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PubMed2003

Place of residence and risk of fracture in older people: a population-based study of over 65-year-olds in Cardiff.

Fracture prevention strategies will be most cost-effective if targeted on groups of frail elderly people who are at particularly high risk of falls and fractures. Elderly people living in care homes are one potential target population, but fracture incidence in this setting remains poorly defined in many countries. We used the All Wales Injury Surveillance System (AWISS) in a population-based study of people aged over 65 years living in the city of Cardiff. We linked a postcode-based register of all sheltered accommodation and all residential and nursing homes in the city with injury data from Cardiff's single Accident and Emergency Department. Cardiff has 47,700 residents aged over 65 years with 1918 (4.0%) living in residential or nursing homes and 1868 (3.9%) in sheltered accommodation. In 1999 we identified a total of 1305 fractures including 366 hip fractures, giving a crude fracture incidence of 27.4/1000 per year and 7.7/1000 per year, respectively. Care home residents suffered 213 fractures, 95 of which were of the hip, giving a crude fracture incidence of 111.1/1000 per year and 49.5/1000 per year, respectively. People living in sheltered accommodation suffered 94 fractures, including 28 at the hip, giving a crude fracture incidence of 51.4/1000 per year and 15.3/1000 per year, respectively. People in care homes and sheltered accommodation tend to be older than those living in the community, and we adjusted for this by calculating age- and gender-standardized relative ratios for each setting. Compared with the community dwelling population, care home residents had an overall fracture risk of 2.9 (95% CI 2.5-3.3) and a hip fracture risk of 3.3 (95% CI 2.6-4.2). People in sheltered accommodation had a total fracture risk of 1.7 (95% CI 1.4-2.1), and a hip fracture risk of 1.6 (95% CI 1.1-2.4). Such figures support the potential cost-effectiveness of strategies that seek to prevent fractures in care homes and sheltered accommodation, and are of special interest to those planning intervention studies in these settings.

Accidental Falls↗
PubMed2025

Development and evaluation of patient-centred polygenic risk score reports for glaucoma screening.

BACKGROUND: Polygenic risk scores (PRS), which provide an individual probabilistic estimate of genetic susceptibility to develop a disease, have shown effective risk stratification for glaucoma onset. However, there is limited best practice evidence for reporting PRS and patient-friendly reports for communicating PRS effectively are lacking. Here we developed patient-centred PRS reports for glaucoma screening based on the literature, and evaluated them with participants using a qualitative research approach. METHODS: We first reviewed existing PRS reports and literature on probabilistic risk communication. This informed the development of a draft glaucoma screening PRS report for a hypothetical high risk individual from the general population. We designed three versions of the report to illustrate risk using a pictograph, a pie chart and a bell curve. We then conducted semi-structured interviews to assess preference of visual risk communication aids, understanding of risk, content, format and structure of the reports. Participants were invited from an existing study, which aims to evaluate the clinical validity of glaucoma PRS among individuals > 50 years from the general population. Numeracy and literacy levels were assessed. RESULTS: We interviewed 12 individuals. The cohort was highly educated (42% university education), all were European and 50% were female. Numeracy (mean 2.1 ± 0.9, range 0 to 3), graph literacy (mean 2.8 ± 0.8, range 0 to 4) and genetic literacy (mean 24.2 ± 6.2, range - 20 to + 46) showed a range of levels. We analysed the reports under three main themes: visual preferences, understanding risk and reports formatting. The visual component was deemed important to understanding risk, with the pictograph being the preferred visual risk representation, followed by the pie chart and the bell curve. Participants expressed preference for absolute risk in understanding risk, along with the written content explaining the results. The importance of follow-up recommendations and time to glaucoma onset were deemed important. Participants expressed varied opinions in the level of information and the colours used, which informed revisions of the report. CONCLUSIONS: Our study revealed preferences for reporting PRS information in the context of glaucoma screening, to support the development of clinical PRS reporting. Further research is needed to assess PRS communication in other groups representative of target populations and with other target audiences (e.g. referring clinicians), and its potential psychosocial impact in the wider community.

Humans↗
PubMedDate not supplied

Genetic screening for individuals at high risk for type 1 diabetes in the general population using HLA Class II alleles as disease markers. A comparison between three European populations with variable rates of disease incidence.

BACKGROUND: To develop screening strategies for identification of individuals at increased genetic risk for type 1 diabetes in three populations with variable disease incidence rates and distinct ethnic origin. METHODS: A stepwise HLA DQB1-DQA1-DRB1-based screening approach was evaluated. Patients with childhood-onset type 1 diabetes were recruited from Finland (n = 1739), Hungary (n = 149), and Greece (n = 119). Consecutive newborns (2568 from Finland and 1047 from Greece) or healthy schoolchildren (n = 177 from Hungary) served as controls. RESULTS: The DQB1*02/0302 genotype conferred the highest disease risk in all populations. The DQB1*02/y (y not equal DQB1*0301,*0302,*0602,*0603, *0604) genotypes were more common and conferred a higher disease risk in the Greek population (OR 4.9) compared to the Finns (OR 1.2). DQB1*0302/x (x not equal DQB1*02, *0301, *0602, *0603, *0604) genotypes were, in contrast, more prevalent among Finnish cases (32.7%) as compared to Hungarians (18.1%) or Greeks (13.5%). The protective DQB1*0602 or *0603 positive genotypes were most common in the Finns, while DQB1*0301 was more common in Hungarians and Greeks. In all groups, DQA1 and DRB1*04 typing considerably increased the sensitivity of the DQB1-based screening. The different high-risk genotype combinations present in about 10% of the background population had a diagnostic sensitivity of 60% in Finland and 80% in Hungary and Greece. CONCLUSIONS: HLA DR-DQ-based screening is a feasible tool for the identification of individuals at increased genetic risk for type 1 diabetes in populations with diverse genetic background. The risk markers should, however, be individually selected for the target population since the screening efficiency of various markers is highly dependent on the ethnic group studied.

Biomarkers↗
PubMed2006

Catecholaminergic neurons in medullary nuclei are among the post-synaptic targets of descending projections from infralimbic area 25 of the rat medial prefrontal cortex.

The infralimbic (IL) 'visceromotor' area of the rat medial prefrontal cortex projects to strategic subcortical nuclei involved in autonomic functions. Central among these targets are the nucleus tractus solitarius (NTS) and the rostral ventrolateral medulla (rVLM). By combining tract-tracing using the anterograde tracer biotinylated dextran amine (BDA) with immunolabeling for tyrosine hydroxylase (TH; an enzyme marker of catecholaminergic neurons), a limited proportion of BDA-labeled IL axonal boutons in the NTS and rVLM was found to be closely associated with TH immunopositive (+) target structures. Such structural appositions were mainly located proximally over the labeled dendritic arbors of identified TH+ neurons. Quantitative ultrastructural examination revealed that in NTS, TH+ dendritic shafts comprised 7.0% of the overall post-synaptic target population innervated by BDA-labeled IL boutons, whereas TH+ dendritic spines represented 1.25% of targets. In rVLM, TH+ shafts represented 9.0% and TH+ spines 2.5% of IL targets. Labeled IL boutons established exclusively asymmetric Gray Type 1 (presumed excitatory) synaptic junctions. The results indicate that subpopulations of catecholaminergic neurons in the NTS and rVLM are among the spectrum of post-synaptic neurons monosynaptically innervated by descending 'excitatory' input from IL cortex. Such connectivity, albeit restricted, identifies the potential direct influence of IL cortex on the processing and distribution of cardiovascular, respiratory and related autonomic information by catecholaminergic neurons in the NTS and VLM of the rat.

Afferent Pathways↗
PubMed2006

It's "back to school" for genetic screening.

Implementation of population genetic screening programmes requires consideration of strategies for reaching the greatest proportion of the target population in order to achieve maximum awareness. This article reviews the current strategy of school-based population genetic screening programmes. The school environment is an ideal setting for offering relevant genetic screening programmes as it provides an opportunity to engage people at a time when they are exposed to a range of educational experiences and are sufficiently mature to be involved in decision-making processes. Such programmes allow all students, not only those studying biology, an opportunity to be educated and experience genetic screening in a supportive environment, ultimately increasing understanding and empowering students. While the major form of genetic screening in schools has been for reproductive health information (eg carrier screening for TaySachs disease and cystic fibrosis), genetic screening in schools for other conditions may be a timely proposition.

Australia↗
PubMed2005

Protein kinase C immunoreactivity in the pigmented and albino rat retina.

The albino retina is abnormal. The central region is under-developed and some cell populations are reduced or increased in number. Not least of these anomalies is the deficit in the rod population in hypopigmented rodents and carnivores. Given this abnormality we have examined the distribution of rod bipolar cells in albino rats to determine whether this subsequent stage in the rod pathway is similarly disrupted. A monoclonal antibody to protein kinase C was used to determine the distribution of rod bipolar cells in juvenile and adult pigmented and albino rats. Immunoreactive rod bipolar cells and their processes were counted in transverse sections passing through both the central and peripheral retina. The mean densities of immunoreactive cells were significantly reduced in albino retinas at both juvenile (postnatal day 15) and adult stages, in the former by 14% and the latter by 9%. This was evident across the entire central-to-peripheral extent of the retina. The reduced rod photoreceptor population found in albinos appears therefore to be consequential for the magnitude of their major target population, rod bipolar cells. The decrease in the rod bipolar population indicates a change in retinal cytoarchitecture and implies a disruption of functional organization of the albino retina, especially that underlying the scotopic channel. This, coupled with observations that some other retinal interneuronal populations may be disrupted, implies disordered retinal processing in albinos and emphasizes the likelihood that abnormal visual function in albinos may be as much a result of anomalous retinal circuitry as of the known photoreceptor deficit or chiasmatic misrouting.

Albinism↗
PubMed1992

Acceptability of opportunistic screening for occult gastrointestinal blood loss.

OBJECTIVE: To test patient compliance for faecal occult blood testing in suburban and inner city general practice. DESIGN: Prospective opportunistic trial using the Haemoccult test kit. Tests were offered during routine surgery attendance. SETTING: Three group general practices in Birmingham. SUBJECTS: All patients aged 40 years or older on the start date who routinely attended surgery during two years. MAIN OUTCOME MEASURES: Numbers of patients approached for testing and the numbers refusing, accepting, and returning the test kits. RESULTS: Only 26.3% (1230/4677) of the potential target population had been screened within the two years, although 988 (39.3%) of the suburban practice target were screened. However, 55.7% (1230/2207) of patients actually offered a test returned completed kits, with only 6% (133) refusing the kit. 683 (61.6%) patients aged 50-69 returned kits, compared with 343 (54.3%) aged 70 or over and 204 (43.8%) aged 40-49. These differences were significant (p less than 0.001). Patients from the inner city practice were significantly less likely to be offered the test than those in suburban practice (242 (11.2%) v 988 (39.9%), p less than 0.001) and return the samples (242 (38.8%) v 988 (62.4%), p less than 0.001). Patients from the inner city practice were also more likely to refuse the test (78 (12.5%) v 55 (3.5%), p less than 0.001). CONCLUSIONS: Opportunistic testing for occult faecal blood in asymptomatic patients was reasonably acceptable to patients, especially those in a suburban practice. If the test is shown to reduce mortality from colorectal cancer then formal screening would probably achieve acceptable target rates, especially among patients aged 50-69, who represent the prime risk group.

Adult↗
PubMed1999

Sensory symptoms of multiple sclerosis: a hidden reservoir of morbidity.

OBJECTIVE: To assess the frequency and quality of sensory symptoms in a population of patients with Multiple Sclerosis (MS) and compare them with controls. DESIGN: Survey to target population and control group evaluating demographic data, data on disease course, presence of various symptoms of MS. SETTING: Neurological practices affiliated with a tertiary community hospital. PARTICIPANTS: 224 patients with MS, 93 controls of similar age and sex. RESULTS: Sensory symptoms were more common in MS patients than in controls, and differed in severity and quality. Fifty per cent described brief (seconds to hours) episodes of neurological dysfunction, significantly more often than in controls (P = 0.001). Pain was present at some time in similar percentages in patients and controls, but active pain problems were present more often in MS patients (P = 0.001). The qualitative description of pain in MS patients was more often neuropathic, with burning, itching, electric and formicatory pain, as opposed to throbbing, sharp or muscular pain. Pain was localized to arms, legs, trunk, hands, feet and face more often in the MS group. Lhermitte's phenomenon was present in two-thirds of patients at some time in their disease course. Twenty per cent of the patients identified themselves as having respiratory problems (Controls 7.5%, P = 0.005). Fatigue limited activity in 78% of patients, but only in 17% of controls (P = 0.001). Dizziness, memory dysfunction, and restless legs symptoms were all more frequent in patients. The self-rated 'worst' symptoms of MS was pain in 12%, fatigue in 17% and dizziness in 5%, a total of 34% of 'worst' symptoms. Sensory symptoms were present in patients with early disease and without disability as often as in disabled patients and in those with longer disease duration. There was however a strong correlation between the total number of sensory symptoms reported and the presence of disability in the MS patients. CONCLUSIONS: Sensory symptoms are common in MS patients. Pain syndromes, transient neurologic events, Lhermitte's phenomenon, fatigue, respiratory symptoms and vertigo were present significantly more frequently in patients with MS than in a control population and contributed to subjective morbidity. Future clinical trials assessing therapy in MS might include sensory symptoms as secondary endpoints to capture this 'hidden reservoir' of disease morbidity.

Adult↗
PubMed1991

Multi-institutional service system development for high risk infants.

This article describes the development of a county-wide multi-institutional follow-up system for a high risk population of children and their families and proposes guidelines for health service system building. The target population for this program known as the Alliance for Infants and based in Allegheny County, Pennsylvania, was the very low birthweight infant and their families. Passage of legislation, P.L. 99-457, Education of the Handicapped Act Amendments of 1986, included provisions for Handicapped and At Risk Infants and Toddlers Program, which provided funds to states to develop and implement early intervention services such as the program described in this article.

Family Health↗
PubMed2004

Screening for type 2 diabetes mellitus: a cost-effectiveness analysis.

BACKGROUND: No randomized, controlled trial of screening for diabetes has been conducted. In the absence of direct evidence, cost-effectiveness models may provide guidance about preferred screening strategies. OBJECTIVE: To estimate the incremental cost-effectiveness of 2 diabetes screening strategies: screening targeted to people with hypertension and universal screening. DESIGN: Markov model. DATA SOURCES: United Kingdom Prospective Diabetes Study, Hypertension Optimal Treatment trial, and recent cost data. TARGET POPULATION: General primary care population in the United States. TIME HORIZON: Lifetime. PERSPECTIVE: Health care system. INTERVENTIONS: Diabetes screening targeted to people with hypertension and universal screening. OUTCOME MEASURES: Cost per quality-adjusted life-year (QALY) gained. Costs (in 1997 U.S. dollars) and QALYs discounted at a 3% annual rate. RESULTS OF BASE-CASE ANALYSIS: At all ages, incremental cost-effectiveness ratios were more favorable for screening targeted to people with hypertension than for universal screening. For example, at age 55 years, the cost per QALY for targeted screening compared with no screening was 34,375 dollars, whereas the cost per QALY for universal screening compared with targeted screening was 360,966 dollars. Screening was more cost-effective for ages 55 to 75 years than for younger ages. RESULTS OF SENSITIVITY ANALYSIS: In single-way and probabilistic sensitivity analyses, findings were robust to therapy costs, screening costs, screening lead time, reduced effectiveness of intensive antihypertensive therapy, and increased relative risk reduction for stroke attributable to intensive hypertension control. LIMITATIONS: We did not consider screening targeted to persons with dyslipidemia, and we used studies of people whose diabetes was detected clinically to estimate screening benefits. CONCLUSIONS: Diabetes screening targeted to people with hypertension is more cost-effective than universal screening. The most cost-effective strategy is targeted screening at age 55 to 75 years.

Adult↗
PubMed2002

Incorporating multiculturalism into oncology nursing research: the last decade.

PURPOSE/OBJECTIVES: To use the Oncology Nursing Society's cultural competence guidelines to review research studies conducted by oncology nurse researchers with racial and ethnic minorities and published in the Oncology Nursing Forum during 1990-2000. DATA SOURCES: Using selected key words (e.g., cultural competence, cultural diversity, multiculturalism, minorities, African American/Black American, Hispanic/Latino, Asian/Pacific Islander, Native American/Alaskan Natives) the authors identified 27 studies that met the inclusion criteria for review. Case studies, sponsored lectureships, review articles, commentaries, editorials, and the like were excluded. DATA SYNTHESIS: Within the context of the cultural competence guidelines, the primary strengths included sufficient background information and literature to establish the existence of the problem in the targeted culture, use of conceptual and theoretical frameworks to guide the study, identification of salient study limitations, and recommendations for dissemination of the findings to a general audience. Limitations included discussion of culture beyond the background and literature review, consideration of potential ethical concerns the target population may have about the methods to be used, inclusion of racial and ethnic minorities in the design and implementation of the study, and implications for oncology nursing education. CONCLUSIONS: Although much has been gleaned from previous oncology nursing research published from 1990-2000, more fully incorporated content related to cultural competence is needed. This is needed particularly in studies specifically targeting racial and ethnic minority populations. IMPLICATIONS FOR NURSING: Including cultural competence when designing and reporting research has a greater potential to inform oncology nursing practice, design future research studies, strengthen existing nursing curricula, and help to shape health policy related to racial and ethnic minority populations. The Oncology Nursing Society Multicultural Outcomes: Guidelines for Cultural Competence provides guidance for enhancing the next generation of oncology nursing research with ethnically and culturally diverse populations.

Adult↗
PubMed1997

Strategies for the prevention of psychiatric disorder in primary care in south London.

STUDY OBJECTIVE: To compare the potential impact of high risk and population based approaches to the prevention of psychiatric disorder, using a representative sample of general practice attenders as the target population. DESIGN: This was a prospective cohort study. SETTING: A health centre in south London. PARTICIPANTS: Three hundred and seven consecutive attenders aged 16-65, recruited at randomly selected general practice surgeries. MAIN RESULTS: A linear association was found between the number of different types of socioeconomic adversity reported at recruitment (T1) and the prevalence of psychiatric disorder one year later (T2). The population attributable fraction (PAF) for socioeconomic adversity at T1 was 37.4%. In theory, social interventions for high risk individuals at T1 would reduce the prevalence of psychiatric disorder at T2 by 9% at most, compared with a reduction of 18% if just one item of socioeconomic adversity were eliminated among those with any socioeconomic risk factors. CONCLUSIONS: Social interventions targeted at individuals at highest risk of the most common mental disorders are likely to be extremely limited in their capacity to reduce the prevalence of these conditions. A population based risk reduction strategy, modified according to individual risk, represents a potentially feasible and effective alternative.

Adolescent↗
PubMed2003

Optimal sampling schedule design for populations of patients.

Generation of pharmacodynamic relationships in the clinical arena requires estimation of pharmacokinetic parameter values for individual patients. When the target population is severely ill, the ability to obtain traditional intensive blood sampling schedules is curtailed. Population modeling guided by optimal sampling theory has provided robust estimates of individual patient pharmacokinetic parameter values. Because of the wide range of parameter values seen in this circumstance, it is important to know how the range of parameter values in the population affects the timing of the optimal samples. We describe a new, simple technique to obtain optimal samples for a population of patients. This technique uses the nonparametric distribution associated with a nonparametric adaptive grid population pharmacokinetic analysis. We used the distribution from an analysis of 58 patients receiving levofloxacin for nosocomial pneumonia at a dose of 750 mg. The collection of parameter vectors and their associated probabilities were entered into a D-optimal design evaluation by using ADAPT II. The sampling times, weighted for their probabilities, were displayed in a frequency histogram (an expression of how system information varies with time for the population). Such an explicit expression of the time distribution of information allows rational sampling design that is robust not only for the population mean vector, as in traditional D-optimal design theory, but also for large portions of the total population. For levofloxacin, one reasonable six-sample design would be 1.5, 2, 2.25, 4, 4.75, and 24 h after starting a 90-min infusion. Such sampling designs allow informative population pharmacokinetic analysis with precise and unbiased estimates after the maximal a posteriori probability Bayesian step. This allows the highest probability of delineating a pharmacodynamic relationship.

Chromatography, High Pressure Liquid↗
PubMed1992

Evaluation of a peer health worker prenatal outreach and education program for Hispanic farmworker families.

This article contains the findings from an evaluation of a prenatal education program to Hispanic migrant farmworker families using peer health workers. The focus of the evaluation was on establishing the validity of the intervention model in the target population. Data are presented on the program setting, characteristics of the clients served, and effects of the educational program on the clients and peer health workers. The evaluation identified factors that established confidence in the program model: (1) there were existing barriers to health care and health information; (2) the program served a culturally specific and disadvantaged population; (3) the prenatal curriculum was culturally sensitive; (4) the peer workers were accepted by the target community; and (5) the model did not threaten the medical community. The directions for future research are presented.

Adolescent↗
PubMed2006

Projected benefits from integrating NTD programs in sub-Saharan Africa.

The integration of preventive chemotherapy programs (PCPs) targeting multiple neglected tropical diseases (NTDs) with similar strategic approaches offers opportunities for enhanced cost-effectiveness. To estimate the potential cost savings and health outcomes of integrated programs, the data available for five NTDs (lymphatic filariasis, onchocerciasis, intestinal helminthiasis, schistosomiasis and trachoma) can be used to define eligible target populations, the probable overlap of at-risk populations, and the cost per person treated in stand-alone and integrated programs. If all targets for 2006 in sub-Saharan Africa are met, then savings of 26-47% can be projected from such integration (a cost of US dollar 58-81 million versus dollar 110 million for stand-alone PCPs). These first estimates can be refined as empirical data become available from integrated PCPs in the future.

Africa South of the Sahara↗
PubMedDate not supplied

Relapse prevention for individuals with developmental disabilities, borderline intellectual functioning, or illiteracy.

The use of relapse-prevention-specific interventions in clinical addictions treatment programs is widely supported. While there is considerable information and research available regarding relapse prevention, there is little if any available regarding such interventions for individuals with developmental disabilities, borderline intellectual functioning, or illiteracy. A group design is proposed for this population that can be easily utilized by programs struggling with a lack of resources for the target population. This group model can be applied to individuals who are dually diagnosed because it is versatile and nonthreatening.

Adult↗
PubMed2003

Prevalence and severity of erectile dysfunction in 50 to 75-year-old Finnish men.

PURPOSE: We estimated the prevalence and severity of erectile dysfunction (ED) in a population based sample of 50 to 75-year-old Finnish men. MATERIALS AND METHODS: The target population consisted of all noninstitutionalized men 50, 60 or 70 years old residing in the study area in 1994. Questionnaires were mailed to 3,143 men in 1994 and to 2,864 men 5 years later. ED was assessed by 2 questions on subject ability to achieve and maintain erection sufficient for intercourse. Subjects were classified for analysis into none, minimal, moderate and complete ED groups. RESULTS: The overall prevalence of ED was 76.5%. The prevalence of ED increased from 67% for men 50 years old to 89% for those 75 years old. The prevalence of moderate and complete ED was 29%, increasing rapidly with age from 12% for age 50 years to 58% at age 75 years. Moderate ED increased by 8%, whereas complete ED increased by 18% for each 1-year age increment. CONCLUSIONS: ED is a highly prevalent disorder in 50 to 75-year-old men. It increases with age and is markedly higher after age 60 years. The prevalence of moderate ED increases linearly and slowly, while that of complete ED increases exponentially and rapidly with advancing age.

Age Factors↗
PubMed2004

Testing for chlamydial and gonorrheal infections outside of clinic settings: a summary of the literature.

BACKGROUND: Nucleic acid amplification tests (NAATs) provide new technology that makes it feasible to initiate testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) infection outside of clinic settings. METHODS: We summarized the English-language literature describing chlamydial or gonorrheal testing with self-collection of urine or vaginal specimens outside of clinic settings in developed countries published between January 1995 and August 2002. RESULTS: Testing for CT or GC infection has been initiated in school, community, and home settings. Purposes include screening of asymptomatic populations, improving quality of clinic-based health care, and research. Challenges include defining and reaching target populations, overcoming logistic issues, developing communication and counseling strategies, and determining whether alternative testing strategies are effectively reducing infection rates. CONCLUSIONS: The use of NAATs to detect CT and GC infection outside of clinic settings will undoubtedly continue. Future research should focus on how to best use this technology to reduce rates of infection.

Ambulatory Care Facilities↗