Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Target Population”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 541 records · Page 30Linked to original sources
PubMed1998

Risk of tuberculosis in dialysis patients: a population-based study.

SETTING: Provincial tuberculosis (TB) and dialysis registries. OBJECTIVE: To document the risk of TB among patients on dialysis and to describe the clinical characteristics of these cases. METHODS: All cases of TB occurring among dialysis patients in British Columbia between January 1990 and December 1994 were reviewed, as were the age-specific rates for TB among the general population during the same period. RESULTS: During that period, a total of seven cases of TB occurred among 560 patients on hemo-dialysis and two cases among 326 patients on peritoneal dialysis. On an annual basis the rate of TB in the dialysis population was 253 per 100,000, compared to an age-matched rate of 10.1 per 100,000 in the general population, giving a relative risk of 25.3 (95% confidence interval 22.86-31.49, P = 0.0000001). CONCLUSIONS: The risk of TB in dialysis patients is significantly higher than previously reported from non population-based studies, indicating that dialysis patients should be considered a possible target population for systematic evaluation for the presence of TB infection and consideration for chemoprophylaxis.

Adult↗
PubMed2006

Influenza pandemic preparedness in France: modelling the impact of interventions.

BACKGROUND: Influenza pandemics result in excess mortality and social disruption. To assist health authorities update the French pandemic plan, the authors estimated the number of health events (cases, hospitalisations, and deaths) in a pandemic and compared interventions in terms of impact and efficiency. METHOD: A Monte Carlo simulation model, incorporating probability distributions of key variables, provided estimates of health events (HE) by age and risk group. Input variables were set after literature and expert consultation. The impact of targeted influenza vaccination and antiviral prophylaxis/treatment (oseltamivir) in high risk groups (elderly, chronic diseases), priority (essential professionals), and total populations was compared. Outcome measures were HE avoided, number of doses needed, and direct cost per HE avoided. RESULTS: Without intervention, an influenza pandemic could result in 14.9 million cases, 0.12 million deaths, and 0.6 million hospitalisations in France. Twenty four per cent of deaths and 40% of hospitalisations would be among high risk groups. With a 25% attack rate, 2000-86,000 deaths could be avoided, depending on population targeted and intervention. If available initially, vaccination of the total population is preferred. If not, for priority populations, seasonal prophylaxis seems the best strategy. For high risk groups, antiviral treatment, although less effective, seems more feasible and cost effective than prophylaxis (respectively 29% deaths avoided; 1800 doses/death avoided and 56% deaths avoided; 18,500 doses/death avoided) and should be chosen, especially if limited drug availability. CONCLUSION: The results suggest a strong role for antivirals in an influenza pandemic. While this model can compare the impact of different intervention strategies, there remains uncertainty surrounding key variables.

Adolescent↗
PubMed2007

Racial differences in tumor stage and survival for colorectal cancer in an insured population.

BACKGROUND: Despite declining death rates from colorectal cancer (CRC), racial disparities have continued to increase. In this study, the authors examined disparities in a racially diverse group of insured patients. METHODS: This study was conducted among patients who were diagnosed with CRC from 1993 to 1998, when they were enrolled in integrated healthcare systems. Patients were identified from tumor registries and were linked to information in administrative databases. The sample was restricted to non-Hispanic whites (n = 10,585), non-Hispanic blacks (n = 1479), Hispanics (n = 985), and Asians/Pacific Islanders (n = 909). Differences in tumor stage and survival were analyzed by using polytomous and Cox regression models, respectively. RESULTS: In multivariable regression analyses, blacks were more likely than whites to have distant or unstaged tumors. In Cox models that were adjusted for nonmutable factors, blacks had a higher risk of death from CRC (hazard ratio [HR], 1.17; 95% confidence interval [95% CI], 1.06-1.30). Hispanics had a risk of death similar to whites (HR, 1.04; 95% CI, 0.92-1.18), whereas Asians/Pacific Islanders had a lower risk of death from CRC (HR, 0.89; 95% CI, 0.78-1.02). Adjustment for tumor stage decreased the HR to 1.11 for blacks, and the addition of receipt of surgical therapy to the model decreased the HR further to 1.06. The HR among Hispanics and Asians/Pacific Islanders was stable to adjustment for tumor stage and surgical therapy. CONCLUSIONS: The relation between race and survival from CRC was complex and appeared to be related to differences in tumor stage and therapy received, even in insured populations. Targeted interventions to improve the use of effective screening and treatment among vulnerable populations may be needed to eliminate disparities in CRC.

Adult↗
PubMedDate not supplied

Dose-response relationship between total cadmium intake calculated from the cadmium concentration in rice collected from each household of farmers and renal dysfunction in inhabitants of the Jinzu River basin, Japan.

The association between total cadmium (Cd) intake and abnormal urinary findings was investigated in the Cd-polluted Jinzu River basin. In 1967 and 1968 the most systematic and large-scale health examinations were conducted among the entire population aged over 30 years of this region. We performed this study by targeting the subjects participating in the 1967 health survey conducted mainly in the heavily polluted area. From subjects who had eaten household rice of known Cd concentration, 1,075 inhabitants who had either resided in their current household since birth or who had moved there from a non-polluted area (group A), and 780 inhabitants who had resided in the current household since birth (group B), were selected as the target population. The total Cd intake for each person was calculated from the Cd dose ingested from rice and other foods. Logistic regression analysis was performed using the prevalence of abnormal urinary findings (proteinuria, glucosuria and proteinuria with glucosuria) as the criterion variable and the total Cd intake and age as explanatory variables. In subjects of groups A and B the odds ratios became higher as the dose of total Cd intake increased. Odds ratios in subjects of group A were statistically significant except for glucosuria of men and proteinuria of women. In subjects of group B the odds ratios were also significant for proteinuria + glucosuria of men and glucosuria of women. It was demonstrated that the greater the increase in total Cd intake, the greater the increase in abnormal urinary findings in the Jinzu River basin, and the association of the two factors was very close.

Adult↗
PubMed2002

Pre- and postsynaptic mechanisms in Hebbian activity-dependent synapse modification.

We have used a three compartment tissue culture system that involved two separate populations of cholinergic neurons in the side compartments that converged on a common target population of myotubes in the center compartment. Activation of the axons from one population of neurons produced selective down-regulation of the synaptic inputs from the other neuronal population (when the two inputs innervated the same myotubes). The decrease in heterosynaptic inputs was mediated by protein kinase C (PKC). An activity-dependent action of protein kinase A (PKA) was associated with the stimulated input and this served to selectively stabilize this input. These changes associated with PKA and PKC activation were mediated by alterations in the number of acetylcholine receptors at the neuromuscular junction. These results suggest that neuromuscular electrical activity produces postsynaptic activation of both PKA and PKC, with the latter producing generalized synapse weakening and the former a selective synapse stabilization. Treatment of the neuronal cell body and axon to increase PKC activity by putting phorbal ester (PMA) in the side chamber did not affect synaptic transmission (with or without stimulation). By contrast, PKA blockade in the side compartment did produce an activity-dependent decrease in synaptic efficacy, which was due to a decrease in quantal release of neurotransmitter. Thus, when the synapse is activated, it appears that presynaptic PKA action is necessary to maintain transmitter output.

Animals↗
PubMedDate not supplied

Prevention of thalassaemia and haemoglobinopathies in remote and isolated communities--the Maldives experience.

The Maldives comprises 1192 islands covering a land mass that amounts to under 1% of the total geographical territory of the country. The population of 280,000 is dispersed across 200 isolated communities, with an average of 1000 people per community. Recent progress in health terms include a reduction in the infant mortality rate from 62 in 1992 to 14 in 2003, and 95% coverage in child immunization. In 1992, SHE a non-governmental organization established that the beta-thalassaemia prevalence rate was 18.1% (1 in 5) and on the basis of the result, launched a nationwide awareness and population screening programme, visiting each island in the Maldives every 5 years and targeting 12-35-year-olds. Screening of 100 cord blood samples indicated a 28% incidence of alpha-thalassaemia. Screening results highlighted significantly high incidence of more than one haemoglobinopathy on individual islands. This is of particular importance given the norm of intra-island marriages. Specific mutation analysis showed that three mutations accounted for more than 95% of the thalassaemia genes, ensuring a high detection rate and cost effectiveness of a prenatal diagnosis programme. Outcomes of the screening programme include screening of more than 25% of the target population; the establishment of a Government National Thalassaemia Centre; inclusion of thalassaemia into the school curriculum; the legal requirement for screening prior to marriage; legalization of prenatal diagnosis and medical termination of pregnancy; and the commencement of prenatal diagnostic services. The programme successes include effective advocacy, resource mobilization, motivation for screening, voluntary blood donation, and thalassaemia becoming a household word in the country.

Adolescent↗
PubMed1995

Model-based estimation of population attributable risk under cross-sectional sampling.

The covariate-adjusted population attributable risk (PAR) measures the proportionate reduction in disease prevalence in the target population when the putative risk factor is removed, after adjusting for covariate effects. This paper extends the model-based approach developed for retrospective and cohort studies to the cross-sectional sampling design. An appropriate logit linear model is utilized to estimate the covariate-adjusted attributable risk. The asymptotic variance of this complex ratio estimate is obtained using Taylor series expansions which incorporate the sampling variation of the estimated model parameters and the appropriate estimates of risk factor prevalence. These methods are illustrated with cardiovascular disease risk factor data from the second National Health and Nutrition Examination Survey (NHANES II).

Adolescent↗
PubMed2005

Comparison of early performance indicators for screening projects within the European Breast Cancer Network: 1989-2000.

In 1989 the European Breast Cancer Network (EBCN) was established by the first pilot projects for breast cancer screening, co-funded by the Europe Against Cancer programme. We report early performance indicators for these EBCN projects while taking into account their organizational setting. Out of 17 projects in the network, 10 projects from six European countries contributed aggregated data on number of invitations, screening examinations, and breast cancers detected over the period 1989-2000. Results were summarized separately for projects in centralized versus decentralized health care environments. The European Guidelines for quality assurance in mammography screening provided reference values for the performance indicators. The most prominent finding in this study was the higher participation rate in centralized versus decentralized projects (average participation in 1998: 74 versus 33%; P<0.001), whereas the invitation system and screening policy in these projects were similar. Detection rates and characteristics of cancers detected at initial and subsequent screening examinations showed no significant differences between centralized and decentralized projects. Even though early performance indicators for centralized versus decentralized projects were similar, the impact of breast screening on mortality from this disease at the population level will differ since the decentralized projects reach only part of the target population.

Adult↗
PubMed1996

Skin disease in rural Tanzania.

BACKGROUND: Skin disease is a common problem, accounting for significant morbidity in developing countries. Knowledge about the prevalence of different skin conditions allows appropriate planning for provision for these health needs. There are currently few data about the needs in rural areas; therefore, this study was set up to investigate skin abnormalities found in a village population in Tanzania. MATERIALS AND METHODS: A village with a population of 2,876 was chosen and one-third of the population was examined for cutaneous abnormalities. RESULTS: During the survey, 97.7% of the target population was examined. Signs of nutritional deficiency were common with koilonychia affecting 18.1% of the population examined and signs of hypoproteinemia being present in 3.4% of them. Infections and infestations were also frequently seen. Scabies was observed in 6.0% and pediculosis capitis in 5.3%. Dermatophyte infection was present in 5.1%. These were all most common in prepubertal children. Leg sores were seen in 5.1% and leg ulcers in 3.0% of the population. CONCLUSIONS: The survey reveals that easily treatable skin infections and infestations are common in a rural Tanzian population. Signs of nutritional deficiency are also frequently seen.

Adolescent↗
PubMed2001

Cardiovascular disease risk stratification and comparison in a California population.

This study was designed to identify the need for primary prevention of cardiovascular disease in an HMO population and to develop appropriate interventions for individuals in different risk groups, based on risk stratification and comparison. The analysis is based on a cross-sectional survey of the HMO members of a large employer group. Respondents (n=17,878) were stratified based on the Framingham model; 34% of respondents without cardiovascular disease were classified as moderate to high attributable risk for the disease, and 66% were classified as low attributable risk. Results of logistic regression analyses suggest that, compared with respondents with pre-existing cardiovascular disease, moderate- to high-risk respondents are more likely to smoke, have unhealthy diets, and be overweight, hypertensive, and hypercholesterolemic. More low-risk respondents had unhealthy diets than did those with pre-existing cardiovascular disease. There were no differences between these groups for physical activity and stress. Respondents had fewer modifiable risk factors and healthier lifestyles than did those who were at risk. These findings suggest that primary prevention should be enhanced, especially among those with significantly increased risk for the disease. Moreover, the approaches of this project-population-based risk assessment, stratification, and comparison-were instrumental in identifying the target population and designing appropriate interventions. (c) 2001 by CHF, Inc.

Journal Article↗
PubMed1976

The front line health worker: selection, training, and performance.

Iranian villagers with basic literacy were recruited, selected, trained, and deployed as Village Health Workers (VHWs) to rural areas of Iran. VHW clinical visit records and activities logs were analyzed to determine levels and nature of effort achieved in the field. Within six months of deployment, the number of patient visits to VHW treatment services constituted 53% of the target population. Within ten months of deployment, the number of family planning acceptors rose from 8% to 21% of the population at risk. Improvements to water supplies have been effected in 50% of target villages. Sanitary improvements have been made to 35% of the houses and 88% of toilets in those villages. Demographic characteristics, class rank, and place of residence of VHWs appear unassociated with village differences in levels of achievement. However, availability of material resources and actual time spent by VHWs on the job may be factors influencing the differences in outcome between villages.

Allied Health Personnel↗
PubMed1996

Bladder cancer screening.

Transitional cell carcinoma of the bladder possesses several features that make it an ideal candidate for screening: metastases rarely occur before tumors invade the muscularis propria; superficial disease is treated very successfully by relatively inexpensive and nonmorbid means; this malignancy is almost never found incidentally at autopsy so that early detection cannot harm a patient; and almost all tumors cause hematuria if one tests frequently enough. When compared with a contemporary age, geography, and gender-matched unscreened population, bladder cancer screening in healthy men age 50 years and older by repeated home hematuria testing using chemical reagent strips significantly decreases bladder cancer morbidity and mortality and is cost-effective. A randomized prospective trial of bladder cancer screening in this population is recommended. Additionally, other potential means of bladder cancer screening and other target populations are discussed in this article.

Biomarkers, Tumor↗
PubMed1997

Zoonoses and fertility control in wildlife--requirements for vaccines.

This paper reflects on public health considerations on the voluntary release of anti-fertility vaccines for wildlife in the environment. The World Health Organization (WHO) has established a variety of recommendations on safety and efficacy requirements for the voluntary release of rabies vaccines used for oral immunization of animals. These requirements cover aspects of control of rabies and possible biological consequences in the target population. They also deal with the protection of the health of humans and other non-target species that might come into contact with the different oral rabies vaccines used in various parts of the world. These recommendations are laid down in several WHO publications. They are specific to the disease concerned, the target animal reservoir, the relationship and types of contact between humans and target animals, the vaccines and baits used and the respective conditions of oral immunization of wildlife in densely-populated areas. Many of these recommendations also apply to the development and application of contraceptive vaccines for wildlife carnivores. Additional safety requirements concern the transmissibility of the antigen, the reversibility of the intervention within an individual animal and in animal populations, as well as the species specificity of the antigen used. The management of animal populations that are reservoirs for zoonotic diseases is a possible means by which diseases that are transmissible from animals to humans could be prevented. Oral contraception by means of vaccines is an appealing method, provided that requirements for protecting public and animal health, as well as ensuring environmental safety, are precisely defined and strictly adhered to.

Animals↗
PubMed1998

[Stages of motivation to change in smokers of the general population].

Secondary preventive measures to reduce cigarette smoking can be effective only if the motivation to change in the target population is taken into account. A useful model to match interventions to the readiness to change differentiates five stages: precontemplation, contemplation, preparation, action, and maintenance. In the USA, general population studies showed that 40% of smokers were in the precontemplation and contemplation stage, respectively, and 20% were in the preparation stage. In Germany, no data according to the distribution of stages among smokers are available; however, such data are necessary to plan population-based interventions. Data with respect to nicotine use, nicotine dependence, and the stages of change were assessed in a representative sample of 4075 respondents in Luebeck, a northern German city, and 46 adjoining communities in a face-to-face interview. The response rate was 70.2%. In this sample, 37.3% were cigarette smokers. Of those smokers with at least one attempt to reduce or quite smoking in the past, 76.4% were in the precontemplation, 17% in the contemplation, and 6.6% in the preparation stage. Including individuals without an attempt to reduce or quit smoking, 95.3% can be allocated to the precontemplation or contemplation stage. Nicotine-dependent smokers were in higher stages compared to smokers without dependence. Severity of dependence was not related to the stages of change. Data demonstrate that common smoking cessation programmes that require the individuals' readiness to change are inappropriate for 95% of the population. Stage-matched interventions are introduced and discussed in the paper. Compared to data from the USA smokers in Germany are more likely to be in early stages of change. Policy-based public health measures are necessary to change these findings.

Adolescent↗
PubMed2001

Principles of area-wide integrated tsetse fly control using the sterile insect technique.

The tsetse fly and the disease trypanosomosis it transmits, is one of the most severe medical and veterinary problems in Africa, infecting around 50,000 people every year and preventing the development of sustainable and productive agricultural systems. The most efficient way to contain the disease is by the management of entire populations of the vector (area-wide approach) using a combination of several control methods in an integrated pest management campaign. A very powerful method for integration in these programmes as a final eradication component is the sterile insect technique (SIT). The technique relies on the rearing of the target insect in large numbers in specialised production centres, the sterilisation with ionising radiation of one of the sexes and the sustained sequential release of the sterilised insects over the target area. Contrary to conventional control methods, the sterile insect technique becomes more efficient with decreasing density of the target population. Hence, the technique fits well within the concept of integrated pest management, as its complementary use in a phased approach with other suppression techniques, results in maximum efficiency. The five main prerequisites required to use the sterile insect technique against a target insect have been achieved for tsetse flies: 1. adequate information on the ecology of the insect is available, 2. the mass-production of the target insect is economically feasible, 3. efficient suppression techniques are available to reduce the population density of the target insect, 4. sufficient sterile males are available for release and their competitiveness is optimal, 5. the gamma treated sperm is competitive with the wild sperm. This paper gives a detailed review of the five implementation phases of the sterile insect technique based area-wide integrated pest management campaign against Glossina austeni on the island of Unguja, Zanzibar. The potential future prospects and requirements of using the sterile insect technique against tsetse populations are likewise presented.

Africa↗
PubMed1998

Cost-effectiveness analysis of lead poisoning screening strategies following the 1997 guidelines of the Centers for Disease Control and Prevention.

OBJECTIVE: To compare blood lead (BPb) poisoning screening strategies in light of the 1997 recommendations by the Centers for Disease Control and Prevention, Atlanta, Ga. DESIGN: Cost-effectiveness analysis from the perspective of the health care system to compare the following 4 screening strategies: (1) universal screening of venous BPb levels; (2) universal screening of capillary BPb levels; (3) targeted screening of venous BPb levels for those at risk; and (4) targeted screening of capillary BPb levels for those at risk. Costs of follow-up testing and treatment were included in the model. RESULTS: Only universal venous screening detected all BPb levels of at least 0.48 micromol/L (10 microg/dL). Universal capillary screening detected between 93.2% and 95.5% of cases, depending on the prevalence of elevated BPb levels. Targeted screening was the least sensitive strategy for detecting cases. Venous testing identified between 77.3% and 77.9% of cases, and capillary testing detected between 72.7% and 72.8% of cases. In high-prevalence populations, universal venous screening minimized the cost per case ($490). In low- and medium-prevalence populations, targeted screening using venous testing minimized the cost per case ($729 and $556, respectively). In all populations, regardless of screening strategy, venous testing resulted in a lower cost per case than capillary testing. Sensitivity analyses of all parameters in this model demonstrated that this conclusion is robust. CONCLUSIONS: Universal screening detects all cases of lead poisoning and is the most cost-effective strategy in high-prevalence populations. In populations with lower prevalence, the cost per case detected using targeted screening is less than that of universal screening. The benefit of detecting a greater number of cases using universal screening must be weighed against the extra cost of screening. Regardless of whether a strategy of universal or targeted screening is used, the cost per case using venous testing is less than that of capillary testing.

Capillaries↗
PubMed2001

Dissecting a population genome for targeted screening of disease mutations.

Compared to mixed populations, population isolates such as Finland show distinct differences in the prevalence of disease mutations. However, little information exists of the differences on the prevalence of different disease alleles in regional populations with different history of multiple bottlenecks. We constructed a DNA-array and monitored the prevalence of 31 rare and common disease mutations underlying 27 clinical phenotypes in a large population-based study sample. Over 64 000 genotypes were assigned in 2151 samples from four geographical areas representing early and late settlement regions of Finland. Each sample was analyzed in duplicate and a total of 142 000 array-derived genotyping calls were made. On average one in three individuals was found to be a carrier of one of the 31 monitored mutations. This should remove fears of the stigmatizing effect of a carrier-screening program monitoring multiple diseases. Regional differences were found in the prevalence of mutations, providing molecular evidence for the deviating population histories of regional subisolates. The mutations introduced early into the population revealed relatively even distribution in different subregions. More recently introduced rare mutations showed local clustering of disease alleles, indicating the persistence of population subisolates and the effect of multiple bottlenecks in molding the population gene pool. Regional differences were observed also for common disease alleles. Such precise information of the carrier frequencies could form the basis for targeted genetic screens in this population. Our approach describes a general paradigm for large-scale carrier-screening programs also in other populations.

Alleles↗
PubMed2005

Performance of screening questionnaires and risk scores for undiagnosed diabetes: the KORA Survey 2000.

BACKGROUND: Validation of published screening questionnaires and risk scores for undiagnosed diabetes has typically not been performed in independent population samples. METHODS: Oral glucose tolerance tests were performed in 1353 participants (aged 55-74 years) without known diabetes in the Cooperative Health Research in the Region of Augsburg (KORA) Survey 2000, Augsburg, Germany. Sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC) for undiagnosed diabetes were calculated for various screening questionnaires. RESULTS: Four screening tests (Rotterdam Diabetes Study, Cambridge Risk Score, San Antonio Heart Study, and Finnish Diabetes Risk Score) were applied to the KORA data. The AUCs were 61% (95% confidence interval [CI], 56%-66%) for the Rotterdam Diabetes Study, 65% (95% CI, 60%-69%) for the Finnish Diabetes Risk Score (P=.10 vs Rotterdam), and 67% (95% CI, 62%-72%) for the Cambridge Risk Score (P<.001 vs Rotterdam). A predictive model including fasting glucose level (San Antonio Heart Study) yielded an AUC of 90% (P<.01 vs all 3 questionnaires); however, this was not significantly different from fasting glucose level alone (AUC, 89%; P=.46). The sensitivities, specificities, and predictive values of questionnaires were substantially lower than originally described, which was mainly due to population variation of risk factors compared with the KORA sample (age, body mass index, antihypertensive medication, and smoking). CONCLUSIONS: Currently proposed questionnaires yielded low validity when applied to a new population, most likely due to differences in population characteristics. Performance of diabetes risk questionnaires or scores must be assessed in the target population where they will be applied.

Adult↗