Gene therapy: what is it and what is its use?

Gene therapy has developed as a method of approach to the treatment of human diseases based on the transfer of genetic material to the cells of an individual. Normally, the aim of this transfer of genetic material is to re-establish a cellular function that has been abolished or is defective, to introduce a new function or to interfere with an existing function. Thus, the different gene therapy strategies are based on the combination of three key elements: the genetic material to be transferred, the method of transfer and the cellular type that will incorporate this genetic material. Attention was initially centred on the treatment of monogenic hereditary diseases, but subsequently the majority of clinical trials (over four hundred) have concerned the treatment of cancer. In China a genetic product has been approved for commercialisation: an adenovirus that transfers the correct version of the tumour suppressor gene p53. And, in the late 1990s, a group of children with severe combined immunodeficiency were successfully treated through the ex vivo transfer of the correct version of the altered gene to their bone marrow, although some of these children later developed lymphoproliferative syndromes due to the activation of an oncogen in the corrected cells. Human gene therapy is feasible and can be useful, but the tools need improving for it to become part of the therapeutic arsenal.     

Rural sports and recreational injuries in Australia: what do we know?

Objective: It is widely recognised that individuals residing in regional or rural areas have poorer health outcomes than those from metropolitan areas. Factors associated with these poorer health outcomes include geographical isolation, population declines, limited health care provision and higher levels of inactivity compared to urban areas. The mental, social and physical health of individuals and communities in rural areas can be improved through active participation in sport and recreation activities. Unfortunately, participation in such activities can potentially lead to injury. There is a suggestion that there is an increased risk of sports injuries in rural areas due to the lack of health professionals and coaching personnel, fewer available volunteers to organise and deliver sport, and the general attitude towards injuries in rural settings. Results: There is very limited information about the number and types of injuries sustained during participation in sports activities in rural and regional settings. This is largely related to a lack of formal sporting structures and support mechanisms including research funding and trained personnel. Conclusion: A range of factors need to be implemented to improve safety for sporting and recreational participants in these areas. These include improved monitoring of injury occurrence, stronger promotion of safety initiatives and wider implementation of education strategies. What is already known: It has been speculated that there is an increased risk of injury during sport in rural areas, compared to metropolitan centres. However, there is very little information about the actual levels of sports injury risk in rural communities. What this study adds: This review of formal and informal sources has identified significant gaps in our knowledge about sports injuries in rural Australia. It is likely that this lack of information, and the injury risk, is related to a lack of formal sporting structures and support mechanisms in these areas.     

Alcohol-related policy measures in Ontario: who supports what and to what degree?

Using 1998 provincial survey data (n = 1,205), the authors examine responses to 7 items concerning public opinion on alcohol-related policy in Ontario. The purpose of the study is to get a sense of overall public opinion on certain topical policy-related measures and to see whether this opinion is predicted by demographic characteristics of respondents (sex, age and self-reported drinking pattern). Cross-tabulations of opinion items with demographic variables revealed strong majority support for the status quo with regard to number of liquor and beer stores, beer and liquor store hours, and prohibition of the sale of alcohol in corner stores. A somewhat less robust majority also supported the status quo for alcohol taxes and legal drinking age. Among the demographic groups, high-risk heavy drinkers stood out for their greater support of relaxation of controls and this finding was confirmed by means of logistic regression. The majority of all groups, except frequent bar-goers, liked the idea of warning labels on alcoholic beverage containers. The authors conclude that, according to these survey data, policy initiatives towards greater access to alcohol, such as extended liquor store hours and sale of alcohol in corner stores, are not mandated by the majority of the population of Ontario.     

Twins in metabolic and diabetes research: what do they tell us?

PURPOSE OF REVIEW: The purpose of this review is to provide a critical update of the impact of the 'thrifty phenotype hypothesis' on metabolism, and its implications for heritability estimates as obtained in so-called classical twin studies. RECENT FINDINGS: Our recent studies demonstrated a complex age or time-dependent relationship between different and independent markers of an adverse intrauterine environment, including birth weight, twin and zygosity status on one side, and distinct defects of insulin secretion and glucose metabolism on the other side. SUMMARY: These novel findings may, to some unknown extent, influence and perhaps bias the heritability estimates of type 2 diabetes-related traits obtained using classical twin analyses. The studies add to the increasing evidence of the intrauterine environment as a - or the - key player in the cause and pathophysiology of type 2 diabetes and the metabolic syndrome. We and others have shown that monozygotic twins represent a powerful tool to demonstrate nongenetic associations between low birth weight and different phenotypes of the metabolic syndrome, including type 2 diabetes, insulin resistance and, recently, hypertension. Future studies of discordant monozygotic twins may provide novel and crucial mechanistic explanations of the link between low birth weight and the metabolic syndrome.     

Medicare beneficiary counseling programs: what are they and do they work?

Medicare beneficiaries face myriad rules, conditions, and exceptions under the Medicare program. As a result, State Information, Counseling, and Assistance (ICA) programs were established or enhanced with Federal funding as part of the Omnibus Budget Reconciliation Act (OBRA) of 1990. ICA programs utilize a volunteer-based and locally-sponsored support system to deliver free and unbiased counseling on the Medicare program and related health insurance issues. This article discusses the effectiveness of the ICA model. Because the ICA programs serve as a vital link between HCFA and its beneficiaries, information about the programs' success may be useful to HCFA and other policymakers during this era of consumer information.     

Control of low-level radiation exposure: what is the problem and how can it be solved?

The carcinogenic risks of exposure to low-level ionizing radiation used by ICRP have been challenged as being, at the same time, both too high and too low. This paper explains that the epidemiological evidence will always be limited at low doses, so that understanding the cellular mechanisms of carcinogenesis is increasingly important to assess the biological risks. An analysis is then given of the reasons why the challenges to ICRP, especially about the linear nonthreshold response model, have arisen. As a result of considering the issues, the Main Commission of ICRP is now consulting on a revised, simpler approach based on an individual oriented philosophy. This represents a potential shift by the Commission from the past emphasis on societal-oriented criteria. These proposals have been promulgated through IRPA, and an open literature publication was published in the Journal of Radiological Protection in June 1999. On the basis of comments received and the observations presented at the IRPA 10 Conference, the Commission will begin to develop the outline of the next recommendations. It is now more than 10 y since ICRP distributed, for comment, a draft of what was to become the publication of the 1990 recommendations. The Commission plans to develop its new recommendations on a time scale of the next 4 or 5 y. In this paper, many of the issues that will need to be addressed in the development of the recommendations will be identified. These issues will cover biological effects, dosimetric quantities, and the establishment of those levels of dose at which different protection requirements will be put into place. Concepts of exclusion and exemption will need to be clarified as well as the meaning of how to achieve what the proposal identifies as "as low as reasonably practicable." Finally, the Commission has decided to develop an environmental radiation protection philosophy that will need to be developed as part of the new recommendations.     

Legal risk-management programs in nursing homes: who has them and do they work?

Legal risk-management systems are designed to identify, prevent, or mitigate the negative effects of situations that potentially expose a health care facility and its staff to avoidable legal and financial liability. This article reports findings on the current status of risk-management systems in nursing homes. The relative costs and benefits of such programs are also discussed.     

Young people who attend specialist alcohol treatment: who are they and do they need special treatment?

OBJECTIVE: Patterns of drinking in adolescence and young adulthood may have major short term impacts and influences on later drinking, yet little is known about the characteristics of young people who seek help for alcohol problems. Here we examine the characteristics of treatment episodes for adolescents and young adults who present to specialist alcohol treatment in New South Wales (NSW). METHODS: The NSW Minimum Data Set for Alcohol and Other Drug Treatment Services was examined for all alcohol-related treatment episodes (N=21,012) reported between July 2004 and June 2005. We compared treatment episodes for adolescents aged 12-19 years, young adults aged 20-29 years and clients aged 30 years or more for their demographics, drug use and service delivery characteristics. RESULTS: Clients aged under 30 years were significantly more likely to be referred into specialist treatment by a police, court or criminal justice diversion program compared with older clients (adolescent: OR=3.7, 95%CI: 3.1-4.4; young adult: OR=2.2, 95%CI: 1.9-2.4). Concern about cannabis use was significantly higher among younger clients (adolescents: OR=2.8 95%CI: 2.3-3.3; young adults: OR=2.1, 95%CI: 2.0-2.4) than those aged 30 years or more. Younger clients were also more likely to be of Indigenous origin or seen in a rural setting. CONCLUSIONS: Adolescent and young adult alcohol treatment clients include a higher proportion of clients who are Indigenous, legally coerced, and who have concerns with polydrug use. Service providers should seek to tailor their treatment programs to better meet these unique needs and to better attract young people into voluntary treatment.     

Defaulters in general practice: who are they and what can be done about them?

BACKGROUND: The study of patients in primary care settings who default on their appointment has been based largely on short-term surveys in individual health centres. OBJECTIVE: As part of a wider research project into the potential of practice computer appointment systems as a data source, we wanted to explore the aggregate pattern of default. METHOD: Comprehensive computer appointment data from nine general practices for 1 or 2 years were analysed to explore the pattern of defaulted appointments for doctors and practice nurses. RESULTS: Around 6.5% of all appointments ended in a default. Default rates were found to be highest amongst young adults and, at a practice level, to be highly correlated with deprivation level. About two-thirds of those who defaulted only did it once during the year. A small core of patients defaulted frequently, but only a quarter of these repeated their behaviour in the following year. CONCLUSIONS: The discussion suggests that strategies based on educating or punishing defaulters in order to change their behaviour may be of limited effectiveness.     

International differences in major depression prevalence: what do they mean?

The international literature concerned with major depression prevalence has been growing rapidly, providing a wealth of new information about prevalence in different countries. In understanding and using these rates, analytically oriented epidemiologists, decision makers, and administrators, however, need to be aware of a set of interpretive difficulties. Experience suggests that international major depression prevalence comparisons should be treated with caution. The portability of major depression diagnostic criteria across countries requires further confirmation, and existing diagnostic interviews have technical vulnerabilities that may render international comparisons vulnerable to measurement bias.