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PubMed1996

Design issues addressed in published evaluations of adolescent HIV-risk reduction interventions: a review.

OBJECTIVE: This study was conducted to determine: (1) issues in intervention design that have been addressed in behavioral interventions targeting human immunodeficiency virus (HIV)-risk behaviors among adolescents; (2) specific choices made in intervention design; (3) historic changes in the likelihood that issues in intervention design will be addressed; and (4) if an association exists between quality of evaluation design and the number of intervention design issues addressed. DESIGN: Literature search employing five electronic databases and 11 journals for articles published from January 1983 through December 1993 reporting evaluations of adolescent HIV-risk reduction interventions. MAIN OUTCOMES MEASURES: The frequency with which 12 issues in intervention design were addressed: basing the intervention on a theory of behavioral change; specifying a target population; involving the targeted community in the formulation of the intervention; addressing developmental issues; providing facts; strengthening interpersonal skills; describing the media (format) for delivering the intervention; specifying potentially relevant characteristics of the interventionists; describing the duration of the intervention; providing boosters; pilot testing the intervention; and including other potentially augmentative elements. RESULTS: Twenty-eight published intervention articles were included in these analyses. The median number of intervention design issues addressed in any study was six (range three to nine), although this number increased significantly over time (p < .01). There was substantial variability in the frequency with which each individual design issue was addressed, with some design issues (e.g., inclusion of specific facts and the description of the channel employed) being addressed in all studies. Other design issues were addressed in less than one-quarter of studies [e.g., basing the intervention on a theory of behavioral change (18%) and addressing developmental issues (21%)]. The targeted community was involved in one-third of studies. More recent studies and studies employing a randomized evaluation design with both preintervention and postintervention assessments addressed more intervention design issues than did earlier studies and studies employing other evaluation designs (p = .01 and p = .03, respectively). CONCLUSION: The majority of published adolescent HIV-risk reduction studies have not addressed important issues in intervention design. However, more recent studies and studies employing a strong evaluation design have addressed a greater number of these issues. Frameworks to guide intervention efforts (e.g., to serve as "practice guidelines") are needed to allow for both accurate replication and meaningful comparison of differing intervention approaches.

Adolescent↗
PubMed1995

Access to health care and geographic mobility of HIV/AIDS patients.

OBJECTIVE: To determine the patterns and determinants of mobility in persons with HIV infection or AIDS on a population basis. DESIGN: Descriptive cross-sectional population health study. TARGET POPULATION: 650 full members (i.e., HIV-positive) of the Vancouver Persons with AIDS Society who were residents of British Columbia and who allow the society to include unsolicited material with their monthly newsletter. MAIN OUTCOME MEASURES: Migration history, access to HIV-related care at diagnosis, current and pre-HIV sociodemographic characteristics, and current health status. RESULTS: Two hundred and fifty-two persons living with HIV/AIDS participated in the study. At the time of the survey, the majority of subjects were male (94 percent), aged between 30 and 54 years (87 percent), and able to carry out daily activities without assistance (84 percent). The median time since the known date of HIV infection was 6 years. Access to care at diagnosis was associated in this population with being diagnosed in the largest metropolitan area in the province (OR = 2.14; 95 percent CI: 1.18, 3.87), a pre-HIV income of $30,000 or more per annum (OR = 0.49; 95 percent CI: 0.27, 0.89), a known date of diagnosis prior to 1990 (78 percent versus 64 percent; p = 0.019), and living in the same residence from the date of known HIV diagnosis to the date of the survey (63 percent versus 51 percent; p = 0.024). CONCLUSION: Although no definitive causal association can be provided by this cross-sectional analysis, our results clearly highlight several ways in which the need for treatment and care potentially affect where persons with HIV/AIDS choose to live.

Adult↗
PubMed2006

An overview of methods for calculating the burden of disease due to specific risk factors.

There are a number of measures that quantify the public health burden due to specific risk factors for specific diseases. Although these measures are of importance for policymakers, epidemiologists do not often calculate them or may be unfamiliar with some of the issues involved when they do. The primary measure of interest is the attributable fraction (AF), representing the fraction of cases or deaths from a specific disease that would not have occurred in the absence of exposure to a specific risk factor either in the exposed population or the population as a whole. AFs can be multiplied by the total number of cases of a given disease to obtain a "body count"--the absolute number of preventable cases due to a specific risk factor. Two other measures of public health burden, used in conjunction with AFs, are attributable years-of-life-lost and attributable disability-adjusted life-years. We provide an overview of the AF and related measures and discuss some of the specific issues involved in calculating AFs. These issues include calculating the variance of AFs (such as Monte Carlo sensitivity methods), biases arising from some formulas for the AF, sources of data for calculating AFs, dependence of AFs on basic decisions about what exposure-disease associations are causal, and extrapolation from the source population to the target population.

Cause of Death↗
PubMed1997

Poststroke depression among the Chinese elderly in a rural community.

BACKGROUND AND PURPOSE: A door-to-door survey was conducted in two townships in the Kinmen islets to investigate the prevalence and other characteristics related to depressive disorders of stroke survivors in an elderly Chinese population. METHODS: Our target population comprised the registered residents > or = 65 years old (n = 2056) of a total population of 26 105 on August 1, 1993. All participants answered a questionnaire, filled in a Geriatric Depression Scale-short form (GDS-S), and received a neurological examination. Depression was defined as a GDS-S score > or = 5. RESULTS: Twenty-eight of 45 stroke survivors (62.2%) and 491 of 1471 nonstroke subjects (33.4%) were classified as depressed. The frequency of stroke survivors' depressive disorders was significantly higher that of nonstroke subjects (P < .001). Multiple regression analysis indicated that GDS-S scores were most related with the activities of daily living (R2 = .19, P = .004) in the stroke survivors. CONCLUSIONS: Depressed mood was common after stroke, and activities of daily living were an important factor for depression in stroke survivors in the community.

Activities of Daily Living↗
PubMed1994

A population survey on the prevalence of diabetes in Kin-Hu, Kinmen.

OBJECTIVE: To investigate the prevalence of non-insulin-dependent-diabetes mellitus in Kin-Hu, Kinmen. RESEARCH DESIGN AND METHODS: This is a community-based population survey. The target population are residents > or = 30 years of age in Kin-Hu, Kinmen, according to the official household registry in 1990. Face to face interviews were conducted by the Yang-Ming Crusade in 1991 using a structured questionnaire. Fasting blood samples were drawn by public health nurses, and a 75-g oral glucose tolerance test was performed for definite diagnosis of diabetes. RESULTS: There were 4,097 eligible subjects (2,026 men and 2,071 women), and 3,236 had complete fasting plasma glucose data (1,536 men and 1,700 women). The response rate was 79% (76% for men and 82% for women). The age-specific response rates were 81% for the 30- to 39-year and 50- to 59-year age-groups, 84% for the 40- to 49-year age-group, and 69% for the > or = 60-year age-group. The crude prevalence of diabetes in Kin-Hu was 6.5% (2.0% previous and 4.5% new). With the standard world population of Segi, the age-adjusted prevalence rate was 4.9% (4.5% for men and 5.4% for women). The prevalence rate of diabetes increased significantly with age. The prevalence of previously diagnosed diabetes accounted for less than one third of the total rate. CONCLUSIONS: The population survey in Kin-Hu, Kinmen, had a high response rate of 79%. The crude prevalence rate of diabetes was 6.5%, and the age-adjusted prevalence rate was 4.9%. The low ratio of previously diagnosed to newly diagnosed diabetic cases may be due to lack of public awareness and medical services in this community.

Adult↗
PubMed1985

Vaccines: quantities, production and costs.

At a birth rate of about 150 million children per year, 300 to 400 million doses DTP-polio and 150 to 200 million doses of measles and BCG vaccines will be required annually for immunization of the world population against the target diseases as defined by the EPI of the World Health Organization. With the introduction of modern fermentation technologies production of these quantities is practically and economically feasible. The main problem is the administration of the vaccine to the target population. This may be achieved by application of a more condense and simplified vaccination schedule which has shown to be effective in clinical studies. Also, the costs of the immunization programmes may be considerably reduced in this way as the costs of administration form the major part of any immunization programme.

BCG Vaccine↗
PubMed1997

Influenza, influenza vaccine, and amantadine/rimantadine.

Influenza viruses are highly contagious viruses that are transmitted from person to person, usually by the airborne route. Persons in semi-closed or crowded environments, such as students and residents of nursing homes, are at high risk of exposure. The illness attack rate in children ranges from 14% to 40% yearly. Fatality rates are highest in persons who have chronic medical conditions, such as chronic obstructive lung disease, cardiovascular disease, and diabetes mellitus, particularly if they are elderly. The effectiveness of influenza vaccine in preventing or attenuating illness varies, depending primarily on (1) the degree of similarity between the virus strains included in the vaccine and those that circulate during the influenza season, and (2) the age and immunocompetence of the vaccine recipient. When there is a good match between vaccine and circulating viruses, influenza vaccine has been shown to prevent illness in approximately 70% to 90% of healthy persons less than 65 years of age. Adverse events following influenza vaccine include mild, local reactions at the injection site (up to 20%) and occasionally fever in approximately 1% of vaccinees. Despite the availability of an effective vaccine, only 55% of persons 65 years of age and older reported receiving influenza vaccine in 1994. Vaccination levels are even lower in persons less than 65 years of age with high-risk medical conditions. Important procedures to improve vaccination rates are (1) assessment of a practice's or medical facility's current vaccination rates, (2) identification of target populations for vaccination, (3) formation of a specific goal (ie, percentage of target population to be immunized), (4) development of a plan of action, and (5) provision of ongoing feedback to the individual physicians about vaccination rates of their own patients.

Amantadine↗
PubMedDate not supplied

Controlled trial of universal neonatal screening for early identification of permanent childhood hearing impairment. Wessex Universal Neonatal Hearing Screening Trial Group.

BACKGROUND: Congenital permanent childhood hearing impairment (PCHI) impairs communication skills and, possibly, mental health and employment prospects. Management within 1 year of birth can alleviate most of its adverse effects. Neonatal screening for this disorder is feasible but its benefit for all babies is disputed. We investigated whether neonatal screening of all babies born in hospital, in addition to the standard health visitor distraction test, would increase the rates of early referral, confirmation, and management. METHODS: Between 1993 and 1996, two teams of four part-time testers and equipment moved between two pairs of hospitals to achieve four periods with neonatal screening and four without neonatal screening, each of 4-6 months' duration. Babies did or did not undergo neonatal screening dependent on during which periods they were born. We used a transient evoked otoacoustic emissions test and, in babies who failed this test, an automated auditory brainstem response test on the same day. We referred babies with positive results for audiological assessment. FINDINGS: 53,781 babies were included in the trial, and 25,609 were born during periods with neonatal screening. Neonatal screening achieved 87% coverage of births, with a false-alarm rate of 1.5%, and an overall yield of 90 cases of bilateral PCHI of 40 dB or more relative to hearing threshold level per 100,000 target population, equivalent to 80% of the expected prevalence of the disorder in the population. 71 more babies with moderate or severe PCHI per 100,000 target population were referred before age 6 months during periods with neonatal screening than during periods without. Early confirmation and management of PCHI were significantly increased. The rate of false-negative results from neonatal screening was significantly lower than that for the distraction test (4 vs 27% p=0.041). INTERPRETATION: Neonatal screening is effective in identification of congenital PCHI early and may be particularly useful for babies with moderate and severe PCHI for whom early management may have the most benefit.

England↗
PubMed1978

Intermediate objectives for the monitoring of family planning services.

Since progress during the early stages of a program cannot easily be measured in terms of the ultimate objectives, there is need to develop a set of intermediate indicators for purposes of necessary evaluation and monitoring. Family planning programs suggest a series of useful intermediate objectives that have a clear cause-and-effect relationship with regard to their ultimate goals. It is important that they be expressed as specific targets. They should provide for a numerical definition of the target population; a given time frame; a service design which takes into account patient load, personnel performance, and service capacities; and a record system that can readily retrieve information about service utilization and also identify each patient individually. At the same time, allowance should be made for periodic review and adjustments in light of modifications that are bound to occur in the composition of the target population as well as possible changes of a sociopolitical nature that might affect the program's scope.

Adolescent↗
PubMed1998

Uptake of family planning services among an ethnically mixed population in a general practice setting.

A descriptive study of the uptake of family planning services within an urban general practice which has a mixed ethnic population, was undertaken with the aim of identifying areas where uptake could be improved. The target population was 572 female patients aged between 16 and 45 years during the period August 1995 to July 1996. Of this target population, about 20 per cent had consulted the practice about contraception and four per cent were pregnant. These were excluded. The remaining majority had not consulted the practice about their contraceptive needs. The study looked in more detail at 194 patients who were available for interview, who had not attended the practice for family planning advice during three months from August 1, 1996 to October 31, 1996. Of these, a group could be identified who would have gained benefit from GP involvement. There were 22 'at risk' women who were not using contraception and 11 who had not returned for IUD checks. There was a definite preference for condom use among Asian patients. There was poor uptake of family planning services among 16 to 25 year old Asian patients. Some personal observations and suggestions, for improving uptake and compliance are given.

Adolescent↗
PubMed2003

Experimental test of predation's effect on divergent selection during character displacement in sticklebacks.

Ecological character displacement is common in nature but the mechanisms causing divergence are not well understood. The contributions of ecological interactions other than competition have received little attention. We conducted a pond experiment to explore the contribution of both competition and predation to character divergence in threespine stickleback species. We estimated the strength of divergent selection on a morphologically intermediate target population between competition treatments under two alternate predation treatments. Divergent selection on the target population tended to be stronger in the predator-addition treatment than in the predator-reduction treatment, a difference that approached significance (P = 0.09). This trend occurred even though competition was strongest in the predator-reduction treatment. Overall, the strength of divergent selection was best predicted by stickleback mortality (P = 0.025) being strongest where mortality was highest. These results indicate that predation and other agents of mortality can enhance the rate of change in competition per unit of phenotypic divergence and, thereby, divergent selection, even as they lower the overall strength of competition. In this way, predation and other agents of mortality may facilitate, rather than hinder, character displacement.

Animals↗
PubMed1995

Evaluating food fortification options: general principles revisited with folic acid.

OBJECTIVES: This article uses folic acid as an example to illustrate some of the complex issues and general principles that emerge when evaluating fortification of the food supply as one possible means to address a public health recommendation. METHODS: Distributions of current daily folate intakes from conventional foods and dietary supplements were estimated. Intakes that might result from fortification of cereal-grain products and ready-to-eat cereals at various levels for eight age-gender groups were also estimated by using the US Department of Agriculture's 1987-1988 Nationwide Food Consumption Survey. RESULTS: The results illustrate that fortification of the US food supply tends to increase folate intakes of consumers at the high end of the intake distribution curves in the general population to a greater extent than it affects consumers at the low end of the intake distribution curves in the target population. CONCLUSIONS: The effectiveness of food fortification options for a target population and the safety for the general population impose conflicting challenges that must be considered concurrently when making decisions about fortifying the US food supply.

Adolescent↗
PubMed2003

Prophylaxis against respiratory syncytial virus (RSV), varicella, and pneumococcal infections: Economic-based decision-making.

OBJECTIVE: To compare costs and health benefits of three prophylactic interventions recommended by the American Academy of Pediatrics (AAP) and to help quantify the impact of illness and enhance the physicians' ability to make informed decisions. STUDY DESIGN: Medline search was conducted of English-language cost-effectiveness studies of varicella and pneumococcal conjugate vaccination recommended for all healthy infants and of respiratory syncytial virus (RSV) prophylaxis with palivizumab (Synagis) for infants at high risk for severe RSV infection. Data were collected on cost-effectiveness, burden of illness, and efficacy and analyzed from the societal and payer perspective. Results were discounted by 5% and costs inflated to year 2002 dollars. RESULTS: From the societal perspective, estimates of cost per life-years saved were money savings for varicella, 175,300 US dollars for pneumococcal conjugate vaccination, and 66,200 US dollars for palivizumab prophylaxis; from the payer perspective, estimates were 28,100, 338,400, and 66,400 US dollars, respectively. CONCLUSIONS: Cost-effectiveness estimates for varicella and pneumococcal conjugate vaccination demonstrate that evaluating economic benefits from the societal rather than the payer perspective makes universal prophylaxis very financially attractive. By comparison, this same differential does not exist for the cost-effectiveness estimates of palivizumab from the societal and payer perspectives because its use is in a well-defined high-risk target population. From a societal perspective, prophylaxis is a rational public policy decision, although in target populations, incidence of serious illness and the primary cost components driving the cost offsets vary across prophylactic measures studied.

Antibodies, Monoclonal↗
PubMed1999

Controlled trial of universal neonatal screening for early identification of permanent childhood hearing impairment: coverage, positive predictive value, effect on mothers and incremental yield. Wessex Universal Neonatal Screening Trial Group.

OBJECT: Congenital bilateral permanent childhood hearing impairment (PCHI) impairs communication skills and, in some cases, mental health and employment prospects. Management of PCHI within the first year of life can alleviate most of its adverse effects. We investigated whether neonatal screening of all babies born in hospital, in addition to the standard Health Visitor Distraction Test (HVDT), would increase the rates of early diagnosis. METHODS: Between 1993 and 1996, two teams of four part-time testers and equipment moved between two pairs of hospitals to achieve four periods with neonatal screening and four without neonatal screening, each of 4-6 mo duration in each hospital. Babies did or did not undergo neonatal screening dependent on the periods during which they were born. We used a transient evoked oto-acoustic emissions (TEOAE) test followed, in infants who failed this test, by an automated auditory brainstem response (AABR) test on the same day. We referred babies with positive results for audiological assessment. RESULTS: 53,781 infants were included in the trial, including 25,609 born during periods of neonatal screening. The neonatal screen achieved 87% coverage of inborn births, with a false alarm rate of 1.5%, and an overall yield from the screen of 90 cases of bilateral PCHI > or = 40dB HTL per 100,000 target population, equivalent to 80% of the expected prevalence of the condition in the population. Seventy-one more babies with moderate or severe PCHI per 100,000 target population were referred before age 6 mo during periods with neonatal screening than during periods without. Early confirmation and management of PCHI were significantly increased. The false-negative rate of neonatal screening was significantly lower than that of HVDT screening (4% vs 27%). CONCLUSIONS: Neonatal screening is effective in identification of congenital PCHI and may be particularly useful for babies with moderate and severe PCHI for whom early management may have the most benefit.

Audiometry, Evoked Response↗
PubMed1999

Psychosocial predictors of first attendance for organised mammography screening.

OBJECTIVE: To study psychosocial predictors of attendance at an organised breast cancer screening programme. SETTING: Finnish screening programme based on personal first round invitations in 1992-94, and with 90% attendance rate. METHODS: Attenders (n = 946) belonged to a 10% random sample (n = 1680 women, age 50, response rate 64%) of the target population (n = 16,886), non-attenders (n = 641, 38%) came from the whole target population. Predictors were measured one month before the screening invitation. Measures included items for social and behavioural factors, Breast Cancer Susceptibility Scale, Illness Attitude Scale, Health Locus of Control Scale, Anxiety Inventory, and Depression Inventory. Univariate and multivariate logistic regression analyses were used to predict attendance. RESULTS: Those most likely to attend were working, middle income, and averagely educated women, who had not had a mass mammogram recently, but who regularly visited gynaecologists, attended for Pap smear screening, practised breast self examination, and who did not smoke. Low confidence in their own capabilities in breast cancer prevention, overoptimism about the sensitivity of mammography, and perception of breast cancer risk as moderate were also predictive of attendance. Expectation of pain at mammography was predictive of non-attendance. CONCLUSION: Mammography screening organised as a public health service was well accepted. A recent mammogram, high reliance on self control of breast cancer, and an expectation of pain at mammography deterred attendance at screening. Further information about these factors and health information on screening are needed.

Breast Neoplasms↗
PubMed1983

Planning alcoholism services: a technique for projecting specific service needs.

In response to an increasing emphasis on health services planning, a technique for projecting in-residence and outpatient alcoholism treatment and rehabilitation needs has been developed. This technique relies on services data from 34 comprehensive alcoholism treatment programs, funded by the National Institute on Alcohol Abuse and Alcoholism. For in-residence services, the methodology involves an analysis of the use of available in-residence services such that it is possible to determine how many beds of a given service type are needed to serve those admitted to the treatment system. Because all who come in contact with the system do not need or receive services, it is possible to calculate how many beds of a given service type are needed to serve each person coming in contact with the system. This is called the "beds per contact." The product of the beds per contact times the number in the identified target population is the number of beds of a given type needed to serve the target population. A similar methodology is used to project outpatient service needs. The assumptions underlying this technique, and its advantages and disadvantages, are discussed.

Alcoholism↗
PubMed1998

[Efficacy of pneumococcal vaccination].

POLYVALENT VACCINE: Pneumococcal vaccination is based on the antigenic properties of polysides carried on the bacterial capsule which induce production of bactericidal serotype-specific antibodies. The 23 serotypes contained in the current vaccine cover 85 to 90% of all strains observed in pneumococcal infections in Europe. PROVEN EFFICACY: Prospective and retrospective studies have demonstrated that pneumococcal vaccination can prevent 60 to 80% of invasive pneumococcal infections in immunocompetent elderly subjects and/or persons in high-risk groups with underlying disorders. TARGET POPULATION: Immunocompetent persons in the 60-65 year and older age group comprise the target population for pneumococcal vaccination. Incidence and mortality of pneumococcal infections is high in this group. Simple vaccination strategies should be implemented.

Adult↗
PubMed2003

Integrating primary care and public health: learning from the community-oriented primary care model.

Community-oriented primary care (COPC), a 50-year-old widely applied innovative approach to primary care development, seems to be the same combination of public health and general practice perspectives currently sought in the formation of primary care trusts in Britain's NHS. The article reviews the experience of implementing COPC methods, the outcomes, and the applicability to and implications for primary care policy, taking the current British reforms as an example. The COPC model has been developed mainly in underserved populations to integrate public health objectives and primary care through interdisciplinary approaches, with active involvement of the target population. COPC methods are time consuming, can create problems with professional boundaries, and are vulnerable to socioeconomic changes. They can also deliver complex packages of care for target populations, particularly in poor areas underserved by traditional medical services. British primary care reforms may be seen as an unplanned, uncontrolled, nationwide experiment in applying COPC methods. They differ from COPC as applied elsewhere because change has been introduced from above rather than below, into a well-developed primary care system rather than underserved communities. International experience suggests the need for attention to factors promoting and impeding success and to reliable outcome measures. If this experiment succeeds, COPC methodology may facilitate similar changes in other health care systems.

Community Health Services↗