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PubMed1998

Hysterectomy fractions in New South Wales, 1971-2006.

Hysterectomy fractions by age group for particular periods are of interest for: estimating proper population denominators for calculation of disease and procedure rates affecting the cervix and uterus; estimating the target population for Pap test programs, and response rates; and as a way of displaying the cumulative consequences of hysterectomies in a population. Hysterectomy fractions for populations can be determined by direct inquiry via a representative sample survey, or, as in this study, from prior hysterectomy rates of the cohorts of women which compose each age bracket. Hysterectomy data 1979-93 were obtained from the hospital In-patients Statistics Collection (ISC) which covers both public and private hospitals in NSW. Annual population denominators of women were obtained from Census data. Data were modelled by Poisson regression, using five-year age group (15- > or = 85 years), annual period, and five-year birth cohort (APC model). Forward- and back-projection of the period effects were undertaken. The resultant NSW hysterectomy fractions by age and period are consistent with fractions obtained from modelled hysterectomy rates for Western Australia (1980-84), and fractions from national representative sample surveys (1989/90 and 1995) for younger women, but not for women aged > or = 70 years in 1995, which revealed higher hysterectomy fractions than modelled hysterectomy data would suggest. Hysterectomy fractions for NSW women by five-year age group for quinquennia centred on 1971 to 2006 are provided.

Adolescent↗
PubMed1990

Maternal and child oral health issues: research.

There is currently little oral research directed toward the maternal and child health population, especially outside of the National Institute of Dental Research funded programs. Although many agencies are involved with research in this area, there is no central national coordination, policy, or research agenda. Not all segments of the population are benefiting from existing knowledge. To improve oral health for all segments of the population, leadership in the establishment of research priorities is needed to direct activities that will benefit the population groups most affected by oral disease. New directions and perspectives are needed in the type of research conducted. The populations and conditions studied and the depth of the analyses performed must be extended. Additional emphasis should be placed on behavioral, evaluation, and health services research and collaborative research with other health fields. The population groups studied need to be expanded from the historical focus on relatively healthy elementary schoolchildren. As discussed by Waldman, information is particularly needed pertaining to children under age five, all women, and special population groups. As Frazier and Horowitz indicated, research on health promotion and health education within these target populations, as well as among other family members and care givers is needed. Data collected from surveys need to be analyzed more thoroughly. As new diagnostic systems and oral health care technologies are developed, they need to be evaluated adequately for safety, effectiveness, and efficiency. To accomplish all these activities, financial and human resources are needed--funding from appropriate sources in the public and private sector and qualified dental researchers interested in public health and clinical issues of concern to the maternal and child population.

Adolescent↗
PubMed1996

Reliability of underlying incidence rates for estimating the effect and efficiency of screening for breast cancer.

The process of setting screening performance targets requires an estimate of what the incidence of breast cancer would have been in the population invited for screening if there had not been a screening programme. Before the introduction of the National Health Service breast screening programme in 1988 the incidence of breast cancer was already increasing in the population targeted for screening. To establish the incidence before screening the most recent complete data from all the regional cancer registries were collated. An age-period model was constructed to predict what these incidence rates might now have been if the screening programme had not been introduced. The model predicted that if prescreening trends continued (between 1987 and 1995) underlying incidence over this period would increase by 2.3 per 10,000 in women aged 50-54, 2.6 per 10,000 in women aged 55-59, and 2.9 per 10,000 in women aged 60-64. If the prescreening trends have continued then the use of a universal rate, applied across all calendar years and age groups, would seem to be inappropriate when setting targets.

Adult↗
PubMed1999

Primary care and addiction treatment: lessons learned from building bridges across traditions.

A primary care unit combined with residential addiction treatment allows patients with addictive disease and chronic medical or psychiatric problems to successfully complete the treatment. These are patients who would otherwise fail treatment or fail to be considered candidates for treatment. Health care providers should have a background in primary care and have the potential to respond professionally to clinical problems in behavioral medicine. Ongoing professional training and statistical quality management principles can maintain morale and productivity. Health education is an integral part of primary care. The costs of such concurrent care when viewed in the context of the high societal and economic costs of untreated addictive disease and untreated chronic medical problems are low. The principles used to develop this primary care unit can be used to develop health care units for other underserved populations. These principles include identification of specific health care priorities and continuity of rapport with the target population and with addiction treatment staff.

Delivery of Health Care↗
PubMed1996

A model for developing longitudinal health records.

The future of population health management will focus on treatment of chronic diseases and avoidance of acute disorders for targeted populations. The key tools for managing population health must involve outcomes measurement and management, wellness/preventive programs, care management programs, and cost management. This can be achieved by the implementation of a computerized patient health record for longitudinal health information (lifetime) recording and management.

Chicago↗
PubMed2006

Addressing cardiovascular disparities through community interventions.

OBJECTIVES: To identify the components and impact of intervention programs aimed at reducing cardiovascular disparities. METHODS: A MEDLINE literature search with key words "cardiovascular" and "African American" was conducted, and all documented interventions targeted at reducing racial disparities were selected for review. We identified the type of intervention, the populations targeted, the length of intervention, and its impact. Articles that documented scientific evidence and some case reports were reviewed. RESULTS: Existing studies widely document cardiovascular disparities as they pertain to structure, process, and outcomes. Other factors affecting disparities pertain to patient, physician, system, or treatment factors. Documented programs tend to focus on lifestyle risk factors and attitudes toward those risk factors. The timelines in the studies are relatively short and do not allow for recording clinical endpoints. Most of the studies do not hinge on comprehensive community support, and they lack a sustainability component. CONCLUSIONS: The impact of programs has been short lived, which points to the need for sustainability programs possibly through community partnerships.

Black or African American↗
PubMed1996

Evaluation of travel and use as a risk factor for seropositivity to Ehrlichia risticii in horses of New York state.

OBJECTIVES: To determine whether mean annual frequency and destination of equine travel was associated with exposure to Ehrlichia risticii and whether these associations were modified by horses' place of residence. DESIGN: Cross-sectional study. SAMPLE POPULATION: 511 equine operations containing 2,587 horses were visited in New York state from a target population of 39,000 operations. PROCEDURE: Each horse was tested for serum antibodies against E risticii, using indirect fluorescent antibody. Information on the horse's travel history, farm's management practices, and surrounding ecology was obtained by personal interview and resource maps. Statistical analyses were performed on 2 cohorts of animals: all horses enrolled in the study and horses born on the property or that resided at least 4 years on the farm. Three county-based risk regions (RR) were identified by use of cluster analysis. RESULTS: Mean seroprevalence for each of the 3 RR was 2.4 (low risk), 8.5 (moderate risk), and 18.5% (high risk) for cohort 1 and 2.5, 8.0, and 18.4% for cohort 2. Among cohorts 1 and 2, pleasure riding and breeding trips were associated with exposure to E risticii, but horse residence (low, moderate, or high RR) was an effect modifier for these associations. Among cohort 1 and stratifying the analysis according to the RR for the travel destination, trail riding at low RR and trail riding at high RR were associated with exposure. Among cohort 2 and stratifying the analysis according to the RR for the travel destination, breeding trips were associated with exposure, and strong effect modification was present for horse residence (low, moderate, or high RR). CONCLUSIONS: Only certain types of travel to specific RR were associated with higher risk of exposure to E risticii. In many instances, travel was not associated, or was associated, with a reduced risk of exposure.

Animals↗
PubMed2004

Cardiovascular risks in a military health care beneficiary population with high blood pressure.

Prevention strategies for coronary artery disease among hypertensive patients require assessment of other modifiable risk factors in the target population. In this article, we describe the prevalence of other cardiovascular risk factors in military beneficiaries with high blood pressure (HBP). Baseline data from an ongoing randomized clinical trial designed to test effectiveness of a comprehensive HBP intervention are used in the analysis. A total of 147 beneficiaries from a military health system participated in this study. Findings indicate that the rate of HBP control in this sample was suboptimal (32%: blood pressure < 140/90). Other prevalent cardiovascular risk factors include high cholesterol, obesity, and diabetes. Many of these patients (31.3%) are also in the moderate-to-high danger level of developing coronary artery disease in the near future. These findings warrant a regular assessment of cardiovascular risk factors and rigorous behavioral interventions for all beneficiaries of the military health care system.

Adult↗
PubMed2006

Best-evidence interventions: findings from a systematic review of HIV behavioral interventions for US populations at high risk, 2000-2004.

OBJECTIVES: The Centers for Disease Control and Prevention's HIV/AIDS Prevention Research Synthesis Team conducted a systematic review of US-based HIV behavioral intervention research literature from 2000 through 2004 to identify interventions demonstrating best evidence of efficacy for reducing HIV risk. METHODS: Standard systematic review methods were used. Each eligible study was reviewed on the basis of Prevention Research Synthesis Team efficacy criteria that focused on 3 domains: study design, implementation and analysis, and strength of evidence. RESULTS: Eighteen interventions met the criteria for best evidence. Four targeted HIV-positive individuals. Of those targeting populations at risk for HIV, 4 targeted drug users, 6 targeted adults at risk because of heterosexual behaviors only, 2 targeted men who have sex with men, and 2 targeted youths at high risk. Eight interventions focused on women, and 13 had study samples with more than 50% minority participants. Significant intervention effects included increased condom use and reductions in unprotected sexual intercourse, number of sexual partners, injection drug use or needle sharing, and newly acquired sexually transmitted infections. CONCLUSIONS: Most of the best-evidence interventions are directly applicable for populations in greatest need of effective prevention programs; however, important gaps still exist.

Evidence-Based Medicine↗
PubMed1995

Coeur en santé St-Henri--a heart health promotion programme in a low income, low education neighbourhood in Montreal, Canada: theoretical model and early field experience.

STUDY OBJECTIVE: Coeur en santé St-Henri is a five year, community based, multifactorial, heart health promotion programme in a low income, low education neighbourhood in Montreal, Canada. The objectives of this programme are to improve heart-healthy behaviours among adults of St-Henri. This paper describes the theoretical model underlying programme development as well as our early field experience implementing interventions. DESIGN: The design of the intervention programme is based on a behaviour change model adapted from social learning theory, the reasoned action model, and the precede-proceed model. The Ottawa charter for health promotion provided the framework for the development of specific interventions. Each intervention is submitted to formative, implementation, and impact evaluations using simple and inexpensive methods. PARTICIPANTS: The target population consists of adults living in St-Henri, a neighbourhood of 23,360 residents. Because of costs constraints, the intervention strategy targets women more specifically. The community is one of the poorest in Canada with 46% of the population living below the poverty line and 20% being very poor. The age-sex adjusted ischaemic heart disease mortality in 1985-87 was 317 per 100,000 compared with 126 per 100,000 in an affluent adjacent neighbourhood. RESULTS: Thirty nine distinct interventions have been developed and tested in the community, eight related to tobacco, 10 to diet, seven to physical activity, and 14 which are multifactorial. The interventions include smoking cessation and healthy recipes contests, a menu labelling and healthy food discount programme in restaurants, a point of choice nutrition education campaign, healthy eating and smoking cessation workshops, a walking club, educational material, print and electronic media campaigns, heart health fairs, and community events. CONCLUSION: An integrated heart health promotion programme is feasible in low income urban neighbourhoods but not all interventions are successful. Such a programme requires substantial energy and resources as well as long term commitment from public health departments.

Cardiovascular Diseases↗
PubMed1991

Cost-benefit analysis of hepatitis-B vaccination. A computerized decision model for Spain.

The availability and efficacy of recombinant deoxyribonucleic acid yeast-derived hepatitis-B vaccine, at a price much lower than the previously available plasma-derived hepatitis-B vaccines against hepatitis-B virus infections, motivate a new cost-benefit analysis of hepatitis-B vaccination. Spanish data were used to calculate direct and indirect costs of hepatitis-B infection and the costs and benefits of different vaccination strategies in defined risk groups of the Spanish population. A vaccination program will reduce direct expenditures for hepatitis B if the attack rate in the target population is higher than 4.9%. If indirect costs are included, the threshold for cost saving is reduced to 0.9%. The results are sensitive to the price of the vaccine, the duration of protection, assumptions about consequences for quality of life, and to indirect costs.

Computer Simulation↗
PubMed2003

Conservation genetics of the fisher (Martes pennanti) based on mitochondrial DNA sequencing.

Translocation of animals to re-establish extirpated populations or to maintain declining ones has often been carried out without genetic information on source or target populations, or adequate consideration of the potential effects of mixing genetic stocks. We consider the conservation status of the fisher (Martes pennanti) and evaluate the potential genetic consequences of past and future translocations on this medium-sized carnivore by examining population variation in mitochondrial control-region sequences. We sampled populations throughout the fisher's range in North America including five populations unaffected by translocations and two western populations that had received long-distance translocations. Twelve haplotypes showed little sequence divergence. Haplotype frequencies differed significantly among subspecies and between populations within subspecies. Analysis of molecular variance (amova) and neighbour-joining analyses of haplotype relationships revealed population subdivision similar to current subspecies designations, but which may reflect an isolation-by-distance pattern. Populations in Oregon and in Montana and Idaho received several translocations and each showed greater similarity to the populations where translocations originated than to adjacent populations. Additional sequences obtained from museum specimens collected prior to any translocations suggest historical gene flow among populations in British Columbia, Washington, Oregon, and California. Anthropogenic impacts in that region have greatly reduced and isolated extant populations in Oregon and California. Future translocations may be necessary to recover populations in Washington and portions of Oregon and California; our results indicate that British Columbia would be the most appropriate source population.

Animals↗
PubMed2005

The 'number needed to sample' in primary care research. Comparison of two primary care sampling frames for chronic back pain.

BACKGROUND: Sampling for primary care research must strike a balance between efficiency and external validity. For most conditions, even a large population sample will yield a small number of cases, yet other sampling techniques risk problems with extrapolation of findings. OBJECTIVE: To compare the efficiency and external validity of two sampling methods for both an intervention study and epidemiological research in primary care--a convenience sample and a general population sample--comparing the response and follow-up rates, the demographic and clinical characteristics of each sample, and calculating the 'number needed to sample' (NNS) for a hypothetical randomized controlled trial. METHODS: In 1996, we selected two random samples of adults from 29 general practices in Grampian, for an epidemiological study of chronic pain. One sample of 4175 was identified by an electronic questionnaire that listed patients receiving regular analgesic prescriptions--the 'repeat prescription sample'. The other sample of 5036 was identified from all patients on practice lists--the 'general population sample'. Questionnaires, including demographic, pain and general health measures, were sent to all. A similar follow-up questionnaire was sent in 2000 to all those agreeing to participate in further research. We identified a potential group of subjects for a hypothetical trial in primary care based on a recently published trial (those aged 25-64, with severe chronic back pain, willing to participate in further research). RESULTS: The repeat prescription sample produced better response rates than the general sample overall (86% compared with 82%, P < 0.001), from both genders and from the oldest and youngest age groups. The NNS using convenience sampling was 10 for each member of the final potential trial sample, compared with 55 using general population sampling. There were important differences between the samples in age, marital and employment status, social class and educational level. However, among the potential trial sample, there were no demographic differences. Those from the repeat prescription sample had poorer indices than the general population sample in all pain and health measures. CONCLUSIONS: The repeat prescription sampling method was approximately five times more efficient than the general population method. However demographic and clinical differences in the repeat prescription sample might hamper extrapolation of findings to the general population, particularly in an epidemiological study, and demonstrate that simple comparison with age and gender of the target population is insufficient.

Adult↗
PubMed1977

An estimate of the prevalence of epilepsy in a rural Appalachian population.

A descriptive study has documented what is felt to be a precise estimate of the prevalence of epilepsy in 1973 in the school-age population of Clay County, Kentucky, a rural Appalachian county. A 96% response rate was achieved from the target population of 5467. By utilizing an accepted definition of epilepsy, an experienced child neurologist and a carefully monitored survey method which required the cooperative efforts of school personnel, local public health nurses and community leaders, a prevalence significantly greater than that previously reported from other areas of this country was observed (p less than .05). The true prevalence of seizures in Clay County, Kentucky, children 6--16 years of age in 1973 is believed to have been between the observed rate of 27 cases per 1000 and the estimated rate of 35 cases per 1000. The prevalence rate of febrile seizures is believed to have been underestimated in the Clay County data. For comparative purposes, the authors are currently applying the same methodology to a non-Appalachian area.

Adolescent↗
PubMed1995

Cancer Research Campaign health education programme to promote the early detection of cutaneous malignant melanoma. II. Characteristics and incidence of melanoma.

The effect on the detection and characteristics of melanoma, resulting from the Cancer Research Campaign's health education programme to promote the early detection of melanoma in the general population, was studied from 1987 to 1989. The seven study areas in England and Scotland yield a target population of 3.6 million. Data were collected from local clinic-based registers, pathology laboratories, and the cancer registries. The average annual incidence rates of melanoma were seven and 12 per 10(5) in males and females, respectively, age-standardized to England and Wales, 1988. These rates are similar to the national figures for Scotland, where there is a national melanoma register, but higher than those reported by the English and Welsh cancer registries. The incidence was significantly higher in females than males (P < 0.001), and increased with age. Fifty-three per cent and 65% of cases in males and females, respectively, were thin (Breslow thickness < or = 1.5 mm), similar to the national figures from Scotland. No significant decrease in the incidence of late-stage tumours was found in either sex as a result of the campaign. Because of difficulties with ascertainment of cases in England, the main evaluation will focus on future trends in mortality rates for melanoma.

Adult↗
PubMed2006

oskar gene expression in the vector mosquitoes, Anopheles gambiae and Aedes aegypti.

A disease control strategy based on the introduction into mosquito populations of a gene conferring a pathogen-refractory phenotype is currently under investigation. This population replacement approach requires a drive system that will quickly spread and fix antipathogen effector genes in target populations. Modified transposable elements containing the control sequences of developmentally regulated genes may provide the basis for a gene drive system that regulates gene mobilization in a sex- and stage-restrictive manner. Screening of a Drosophila melanogaster database for genes whose products localize exclusively in the future germ cells during early embryonic development resulted in the identification of several candidate genes. The regulatory sequences of these genes could be used to drive transposition. Mosquito orthologous genes of oskar were identified based on sequence homology and characterized further. The tissue- and sex-specific expression profiles and hybridizations in situ show that oskar orthologous transcripts in Anopheles gambiae and Aedes aegypti accumulate in developing oocytes of adult females and localize to the posterior poles of early embryos. These characteristics potentiate the use of the regulatory sequences of mosquito oskar genes for the control of modified transposable elements.

Aedes↗
PubMed1991

Rapid Immunocapture of Pseudomonas putida Cells from Lake Water by Using Bacterial Flagella.

Monoclonal antibodies to Pseudomonas putida Paw340 cells were produced. In an enzyme-linked immunosorbent assay (ELISA) against whole bacterial cells, a hybridoma cell line termed MLV1 produced a monoclonal antibody that reacted with P. putida Paw340 but showed no cross-reaction with 100 medical isolates and 150 aquatic isolates. By ELISA, immunogold electron microscopy, and Western blot (immunoblot) analysis, MLV1 antibody was found to react with purified bacterial flagella. The surfaces of magnetic polystyrene beads were coated with MLV1 antibody. By mixing MLV1 antibody-coated beads with lake water samples containing the target P. putida host, bead-cell complexes which could be recovered by attraction towards a magnet were formed. Prevention of nonspecific attachment of cells to the beads required the incorporation of detergents in the isolation protocol. These detergents affected colony-forming ability; however, the cells remained intact for direct detection. When reisolated by standard cultural methods, approximately 20% of the initial target population was recovered. Since the beads and bead-cell complexes were recovered in a magnetic field, target bacteria were separated from other lake water organisms and from particulate material which was not attracted towards the magnet and were thereby enriched. This method may now provide a useful system for recovering recombinant bacteria selectively from environmental samples.

Journal Article↗
PubMed1993

Measurement of rRNA Variations in Natural Communities of Microorganisms on the Southeastern U.S. Continental Shelf.

The development of a clear understanding of the physiology of marine prokaryotes is complicated by the difficulties inherent in resolving the activity of various components of natural microbial communities. Application of appropriate molecular biological techniques offers a means of overcoming some of these problems. In this regard, we have used direct probing of bulk RNA purified from selective size fractions to examine variations in the rRNA content of heterotrophic communities and Synechococcus populations on the southeastern U.S. continental shelf. Heterotrophic communities in natural seawater cultures amended with selected substrates were examined. Synechococcus populations were isolated from the water column by differential filtration. The total cellular rRNA content of the target populations was assayed by probing RNA purified from these samples with an oligonucleotide complementing a universally conserved region in the eubacterial 16S rRNA (heterotrophs) or with a 1.5-kbp fragment encoding the Synechococcus sp. strain WH 7803 16S rRNA (cyanobacteria). The analyses revealed that heterotrophic bacteria responded to the addition of glucose and trace nutrients after a 6-h lag period. However, no response was detected after amino acids were added. The cellular rRNA content increased 48-fold before dropping to a value 20 times that detected before nutrients were added. Variations in the rRNA content from Synechococcus spp. followed a distinct diel pattern imposed by the phasing of cell division within the irradiance cycle. The results indicate that careful application of these appropriate molecular biological techniques can be of great use in discerning basic physiological characteristics of selected natural populations and the mechanisms which regulate growth at the subcellular level.

Journal Article↗