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PubMed2004

The role of hypothermia and drowning in commercial fishing deaths in Alaska, 1990-2002.

OBJECTIVES: To describe the patterns associated with cold-water immersion and drowning in commercial fishermen in Alaska from 1990 through 2002. STUDY DESIGN: This is a retrospective study using data from the Alaska Occupational Surveillance System (AOISS), a database with records from all occupational mortalities occurring in Alaska from 1990 on. METHODS: We extracted and analyzed all records describing deaths from drowning or hypothermia to commercial fishermen in Alaska from 1990 through 2002 that were registered within AOISS. We also used a subset of records from AOISS to compare use of Personal Flotation Devices (PFDs) between the target population and survivors of fatal events. RESULTS: There were 228 deaths resulting from cold-water immersion and subsequent drowning in the target population for the time period studied. Victims were far less likely to have used PFDs than were survivors of events where cold-water drowning occurred. CONCLUSION: The strong protective association seen with the use of PFDs, particularly immersion suits, in surviving cold-water events indicates that many of the events that led to deaths in the target population could well have been survivable.

Accidents, Occupational↗
PubMed1987

Predictors of atherosclerosis in the Honolulu Heart Program. II. Adjustment for autopsy bias.

Although autopsy is considered the final word on many medical questions, there has long been concern over possible bias in inference about a living population from analysis of autopsy material. Focus of the present paper is on the relationship between results obtainable only at autopsy and risk factors recorded as part of a prospective study of the entire "target population." Since pathologies are sure to be overrepresented in an autopsy sample compared to the target population, the dependence of autopsy scores upon risk factors may be distorted in the autopsy sample. The present paper proposes a method of adjustment for this bias. When both autopsy sample and target population can be stratified by major disease categories, under certain assumptions of equal effect, adjustment similar to the direct method for age adjustment may be applied. If, in addition, dependence can be characterized accurately by linear regression of both autopsy score and disease category frequency onto risk factors, then a very convenient calculation produces adjusted regression coefficients. This "parametric" method usually provides the most convenient results, with the greatest statistical power.

Analysis of Variance↗
PubMed1995

Readiness of older adults to stop smoking in a televised intervention.

Smokers aged 60 and older who enrolled in a televised smoking cessation program were compared with older smokers in the target population, using data from telephone interviews. Multiple logistic regressions identified factors that differentiated older smokers at various stages of readiness to quit. Within the target population, smokers planning to quit someday (N = 238) were more likely to have had greater concern about health effects of smoking and perceived a stronger desire by others for them to quit than smokers with no such plan (N = 127). Compared with older smokers in the target population who were planning to quit someday, program registrants (N = 95) perceived greater severity of lung cancer, had greater concern about the health effects of smoking, perceived greater reduction of lung cancer risk from quitting, and had more determination to quit. These findings indicate important factors according to the stage in the smoking cessation process that must be considered when intervening with older smokers.

Aged↗
PubMed1992

On content of practice. An Icelandic multicentre study, population, practices and contacts.

To establish data on the content of Icelandic family practice, a prospective practice audit was made of all Icelandic health centres with computerized contact data from 1 January to 31 December 1988. The study comprised 17 community health centres in Iceland and their target populations, 13 rural and four urban. The main subjects for study were population characteristics, practice sizes, types of health care providers, and contacts. The study population, 50,865 subjects, comprised 20.2% of the Icelandic population. Rural and urban populations were different and are described separately. The 17 health centres had a mean of 1,152 subjects/doctor. The target population had a total of 257,188 contacts: 155,526 rural contacts, 5.1/subject (3.3 office-, 1.1 phone-, and 0.4 home-contacts); 101662 urban contacts, 5.1/subjects (2.8 office-, 1.6 phone-, and 0.4 home-contacts). During 1988, 88.9% of the rural target population made contact. These data are comparable to data from other countries; the observed office and home contact rates were similar, but phone-calls were more frequent. Computer systems in family practice provide a feasible way to collect data on a regular basis for epidemiological purposes and for performance review.

Community Health Centers↗
PubMed2000

Cervical cancer screening in Austria.

Austria's target population of women aged 20 years and over consists of 3 million people. There is mainly opportunistic screening, except in one county with a target population of 120000, in which organised screening has been practiced for several years. There are approximately 1.5 million smears annually, exclusively taken by gynaecologists. The recommended screening interval is 1 year. The slides are screened by MTs with a maximum workload of 12000 smears annually in 65 laboratories, mainly headed by pathologists. As shown by Vutuc and colleagues (Wien Klin Wochenschr 1999, 111, 354-359) the opportunistic screening system covers 60% of the Austrian target population leaving an unsatisfactorily high rate of underserved, mainly postmenopausal, women. Nevertheless, the cervical cancer mortality rate could have been decreased to one third during the past 40 years.

Adult↗
PubMed2005

Upsurge in neonatal tetanus in Benin City, Nigeria.

BACKGROUND: Neonatal tetanus was on the decline from mid 1970's to mid 1990's due to the various efforts by many governments of the developing countries and such agencies as World Health Organisation (WHO) and United Nation's Children's Fund (UNICEF). However recently there appear to be an increase in neonatal tetanus despite these interventions leading to increasing neonatal morbidity and mortality. OBJECTIVE: To study the upsurge in neonatal tetanus despite the various interventions, examine possible causes responsible for it and proffer suggestions for eliminating neonatal tetanus by new target date of 2005 set by World Health Organisation. DESIGN: A prospective study. SETTING: The study was done at the University of Benin Teaching Hospital, Benin city and Modic Medical Centre, a private paediatric hospital in Benin City, Nigeria between January 1997 to December 2001. SUBJECTS: In 1996, it was noticed that cases of neonatal tetanus had increased suddenly among the total admissions. Morbidity and mortality among the under six months children had also increased and about ten percent of it was due to neonatal tetanus. It became imperative therefore to determine the magnitude of this problem. Consequently, cases of neonatal tetanus admitted to Special Care Baby Unit (SCBU) of the University of Benin Teaching Hospital and the Intensive Care Unit (ICU) of the Modic Medical Centre, a private paediatric hospital in Benin over a five year period January 1997 to December 2001 were examined. One hundred and fifty three tetanus cases were recorded during the period comprising 87 (56.9%) males and 66 (43.1%) females. RESULTS: The annual incidence in UBTH was 6.9% (99/1425) and 5.3% (54/1021) in Modic Centre. Forty three point eight percent (67/153) survived while 56.2% (86/153) died. There was a yearly increase in incidence of neonatal tetanus of total neonatal admissions. Average age on admission was 8.8 days and incubation period was 5-22 days. Only 40 (26.1%) did not have any antenatal care. Eighteen of the 40 (45%) mothers who had antenatal care had two doses of tetanus toxoid only. Many of the mothers were ignorant about immunisation, feared about the consequences of immunisation, some got disenchanted with it because of the out of stock syndromes associated with the vaccines whenever they visited the health centres. Some of them did not even know about antenatal care. CONCLUSION: Problem identified included lack of awareness of antenatal services among the target population, under utilisation of antenatal service, non immunisation with tetanus toxoid vaccines, negative cultural beliefs, primordial cord care, lack of economic and decision making empowerment of the target population and lack of government commitment towards elimination of neonatal tetanus. The following recommendations which may lead to elimination of Neonatal Tetanus were made: Strengthening school health programmes, intensive mobilisation and advocacy, regular availability of tetanus toxoid vaccines, empowerment of the target population, training and retraining personnel including Traditional Birth Attendants and increasing commitment by various tiers of government.

Attitude to Health↗
PubMed2006

Use of population-weighted Estimated Average Requirements as a basis for Daily Values on food labels.

In both Canada and the United States, nutrition labeling is now mandatory for most packaged foods. The labeling is intended to help consumers select foods that can contribute to a healthful diet, but current label values are based on outdated notions of nutrient requirements. The Committee on Use of Dietary Reference Intakes in Nutrition Labeling has recommended that the reference values used for nutrition labeling be based on a population-weighted Estimated Average Requirement (EAR) for any nutrient for which requirements have been estimated. This value approximates the median of the distribution of nutrient requirements for individuals who are members of the target population for food labels. It provides the most scientifically valid, single point of comparison for an appraisal of the probable contribution of a specific food to the overall nutrient needs of individuals in the target population. In contrast, a reference value based on a population coverage approach would understate the nutrient contribution of the food item relative to the requirements of the vast majority of individuals in the target population and thus offer misinformation rather than positive guidance to the consumer.

Adolescent↗
PubMedDate not supplied

Activity level and process indicators of organised programmes for cervical cancer screening in Italy.

The target population of Italian organised cervical screening programmes that were active (that invited at least 1000 women) in 2004 was 10,206,741 women, corresponding to 64% of the Italian female population in the 25-64 year age range. This proportion was 66%, 83% and 49% in Northern, Central, and Southern Italy respectively. Some 27% of this target population was invited during 2004. Among women invited in 2004, 37.7% had cytology within organised programmes up to April 2005 (46.2%, 36.0% and 26.2% in Northern, Central, and Southern Italy respectively). It must be kept in mind that many women have spontaneous tests that are not registered in organised programmes. Further data on women invited in 2003 were collected as aggregated tables, provided by the local screening registration systems. We obtained data from 99 programmes with an overall target population of 8,698,480 women. At least 70% of programmes could provide data for most indicators. Overall, 3.2% of smears were classified as unsatisfactory. At a national level 6.6% of women was advised to repeat cytology and 62.2% of them actually did. However 13/71 programmes recommended repeat cytology to > 10% of screened women. Nationwide, 2.6% of screened women were referred to colposcopy. The Positive Predictive Value (PPV) of detecting a biopsy-proven Cervical Intraepithelial Neoplasia grade 2 (CIN2) or more severe among women referred because of cytology "Atypical Squamous Cells of Undetermined Significance" or more severe was 15.0%. There was however a relevant variability: 9/90 programmes had a referral rate >5%. There was an inverse correlation between referral rate and PPV. Compliance with recommended colposcopy was 86% (91% among women with high-grade cytology). The raw detection rate of biopsy-proven CIN2+ was 2.7 per 1000 screened women (2.8 per 1000 when standardised on the Italian population). In conclusion, during 2004 there was a further increase of active organised programmes, especially in Southern Italy. This is important, as spontaneous activity is known to be low there. Despite this rise, quality indicators were stable. However, in a few programmes, the use of excessively broad criteria in the interpretation of cytology decides an excessively high rate of referrals to colposcopy.

Adult↗
PubMedDate not supplied

[An epidemic of meningococcal meningitis in the region of Savanes in Togo in 1997: research and control strategies].

Neisseria meningitidis is responsible for high levels of morbidity and mortality in the developing countries of the African meningitis belt. There are frequent meningococcal meningitis epidemics in this region affecting almost 1,000 people in every 100,000 (1%). Epidemics generally occur during the dry season but the interval between epidemics is variable (between 2 and 25 years). The reasons for these recurrent epidemics are unclear. There is a safe and effective polysaccharide vaccine against meningococci A and C. Unfortunately, the immunity it provides decreases with time, especially in young children (aged less than 5 years) and it is thus not included in the Expanded Program on Immunization (EPI). WHO recommends mass vaccination using a threshold approach. This control strategy is effective if vaccination begins very soon after the threshold is crossed. There was an outbreak of group A meningococcal meningitis in the Savanes region of northern Togo in December 1996. The national surveillance system put out an alert and control measures were implemented. These involved improvement of the surveillance system, and containment immunization in villages for early cases followed by a mass immunization campaign in the entire region, distribution of oily chloramphenicol and decentralized case management. The target population for mass vaccination included everyone older than 6 months of age living in the Savanes region. The aim was to vaccinate at least 80% of the target population. There were 2,992 cases of meningitis reported in the Savanes region between December 1996 and May 1997 (in a population of about 500,000). This gives a cumulative incidence rate of 581 per 100,000 population. The epidemic was bimodal, with the first peak in the number of cases occurring at the end of January and the second peak in March. There were 60,700 vaccinations in two of the four districts of the region in December and January, as part of the containment strategy and 346,469 vaccinations in the four districts of the region during February, as part of the mass vaccination campaign. By the end of the mass campaign, 67.3% of the target population in the region as a whole had been vaccinated, with 61% vaccinated in the Kpendjal district and 78% in the Oti district. There was an increase in the number of cases 2 weeks after the end of the mass vaccination campaign. This was attributed to the inadequate level of vaccination achieved. Only 52% of the urban population of Dapaong were vaccinated. The national surveillance system put out an alert early in the epidemic. The intervention was planned and adapted according to the progression of the epidemic, and national and international efforts were well coordinated. This emphasizes the importance of a rapid reaction from the surveillance system and of the choice of strategy for dealing with meningitis epidemics in sub-Sahelian Africa.

Adolescent↗
PubMed1976

The relative effectiveness of a medical hospitalization program vs a feedback-behavior modification program in treating alcohol and drug abusers.

There is a sparsity of studies specifying the relative effectiveness of different types of treatment programs in treating a similar target population of drug and alcohol abusers in the same locale. In this paper, two drug and alcohol rehabilitation programs are described and their relative effectiveness compared in treating similar target populations. The first treatment program evaluated is a medically oriented hospitalization program and the second is a short-term therapeutic community program, called "Feedback" because it is structured on the basis of a collection of feedback and behavior modification principles and techniques. Both programs were implemented by basically the same staff and both treated similar target populations of multiple drug abusers and alcohol abusers during comparable time periods. The results indicated that the feedback program was significantly more effective in rehabilitating multiple drug abusers (nonheroin abusers) than the hospitalization program with regard to three criteria (return to work for 60 days, perform effectively according to the supervisor, and control drug or alcohol problems). But both programs were equally effective in rehabilitating alcohol abusers (problem drinkers and alcoholics).

Alcoholism↗
PubMed1991

[The status of colon cancer screening].

Recent research into an early detection of colorectal cancers shows a surprisingly great progress. In 1991, Mr. Hisamichi reports that a mass screening method for colorectal cancers through immunological fecal occult blood tests may result in fewer fatalities due to colorectal cancers. This paper describes the current situations and future prospects of UICC workshops in principle, as undermentioned in 1 through 6. 1. The target population should be clearly defined and selected in such a way that, given the likely sensitivity and specificity of the test, an acceptable predictive value will be achieved. 2. As far as possible, the target population should be limited to those at particular risk of the disease in order to give a reasonable prevalence of detection when such individuals at risk can be identified. 3. There should be a reasonable expectation of reaching the target population and of achieving reasonable compliance in response to invitations to attend. The expected level of compliance should be stated. 4. There should be a reasonable expectation that recommendations for further diagnostic evaluation will be complied with by individuals who have a positive test. 5. There should be an agreed-upon policy on the classification of borderline abnormalities and also on their management, as well as on recommendations for their follow-up. 6. There should be a reasonable expectation that recommendations for appropriate management of lesions discovered by a screening program will be complied with both by the individual with the lesion and by the physicians responsible for his health care.

Colonic Neoplasms↗
PubMed2001

Target cell populations of human immunodeficiency virus type 1 in peripheral blood lymphocytes with different chemokine receptors at various stages of disease progression.

We studied the distribution of human immunodeficiency virus type 1 (HIV-1) DNA in CCR5-positive and -negative peripheral blood lymphocyte populations in HIV-1-infected individuals. While HIV-1 DNA in the CCR5-positive population showed no correlation with CD4 count, the increase of total HIV-1 DNA with lower CD4 count was mainly contributed by the increase of HIV-1 DNA in the CCR5-negative population. This might indicate the change in coreceptor usage from CCR5 to CXCR4 in later stages of disease progression. However, some of the samples with a high viral DNA load in the CCR5-negative population did not have any characteristic of the V3 loop sequence that is compatible with CXCR4 usage or the syncytium-inducing (SI) phenotype. We also did not find any known characteristic change predictive of the SI phenotype in V1 and V2 sequences. Our findings showed that there might be a shift in target cell populations during disease progression, and this shift was not necessarily associated with the genetic changes characteristic of CXCR4 usage.

Amino Acid Sequence↗
PubMedDate not supplied

Smokeless Tobacco Reduction Program.

To reduce the incidence and prevalence of oral cancer, the Smokeless Tobacco Reduction Program will consist of a mass media campaign, public oral screening, and a week-long school health program for 350 students in the seventh, eighth, and ninth grades in Willows, Glenn County, CA. Mass media will include radio, television, newspapers, posters, and literature. The program will use resources of the public health department and junior high school; it will also depend on 8 teachers and 25 peer leaders, all trained in the program. Reducing the use of smokeless tobacco is the program's objective. If that goal is achieved, the program will reduce oral cancers in the target population by 75 percent within 10 years. The incidence of leukoplakia will be reduced by 50 percent within 3 years of the end of the program. By the end of the program, 90 percent of the target population will be able to identify warning signs of oral cancer and leukoplakia, and 85 percent of the students will no longer believe that use of smokeless tobacco is less harmful than smoking. As a result of the program, use of smokeless tobacco will not be viewed favorably by 80 percent of the target population; usage will be regarded as socially unacceptable.

Adolescent↗
PubMed2006

Palliative care program effectiveness research: developing rigor in sampling design, conduct, and reporting.

Research on palliative care presents some unique sampling challenges. The purpose of this paper is to articulate the sampling challenges that palliative care researchers face during phases of study design, conduct, and the reporting of results. Challenges include identifying a target population, avoiding selection bias in the face of clinician and patient denial of serious illness, developing eligibility criteria for a seriously ill population, minimizing high patient refusals due to illness, and accurate reporting of all screened and eligible participants. These challenges are explored within the context of a randomized clinical trial testing a palliative care intervention. Suggestions for improving scientific rigor in sampling design include 1) defining a target population that is consistent with research goals; 2) identifying eligibility criteria that are objective and understandable to clinicians to yield the desired sample; and 3) reporting results about the target population, sample eligibility/exclusions, and participation using standardized criteria.

Biomedical Research↗
PubMedDate not supplied

Use of process evaluation to guide health education in Forsyth County's project to prevent cervical cancer.

The Forsyth County, NC, Cervical Cancer Prevention Project is a 5-year public health education program designed to increase the proportion of black women in the county who are appropriately screened for cervical cancer. In this paper, the authors report on process evaluation--the procedures used to monitor the intervention and to insure that the target population was reached with a high quality, community-based health education program. A system that encompasses documentation of program activities, interviews with women in waiting rooms of primary care providers, semiannual interviews with a panel of approximately 100 women from the target population, and telephone followup with participants in direct education workshops was designed and implemented. Through October 1990, more than 2,100 interviews had been conducted. Data from these activities have facilitated continued development and refinement of educational materials, provided guidance for developing new strategies for reaching the target population, and provided continuous feedback to program managers to allow monitoring the impact of all program activities.

Black or African American↗
PubMed1999

Using 3 data sources and methods to shape a nutrition campaign.

The first objective of this research was to define a target population of African-American women more clearly. The second was to provide specific information about the needs and preferences of that population in order to design an effective, culturally relevant, community-based communications campaign to promote more healthful lifestyles. Data collection and analysis included the following: interviews with 10 community nutritionists and the director of the State Office of Nutrition, 6 focus groups with a total of 47 members of the target population, and direct observation and documentation of key community resources. This approach, called "triangulation," permits more in-depth understanding of issues, provides different perspectives on the problem, and helps ensure accuracy of conclusions. Interviews with nutritionists identified young African-American women as the appropriate target population for the campaign. These interviews and the focus-group discussions confirmed the acceptability of higher weight and better body-esteem among African-American women than among white women. Both the nutritionists and the focus-group members identified the need and desire for information and skills related to food preparation and provided specific direction for program content. Community observation confirmed the need for food markets with merchandise of consistently high quality, especially in the fresh and frozen produce sections. Observation also helped identify community services and programs. The 3 sets of data, which augmented a comprehensive literature review, provided a firm foundation for the campaign's design and development. Dietitians and nutritionists working in community settings can use triangulation to gain a better understanding of their populations in order to develop more effective interventions.

Adolescent↗
PubMed1995

Target cell populations in virus-associated hepatocarcinogenesis.

Studies on the natural course of virus-associated hepatocellular carcinoma (HCC) in high risk areas, particularly hepatitis B virus (HBV), have shown a stage of persistent liver cell hyperplasia characterized by a low level elevation of serum alpha-fetoprotein (AFP). We have recently identified a population of epithelial cells with distinct structure and expression of cytokeratin and AFP in non-neoplastic liver tissues from humans with HBV-associated HCC. These cells were characterized by oval nuclei, scant pale cytoplasm, small cell size, and cross-reactivity to a monoclonal antibody against rat oval cells. These human epithelial cells, putative human oval-type cells, stained strongly positive for cytokeratin 19 and displayed considerable heterogeneity in AFP and albumin expression. These findings suggest that a cell population structurally and phenotypically similar to oval cells seen in the early stages of chemical hepatocarcinogenesis in the rat is also present in humans in regenerating liver lesions observed in HBV-associated HCC. Hepatitis B surface antigen (HBsAg) was detected in 69, 81, and 85% of oval-type cells, transitional cells, and hepatocytes, respectively, but not in bile ducts or ductular cells. Also, high levels of expression of transforming growth factor alpha (TGF-alpha) were frequently seen in oval-type and transitional cells expressing HBsAg. These data suggest the possibility that oval-type cells are a target cell population for HBV infection; in the presence of elevated TGF-alpha expression, these cells may constitute a progenitor population for human HCC.

Animals↗
PubMedDate not supplied

Teen Peer Outreach-Street Work Project: HIV prevention education for runaway and homeless youth.

Each year, there are approximately 2 million homeless and runaway youths in the United States. On any given night, there are 1,000 homeless youngsters living on the streets of San Diego, CA. Homeless young people are commonly involved in one or more of the following activities that place them at risk for HIV infection--unprotected sexual intercourse, needle-sharing in the use of injectable drugs, sex with someone who injects drugs. The Teen Peer Outreach-Street Work Project trains teen peer educators to work in three existing San Diego youth service programs with street outreach staff members to provide HIV prevention education and referral services to San Diego's homeless youth. Selected teens from the target population also participate in street-based case management that provides skill development to bring about behavioral and attitudinal changes. An HIV outreach program cannot stand alone and is most successful if it is integrated with services that meet the basic needs of its clients. In the three participating youth service programs of the Teen Peer Outreach-Street Work Project, food, clothes, and shelter information are provided. There are shelters in two of the three programs that become places where HIV educational messages, delivered on the street, can be reinforced. Immediate and concrete assistance can be offered to homeless youth. Low literacy among the target population presents a significant obstacle to adequate and appropriate HIV prevention education for homeless youth. Currently, education materials that specifically target homeless youth do not exit. The outreach street project is being expanded to develop materials for homeless youth with low literacy levels. Teen peers will be used to facilitate structured focus groups composed of members of the target population. Focus groups will be used in concept development, product development, and evaluation of draft products.Because the project is unique.in San Diego, it addresses an unmet need, reaching a population often missed by traditional HIV education efforts.

Adolescent↗