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PubMed1992

Alzheimer's disease in Nigeria.

The age-related dementias of the elderly (those aged 65 years or more) are of major public health importance in developed countries. Developing countries, most of which are undergoing epidemiological transition and greying of population, currently contain more than half of the world's population of elderly, a proportion that would reach 75% by 2020. Apart from reports from China, there is little or no information on the dementias of the elderly in developing countries. Alzheimer's disease, which accounts for two-thirds of dementia of the elderly in Caucasian population, is under-documented and believed to be rare in black Africans. But black Americans who are of black African lineage commonly suffer from Alzheimer's disease. A recent autopsy survey of the brains of elderly Nigerians showed absence of senile plaques and neurofibrillary tangles, the pathognomonic histologic lesions of Alzheimer's disease and ageing found in 25% to 80% of normal undemented elderly Caucasians and Japanese. In a community-based door-to-door survey of a population of 9000, including 932 elderly Nigerians, no subject with dementia as defined by DSM-IIIR was found, although there was significant decline of cognition with age, female sex and less than 6 years of formal education. The distribution of cognitive scores is a highly skewed unimodal curve. We emphasize the potential value of cross-cultural epidemiological studies of ethnic groups in different environments and with different prevalence ratios of Alzheimer's disease, in identifying putative environmental factors for this disease.

Adult↗
PubMedDate not supplied

Prenatal diagnosis and control strategies for beta-thalassaemia on the Indian subcontinent.

BACKGROUND: The control of beta-thalassaemia by prenatal diagnosis is an important option in India. The disease is common and resources are scarce for the treatment of affected children. Presently the most suitable approach for prenatal diagnosis is DNA analysis of a chorion villus sample by direct mutation detection. For the implementation of such a prenatal diagnosis programme it is essential to know the spectrum of beta-thalassaemia mutations in the population. METHOD: The beta-thalassaemia mutations of 708 unrelated carriers from seven different regions of the Indian subcontinent were characterized by the allele-specific polymerase chain reaction and DNA sequencing. RESULTS: Sixteen different beta-thalassaemia mutations were identified which could be divided into three groups according to their frequencies. Five common mutations accounted for 93% of alleles. Significant regional differences in the frequency and distribution of mutations were observed. CONCLUSIONS: The spectrum of mutations defined forms the basis for a beta-thalassaemia prenatal diagnosis programme in India. A strategy has been outlined for mutation detection which could be successfully applied. Since prenatal diagnosis has become comparatively simple, recommendations are made for a community-based thalassaemia control programme.

Base Sequence↗
PubMed1992

Patient care episodes in mental health organizations, United States: selected years from 1955 to 1988.

The 4,930 mental health organizations providing mental health services in the United States during 1988 (excluding the Territories) generated just over 8.3 million patient care episodes (table 1). However, in order to compare 1988 data with those for other years dating back to 1955, outpatient and partial care programs administered by the Department of Veterans Affairs (formerly the Veterans Administration) (VA) need to be omitted (table 2). Thus the 7.8 million patient care episodes in 1988 (exclusive of VA outpatient and partial care programs) represented a more than four-fold increase over the 1.7 million patient care episodes in mental health organizations observed more than three decades earlier in 1955. The major shifts in patient care episodes over the period from 1955 to 1988 have been from inpatient to ambulatory care services in mental health organizations, and from State and county mental hospitals to community-based mental health organizations. For example, in 1955, 77 percent of all patient care episodes were inpatient episodes, and the remaining 23 percent were outpatient episodes. By 1988, inpatient episodes constituted only 28 percent of the total, while 66 percent were outpatient episodes, and 6 percent were partial care episodes (table 2 and figure 1). However, the relative distribution of inpatient, outpatient, and partial care episodes has been relatively stable since 1975. From 1955 to 1988, the primary locus of inpatient care shifted from State and county mental hospitals to non-Federal general hospitals. Also, by 1988, the locus of over one-half of the outpatient care episodes and almost two-thirds of the partial care episodes was in multiservice mental health organizations.

Ambulatory Care↗
PubMed1977

Blood pressure studies in 14 communities. A two-stage screen for hypertension.

the Hypertension Detection and Follow-up Program (HDFP) is a community-based national trial to determine whether special programs can improve the treatment for persons with uncontrolled hypertension and reduce morbidity and mortality in wide strata of these patients. A total of 158,906 persons, aged 30 to 69 years, were screened to identify those with a diastolic blood pressure (DBP) of 95 mm Hg or higher. Age-sex-race means and distributions of DBP at a first and a second screen and prevalence rates or actual hypertension by sex, race, and level of control suggest a recently increased awareness of hypertension with more widespread and effective treatment, especially among women, although blacks under treatment had their DBP controlled less frequently. The response to this program of screening and initial follow-up offers encouragement for improved community control of high blood pressure.

Adult↗
PubMed1992

Community-based survey on blood pressure, blood biochemistry and dietary habits in Pu-Li, Taiwan.

The target population of this study were all residents over the age of 30 in Pu-Li. Stratified cluster sampling was employed. Household visits were carried out in 1987 by the Yang-Ming Crusade, organized by well-trained medical students of the National Yang-Ming Medical College. A total of 1,738 persons out of a potential 2,573 eligible subjects were contacted by at least one of the two interviews or a blood draw. The crude and adjusted (for vacant households) rates were 68% and 84% respectively. Age, sex, and education were evenly distributed. The distribution of physiological variables and blood biochemistry were as follows: 23.0 +/- 3.2 for body mass index (BMI = kg/m2; men 22.8 +/- 3.0, women 23.2 +/- 3.3), 129.7 +/- 20.7 mmHg for systolic blood pressure (men 130.4 +/- 19.6 mmHg, women 128.9 +/- 21.8 mmHg), 81.9 +/- 12.9 mmHg for diastolic blood pressure (men 82.9 +/- 12.8 mmHg, women 80.9 +/- 12.9 mmHg), 103.6 +/- 29.6 mg/dl for fasting plasma glucose (men 101.8 +/- 21.9 mg/dl, women 105.2 +/- 35.2 mg/dl), 222.1 +/- 57.2 mg/dl for cholesterol (men 221.9 +/- 56.5 mg/dl, women 222.3 +/- 57.9 mg/dl), 162.7 +/- 115.5 mg/dl for triglyceride (men 170.3 +/- 117.1 mg/dl, women 155.7 +/- 113.6 mg/dl), 5.8 +/- 3.0 mg/dl for uric acid (men 6.5 +/- 4.8 mg/dl, women 5.2 +/- 1.5 mg/dl). Blood pressure and blood biochemistry variables were positively associated with age. Comparatively, men had much more unhealthy life styles than women; due to prevalences for cigarette smoking (56.0% vs. 3.0%), alcohol intake (43.8% vs. 6.6%) and betel-nut chewing (18.2% vs. 0.8%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Clustering in sparse data and an analysis of rhabdomyosarcoma incidence.

Time series of epidemiologic events often contain periods of atypically low or high frequency. Correspondingly, for quite rate diseases there occur instances of long vacuous durations interrupted noticeably by periods of some disease activity. A recent community-based observation of the incidence of rhabdomyosarcoma (RMS), and an investigation of it, yielded sparse data of this general description. We introduce a combinatorial test for patchy time series and apply it to the RMS data. We comment on the prevalent practice of post hoc data analysis of alleged clusters, and on scale effects.

Adolescent↗
PubMedDate not supplied

Family planning information sources and media exposure among Zimbabwean men.

This report describes, for a sample of Zimbabwean men, sources of family planning information, media exposure, media preferences, and whether they would like to learn more about family planning methods. The data are from the 1988 Zimbabwe Male Fertility Survey, a representative sample of 711 currently married men aged 20 and over. The analysis is restricted to the 512 men whose wives were aged 49 and under at the time of the survey. The radio and personal communications, followed by posters and newspapers, are the most frequently reported sources of family planning information. The radio is considered to be the best medium for learning about family planning, followed by community-based distributors. Nearly 85 percent of respondents indicated that they would like to learn more about family planning. Information from men should be included in information, education, and communication programs in order to enhance male involvement in the family planning process.

Adult↗
PubMed1991

Effects of repeated doses of ivermectin on ocular onchocerciasis: community-based trial in Sierra Leone.

Ivermectin seems to be a safe and effective treatment for onchocerciasis when given in a single dose, but less is known about the effects of repeated doses. Also, there seem to be differences in its effectiveness in anterior and posterior segment ocular disease. The ocular effects of ivermectin were studied in 586 villagers who were taking part in a double-blind, placebo-controlled, randomised trial in Sierra Leone. Only those who had received four doses, with 6-month intervals, of ivermectin or placebo were eligible. The 296 ivermectin-treated subjects and the 272 who received placebo were comparable with respect to age, sex, Onchocerca infection, blindness, and visual impairment before treatment. After treatment, the ivermectin group had less anterior segment disease than the placebo group, with significantly lower prevalences of microfilariae in the anterior chamber and cornea, and punctate keratitis (all p less than 0.001), and iritis (p less than 0.05). There was no significant difference in the prevalence of sclerosing keratitis, optic atrophy, or chorioretinitis between the groups. Visual acuities tended to be better in the ivermectin group, but the difference was not significant. There was a small but significant (p less than 0.01) excess of vascular sheathing in the ivermectin group. These differences persisted when subjects who were blind or visually impaired at baseline were excluded from analysis. The long-term effects of ivermectin, particularly on posterior segment disease, need further evaluation. In the mean time, the mass distribution of ivermectin should be promoted for all communities with hyperendemic onchocerciasis at risk of anterior segment disease.

Adolescent↗
PubMed1992

Sex, cardiac hypertrophy and diurnal blood pressure variations in essential hypertension.

OBJECTIVE: To test the hypothesis of a difference between men and women in the left ventricular hypertrophic response to diurnal variations of ambulatory blood pressure in essential hypertension. DESIGN: Non-invasive ambulatory blood pressure monitoring and echocardiography in untreated hypertensive patients and healthy normotensive subjects. SETTING: Community-based ambulatory population in tertiary care centers. PATIENTS: Two hundred and sixty hypertensive patients and sixty-three healthy normotensive subjects. MAIN OUTCOME MEASURE: Patients with average daytime systolic blood pressure (SBP) and diastolic blood pressure (DBP) falling by less than 10% during the night were defined as non-dippers, the others as dippers. RESULTS: In the hypertensive group, dippers and non-dippers did not differ, in either gender, in several covariates possibly affecting left ventricular structure, including daytime ambulatory blood pressure, prevalence of white coat hypertension, age, body mass index, family history and known duration of hypertension, funduscopic changes, diabetes, alcohol consumption and renal function. Left ventricular mass (LVM) did not differ between dippers and non-dippers in hypertensive men whilst in hypertensive women it was significantly lower in dippers than in non-dippers. This sex difference held for all quartiles of the distribution of mean daytime blood pressure. In hypertensive women there was an inverse correlation between LVM and the per cent reduction of SBP and DBP from day to night, but this relationship was absent in hypertensive men. Other indices of left ventricular structure differed between dippers and non-dippers in both genders, as did LVM. CONCLUSIONS: For any level of daytime ambulatory blood pressure, a reduction of SBP and DBP by less than 10% from day to night identifies a subset of hypertensive patients at increased risk of left ventricular hypertrophy only in the female gender. These data suggest that, compared with men, hypertensive women require a longer duration of exposure to high blood pressure levels during the 24 h to develop left ventricular hypertrophy.

Blood Pressure↗
PubMed1991

A community-based study of incidence, risk factors and outcome of transient ischaemic attacks in Umbria, Italy: the SEPIVAC study.

The SEPIVAC study is a community-based epidemiological survey of incidence and outcome of transient ischaemic attacks (TIAs) and strokes in the territory of the 6th Local Health Unit, Umbria, Italy, where 49,218 people live, from 1 September 1986 to 31 August 1989. All cases were registered with the study either by notification from general practitioners (GPs) or by a check of hospital admission within the study area and in the two hospitals of Perugia. There were 94 incident cases of TIAs (45 males, 49 females), thus giving a crude rate of 0.64 per 1000 per year [95% conficence intervals (CI) 0.52/0.78]. The rate adjusted to the European population is 0.42 (CI 0.33/0.54). Mean age was 69.4 years, and females were significantly older than males. The weighted relative risk for males was 1.19 (CI 0.79/1.79). Thirty-one patients were treated at home by their GPs. Females had hypertension more frequently than males, whereas males smoked more frequently; we did not find any other statistically significant difference in the distribution of risk factors. Twelve patients out of 58 who had CT had an infarct, and 29 out of 54 submitted to Doppler ultrasonography had carotid stenosis. At 1 month, 4 patients had suffered an ischaemic stroke, 1 of whom died. At 6 months, 3 further strokes and 2 further deaths (1 due to myocardial infarction) had occurred.

Aged↗
PubMed1992

The FINMONICA Stroke Register. Community-based stroke registration and analysis of stroke incidence in Finland, 1983-1985.

In the early 1980s, a standardized community-based stroke register was started in three geographic areas in Finland: North Karelia and Kuopio in eastern Finland and Turku/Loimaa in southwestern Finland. The results from the first 3 years, 1983-1985, confirmed the high incidence of stroke in Finland. The incidence of stroke was higher in eastern Finland than in the southwestern part of the country. The age-standardized annual incidence among men aged 25-74 years varied from 206 per 100,000 population in southwestern Finland to 322 per 100,000 population in the province of Kuopio in eastern Finland. Among women aged 25-74, incidence was 119 and 187 per 100,000 population in these two areas, respectively. The age-standardized male:female ratio in incidence was 1.7, slightly higher than that previously reported in Finland. Out of 3,574 stroke events registered, 78% were first events without a history of previous stroke. People aged 65-74 years accounted for 45% of all events among men and 62% of all events among women. The authors' experience shows that the geographic variation in stroke incidence and attack rates is difficult to assess even within a country with a relatively uniform health care system. Rigorous standardization and quality control is needed for the assessment of long-term trends; this is the primary goal of the FINMONICA Stroke Register. The findings of this study suggest that the incidence of stroke is still high in Finland, although mortality from stroke has steeply declined during the past 15-20 years. The number of stroke survivors in Finland may actually be increasing. Since the occurrence of stroke is high in Finland as compared with other countries, intensified primary and secondary prevention measures are needed to reduce it.

Adult↗
PubMed1992

Medication utilization and patient information in homes for the aged.

A random cross-sectional sample of 198 residents was taken from a convenience sample of 20 Flemish, community-based nursing homes for the aged. Twenty trained interviewers reviewed the medication list of these residents and interviewed the nurses responsible for their daily care to assess their activities of daily living (ADL) and cognitive status. Direct interview was possible of 128 residents (65%); communication with the other 70 residents was impossible because of dementia (55 patients) or communication problems, such as aphasia and deafness (15 patients). An average of 4.5 different medicines was mentioned on the medication lists of the 198 residents. Drug use increases with age but stabilises after the age of 80 y. Medicines are ordered from local community pharmacies and are delivered to the ward rooms in original drug dispensing packs. The nursing staff is responsible for distribution inside the institution. Nursing personnel read the inserts of the medicines given to 98% of the residents and keep the inserts of 77% in the nursing office. Only 11% of the residents maintained some autonomy in ordering, keeping and taking their medication, although 42% were evaluated by the nurses as functionally and cognitively fit. Only 4% of the 128 residents able to respond to an interview had a notion of the potential adverse effects of their medication; the two most important sources of information about medicines mentioned by those residents were the general practitioner and the nursing personnel; 4% mentioned relatives and friends, or the pharmacist, as information sources.

Activities of Daily Living↗
PubMed1991

Reduction in total under-five mortality in western Nepal through community-based antimicrobial treatment of pneumonia.

Pneumonia is a leading cause of death among children world wide but those at highest risk in developing countries have limited access to clinical services; effective and low-cost alternatives are a global public health priority. We have done a controlled intervention trial among 13,404 children under five in Jumla, Nepal, which relied exclusively on indigenous community health workers to detect and treat pneumonia according to the World Health Organisation decision strategy, with a five-day home-treatment course of oral co-trimoxazole. No other health services were provided, and referral of children to hospital was not practicable. During the three-year study, 2101 deaths were recorded. The programme led to a 28% reduction in the risk of death from all causes by the third year of services (relative risk 0.72, 95% confidence interval 0.63-0.82), with a significant trend (p less than 0.02) of lower mortality with greater duration of the programme. The greatest benefit was among infants. In addition to reduction in deaths due to pneumonia, there was a significant reduction in deaths due to diarrhoea and measles, indicating that reduction in pneumonia morbidity had considerable carry-over effect. Our findings show that indigenous community workers can effectively detect and treat pneumonia, and reduce overall child mortality, even without other primary care activities.

Administration, Oral↗
PubMed2026

Indigenous body image amid rapid social and economic change: A reflexive thematic analysis of Wayuu narratives.

The Wayuu, Colombia's largest Indigenous group, are experiencing rapid social, economic, and technological change, including expanding internet access, educational opportunities, and increasing exposure to globalised media. Though the harmful effects of appearance-idealised media imagery on body image are well documented, indigenous body image research remains unevenly distributed across global contexts, with Latin American Indigenous communities particularly underrepresented. This study explored how Wayuu people understand and experience appearance ideals and body image in the context of expanding digital media exposure and rapid sociocultural and economic change. Five focus groups of up to 9 participants were conducted with 29 Wayuu participants (18-68 years; 23 women, 6 men). Using reflexive thematic analysis, three overarching themes were identified: (1) Intersecting sources of appearance pressure: encompassing influences from social media, Wayuu family expectations, and discrimination from non-Indigenous peers; (2) Negotiating and resisting appearance ideals: from body dissatisfaction and restrictive eating to affirmation of cultural identity as protection; and (3) The changing role of appearance in today's Wayuu culture: participants linked globalised appearance ideals to expanding educational opportunities, migration, digital connectivity, and broader socioeconomic transformations occurring within Wayuu territories. While exposure to global ideals fostered comparison and dissatisfaction, cultural pride and collective belonging appeared to buffer against internalised colonial values. Culturally grounded media literacy and education initiatives co-developed with Wayuu communities could foster critical reflection while strengthening heritage. These results highlight the need for decolonial, community-based approaches to body image research and intervention in Indigenous contexts.

Adolescent↗
PubMed1992

Statistical description of the Mini-Mental State Examination for French elderly community residents. Paquid Study Group.

The distribution of total Mini-Mental State Examination (MMSE) scores, individual items, and groups of items were studied in French elderly community residents from a random sample of 2727 subjects. Serial seven, recall three objects, and copy pentagons had the lowest percentage of correct responses, while orientation to place, naming two objects, and three objects registration had the highest percentage of correct responses. The structure of correlation of the items was studied using Principal Components Analysis. The projection of the items on the first axis reflects the tendency of the items to vary in the same direction and is compatible with the fact that the MMSE items are all indicators of the same concept: cognitive performance. The second and third axes identify clusters of highly correlated variables and provide support for the internal validity of the MMSE score for a French population. The full MMSE score seems to be a valid instrument for the evaluation of cognitive performance in community-based elderly residents.

Aged↗
PubMed1978

Patient outcomes in alternative long-term care settings.

The purpose of this study was to compare health status outcomes in three alternative long-term care settings in the Veterans Administration : 1) home care; 2) community-based nursing home care; and 3) hospital-based nursing home care. Patients were measured on a behavioral index of health status, at two points in time: when transferred from the acute care hospital to one of the three treatment programs (pretest and three months later (posttest). Since patients could not be randomly distributed to programs, two methods were employed to control for potential sample selection bias: the choice of a nonequivalent control group design, and multivariate analytic techniques. First, within each program type, patients were randomly selected from both a hospital that offered only that program as a long-term care alternative and from a hospital that provided all three treatment settings. Second, multiple regression analysis was used to control for pretest differences among patients. Patients placed in the home care program displayed the greatest mean improvement in functional health status, holding all other variables constant. This treatment effect was not uniform, however; patients showed differential rates of improvement across the three programs, based upon both initial health status and prognosis.

Adult↗
PubMed1992

Rubella among the Amish: resurgent disease in a highly susceptible community.

Although the Amish make up less than 0.05% of the United States population, nearly all rubella reported in the United States in 1991 occurred in this population. In early 1991 a large rubella outbreak in a Tennessee Amish community that had experienced no rubella for 17 years afforded an opportunity to describe the epidemiology of rubella in this unique population. Structured interviews were conducted with 54 Amish families. Of 383 persons in the sample 85 (22%) had rubella. Illnesses were mild; 16% of cases lacked fever and 20% of cases reported no symptoms except rash. Children < 17 years of age were 7 times more likely than older individuals to be affected (77 of 214 vs. 8 of 165). All pregnant women in the community were > 20 years of age; none developed rubella. No congenital rubella syndrome was recognized. Although rubella is increasingly a disease of adolescents and young adults, in this outbreak, rubella was again a childhood disease. Illness in this community-based investigation was mild; rubella may be difficult to diagnose and report. Immunity after remote natural infection was durable since the community's last outbreak. Pregnant women probably were protected by the age distribution of immunity; this age distribution may not occur in other Amish populations. If preventable morbidity from rubella and other vaccine preventable diseases is to be avoided in this group, increased attention should be directed to encouraging vaccinations among Amish persons.

Disease Outbreaks↗
PubMed2026

Healthcare-facility-based SARS-CoV-2 genomic surveillance in Brazil: experience from the global action in healthcare network.

UNLABELLED: Genomic sequencing is essential to effectively monitor the SARS-CoV-2 evolution and spread of its lineages. Healthcare-facility-based SARS-CoV-2 genomic surveillance has been proposed as a valuable strategy, considering the characteristics of its target population. As part of the Centers for Disease Control and Prevention's Global Action in Healthcare Network program, this study aimed to describe the distribution and frequency of SARS-CoV-2 lineages in two tertiary-care hospitals in Brazil, where the genomic sequencing capacity is limited. Whole-genome sequencing of SARS-CoV-2 samples obtained from 993 healthcare workers (75.4%) and inpatients (24.6%) was analyzed between February 2023 and August 2024. In total, 113 distinct lineages were identified. Notably, we observed a temporal replacement of predominant lineages corresponding to three distinct epidemic waves: the first wave dominated by XBB.1.5 and XBB.2.3 (February 2023 to June 2023), the second by GK.1.1 and JD.1.1 (September 2023 to December 2023), and the third by JN.1 and JN.1.9 (January 2024 to April 2024). JN.1.9 was the only lineage with a significantly higher prevalence among healthcare workers compared to inpatients. Additionally, we identified cases of co-infection with genetically distinct variants, underscoring the potential for healthcare-based monitoring to capture events relevant to viral evolution. Overall, our findings were consistent with those observed across Brazil, suggesting that this strategy may be valuable for SARS-CoV-2 genomic surveillance. They also indicate a clear temporal pattern of lineage replacement, reflecting successive waves driven by emerging variants and rapid global dissemination. IMPORTANCE: Genomic surveillance of SARS-CoV-2 remains essential for identifying emerging variants with increased transmissibility, immune escape, or pathogenicity. While most genomic surveillance efforts focus on community-based sampling, a healthcare-facility-based strategy may offer a complementary approach. In this study, we describe SARS-CoV-2 lineage dynamics over an 18-month period among healthcare workers and hospitalized patients in southern Brazil. Our findings align closely with regional and national trends, supporting the value of healthcare-facility-based SARS-CoV-2 genomic surveillance for documenting the local genomic landscape and demonstrating the feasibility and value of this approach in settings with limited genome sequencing capacity. Additionally, this approach may be applicable to other respiratory viruses in healthcare settings; however, further studies would be needed to confirm this.

Humans↗