Defined System to Assess the in Vitro Induction of a Psoriasis Phenotype on Normal Keratinocytes by Fibroblasts from Psoriatic Subjects

Background:

Research has shown that involved as well as uninvolved skin of psoriatic subjects have an inherent defect that manifests, at a minimum, as nonapparent epidermal hyperplasia. Fibroblasts have been shown to regulate epidermal proliferation and differentiation; furthermore, fibroblasts from patients with psoriasis have altered growth, response, and mediator release when compared with normal.

Objective:

We conjectured that it might be possible to generate the enhanced epidermal proliferation inherent to psoriatic skin in vitro using a defined interactive culture system with cellular components from the skin of normal and psoriatic subjects.

Methods:

To reduce the variables whereby fibroblasts stimulate keratinocyte proliferation in vitro, a system was developed that does not permit direct contact between keratinocytes and fibroblasts, but does permit the exchange of media and mediators as well as an assessment of keratinocyte growth as a function of time. Fibroblasts from involved and uninvolved sites from biopsies of seven untreated psoriatic subjects were assessed for their effect on the growth of keratinocytes from normal subjects.

Results:

Analysis shows that five of seven fibroblast sources from involved sites and six of seven from uninvolved sites of psoriatic subjects induce normal keratinocytes to display enhanced outgrowth. Three of 14 fibroblast sources consistently do not induce this change. Fibroblasts from uninvolved sources are particularly effective, with a mean of 40 ± 8% (SD) more growth than with normal fibroblasts.

Conclusion:

It is concluded that fibroblasts from psoriatics can induce the phenotype of increased epidermal proliferation on normal keratinocytes via a soluble mediator in a defined system.

An analysis of hepatitis C virus-related public inquiries from health professionals: 2009-2010

A content analysis was performed on e-mail inquiries about viral hepatitis that were submitted by health professionals to the Centers for Disease Control and Prevention's (CDC's) public inquiry system, CDC-INFO. All hepatitis C virus (HCV)-related inquiries from health professionals were identified, representing 10% of all inquiries received during the 2-year period of 2009-2010. Three-fourths of the inquiries included professional degree and organizational affiliation information, with 35% representing physicians, 33% representing nurses, and 6% representing midlevel clinicians, the majority of whom provided direct clinical care or worked in a healthcare organization. Two independent coders analyzed content, with κ coefficients for interrater agreement ranging from 0.82 to 0.93. Overall, the inquiries demonstrated important knowledge gaps regarding HCV, with the most frequently asked questions focusing on transmission, serology, and policy/legal issues surrounding patient care and infected healthcare workers.

Lessons Learned From Exploratory Research About Viral Hepatitis

The Centers for Disease Control and Prevention conducted exploratory research as part of planning a national education campaign to raise awareness about viral hepatitis in the United States. The purpose of this qualitative research was to assess the baseline knowledge, attitudes, and screening behaviors of four population groups. Sixteen focus groups were conducted during a 6-week period in the fall of 2009, with a total of 119 adults aged 35 to 60 years in Boston, Massachusetts; Chicago, Illinois; and Houston, Texas. The groups were stratified by Asian Americans, African Americans, gay or bisexual men, and general population. Group size ranged from three to nine participants, and each session was approximately 90 minutes in length. Both awareness and knowledge of viral hepatitis were low among all participants, including those at increased risk for the disease. Little was known about the different types of hepatitis, risk factors, or how the viruses are transmitted. Regarding the last, many indicated that the disease was airborne. In addition, participants incorrectly assumed that if they had viral hepatitis, they would have symptoms and know they were infected. Many participants also believed that they had been tested for the disease since their health care providers routinely “test their blood.” The findings indicate that significant and concerted educational efforts are needed to improve basic knowledge of viral hepatitis, as well as knowledge about transmission, risk factors, screening, and treatment. As a result, a general awareness and education campaign must precede and support efforts to encourage screening.

Experimental models for psoriasis

Evidence suggests that inherent in skin of psoriatic subjects are cells, architectural structures, and/or mediators, which are, at a minimum, responsible for its hyperproliferative epidermis. An objective of our laboratory has been to establish an in vitro definition of this inherent aberration. Fibroblasts are important to epidermal proliferation/differentiation. This, and an unconfirmed report that fibroblasts from psoriatic subjects might drive the abnormal epidermal proliferation in psoriasis, have caused further focus on the fibroblast. Data show that fibroblasts from patients with psoriasis, both involved and uninvolved, in the presence of human serum, either normal or psoriatic, have an increased rate of proliferation. Fibroblasts from uninvolved psoriatic sites are most responsive. To determine if fibroblasts from psoriatics could induce the psoriasiform phenotype on normal keratinocytes, an interactive skin equivalent system has been developed. With this system, fibroblasts from uninvolved and involved sites cause normal keratinocytes to have an enhanced outgrowth. Uninvolved fibroblasts cause the greatest changes. The nature of the skin equivalent system calls for this to occur via message over distance. We conclude that fibroblasts from psoriatic subjects can induce a psoriasiform phenotype via a soluble message.

A content analysis of news coverage of the HPV vaccine by U.S. newspapers, January 2002-June 2005

Genital Human Papillomavirus (HPV) is the most common sexually transmitted infection in the United States. Of the 100 HPV types, HPV type 16 and HPV type 18 have been demonstrated to cause cervical cancer. Two pharmaceutical manufacturers have developed and tested HPV vaccines and are applying to the FDA for licensure. This research describes the content of HPV vaccine information contained in news articles. The Lexis-Nexis database was used to identify 25 articles on HPV that were published in 285 U.S. newspapers from January 1, 2003 to June 17, 2005. The coding schema captured information about the news event and source, as well as HPV and cervical cancer, transmission, vaccine, potential impact of the vaccine, and its relationship to PAP tests. The content analysis revealed that the news coverage of HPV vaccine provides information on the experimental status and efficacy of the vaccine, explains link between HPV and cervical cancer, and reports the manufacturers by name, as well as relies on them for a news source. Detailed information about HPV, however, was frequently missing which could lead to an incomplete picture or lack of understanding of the complexity of HPV and cervical cancer. As a major source of medical information, the media can be particularly important in educating policy makers and the general public about new scientific advances. Public health officials may wish to collaborate with journalists, health educators, healthcare providers, and women's health advocates to ensure that future educational initiatives explain the complexity of the association of HPV and cervical cancer and to stress the importance of continued cervical cancer screening.

Using telephone focus groups methodology to examine the prostate cancer screening practices of African-American primary care physicians

African-American men have a greater burden from prostate cancer than do white men and men of other races/ethnicities in the United States. To date, there have been no studies of how African-American primary care physicians screen their patients for prostate cancer. The purpose of this study was to examine the use of telephone focus groups as a methodology and to learn about this practice among a group of African-American primary care physicians. A total of 41 physicians participated in eight telephone focus groups. Results from the study are found in a separate article. Regarding telephone focus group methodology, we found that a majority of the physicians in this study preferred telephone focus groups over the conventional face-to-face focus groups. We also discuss some of the advantages (e.g., no travel, high acceptance rates, more flexibility than in-person groups, and general cost efficiency) as well as disadvantages (e.g., nonverbal communication limits and reduction of group interaction) of this methodology. This methodology may prove useful in studies involving African-American physicians, physicians in general and other difficult-to-reach healthcare professionals.

Developing English and Spanish television public service announcements to promote colorectal cancer screening

Screen for Life: National Colorectal Cancer Action Campaign (SFL) is a federally funded campaign to promote understanding of colorectal cancer and the importance of regular screening for adults aged 50 years and older. SFL uses a variety of communication strategies, including television public service announcements (PSAs). SFL materials are developed using the Health Communication Process endorsed by the U.S. Department of Health and Human Services, which has four stages: (a) planning and strategy development; (b) developing and pretesting concepts, messages, and materials; (c) implementing the program; and (d) assessing effectiveness and making refinements. This article describes SFL's application of this process to develop television PSAs in English and Spanish.

To screen or not to screen, when clinical guidelines disagree: primary care physicians' use of the PSA test

BACKGROUND

Clinical guidelines for using the prostate-specific antigen (PSA) test as a population-based screening tool vary considerably. This study qualitatively explored primary care physicians' PSA screening practices and their understanding of the PSA screening controversy.

METHODS

Fourteen telephone focus groups were conducted with 75 primary care physicians practicing in 35 US states. Data were coded around three major topics: PSA screening practices, factors influencing these practices, and familiarity with clinical guidelines.

RESULTS

Two practice patterns emerged. Most participants recommended regular PSA screening beginning around age 50 for asymptomatic men with no known risk factors and at least a 10-year life expectancy. These "routine screeners" attributed their approach to experience that supported the benefit of PSA screening and to patient demand for the test. Other physicians discussed the implications of PSA screening with patients before offering the test, but neither recommended for or against it. The approach of these "nonroutine screeners" was primarily guided by the lack of scientific evidence documenting the benefit of PSA screening.

CONCLUSIONS

The observed practice patterns reflect both sides of the PSA screening controversy. While routine and nonroutine screeners differ in their approach, both reported high rates of PSA screening.

Report from the CDC. Telephone Focus Groups: An Emerging Method in Public Health Research

BACKGROUND

The focus group is a widely used qualitative method in public health research. Typically, focus groups involve face-to-face interaction, although focus groups have also been conducted via telephone conference calls.

METHODS

The indexed medical and social sciences literature was reviewed to assess what is empirically known about the telephone focus group method and how this method has been used to explore health topics.

RESULTS

Thirteen studies reported in 16 publications were found that used telephone focus groups. Of the 13 studies, 12 investigated health topics, and none explored any methodological issues. Some health studies used the telephone focus group method exclusively, whereas others used it in conjunction with additional methods. The studies involved a variety of lay and professional populations in six countries and explored a range of topics. Several of the studies included participants from a wide geographic area, such as across the entire United States. Two rationales for using the telephone focus group method were reported: assembling geographically disparate participants and increasing participant anonymity by eliminating visual contact.

CONCLUSIONS

Health researchers appear to be the primary users of the telephone focus group method for academic research. The telephone focus group method may be especially useful in health studies involving populations that do not have adequate representation in any single region and studies investigating sensitive topics. Methods studies are needed to compare the group dynamics of telephone and in-person focus groups and determine the most appropriate size and duration for telephone focus groups.

Normal and Gene-Corrected Dystrophic Epidermolysis Bullosa Fibroblasts Alone Can Produce Type VII Collagen at the Basement Membrane Zone

Type VII collagen is synthesized and secreted by both human keratinocytes and fibroblasts. Although both cell types can secrete type VII collagen, it is thought that keratinocytes account for type VII collagen at the dermal-epidermal junction (DEJ). In this study, we examined if type VII collagen secreted solely by dermal fibroblasts could be transported to the DEJ. We established organotypic, skin-equivalent cultures composed of keratinocytes from patients with recessive dystrophic epidermolysis bullosa (RDEB) and normal dermal fibroblasts. Immuno-labeling of skin equivalent sections with the anti-type VII collagen antibody revealed tight linear staining at the DEJ. RDEB fibroblasts, were gene-corrected to make type VII collagen and used to regenerate human skin on immune-deficient mice. The human skin generated by gene-corrected RDEB fibroblasts or normal human fibroblasts combined with RDEB keratinocytes restored type VII collagen expression at the DEJ in vivo. Further, intradermal injection of normal human or gene-corrected RDEB fibroblasts into mouse skin resulted in the stable expression of human type VII collagen at the mouse DEJ. These data demonstrate that human dermal fibroblasts alone are capable of producing type VII collagen at the DEJ, and it is possible to restore type VII collagen gene expression in RDEB skin in vivo by direct intradermal injection of fibroblasts.

Gender differences in young adults' beliefs about sunscreen use

This study employs focus group methodology to explore gender differences in sunscreen use. Guided by the theory of reasoned action, males and females were found to differ on each of the following constructs: behavior, behavioral beliefs, and normative beliefs. Males and females differed in their sunscreen use, with females adopting a more preventive style of sunscreen use and males a more reactive style. Males and females differed in their salient beliefs that motivated their sunscreen use, many of which were related to traditional American gender roles. In addition, although males and females were aware of both positive and negative sources of normative beliefs regarding sunscreen use, females received more encouragement from their mothers and peers than males. Findings are discussed in terms of their implications for the design of future interventions.

Observations from the CDC: CDC's Screen for Life: a National Colorectal Cancer Action Campaign

Colorectal cancer is the second leading cause of cancer-related deaths in the United States. Despite the availability of several different screening tests for colorectal cancer, screening rates remain low. To raise awareness about colorectal cancer and encourage men and women aged 50 and older to speak with their physicians about being screened for colorectal cancer, the Centers for Disease Control and Prevention and the Health Care Financing Administration launched Screen for Life: A National Colorectal Cancer Action Campaign in 1999. The purpose of this paper is to outline the development of this multiyear, multimedia campaign, from conducting formative research to developing campaign messages and materials. Limited process evaluation results are presented.

Protection from sun exposure in US white children ages 6 months to 11 years

OBJECTIVES

To estimate the prevalence of protection from sun exposure among US white children ages 6 months to 11 years.

METHODS

During the summer of 1998, using telephone directory lists supplemented by random-digit dialing, the authors surveyed parents living in the contiguous United States. They calculated weighted prevalence estimates for protection methods and conducted logistic regression analyses to determine parent and child characteristics predictive of protection behaviors.

RESULTS

Parents of 1,055 white children were interviewed. Children spent a median of 20 hours per week outdoors during the summer, of which 10 hours were at school. Sunscreen (61.8%, 95% confidence interval [CI] 57%, 66%) and shade (26.5%, 95% CI 22%, 31%) were the most frequently reported protection methods. Parents reported higher rates of protection for younger children and children who sunburn easily.

CONCLUSIONS

Parents report that a large proportion of white children is protected from sun exposure by one or more methods. Health care providers and educators might encourage the use of all methods of protection, not just sunscreen use, and educate older children to protect themselves from the sun.

Factors associated with sunburn in white children aged 6 months to 11 years

OBJECTIVE

To determine the sunburn experience and factors associated with sunburn among white children aged 6 months to 11 years.

METHODS

Telephone interviews were conducted with parents and primary caretakers of children, selected by random, stratified sampling, in the contiguous United States in the summer of 1998. Information was gathered on demographic characteristics of parents and children, and children's sunburn experience during the past year, protection from sun exposure, and hours per week spent outdoors. The proportion of children experiencing sunburn in the past year was calculated. Multivariate logistic regression analyses were conducted to determine factors associated with sunburn. Information for 1052 white children was available for the analyses.

RESULTS

An estimated 42.6% of U.S. white children experienced one or more sunburns within the past year (95% CI 38.2-47.0). Sunburn was less common among children who ever wore hats (adjusted OR 0.59, 95% CI 0.40-0.87) and more common among children who did not always wear sunscreen (OR for using sunscreen sometimes compared with always, 2.25; 95% CI 1.31-3. 86). Sunburn was also more common among children with sun-sensitive skin and older children.

CONCLUSIONS

A large proportion of U.S. white children experience sunburns. Parents and children may benefit from education about protection from sun exposure.

Colorectal cancer screening in older men and women: qualitative research findings and implications for intervention

As part of the formative research for developing interventions to increase colorectal cancer screening in men and women aged 50 and older, 14 focus groups were conducted to identify (1) knowledge, attitudes, and beliefs about colorectal cancer and colorectal cancer screening, (2) barriers to screening, and (3) strategies for motivating and supporting behavior change. Participants had either private insurance or Medicare and reported different levels of experience with colorectal cancer screening. Overall, they were poorly informed about colorectal cancer and the possible benefits of screening, reporting little or no information from physicians or mass media, negative attitudes toward screening procedures, and fear of cancer. Despite references to the subject matter as embarrassing or private, both men and women, African Americans and whites, appeared to talk candidly and comfortably in the permissive context of the focus group. This study's findings suggest that public education campaigns, decision aids, and targeted interventions are urgently needed to put colorectal cancer screening on the public's "radar screen," to increase awareness of the prevention and early detection benefits of screening, and to encourage people 50 and older-and the health care providers who serve them-to make screening a high priority.

Health promotion programs in small worksites: results of a national survey

PURPOSE

This study documents the prevalence of workplace health promotion activities at small worksites with 15 to 99 employees.

DESIGN

A random sample of U.S. worksites stratified by size and industry (n = 3628) was drawn using American Business Lists.

MEASURES

Each worksite was surveyed using a computer-assisted telephone interview system to document activities related to health promotion and related programs, worksite policies regarding health and safety, health insurance, and philanthropic activities.

SUBJECTS

Participation varied by industry and size, with an overall response rate for eligible worksites of 78% for a total sample of 2680 worksites.

DATA ANALYSIS

Data were analyzed using SUDAAN statistical software.

RESULTS

Approximately 25% of worksites with 15 to 99 employees offered health promotion programs to their employees, compared with 44% of worksites with 100+ employees. As with the larger worksites, the most common programs for worksites with 15 to 99 employees were those related to occupational safety and health, back injury prevention, and CPR. The majority of worksites in both size categories had alcohol, illegal drug, smoking, and occupant protection policies. The majority of both small and large worksites also offered group health insurance to their employees (92% and 98%, respectively), with many of the worksites also extending benefits to family members and dependents (approximately 80% for both business sizes).

CONCLUSIONS

The results indicated that small worksites are providing programs to their employees, with a primary focus on job-related hazards. Small worksites also have formal policies regarding alcohol, drug use, smoking, and seatbelt use and offer health insurance to their employees at a rate only slightly lower than that of large worksites.

Persistent transgene expression and normal differentiation of immortalized human keratinocytes in vivo

Cells transduced ex vivo with transgenes encoded on retroviruses have constant and prolonged expression in vitro; however, in vivo expression is quickly lost. Much attention has been directed at methods to circumvent this problem. We have shown that loss of transgene expression does not occur when transduced immortalized 3T3 cells are transplanted to the in vivo setting of athymic mice. Ease of acquisition and potential for clinical application led us to assess the potential of using immortalized human keratinocytes for expression of transgenes in vivo. Human keratinocytes were immortalized with a HPV16-E6/E7 retrovirus, transduced with a lacZ retrovirus, cloned by limiting dilution, seeded onto a physiologic dermal substrate, and transplanted to athymic mice. Six weeks after transplantation, the immortalized transgene expressing keratinocytes had formed an epidermis that was indistinguishable from one formed by nonimmortalized keratinocytes; furthermore, there was no loss of expression of the lacZ gene. These observations show that methods to extend cell survival are an alternative approach to achieving stable and prolonged expression of transgenes in vivo and that HPV16-E6/ E7 immortalized keratinocytes generate an epidermis with normal morphology.

Concerns and dilemmas of Hispanic AIDS information seekers: Spanish-speaking callers to the CDC National AIDS hotline

Hispanic communities suffer disproportionately from the impact of human immunodeficiency virus infection (HIV). Each year, thousands of Spanish-speaking Hispanics call the Centers for Disease Control and Prevention National AIDS Hotline to ask questions about HIV. During 1995 alone, Spanish line staff answered more than 29,000 calls. This article presents a profile of callers and their concerns based on a systematic sample of these calls (N = 6,933) and qualitative data. The authors triangulated quantitative and qualitative results to provide a deeper understanding of the issues and dilemmas discussed with callers. Males and females called in equal numbers, but significant gender differences were observed in both situational and content variables. Gender roles, cultural values, and anxiety strongly affect the way that callers approach information and prevention. Findings suggest that health educators need to carefully examine whether prevention programs will reinforce or challenge traditional gender roles, sexual norms, and cultural values.

The effects of HIV counseling and testing on risk-related practices and help-seeking behavior

In an earlier review of the behavioral effects of HIV counseling and testing (HIV CT), Higgins and colleagues (1991) found that the evidence regarding the ability of HIV CT to influence HIV-risk related practices was largely inconclusive. This article reviews 35 domestic and international studies published since that time to reassess the scientific data regarding the ability of HIV CT to motivate changes in risk-related practices and to promote help-seeking behavior. The studies identified for this review were grouped into four categories according to subject population: (1) men who have sex with men, (2) injection and other drug users, (3) women and heterosexual couples, and (4) mixed samples recruited from sexually transmitted disease (STD) clinics and other settings. Findings from the studies reviewed were generally mixed--many provided at least some evidence supporting the ability of HIV CT to motivate risk-reducing and help-seeking behavior, but others did not. The pattern of results varied substantially across, and within, study populations and were often limited by considerable methodological weaknesses.

Effects of Serum from Normal and Psoriatic Subjects on the Proliferation of Fibroblasts from Involved and Uninvolved Skin of Psoriatic Patients

Background:

A framework hypothesis for the pathogenesis of psoriasis states that “there is an aberration throughout the skin of patients with psoriasis that is modified to disease expression by circulating factors.”

Objective:

A question to emerge from this hypothesis concerns whether fibroblasts could be more central to the aberration than other cells of the skin? This article focuses on the modulation of growth of fibroblasts from uninvolved and involved sites of patients with psoriasis as a function of the type of serum in which they are grown.

Methods:

Fibroblasts were generated from normal subjects and from involved and uninvolved sites of six untreated psoriatic subjects and their growth in vitro was assessed as a function of the type of serum (fetal bovine serum, normal human serum, and serum from psoriatic subjects) in which they are grown.

Results:

The data show (a) that fibroblasts from psoriatic subjects, especially from uninvolved sites, have an inherent capacity to proliferate at an enhanced rate relative to normal fibroblasts; (b) that this enhanced proliferation can be augmented by normal human serum and to a greater degree by serum from psoriatic subjects; (c) that ≈ 40% of the enhanced proliferation is secondary to the psoriasis serum phenotype; (d) that ≈ 30% of enhanced proliferation is secondary to the psoriasis fibroblast phenotype; and (e) that the magnitude of these features are independent of the severity of psoriasis, as assessed at the time of donation of biopsies for generation of test fibroblasts or of blood for serum.

Conclusion:

These data support the hypothesis that there is an aberration throughout the skin of patients with psoriasis (enhanced proliferation of fibroblasts in vitro, especially from uninvolved sites) that is modified by circulating factors (serum).

Use of cloned genetically modified human fibroblasts to assess long-term survival in vivo

Because human fibroblasts are easily brought to tissue culture conditions and can be stably transduced with retroviral vectors encoding transgenes ex vivo, genetically modified fibroblasts are frequently considered in strategies to correct disease with gene therapy. This enthusiasm has been dampened by studies showing that transgene expression by genetically modified fibroblasts diminishes with time in vivo, but not in vitro, for reasons that are unclear. We elected to study this problem using cloned human fibroblasts that had been cloned by limiting dilution and stably transduced with a retroviral vector encoding lacZ ex vivo. These were seeded onto a nonbiodegradable nylon matrix that was transplanted to nude mice. Transgene expression was followed prospectively by histologic exam. Data show that human fibroblasts can withstand the pressure of cloning by limiting dilution. In addition, they can be passaged from 10 to > 20 times, and > 1 x 10(20) of genetically modified fibroblasts can be generated as progeny of one cell. Loss of transgene expression by the cloned genetically modified fibroblasts in vivo occurs in an orderly and progressive fashion, but is not complete by 4 months. Neither the loss nor the persistence of expression appear to be random. These observations are most compatible with the thesis that a major cause of the loss of transgene expression in vivo is secondary to apoptosis of the genetically modified fibroblast. Loss of expression of transgenes in senescent genetically modified fibroblasts occurs more rapidly than in their presenescent counterparts in the age-neutral, in vivo setting of the nude mouse.

Sustained production of human transferrin by transduced fibroblasts implanted into athymic mice: a model for somatic gene therapy

Somatic gene therapy has been proposed as a means of treating inherited diseases involving defective or absent plasma proteins, viral diseases, and cancer. Introduction of the gene of interest into fibroblasts and implantation of these genetically modified fibroblasts using a skin equivalent system may be an attractive model for gene therapy because skin fibroblasts are easily obtained and propagated in culture. This study evaluated expression of the gene for human transferrin (hTf) by genetically modified fibroblasts in vitro and in vivo. NIH 3T3 fibroblasts, which form non-metastasizing tumors in athymic mice, were transduced with a retroviral vector encoding hTf. The transduced cells were cloned by limiting dilution and hTf production by the cloned cells measured. Two clones of cells producing high levels of hTf were used to seed collagen-coated nylon matrices, which were maintained in culture for up to 53 d. The rate of synthesis of hTf by the seeded matrices was constant after 22 d in vitro. Matrices seeded with cloned, transduced cells were implanted subcutaneously into seven athymic mice, and plasma levels of hTf were assessed biweekly. In all animals, the plasma level of hTf was detectable at week 6 after implantation. Levels of hTf remained elevated in the animals until the implants were removed at week 12. At week 10, the level of hTf in the plasma correlated with tumor volume in tumors less than 2000 mm3 in size. The half-life of hTf in the mice was 39.5 h. In this model, gene expression did not decline for the 12-week observation period.

Genetically modified skin to treat disease: potential and limitations

Molecular definition of disease at the level of the gene and advances in recombinant DNA technology suggest that many diseases are amenable to correction by genes not bearing the defective elements that result in disease. Many questions must be answered before this therapy can be used to correct chronic diseases. These questions fall into safety and efficacy categories. Experience with transplanting cellular elements of skin or skin substitutes (defined as skin that possess the cell types and a dermal structure to develop into a functioning skin) to athymic rodents is considerable and is seen as a system where these questions can be answered. This paper reviews these questions and presents our early analysis of genetically modified cells in skin substitutes in vivo and in vitro. Experimental data demonstrate that both a matrix of woven nylon, housing a fibroblast generated collage, and dead dermis can be utilized to shuttle genetically modified human fibroblasts from the laboratory to an in vivo setting. Genetically modified fibroblasts do not migrate from the shuttle to the surrounding tissue. The survival of significant numbers, approximately 70%, of genetically modified fibroblasts for at least 6 weeks in these shuttles, supports this general approach as having clinical utility. It is also concluded that skin substitute systems can be used to generate a genetically modified skin in vitro that has the capacity to develop into functional skin in vivo. Further, as genetically modified keratinocytes differentiate there is increased production by the transgene, supporting the concept that keratinocytes have true potential as shuttles for therapeutic genes. This work demonstrates that transplantation of systems containing genetically modified cells of the skin can be used to experimentally define many aspects of gene therapy using skin before this technology is taken to the clinic. Examples include determining the effect of gene transduction and expression on structure and function of the genetically modified skin as well as on distant skin and an assessment of the translational capacity of the transgene as function of time and cell number.

Health education: what can it look like after health care reform? 1993 SOPHE presidential address

In the fall of 1993 the plans for the Health Security Act were unveiled: health education was referenced no fewer than 18 times. This 1993 SOPHE Presidential Address examines the role of health education under the plans for and principles of health care reform. As Bill Clinton stated, "an intensified health education system must be designed to educate and encourage the American people to change behavior that results in ill health and high costs." It is argued that health education has been demonstrated to be effective at reducing risk behaviors associated with each of the leading causes of death. Likewise health education should, can, and does play a role in each of the health goals and objectives for the year 2000. Health reform provides new opportunities to invest in prevention, public health and health education--not only in medical care settings--but in schools, at worksites, and in the community. Health education in these settings can help create supportive environments that make healthy choices the easy choices, ensuring that health reform can succeed.

Monitoring the exposure of "America Responds to AIDS" PSA campaign

The "America Responds to AIDS" campaign is the focal point of an integrated mass communications system for AIDS education and information dissemination developed by the National AIDS Information and Education Program of the Centers for Disease Control. Television and radio public service announcements are an integral part of the campaign. One measure of their success is the extent to which they are aired on both national and local levels. Since 1987, the total dollar value for air time donated to the "America Responds to AIDS" campaign is more than $65 million, representing 47 percent of all donations of air time for AIDS public service announcements. These results suggest that the campaign has been successful in reaching a large proportion of the public.

The menopausal transition: guidelines for researchers

We believe that the menopausal transition can be eased for women if they have information about normal changes they can anticipate. Until now, research on the subject of menopause has been fragmented and flawed, in large part because an "oppositional approach" to the study of menopause has pitted biology against culture and has slowed progress toward a more fruitful interactive approach. Failure to agree on basic definitions has contributed further to fragmentation. Future research efforts must employ healthy, non-clinical samples and prospective designs that will avoid recall problems. Women must be at the center of this research, as respondents whose experiences and interpretations of these experiences become the focus of study. It is the normalcy of menopause that remains undocumented (Voda & George, 1986). When research has identified a range of experiences common to the menopausal transition for healthy women, it will be possible for aging women and their health care providers to make accurate assessments of their individual patterns of change. It is anticipated that studies will document a wider range of changes as normal than is currently accepted, perhaps reducing the number of interventions occurring when pathology is identified incorrectly. Studies with a bi-directional focus will make possible an understanding of the mutual influences of biology and culture on premenopausal women's changing experiences. Knowledge of which symptoms are inevitable conditions of hormonal shifts and which are not will remove the burden of ignorance from women and empower them to better cope with this life stage.

Approach for and assessment of interactive communication via cytokines of cellular components of skin

Structure and function of skin are dependent upon interaction of the cells and matrix components that are unique to skin which, in turn, are dependent upon an interactive message system of cytokines acting over distance. Our laboratory has utilized a system which is sufficiently complex to permit a component of the skin to mature into a functional unit that can be indirectly influenced by cell types inherent to the skin, message over distance. The system, human epidermal cells, maturing into an epidermis on an overlying Millicell-HA membrane in the presence of normal fibroblasts or peripheral blood mononuclear cells in a lower chamber has been used to assess the role of interactive cytokines in skin. Data demonstrate: (a) normal fibroblasts enhance the outgrowth and induce a more organized phenotype in squamous cell carcinoma cells; (b) keratinocytes enhance fibroblast proliferation while squamous cell carcinoma cells suppress fibroblast proliferation, and (c) both activated and nonactivated mononuclear cells affect the outgrowth and organization of the squamous cell carcinoma cell line. It is concluded that cells of the skin, by their mediators, do affect the growth of one another in a highly interactive way.