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PubMed1994

Testing antiepileptic drugs in children.

Few drugs have been approved by the Food and Drug Administration specifically for the treatment of pediatric patients with epilepsy in the United States. There are many factors that make tests of drugs in this group different from studies among adults. This report reviews issues that must be considered in designing studies that will help bring to market antiepileptic drugs for children. Information on the wide variety of antiepileptic drugs rapidly being developed can only be obtained through well-controlled, well-designed clinical trials. Despite the obstacles and pitfalls, trials among the pediatric population are necessary to establish the unique efficacy and safety profile of each drug and to determine the target, population most likely to benefit from each drug.

Adolescent↗
PubMedDate not supplied

[Epidemiologic study on the performance of a smoking prevention program in an adolescent population].

In the last few years, the relative number of adolescent smokers has increased, which indicates the need to boost the adoption of new preventive strategies aimed at this part of the population. In order to be effective, preventive actions should be put in the local setting thoroughly knowing the target population and any specific-predictive factors of the insurgence of smoking addiction. To this purpose, we conducted a study aimed at describing the prevalence of smoking addiction in a population of 2472 adolescents and at identifying any predisposing factors. From the analysis of the results, both predisposing and protective factors emerged, together with many formative requests from the adolescents. On the basis of such results, we were able to create ad hoc preventive interventions. The proposed strategy seems to be potentially valid; however, we will be able to express a more precise judgment only at the end of the implementation phase.

Adolescent↗
PubMed2005

Health promotion interests of women with disabilities.

The number of women with disabilities (WWD) in the United States is substantial and growing. Health promotion education can play a key role in the achievement of optimal health and well-being for this population. A preliminary step in planning educational programs is to identify health promotion topics of interest to this target population. This study surveyed WWD about their interest in health promotion topics and compared their interests by demographic characteristics (i.e., age, employment status, ethnic group, type of disabling condition, and level of disability). The sample population, comprising 604 women with a variety of disabilities, completed a written or online survey. Topic of interest selected were tallied and ranked by order of interest. Topics ranking highest in interest and selected by at least half of the WWD were aging with a disability, stress management, exercise, nutrition, overview of health promotion, and maintaining mental health. Significant health issues not identified included smoking cessation, pregnancy, and osteoporosis. If healthcare providers are aware of the topics that interest WWD, they can better develop educational programs to meet the needs of this vulnerable population.

Adolescent↗
PubMed2005

Identification of health hazards to rural population living near pesticide dump sites in Poland.

OBJECTIVES: The aim of the present project was to assess population exposure to pesticides in the vicinity of pesticide dump sites and make a preliminary evaluation of the potential health hazards to humans. MATERIALS AND METHODS: Of the 286 pesticide dump sites registered in Poland, 40 were selected as the largest source of ecological hazard. The application of the Hazard Ranking System made it possible to identify 17 priority dump sites where pesticide wastes are deposited. For population exposure assessment, two dump sites located close to the residence area and drinking water intakes were selected as potentially most hazardous to health. They have a piezometric system installation that enables ground water sampling for analysis. RESULTS: In water samples collected from the water-bearing layer in areas adjacent to pesticide dump site, 31 different pesticides in total have been detected (15 organochlorine pesticides, 10 organophosphorous pesticides and 6 phenoxyacids), 12 of which - dichlorvos, mevinphos, endosulfan, dieldrin, heptachlor epoxide, p,p'-DDT, p,p'-DDD, p,p'-DDE, methoxychlor, 2,4-D, MCPA, MCPP--had concentration levels higher than the detection limit. The estimated size of the potentially exposed population approximates 900 inhabitants; 33% of this population are children (aged 0-14 years) and women at reproductive age (aged 15-45 years). Both these target populations are considered particularly susceptible to the adverse health effects of pesticides. Assessment of population exposure to pesticides (p,p'-DDT - 0.15 microg/l; p,p'-DDD - 0.13 microg/1; MCPP - 12.3 microg/l; MCPA - 0.64 microg/l; methoxychlor - 0.31 microg/l; 2,4'-D - 5.4 microg/l) with concentration levels higher than the drinking water standard (0.1 microg/1) was based on pesticide daily intake in drinking water. CONCLUSIONS: The results indicated a low cancer risk (R = 10(-8)) for people drinking water contaminated with p,p'-DDT and p,p'-DDD as well as low non-cancer risk related to MCPA, MCPP and methoxychlor exposure. At one of the dump sites examined, the level of population exposure to 2,4'-D implies possible hematopoietic, nephrotoxic and hepatotoxic effects as well as reproductive disorders.

Environmental Exposure↗
PubMedDate not supplied

[Anti-flu vaccination: satisfaction study in a vaccinated population].

Most of the studies on the coverage of our country with regard to flu vaccinations reveal figures which do not surpass 50%-70% of the target population. In the USA, this figure only amounts to 20%-30%. There seems to be a certain "reticence" on the part of the population with regard to taking these injections or to continue the vaccination programs yearly. For this reason, we have made a prospective surveillance and monitoring study of the individuals vaccinated with the flu vaccine, which has taken in two flu injection campaigns (1988-1989) for the purpose of ascertaining the possible causes of this "reticence" and the degree of satisfaction achieved with the flu vaccine procedures. The study reveals the only 51.8% of the population receiving the vaccine was satisfied with the procedure, although 75.2% repeated the procedure the following year. The highest degree of insatisfaction is shown among women, and the customary patients who visit their physicians for every ache and pain, and those receiving the vaccine for the first time confuse acute respiratory symptoms with flu symptoms.

Adolescent↗
PubMed2005

Shared care with task delegation to nurses for type 2 diabetes: prospective observational study.

BACKGROUND: To study the effects of two different structured shared care interventions, tailored to local needs and resources, in an unselected patient population with type 2 diabetes mellitus. METHODS: A three-year prospective observational study of two interventions and standard care. The interventions involved extensive (A) or limited (B) task delegation from general practitioners to hospital-liaised nurses specialised in diabetes and included a diabetes register, structured recall, facilitated generalist-specialist communication, audit and feedback, patient-specific reminders, and emphasised patient education. The target population consisted of 2660 patients with type 2 diabetes treated in the primary care setting. Patients who were terminally ill or who had been diagnosed with dementia were excluded from the study. RESULTS: The participation rates were high (90%) for patients, and none of the 64 GPs discontinued their participation in the study. Longitudinal analyses showed significant improvements in quality indicators for both intervention groups (process parameters and achieved target values on the individual patient level); in standard care, performance remained stable or deteriorated. Both patients and caregivers appeared satisfied with the project. CONCLUSION: This study shows that structured shared care with task delegation to nurses, targeted at a large unselected general practice population, is feasible and can positively affect the quality of care for patients with type 2 diabetes.

Aged↗
PubMed1984

Stereotypic responding: a review of intervention research.

More than 60 studies using behavioral strategies to suppress stereotypic responding in handicapped individuals were reviewed in order to identify the populations studied, the behavior observed, the interventions employed, and the relative effectiveness of these interventions when used alone or in combinations. The target populations were distributed across nine categories, three of which (severely mentally retarded, profoundly mentally retarded, and severely emotionally disturbed) constituted approximately three-quarters of all subjects studied. Fifty types of target behavior were identified; body rocking was the target in approximately two-thirds of all studies, and mouthing and complex finger and hand movements were the targets in at least one-third. Ten interventions (seven aversive, three positive) were identified. The aversive interventions were used in approximately three-quarters of the studies whereas positive procedures were used in approximately one-third. One aversive procedure (overcorrection) was used in more than one-third of the studies, whereas another, shock, was the most effective. The other six aversive procedures, however, and three positive procedures were relatively equal in effectiveness. Discussion centered on the relative effectiveness of the interventions and their relationship to the concept of least restrictive alternatives.

Autistic Disorder↗
PubMed2002

Carrier screening and genetic counselling in beta-thalassemia.

This paper review the most important aspects of carrier detection procedures, genetic counselling, population screening and prenatal diagnosis of beta-thalassemias. Carrier detection can be made retrospectively, following the birth of an affected child or prospectively. Several programmes, with the aim of preventing homozygous beta-thalassemia, based on carrier screening and counselling of couples at marriage; preconception or early pregnancy, are operating in several Mediterranean at-risk populations. These programmes have been very effective, as indicated by increasing knowledge on thalassemia and its prevention by the target population and by the marked decline of the incidence of thalassemia major. Carrier detection is carried out by haematological methods followed by mutation detection by DNA analysis. Prenatal diagnosis is accomplished by mutation analysis on PCR-amplified DNA from chorionic villi. Future prospects include automation of the process of mutation-detection, simplification of preconception and preimplantation diagnosis and fetal diagnosis by analysis of fetal cells in maternal circulation.

Female↗
PubMedDate not supplied

Critical value of prevalence for vaccination programmes. The case of hepatitis A vaccination in Spain.

Programmes using screening and vaccination are efficient in populations with higher levels of antibodies, while in those with lower levels is more efficient to vaccine the whole target population. The prevalence that makes the cost-effectiveness of vaccination programmes equal to that obtained for programmes using screening and vaccination is defined as the critical value of prevalence p*. In this study, a mathematical procedure to obtain the critical value of prevalence is developed. The formula obtained is used to decide the best vaccination strategy against hepatitis A in Spain. If V is the vaccination cost, S the screening cost, PV the predictive value of a positive test result, D the mean disease cost, A the attack rate in susceptible individuals, E the vaccine efficacy and C the vaccination compliance, the critical value of prevalence is equal to: [formula: see text] The critical value of prevalence obtained for vaccination against hepatitis A in Spain with three doses of vaccine Havrix 720 is 22%. This result show that the optimal decision is to implement vaccination programmes without screening for immunity in individuals aged < 15 years and with screening in those aged > 15 years.

Adolescent↗
PubMed1998

Physical activity interventions in low-income, ethnic minority, and populations with disability.

BACKGROUND: Low-income, racial and ethnic minority, and populations with disabilities are more likely to be sedentary than the general population. Increasing physical activity in these groups is an important public health challenge. This report summarizes interventions that have targeted populations at risk for inactivity. METHODS: Computer and manual searches were performed to identify manuscripts published from 1983 to 1997. Interventions conducted in these populations in which physical activity was part of the intervention, and activity or cardiorespiratory fitness were outcome measures, were included in the review. RESULTS: Fourteen studies were identified. Most studies used pre-post or quasi-experimental designs. Common intervention features for the ten studies that included ethnic minority groups were community advisory panels, community needs assessments, and community members delivering the intervention. Eight studies reported a theoretical framework that guided the intervention. Increased physical activity was documented in two studies. Post-intervention follow-up was conducted in two studies; both reported no significant findings. Only four studies for people with disabilities were found; all four reported post-intervention physical activity change. CONCLUSION: Much work remains to develop effective interventions for these populations. Research that involves the community at all steps in the design and implementation of the intervention shows greatest promise for promoting behavior change. Future intervention studies should include: (1) rigorous experimental designs; (2) theoretically based interventions; and (3) validated assessment instruments to detect physical activity change.

Adolescent↗
PubMed1999

The Cardiovascular Health Education Program: assessing the impact on rural and urban adolescents' health knowledge.

In this research study, a quasi-experimental, nonequivalent control group pretest-posttest design was used to assess the impact of the Cardiovascular Health Education Program (CHEP) on the cardiovascular health knowledge of grade eight adolescents. A total of 146 adolescents participated in study, with 88 in the experimental group and 58 in the control group. One-hundred two of the adolescents resided in a rural region and 44 resided in an urban region in the province of Newfoundland and Labrador, Canada. The findings from this study indicate that the CHEP did have a significant positive impact on the cardiovascular health knowledge of the rural adolescents, but it did not have a comparable impact on the cardiovascular health knowledge of the urban adolescents. The findings also indicate that there was no significant difference between rural and urban cardiovascular health knowledge prior to implementing the program. These findings support the need for implementation of the CHEP within this population. This study also shows that nurses can design, implement, and evaluate community-based health promotion programs for targeted populations.

Adolescent↗
PubMed1998

Prenatal diagnosis and screening of the haemoglobinopathies.

This paper reviews the most important aspects of carrier detection procedures, genetic counselling, population screening and prenatal diagnosis of the thalassaemias and sickle cell anaemia. Carrier detection can be made retrospectively, following the birth of an affected child, or prospectively. Carrier detection and genetic counselling in at-risk populations for alpha-thalassaemia and sickle cell anaemia is carried out mostly retrospectively. However prospective carrier screening is ongoing in Cuba and Guadeloupe for sickle cell anaemia and, in a very limited way, in some South East Asian populations, for alpha-thalassaemia. For beta-thalassaemia, several programmes, based on carrier screening and counselling of couples at marriage, preconception or early pregnancy, are operating in several Mediterranean at-risk populations. These programmes have been very effective, as indicated by increasing knowledge on thalassaemia and its prevention by the target population and by the marked decline of the incidence of thalassaemia major. Carrier detection is carried out by haematological methods followed by mutation detection by DNA analysis. Prenatal diagnosis is accomplished by mutation analysis on PCR-amplified DNA from chorionic villi. Future prospects include automation of the process of mutation-detection, simplification of preconception and preimplantation diagnosis and fetal diagnosis by analysis of fetal cells in maternal circulation.

Anemia, Sickle Cell↗
PubMed1999

Prescription of hormone replacement therapy in postmenopausal women with renal failure.

UNLABELLED: Prescription of hormone replacement therapy in postmenopausal women with renal failure. BACKGROUND: Although patients with end-stage renal disease (ESRD) are at increased risk for early menopause, osteoporosis, cognitive dysfunction, and cardiovascular disease, few postmenopausal women are prescribed hormone replacement therapy (HRT). The reasons for the low prescription rate are not known. This study uses data from the United States Renal Data System (USRDS) to assess the prevalence and predictors of HRT use in postmenopausal women with ESRD. METHODS: Data were obtained from the USRDS Dialysis Morbidity and Mortality Study Wave 2. All women who were at least 45 years of age were considered postmenopausal and were selected for our analysis. Demographics, behavior and medical characteristics were abstracted from the database. Logistic regression was used to estimate the independent contribution of population characteristics in predicting the use of HRT. Linear regression models were used to estimate the relationship between HRT use and both triglycerides and total cholesterol. RESULTS: The overall prevalence of HRT prescription was 10.8%. Important predictors of HRT use included age (aOR = 0.74, 95% CI 0.13 to 0.88, P < 0.001), black ethnicity (aOR = 0.50, 95% CI, 0.31 to 0.78, P < 0.002), college education (aOR = 3. 00, 95% CI, 1.70 to 5.24, P < 0.001), and the ability to ambulate (aOR = 1.99, 95% CI, 1.01 to 3.91, P = 0.05). Serum triglyceride and total cholesterol levels were higher among women treated with HRT than among those not treated with HRT (264 +/- 155 vs. 217 +/- 159 mg/dl, P = 0.001 and 220 +/- 62 vs. 209 +/- 55 mg/dl, P = 0.02, respectively). CONCLUSIONS: HRT is prescribed less frequently in postmenopausal ESRD patients than in the general population. Younger age, higher education levels, white race, and the ability to ambulate were important predictors of HRT use. Targeting populations of patients who are likely to benefit from but less likely to be prescribed HRT may increase the prescription of HRT.

Aged↗
PubMedDate not supplied

Cell number in the inferior olive of nervous and leaner mutant mice.

Naturally occurring cell death is an important feature of neuronal network development: the absence of adequate postsynaptic target neurons during a critical period may result in the death of presynaptic neurons, the degree of death varying inversely with the size of the target population. Studies of mouse mutants with abnormal cerebellar development provide support for this neuron/target relationship in circuits within the CNS. In the present study we analysed the inferior olivary cell population in two cerebellar mutant mice, nervous (nr/nr) and leaner (Cacna1ala/la). In these mice Purkinje cell degeneration begins near the end of the first postnatal month. In nervous mice the loss starts at postnatal day 20 (P20) and by the end of second month almost 90% of the Purkinje cells in the hemisphere and 50% in the vermis have disappeared. In leaner mice Purkinje cell loss starts after P30 and by P60 almost 50% of these cells are lost. We report here a loss of one third of inferior olivary neurons in the nervous mutation while the entire population appears intact in the leaner mouse. These results allow better definition of the end of the period of target dependency of inferior olive neurons. Their implications for the cell-cell interactions in the developing olivo-cerebellar system are discussed.

Animals↗
PubMedDate not supplied

Mass vaccination against poliomyelitis in Mexico.

In 1959, oral poliovirus vaccine ( OPV ) was introduced as an antiepidemic measure in Mexico. As in many other developing countries, the vaccine was misused, coverages achieved were often poor, and an adequate cold chain was lacking. However, in 1972 a mass campaign reached 70% of children younger than five years of age, and consequently the reported cases declined sharply from 1.9 to 0.4 per 100,000 population. Due to economic restrictions, only single doses of monovalent type 1 OPV were administered to 80% of the target population in 1981, 1982, and 1983. The present incidence of poliomyelitis of 0.1 per 100,000 population represents a 96.7% reduction from the rate during the prevaccine era, when the annual average rate was 4.26 per 100,000. The present aim of poliomyelitis control is to maintain and decrease the present incidence of disease. Future plans are to continue mass vaccination in an attempt to reach small and isolated villages that have been without vaccination and limit possible rural foci of wild poliovirus.

Humans↗
PubMed1998

Screening for colorectal cancer: alternative faecal occult blood tests.

Hemoccult-based colorectal cancer (CRC) screening, while shown to be effective in randomized controlled trials, is suboptimal; alternative faecal occult blood tests which are either modifications of current guaiac-peroxidase tests or newer technologies (immunochemical), are available and show real promise. The goals of the alternative tests are improved sensitivity with acceptable specificity and improved compliance by screenees. The process of demonstrating superiority to Hemoccult need not include mortality as an endpoint, but must involve a direct comparison in large numbers of screenees (say 20,000) with cancer yields, apparent specificity and compliance determined for each test. Only the more sensitive and more readable guaiac test, HemoccultSENSA, and the immunochemical test Immudia-HemSp (the international version is HemeSelect) have undergone such extensive testing and could be considered as acceptable alternatives to Hemoccult for population-based screening. Even then, the test positivity rate of HemoccultSENSA warrants checking in a pilot study in the target population because it may pose a problem of specificity in some populations.

Colorectal Neoplasms↗
PubMed1996

Aboriginal health.

OBJECTIVE: To inform health care workers about the health status of Canada's native people. DATA SOURCES: A MEDLINE search for articles published from Jan. 1, 1989, to Nov. 31, 1995, with the use of subject headings "Eskimos" and "Indians, North American," excluding specific subject headings related to genetics and history. Case reports were excluded. Material was also identified from a review of standard references and bibliographies and from consultation with experts. STUDY SELECTION: Review and research articles containing original data concerning epidemiologic aspects of native health. Studies of Canadian populations were preferred, but population-based studies of US native peoples were included if limited Canadian information was available. DATA EXTRACTION: Information about target population, methods and conclusions was extracted from each study. RESULTS: Mortality and morbidity rates are higher in the native population than in the general Canadian population. The infant mortality rates averaged for the years 1986 to 1990 were 13.8 per 1000 live births among Indian infants, 16.3 per 1000 among Inuit infants, and only 7.3 per 1000 among all Canadian infants. Age-standardized all-cause mortality rates among residents of reserves averaged for the years 1979 to 1983 were 561.0 per 100,000 population among men and 334.6 per 100,000 among women, compared with 340.2 per 100,000 among all Canadian men and 173.4 per 100,000 among all Canadian women. Compared with the general Canadian population, specific native populations have an increased risk of death from alcoholism, homicide, suicide and pneumonia. Of the aboriginal population of Canada 15 years of age and older, 31% have been informed that they have a chronic health problem. Diabetes mellitus affects 6% of aboriginal adults, compared with 2% of all Canadian adults. Social problems identified by aboriginal people as a concern in their community include substance abuse, suicide, unemployment and family violence. Subgroups of aboriginal people are at a greater-than-normal risk of infectious diseases, injuries, respiratory diseases, nutritional problems (including obesity) and substance abuse. Initial data suggest that, compared with the general population, some subgroups of the native population have a lower incidence of heart disease and certain types of cancer. However, knowledge about contributing factors to the health status of aboriginal people is limited, since the literature generally does not assess confounding factors such as poverty. CONCLUSIONS: Canadian aboriginal people die earlier than their fellow Canadians, on average, and sustain a disproportionate share of the burden of physical disease and mental illness. However, few studies have assessed poverty as a confounding factor. Future research priorities in native health are best determined by native people themselves.

Canada↗
PubMedDate not supplied

What providers should know about community cancer control.

PURPOSE: The authors describe a framework for developing an effective, community-focused cancer control program. OVERVIEW: Progress in the application of cancer control interventions has proven to be quite variable across different populations and communities. The Kentucky Cancer Program, developed under joint sponsorship of cancer centers at two state universities, has been using a model that appears to provide a high degree of sensitivity to community-specific problems and solutions. The Kentucky four-step model includes 1) using data from a population-based cancer registry and other sources to identify problems; 2) ensuring community involvement with providers in selecting the target population and developing the intervention strategy; 3) implementing the intervention plan; and 4) using cancer registry and other data to evaluate the impact of this intervention. CLINICAL IMPLICATIONS: This framework may be useful to providers as they try to balance the goals of their clinical practice and the goals of community cancer control. Developing an effective, community-focused cancer control program requires that providers gain a solid knowledge about their community. The depth and richness of that knowledge base is enhanced by the active participation of community members as they collaborate with the providers on planning and implementing cancer control activities.

Breast Neoplasms↗