Moving Upstream

Moving Upstream-Health Extension and Primary Care.

Health extension programs represent an opportunity for practice-based research networks (PBRNs) and primary care practices to develop collaborations reaching beyond the clinic walls to address the upstream social determinants of health and engage in community-based research. The Health Extension Regional Officers (HEROs) program at the University of New Mexico described in this issue of the JAB...

Moving upstream in the war on WNTs.

Cholangiocarcinoma is a relatively rare cancer of the biliary ducts that is highly refractory to treatment. The factors that drive cholangiocarcinoma are poorly understood, though chronic liver fluke infection is a risk factor for disease. In this issue of the JCI, Boulter and colleagues demonstrate that the WNT/β-catenin signaling pathway is upregulated in patients with sporadic cholangiocarci...

Moving Upstream: A Workshop on Evaluating Adverse Upstream Endpoints for Improved Decision Making and Risk Assessment

An initial step in hazard and risk assessment for an environmental contaminant is to identify the adverse effects resulting from exposure to a contaminant. What constitutes an adverse effect is not defined in environmental health legislation but is broadly defined in Federal risk assessment guidelines. For example, the EPA Integrated Risk Information System defines an adverse effect as “a bioch...

Meeting Report: Moving Upstream—Evaluating Adverse Upstream End Points for Improved Risk Assessment and Decision-Making

BACKGROUND Assessing adverse effects from environmental chemical exposure is integral to public health policies. Toxicology assays identifying early biological changes from chemical exposure are increasing our ability to evaluate links between early biological disturbances and subsequent overt downstream effects. A workshop was held to consider how the resulting data inform consideration of an ...

Moving Upstream: The Merits of a Public Health Law Approach to Human Trafficking