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PubMed2001

Severely mentally ill substance abusers: an 18-month follow-up study.

BACKGROUND: The aims of this study were to investigate initial characteristics and improvement after 18 months in patients with comorbidity of severe mental illness and substance dependence. These patients took part in a multicentre study aimed at improving co-operation between psychiatric health care units and social services. METHODS: A total of 358 patients, 66% men, were included. There were four diagnostic subgroups: psychosis 29%, depression 17%, borderline personality disorder 23%, and other diagnoses of equal severity 31%. Initially and at follow-up the following measurements were used: global functioning axis V DSM-III-R (GAF), seven areas of Addiction Severity Index (ASI) and psychological symptoms (SCL-90). The outcome of substance use during the past 6 months was estimated by the Clinical Rating Scale (CRS). RESULTS: Most patients were single (77%) and few (10%) had income from employment. Many (61%) had made suicide attempts, and 52% had somatic diseases before entering this project. After 18 months, 14 patients (3.9%) had died, and 288 patients (84%) could be interviewed. There were significant improvements in all but one ASI area (employment), in psychological symptoms and in global functioning. There was a positive correlation between the reductions in severity of alcohol abuse, drug abuse, psychiatric symptoms, relationships (ASI) and psychological symptoms. Forty-eight percent of patients with mainly alcohol-related problems, and 57% of those with mainly drug-related problems were either "abstinent" or using drugs "without impairment" (CRS) after 18 months. Improvement did not differ between psychiatric subgroups. CONCLUSION: These patients have weak social integration. Alcohol dependence was the most common substance use disorder. In most areas investigated, patients had improved. No substance abuse was found in half of the patients at follow-up.

Adult↗
PubMed1985

Methodological issues in collecting data from traditional birth attendants.

Information on the activities, practices and social context of pregnancy and delivery care provided by traditional birth attendants (TBA) is a critical requirement in planning, monitoring and evaluating maternal health programs in many countries. As a result of experimental studies in which such information was obtained by a variety of methods, and a review of alternative methodologies, a set of guidelines has been developed for the collection of such information. High-lighted are the need for good background knowledge on the local situation, involving TBAs themselves in design and collecting methods, a system of supervision to ensure adequate training and careful monitoring, and finally sharing the findings with the TBAs as well as with health officials.

Brazil↗
PubMed1985

Recent changes in the sociodemographic profile of sterilization acceptors in Nepal.

The records of 8056 Nepalese males and 9291 females sterilized from 1979-1983 were analyzed. Compared with data from previous studies (1970-1976), significant decreases occurred in the average age of female acceptors (30.6 vs. 33.1, P less than 0.01) and wives of male acceptors (28.4 vs. 31.7, P less than 0.01). Also, the average number of living children per couple decreased by one child (4.9-3.9, P less than 0.01) for male acceptors and 0.6 (4.8-4.2, P less than 0.01) for female acceptors. Finally in 83.2% of the cases, the operation was performed within 3 years of the last delivery.

Adult↗
PubMedDate not supplied

One year surveillance of HIV-1 infection in Johannesburg, South Africa.

A sero-epidemiological surveillance study to monitor the prevalence of HIV-1 infection in Johannesburg, South Africa, was commenced in February 1988. The population selected for study were attenders at clinics for sexually transmitted diseases (STD) and at family planning (FP) clinics. In the 12 months of the study 6631 sera were tested. Of the STD attenders, 15 of 1224 black females (1.2%) and 21 of 2482 black males (0.8%) were positive. Of the 449 white males tested 49 were homosexual, amongst whom 10 (20.4%) were positive; in the heterosexual white male group 4 of 400 (1.0%) were positive. Of the FP clinic attenders, 4 of 1459 black females (0.3%) were positive. 68 of the 6631 sera tested were indeterminate for infection. No attenders were positive for HIV-2 infection. These data confirmed the entry of HIV infection into the black population in South Africa.

Ambulatory Care Facilities↗
PubMed1990

Use of smokeless tobacco among conscripts: a cross-sectional study of Norwegian army conscripts.

In a cross-sectional study of 2,112 Norwegian army conscripts ages 18 to 25 years, 10% reported daily use of wet snuff, while 23% were occasional users. Nearly half of the snuff users had started or increased their consumption during the military service. Cigarette smoking, alcohol consumption, and having a best friend using snuff were positively correlated with starting to use snuff. Daily use was associated with high physical activity. Use of snuff did not vary significantly with length of education when adjusting for other variables. Nearly all subjects believed prolonged snuff use to be a hazard to health. Forty percent of the snuff users believed they would give up snuff after the military service. Giving up during the service was statistically associated with having a steady relationship with a girlfriend and with length of time served. The relatively high percentage of occasional users and the high rate of stopping and starting reflect the novelty of snuff use among Norwegian youth. The widespread intention to give up seems to indicate that a large proportion of snuff users have ambivalent attitudes toward their own behavior. Therefore, future intervention measures in the armed forces could have a substantial impact on young males' use of smokeless tobacco.

Adolescent↗
PubMed1992

Impact of user fees on attendance at a referral centre for sexually transmitted diseases in Kenya.

We investigated the impact of a short-lived policy of charging fees to patients attending public-sector outpatient health facilities in Kenya by collecting data on attendance at Nairobi's Special Treatment Clinic for sexually transmitted diseases (STDs) before (23 months), during (9 months), and after (15 months) the user-charge period. During the user-charge period, the seasonally adjusted total mean monthly attendance of men decreased significantly to 40% (95% CI 36-45) of that before fees were levied. Attendance rose in the post-user-charge period, but reached only 64% (59-68) of the pre-user-charge level. For women, the adjusted total mean monthly attendance during the user-charge period was reduced significantly to 65% (55-77) of the pre-user-charge level. Mean monthly attendance by women rose in the post-user-charge period to 22% (9-37) above the pre-user-charge level. There was no evidence of an increase in attendance over the course of the user-charge period among either men or women. The introduction of user fees probably increased the number of untreated STDs in the population, with potentially serious long-term health implications. The user-fee experience in Kenya should be carefully evaluated before similar measures are introduced elsewhere.

Community Health Centers↗
PubMed1988

Problems and help seeking in high-risk adolescent patients of health clinics.

In this study, 2787 adolescents between the ages of 13 and 18 years living in inner-city communities were interviewed about their mental and physical health and their clinic use. The patients used consolidated mental and physical health clinics located in neighborhoods, hospitals, or schools; or traditional neighborhood or hospital health clinics. Analyses of selected patient problems reveal that less than one third of adolescent patients with suicide ideation, conduct disorder, and substance abuse or dependency sought or received care for those problems. Only half of the adolescents with major depression sought or received care for depression, and only two thirds of the sexually active females sought or received help with birth control. A special effort needs to be made to attract troubled youth to clinics and to identify and treat their problems, particularly when those problems involve mental health concerns.

Adolescent↗
PubMed1994

Factors affecting number of prenatal care visits during second pregnancy among adolescents having rapid repeat births.

PURPOSE: To examine factors associated with the number of prenatal care visits during second pregnancy for adolescents having a short interval between pregnancies. METHODS: The sample includes all adolescents aged 13 to 17 years whose first pregnancy resulted in a birth at a regional medical center in southeastern North Carolina from January 1983 to December 1989 and who had a repeat pregnancy within 24 months which resulted in a birth. We abstracted data from medical records and birth certificates. We fit a negative binomial regression model to determine the effects of various factors on the number of prenatal care visits during second pregnancy. RESULTS: The number of prenatal care visits during the first pregnancy, poor first birth outcome, interval between first and second pregnancy, and care provided by health department staff during first pregnancy were all positively associated with number of prenatal care visits during second pregnancy when controlling for gestation age of second birth. Other independent variables in the model included maternal age, education, black race, and being unmarried at the time of second birth. CONCLUSIONS: Because prenatal care is important for healthy mothers and babies, adolescents should be encouraged to seek prenatal care early in the first pregnancy. This could be an important time to implement interventions aimed at increasing prenatal care utilization in this and subsequent pregnancies.

Adolescent↗
PubMed1994

SMART START: an option for adolescents to delay the pelvic examination and blood work in family planning clinics.

PURPOSE: The goal was to encourage earlier use of family planning services and effective birth control for teens. METHOD: In three federally-funded family planning clinics, the SMART START service model was offered to non-pregnant teens under 18. Teens making their first family planning visit to the clinics for family planning services had the option to delay the requisite pelvic examination and blood work following a careful medical and social history for up to 6 months while obtaining oral contraceptives and/or other non-prescriptive contraceptives. Each teen also received individualized counseling and follow-up telephone contacts. Survey and medical chart data were collected during the project period to evaluate the effects of SMART START on 151 teens. RESULTS: Of the 151 teens, 26% delayed the pelvic examination and 40% delayed the blood work. The delay of medical services did not result in negative health outcomes. Teens who elected to delay the pelvic examination returned to the clinic as frequently for revisits, they reported using condoms more consistently, they had fewer pregnancies and had similar STD rates compared with those not delaying. SMART START also found that ethnic factors correlated with deferring the blood work. CONCLUSIONS: SMART START offered teens options over how and when they receive reproductive health care services without withholding effective contraceptive methods. No serious complications of STDs resulted from the delay procedures. Expansion of the SMART START model to include both teen and adult populations is encouraged.

Adolescent↗
PubMed2005

The Norwegian School Fruit Programme: evaluating paid vs. no-cost subscriptions.

BACKGROUND: This study reports the effect of providing Norwegian school children with free fruit or vegetables every school day and the effect of an existing fee-based School Fruit Programme. METHODS: Seventh grade pupils and their parents completed questionnaires at baseline (autumn 2001) and at follow-up (spring 2002). Nine schools participated in the School Fruit Programme for free (Free fruit), nine schools took part at standard conditions (Paid fruit), and 20 schools did not take part in the subscription programme (No fruit). A total of 795 7th graders (11 or 12 years old at baseline) participated both at baseline and at follow-up. RESULTS: At follow-up, pupils attending the Free fruit schools had significantly higher intake of fruit and vegetables at school than the pupils at the Paid fruit and No fruit schools (P < 0.001, mean intakes were 1.1, 0.4 and 0.2 portions, respectively). Subscribers at the Paid fruit schools had significantly higher intake than the non-subscribers at the same schools. CONCLUSIONS: Providing a free piece of fruit or a vegetable is an effective strategy to increase school children's fruit and vegetable intake. The existing School Fruit Programme appears to increase the intake among the subscribers, but thereby also tends to increase an existing difference in consumption patterns among subscribers and non-subscribers.

Adolescent↗
PubMed1997

Factors influencing attendance to immunization sessions for children in a rural district of Ghana.

Improving immunization coverage is vital to promoting child health and reducing childhood diseases and deaths. In spite of being actively promoted as a major public health intervention for national development since the late 1970s, immunization coverage in Ghana remains low. We investigated factors that influence attendance to immunization sessions in the Komenda-Edina-Eguafo-Abrem District of Ghana. The major factors hindering attendance were poor knowledge about immunization, lack of suitable venues and furniture at outreach clinics, financial difficulties, long waiting times, transport difficulties, poorly motivated service providers and weak intersectoral collaboration. The timing of immunization sessions, length of prior notice to the community, attitude of service providers and fear of side-effects generally did not deter attendance.

Adolescent↗
PubMed1998

Can intrauterine device removals for bleeding or pain be predicted at a one-month follow-up visit? A multivariate analysis.

From 4%-14% of intrauterine device (IUD) users have their IUD removed due to bleeding or pelvic pain in the first year of use. Past studies have analyzed whether baseline patient information can help predict such removals, but no previous analysis has examined whether information provided at the recommended 1-month follow-up visit could improve such predictions. Using data from an international multicenter randomized controlled trial, 89 women with removals for bleeding and pain after the 1-month visit were compared with 2536 continuing users. Logistic regression indicated several significant predictors of removal. Women reporting intermenstrual bleeding since last menses were nearly three times more likely to have removals for bleeding or pain (odds ratio [OR] 2.9; 95% confidence interval [CI] 1.4-5.9). Similarly, those complaining of excessive menstrual flow were 3.5 times more likely to have removals within 12 months (95% CI 1.4-9.2). Women reporting these menstrual problems during scheduled revisits may benefit from counseling and treatment with nonsteroidal anti-inflammatory drugs (NSAID).

Adolescent↗
PubMed1989

A model for planning local contraceptive services.

Data were collected on abortion referral rates, single young maternity rates and uptake of contraceptive services in order to identify specific areas of unmet need in the Nottingham Health District. Comparisons were made between boroughs and in the City of Nottingham between electoral wards. There was a direct relationship between abortion rate, single young maternity rate and social disadvantage. Analysis of contraceptive usage suggested a more ineffective service in the inner city, which has implications for the more efficient use of resources in the future. Targeting of consumer acceptable services to residents of the inner city and teenagers in general was recommended as a result of the study. For future planning a more useful routine data set was developed to record the activity at family planning clinics.

Adolescent↗
PubMed1986

Improvement in coverage of primary health care in a developing country through use of food incentives.

To improve attendance at mobile clinics for children food incentives were offered to attenders in a rural municipality in northern Nicaragua. Clinic attendance in villages where food incentives were offered was higher than that in control villages (96.5% vs 63.3% of child population, p less than 0.005). When food was later offered in control villages, attendance rose by 60.2% to full attendance (p less than 0.001). Some of the large amounts of non-emergency food aid available could be offered as incentives to increase the use of basic health services in developing countries.

Adult↗
PubMed1996

Randomised controlled trial of a reduced-visits programme of antenatal care in Harare, Zimbabwe.

BACKGROUND: Many of the individual components of antenatal care have been studied in randomised controlled trials, but few studies have compared whole programmes of antenatal care. Our aim was to test the hypothesis that a new programme of antenatal care with fewer goal-oriented visits would give an equivalent or better result in the outcomes associated with pregnancy and delivery. METHODS: In a randomised clinical trial in Harare, Zimbabwe, we compared a new programme of antenatal care with the standard programme. The new programme consisted of fewer but more objectively oriented visits and fewer procedures per visit. Seven primary care clinics were randomly assigned to the two programmes-three to the standard programme and four to the new programme. FINDINGS: Over a 2-year period, 15,994 women were recruited into the study at the time they booked antenatal care. 97% of the women were followed up, 9,394 who had followed the new programme, and 6,138 from clinics with the standard one. Women allocated to the new programme made, as planned, fewer visits than those in the standard programme (median 4 vs 6 visits, respectively). The proportion of antenatal referrals was also lower (13.6 vs 15.3%; odds ratio 0.87 [95% CI 0.79-0.95]) because of significantly fewer referrals for pregnancy-induced hypertension (2.5 vs 3.8%; 0.66 [0.55-0.79]). Nevertheless, there were significantly fewer labour referrals for severe hypertension or eclampsia (2.1 vs 2.6%; 0.81 [0.66-1.00]). The risk for preterm (< 37 weeks) delivery was significantly lower for women on the new programme (10.1 vs 11.5%; 0.86 [0.78-0.96]). There were no other significant differences between the programmes in other major indices of pregnancy outcome, including antenatal referrals for other causes, labour referrals, obstetric interventions, low birthweight, and perinatal and maternal mortality and morbidity. INTERPRETATION: An antenatal care programme with fewer more objectively oriented visits can be introduced without adverse effects on the main intermediate outcome pregnancy variables.

Adult↗