Using technical assistance to bridge the gap between policy, research, and implementation.

This case study on the Children, Youth, and Families At-Risk (CYFAR) Professional Development and Technical Assistance (PDTA) Center highlights a government-funded entity's efforts to provide technical assistance to federal grantees of the CYFAR Sustainable Community Projects (SCP) grant program. The PDTA Center aligns with and supports components of an evidence-based system for innovation support. Through these components, the system provides targeted tools, training for CYFAR SCP grantees, dedicated technical assistance in the form of coaching, and quality improvement support through the evaluation of available program data.

Including Pregnant Women in Clinical Research: Practical Guidance for Institutional Review Boards.

Scanty evidence exists about the safety and effectiveness of drugs-and of their efficacious dosing-that women may need to treat acute and chronic health issues during their pregnancies. This lack of evidence puts pregnant women and their fetuses at risk of harm from the use or avoidance of drugs during pregnancy. In light of the protectionist approach in regulations governing research with pregnant women and fetuses, trial sponsors, researchers, clinicians, and institutional review boards (IRBs) have been reluctant to include pregnant women in clinical drug trials, applying ethical reasoning for exclusions that reflects a default exclusionary approach. Yet in recent years, many clinicians, researchers, bioethicists, and professional societies have called for a reexamination of the routine practice of excluding pregnant women from clinical research. This paper proposes a practical approach to an ethical framework for IRBs that supports fair inclusion, rather than routine exclusion, of pregnant women in clinical research. This guidance will aid IRBs in ethically including and appropriately protecting pregnant women in research.

Sexual expression: its emotional context in heterosexual, gay, and lesbian couples.

Much of what is known about emotions and sexuality explores the relationship enhancing qualities of positive affect. This research extends the current literature by focusing on the association between negative feelings and sexual thoughts and experiences in the context of close relationships, controlling for the effect of positive feelings. Specifically, the unique effects of daily negative feelings toward one's partner in general and specific negative feelings (i.e., anger, anxiety, and sadness) on the sexual experience of heterosexual, gay male, and lesbian relationships were explored. Participants completed an initial questionnaire followed by daily diary measures for 14 consecutive days. Positive feelings were positively associated with sexual variables as expected. Negative feelings were associated with increases in sexual behaviors for heterosexual men and women and gay men, but not lesbian women. Sadness showed a unique positive association with arousal, lust, wanted sexual behavior, and sexual behavior for heterosexual men and women and gay men, but not lesbian women. Neither anger nor anxiety was uniquely associated with the sexual experience for heterosexual or same-sex couples.

Transition from tube to oral feeding in the school setting.

PURPOSE: A school-based treatment program for tube-fed children with medically complex conditions and food refusal was implemented to facilitate the children's transition to oral feeding and advance their eating skills. METHOD: The program combined educational and therapeutic goals. It was implemented in a regional public school for children with hearing impairments. A team approach was used. Collaboration with the student's families, medical care providers, personal assistants, and classroom staff was maintained. RESULTS: Detailed case reviews are provided for 2 of the children who completed the program at age 8;1 (years;months) and 7;8 after 29 and 26 months of treatment, respectively. At the end of the program, tube feeding was discontinued; the children were feeding themselves and taking medications orally. One child was using mature eating skills to eat an unrestricted diet; the other was eating a modified diet consisting of a full nutrient drink and limited smooth and lightly textured solids. CONCLUSION: Successful transition to oral feeding and advancement of developmental eating skills were accomplished in a school setting for long-term tube-fed children with medically complex conditions. The program included collaboration with family and medical personnel as well as integrated therapeutic and educational goals.

Tobacco control: consensus report of the National Medical Association.

ISSUES: Tobacco Control remains one of the greatest determinants for reducing the morbidity and mortality of African Americans. OBJECTIVE: To examine the scope and consequences of tobacco use among African Americans and characterize its implications for the National Medical Association physician membership and their patients, and identify policy, education, advocacy and research issues in Tobacco Control for the organization. CONSENSUS PROCESS: Literature review using the MEDLINE database from January 1966 to August 1999 Week 1, searching Medical Subject Heading (MeSH) reading combined with text words "Black" or "African American" and "Tobacco" as a search term, identified 130 articles/110 abstracts published between 1988 and February 1999. The panel selected 61 appropriate articles and a paper summarizing the literature review was developed. The summary paper was used as background material for a formal consensus panel discussion on July 16-17, 1999. Consensus among committee members was reached via mail, fax and e-mail using the summary review paper, annotated bibliographies key informant surveys, and previous NMA resolutions on tobacco control. A formal working session was held on July 16-17, 1999 in which four areas of concentration of issues were determined: Policy, Advocacy, Education and Research. All committee members approved the final report. SUMMARY: Because tobacco control issues in African Americans are both complex and poorly understood, the panel views the NMA's role as pivotal in the coordination of resources and capacity-building to address all four areas identified. Stronger partner-ships with traditional federal and nonprofit agencies associated with tobacco control/advocacy in African Americans as well as nontraditional organizations (i.e., churches, academia, marketing and media organizations) also must occur to strengthen the infra-structure needed to assess needs, design appropriate interventions and evaluate the appropriateness, effectiveness and efficacy of tobacco control efforts in African American communities.