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PubMed1990

[Vaccination coverage in a pediatric population attended by a primary health care center].

It is hereby presented a quality control study of a systematic vaccination program developed in an urban primary care center. Target population were children between 0 and 8 years attended in the center. They were considered as having a correct vaccination coverage those cases in which it was possible to verify documented accomplishment of the local vaccination schedule. Out of the 538 children included in our study, 168 (31%) were founded not to have appropriate vaccination coverage evidenced in their clinical records, and their families were requested for an interview: 126 (75%) attended de appointment. In 93 of them it was founded a recording mistake, and 33 cases were verified as no correctly covered. Vaccination coverage rate was 86%, being inverse relationship between age and coverage rate. They are discussed corrective actions derived from the quality control.

Child↗

PubMed1978

The Shetland Islands: the effects of social and ecological change on mental health.

The authors review the literature concerning the mental health and social effects of industrialization, urbanization and the transition from a rural to an industrial society. They point out the need for prospective and longitudinal studies. To illustrate a working model of the type of research needed, the authors describe a long-term study now underway in the Shetland Islands. This research investigates the effects that rapid social and ecological change (from the North Sea oil developments) will have on the islanders. To test the hypothesis that the changes, associated with the construction of Europe's largest oil port in these previously isolated rural islands, will have a deleterious effect on the Shetlanders' health and way of life, a prospective study has been initiated that contains two sub-studies. The General Survey involves monitoring reported data on ecological, epidemiological and sociological change and is intended to provide an overview of the general impact of the oil developments. The Individual Survey involves interviewing two populations (total N = 533) and is designed to examine individuals' reactions to change and variables associated with those reactions. The target population live in a conservation region where they are not likely to be directly affected by the oil developments. Baseline findings are presented from the General Survey concerning psychiatric morbidity, crime, divorce and suicide and from the Individual Survey that focus on the prevalence of medical and psychiatric symptoms and illnesses.

Adaptation, Psychological↗

PubMed1993

The prevalence of diabetic retinopathy and maculopathy and their risk factors in the non-insulin-treated diabetic patients of an English town.

A total population study of the ocular status of all known non-insulin-treated diabetic patients resident in the English town of Melton Mowbray has been conducted. The population prevalence of non-insulin-treated diabetes in the town was 6.7/1000. There were 215 patients in the target population, with 65% of the resident survivors participating in the study. Further data on ocular status were gathered from hospital records, bringing the total percentage for whom some information on ocular status was available to 74%. Corrected Snellen acuity was 6/12 or better in 76% of patients and the over-all prevalence rate for any diabetic retinopathy was 52%, for proliferative retinopathy was 4%, and for maculopathy requiring treatment was 10%. In a multivariate analysis, risk factors for retinopathy and/or maculopathy included longer diabetic duration, female sex, higher blood pressure, the use of anti-hypertensive drugs and cigarette smoking.

Adult↗

PubMed2001

Prevalence of concern about physical appearance in the general population.

Using information gathered in the introductory sections of the Derriford Appearance Scales (DAS24 and DAS59), the prevalence and epidemiological characteristics of concern about physical appearance have been determined for a carefully constructed sample of the general population of southwest Devon (rural and urban). In all, 2108 usable replies were received from a postal survey of a targeted population of 5400 men and women, aged 18 and over and randomly selected with constraints for age, sex and socio-economic status. The prevalence of concern about physical appearance was highest among women through to age 60 and younger men. There was no association with socio-economic status or living status. Concerns about the nose, weight and skin disorders were reported most frequently by both men and women and additionally concerns about breasts and abdomen were reported by women and premature balding by men. The mean DAS24 and DAS59 full-scale scores of 19% of male and 25% of female responders who were concerned about appearance exceeded the mean scores of preoperative patients undergoing reconstructive and cosmetic plastic surgery. Concern about appearance is widespread in the general population. More often than not, concern is about one feature only, which runs counter to the hypothesis that concern about appearance reflects a neurotic trait. The high levels of measured psychological distress and dysfunction found in a substantial minority of those in the general population who are concerned about appearance highlight the need for appropriate services.

Adolescent↗

PubMed2004

Evaluation of an ethnic media campaign on patterns of HIV testing among people from culturally and linguistically diverse backgrounds in Australia.

OBJECTIVE: To evaluate a 2-week pilot ethnic media campaign that was implemented in 14 languages to promote awareness of HIV/AIDS and HIV testing among selected non-English speaking populations in Australia in November/December 2000. METHODS: The main outcome measure was clinic attendances for the purpose of HIV testing by individuals from the target populations at one ofthree public sexual health clinics in Sydney and Melbourne prior to and immediately after the campaign. RESULTS: The number of HIV tests on members of the 14 target language communities attending the clinics almost doubled from 66 to 122 tests. However, as a proportion of the total number of HIV tests performed at the three clinics this increase was not significant (16.3-18.8%; P = 0.31). For both periods in 2000 the proportion of HIV tests that were performed on members of the target language group were higher than during a 1999 comparison period (10.5%, both P < 0.01). CONCLUSIONS AND IMPLICATIONS: This study did not demonstrate a significant increase in testing attributable to the pilot intervention. A larger campaign, with a more extensive evaluation, would probably be needed to demonstrate a measurable effect.

Adult↗

PubMed2001

Conceptualizing quality of life for elderly people with stroke.

PURPOSE: Despite increased interest in quality of life (QOL) as an outcome measure and as a means of identifying client needs in health care, its conceptualisation and the identification of its constituents have been poorly researched for elderly people with stroke in Hong Kong. METHOD: This article analysed the literature to identify components relevant to the QOL of Chinese elderly people with stroke living in the community in Hong Kong. RESULTS: While common components of QOL for elderly people with and without stroke and regardless of cultural background were identified, a number were specific to an elderly Chinese stroke population. CONCLUSION: Recommendations for future research have been made with reference to further exploring and validating these components for the target population. A clear understanding of these aspects is essential for the development of sensitive QOL measures to guide and evaluate service delivery to this population.

Activities of Daily Living↗

PubMed1998

Soliciting defined populations to recruit samples of high-risk older adults.

BACKGROUND: Generalizable research on high-risk older persons requires samples that are both large enough for adequate statistical power and similar enough to community populations that its results can be generalized to them. We tested the effectiveness and efficiency of mixed-mode (mail-telephone) solicitation of a defined population as a method for recruiting a large, representative sample for a randomized trial of outpatient geriatric evaluation and management (GEM). METHODS: Fee-for-service, community-dwelling older Medicare beneficiaries were mailed a short self-administered screening questionnaire. Eligible respondents were called to assess eligibility and willingness to give consent; consenters were called again for baseline data. Information about nonrespondents, ineligibles, and refusers was obtained from the Health Care Financing Administration. RESULTS: The response rate to the screening questionnaire was 61.1%. Of the respondents, 13.2% were eligible for the study and, of those, 34.4% agreed to participate. Response rates appeared to be influenced by small financial incentives and by subjects' age, race, sex, location of residence, and use of hospitals in the previous year. Consent rates were influenced by age and sex. The final sample (N = 522) was representative of community high-risk respondents in racial composition, previous use of hospitals, and probability of repeated admission (Pre) in the future, but it was slightly younger and contained a higher percentage of men. Recruitment costs averaged $286.92 per consenting person. CONCLUSIONS: Mixed-mode solicitation of defined populations can produce, at reasonable cost, large samples whose representativeness of community high-risk populations can be determined. Procedures that may enhance the success of this approach include: advance communication with members of the target population and their families and physicians; provision of medical and small financial incentives; continuous monitoring of recruitment results; and attention to subjects' needs for convenience, time, transportation, and reassurance.

Aged↗

PubMed1990

Evaluation of a village health worker programme: the use of village health worker retained records.

A village health worker (VHW) programme in a rural area in South Africa is evaluated, a year after the introduction of VHW-retained child record cards. The programme's success in promoting immunization and breastfeeding and the coverage of and contact with the community by the VHWs was investigated. A population survey on children under one year was matched to VHW records, showing that VHWs were reaching 70.8% of the target population. VHWs were more likely to visit a child with a Road to Health Card (RTHC) and who was born in the village. VHWs generally visit mothers once a month and make contact with most children in their first month of life. Children born before the start of the new VHW programme were compared with those born after, using survival analysis techniques and data from the RTHC on the first year of life of all children under two. An increase in polio immunization coverage was detected but there was a drop in measles immunization coverage. We conclude that a VHW-retained child record for the first year of life plays a valuable role in ongoing health care evaluation.

Breast Feeding↗

PubMed2006

Incidence of initial local therapy among men with lower-risk prostate cancer in the United States.

BACKGROUND: The frequently indolent nature of early-stage prostate cancer in older men and in men with low- or moderate-grade tumors and the demonstration that the survival benefits of radical prostatectomy are primarily among men younger than 65 years have led to concerns about prostate cancer overtreatment. METHODS: Using data from 13 Surveillance, Epidemiology, and End Results registries, we performed a retrospective cohort study of 71,602 men who were diagnosed with localized or regional prostate cancer between 2000 and 2002. We quantified the incidence of initial curative therapy (i.e., surgery or radiation therapy) among men with lower-risk cancers as defined by their limited likelihood of either dying from expectantly managed prostate cancer or achieving a survival benefit from local therapy. Stratified analyses and multinomial logistic regression models were used to quantify the absolute and relative rates of curative therapy among men in various age-grade strata. All statistical tests were two-sided. RESULTS: We identified 24,405 men with lower-risk prostate cancers and complete data for the first course of treatment. Initial curative therapy was undertaken in 13,537 of these men (55%); 81% of treated men received radiation therapy. The likelihood of curative therapy, relative to expectant management, varied statistically significantly among lower-risk age-grade strata (all P<.05). Assuming that initial expectant management is appropriate for all lower-risk cancers, 2564 men (10%) in this population-based sample were overtreated with radical prostatectomy and 10,973 (45%) with radiation therapy. CONCLUSIONS: These data quantify a target population for whom greater use of expectant approaches may reduce overtreatment and improve the quality of localized prostate cancer care.

Aged↗

PubMed1996

Problems of measuring asthma prevalence.

This review considers the issues involved in measuring the community prevalence of asthma, particularly in the context of international comparisons. We argue that there is no gold standard definition for measuring asthma prevalence, and discuss the currently available methods of case ascertainment. Prevalence studies, if they are to be generalizable, need to involve large sample sizes with high response rates. This necessitates methods that are simple, inexpensive and practicable, but also as sensitive and specific for asthma as possible. We discuss some of the issues that are specific to comparisons of asthma prevalence between diverse populations, and suggest that large surveys using written or video questionnaires of self reported symptoms validated in all of the target populations are the method of choice.

Asthma↗

PubMed2006

Absolute pitch among American and Chinese conservatory students: prevalence differences, and evidence for a speech-related critical period.

Absolute pitch is extremely rare in the U.S. and Europe; this rarity has so far been unexplained. This paper reports a substantial difference in the prevalence of absolute pitch in two normal populations, in a large-scale study employing an on-site test, without self-selection from within the target populations. Music conservatory students in the U.S. and China were tested. The Chinese subjects spoke the tone language Mandarin, in which pitch is involved in conveying the meaning of words. The American subjects were nontone language speakers. The earlier the age of onset of musical training, the greater the prevalence of absolute pitch; however, its prevalence was far greater among the Chinese than the U.S. students for each level of age of onset of musical training. The findings suggest that the potential for acquiring absolute pitch may be universal, and may be realized by enabling infants to associate pitches with verbal labels during the critical period for acquisition of features of their native language.

Adolescent↗

PubMed2003

Randomized trials, generalizability, and meta-analysis: graphical insights for binary outcomes.

BACKGROUND: Randomized trials stochastically answer the question. "What would be the effect of treatment on outcome if one turned back the clock and switched treatments in the given population?" Generalizations to other subjects are reliable only if the particular trial is performed on a random sample of the target population. By considering an unobserved binary variable, we graphically investigate how randomized trials can also stochastically answer the question, "What would be the effect of treatment on outcome in a population with a possibly different distribution of an unobserved binary baseline variable that does not interact with treatment in its effect on outcome?" METHOD: For three different outcome measures, absolute difference (DIF), relative risk (RR), and odds ratio (OR), we constructed a modified BK-Plot under the assumption that treatment has the same effect on outcome if either all or no subjects had a given level of the unobserved binary variable. (A BK-Plot shows the effect of an unobserved binary covariate on a binary outcome in two treatment groups; it was originally developed to explain Simpsons's paradox.) RESULTS: For DIF and RR, but not OR, the BK-Plot shows that the estimated treatment effect is invariant to the fraction of subjects with an unobserved binary variable at a given level. CONCLUSION: The BK-Plot provides a simple method to understand generalizability in randomized trials. Meta-analyses of randomized trials with a binary outcome that are based on DIF or RR, but not OR, will avoid bias from an unobserved covariate that does not interact with treatment in its effect on outcome.

Data Interpretation, Statistical↗

PubMed2004

Screening for Chlamydia trachomatis in women 15 to 29 years of age: a cost-effectiveness analysis.

BACKGROUND: Clinical guidelines have traditionally advised annual Chlamydia trachomatis screening for women younger than 25 years of age. OBJECTIVE: To assess the cost-effectiveness of recently proposed strategies for chlamydia screening. DESIGN: State transition simulation model; cost-effectiveness analysis. DATA SOURCES: Published literature. TARGET POPULATION: Sexually active U.S. women 15 to 29 years of age. TIME HORIZON: Lifetime. PERSPECTIVE: Modified societal. INTERVENTIONS: Four strategies targeted to 3 specific age groups (15 to 19 years, 15 to 24 years, and 15 to 29 years): 1) no screening, 2) annual screening for all women, 3) annual screening followed by 1 repeated test within 3 to 6 months after a positive test result, and 4) annual screening followed by selective semiannual screening for women with a history of infection. OUTCOME MEASURES: Clinical events (for example, pelvic inflammatory disease, chronic pelvic pain, ectopic pregnancy, and infertility), lifetime costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios. RESULTS OF BASE-CASE ANALYSIS: Annual screening in women 15 to 29 years of age followed by semiannual screening for those with a history of infection was the most effective and cost-effective strategy. It consistently had an incremental cost-effectiveness ratio less than 25,000 dollars per quality-adjusted life-year (QALY) compared with the next most effective strategy. When the indirect transmission effects of a 10-year screening program on the probability of infection in uninfected women (that is, per-susceptible rate of infection) were considered, all strategies became more cost-effective. RESULTS OF SENSITIVITY ANALYSIS: Results were sensitive to the annual incidence of chlamydia, probability of persistent infection, screening test costs, and costs of treating long-term complications. Each variable was associated with threshold values beyond which screening became cost-saving. In probabilistic analysis, annual screening in women 15 to 29 years of age followed by semiannual screening for those with a history of infection had an incremental cost-effectiveness ratio less than 50,000 dollars per QALY in 99% of simulations. LIMITATIONS: Uncertainty about the natural history of chlamydial infection and consideration of only the indirect transmission effects of C. trachomatis screening. CONCLUSIONS: Annual C. trachomatis screening for all women 15 to 29 years of age and selective targeting of those with a history of infection for semiannual screening is very cost-effective compared with other well-accepted clinical interventions.

Adolescent↗

PubMedDate not supplied

Community health nursing: population focus and evaluation.

A synposis of recent research contributions to evaluation in the field of community health nursing is presented in a framework which distinguishes this population-focused practice from clinical nursing and emphasizes the scientific aspects of community health practice. Systematic need assessment, estimation of target population coverage, evaluation based on outcome, and evaluation based on process represent the four major types of studies discussed. Throughout the paper issues related to the conduct and utilization of the type of research reviewed are considered; the paper concludes with a brief discussion of fruitful directions for future research and ways to foster practitioners' utilization of research.

Community Health Nursing↗

PubMed2000

Earnings histories of SSI beneficiaries working in December 1997.

Disabling conditions previously considered to be permanent and total are no longer viewed as automatic barriers to work. Medical advances, improved accommodations in the workplace, and changes in the nature of work for the working disabled have allowed many disabled people to rejoin the workforce. The Social Security Administration (SSA) has followed those developments with a view toward encouraging people receiving disability benefits to consider returning to work. To effectively target SSA's efforts and evaluate their success, information about previous work histories of the Supplemental Security Income (SSI) beneficiary population is used to provide baseline data. This article examines the earnings histories of 300,000 disabled SSI beneficiaries--one of the populations targeted by the expanded work-incentive measure under Public Law 106-70--who were working in December 1997. The article also investigates whether beneficiaries who are working have significant lifetime earnings and whether earnings patterns exist that might assist with SSA's work-support activities. SSI program records were matched to data in the Master Earnings File to explore the characteristics and earnings patterns before and after a person applies for benefits. The article addresses several questions: What are the general characteristics of disabled SSI beneficiaries? What are their earnings histories? Did they have an earnings record when they applied for SSI? Of the SSI beneficiaries working in December 1997, most tended to be younger than other disabled beneficiaries, to have some sort of mental disability, and to have earnings well below levels that would suggest their eventual, complete independence from the SSI cash benefits program. A look at past covered earnings revealed that the vast majority of SSI workers had a history of earnings before they applied for SSI benefits. Despite their severe impairments and age at the time of first eligibility, nearly 40 percent had earnings in 11 years or more. The amounts of those earnings were quite low, however, and were usually not high enough to preclude SSI eligibility. Examining the years immediately before and after the point of application indicated whether recent pre-application earnings were consistent with post-application return to work. Results were a bit surprising. They revealed that one-third of the 1997 SSI workers had no earnings, and another 28 percent returned to work despite having no earnings in the 4-year period before application. Persons receiving SSI because of mental retardation seemed to have poorer earnings histories than other workers but were more likely to return to work after application. That may be explained by their younger ages or may reflect the outside assistance they received in responding to SSA work incentives.

Adolescent↗

PubMed2002

Research shows targeted HIV prevention succeeds.

Systematic reviews of HIV prevention intervention literature for the target populations of African-Americans, Latinos, youths, and men who have sex with men in the United States shows that targeted interventions work in reducing HIV risk behaviors. Interventions that succeeded were culturally sensitive, of longer duration, and included skills training, according to a project supported by the Surgeon General's Leadership Campaign on AIDS and teh California HealthCare Foundation in Oakland.

Adult↗

PubMed2003

[Benzodiazepines: Consequences on memory in the elderly].

Studies conducted with a healthy voluntary population with a unique medication indicate that benzodiazepines (BZD) are known to induce memory deficits. However, this group does not correspond to the population usually using these medication on a regular basis, knowingly the elderly people. Few studies have been conducted with this target population to determine the impact of BZD on their memory. However, some findings suggest that there are important consequences on the functioning of memory of the elderly people taking BZD. The current data go as far as suggesting that BZD exacerbate memory deficits in the elderly. This could even constitute a risk factor that could hasten cognitive decline and thus increase development of dementia.

English Abstract↗

PubMedDate not supplied

Metabolic screening in the NICU population: a proposal for change.

To be an effective preventive pediatric and public health strategy, newborn screening for hereditary metabolic disorders should include 100% of all neonates as the target population. Delaying screening for critically-ill and premature infants places the neonatal intensive care unit (NICU) population at high risk for developing devastating side effects of untreated or late-treated metabolic diseases. A clinical nursing project was undertaken in The Johns Hopkins Hospital NICU to develop specific metabolic screening criteria for this special population.

Humans↗