J Med Genet 1993;30: linkage of schizophrenia to markers on chromosome 13q14 purchase 5mg proscar mastercard prostate volume formula. Comparison of statistics for candidate 1998;20:70–73 cheap 5mg proscar visa androgen binding hormone. Linkage of Genet 1994;55:402–409 familial schizophrenia to chromosome 13q32. The relative power of family-based and case- 1999;65:1096–1103. Genome Res 1998;8: of a locus on chromosome 5q31 contributing to susceptibility 1273–1288 for schizophrenia in German and Israeli families by multipoint 114. Positive association be- affected sib-pair linkage analysis. Mol Psychiatry 1997;2: tween a DNA sequence variant in the serotonin 2A receptor 156–160, gene and schizophrenia. Association between schizophrenia vulnerability locus in region 5q22-31 in Irish schizophrenia and T102C polymorphism of the 5-hydroxytryp- families. A family-based associa- some 18p locus conferring susceptibility to functional psychoses tion study of T102C polymorphism in 5-HT2Aand schizophre- in families with schizophrenia, by association and linkage analy- nia plus identification of new polymorphisms in the promoter. Results of the NIMH association between the 5-HT2a receptor T102C polymor- Genetics Initiative and Millennium Consortium. Mol Brain Res 1998;59:90–92 may be located in region 10p15-p11. A meta-analysis and confirmation in an independent series of pedigrees. Genomics transmission disequilibrium study of association between the 1997;43:1–8. The molecular genetics of schizo- major susceptibility locus for familial schizophrenia on chromo- phrenia. Am bipolar disorder are associated with expanded CAG/CTG re- J Med Genet 1992;44:261–268. CAG repeat expan- involving cleft palate, cardiac anomalies, typical facies and learn- sions and schizophrenia—association with disease in females ing disabilities: velo-cardio-facial syndrome. Bipolar spectrum disorders association between expanded CAG/CTG repeats and both in patients diagnosed with velo-cardio-facial syndrome: does a schizophrenia and bipolar disorder. Psychol Med 1996;26: hemizygous deletion of chromosome 22q11 result in bipolar 1145–1153. Late-onset wide CAG/CTG repeats, and at SEF2-1B and ERDA1 in schizo- psychosis in the velo-cardio-facial syndrome. Am J Med Genet phrenia and bipolar affective disorder. Anticipation in schizo- in adults with velo-cardio-facial syndrome. Arch Gen Psychiatry phrenia: no evidence of expanded CAG/CTG repeat sequences 1999;56:940–945. Velo-cardio-facial syn- novel potassium channel gene hSKCa3 containing a polymor- drome associated with chromosome 22 deletions encompassing phic CAG repeat: a candidate for schizophrenia and bipolar the DiGeorge locus. Schizophrenia tissues and localization to chromosome 1q21. Mol Psychiatry susceptibility associated with interstitial deletions of chromo- 1999;4:254–260. Velocardiofacial manifes- association between a polymorphic CAG repeat in the hKCa3 tations and microdeletions in schizophrenic patients. Am J Med Genet 1998; equilibrium test in 193 offspring parents trios. Transmission disequilibrium of potential linkage on chromosome 22q12-q13. Am analysis of a triplet repeat within the hKCa3 gene using family J Med Genet 1994;54:36–43. A genome wide search for repeat polymorphism to schizophrenia. Mol Psychiatry 1999;4: 261–266 schizophrenia susceptibility genes.

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Selecting demonstration sites on criteria of motivation and capacity Suggestion: The spread of an intervention depends on how initial demonstration sites are seen by others buy cheap proscar 5 mg prostate 20 grams. So cheap proscar 5 mg otc androgen hormone katy, when selecting demonstration sites, consider which sites will have a positive influence. Advocating single interventions as the solution to a problem Suggestion: One intervention is unlikely to fit all circumstances; offering a cluster of evidence-based practices is usually more effective (105, 110). Tird, by what criteria do potential users circumstances. By and large, programmes can decide to adopt a new intervention? Ideally, the be expected to work imperfectly at frst and will decision formally to adopt will ultimately be need to be adapted and refned (105). To help answer these four questions for a And fourth, once the decision to adopt variety of interventions in diferent settings, an has been taken, how should an intervention be assortment of networks, tools and instruments implemented and evaluated? In practice, there is available, including EvipNet, SURE, TRAction is a tension between preserving the interven- and SUPPORT (Box 4. In the context of health tion in its original form and adapting it to local systems performance, the methods for judging 114 Chapter 4 Building research systems for universal health coverage Box 4. Translating research into policy and practice There is an important distinction between evidence used to set policy and evidence used to influence practice. The first two examples below focus on policy, the third on practice. Evidence-Informed Policy Networks (EVIPNet) The purpose of EVIPNet (www. EVIPNet is a network of teams in more than 20 countries around the world, which synthesize research findings, produce policy briefs, and organize policy forums that bring together policy-makers, researchers and citizen groups. Recent initiatives have, for example, helped to improve access to ACT for the treatment of malaria in Africa and debated the role of primary health care in the management of chronic noncommunicable diseases in the Americas (112). As a component of EVIPnet, SURE (Support for the Use of Research Evidence) offers a set of guides for preparing and using policy briefs to support health systems development in Africa. SUPPORT tools for evidence-informed health policy-making SUPPORT is a collection of articles that describe how to use scientific evidence to inform health policy (113). The series shows, among other things, how to make best use of systematic reviews and how in general to use research evidence to clarify problems linked to health policy. The Translating Research into Action (TRAction) project Recognizing that many health problems in developing countries already have solutions that have not been applied, TRAction (www. TRAction is part of the Health Research Program (HaRP) of the United States Agency for International Development (USAID). However, new tools are needed ment located within a health ministry should to help assess evidence from systematic reviews be well positioned to transfer research fndings in terms of the acceptability of policy options to policy-makers and to help oversee national to stakeholders and the feasibility of implemen- research practice – for instance by setting up tation, and in terms of equity. Research is also national databases of research projects approved needed on ways to develop, structure and pre- and completed, of scientifc publications pro- sent policy options in relation to the functions duced, and of patents awarded. When researchers are put in close contact Researchers and decision-makers typi- with policy-makers they will be in a position not cally work in diferent communities, and the simply to produce results on demand but also to research described in technical publications shape the research agenda (117). For instance, and scientifc journals cannot easily be evalu- routine evaluation of public health programmes ated by most of the people who make most of is an important source of questions for research, the decisions (see Box 2. Te infuence of research depends on how One weakness of existing schemes for promot- research activities are positioned with respect ing universal health coverage is that they fail to to the bodies that are responsible for setting involve evaluators from the start (119). For maximum efect, health scientists placed in public health programmes research should be embedded as a core function would stimulate monitoring and evaluation. Tese registration of clinical trials; are closely related and have repeatedly been ■ in collaboration with other organizations proposed as ways of promoting and support- that currently gather data on science and ing high-priority research (120–122). UNESCO, recently, the report of the Consultative Expert OECD, the Network for Science and Working Group on Research and Development: Technology Indicators – Ibero-American Financing and Coordination (CEWG) made a and Inter-American, the World Intellectual series of recommendations to support R&D for Property Organization), bring together health technology, and the Alliance on Health information on research publications, Policy and Systems Research did the same for clinical trials and patents, as envisaged in HPSR (Box 4. Many of the the Global Strategy and Plan of Action on ideas for promoting R&D and HPSR apply to Public Health, Innovation and Intellectual all aspects of health research, so these are drawn Property (Box 2. WHO Strategy on Health Policy and Systems Research The WHO Strategy on Health Policy and Systems Research (HPSR), launched in November 2012, was shaped by the Alliance on Health Policy and Systems Research. The strategy explains how the evolving field of health policy and systems research (Box 2. As the first- ever global strategy in this area, it represents a milestone in the evolution of HPSR. First, it seeks to unify the worlds of research and decision-making and connect the various research disciplines that generate knowledge on health systems.

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BED; therefore purchase 5 mg proscar with mastercard prostate cancer treatment radiation, effective treatments for this disorder may 12 order proscar 5 mg with amex prostate cancer icd 9 code. Personality variables and disorders in an- orexia nervosa and bulimia nervosa. J Abnorm Psychol 1994; be of widespread clinical utility. Am J Psychia- ber of important issues are unresolved. BED have disturbances in eating behavior by definition, 14. Ten-year follow-up of 50 patients with bu- and are typically overweight and exhibit symptoms of anxi- limia nervosa. Bulimia nervosa: a 5- ety and depression in clinical samples. Alterations in serotonin it is surprising that the response of these presumably related activity and psychiatric symptomatology after recovery from bu- symptoms to medication is at least somewhat inconsistent, limia nervosa. Outcome, recovery, relapse and mor- tality across six years in patients with clinical eating disorders. A major problem in the develop- Psychiatr Scand 1993;87(6):437–444. L-Dopa as treatment for anorexia ner- response of binge eating to nonspecific interventions, in- vosa. In part for this reason, the effects of medi- Press, 1977:363–372. Treatment of compulsive eating disturbances once medication has been discontinued. Am J Psychol 1974;131: the role of pharmacotherapy for BED currently unresolved, 428–432. The use of diphenylhydantoin in compulsive studies to examine the potential benefits of combining med- eating disorders: further studies in anorexia nervosa. New York: Raven Press, 1977: ication with psychological treatment, especially CBT. Naloxone in the treatment of REFERENCES anorexia nervosa: effect on weight gain and lipolysis. In: Kaplan HI, Freedman AM, noses in anorexia nervosa. Comprehensive textbook of psychiatry, vol 2, 3rd 712–718. A comparative psychometric family therapy in anorexia nervosa and bulimia nervosa. Arch study of anorexia nervosa and obsessive neurosis. Long term follow-up of therapy in the short-term treatment of anorexia nervosa. Neuroleptics in the short-term treatment of vosa in women with obsessive compulsive disorder. Int J Eating anorexia nervosa: a double-blind, placebo controlled study with Dis 1986;5:1069–1075. J Clin Psy- activity in anorexia nervosa after long-term weight restoration. Obsessive-compulsive disorder: psychobiologi- treatment of anorexia nervosa. Int J Eating Dis 2000;27(3): cal approaches to diagnosis, treatment, and pathophysiology. Antiserotonin-antihista- 9-tetrahydrocannabinol in primary anorexia nervosa.

Although participation is widely endorsed as a core intervention objective of therapy interventions generic proscar 5mg on line prostate blood test, its suitability 5mg proscar for sale prostate cancer news 2016, or appropriateness, as an outcome measure was questioned. Other child and/or parent outcomes were identified as more or equally important. Notions of intermediate outcomes – in terms of body structure/function, and the achievement of activities – were regarded as important and not counter to participation-focused approaches. Among therapists, research on intervention effectiveness was (cautiously) welcomed. A number of methodological challenges were identified. A portfolio of study designs – quantitative and qualitative, experimental and observational – was called for, and which included economic evaluation and clear pathways to impact. Limitations: The study was not successful in recruiting children and young people. Further work is required to elucidate the views of this key stakeholder group. Conclusions: Therapy interventions are poorly understood. There was strong support, tempered a little by concerns among some about the feasibility of demonstrating impact, for investment in research. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals v provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK. ABSTRACT Future work: The identification of research priorities was a core study objective, and a wide-ranging research agenda was identified. Three areas of evaluation were identified: overall approaches to therapy, service organisation and delivery issues, and the evaluation of specific techniques. Parents regarded evaluations of approaches to therapy (e. In terms of specific techniques, there was no shared agreement regarding priorities, with views informed by personal interests and experiences. Funding: The NIHR Health Technology Assessment programme. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals vii provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals ix provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals xi provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals xiii provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals xv provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals xvii provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals xix provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK. To aid decisions about what, or whether, to fund research on this topic, the National Institute for Health Research commissioned a small scoping study.

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