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PubMed1999

Carrier testing program in a high-risk cystic fibrosis population from northeastern Italy. Active recruitment of relatives via probands' parents.

OBJECTIVE: To assess the practicability and monitor the results of an active carrier testing program among relatives of cystic fibrosis (CF) patients. METHODS: Parents of CF patients in the Veneto and Trentino regions of northeastern Italy were asked to help recruit relatives aged between 18 and 45 years for CF mutation testing. RESULTS: Of 409 enrolled CF parents, 59.6% agreed to send to the CF Center family composition data of relatives up to the third degree, and 28.8% recruited relatives to carrier testing, providing names and addresses of those who, being contacted, expressed a willingness to be tested. The participation of parents was higher if they were young and had a child recently diagnosed with CF. Recruiting parents indicated 333 close relatives (59%) for testing. When contacted by the CF Center, 170 of these 333 (51%) attended for testing. The percentage of close relatives who spontaneously asked for the test was 5.4% before the carrier testing program started; it rose to 25.3% following the introduction of the active strategy. CONCLUSIONS: The participation of the parents of CF patients is an important factor affecting the utilization of testing by relatives. Besides this, the influence of a favorable medical and cultural context (participation of gynecologists and family doctors in testing programs, genetic education of the general population) has to be considered.

Journal Article↗
PubMed1988

Developing reliable assessment in case-managed geriatric long term care programs.

Analyses of frail elderly populations and their service needs are increasingly important in shaping future policies for long term care (LTC) financing and service delivery. Because assessment information on elderly LTC clients generates essential data bases on programs and the population, it is important that the data be reliable. This article describes a method for obtaining reliable assessment data in multisite programs involving many clinical assessors. Regular reliability checks showed marked improvement over time and generally high levels of interrater reliability.

Activities of Daily Living↗
PubMed1995

An economic analysis of pregnancy resolution in Virginia: specific as to race and residence.

This study analyses an economic model of pregnancy resolution; that is, a model of the choice by a pregnant woman to abort her fetus or carry it to term. This analysis, using an analytical model derived from the household utility framework, adds to previous research by presenting race- and residence-specific estimates of how individual characteristics, history of abortion, and the community-based factors determine women's choices of giving birth vs. aborting. The main data for estimating the model were drawn from the 1984 vital statistics of all induced abortions and live births in the Commonwealth of Virginia. The major findings indicate that low parental education, high maternal age, previous early abortions, and the availability of abortion providers all significantly reduce the probability of choosing the live birth option. Married status and the availability of family planning clinics significantly increase the probability of the live birth option. The findings also suggest that women's choices between abortion and live birth vary substantially with race (White vs. Black) and residential (urban vs. rural) location.

Abortion, Induced↗
PubMedDate not supplied

[Applicability of the Torrington and Henderson scale].

PURPOSE: To validate the Torrington & Henderson preoperative risk assessment program in the population of surgical patients in an university hospital (Hospital São Paulo, UNIFESP, São Paulo, Brasil). MATERIAL AND METHODS: We evaluated 1162 patients who underwent to major thoracic, upper and under abdominal surgery using the Torrington & Henderson program. The patients were classified in low (785), moderate (317) and high risk (60). All patients were accompanied daily during the postoperative period by the same medical team which assessed the preoperative period, until discharged or died. RESULTS: The postoperative pulmonary complications were present in 6.1%, 23.3% and 35.0% in the low, moderate and high risk respectively. The relative risk to develop postoperative pulmonary complications was 3.8 higher in the patients with moderate risk and 5.7 higher in the patients with high risk. The mortality rate due to pulmonary complications was 1.7%, 6.3% and 11.7% respectively in the patients with low, moderate and high risk. The relative risk to the death was 3.7 higher in the patients with moderate risk and 6.9 in the high risk. CONCLUSION: We concluded that the Torrington & Henderson preoperative risk assessment program can identify in our population patients who will develop postoperative pulmonary complications.

Adolescent↗
PubMed1997

Measurement of apoptosis in heterogenous cell populations.

The increasing interest in programmed cell death has created the need to measure apoptosis in complex cell systems. We have combined the use of fluorescent antibodies with the Hoechst 33342/propidium iodide system in order to quantitate programmed cell death in fractions of heterogenous cell populations. Here we describe the analysis of T-cell apoptosis after ligation of the T-cell antigen receptor by superantigen in vitro and ex vivo. This technique can separate cells according to seven parameters, fluorescence caused by FITC, PE, allophycocyanin, incorporation of Hoechst 33342, PI, forward scatter, and side scatter, and it allows determination of elevated Hoechst 33342 uptake in less than 10% of the cell population.

Animals↗
PubMed2000

A program for the optimization of cyclosporine therapy using population kinetics modeling.

Cyclosporine is one of the most widely used immunosuppressive agents in organ transplantation. Due to large inter- and intra-individual variations, its behavior in the specific patient is still difficult to predict. Dosage optimization is thus mainly performed on a trial-and-error basis. In this paper, we present a new program based on the population kinetics approach, which was designed to help physicians in the difficult task of adjusting patient specific cyclosporine dosing regimens. Dose optimization is carried out by model simulation, using a two-compartment mathematical model of cyclosporine kinetics to predict the drug behavior in the patient. Two of the model parameters are assumed from the literature, the other two are estimated from the patient data through a Bayesian estimation procedure. Previous information needed by the Bayesian algorithm is derived by a population analysis, performed beforehand and based on a nonlinear mixed effect model. A user-friendly graphical interface written in Delphi under Windows makes the program easily accessible to physicians. A preliminary retrospective validation of the program, performed on data from 18 renal transplanted patients, yielded very satisfactory results.

Algorithms↗
PubMed2002

Six-year follow-up of preventive interventions for children of divorce: a randomized controlled trial.

CONTEXT: Compared with their peers with nondivorced parents, adolescents with divorced parents are more likely to have mental health problems, drop out of school, and become pregnant. The long-term effects of intervention programs for this population are unknown. OBJECTIVE: To evaluate the long-term effectiveness of 2 programs designed to prevent mental health problems in children with divorced parents. DESIGN AND SETTING: Six-year follow-up of a randomized controlled trial of 2 intervention programs (mother program: 11 group and 2 individual sessions; mother plus child program: mother program and 11 group sessions for children) and a control condition (books on postdivorce adjustment), which was conducted in a large metropolitan US city from April 1998 through March 2000. PARTICIPANTS: A total of 218 families (91% of the original sample) with adolescents aged between 15 and 19 years were reinterviewed. MAIN OUTCOME MEASURES: Externalizing and internalizing problems, diagnosed mental disorders, drug and alcohol use, and number of sexual partners. RESULTS: Eleven percent of adolescents in the mother plus child program (95% confidence interval [CI], 3.8%-18.2%) had a 1-year prevalence of diagnosed mental disorder compared with 23.5% (95% CI, 13.8%-33.2%) of adolescents in the control program (P =.007). Adolescents in the mother plus child program had fewer sexual partners (mean [SE], 0.68 [0.16]) compared with adolescents in the control program (1.65 [0.37]; P =.01). Adolescents with higher initial mental health problems whose families were in the mother plus child program had lower externalizing problems (P =.007) and fewer symptoms of mental disorder (P =.02) compared with those in the control program. Compared with controls, adolescents whose mothers participated in the mother program and who had higher initial mental health problems had lower levels of externalizing problems (P<.001); fewer symptoms of mental disorder (P =.005); and less alcohol (P =.005), marijuana (P =.02), and other drug use (P =.01). CONCLUSIONS: In adolescents of divorced parents, the mother program and the mother plus child program reduced symptoms of mental disorder; rates of diagnoses of mental disorder; levels of externalizing problems; marijuana, alcohol, and other drug use; and number of sexual partners.

Adaptation, Psychological↗
PubMed2005

Feasibility of management of high-grade cervical lesions in a single visit: a randomized controlled trial.

CONTEXT: The incidence of cervical cancer is higher among low-income and minority women who have never undergone a conventional Papanicolaou test or who do not follow up after testing. Screening has been shown to reduce cervical cancer incidence rates. OBJECTIVES: To determine the feasibility and acceptability of immediately treating women with severely abnormal Papanicolaou test results by using a single-visit cervical cancer screening and treatment program and to compare treatment rates and 12-month follow-up rates with those of women who received usual care. DESIGN, SETTING, AND PARTICIPANTS: Randomized controlled trial conducted among 3521 women aged 18 years or older recruited between January 1999 and April 2002 at US community health centers located in predominantly Latino underserved areas. INTERVENTIONS: Women randomized to usual care (n = 1805) were discharged immediately after examination. Women randomized to the single-visit group (n = 1716) remained at the clinic until the results of their conventional Papanicolaou test were available. Large loop electrosurgical excision procedure was performed in single-visit patients with either a diagnosis of a high-grade squamous intraepithelial lesion (HGSIL)/atypical glandular cells of undetermined significance (AGUS) or suspicion of carcinoma. All other patients with abnormal Papanicolaou test results were referred to abnormal cytology clinics or elected to receive follow-up care outside the study's medical system. MAIN OUTCOME MEASURES: Treatment rates for HGSIL/AGUS at 6 months, follow-up rates at 6 months for lower-grade lesions, and 1-year follow-up rates for all patients. RESULTS: The rate of abnormal Papanicolaou test results was 4.1%. One percent of results showed high-grade lesions. In the single-visit group, the mean visit time was 2.8 hours and the mean time for delivery and processing of the Papanicolaou tests was 66 minutes. Six months after randomization, 14 (88%) of 16 single-visit and 10 (53%) of 19 usual care patients with HGSIL/AGUS had completed treatment. Fifty percent in the single-visit program and 53% of usual care with less abnormal Papanicolaou tests completed treatment within 6 months. Overall, 36% in each group presented for a follow-up Papanicolaou test 1 year later. Women in the single-visit group with high-grade lesions (10/16; 63%) were significantly more likely to attend follow-up for Papanicolaou tests 12 months later than women with similar lesions in the usual care group (4/19; 21%). CONCLUSIONS: For cervical cancer screening, the single-visit program was feasible and the degree of acceptability was high in this underserved population. Single visit programs provide an opportunity to increase the rate of immediate treatment and follow-up of women with severely abnormal Papanicolaou test results. This strategy did not improve follow-up rates for women with less-abnormal results. Trial Registration http://ClinicalTrials.govIdentifier: NCT00237562.

Adult↗
PubMedDate not supplied

Rapid assessment procedures in environmental sanitation research: a case study from the northern border of Mexico.

BACKGROUND: There is a need to enhance the quality and sustainability of environmental health programs in Mexico. What socio-cultural factors influenced the adoption or rejection of Clean Water in Homes programs in this population? We applied rapid appraisal procedures (RAP) to evaluate these community-based programs. METHOD: Qualitative study conducted in communities along Mexico's northern border. We conducted informal dialogues, semi-structured interviews, field notes and observations. Home visits used a checklist to observe: sources of water, handwashing, as well as human waste and garbage disposal patterns. Data analysis was conducted using ATLAS.ti, which facilitated comparison and illustration of discrepancies, the elaboration of emerging issues and relationships between them. RESULTS: Community members perceived that the Clean Water program was a top-down intervention. Water is perceived as a political issue and a matter of corruption. Inequity also limits solidarity activities involved in environmental sanitation. Migration to the United States of America (US) contributes to community fragmentation, which in turn dilutes communal efforts to improve water and sanitation infrastructure. While targeting women as program "recipients", the Clean Water program did not take gendered spheres of decision-making into account. Community members and authorities discussed the main results in "assemblies", particularly addressing the needs of excluded groups. CONCLUSION: The oversight of not exploring community members' needs and priorities prior to program implementation resulted in interventions that did not address the structural (economic, infrastructure) and socio-cultural barriers faced by community members to undertake the health-promoting behaviour change, and provoked resentment.

Adolescent↗
PubMed1993

Low-birth-weight infants born to adolescent mothers. Effects of coresidency with grandmother on child development.

OBJECTIVE: To explore the impact of young maternal age, coresidency with infant's grandmother, and other familial and environmental factors on development of low-birth-weight (LBW) infants. DESIGN: Prospective cohort analyses. SETTING: Eight medical institutions in different geographical locations participating in the Infant Health and Development Program. PARTICIPANTS: Control population of 272 LBW, preterm infants enrolled in the Infant Health and Development Program born to mothers aged 15 to 24 years. MAIN OUTCOME MEASURE: Child cognitive, behavioral, and health outcomes at 36 months' gestation-corrected age. RESULTS: Maternal age was not significantly related to child development. Coresidence with infant's grandmother was associated with improved cognitive and health outcomes. Maternal ethnicity, maternal verbal ability, and other environmental factors were also associated with child outcomes. CONCLUSIONS: Findings of this study support the need for programs that include the extended family of at-risk infants, providing education and literacy skills to the mothers and encouraging participation of all care givers of the child.

Adolescent↗

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