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PubMedDate not supplied

Screening for cancer: state of the art and prospects for the future.

Effectiveness of screening has been established for two cancer sites: breast and cervix uteri. Only for these, therefore, are national policies applicable. The degree of effectiveness of such programs will depend on the coverage of the eligible population; organized programs are, therefore, essential. For cancer of the cervix, nearly maximal efficacy will be obtained by screening sexually active women from 25 to 60 years of age every 3 years. For cancer of the breast, current evidence only justifies screening from 50 years of age; most programs will stop at 70 years of age. Mammography every 2 years will provide nearly maximal efficacy. The place of breast self-examination and physical examination of the breasts is under investigation. In Japan, screening for stomach cancer is justifiable, although strict evidence of effectiveness is lacking. Screening for other cancers must still be regarded as experimental, including the use of sigmoidoscopy and fecal occult blood tests for colorectal cancer, and visual examination of the mouth for oral cancer. Because of organizational and other difficulties, screening seems unlikely to make a major contribution to reduction in overall cancer mortality by the year 2000. However, if organizational problems can be overcome, screening has the potential to control invasive cancer of the cervix, and to make a major contribution to reduction in breast cancer mortality.

Humans↗
PubMed2000

Agency-based tracking of difficult-to-follow populations: runaway and homeless youth programs in St. Louis, Missouri.

OBJECTIVES: This study explored agency-based tracking methods for one of the most difficult-to-follow populations: runaway and homeless youth. METHODS: A total of 118 program discharges from three federally funded agencies serving runaway/ homeless youth in St. Louis, Missouri were tracked for a follow-up study of this population. Agency staff attempted to locate and interview program participants three months post-discharge using a protocol that systematically varied times and location of contact attempts. Separate analyses were conducted to compare the group of subjects whose locations were ascertained with those who were not, and who were successfully interviewed with those who were not. Variables related to the tracking protocol and individual descriptive and service use variables were examined in these analyses. RESULTS: Sixty-nine percent of the sample was successfully located and fifty-nine percent interviewed. Significant findings included: fewer contact attempts over fewer days were made for individuals successfully interviewed, individuals tracked through Division of Family Services were less likely to be both located and interviewed, and individuals successfully located were significantly younger. CONCLUSIONS: This report provides encouraging evidence that even relatively unsophisticated protocols for tracking agency clients developed in collaboration with community agencies can--with consistent implementation--yield follow-up samples that are acceptably representative of program participants.

Adolescent↗
PubMed1996

Native Americans' cancer rates in comparison with other peoples of color.

BACKGROUND: The National Cancer Institute developed population-specific programs to better understand cancer as it occurs within underserved populations such as American Indians, Alaska Natives, Native Hawaiians, and American Samoans. METHODS: The data for American Samoans are derived from regional studies and from data collected from the Hawaii Surveillance, Epidemiology, and End Results (SEER) Registry. Native Hawaiian data are from the Hawaii SEER program and are limited to Native Hawaiians who live in that state. Alaska Native data are from the Lanier and Knutson 15-year summary of Alaska Native cancer data. American Indian data are from the New Mexico SEER program, which is generalizable to natives living in Arizona and New Mexico only and is relatively free of racial misclassification errors. RESULTS: An overview of age-adjusted cancer incidence and mortality rates among American Indians, Alaska Natives, Native Hawaiians, African Americans, and whites for 1977-1983 is provided. Five-year relative survival rates from cancer are from 1975-1984. Relative survival rates are provided for American Indians, Native Hawaiians, African Americans, and whites. CONCLUSIONS: Based on the limited data available, divergent cancer patterns appear to be present in these Native American populations. Alaska Natives and Native Hawaiians consistently display elevated rates that are frequently camouflaged when data are collapsed into "other" racial categories.

Black or African American↗
PubMed2026

Fecal immunochemical tests from population-based colorectal cancer screening programs support prospective microbiome cohorts.

BACKGROUND: Large, prospective cohorts are needed to research the gut microbiome's role in colorectal cancer (CRC) risk. We evaluated the gut microbiome leveraging residual fecal immunochemical tests (FIT) from a CRC screening program in Turin, Italy, and conducted one of the largest population-based case-control studies across the adenoma-carcinoma sequence to date. METHODS: We extracted DNA from residual FIT stool, used whole-genome shotgun sequencing, and included those with CRC (N = 44), advanced adenomas (N = 269), early adenomas (N = 134), and FIT-negative controls (N = 478). Alpha diversity, beta diversity, and species, gene, and pathway relative abundances were estimated. Multivariable logistic regression models were used to estimate associations of these metrics with colorectal neoplasms. RESULTS: Alpha diversity was mostly inversely associated with colorectal neoplasms, particularly early adenomas (OR: 0.45, 95% CI: 0.25-0.80; P = 0.01). Presence of oral pathogens, including Parvimonas micra, was associated with higher odds of CRC. Furthermore, Escherichia coli and Bacteroides fragilis were strongly associated with higher odds of all colorectal neoplasms. Several genes and pathways were associated with colorectal neoplasms. CONCLUSIONS: Our findings align with smaller studies of the gut microbiome and colorectal neoplasms, supporting that CRC screening programs provide opportunities to prospectively study the gut microbiome's association with cancer risk in large populations.

Humans↗
PubMed1982

Health education program effects on the management of hypertension in the elderly.

Because the elderly are viewed as having more difficulty in complying with therapy, this analysis was directed at the effects of a health education program on their control of primary hypertension when compared with a younger population. The program consisted of three sequential interventions introduced in a randomized factorial design. Depsite the fact that elderly patients had more chronic disease, more complications from hypertension, and were receiving more complex drug therapies than younger patients exposed to the same experimental interventions, they demonstrated significantly higher levels of compliance with drug therapy, significantly higher levels of appointment keeping, and no difference in the proportion having their BP under control at two-year-follow-up. Longitudinal data collected at five-year follow-up indicate no decay effect. These results indicate such programs can be successfully implemented and equally effective for an elderly population.

Aged↗
PubMed1989

Hypertension studies in the Soviet Union.

Arterial hypertension control trials conducted during the last decade in the Soviet Union are reviewed. Epidemiologic data illustrating a considerable prevalence of arterial hypertension in various regions are presented. The results of population hypertension control programs are discussed, and the feasibility of reducing total mortality in the intervention vs reference groups at the community level is demonstrated, with the mortality and morbidity due to stroke showing a two-fold decrease. An outline is given of the major approaches used in population programs started in recent years, which are geared at improving drug and nondrug prevention and altering approaches to hypertension control in public health care.

Adult↗
PubMed2002

Strategies used by interdisciplinary rural health training programs to assure community responsiveness and recruit practitioners.

In this article, the strategies used by five US rural interdisciplinary training grant programs to respond to local needs and to promote recruitment in rural communities are described. The programs provide training to 17 health care disciplines and serve disadvantaged Hispanic, African-American, Amish, Native American, and Anglo populations. Four programs are based in academic institutions; one is based in a community health center. The programs provide services to the rural communities through individual clinical or case management services, population-level interventions, and collaborative research. All programs use specific mechanisms (e.g. case conferences or participation in local coalitions) to facilitate collaboration with residents and to link student activities with community or individual needs. Unique strategies include the use of problem-based learning and community health workers on the interdisciplinary team to increase responsiveness. The programs also provide educational support to students while they work in the rural communities. Finally, the primary strategy used to promote recruitment is the training experience in rural communities. The programs also appear to indirectly improve the environment of rural practice.

Case Management↗
PubMed1984

The relative success of the Kainji resettlement scheme as compared with that of Volta.

The author compares the population resettlement programs undertaken in connection with the construction of dams at Lake Volta in Ghana and Kainji Lake in Nigeria. Data are from published sources and from a 1971 survey conducted by the author in Nigeria. Differences between the policies and procedures are outlined. It is noted that "these differences resulted in the differences in the patterns of adjustment of the resettled people."

Africa↗
PubMed1999

Program closure and change among VA substance abuse treatment programs.

OBJECTIVE: The population of Veterans Affairs (VA) substance abuse treatment programs in 1990 and 1994 was examined to determine which factors-program legitimacy or cost-accounted for program closure and change. Legitimacy is a concept in institutional theory that organizations tend to take on a form appropriate to the environment. METHODS: The study had two competing hypotheses. The first was that if external pressures push programs to produce high-quality and efficient treatment, then those that are initially closer to the legitimate form should be less likely to close later, and among surviving programs they should be less likely to experience change. The second hypothesis was that cost is the primary factor in program closure and change. The study used data from administrative surveys of all VA programs (273 in 1990 and 389 in 1994). Program legitimacy variables measured whether programs offered the prevalent type of treatment, such as 12-step groups or behavioral treatment, and had the prevalent type of staff. RESULTS: Program costs did not explain closure or change. For inpatient programs, the risk of closure increased in facilities with more than one substance abuse treatment program. The risk of closure increased for outpatient programs offering the prevalent type of treatment, contrary to what was predicted by the legitimacy hypothesis. Inpatient programs that offered the prevalent treatment were less likely to change the type of treatment offered. CONCLUSIONS: Patterns of change differed over time for inpatient and outpatient programs. Legitimacy factors, rather than cost, seem to play a role in program closure and change, although the picture is clearer for inpatient programs than for outpatient programs.

Health Facility Closure↗
PubMedDate not supplied

Population health--a new discipline.

A new discipline--population health--has emerged with the potential to profoundly impact the U.S. health care system. Multiple forces stimulating the new population health concept include: (1) the increasing dominance of managed care and critical scrutiny of its development; (2) the continued refinement of clinical effectiveness and outcomes assessment research; (3) increasing public policy emphasis on cost-effectiveness accountability for health care services; and (4) a new focus on the importance of collaboration between the medicine and public health enterprises in this country. The need for sophisticated analysis of population health determinants has never been greater in history. New programs, like the University of Wisconsin-Madison's interdisciplinary Graduate Program in Population Health, address the need for analysis, dissemination, and application of information about the many factors affecting the health of populations.

Community Health Planning↗
PubMed1981

Blue Shield plan physician participation.

Many Blue Shield Plans offer participation agreements to physicians that are structurally similar to the participation provisions of Medicaid programs. This paper examines physicians' participation decisions in two such Blue Shield Plans where the participation agreements were on an all-or-nothing basis. The major results show that increases in the Plans' reasonable fees or fee schedules significantly raise the probability of participation, and that physicians with characteristics associated with "low quality" are significantly more likely to participate than are physicians with characteristics associated with "high quality." In this sense the results highlight the tradeoff that must be faced in administering governmental health insurance policy. On the one hand, restricting reasonable and scheduled fees is the principal current tool for containing expenditures on physicians' services. Yet these restrictions tend to depress physicians' willingness to participate in government programs, thereby reducing access to high quality care by the populations those programs were designed to serve.

Blue Cross Blue Shield Insurance Plans↗
PubMedDate not supplied

Population policy in South Africa.

This report examines the current state and likely future directions of population policy in South Africa with particular reference to family planning activities set against the background of apartheid and its demise. In the apartheid era, population policy was perceived by most blacks as an instrument for the control of their number and movements. Recently, policy has been adjusted by the national Population Development Program in response to the changing sociopolitical situations in the country. A national post-apartheid population policy is likely to retain many of the components of this new program. However, a future nonracist and democratic society would probably invite a review of population activities in the country and raise wider issues concerning rationales, organization, and strategies for the delivery of family planning in South Africa.

Adolescent↗
PubMed2000

The impact of programs for high-risk drinkers on population levels of alcohol problems.

AIMS: Historically, treatment programs and related activities for alcoholics or high-risk drinkers have been viewed as not relevant to efforts to prevent alcohol problems, and in particular population-based prevention efforts. In this review we consider evidence that high-risk programs may have an impact on population or aggregate levels of these problems. DESIGN: We first summarize recent reviews of the clinical impact of programs for high-risk drinkers, since some level of effectiveness at the individual level is necessary for these programs to have an aggregate level impact. Following that, correlational evidence on the impact of high-risk programs on aggregate problem levels is examined. Estimates of the potential impact of high-risk programs on aggregate problem levels, based on available information on the impact of these programs and the numbers of individuals affected, are then considered, as are estimations of the comparative aggregate level impact of high-risk and consumption reduction strategies. FINDINGS: There is increasing evidence that high-risk programs have beneficial effects for individuals. Available correlational evidence supports the proposal that increases in treatment and AA have contributed to the declines in alcohol-related morbidity and mortality observed in some countries in recent years. Studies estimating the recent impact of increases in levels of treatment and AA membership support that interpretation, and studies comparing estimated effects of high-risk and population strategies find similar potential for aggregate effects. CONCLUSIONS: Programs for high-risk drinkers can have beneficial aggregate-level effects and are thus a valuable component of population-based efforts to reduce alcohol problems.

Alcohol-Related Disorders↗
PubMedDate not supplied

Quick response programs: effective management of a population in crisis.

In our present health care system, emergency departments have become the gatekeepers of the acute care system for the elderly. These departments need other alternatives to in-hospital treatment for elderly patients. The Windsor-Essex County Quick Response Program was developed as an innovative alternative to assist Hotel Dieu of St. Joseph Hospital's emergency department with this complex client population. This article describes the program, provides a rationale for this specialized service, offers suggestions for program success and reports on its accomplishments during the first year of operation.

Acute Disease↗