Reducing child poverty by promoting child well-being: Identifying best practices in a time of great need
ABSTRACT Child poverty in the United States persists despite a range of social services designed to reduce poverty rates and improve the economic self-sufficiency of families. The economic downturns resulting in job losses and the housing crisis have converged to create a new group of families who were managing to remain out of poverty prior to the recession but are now slipping into poverty, putting additional strain on services. In light of these pressing issues, this article synthesizes the literature examining child poverty to take a long-range view of the relationship between economic strain, system involvement, and impacts on children and the systems attempting to serve these children. The effectiveness of various policy and program efforts aimed at reducing child poverty rates and/or ameliorating the negative effects of living in poverty is reviewed. The article concludes by suggesting a major shift in focus from reducing child poverty as a singular goal to a comprehensive approach to promoting child and family well-being.
Article: Pancreatic endocrine tumors.[show abstract] [hide abstract]
ABSTRACT: Pancreatic endocrine tumors are rare but have long held a fascination for clinicians because of the physiologic derangements that they can cause, and the dramatic corrections that can be achieved by appropriate management. In the year reviewed in this article, the literature again demonstrated the ongoing interest and research in this area. In particular, the areas of gastrinoma, insulinoma, and multiple endocrine neoplasia type 1 have received careful attention.Current Opinion in Oncology 02/2001; 13(1):52-6. · 4.03 Impact Factor
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ABSTRACT: Somatostatin receptor scintigraphy (SRS) has been used for the detection of gastroenteropancreatic (GEP) tumors. This study evaluates the clinical impact of SRS in GEP tumor detection and its therapeutic implications on patient management. We prospectively studied 160 patients with biologically and/or histologically proven GEP tumors. Before SRS, patients were classified into three groups: gastrointestinal (Group 1; n = 90) patients without known metastases; (Group 2; n = 59) patients with metastases limited to the liver; (Group 3; n = 11) patients with known extrahepatic metastases. The scintigraphic data were compared to the radiological findings. In Group 1, without known metastases, conventional imaging detected 53 primary sites in 44 patients: SRS was positive in 68% of these sites and discovered 4 additional primary tumors in 3 patients and 16 metastases in 14 patients. Conventional imaging was negative in 46 patients: SRS discovered 47 new sites in 36 patients. In Group 2, SRS confirmed liver metastases in 95% of patients and discovered 45 new sites in 36 of these patients. In Group 3, SRS disclosed 11 new sites in 7 patients. These results modified patient classification in 38 cases (24%). Surgical therapeutic strategy was changed in 40 patients (25%). Somatostatin receptor scintigraphy improves tumor detection, has major clinical significance and should be performed systematically for staging and therapeutic decision making in patients with GEP tumors.Journal of Nuclear Medicine 07/1997; 38(6):853-8. · 5.77 Impact Factor
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ABSTRACT: Although carcinoid tumors of the gastrointestinal tract are relatively common, their occurrence in the esophagus is exceedingly rare. The authors report a case of an atypical carcinoid presenting in the cervical esophagus of an 82-year-old woman. The tumor was studied with routine, silver, and immunohistochemical techniques for cytokeratin, chromogranin, and various secretory products. In addition, the literature was reviewed for carcinoid tumors of the esophagus and the findings summarized. The esophageal tumor showed focal necrosis, atypical cytologic features, and increased mitotic activity. It stained diffusely for chromogranin and focally for serotonin; thus it was considered an atypical carcinoid. The patient was free of disease 9 months after excision. On review of the literature, 13 additional cases of esophageal carcinoid were found. The average age of the patients was 60 years with a male predominance of 6:1; the most common presenting symptoms included dysphagia and weight loss. The majority of tumors occurred in the submucosa of the lower esophagus, and ranged in size from 1 to 12 cm. All patients except one had surgical treatment, three received adjuvant radiotherapy or chemotherapy. Although follow-up was limited, survival correlated with stage; seven of ten Stage I or II patients were disease free whereas three of four Stage III or IV patients had died of disease; the fourth patient is alive with brain metastases. Esophageal carcinoid tumors are exceedingly rare neoplasms. They usually occur in the lower esophagus of males who present with dysphagia. Survival statistics are limited, but appear best correlated with disease stage.Cancer 05/1997; 79(8):1476-81. · 5.20 Impact Factor