Risk factors research needs

The pharmaceutical industry is much more research oriented than other industries and has to cope with higher risks. Due to the high development cost and long development times, risks must be eliminated as early and consequently as possible. Risk elimination must already start in the research phase and before the expensive industrial development commences. High-risk research projects need much time, thus they must be kept small and have to focus only on the major risk factors. Research projects should be clearly separated - if not physically, at least in mind - from the more rigid and much more expensive development. 

For pharmacists, the message is clear To improve adherence to pharmacotherapy, and hence to improve health outcomes, we must assess each patient individually, then provide targeted interventions that are responsive to his or her unique risk factors and needs (see Fig. 1). Research, such as the American Pharmaceutical Association Foundation s Project ImPACT Hyperlipidemia, has clearly documented the value of pharmacist-led patient care in fostering better adherence and outcomes. 

Polypharmacy is often a consequence of the cascade of problems. A literature review found that polypharmacy continues to increase and is a known risk factor for important morbidity and mortality (Hajjar et al. 2007). The reviewers states that many studies have found that various numbers of medications are associated with negative health outcomes, but more research is needed to further delineate the consequences associated with unnecessary drug use in elderly patients. Health care professionals should be aware of the risks and fully evaluate all medications at each patient visit to prevent polypharmacy from occurring . 

Hence, it appears that hormone replacement can play a role in modifying certain risk factors associated with coronary heart disease in postmenopausal women, but the actual outcomes (heart attack, death) do not seem to be affected significantly by these hormonal interventions. Clearly, continued research in this area is needed to clarify if hormone replacement therapy can help decrease cardiac morbidity and mortality in certain postmenopausal women.60,121... 

The committee s attention to those limitations and uncertainties is important for two reasons. First, full disclosure of limiting factors gives scientists and the public a fuller understanding of the reliability and credibility of biomonitoring results. It provides risk assessors with information needed to characterize risk conclusions fully, as called for by the National Research Council risk-assessment paradigm (NRC 1983 1994). Second, and equally important, the kinds of uncertainty define data gaps for immediate attention and related long-term research needs. 

Depression and Diabetes Mellitus. Patients with chronic medical illness have a high prevalence of major depressive disorder [59], Depression may be three times more prevalent in the diabetic population when compared with its occurrence in nondiabetic individuals [60], In addition, microalbuminuria, hypertension, and hyperinsulinemia are another three independent risk factors for cardiac disease in non-insulin-dependent diabetes mellitus (NIDDM) [61], Nosadini et al. showed that peripheral insulin resistance, hypertension, microalbuminuria, and lipid abnormalities are associated with NIDDM [61], Further, Helkala et al. determined that cognitive and memory dysfunction are associated with NIDDM and explored the disease s relationship with depression, metabolic control, and serum lipids. The results showed that the NIDDM patients had impaired control of their learning processes [62], Obviously, future research examining the causal relationship of depression to the onset on diabetes and the effect of depression on the natural course of diabetes is needed [60]. 

For a long time practical catalysis remained an empirical art rather than a scientific discipline, mainly because the complexity of the catalytic systems obscured the molecular insights needed for their control in a predictive manner. The modern spectroscopic techniques available to the analytical laboratory enable detailed catalyst analysis and in-situ studies. Advanced inorganic and organometallic chemistry and catalyst synthesis (e.g. zeolite synthesis) are also significant. This has changed catalytic practice and has resulted in a considerable reduction of catalyst development times. Nonetheless, in catalysis, accidental discovery and high risk exploratory research are still important factors in innovation. 

Biomarkers can also be used to identify factors that increase the likelihood that an individual will develop disease. This is an important area of research in molecular epidemiology as it becomes more evident that not all risk factors will contribute to disease equally across the human population. Therefore, in order to determine whether an environmental agent is related to disease, those factors that are also required for disease development need to be taken into account. Otherwise, many disease risk factors may go undetected. Examples of susceptibility factors that can be ascertained using biomarkers are some viral infections, which may predispose to specific diseases (for example, HIV infection and Kaposi sarcoma) or HBV infection and liver cancer. Biomarkers can also be used to measure dietary factors that can contribute to disease. The most common susceptibility factor studied using a molecular epidemiological approach are hereditary factors, which are discussed in the following section. 

OCCUPATIONAL AND RESIDENTIAL RISK ASSESSMENT 371 AOELs Versus MOEs 371 Route Considerations 372 Uncertainty and Safety Factor Selection 372 Aggregation and Cumulative Risk Assessment 372 CO-OPERATIVE REGULATORY ACTIVITIES 373 SUMMARY AND CONCLUSIONS 374 Terminology 374 Framework 374 Data Requirements 374 Methodological Guidance 375 Development and Utility of Databases 375 Modeling Initiatives 375 Data Analysis 375 Metric Selection 376 Research Needs 376 Exposure Mitigation 376 Risk Assessment 376 REFERENCES 376... 

Primary prevention strategies that address the risk factors for ischemic stroke can be powerful in reducing the costs of stroke. Many of the stroke risk factors can be modified and some eliminated at very low costs (lifestyle changes), therefore developing risk-factor-reduction strategies may be the most cost-effective measure of all. More research is needed in identifying the cost-effectiveness of other forms of acute stroke treatment. 

Under normal conditions, GFR is submaximal because adaptive increases in single nephron GFR follow loss of damaged nephrons. Sensitized animal models that mimic risk factors commonly found in patients with drug-induced acute renal failure are advisable. This need should stimulate research in the field of safety pharmacology. The choice of the species, strain, and sex of test animals should take into account physiological and/or pharmacotoxicological specificities. 

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