).

For local objectives to be realize, recommendations provided in the Community Guide and other evidence should be used in the context of local information (e.g., resource availability; administrative support; and the economic and social environment of communities, neighborhoods, and health-care systems). Program theory test and design should muse the range of option relevant to the specific communities.

This review and the accompanying recommendation from the Task Force on Community Preventive Services can be used by public health policymakers, program planners and implementers, and researchers. It might help to in safe paw interest, possessions, and commitment for implementing these interventions and provide direction and scientific questions for additional empirical research to improve the effectiveness and usefulness of these programs.

To see the Table please click here and scroll down ADDITIONAL INFORMATION ABOUT THE COMMUNITY GUIDE Community Guide reviews are all solidify and released as each is completed. Previously published reviews and recommendations shield findings from systematic reviews of vaccine-preventable disease, tobacco use prevention and reduction, motor-vehicle inhabitant injury, physical stir, diabetes, oral health, the effect of the social environment on health, violence prevention (firearms laws and home visitation), skin lowness cancer, and informed result making in cancer screening. A collected works of systematic reviews will be published in book form. Additional information regarding the Task Force and the Community Guide, in cooperation with a list of published articles, is available at REFERENCES 1 Hudson J, Nutter RW, Galaway B. Treatment foster family care: development and customary status. Community Alternatives: International Journal of Family Care 1994;6:1--24.

2 Meadowcroft P. Treating emotionally impatient children and adolescents in foster homes. Child Youth Serv 1989;12:23--43.

3 Bureau of Justice Statistics. Criminal victimization in the United States---statistical table index. US Department of Justice, Bureau of Justice Statistics, 2002. Available at /bjs/abstract/cvus/age456.htm.

4 Pastore AL, Maguire K, eds. Sourcebook of criminal justice statistics 2001. Washington, DC: US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, 2002.

5 Snyder HN, Sickmund M. Juvenile offenders and victims: 1999 national report. Washington, DC: US Department of Justice, Office of Juvenile Justice and Delinquency Prevention, 1999.

6 US Department of Justice, Office of Juvenile Justice and Delinquency Prevention. Serious and violent juvenile offenders. Washington, DC: US Department of Justice, Office of Juvenile Justice and Delinquency Prevention, 1998.

7 Huizinga D, Loeber R, Thornberry TP, Cothern L. Co-occurence of delinquency and other problem behaviors. Washington, DC: US Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention, 2000; NCJ 182211.

8 Hart TC, Rennison C. Reporting crime to the police, 1992--2000. Washington, DC: US Department of Justice, Office of Justice Programs, 2003; NCJ 195710.

9 Dunford FW, Elliott DS. Identifying art offenders using self-reported data. J Res Crime Delinq 1984;21:57--86.

10 Snyder HN. Juvenile arrests 2001. Washington, DC: US Department of Justice, Office of Justice Programs, 2003; NCJ 201370.

11 Chamberlain P. Treatment foster care. Washington, DC: US Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention, Juvenile Justice Bulletin, December 1998.

12 CDC. First reports evaluating the effectiveness of strategies for preventing violence: early immaturity home visitation and firearm laws. Findings from the Task Force on Community Preventive Services. MMWR 2003;52(RR-14):1--20.

13 Briss PA, Zaza S, Pappaioanou M, et al. Developing an evidence-based Guide to Community Preventive Services---methods. Am J Prev Med 2000;18(Suppl 1):35--43.

14 Carande-Kulis VG, Maciosek MV, Briss PA, et al. Methods for systematic reviews of economic evaluations for the Guide to Community Preventive Services. Am J Prev Med 2000;18(Suppl 1):75--91.

15 US Department of Health and Human Services. Healthy People 2010. 2nd ed. With command and on an upward arch health and objectives for improving health (2 vols.). Washington, DC: US Department of Health and Human Services, 2000.

16 American Psychiatric Association. Diagnostic and statistical handout of mental disorders (DSM-IV). Washington, DC: American Psychiatric Association, 1994.

17 Hann DM, Borek N, eds. Taking cattle of venture factors for child/youth externalizing behavior problems. Bethesda, MD: US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Mental Health, 2001.

18 Zaza S, Wright-de Agero L, Briss PA, et al. Data omnibus instrument and habit for systematic reviews in the Guide to Community Preventive Services. Am J Prev Med 2000;18(Suppl 1):44--74.

19 Chamberlain P. Comparative evaluation of specialized foster care for seriously delinquent youth: a first rung. Community Alternatives: International Journal of Family Care 1990;2:21--36.

20 Chamberlain P, Reid JB. Differences in risk factors and adjustment for male and female delinquents in treatment foster care. J Child Fam Stud 1994;3:23--39.

21 Chamberlain P, Reid JB. Comparison of two community alternatives to incarceration for chronic juvenile offenders. J Consult Clin Psychol 1998;66:624--33.

22 Evans ME, Armstrong MI, Kuppinger AD, Huz S, McNulty TL. Preliminary outcomes of an provisional study compare treatment foster care and family-centered intensive case management. In: Epstein MH, Kutash K, Duchnowski A, eds. Outcomes for children and youth with emotional and behavioral disorders and their families: programs and evaluation most select practice. Austin, TX: Pro-Ed, Inc.,1998:543--80.

23 Rubinstein JS, Armentrout JA, Levin S, Herald D. The Parent-Therapist Program: alternate care for emotionally disturbed children. Amer J Orthopsychiatry 1978;48:654--62.

24 Quay H, Peterson D. Manual for the Behavior Problem Checklist. Champaign, IL: University of Illinois, Children's Research Center, 1975.

25 Achenbach TM, Edelbrock C. Manual for the child behavior checklist and revise child behavior profile. Burlington, VT: University of Vermont, Department of Psychiatry, 1983.

26 Chamberlain P, Reid JB. Using a specialized foster care community treatment classic for children and adolescents leaving the state mental hospital. J Community Psychol 1991;19:266--76.

27 Chamberlain P, Moreland S, Reid K. Enhanced services and stipends for foster parents: effects on retention rates and outcomes for children. Child Welfare 1992;71:387--401.

28 Eddy JM, Chamberlain P. Family management and deviant peer group as disinterested party of the impact of treatment coincidence on youth antisocial behavior. J Consult Clin Psychol 2000;68:857--63.

29 Chamberlain P, Mihalic SF. Blueprints for violence prevention: multidimensional treatment foster care. Boulder, CO: University of Colorado at Boulder, Center for the Study and Prevention of Violence, 1998.

30 Moore KJ, Osgood DW, Larzelere RE, Chamberlain P. Use of pooled time series in the study of intrinsically occurring clinical business and problem behavior in a foster care setting. J Consult Clin Psychol 1994;62: 718--28.

31 Aos S, Phipps P, Barnoski R, Lieb R. The comparative costs and benefits of programs to reduce crime. Olympia, WA: Washington State Institute for Public Policy, 2001.

To see the Table please click here and scroll down * Points of view are those of the contributor and do not necessarily parallel those of the National Institutes of Health.

Points of view are those of the contributor and do not necessarily reflect those of the National Institute of Justice or the Department of Justice.

Laurie M. Anderson, Ph.D., Division of Prevention Research and Analytic Methods, Epidemiology Program Office, CDC, Olympia, Washington; Carl Bell, M.D., Community Mental Health Council, Chicago, Illinois; Red Crowley, Men Stopping Violence, Atlanta, Georgia; Sujata Desai, Ph.D., Division of Violence Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, Georgia; Deborah French, Colorado Department of Public Health and Environment, Denver, Colorado; Darnell F. Hawkins, Ph.D., J.D., University of Illinois at Chicago, Chicago, Illinois; Danielle LaRaque, M.D., Harlem Hospital Center, New York, New York; Colin Loftin, Ph.D., State University of New York, Albany, New York; Barbara Maciak, Ph.D., M.P.H., Division of Prevention Research and Analytic Methods, Epidemiology Program Office, CDC, Detroit, Michigan; James Mercy, Ph.D., Division of Violence Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, Georgia; John Reid, Ph.D., Oregon Social Learning Center, Eugene, Oregon; Suzanne Salzinger, Ph.D., New York State Psychiatric Institute, New York, New York; Patricia Smith, Michigan Department of Community Health, Lansing, Michigan.

As defined by the World Bank, these include Andorra, Australia, Austria, Belgium, Bermuda, Canada, Channel Islands, Denmark, Faeroe Islands, Finland, France, Germany, Gibraltar, Greece, Greenland, Holy See, Iceland, Ireland, Isle of Man, Italy, Japan, Liechtenstein, Luxembourg, Monaco, The Netherlands, New Zealand, Norway, Portugal, San Marino, Spain, St. Pierre and Miquelon, Sweden, Switzerland, the United Kingdom, and the United States.

** These databases can be access as track: Medline, /entrez/query.fcgi; Embase, (requires identification/password account); Applied Social Sciences Index and Abstracts, (requires identification/password account); National Technical Information Service (NTIS), /products/types/databases.asp?loc4-4-3; PsychLit (now called PsycInfo), /psycinfo; Sociological Abstracts, /csa/factsheets/socioabs.shtml; National Criminal Justice Reference Service (NCJRS), /content/AbstractsDB_Search.asp; and Cinahl, /wpages/login.htm (requires identification/password account).

Relative percentage changes were calculated as follows: -- for studies with before-and-after measurements and concurrent comparison groups, effect size (Ipost / Ipre / Cpost / Cpre) -- 1 -- for studies with postmeasurements only and concurrent comparison groups, effect size (Ipost -- Cpost) / Cpost -- for studies with before-and-after measurements but no concurrent comparison, effect size (Ipost -- Ipre) / Ipre, where on earth, --- Ipost cessation reported outcome rate in the intervention group after the intervention; --- Ipre reported outcome rate in the intervention group before the intervention; --- Cpost last reported outcome rate in the comparison group after the intervention; and --- Cpre reported outcome rate in the comparison group before the intervention; and -- for studies in which outcomes were reported in extent measures (as in behavior examine lists) and information on standard peculiarity (s) was available, effect size (Ipost -- Cpost) /sC, where sC is the standard deviation of the control population.

To see the Table please click here and scroll down Task Force on Community Preventive Services* Chair: Jonathan E. Fielding, M.D., Los Angeles Department of Health Services, Los Angeles, California Members: Noreen Morrison Clark, Ph.D., University of Michigan School of Public Health, Ann Arbor, Michigan; John Clymer, Partnership for Prevention, Washington, D.C.; Alan R. Hinman, M.D., Task Force for Child Survival and Development, Atlanta, Georgia; Robert L. Johnson, M.D., New Jersey Medical School, Department of Pediatrics, Newark, New Jersey; Garland H. Land, M.P.H., Center for Health Information Management and Epidemiology, Missouri Department of Health, Jefferson City, Missouri; Patricia A. Nolan, M.D., Rhode Island Department of Health, Providence, Rhode Island; Dennis E. Richling, M.D., Union Pacific Railroad, Omaha, Nebraska; Barbara K. Rimer, Dr.P.H.; School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Steven M. Teutsch, M.D., Merck & Company, Inc., West Point, Pennsylvania Consultants: Robert S. Lawrence, M.D., Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; J. Michael McGinnis, M.D., Robert Wood Johnson Foundation, Princeton, New Jersey; Lloyd F. Novick, M.D., Onondaga County Department of Health, Syracuse, New York.

* Patricia A. Buffler, Ph.D., University of California, Berkeley; Ross Brownson, Ph.D., St. Louis University School of Public Health, St. Louis, Missouri; Mary Jane England, M.D., Regis College, Weston, Massachusetts; Caswell A. Evans, Jr., D.D.S., National Oral Health Initiative, Office of the U.S. Surgeon General, Rockville, Maryland; David W. Fleming, M.D., CDC, Atlanta, Georgia; Mindy Thompson Fullilove, M.D., New York State Psychiatric Institute and Columbia University, New York, New York; Fernando A. Guerra, M.D., San Antonio Metropolitan Health District, San Antonio, Texas; George J. Isham, M.D., HealthPartners, Minneapolis, Minnesota; Charles S. Mahan, M.D., College of Public Health, University of South Florida, Tampa, Florida; Patricia Dolan Mullen, Dr.P.H., University of Texas--Houston School of Public Health, Houston, Texas; Susan C. Scrimshaw, Ph.D., University of Illinois School of Public Health, Chicago, Illinois; and Robert S. Thompson, M.D., Department of Preventive Care, Group Health Cooperative of Puget Sound, Seattle, Washington also served on the Task Force while the recommendations were being developed.

To see the Table please click here and scroll down Prepared by Robert A. Hahn, Ph.D.1 Jessica Lowy, M.P.H.1 Oleg Bilukha, M.D., Ph.D.1 Susan Snyder, Ph.D.1 Peter Briss, M.D.1 Alex Crosby, M.D.2 Mindy T. Fullilove, M.D.3,4 Farris Tuma, Sc.D.5* Eve K. Moscicki, Sc.D.5* Akiva Liberman, Ph.D.6 Amanda Schofield, M.P.H.1 Phaedra S. Corso, Ph.D.1 1Division of Prevention Research and Analytic Methods, Epidemiology Program Office, CDC 2Division of Violence Prevention, National Center for Injury Prevention and Control, CDC 3New York State Psychiatric Institute, Columbia University, New York, New York 4Task Force on Community Preventive Services 5National Institute of Mental Health, Bethesda, Maryland 6National Institute of Justice, U.S. Department of Justice, Washington, DC The textile in this report was prepared by the Epidemiology Program Office, Stephen B. Thacker, M.D., Director; Division of Prevention Research and Analytic Methods, Anne Haddix, Ph.D., Acting Director.

To see the Table please click here and scroll down

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