Back to first principles: a new model for the regulation of drug promotion

The US Food and Drug Administration's ('FDA' or the 'Agency') current regulatory framework for drug promotion, by significantly restricting the ability of drug manufacturers to communicate important, accurate, up-to-date scientific information about their products that is truthful and non-misleading, runs afoul of the First Amendment and actually runs counter to the Agency's public health mission. Our article proposes a New Model that represents an initial proposal for a modern, sustainable regulatory framework that comprehensively addresses drug promotion while protecting the public health, protecting manufacturers' First Amendment rights, establishing clear and understandable rules, and maintaining the integrity of the FDA approval process. The New Model would create three categories of manufacturer communications-(1) Scientific Exchange and Other Exempt Communications, (2) Non-Core Communications, and (3) Core Communications-that would be regulated consistent with the First Amendment and according to the strength of the government's interest in regulating the specific communications included within each category. The New Model should address the FDA's concerns related to off-label speech while protecting drug manufacturers' freedom to engage in truthful and non-misleading communications about their products.

An Exemplary Case of Promotion Activities and Taste Panels from the Perspective of Tobacco Control

The Framework Convention on Tobacco Control is a multilateral international agreement which has been generated to protect the health of nationals and nations against the hazards/risks of tobacco and its products. All high contracting parties to the Convention undertake the international responsibility to fulfill all the requirements of the Convention's articles in national legal systems. The Framework Convention on Tobacco Control has a considerable place among other international conventions on health. Within the self-executing desing/system of the Convention, a vital regulation focuses on banning the advertisement, promotion, and sponsorship of tobacco products. Because they are one of the various components of tobacco advertisement, promotion, and sponsorship, taste panels should be assessed within the content of the Convention. Thus, banning taste panel activities is an important step in tobacco control and it is one of the basic areas where medical and law sciences should collaborate. In this article, a comprehensive frame has been drawn to the issue and recommendations have been developed for the future.

Selective electrocatalytic oxidation of sorbitol to fructose and sorbose

A new electrocatalytic method for the selective electrochemical oxidation of sorbitol to fructose and sorbose is demonstrated by using a platinum electrode promoted by p-block metal atoms. By the studying a range of C4, C5 and C6 polyols, it is found that the promoter interferes with the stereochemistry of the polyol and thereby modifies its reactivity.

Attitude and awareness towards organ donation in western India

BACKGROUND

To determine the knowledge, attitudes and practices regarding organ donation in western India.

METHODS

Convenience sampling was used to generate a sample of 250; 200 interviews were successfully completed and used for analysis. Data collection was carried out via face to face interviews based on a pre-tested questionnaire in selected public areas of Ahmedabad, Gujarat state of India. Data entry was made in excel software in codes and analysis was done by SPSS software.

RESULTS

About 86% of participants were aware of the term organ donation but knowledge about its various aspects was low. About 48% aware people heard about organ donation through medical fraternity, whereas only about 21% became aware through mass media. About 59% of aware people believed there is a potential danger of donated organs being misused, abused or misappropriated. About 47% of aware people said they would consider donating organs, while only 16% said they would definitely donate irrespective of circumstances. Around 97.67% participants said they would prefer to donate to nonsmokers. About 74.41% participants were unaware about any legislation regarding organ donation. About 77% participants showed their will to donate to mentally sound persons, and 42.04% participants showed their will to donate even physically challenged people. Around 78 participants felt that they would donate organs to persons irrespective of their religion. About 81% of aware people were of the opinion that consent for organ donation after death should be given by family members. None of the interviewed participants had a donor card.

CONCLUSION

Better knowledge and awareness will help in promoting organ donation. Effective campaign needs to be driven to educate people with relevant information with the involvement of media, doctors and religious scholars.

Menopause knowledge and attitude among Iranian women

Objective: The present study was done to assess the effects of training on knowledge and attitude level promotion of post menopause women about menopause. Methods & Material: The research communication included 100 menopausal women aged 45-60 years, who were selected in a stratified manner (according to the economic status: poor, average, and good). The tool used was an examiners-made questionnaire, which contained 3 parts: demographic characteristics, knowledge and attitude measurement. Results: Eleven percent of the studied women had a low knowledge regarding menopause and 1% was good. After training, 27% got a good knowledge and no one remained at the low level. The attitude of 59% of the studied women regarding menopause was positive and 80% got a positive attitude after training. A significant relation was found between knowledge and attitude, before and after training. Conclusion: Despite the fact that the majority of women judge menopause as a positive incident, it seems that paying attention to their training caused the bringing to their knowledge of the natural menopause and having a healthy and jolly life.

Favourite alcohol advertisements and binge drinking among adolescents: a cross-cultural cohort study

AIMS

To investigate the association between having a favourite alcohol advertisement and binge drinking among European adolescents.

DESIGN

Data were obtained from a longitudinal observational study on relationships between smoking and drinking and film tobacco and alcohol exposures.

SETTING

State-funded schools.

PARTICIPANTS

Baseline survey of 12 464 German, Italian, Polish and Scottish adolescents (mean age 13.5 years), of whom 10 259 (82%) were followed-up 12 months later.

MEASUREMENTS

Pupils were asked the brand of their favourite alcohol advertisement at baseline. Multi-level mixed-effects logistic regressions assessed relationships between having a favourite alcohol advertisement ('alcohol marketing receptivity') and (i) binge drinking at baseline; and (ii) initiating binge drinking during follow-up among a subsample of 7438 baseline never binge drinkers.

FINDINGS

Life-time binge drinking prevalence at baseline was 29.9% and 25.9% initiated binge drinking during follow-up. Almost one-third of the baseline sample (32.1%) and 22.6% of the follow-up sample of never-bingers named a branded favourite alcohol advertisement, with high between-country variation in brand named. After controlling for age, gender, family affluence, school performance, TV screen time, personality characteristics and drinking behaviour of peers, parents and siblings, alcohol marketing receptivity was related significantly to both binge drinking at baseline [adjusted odds ratio (AOR) = 2.13, 95% confidence interval (CI) = 1.92, 2.36] and binge drinking initiation in longitudinal analysis (AOR = 1.45, 95% CI = 1.26, 1.66). There was no evidence for effect heterogeneity across countries.

CONCLUSIONS

Among European adolescents naming a favourite alcohol advertisement was associated with increased likelihood of initiating binge drinking during 1-year follow-up, suggesting a relationship between alcohol marketing receptivity and adolescent binge drinking.

Truth, control, and value motivations: the "what," "how," and "why" of approach and avoidance

The hedonic principle—the desire to approach pleasure and avoid pain—is frequently presumed to be the fundamental principle upon which motivation is built. In the past few decades, researchers have enriched our understanding of how approaching pleasure and avoiding pain differ from each other. However, more recent empirical and theoretical work delineating the principles of motivation in humans and non-human animals has shown that not only can approach/avoidance motivations themselves be further distinguished into promotion approach/avoidance and prevention approach/avoidance, but that approaching pleasure and avoiding pain requires the functioning of additional distinct motivations—the motivation to establish what is real (truth) and the motivation to manage what happens (control). Considering these additional motivations in the context of moral psychology and animal welfare science suggests that these less-examined motives may themselves be fundamental to a comprehensive understanding of motivation, with major implications for the study of the “what,” “how,” and “why” of human and non-human approach and avoidance behavior.

Why are people with high self-control happier? The effect of trait self-control on happiness as mediated by regulatory focus

BACKGROUND

While self-control has often been related to positive outcomes in life such as higher academic achievements and better health, recent insights reveal that people with high trait self-control (TSC) may even experience greater life satisfaction or happiness.

OBJECTIVE

The current study further scrutinizes this potential association between TSC and happiness, and examines how regulatory focus, defined as the way people frame and direct their goal pursuit strategies, plays a role in this relationship. Accordingly, the present study examines the mediating role of regulatory-focus (promotion and prevention focus) on the relationship between TSC and happiness.

METHOD

Data was collected from 545 individuals (65.9% female, M age = 27.52 years) regarding their TSC, regulatory focus, and happiness.

RESULTS

Mediation analyses demonstrate that TSC positively predicts happiness, while this effect was partially mediated by relatively more promotion focus and less prevention focus.

CONCLUSION

RESULTS suggest that people with higher TSC are happier possibly because they are: (1) more promotion-focused on acquiring positive gains thereby facilitating more approach-oriented behaviors, and (2) less prevention-focused on avoiding losses thereby reducing avoidance-oriented behaviors. These findings are relevant for topical scientific debates regarding the underlying mechanisms of self-control regarding initiatory and inhibitory behaviors.

Are there mental health differences between francophone and non-francophone populations in manitoba?

OBJECTIVE

Francophones may experience poorer health due to social status, cultural differences in lifestyle and attitudes, and language barriers to health care. Our study sought to compare mental health indicators between Francophones and non-Francophones living in the province of Manitoba.

METHODS

Two populations were used: one from administrative datasets housed at the Manitoba Centre for Health Policy and the other from representative survey samples. The administrative datasets contained data from physician billings, hospitalizations, prescription drug use, education, and social services use, and surveys included indicators on language variables and on self-rated health.

RESULTS

Outside urban areas, Francophones had lower rates of diagnosed substance use disorder (rate ratio [RR] = 0.80; 95% CI 0.68 to 0.95) and of suicide and suicide attempts (RR = 0.59; 95% CI 0.43 to 0.79), compared with non-Francophones, but no differences were found between the groups across the province in rates of diagnosed mood disorders, anxiety disorders, dementia, or any mental disorders after adjusting for age, sex, and geographic area. When surveyed, Francophones were less likely than non-Francophones to report that their mental health was excellent, very good, or good (66.9%, compared with 74.2%).

CONCLUSIONS

The discrepancy in how Francophones view their mental health and their rates of diagnosed mental disorders may be related to health seeking behaviours in the Francophone population. Community and government agencies should try to improve the mental health of this population through mental health promotion and by addressing language and cultural barriers to health services.

Changing the academic culture: valuing patents and commercialization toward tenure and career advancement

There is national and international recognition of the importance of innovation, technology transfer, and entrepreneurship for sustained economic revival. With the decline of industrial research laboratories in the United States, research universities are being asked to play a central role in our knowledge-centered economy by the technology transfer of their discoveries, innovations, and inventions. In response to this challenge, innovation ecologies at and around universities are starting to change. However, the change has been slow and limited. The authors believe this can be attributed partially to a lack of change in incentives for the central stakeholder, the faculty member. The authors have taken the position that universities should expand their criteria to treat patents, licensing, and commercialization activity by faculty as an important consideration for merit, tenure, and career advancement, along with publishing, teaching, and service. This position is placed in a historical context with a look at the history of tenure in the United States, patents, and licensing at universities, the current status of university tenure and career advancement processes, and models for the future.

Faculty perceptions of how community-engaged research is valued in tenure, promotion, and retention decisions

PURPOSE

We assessed the perceptions of community core faculty in academic medical center institutions that received Clinical and Translational Science Awards (CTSA) about how these institutions consider community-engaged scholarship (CES) when tenure, promotion, and retention decisions are made.

METHOD

An assessment tool was adapted to create an 18-item survey that was sent during November and December 2011 via the Internet to the 369 members of the community-engagement core mailing list of the CTSA.

RESULTS

Fifty-nine responses were received which represented 37 of the possible 60 different funded institutions. The mean score was 48.14 (SD = 11.18); range of 23-74; and Cronbach's alpha was .91 About half reported that support for CES and its inclusion in the academic decision process increased since the institution was awarded a CTSA. Open-ended responses indicated some confusion with terminology although a definition of CES had been provided in the instrument instructions.

CONCLUSION

Respondents overall agreed there was moderate support for CES in tenure, promotion, and retention decisions which may have been influenced by the CTSA application requirements. This survey could be used to identify if there are differences in institutional and departments and measure changes over time.

University hospitals as drivers of career success: an empirical study of the duration of promotion and promotion success of hospital physicians

BACKGROUND

German hospitals have a well-defined career structure for clinicians. In this hierarchical career system university hospital are stepping stones for career advancement. This longitudinal study investigates the impact of working in university hospitals on the career success of junior physicians and senior physicians.

METHODS

Consideration of the career trajectories of 324 hospital physicians. Discrete-time event history analysis is used to study the influence of working in university hospitals on the chance of promotion from junior physician to senior physician and senior physician to chief physician. A comparison of medians provides information about the impact of working in university hospitals on the duration of promotion to senior and chief physician positions.

RESULTS

Working in university hospitals has a negative impact for advancement to a senior physician position in terms of promotion duration (p = 0.005) and also in terms of promotion success, where a short time span of just 1-2 years in university hospitals has a negative effect (OR = 0.38, p < 0.01), while working there for a medium or long term has no significant effect. However, working in universities has a positive effect on the duration of promotion to a chief physician position (p = 0.079), and working in university hospitals for 3-4 years increases the chance of promotion to a chief physician position (OR = 4.02, p < 0.05), while working there > =7 years decreases this chance (OR = 0.27, p < 0.05). In addition, physicians have a higher chance of promotion to a chief physician position through career mobility when they come to the position from a university hospital.

CONCLUSION

Working at university hospitals has a career-enhancing effect for a senior physician with ambitions to become a chief physician. For junior physicians on the trajectory to a senior physician position, however, university hospitals are not drivers of career success.

Systems biology perspectives on the carcinogenic potential of radiation

This review focuses on recent experimental and modeling studies that attempt to define the physiological context in which high linear energy transfer (LET) radiation increases epithelial cancer risk and the efficiency with which it does so. Radiation carcinogenesis is a two-compartment problem: ionizing radiation can alter genomic sequence as a result of damage due to targeted effects (TE) from the interaction of energy and DNA; it can also alter phenotype and multicellular interactions that contribute to cancer by poorly understood non-targeted effects (NTE). Rather than being secondary to DNA damage and mutations that can initiate cancer, radiation NTE create the critical context in which to promote cancer. Systems biology modeling using comprehensive experimental data that integrates different levels of biological organization and time-scales is a means of identifying the key processes underlying the carcinogenic potential of high-LET radiation. We hypothesize that inflammation is a key process, and thus cancer susceptibility will depend on specific genetic predisposition to the type and duration of this response. Systems genetics using novel mouse models can be used to identify such determinants of susceptibility to cancer in radiation sensitive tissues following high-LET radiation. Improved understanding of radiation carcinogenesis achieved by defining the relative contribution of NTE carcinogenic effects and identifying the genetic determinants of the high-LET cancer susceptibility will help reduce uncertainties in radiation risk assessment.

Funding sources in faculty development: strategies for success in submitting proposals

Although the capacity for integrated research and potential for translating research findings to the clinical setting have never been stronger, we are paradoxically entering a period of highly constrained funding. It is more important than ever for clinician scientists and young researchers to be strategic in the approach to funding. The purpose of this article is to discuss strategies for a successful approach to appropriate grant funding agencies.

Promotion

This article gives an overview of the promotion process in an academic medical center. A description of different promotional tracks, tenure and endowed chairs, and the process of submitting an application is provided. Finally, some practical advice about developing skills and attributes that can help with academic growth and promotion is dispensed.

Alcohol brand references in U.S. popular music, 2009-2011

This study aimed to assess the prevalence and context of alcohol brand references in popular music. Billboard Magazine year-end charts from 2009 to 2011 were used to identify the most popular songs in four genres: Urban, Pop, Country, and Rock. Of the 720 songs, 23% included an alcohol mention, and 6.4% included an alcohol brand mention. Songs classified as Urban had the highest percentage of alcohol mentions and alcohol brand mentions. The context associated with alcohol brand mentions was almost uniformly positive or neutral. Public health efforts may be necessary to reduce youth exposure to these positive messages about alcohol use.

Combined treatment with the antibiotics kanamycin and streptomycin promotes the conjugation of Escherichia coli

It is widely accepted that antibiotics provide a critical selective pressure for the horizontal transfer of antibiotic resistance between bacterial species. This study demonstrated that a combination of low doses of kanamycin and streptomycin, which inhibited the growth of recipient and donor cells, respectively, had positive effects on the transmission of the conjugation plasmids pRK2013, pSU2007, and RP4 from Escherichia coli DH5α to HB101 at their minimum inhibitory concentrations (MICs). Administration of either antibiotic alone as well as other antibiotics in combination or alone did not have this effect. Two-dimensional electrophoresis revealed that 60 proteins were downregulated and 14 proteins were upregulated in the conjugation of E. coli DH5α (pRK2013) and HB101 in the presence of kanamycin and streptomycin. Of these proteins, 64 were subsequently identified by mass spectrometry. Two antibiotic-induced genes encoding oligopeptide-binding protein (OppA) and ribose-binding protein (RbsB) were further confirmed by quantitative real-time PCR. When these genes were deleted, the number of transconjugants decreased in the same fashion as when the cells were treated with kanamycin and streptomycin. These results indicate that the process of E. coli conjugation may be promoted by combination treatment with kanamycin and streptomycin and that two proteins potentially participated in this process.

Prevention of common mental disorders: what can we learn from those who have gone before and where do we go next?

OBJECTIVE

Prevention strategies have made a major contribution to the considerable successes in reductions in cardiovascular disease and cancer mortality seen in recent decades. However, in the field of psychiatry, similar population-level initiatives in the prevention of common mental disorders, depression and anxiety, are noticeably lacking. This paper aims to provide a brief overview of the existing literature on the topic of the prevention of common mental disorders and a commentary regarding the way forward for prevention research and implementation.

METHODS

This commentary considers what we currently know, what we might learn from the successes and failures of those working in prevention of other high prevalence health conditions, and where we might go from here. Taking cognisance of previous preventive models, this commentary additionally explores new opportunities for preventive approaches to the common mental disorders.

RESULTS

The consensus from a large body of evidence supports the contention that interventions to prevent mental disorders across the lifespan can be both effective and cost-effective. However, funding for research in the area of prevention of common mental disorders is considerably lower than that for research in the areas of treatment, epidemiology and neurobiology. Thus, there is a clear imperative to direct funding towards prevention research to redress this imbalance. Future prevention interventions need to be methodologically rigorous, scalable to the population level and include economic evaluation. Evidence-based knowledge translation strategies should be developed to ensure that all stakeholders recognise preventing mental disorders as an imperative, with appropriate resources directed to this objective.

CONCLUSION

There has been a recent expansion of research into potentially modifiable risk factors for depression, and it is now timely to make a concerted effort to advance the field of prevention of common mental disorders.

The Functional Well-Being Scale: a measure of functioning loss due to well-being-related barriers

The objective of this study was to develop the Pro-Change Functional Well-Being Scale, a measure that provides an informative evaluation of general functioning loss due to well-being-related barriers. Exploratory and confirmatory analyses on data from 642 individuals supported a one-factor solution with good model fit. A strong positive correlation existed between the Pro-Change Functional Well-Being Scale and Well-Being Assessment for Productivity. Initial construct validity was demonstrated by predictable relationships between functioning loss and other measures of health and well-being. This initial psychometric evidence suggests that the Pro-Change Functional Well-Being Scale is a reliable and valid assessment of functioning loss due to common well-being-related barriers.

On ethics, the pursuit of knowledge, truth and status in the hallowed halls of academe

Advancement in academe is largely on the basis of research output; that is, refereed journal papers. This paper first explores pressures on academics, especially emerging researchers, when English is not a first language. We assess why, when faculty members rush to improve their station that they may elect to circumvent ethical protocols to accelerate their promotion and status. The resulting unethical behavior includes plagiarism and forms of duplication such as co-submission. Consideration is then given to the wider implications of both plagiarism and the theft of intellectual property, and the role these have played in the development of individuals, the university and society.

The utility of hybrid promotion and tenure tracks for dental school faculty

The promotion and tenure process for faculty members varies, by design, for different disciplines, departments, and academic institutions. For many faculty members in U.S. dental schools, the process may thus appear nebulous and be difficult to navigate. In this article, we review the history, forces of change, and some of the mechanisms utilized for promotion and tenure of faculty in the health sciences, particularly for clinician-educators. Some institutions have successfully created hybrid tracks for clinician-educators in order to develop and recognize these faculty members' scholarly activity in addition to their clinical teaching. Hybrid tracks empower faculty members to successfully perform scholarly activities that realistically reflect institutional missions. The authors of this article conclude with a number of practical suggestions to enhance development and retention of faculty using the hybrid promotion and tenure mechanism. These include demonstrating the congruence of institutional mission, faculty activities, and promotion and tenure guidelines; developing scholarly activities for clinician-educators that can be measured in the promotion and tenure process; rewarding scholarly achievement for clinician-educators utilizing the promotion and tenure mechanism; and developing an evaluation system that accounts for changes in mission and faculty activities.

What shall I be, what must I be: neural correlates of personal goal activation

How is the brain engaged when people are thinking about their hopes, dreams, and obligations? Regulatory focus theory postulates two classes of personal goals and motivational systems for pursuing them. Ideal goals, such as hopes and aspirations, are pursued via the promotion system through "making good things happen." Ought goals, such as obligations or responsibilities, are pursued via the prevention system through "keeping bad things from happening." This study investigated the neural correlates of ideal and ought goal priming using an event-related fMRI design with rapid masked stimulus presentations. We exposed participants to their self-identified ideal and ought goals, yoked-control words and non-words. We also examined correlations between goal-related activation and measures of regulatory focus, behavioral activation/inhibition, and negative affect. Ideal priming led to activation in frontal and occipital regions as well as caudate and thalamus, whereas prevention goal priming was associated with activation in precuneus and posterior cingulate cortex. Individual differences in dysphoric/anxious affect and regulatory focus, but not differences in BAS/BIS strength, were predictive of differential activation in response to goal priming. The regions activated in response to ideal and ought goal priming broadly map onto the cortical midline network that has been shown to index processing of self-referential stimuli. Individual differences in regulatory focus and negative affect impact this network and appeared to influence the strength and accessibility of the promotion and prevention systems. The results support a fundamental distinction between promotion and prevention and extend our understanding of how personal goals influence behavior.

Development and evaluation of a nutritional health program for adolescents

BACKGROUND

Unhealthy nutritional behaviors are a threat to adolescents. In this regard, we compared different training methods through a participatory interventional study.

MATERIALS AND METHODS

Through proportional random selection, 1823 female students were selected from 15 middle schools of Tehran. Following 2 years of intervention, nutritional habits of three different interventional groups were assessed.

RESULTS

Eating breakfast was significantly higher in the trained groups, and the use of weight loss diets was lower in them than in the control group. Also, satisfactory consumption of various kinds of nutrients in the trained groups was more than in the control group.

CONCLUSION

Participatory health training, especially through parents, leads to adolescence nutritional health promotion.

A critical appraisal of and recommendations for faculty development

The 2009-2010 American Association of Colleges of Pharmacy (AACP) Council of Faculties Faculty Affairs Committee reviewed published literature assessing the scope and outcomes of faculty development for tenure and promotion. Relevant articles were identified via a PubMed search, review of pharmacy education journals, and identification of position papers from major healthcare professions academic organizations. While programs intended to enhance faculty development were described by some healthcare professions, relatively little specific to pharmacy has been published and none of the healthcare professions have adequately evaluated the impact of various faculty-development programs on associated outcomes.The paucity of published information strongly suggests a lack of outcomes-oriented faculty-development programs in colleges and schools of pharmacy. Substantial steps are required toward the development and scholarly evaluation of faculty-development programs. As these programs are developed and assessed, evaluations must encompass all faculty subgroups, including tenure- and nontenure track faculty members, volunteer faculty members, women, and underrepresented minorities. This paper proposes AACP, college and school, and department-level recommendations intended to ensure faculty success in achieving tenure and promotion.

Sources of drug information and their influence on the prescribing behaviour of doctors in a teaching hospital in Ibadan, Nigeria

Background

Pharmaceutical drug promotion is a means of informing health professionals about new drugs. The approach is often times unethical and inappropriate and may promote irrational prescribing. Dearth of information on impact of pharmaceutical drug promotion on prescribing behaviour of doctors in developing African countries has necessitated this study. We therefore aimed to determine the sources of drug information for doctors working in a teaching hospital in Nigeria and to assess the self-reported impact of the sources on their prescribing behaviour.

Methods

A total of 163 doctors working at the University College Hospital (UCH), Ibadan in Nigeria were evaluated with a questionnaire for their demographics and sources of drug information. For doctors who relied on drug promotion, they were asked to self-report and self-rate their opinion on extent of interactions with pharmaceutical companies as well as how such interactions had impacted on their prescribing behaviour. Apart from the demographics, each question was evaluated with a typical five-level Likert item. Data analyses were with simple descriptive statistics.

Results

Of the 400 doctors working at UCH, only 40.8% participated in the study. Drug information was sourced from colleagues (161, 98.8%), reference books (158, 96.9%), pharmaceutical sales representatives-PSRs (152, 93.2%), promotion materials (151, 92.6%), scientific papers/journals/internet (149, 91.4%), and drug promotion forum/product launches (144, 88.3%). Each source was highly utilized but there was no wide variation in their pattern of use. According to the self-report of over a half of the respondents, PSRs was an accurate and reliable drug information resource; PSRs increased their awareness of the promoted drugs; and their prescribing behaviours were influenced by information from PSRs.

Conclusion

Respondents tend to rely on a broad range of drug information resources which include potentially inappropriate resources such as PSRs. Since this study was based on self-report, the influence of drug information resources reported by the respondents on their prescribing behaviour may have been underestimated. Measures should be taken to minimize interactions between PSRs and the respondents.

Health-Led Interventions in the Early Years to Enhance Infant and Maternal Mental Health: A Review of Reviews

BACKGROUND

  Increasing recognition of the importance of maternal mental health and early parenting in optimising the later mental health of the child has given rise to new ways of working during the perinatal period.

AIMS

  The objective of this review is to identify effective health-led interventions to support parents, parenting and the parent-infant relationship during the perinatal period,¹ and beyond.

METHOD

  A systematic search of key electronic databases was undertaken to identify secondary and primary sources of data addressing the research question. Twenty-four reviews addressed the effectiveness of interventions delivered during the postnatal period in promoting closeness and sensitive parenting, infant sensory and perceptual capabilities, and positive parenting, and in addressing infant regulatory problems, maternal mental health problems, and parent-infant relationship problems.

CONCLUSIONS

  A number of methods of working are recommended as part of a model of progressive-universalism beginning ante-natally and continuing through the first two post-natal years, and beyond. The implications for universal, targeted and specialist healthcare services are explored, alongside the role and contribution of CAMHS practitioners.

Do antidepressant advertisements educate consumers and promote communication between patients with depression and their physicians?

OBJECTIVE

To examine how online depression support group members respond to direct-to-consumer (DTC) antidepressant advertising.

METHODS

Survey of 148 depression forum members, administered via an online questionnaire.

RESULTS

Chronicity was high, as 79.1% had received a diagnosis of depression 3 or more years earlier. Respondents reported seeing advertisements for an average of 4.3 of seven brands investigated. A majority rated the information quality of these advertisements as "poor" or "fair." Attitudes toward antidepressant advertisements were neutral (mean: 2.96 on a five-point scale). More than half (52.4%) visited official websites provided in these advertisements, 39.9% had talked with a doctor after seeing an advertisement, 20.3% made an advertisement-induced prescription request, and 25.7% said these advertisements reminded them to take their antidepressants. Amount of attention given to these advertisements correlated positively with belief in the brain chemical imbalance causal model, but belief in this model did not predict prescription requests.

CONCLUSION

Awareness of DTC antidepressant advertisements is high among individuals with depression, but so is skepticism.

PRACTICE IMPLICATIONS

Among members of an online support group, these advertisements encourage patient-doctor dialogue, prescription requests, and adherence, but might also reduce the acceptability of psychotherapy and encourage doctor switching in a small number of patients.

Academic appointment and the process of promotion and tenure

A critical component of a successful academic career is the understanding of institutional criteria and guidelines for academic appointment, promotion, and tenure. It is important to point out that these criteria and guidelines may vary from institution to institution; however, they are uniform for all clinical faculty within a single institution and do not differ from department to department. The purpose of this article is to provide the aspiring academic colon and rectal surgeon with a basic understanding of academic faculty appointments, promotion, and tenure.

Medicines information in medical journal advertising in Australia, Malaysia and the United States: A comparative cross-sectional study

OBJECTIVE

The aim of this study was to compare the provision of medicines information in medical journal advertising in Australia, Malaysia and the United States.

METHODS

A consecutive sample of 85 unique advertisements from each country was selected from the advertisements published between January 2004 to December 2006 in three widely circulated medical journals and one prescribing reference manual. The availability of brand name and generic name, indication, contraindications, dosage, side-effects, warnings, interactions and precautions was compared between the three countries.

RESULTS

We examined 255 distinct advertisements for 136 pharmaceutical products. Journal advertising in Australia, Malaysia and the US usually provided brand names and generic names (range 96 -100%). Information on dosage was significantly less likely to be mentioned (32%) in the US than in Australia (92%) and Malaysia (48%) (P < 0.001). Warning information was significantly less likely to be provided in Australia (5%) than in the US (81%) and Malaysia (9%) (P < 0.001). Apart from information on brand name, generic name, warnings and dosage, other product information significantly less likely to be provided in journal advertising in Malaysia than in Australia and the US (P < 0.001). Similar trends in the provision of product information for the same medicines published in these countries were noted. Brand name and generic name were always provided in the three countries (100%). However, information on the negative effects of medicines was less frequently provided in Malaysia than in Australia and the US.

CONCLUSIONS

Journal advertising in Australia, Malaysia and the US failed to provide complete product information. Low quality of information provided in Malaysia indicates the need for effective regulation of provision of medicines information in journal advertising. Different standards of medicines information provided in these three countries suggest that pharmaceutical promotion needs to be better controlled at the international level.

Implications of academic medicine's failure to recognize clinical excellence

OBJECTIVE

To better understand the implications of inadequately recognizing clinical excellence in academia by exploring the perspectives of clinically excellent faculty within prominent American departments of medicine.

DESIGN

Qualitative study.

SETTING

8 academic institutions.

PARTICIPANTS

24 clinically excellent department of medicine physicians.

METHODS

Between March 1 and May 31, 2007, investigators conducted in-depth semi-structured interviews with 24 clinically excellent physicians at leading academic institutions. Interview transcripts were independently coded by two investigators and compared for agreement. Content analysis identified themes related to clinical excellence in academia.

RESULTS

Twenty informants (83%) were Associate Professors or Professors, 8 (33%) were females, and the physicians hailed from a wide range of internal medicine specialties. The mean percent effort spent in clinical care by the physicians was 48%. The five domains that emerged related to academic medicine's failure to recognize clinical excellence were: (1) low morale and prestige among clinicians, (2) less than excellent patient care, (3) loss of talented clinicians, (4) a lack of commitment to improve patient care systems, and (5) fewer excellent clinician role models to inspire trainees.

CONCLUSIONS

If academic medical centers fail to recognize clinical excellence among its physicians, they may be doing a disservice to the patients that they pledge to serve. It is hoped that initiatives aiming to measure clinical performance in our academic medical centers will translate into meaningful recognition for those achieving excellence such that outstanding clinicians may feel valued and decide to stay in academia.

Barriers to scholarship in dentistry, medicine, nursing, and pharmacy practice faculty

There has been an increased emphasis on scholarly activities by health sciences faculty members given the importance of the promotion of public health over the last 50 years. Consequently, faculty members are required to place greater emphasis on scholarly activities while maintaining their teaching and service responsibilities. This increasing requirement of scholarly activities has placed great demands on clinical practice faculty members and it has made their management of clinical practice, teaching responsibilities, and expectations for promotion and tenure a difficult task. This retrospective literature review identifies barriers to the scholarship activities of clinical faculty members in dentistry, medicine, nursing, and pharmacy and discusses strategies for enabling faculty members to pursue scholarly activities in the current health science academic environment. The review indicates commonalities of barriers across these 4 disciplines and suggests strategies that could be implemented by all of these disciplines to enable clinical practice faculty members to pursue scholarly activities.

Mentoring at the University of Pennsylvania: results of a faculty survey

BACKGROUND

Research suggests mentoring is related to career satisfaction and success. Most studies have focused on junior faculty.

OBJECTIVE

To explore multiple aspects of mentoring at an academic medical center in relation to faculty rank, track, and gender.

DESIGN

Cross-sectional mail survey in mid-2003.

PARTICIPANTS

Faculty members, 1,432, at the University of Pennsylvania School of Medicine

MEASUREMENTS

Self-administered survey developed from existing instruments and stakeholders.

RESULTS

Response rate was 73% (n = 1,046). Most (92%) assistant and half (48%) of associate professors had a mentor. Assistant professors in the tenure track were most likely to have a mentor (98%). At both ranks, the faculty was given more types of advice than types of opportunities. Satisfaction with mentoring was correlated with the number of types of mentoring received (r = .48 and .53, P < .0001), job satisfaction (r = .44 and .31, P < .0001), meeting frequency (r = .53 and .61, P < .0001), and expectation of leaving the University within 5 years (Spearman r = -.19 and -.18, P < .0001), at the assistant and associate rank, respectively. Significant predictors of higher overall job satisfaction were associate rank [Odds ratio (OR) = 2.04, CI = 1.29-3.21], the 10-point mentoring satisfaction rating (OR = 1.27, CI = 1.17-1.35), and number of mentors (OR = 1.60, CI = 1.20-2.07).

CONCLUSIONS

Having a mentor, or preferably, multiple mentors is strongly related to satisfaction with mentoring and overall job satisfaction. Surprisingly, few differences were related to gender. Mentoring of clinician-educators, research track faculty, and senior faculty, and the use of multiple mentors require specific attention of academic leadership and further study.

The Prospective Study of Promotion in Academia (Prospective Study of Promotion in Academia)

OBJECTIVE

The study's objectives were to determine (1) the rate at which department of medicine faculty in the United States are promoted, (2) if clinician-educators (CEs) are promoted to Associate Professor at the same rate as clinician-investigators (CIs), and (3) the variables that predict promotion.

METHODS

The Prospective Study of Promotion in Academia was a part-retrospective, part-prospective (from 2000 to 2003) cohort study. Six-hundred and four Internal Medicine junior faculty across the United States who had been registered as new appointees with the Association of American Medical Colleges in 1995 were invited to participate. Twenty-one percent of these had already left their institution when the study began. One hundred and eighty-three Internal Medicine faculty from 87 institutions in 35 states enrolled. The main outcome measure was the time from appointment as Assistant Professor to promotion to Associate Professor.

RESULTS

Follow-up was complete for all 183 faculty. Among the faculty that achieved promotion, the estimated median time to promotion was 6.0 years (95% Conf. Int.=5.8 to 6.2). The unadjusted sixth-year promotion rate for CEs was 16%, while for CIs it was 26% (P=.002). Independent negative predictors of promotion included low amount of research time (Hazard Ratio [HR] =0.3, 95% Conf. Int.=0.2 to 0.5), having a manuscript review service (HR=0.4, 95% Conf. Int.=0.2 to 0.7), never meeting with Chairman/Chief about promotion (HR=0.4, 95% Conf. Int.=0.2 to 0.7), low job satisfaction (HR=0.5, 95% Conf. Int.=0.3 to 0.9), and working in the Northeast (HR=0.6, 95% Conf. Int.=0.4 to 1.1). Positive predictors included making between 130 dollars and 149,000 dollars per year (HR=1.9, 95% Conf. Int.=1.1 to 3.4), working more than 60 h/wk (HR=1.9, 95% Conf. Int.=1.1 to 3.0), having a career mentor available (HR=1.8, 95% Conf. Int.=1.1 to 2.9), and having access to a grant office (HR=1.6, 95% Conf. Int.=1.0 to 2.6).

CONCLUSION

CEs and CIs appear to be promoted at different rates. The characteristics that are independently associated with earlier promotion may be helpful for institutions and individual faculty that are committed to achieving promotion efficiently.

Prevention of mental and behavioural disorders: implications for policy and practice

There is sufficient evidence indicating the efficacy of interventions in reducing risk factors, increasing protective factors, preventing psychiatric symptoms and new cases of mental disorders. Macro-policy interventions to improve nutrition, housing and education or to reduce economic insecurity have proven to reduce mental health problems. Specific interventions to increase resilience in children and adolescents through parenting and early interventions, and programmes for children at risk for mental disorders such as those who have a mentally ill parent or have suffered parental loss or family disruption, have also shown to increase mental well-being and decrease depressive symptoms and the onset of depressive disorders. Interventions for the adult population, from macro-policy strategies, such as taxation of alcohol products or workplace legislation, to individual support for those with signs of a mental disorder, can reduce mental health problems and associated social and economic burdens. Exercise, social support or community participation have also shown to improve mental health of older populations. Public mental health will benefit from continuing building the evidence base through combining different evaluation methods across low, middle and high income countries. The translation of evidence into policy and practice calls for action at the international, national and local level, including building capacity, advocacy, mainstreaming mental health into public health and other policies and securing infrastructures and sustainability. Mental health professionals have an important role to play in improving the evidence on prevention and promotion in mental health, in engaging relevant stakeholders for developing programmes, and as professional care providers in their practice.

The role of cultural diversity climate in recruitment, promotion, and retention of faculty in academic medicine

BACKGROUND

Ethnic diversity among physicians may be linked to improved access and quality of care for minorities. Academic medical institutions are challenged to increase representation of ethnic minorities among health professionals.

OBJECTIVES

To explore the perceptions of physician faculty regarding the following: (1) the institution's cultural diversity climate and (2) facilitators and barriers to success and professional satisfaction in academic medicine within this context.

DESIGN

Qualitative study using focus groups and semi-structured interviews.

PARTICIPANTS

Nontenured physicians in the tenure track at the Johns Hopkins University School of Medicine.

APPROACH

Focus groups and interviews were audio-taped, transcribed verbatim, and reviewed for thematic content in a 3-stage independent review/adjudication process.

RESULTS

Study participants included 29 faculty representing 9 clinical departments, 4 career tracks, and 4 ethnic groups. In defining cultural diversity, faculty noted visible (race/ethnicity, foreign-born status, gender) and invisible (religion, sexual orientation) dimensions. They believe visible dimensions provoke bias and cumulative advantages or disadvantages in the workplace. Minority and foreign-born faculty report ethnicity-based disparities in recruitment and subtle manifestations of bias in the promotion process. Minority and majority faculty agree that ethnic differences in prior educational opportunities lead to disparities in exposure to career options, and qualifications for and subsequent recruitment to training programs and faculty positions. Minority faculty also describe structural barriers (poor retention efforts, lack of mentorship) that hinder their success and professional satisfaction after recruitment. To effectively manage the diversity climate, our faculty recommended 4 strategies for improving the psychological climate and structural diversity of the institution.

CONCLUSIONS

Soliciting input from faculty provides tangible ideas regarding interventions to improve an institution's diversity climate.

Degrees and kinds of selection in spontaneous neoplastic transformation: an operational analysis

Spontaneous neoplastic transformation develops within days in the NIH 3T3 line of cells through differential inhibition of their proliferation under contact inhibition. A small fraction of the population continues to multiply after saturation density is reached and is selected to progressively increase saturation density in successive rounds of confluence. The degree of selection at confluence depends on the extent of proliferation of some cells in a heterogeneous population. The development of transformed foci is an extension of the same selective process that increases saturation density. The expression of the foci is enhanced with increases in the saturation density of the surrounding cells. Transformation is also induced by moderately reducing the concentration of calf serum in the medium during low-density passages, which allows selection of cells that require less growth factor. Further stepwise reductions in serum increase the degree of transformation. Contact inhibition and reduction in serum concentration select for the same phenotype of cell that increases saturation density and generates transformed foci. There is mounting evidence that selection is a major factor in the development of common epithelial tumors of humans, but it extends over decades rather than days, and the in vivo microenvironment selects from more stable populations of cells than those in culture. The many progressive levels of increased saturation density and transformed focus formation suggest that a very large number of genes participate in neoplastic development. The operational model of variation and selection presented here may aid in understanding chemical carcinogenesis and cancer recurrence after chemotherapy.

The interventional radiology clinic: what you need to know

It is increasingly recognized that clinical management in interventional radiology is necessary. To effectively participate in such management requires patient management infrastructure. The cornerstone of this effort is the clinical office.

[Maternal assessment of pre-natal measures to promote natural breast-feeding]

OBJECTIVES

To value the satisfaction between mothers about the different professionals and the prenatal promotion on breast-feeding (BF) in our basic health zone. To value the role of a paediatric prenatal contact in the health centre.

DESIGN

An descriptive and retrospective, cross-sectional study based on an anonymous closed questionnaire filled by two groups without random selection defined on the variable yes/no BF.

SETTING

Paediatric room in the Health Centre of Lugones, Health Area of Oviedo.

PARTICIPANTS

Every mother of childs aged between 6 and 18 months attending to the Healthy Child Program since June to November of 2000.

MEASUREMENTS AND RESULTS

60 questionnaires were delivered, 51 to the group BF and 9 to the group no BF (85% BF including mixed and independent of the duration). 52 questionnaires were collected, 44 BF and 8 no BF. We observe a great satisfaction in both groups on the area midwife, who is considered decisive. Obstetrician, hospital and primary nurse, hospital paediatrician and general practitioner may improve their rule in BF promotion. Both groups are interested in the prenatal visit with the health centre paediatrician. Women on no BF group thought that this interview could have changed their decision.

CONCLUSIONS

Area midwife is considered the most value professional by the mothers. Hospital and primary professionals may improve his rule in BF promotion in our basic health zone. Only 50% women in no BF group took their decision before the birth. They think that the prenatal paediatric visit could have changed their decision.

Carcinogenic potential of duodenal reflux juice from patients with long-standing postgastrectomy

AIM: To determine whether study on the carcinogenic potential of reflux juice from patients with remote gastrectomy could clarify the inherent relationship between duodenal reflux and gastric stump cancer.

METHODS: A total of 37 reflux juice samples (13 Billroth I, 24 Billroth II) were employed in the present study. A two-stage transformation assay using BALB/c 3T3 cells was carried out to test the initiating or promoting activity of these samples.

RESULTS: Two of 18 (11.1%) reflux samples exerted initiating activities, whereas 9/19 (47.4%) samples enhanced the MNNG-initiating cell transformation, suggesting the duodenal reflux juice might more frequently possess the tumor-promoter activity (P = 0.029). In addition, there was no difference in initiating activities of the samples irrespective of surgical procedures (P = 0.488), while Billroth II samples exhibited stronger tumor-promoter activity than Billroth I samples (P = 0.027). Furthermore, the promoter activities were well correlated with the histological changes of the stomas (r_s = 0.625, P = 0.004), but neither their cytotoxicities nor initiating activities had this correlation (Probabilities were 0.523 and 0.085, respectively).

CONCLUSION: The duodenal reflux juice from patients with remote postgastrectomy did have carcinogenic potential, and suggested that tumor-promoting activity should principally account for the high incidence of gastric cancer in gastrectomy patients. In contrast, it is difficult to explain the high stump-cancer incidence with the "N-nitroso compounds" theory-a popular theory for the intact stomach carcinogenesis, and it seemed to be justified to focus chemoprevention of this cancer on the tumor-promoting potential of reflux juice.

Scholarly Productivity of Athletic Training Faculty Members

OBJECTIVE: To compare the scholarly productivity index (SPI) among the levels of academic appointment, degree type, and percentage of academic appointment of athletic training faculty members. DESIGN AND SETTING: We used a 5 x 6 x 4 factorial design for this study. A survey instrument was used to determine the number of publications and the number of years in their current appointment. SUBJECTS: Subjects were faculty members in Commission on Accreditation of Allied Health Education Programs-accredited athletic training education programs. MEASUREMENTS: The SPI was calculated by dividing the total number of publications (peer-reviewed and non-peer-reviewed journal articles, peer-reviewed abstracts, books written or edited, book chapters, platform presentations, published book reviews, and external funding) by the number of years in the productivity period. RESULTS: The SPIs were different for the levels of academic rank. Full professors had a higher SPI than all other groups (Tukey honestly significant difference, P </=.05). Associate professors had higher SPIs than instructors or lecturers and clinical specialists, equivalent SPIs to assistant professors, and lower SPIs than full professors. Assistant professors had lower SPIs than full professors but were equivalent to all other groups. There were no differences among the levels of degree type or percentage of academic appointment. CONCLUSIONS: The scholarly productivity of athletic training educators was affected by their academic rank but not by the percentage of time they were assigned to academics or their academic degree type.

Endogenous N-nitroso compounds, and their precursors, present in bacon, do not initiate or promote aberrant crypt foci in the colon of rats

Processed meat intake is associated with increased risk of colorectal cancer. This association may be explained by the endogenous formation of N-nitroso compounds (NOC). The hypothesis that meat intake can increase fecal NOC levels and colon carcinogenesis was tested in 175 Fischer 344 rats. Initiation was assessed by the number of aberrant crypt foci (ACF) in the colon of rats 45 days after the start of a high-fat bacon-based diet. Promotion was assessed by the multiplicity of ACF (crypts per ACF) in rats given experimental diets for 100 days starting 7 days after an azoxymethane injection. Three promotion studies were done, each in 5 groups of 10 rats, whose diets contained 7%, 14%, or 28% fat. Tested meats were bacon, pork, chicken, and beef. Fecal and dietary NOC were assayed by thermal energy analysis. Results show that feces from rats fed bacon-based diets contained 10-20 times more NOC than feces from control rats fed a casein-based diet (all p < 0.0001 in 4 studies). In bacon-fed rats, the amount of NOC input (diet) and output (feces) was similar. Rats fed a diet based on beef, pork, or chicken meat had less fecal NOC than controls (most p < 0.01). No ACF were detected in the colon of bacon-fed uninitiated rats. After azoxymethane injection, unprocessed but cooked meat-based diets did not change the number of ACF or the ACF multiplicity compared with control rats. In contrast, the bacon-based diet consistently reduced the number of large ACF per rat and the ACF multiplicity in the three promotion studies by 12%, 17%, and 20% (all p < 0.01). Results suggest that NOC from dietary bacon would not enhance colon carcinogenesis in rats.

Effect of meat (beef, chicken, and bacon) on rat colon carcinogenesis

High intake of red meat or processed meat is associated with increased risk of colon cancer. In contrast, consumption of white meat (chicken) is not associated with risk and might even reduce the occurrence of colorectal cancer. We speculated that a diet containing beef or bacon would increase and a diet containing chicken would decrease colon carcinogenesis in rats. One hundred female Fischer 344 rats were given a single injection of azoxymethane (20 mg/kg i.p.), then randomized to 10 different AIN-76-based diets. Five diets were adjusted to 14% fat and 23% protein and five other diets to 28% fat and 40% protein. Fat and protein were supplied by 1) lard and casein, 2) olive oil and casein, 3) beef, 4) chicken with skin, and 5) bacon. Meat diets contained 30% or 60% freeze-dried fried meat. The diets were given ad libitum for 100 days, then colon tumor promotion was assessed by the multiplicity of aberrant crypt foci [number of crypts per aberrant crypt focus (ACF)]. The ACF multiplicity was nearly the same in all groups, except bacon-fed rats, with no effect of fat and protein level or source (p = 0.7 between 8 groups by analysis of variance). In contrast, compared with lard- and casein-fed controls, the ACF multiplicity was reduced by 12% in rats fed a diet with 30% bacon and by 20% in rats fed a diet with 60% bacon (p < 0.001). The water intake was higher in bacon-fed rats than in controls (p < 0.0001). The concentrations of iron and bile acids in fecal water and total fatty acids in feces changed with diet, but there was no correlation between these concentrations and the ACF multiplicity. Thus the hypothesis that colonic iron, bile acids, or total fatty acids can promote colon tumors is not supported by this study. The results suggest that, in rats, beef does not promote the growth of ACF and chicken does not protect against colon carcinogenesis. A bacon-based diet appears to protect against carcinogenesis, perhaps because bacon contains 5% NaCl and increased the rats' water intake.

Glycemic index, nutrient density, and promotion of aberrant crypt foci in rat colon

We speculated that a diet with a high glycemic index (GI) or a diet with a low nutrient density (nutrient-to-calorie ratio) would enhance colon carcinogenesis, presumably via increased insulin resistance. Forty-eight Sprague-Dawley (SD) rats received an azoxymethane injection (20 mg/kg) and were randomized into five groups given an AIN-76 diet containing 1) 65% starch by weight, 2) 65% glucose (GI = 100), 3) 65% fructose (GI = 23), 4) 82% starch, or 5) 39% oil and 39% sucrose. The nutrient density of Diets 4 and 5 was one-half that of Diets 1-3. Promotion was assessed by the multiplicity (number of crypts) of aberrant crypt foci (ACF), an early marker of colon carcinogenesis. Insulin resistance was estimated by the FIRI index (blood insulin x blood glucose), by plasma triglycerides, and by visceral fat. To confirm the results in another rat strain, the experiment was duplicated in 48 Fischer (F344) rats. Results show that 1) the ACF multiplicity was not different in glucose- and fructose-fed rats (p > 0.7): diets with contrasting GI had the same effect on ACF growth; 2) diets of low nutrient density increased visceral fat (p < 0.05) but reduced the ACF size in F344 rats (p < 0.001, no reduction in SD rats); and 3) indirect insulin resistance markers (FIRI index, blood triglycerides, and visceral fat) did not correlate with ACF multiplicity. These results do not support the hypothesis that diets with a high GI or low nutrient density or diets that increase some indirect insulin resistance markers can promote colon carcinogenesis in F344 or SD rats.

Promotion of rat hepatocarcinogenesis by praziquantel

Praziquantel, the widely used anti-helminthic agent, was investigated for hepatocarcinogenesis-promoting potential using a medium-term liver bioassay system for carcinogens. F344 male rats were given a single intraperitoneal injection of diethylnitrosamine (DEN, 200 mg/kg) and then starting 2 weeks later, received praziquantel in the diet at concentrations of 1.5 or 0.5%, or intragastrically at a dose of 1,500 mg/kg once a week for 6 weeks. Control groups received DEN or praziquantel alone. All rats were subjected to two-thirds partial hepatectomy at week 3 and killed at week 8. Development of glutathione S-transferase placental form-positive foci in the liver was significantly increased in terms of both number and area with the 1.5% dose, while only area was affected by the 0.5% dose. The results thus indicate that praziquantel at high dose has promoting potential in rat hepatocytic tumorigenesis.