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PubMed1998

The Prevention Minimum Evaluation Data Set (PMEDS). A tool for evaluating teen pregnancy and STD/HIV/AIDS prevention programs.

This article presents the Prevention Minimum Evaluation Data Set (PMEDS), a ready-to-use questionnaire or tool for evaluating teen pregnancy prevention and teen STD/HIV/AIDS prevention programs. Recognizing the diversity of approaches taken by these programs, PMEDS has two parts. Part 1 contains a primary questionnaire applicable to all programs. Part 2 consists of 15 additional supplementary modules for optional use by programs with a more specific target population or intervention approach that matches the module's content. It is hoped that PMEDS will facilitate the conducting of high-quality evaluations, first by highlighting important aspects of a program model that should be included in an evaluation, such as the demographic profile of the target population, the specific aspects of the intervention or treatment received by each participant, and the short-term outcomes and long-term goals that the program is trying to affect; second, by presenting measures for these evaluation constructs that have been extensively pretested and used in large-scale national studies and for which national comparison norms and data exist.

Adolescent↗
PubMed2003

Provider Volume of Total Knee Arthroplasties and Patient Outcomes in the HCUP-Nationwide Inpatient Sample.

BACKGROUND: The relationship between volume and outcome of total knee arthroplasties has never been evaluated in a nationally representative sample, to our knowledge. We hypothesized that surgeons and hospitals with higher patient volumes would have better outcomes, as defined by lower mortality rates, shorter hospital stays, and lower postoperative complication rates. METHODS: The 1997 Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample, Release 6, provided discharge abstracts of patients undergoing total knee arthroplasty from a national stratified probability sample. Logistic and multiple regression models were used to estimate the adjusted association of surgeon or hospital volume with rates of in-hospital mortality, pulmonary thromboembolism, deep venous thrombosis in the lower extremity, and postoperative wound infection as well as length of hospital stay. Estimates were calculated for a target population of 277,550 patients. Models were adjusted for comorbidity, age, gender, race, household income, and procedure (primary or revision arthroplasty). RESULTS: The patients were mostly white (70.2%) and female (62.7%), with a mean age of 68.9 years. The overall in-hospital mortality rate for the target population was 0.2%, and the average length of stay was 4.6 days for the primary total knee arthroplasties and 4.9 days for the revision procedures. Surgeon volumes of at least fifteen procedures per year and hospital volumes of at least eighty-five per year were significantly and linearly associated with lower mortality rates (odds ratio = 0.56 [0.24 to 1.31] for surgeon volume of > or = 60). No other association demonstrated a significant and directionally consistent linear trend for improved outcomes. CONCLUSION: Patients treated by providers with lower caseload volumes had higher rates of mortality following total knee arthroplasty in 1997. Proposing volume standards could decrease patient mortality following this procedure.

Aged↗
PubMed2003

Translation of the recommendations for the diagnosis of diabetes mellitus into daily clinical practice in a primary health care setting.

AIMS: to assess the implementation of 1985 recommendations for the diagnosis of diabetes (World Health Organization [WHO]) in a primary care setting, and the physician's attitude toward the diagnosis of diabetes mellitus (DM). MATERIAL AND METHODS: Subjects with a fasting plasma glucose (FPG)>6.1 mmol/l (> or =110 mg/dl) and with previously unknown glucose tolerance status were identified retrospectively in a primary health care center during a 45-month period. The following variables were evaluated: anthropometric parameters, fasting plasma glucose and oral glucose tolerance test (OGTT) values, registration of a diagnosis of diabetes in clinical records, smoking status, lipid profile and blood pressure. RESULTS: 1181 subjects with a FPG>6.1 mmol/l were identified (target population): 171 with a FPG>7.8 mmol/l and 1010 with a FPG between 6.1 and 7.7 mmol/l. In the latter group, an OGTT was performed in 553 subjects (54.8%) (173 yielded a diagnosis of diabetes). During the study period, diabetes was diagnosed in 29.1% (n=344) of the target population. Following the 1985 WHO recommendations, a confirmatory diagnostic test was repeated in 92 (69.7%) subjects with a FPG between 7.8 and 11.0 mmol/l, and in 132 subjects (23.87%) who had already received an initial OGTT. The analysis of the diagnostic process followed by the different physicians revealed a high interindividual variability in terms of: proportion of cases diagnosed as diabetes by an OGTT (from 35.7 to 65.2), percentage of subjects with a FPG 6.1-7.7 mmol/l without an OGTT (7.33-70.27%), proportion of confirmatory OGTTs (0-57.89%), and percentage of misdiagnosed cases (1.16-6.34%). The percentage of subjects misdiagnosed was negatively correlated with the proportion of OGTT repetitions. CONCLUSIONS: 1985 WHO recommendations for the diagnosis of diabetes are only partially followed at a primary health care level. There is a high interindividual variability among physicians in the implementation of these recommendations that is associated with the misdiagnosis of diabetes.

Attitude of Health Personnel↗
PubMed2000

Effect of distance and social disadvantage on the response to invitations to attend mammography screening.

STUDY OBJECTIVES: To investigate whether public response to an invitation to attend mammography screening can be increased by strategic relocation of the clinics. METHODS: Women invited to attend mammography screening were classified by attendance, socioeconomic status, and distance from their screening clinic. A geographic information system was used to investigate whether the response could be increased by relocating clinics to facilitate access. SETTING: The metropolitan city of Perth in Western Australia with six fixed site, publicly funded, mammography screening clinics. MAIN RESULTS: Women from disadvantaged areas, not screened previously by the mammography screening programme, had a higher response to an invitation to attend screening if they lived within 3 km of their closest clinics (12%) than if they lived further away (8%). Theoretically, the response of the target population could be increased if the existing clinics were replaced by six new clinics located closer to disadvantaged areas. CONCLUSIONS: Public health planners should be aware of the use of geographic information systems to model optimum locations of health care facilities, and be willing to assess the potential target population response to those locations.

Demography↗
PubMed2000

Vice president Al Gore's health care agenda and the utilization of medical services: An empirical analysis.

OBJECTIVE: To estimate the impact of Vice President Al Gore's healthcare agenda on the utilization of physician and hospital services among 4 uninsured target populations: parents of publicly insured children; near elderly adults, ages 55-64; employed adults with disabilities; and adults employed in small firms or self-employed. METHODS: From the 1993 National Health Interview Survey, we select 4 representative samples of uninsured adults, ages 18-64, corresponding to the target groups described in Gore's healthcare agenda. For each adult in these samples, we estimate the change in medical service utilization caused by becoming insured using results from Craig and Ko.[1] The weighted average of these estimates represents the expected change in medical service utilization attributable to insurance. RESULTS: The increase in the utilization caused by insurance depends on the target group and the service in question. The increase in utilization of physician visits is 16% among parents of publicly insured children, 37% among the near elderly, 8% among the employed, disabled adults, and 21% among the self-employed. This effect is small compared with the increase in surgical procedures (31%, 110%, 316%, and 101%, respectively). However, given the size of the US healthcare system, this amounts to about a 0.5% increase in the production of medical services. Even if a universal coverage plan were instated in place of Gore's incremental coverage plan, production would increase by about 2%. CONCLUSIONS: Points 2 through 5 of Vice President Al Gore's healthcare agenda have an impact on the utilization of medical care by the 4 target populations. However, this impact varies by service and population, and its system-wide impact on the production of care is minor.

Adolescent↗
PubMed2007

Effective heart disease prevention: lessons from a qualitative study of user perspectives in Bangladeshi, Indian and Pakistani communities.

OBJECTIVES: Coronary heart disease (CHD) has a high mortality, incidence and prevalence among Indian, Pakistani and Bangladeshi communities in the UK, indicating the need for effective heart disease prevention initiatives for these communities. This paper considers how service user perspectives can be used to develop effective, culturally focused CHD prevention interventions for these target groups by addressing identified barriers, including deeply held cultural beliefs. STUDY DESIGN: A qualitative research study, using a longitudinal action research approach. METHODS: This was a community-based study in Edinburgh. Six focus group discussions--two for each community--were organized with participants from these communities at the beginning of the project. A further six focus group discussions for the same communities were organized six months later. RESULTS: Over the period examined, participants reported varying changes in levels of knowledge relating to the nature, causes and symptoms of CHD. Some participants reported taking slight to significant steps to reduce or prevent heart disease, while others did not. The project was viewed as helpful in increasing knowledge about CHD and preventive measures and encouraging healthier lifestyles. However, persistent barriers to change were also identified, requiring changes to the project that involved not only matching intervention materials and messages to observable, superficial characteristics of the target population, but more fundamental changes that address the cultural, social, historical, environmental and psychological forces that influence health behaviour. CONCLUSION: CHD prevention initiatives need to identify and respond to deep-rooted influences on health-behaviour in 'at-risk' groups, in addition to superficial characteristics of the target populations. It is important for specific prevention initiatives to be linked into wider CHD frameworks to ensure transferability of learning and integration within wider service provision.

Asia, Western↗
PubMed1998

[Practice of preventive activities in primary care and objectives of the 1993-1995 Health Plan of Catalonia].

OBJECTIVES: To find how much the detection of two factors of cardiovascular risk, over-consumption of alcohol and anti-tetanus vaccination, has been incorporated into clinical practice in the treatment of adults in the primary care reform; and to what extent the objectives on these questions of the Health Plan for Catalonia 1993-1995 were met. DESIGN: A descriptive crossover study of a sample of primary care clinical histories (PCCHs). PATIENTS: A random sample of 3000 PCCHs of patients aged 15 and over attended during 1995 in the Health Districts in Catalonia which had been in operation for over three years. MEASUREMENTS AND MAIN RESULTS: The following data were obtained from the PCCHs: patients' age and sex, whether blood pressure values were recorded, cholesterol levels, glucose levels, weight, size, tobacco habit, alcohol consumption, antitetanus vaccination and explicit documentation of diagnoses in relation to risk factors studied. The results showed that recording was above the level established in the Plan for cholesterol levels (64.4%), glucose levels (72.1%) and tobacco habit (66.5%); and slightly below, for blood pressure (57.8%) and alcohol consumption (9.6%). Among the youngest of the target population, detection was less common, especially for tobacco habit and alcohol consumption. Antitetanus vaccinations were recorded in 24.3% of the PCCHs. CONCLUSIONS: In general the objectives set in the plan have been reached. The detection of cardiovascular risk factors and over-consumption of alcohol was adequate for the target population groups established. Antitetanus vaccination is the preventive activity with the least compliance.

Adolescent↗
PubMed2001

Pregnancy registries in epilepsy.

The risk of major malformations in the offspring of mothers with epilepsy receiving antiepileptic drugs is 4--8% compared to 2--4% in the general population. Risk factors include daily dose and polytherapy. Selected drugs have been found to be associated with a higher risk of specific malformations (congenital heart defects and cleft palate with phenytoin and barbiturates; neural tube defects with valproate and carbamazepine). Although some of these findings are unquestionable, several questions are still unsolved, depending the characteristics of the target populations, the small samples of patients, and the design and limiting factors of the published reports. In the last decade, pregnancy registries have been activated by collaborative groups of physicians in Europe (EURAP), North America (NAREP), Australia and India (the latter two recently merged into EURAP), to enroll a large number of exposed women to be monitored prospectively with standardized methods, and by three pharmaceutical companies marketing lamotrigine, gabapentin and vigabatrin, as part of their post-marketing surveillance. Even though the structure of these registries and the target populations should theoretically result in the identification of a sufficient number of women exposed to different drugs and examined for the occurrence of malformations of any type and severity, the implementation of a common database with information from the existing registries may provide valuable information in a shorter time period. Although differences between some of the registries limit the possibility to pool data, a gradual development of a collaboration is highly desirable to discuss a list of design issues and assess to what extent and how data could be compared and organized.

Abnormalities, Drug-Induced↗
PubMed1983

Obstetric and gynecological care for Third World women.

The particular characteristics required for women's health care in the Third World are compared with these in developed countries. Women of the Third World present a different prevalence of specific diseases and give less attention to symptoms and to preventive measures. The health system is usually not well adapted to respond to these problems. Examples of the differences between the needs of health care of Third World women and those of developed countries are taken from certain aspects of pre-natal care, from the prevention of cancer of the cervix and from family planning. A critical analysis of the prevalent characteristics of women's care in the Third World was undertaken. As a result some basic points to be considered in the implementation of women's health care for the Third World were proposed: (1) avoid the uncritical simple replication of developed country's models; (2) application of a larger proportion of the resources to primary health care; (3) a more aggressive attitude to improve preventive measures; (4) efforts to maintain a continuous and non-sporadic contact between the health system and the target population: (5) greater attention to reference and contra-reference to improve the integration of the various levels of the health system; (6) delegation of functions from physicians to paramedical personnel; (7) emphasis on health education, both formal and in the day-to-day contact between health agents and target population.

Delivery of Health Care↗
PubMed1999

Adolescent interpersonal communication patterns.

Adolescents are admitted to psychiatric wards presenting with psychiatric problems which are essentially secondary to problematic interpersonal relationships. Successful interpersonal relationships however depend on effective interpersonal communication. Therefore the aim of research on adolescent interpersonal communication was to explore and describe the interpersonal communication patterns of adolescents and to develop an interpersonal communication skills approach to facilitate adolescent interpersonal communication skills within a training programme for adolescents. In this article however attention will be given to the description of the interpersonal communication patterns of adolescents. The target population of the research was 17 year old adolescents. The research consisted of a pre-phase where two contextual scenarios were formulated within group discussions with adolescents. During phase one of the research these scenarios were used to obtain video taped role plays from pairs of adolescents of the target population which were transcribed for data gathering purposes. Written dialogues were also obtained from each pair of adolescents on the same scenarios used for triangulation purposes. During phase two of the research the data was analysed according to Tesch's method and a literature control was done to verify the results. Guba's model for the trustworthiness of qualitative research was used. Four recurrent interpersonal communication patterns were identified, namely: Recurrent patterns of defocusing and externalizing the topic under discussion; Recurrent patterns of struggling for power; Recurrent patterns of not listening; and Recurrent patterns of focusing only on cognitive contents of messages and not on feelings. The research showed that adolescents have ineffective interpersonal communication patterns. Recommendations were made to facilitate adolescent interpersonal communication within an interpersonal communication skills approach.

Adolescent↗
PubMedDate not supplied

A forecasting approach to accelerate drug development.

The clinical phase of drug development should be concluded sooner and at a lower cost if primarily only the pivotal and supportive studies were to be conducted. Such improved efficiency requires development of a decision support system that delivers five new capabilities: (i) it enables one to predict a result of a clinical study and to identify those studies that are expected to have an acceptable probability of success; (ii) it will allow one to optimally utilize available pharmacokinetic and pharmacodynamic (PK/PD) data and improve its predictive capability as more data become available; (iii) it will enable one to project useful population results, not just mean results; (iv) predictions will be accompanied by a measure of reliability; and (v) expected initial clinical results will be predictable from animal and related drug class data. With such a tool population targets could be specified very early in the drug development programme, challenged, and then rationally revised at each step during the development process. This report describes progress in developing and testing a clinical trials Forecaster, a prototype for such a system. The Forecaster generates estimates of the joint density for a population of combined PK/PD parameters. That population then serves as a surrogate for the population of individuals. When the resulting joint density is sampled, the obtained sets of parameters may be used to generate data that is statistically indistinguishable from the original experimental data. Such simulated data can be used to validate assumptions, and make inferences on specified population targets that are accompanied by a measure of prediction reliability. We demonstrate use of the forecaster by employing N = 22 PK/PD parameter sets for an orally administered analgesic.

Bias↗
PubMed1996

Patient education pamphlets about prevention, detection, and treatment of breast cancer for low literacy women.

The objective of this project was to identify and assess readily available patient education literature about prevention, detection and treatment of breast cancer for the patient with low literacy skills. The target population had a reading comprehension level of sixth grade or lower. Nineteen pamphlets were analyzed using RightWriter and were found to have an average readability index of 9.15, therefore requiring at least a ninth grade level of reading comprehension. As a consequence, many pieces of the available literature were inappropriate for the target population. There are implications as a broader group of health care providers becomes more involved in the treatment of low literacy patients. In providing patient education literature to poorly educated patients, special emphasis should be given to determining readability. Both currently available and newly created literature should be analyzed for readability before assuming it is an aid to patient education.

Breast Neoplasms↗
PubMedDate not supplied

A perspective on non-formal education for health: the research potential of health fairs.

The proliferation of health fairs provides a unique opportunity for the incorporation of research protocols into nonformal educational situations. One such fair, designed as a first step in implementing a health risk reduction program for a target population of parents and teachers of handicapped children, served as a catalyst for a comprehensive analysis of research possibilities. The health fair was organized and operated by faculty and graduate students of the University of Texas School of Public Health, following goals established by an advisory committee, which included representatives of the target population. Following the fair, there was an evaluation by participants, designers, implementers, and observers. This evaluation led to a more comprehensive assessment of health fairs in general as potential sites for research. The extensive feedback and indepth analyses generated a series of questions compatible with research paradigms.

Health Education↗
PubMed2005

The cross-cultural adaptation to Portuguese of the Trauma History Questionnaire to identify traumatic experiences.

BACKGROUND: Despite the high prevalence of exposure to traumatic events in Brazil, there are few studies on trauma and post-traumatic stress disorder. This paper presents the cross-cultural adaptation to Portuguese of the Trauma History Questionnaire. METHODS: Two translations and their respective back-translations were made, as well as the evaluation of the semantic equivalence, the preparation of the synthesis version, the pre-testing in the target population and the definition of the final version. DISCUSSION: Similar levels of referential meaning between the two back-translations and the original instrument were observed. Priority was given to the first translation in the decision process for the elaboration of the synthesis version. The pre-testing of this version in the target population confirmed the goal to achieve the semantic and the operational equivalence criteria. This work offers the first adaptation of a specific instrument to detect traumatic experiences in the Brazilian context.

Adult↗
PubMed1990

AIDS education and prevention programs for intravenous drug users: the California experience.

The state of California, pursuant to 1985 legislation, established the California AIDS Program (CAP) within the state Office of AIDS. As part of this program, the Office of AIDS contracts with public and private agencies to provide AIDS education to specific target groups throughout the state. Intravenous drug users (IVDUs) constitute one of the target populations singled out for special attention by the state. This article, based on a statewide evaluation, describes the AIDS education programs for IVDUs funded by the Office of AIDS. The types of educational interventions used are presented, both for IVDUs in treatment and those not in treatment. The unique problems in reaching this target population are also discussed. The article concludes that the state is making a good effort to reach IVDUs, but that further educational and evaluative efforts are needed. Specifically, the individual educational programs must move beyond the transmission and evaluation of cognitive knowledge about AIDS to an assessment of the attitudes that impede behavior change.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Empirical anti-Candida therapy among selected patients in the intensive care unit: a cost-effectiveness analysis.

BACKGROUND: Mortality from invasive candidiasis is high. Low culture sensitivity and treatment delay contribute to increased mortality, but nonselective early therapy may result in excess costs and drug resistance. OBJECTIVE: To determine the cost-effectiveness of anti-Candida strategies for high-risk patients in the intensive care unit (ICU). DESIGN: Cost-effectiveness decision model. DATA SOURCES: Published data to 10 May 2005, identified from MEDLINE and Cochrane Library searches, ICU databases, expert estimates, and actual hospital costs. TARGET POPULATION: Patients in the ICU with suspected infection who have not responded to antibacterial therapy. TIME HORIZON: Lifetime. PERSPECTIVE: Societal. INTERVENTIONS: Fluconazole, caspofungin, amphotericin B, or lipid formulation of amphotericin B given as either empirical or culture-based therapy and no anti-Candida therapy. OUTCOME MEASURES: Incremental life expectancy and incremental cost per discounted life-year (DLY) saved. RESULTS OF BASE-CASE ANALYSIS: Ten percent of the target population will have invasive candidiasis. Empirical caspofungin therapy is the most effective strategy but is expensive (295,115 dollars per DLY saved). Empirical fluconazole therapy is the most reasonable strategy (12,593 dollars per DLY saved) and decreases mortality from 44.0% to 30.4% in patients with invasive candidiasis and from 22.4% to 21.0% in the overall target cohort. RESULTS OF SENSITIVITY ANALYSIS: Empirical fluconazole therapy is reasonable for likelihoods of invasive candidiasis greater than 2.5% or fluconazole resistance less than 24.0%. For higher resistance levels, empirical caspofungin therapy is preferred. For low prevalences of invasive candidiasis, culture-based fluconazole is reasonable. For prevalences exceeding 60%, empirical caspofungin therapy is reasonable. For caspofungin to be reasonable at a prevalence of 10%, its cost must be reduced by 58%. LIMITATIONS: Less severe illness and limited use of broad-spectrum antimicrobial agents, typical of smaller hospitals, could result in a lower risk for invasive candidiasis. CONCLUSIONS: In patients in the ICU with suspected infection who have not responded to antibiotic treatment, empirical fluconazole should reduce mortality at an acceptable cost. The use of empirical strategies in low-risk patients is not justified.

Amphotericin B↗
PubMed2006

[Evaluation and improvement in the quality of the program of preventive activities and health promotion].

OBJECTIVE: To confirm that the use of the programme of preventive activities and health promotion (PPAHP) for adults in a health district has improved over time. DESIGN: Retrospective and transversal descriptive study. SETTING: Primary care, Molina la Ribera Health District, Murcia, Spain. PATIENTS AND PARTICIPANTS: The target population was the health district s patients between 18 and 79 years old seen during the 2 periods of study: 16,236 from 1-05-1995 to 30-04-1996 and 17,377 from 1-07-2003 to 30-06-2004. Randomised sampling stratified for age and sex of the clinical records of the target population gave these samples: 140 at the first evaluation and 250 at the second (95% CI). MEASUREMENTS: Two internal-audit, retrospective evaluations were made, by means of review of clinical records by health professionals at the centre (peer review). The variables reviewed were activities of PPAHP for adults. RESULTS: The overall improvement attained was 64.45% (Pareto Diagram). All PPAHP activities (except Anamnesis for Metrorrhagia) showed significant improvement in compliance (P < .05). The PPAHP activity with the highest degree of improvement was Mammography, which went up from 3.70% (+/-7.12) of compliance (first evaluation) to 83.87% (+/-12.95) (second evaluation). CONCLUSIONS: Degree of compliance with PPAHP improved with time, except for anamnesis on metrorrhagia. The activity with the greatest degree of improvement was mammography.

Adolescent↗
PubMed2005

Pattern of community compliance with spaced, single-dose, mass administrations of diethylcarbamazine or ivermectin, for the elimination of lymphatic filariasis from rural areas of southern India.

Current programmes to eliminate lymphatic filariasis (LF) are largely based on annual mass administrations of single doses of antifilarial drugs. The level and pattern of compliance by the target population are important determinants of the success of such mass drug administrations (MDA). Community compliance was therefore investigated during a study in southern India of the effects, on Wuchereria bancrofti microfilaraemia and transmission, of spaced MDA based on diethylcarbamazine (DEC) or ivermectin (IVM). During six rounds of MDA, the frequency of compliance in the target populations, in the five study villages given DEC and the five given IVM, ranged from 55%-77%. Analysis of the relevant cohort data indicated that about 30% of the villagers had complied with treatment during all six rounds, but 3.5% of those in the DEC arm and 4.0% of those in the IVM arm had never complied with treatment. Most of the villagers (>90%) had received treatment at least once, however, and >60% had each received treatment in at least four of the six rounds. Overall, there was a significant negative correlation (r=-0.78; P=0.008) between the size of the village, in terms of the number of villagers, and the mean frequency of compliance over the six rounds of MDA. The pattern of community compliance was found to be 'semi-systematic', laying between random and systematic. In terms of the elimination of LF, a semi-systematic pattern of compliance is worse than random compliance but better than systematic. The relevance of the levels and patterns of compliance to LF control or elimination is discussed.

Animals↗