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PubMed1992

Relationship of skin test reactivity and eosinophilia to level of pulmonary function in a community-based population study.

We studied the relationship of skin test reactivity (sumscore greater than or equal to 3) and eosinophilia (greater than or equal to 275 cells/mm3 blood), separately and combined, to the level of FEV1 in a community cohort. We used the regression analysis technique, adjusting for age and area of residence, and stratifying by gender and cigarette smoking. Eosinophilia, among men, was associated with lower levels of FEV1 in skin test negative subjects with moderate cigarette smoking (greater than or equal to 10 pack-yr: beta = -250 ml, p = 0.02; greater than or equal to 10 pack-yr: beta = -234 ml, p less than 0.01) and in skin test positive subjects who either never smoked (beta = -228 ml, p = 0.06) or had only a brief history of smoking (beta = -428 ml, p less than 0.01). Eosinophilia, among women, was significantly associated with lower levels of FEV1 in never smokers (beta = -95 ml, p less than 0.01), especially if subjects were skin test positive as well (beta = -289 ml, p less than 0.01). Moderate cigarette smoking was uncommon in women. These data suggest an association of indices of inflammation (eosinophilia alone) and allergic inflammation (eosinophilia combined with skin test reactivity) with lower levels of FEV1, independent of the effect of cigarette smoking.

Age Factors↗
PubMed1988

Social marketing and public health intervention.

The rapid proliferation of community-based health education programs has out-paced the knowledge base of behavior change strategies that are appropriate and effective for public health interventions. However, experiences from a variety of large-scale studies suggest that principles and techniques of social marketing may help bridge this gap. This article discusses eight essential aspects of the social marketing process: the use of a consumer orientation to develop and market intervention techniques, exchange theory as a model from which to conceptualize service delivery and program participation, audience analysis and segmentation strategies, the use of formative research in program design and pretesting of intervention materials, channel analysis for devising distribution systems and promotional campaigns, employment of the "marketing mix" concept in intervention planning and implementation, development of a process tracking system, and a management process of problem analysis, planning, implementation, feedback and control functions. Attention to such variables could result in more cost-effective programs that reach larger numbers of the target audience.

Health Promotion↗
PubMed1995

Interactions of apolipoprotein E genotype, total cholesterol level, age, and sex in prediction of Alzheimer's disease: a case-control study.

OBJECTIVE: The joint effects of total cholesterol (TC) levels and the APOE genotype in Alzheimer's disease (AD) were evaluated because of previous reports that the APOE locus epsilon 4 allele was associated with both late-onset AD and elevated TC. DESIGN: Logistic regression was used to determine the effects of the APOE genotype, TC, age, and sex on prediction of AD in a community-based study of 206 cases and 276 controls. RESULTS: The relationship of the APOE genotype and AD was dependent on TC, age, and sex. However, current TC level does not fully explain the epsilon 4-Alzheimer's disease association. Affected men with higher TC and age under 80 years had the highest epsilon 4 allele frequencies. The epsilon 4 frequency declined significantly with age. SIGNIFICANCE: A pathologic role of higher TC or cholesterol-based differential survival of epsilon 4-carrying individuals may be involved in the relationship of the epsilon 4 allele with AD. The observed association of the APOE genotype and AD is expected to depend on the age, sex, and TC distributions of a given sample.

Aged↗
PubMed1987

The cost-effectiveness of three smoking cessation programs.

This study analyzed the cost-effectiveness and distribution of costs by program stage of three smoking cessation programs: a smoking cessation class; an incentive-based quit smoking contest; and a self-help quit smoking kit. The self-help program had the lowest total cost, lowest per cent quit rate, lowest time requirement for participants, and was the most cost-effective. The most effective program, the smoking cessation class, required the most time from participants, had the highest total cost, and was the least cost-effective. The smoking contest was in-between the other two programs in total costs, per cent quit rate, and cost-effectiveness; it required the same time commitment from participants as the self-help program. These findings are interpreted within the context of community-based intervention in which the argument is made that cost-effectiveness is only one of several factors that should determine the selection of smoking cessation programs.

Adult↗
PubMedDate not supplied

Emerging patterns of disability distribution in developing countries.

A study based on the WHO model of community-based rehabilitation in Guangzhou City, China, is described. Preliminary epidemiological data are reported, and compared with analogous data from Korea, Vietnam, Malaysia, Mexico, Indonesia, and Pakistan. Confidence levels for estimates of the prevalence of limb dysfunction, visual dysfunction, hearing and/or speech dysfunction, and mental retardation are also reported.

Adolescent↗
PubMed1989

Primary prevention of coronary heart disease versus health promotion--a contradiction?

The German Cardiovascular Prevention Study is a multicentre community-based intervention study with the primary goal of reducing cardiovascular mortality by primary prevention measures. The intervention strategy comprises improving people's life styles as well as health promotion so as to modify cardiovascular risk factors (hypercholesterolemia, cigarette smoking, arterial hypertension, physical inactivity and over-weight). Design elements of the German Cardiovascular Prevention Study, now in its fifth year, were adopted from well known community intervention studies, including monitoring of mortality and morbidity, health examination surveys to assess distribution of cardiovascular risk factors, health attitudes and health behaviour in the community and use of formative and process evaluation to monitor the effects of intervention policies in the community. To identify risk factor profiles a cluster analysis was carried out from survey data. Four clusters were identified: a) people with none or few risk factors; b) those with high prevalence of smoking; c) those with high prevalence of hypercholesterolemia and hypertension; d) high risk factor exposure individuals. The clusters are different along social indicators like age, sex and social status. Process evaluation data show that special strategies like interventive blood pressure screenings reached a relatively high proportion of people from lower socioeconomic status. But they also indicate that there is a long way to go from publicity of intervention programs to lasting changes in behaviour.

Adult↗
PubMed1994

Community participation in vector control: lessons from Chagas' disease.

As applied to vector-borne disease control, the term community participation has been broadly interpreted. Community-based vector control projects have been described as having both active and passive components. Recently, community participation in organized efforts to control Chagas' disease has become more dynamic, with increasingly active involvement by local community members. Chagas' disease is a particularly significant vector-borne disease problem in the South American countries of Brazil, Venezuela, and Bolivia, and health officials there are beginning to emphasize horizontal or decentralized approaches to control of triatomine vectors. Experience suggests that vector control programs using community participation have significant and sustainable impact on vector density, appear to be more cost-effective than purely vertically structured programs, are readily integrated with other health or development programs, promote an enduring sense of pride in home and community, and are politically viable vector control strategies. Community participation per se has inherent value because of its positive effect on social relationships and community solidarity. Moreover, it is a dynamic process that results in accrued benefits for public health that exceed most vector control program goals and persist well beyond program termination.

Animals↗
PubMed1991

Low prevalence of delta hepatitis virus infection among blacks in Natal.

The prevalence of delta hepatitis virus (DHV) infection among hepatitis B surface antigen (HBsAg)-positive black subjects in Natal was determined. A total of 172 subjects was tested for the presence of antibodies to DHV; all were HBsAg-positive. They comprised three groups: 51 urban children identified in a community-based seroprevalence survey, 81 subjects identified during a family study, and 40 institutionalised children. None of the 172 subjects was positive for antibodies to DHV. Based on calculations using a binomial distribution of infection, there was a 95% probability that the prevalence of DHV infection was below 30/100,000 HBsAg-positive persons. While DHV infection was found to be rare among blacks in Natal, the risk of delta hepatitis becoming widespread is ever-present, since the high incidence of hepatitis B virus infection in black children provides ample opportunity for the concomitant spread of DHV.

Black or African American↗
PubMedDate not supplied

Services for urban poor families in Kuala Lumpur, Malaysia: a case study.

With 25% of its population living in over 148 squatter settlements, with a high incidence of communicable diseases, teenage pregnancies, and psychological and familial stress, the city of Kuala Lumpur has sought ways to improve conditions. This article describes one particularly promising approach: community-based centers integrating three socioeconomic components--preschool education, maternal and child health clinics, and income-generating activities.

Child Welfare↗
PubMed1991

Measles among under-9-month-olds in rural Bangladesh: its significance for age at immunization.

Any decision to modify measles immunization strategies away from the use of the conventional vaccine given to children at 9 months of age to the adoption of recently proposed vaccine strains that can be given to 4-6-month-olds will depend on the age distribution of severe cases of measles in the community. Reported are the results of an analysis of two community-based measles surveillance systems in rural Bangladesh, which found that 17% of all measles cases reported for under-5-year-olds in a nonvaccinated population involved infants aged less than 9 months. In a vaccinated population from the same area, 31% of all measles cases reported for under-5-year-olds occurred among under-9-month-olds. Using a rather restrictive definition for measles-related deaths (those occurring within 6 weeks of the onset of the rash), the proportion of measles-related deaths that occurred before 9 months of age was 13% of all such deaths that were reported.

Age Factors↗
PubMed1990

Low specific gravity urine with crystalluria as discriminant index for nephrolithiasis.

A community-based study for crystalluria in morning urine (MU) specimens was carried out under light microscopy. The MU specimens were collected from 29 males with renal stones (GI), 36 age-and sex-matched normal controls (GII) and 27 household members of GI who did not have stones (GIII). The findings can be summarized as follows. 1. In the groups as a whole, almost all crystal and crystal aggregate found was oxalate type and with highest prevalence in GI. 2. In urine with low specific gravity (SG) i.e. less than or equal to 0.010, prevalence of oxalate crystals in GI (57.7%) was significantly higher (p less than 0.05) than in both GII (5.9%) and GIII (13%). Furthermore, at this range of SG, 15 per cent of the MU specimens in GI showed aggregation of oxalate crystals, whereas, the condition was neither found in GII nor GIII. 3. Our data suggest urine supersaturation with respect to calcium oxalate was found in both renal stone patients and normal subjects but more frequently in the former and also suggests more deficiency or lack of inhibitors for oxalate crystal nucleation and aggregation in urine of renal stone patients. The occurrence of oxalate crystals and crystal aggregates in urine of low SG may be useful as an index to discriminate stone patients from normal subjects or as an index to indicate the high risk group in the community.

Adult↗
PubMed1990

A simplified methodology for the community-based assessment of breast-feeding and amenorrhoea in Mexico.

Reported is the use of a simplified methodology for carrying out a community-based epidemiological assessment that is compatible with the goals of primary health care research. For this purpose, a current-status life table analysis of data from 1131 women who were served by community health workers in the State of México was used to determine the distributions of the duration of postpartum breast-feeding, amenorrhoea, and contraceptive use. The field methods used incorporated quality assurance procedures. At 1 month postpartum, 78% of the infants were still being breast-fed, at 5 months 50%, and at 12 months 25%. The level of amenorrhoea at 1 month postpartum was 85%, at 3 months 50%, and at 5 months 25%. Use of contraceptives was initiated at an early stage, with 42% of all users beginning during the first month postpartum. The simplified method described permitted the area's primary health care administrators to carry out research projects for programme development rapidly and was compatible with the locally available resources.

Adult↗
PubMed1989

Parasitic, bacterial and viral pathogens isolated from diarrhoeal and routine stool specimens of urban Bangladeshi children.

Few data exist in Bangladesh on longitudinal, community-based studies of bacterial or parasitic pathogens identified in routine and diarrhoeal stools of urban dwelling children. We undertook the following study on 343 children of age less than 6 years who resided in one of 51 slum settings in Dhaka, Bangladesh, between October 1984 and February 1986. Specimens from diarrhoeal episodes and from routine stools obtained at 3-monthly intervals were examined for parasites, rotavirus and pathogenic bacteria. Parasites were isolated from 509 (51%) of the 1006 routine stools and from 95 (42%) of the 225 diarrhoeal stools. Isolation rates steadily increased with age. Ascaris lumbricoides and Trichuris trichiura accounted for approximately 80% of all parasitic isolates in routine and diarrhoeal stools. Giardia lamblia was isolated from 11% diarrhoeal stools. Entamoeba histolytica was an uncommon isolate (less than 1%). Bacterial pathogens were identified in 55 (24%) of the diarrhoeal stools but were identified in only 164 (16%) of the 1028 routine stools examined (P less than 0.01). Toxigenic Escherichia coli, Shigellae and Campylobacter were the most frequent isolates from diarrhoeal and routine specimens. This pathogen profile appears to be more in keeping with that from urban settings in other developing countries than from rural Bangladesh, suggesting that extrapolations from rural-based data should not be made for urban settings.

Age Factors↗
PubMed1995

Prostate-specific antigen in a community screening program.

BACKGROUND: This study was designed to determine who participates in community-based prostate-specific antigen (PSA) screening programs and what serum PSA levels can be expected. METHODS: A descriptive analysis of men who participated in an annual community health screening program was used to compare men who chose PSA screening with those who did not. The relationship of demographic variables to PSA level was evaluated by multivariate regression analysis. Data were available on 5548 men, 6% of whom were black. RESULTS: The population of PSA screening participants included proportionately more middle-aged white men with higher median income, as compared with men who did not participate. Those who did not participate in the screening were more likely to be either very old or very young. PSA levels increased with age, and the percentage of men with elevated PSA levels increased with age. One tenth (9.6%) of all participants had PSAs between 4 ng/mL and 10 ng/mL, and 1.9% had levels greater than 10 ng/mL. Within 1 year of the screening, 1.7% of the screened participants had a diagnosis of prostate cancer. The mean PSA in this group was 15.9 ng/mL. CONCLUSIONS: These data confirm the need for age-specific PSA reference ranges. It is likely that the same reference range can be used for all racial ethnic populations.

Black or African American↗
PubMed1995

Community-based prevalence of anal incontinence.

OBJECTIVE: To determine the prevalence of and characteristics associated with anal incontinence in the general community. SETTING: Community survey. PARTICIPANTS: The population of the state of Wisconsin sampled in the Wisconsin Family Health Survey. Subjects were identified by random digit dialing with telephone interview. The individual within each household identified as most knowledgeable about the health status of all other members of the household was asked about the health status of each member of the household. Approximately 200 households were surveyed each month. MAIN OUTCOME MEASURES: The presence of anal incontinence to solid or liquid feces or gas, who suffered from it, the frequency of anal incontinence, and how the incontinent person coped with it. RESULTS: A total of 2570 households comprising 6959 individuals were surveyed, and 153 individuals were reported to have anal incontinence, representing 2.2% of the population (95% confidence interval [Cl], +/- 0.3%). Thirty percent of the incontinent subjects were older than 65 years, and 63% were women. Of those with anal incontinence, 36% were incontinent to solid feces, 54% to liquid feces, and 60% to gas. In a multivariate analysis, independent associations of the following risk factors with anal incontinence were found: female sex (odds ratio [OR], 1.5; Cl, 1.1 to 2.1), age (continuously adjusted) (OR, 1.01; Cl, 1.01 to 1.02), physical limitations (OR, 1.8; Cl, 1.2 to 2.7), and poor general health (OR, 1.6; Cl, 1.4 to 1.9). CONCLUSIONS: Anal incontinence was reported in 2.2% of the general population. Independent risk factors for incontinence include female sex, advancing age, poor general health, and physical limitations.

Adult↗
PubMed1994

Epidemiology of celiac sprue: a community-based study.

OBJECTIVE: To address the frequency and outcome of celiac disease in a United States community. METHODS: We identified all Olmsted County, Minnesota, residents diagnosed with this condition during the period, 1960 through 1990, using the resources of the Rochester Epidemiology Project. Twenty-eight incident cases (19 women, nine men) were identified. RESULTS: The overall age- and gender-adjusted incidence of celiac disease in the community was 1.2 per 100,000 person-yr (95% CI 0.7, 1.6). There were no significant changes in incidence over time, although rates did increase; the incidence was similar in men and women and rose with age in both genders (p < 0.05). Survival in this inception cohort was 100% at 6 months and 96% at 5 yr, which was not significantly different from expected. The estimated prevalence on January 1, 1991, was 21.8 per 100,000. CONCLUSION: This study provides the first epidemiologic data on celiac disease in the United States.

Adult↗
PubMed1993

Schistosomiasis and intestinal parasites in rural villages in southwest Nigeria: an indication for expanded programme on drug distribution and integrated control programme in Nigeria.

A cross sectional survey of schistosomiasis, intestinal parasite infections and pattern of schistosomiasis transmission was undertaken in four rural villages around the Erinle dam, Nigeria. The prevalence of Schistosoma haematobium ranged from 10% to 60%. 30% of infected school children excreted over 50 eggs/10 ml urine and high rates of haematuria, proteinuria, leucocyturia and nitrites in urine were observed in infected children and the villagers. Prevalence of infection with S. mansoni ranged from 11.4% to 36.8%. Intensity of infection based on geometric mean eggs/gram of faeces ranged between 100 and 545.7 eggs/g. Malacological surveys showed that Biomphalaria pfeifferi was the predominant potential snail hosts recovered at all the contact sites. Higher infections with schistosome parasites were also recorded for B. pfeifferi than Bulinus globosus. The pattern of transmission of schistosomiasis by the snails is consistent and makes incorporation of community-based focal application of a molluscicide such as Tetrapleura tetraptera in integrated control of schistosomiasis feasible in the area. Prevalence and intensity with Ascaris lumbricoides was high. The highest prevalence was 68.9% while the highest intensity of infection was 2,440.9 eggs/gram of faeces. Multiple infections occured with various combinations of Ascaris lumbricoides, hookworm, S. haematobium, Fasciola gigantica, S. mansoni, and Entamoeba histolytica (as double, triple or quadruple infections). The results suggest an integrated approach to the control of schistosomiasis and intestinal parasites in this part of the country.

Adult↗
PubMedDate not supplied

Use of peer role models to increase Pap smear and mammogram screening in Mexican-American and black women.

We evaluated the use of a community-based intervention model to increase Pap smear and mammogram screening in minority women. The community programs were based on the A Su Salud (To Your Health) model, which includes the presentation of positive role models in the media and positive social reinforcement by community volunteers. Mexican-American women 40-70 years of age in Corpus Christi, Texas, and black women 40-70 years of age in Galveston, Texas, were targeted. Role models from the target community told their personal stories about cancer screening through local media (television, radio, and newspapers). Volunteers reinforced media messages among the target audience by distributing newsletters. Preintervention and postintervention cross-sectional surveys among the target group measured relative increases in knowledge, attitude, and practice. Pap smear use (past two years) was not substantially improved. Mammogram use (past two years) increased 57% among Mexican-American women (prevalence rate ratio [PRR] = 1.57; 90% confidence interval [CI] = 1.19, 2.08) and 30% among black women (PRR = 1.30; 90% CI = 1.04, 1.63). We demonstrated the feasibility of implementing a peer role model intervention at the local health department level. The improvement in mammogram use among high-risk women is encouraging, but further controlled research is needed to test the effectiveness and cost-efficiency of this approach.

Adult↗