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PubMed2006

Screening campaign of hepatitis C among underprivileged people consulting in health centres of Lyon area, France.

BACKGROUND: A screening campaign for hepatitis C virus (HCV) infection was carried out in eight health centres of Lyon from June 2003 until March 2004. The population targeted for screening was underprivileged individuals without any social insurance, protected by Couverture Mutuelle Universelle or Aide Médicale Etat (AME), to estimate the prevalence of anti-HCV antibodies in this population and to identify associated risk factors. METHODS: After training in HCV infection and screening, 43 general practitioners participated in the campaign. Information about patient socio-demographics and risk factors was collected prior to proposing screening serology. Blood samples were often taken in health centres. Follow-up of positive cases was organised via the Reference Centre of HCV Infection in Lyon with possible specialised consultations in health centres. RESULTS: The average age of the 988 individuals in the campaign was 37 years; 51% were women; 54% had a foreign nationality; 21% lived in sheltered accommodation; 19% were lodged in third-party accommodation; 9% were homeless; and 57% possessed less than euro562 (Revenu Minimum d'Insertion level). Screening was not proposed to nine patients because of medico-psychological problems. The acceptance rate for screening was 98.8% (967/979), and testing was carried out on 97.6% of these subjects (944/967). The prevalence of anti-HCV antibodies in the sample was 4.7% (44/944) (95% CI = 3.4-6.2). Nearly 80% of positive cases were unknown prior to the campaign. Multivariate logistic regression modelling identified lifetime injection drug use [odds ratios (OR) = 15.99; P < 0.0001], lifetime medical care in a foreign country (OR = 4.46; P = 0.001), and wearing tattoos (OR = 2.75; P = 0.048) as significant risk factors for carrying anti-HCV antibodies. Characteristics independently associated with HCV seropositivity were age between 40 and 49 years, AME benefits, and no social insurance. CONCLUSION: Wide acceptance of screening, high prevalence of anti-HCV antibodies (much higher than in the French population in general), a high proportion of positive cases unknown beforehand, and satisfactory follow-up of seropositive patients are all factors which support the need for a screening campaign targeting HCV infection in underprivileged persons living in France.

Adolescent↗
PubMedDate not supplied

De novo age-related retinal disease and intraocular-pressure changes during a 10-year period in a Japanese adult population.

PURPOSE: To determine the proportion of age-related ophthalmologic diseases discovered in a healthy Japanese adult population, as well as to evaluate the age-related changes in intraocular pressure (IOP) in this population during a 10-year period. METHODS: Ophthalmologic surveys were conducted in 1988 and 1998 at Tamaho-cho in Yamanashi Prefecture. The target population of the first survey was 1389 subjects over 40 years of age, and of these, 1250 subjects (473 men and 777 women) participated in the survey. Their mean age was 57.8 +/- 11.9 years. Of these 1250 subjects, 245 subjects participated in the second ophthalmologic survey in 1998. The cases of glaucoma or age-related ophthalmologic diseases developing over the intervening 10-year period were determined among the subjects who had been diagnosed with no ophthalmologic abnormalities in the 1988 survey. We also compared the IOP values of the 219 subjects who were diagnosed with no ophthalmologic abnormalities in either the 1988 or the 1998 survey. RESULTS: The number of cases in the 1998 survey with newly discovered ocular diseases were as follows: two cases (0.82%) of normal-tension glaucoma, two cases (0.82%) of epiretinal membrane, one case (0.41%) of age-related macular degeneration, one case (0.41%) of angle-closure glaucoma, and one case (0.41%) of branch retinal vein occlusion. The mean IOP of the 219 subjects diagnosed with no ophthalmic abnormalities in either survey was 13.88 +/- 3.04 mmHg in 1988, which declined significantly to 13.16 +/- 2.75 mmHg in 1998 (P < 0.0001). CONCLUSIONS: The 10-year follow-up of the 245 subjects participating in both surveys showed one or two de novo cases of age-related macular degeneration, epiretinal membrane, branch retinal vein occlusion, normal-tension glaucoma, or angle-closure glaucoma. IOP was found to decline significantly with age.

Adult↗
PubMed2003

Effect of chronic diseases on incidence of erectile dysfunction.

OBJECTIVES: To estimate the incidence of erectile dysfunction (ED) in a population-based sample during 5 years' follow-up and determine how the rate was affected by age and medical conditions. METHODS: The target population comprised all men aged 50, 60, or 70 years residing in the study area at the time the study began. Questionnaires were mailed to 3143 men in 1994 and to 2864 men in 1999. The follow-up sample consisted of the 1442 men who responded to both the baseline and the follow-up questionnaires. ED was assessed by two questions concerning the subject's ability to achieve and maintain an erection sufficient for intercourse. We estimated the incidence of minimal ED among the 391 men free of ED, of moderate ED in the 1130 with no or minimal ED, and of complete ED among the 1323 men free of complete ED at baseline. RESULTS: The incidence of minimal ED was 127 cases per 1000 person-years (95% confidence interval 110 to 148). For moderate ED, it was 41 (95% confidence interval 36 to 47) and for complete ED, it was 18 (95% confidence interval 15 to 22). The incidence of minimal ED increased 40% and moderate ED 80% with each decade increment in age; the incidence of complete ED increased 190%. The incidence of ED was increased in men with diabetes (rate ratio 2.4 for minimal, 2.6 for moderate, and 3.4 for complete ED). Hypertension, heart disease, arthritis, pulmonary disease, and cerebrovascular disease had little or no effect on the incidence of ED. CONCLUSIONS: ED is a commonly occurring disorder that increases in incidence strongly between 50 and 75 years of age. Diabetes is a major determinant of ED, but hypertension, heart disease, arthritis, and cerebrovascular disease increase the incidence of ED only marginally.

Age Distribution↗
PubMed2006

Influenza as an issue on the agenda of health care workers: what can we do? What do we need?

ESWI recommends that the 25 European Union nations strive to vaccinate one-third of their collective population every year by 2010. This translates into an annual vaccine usage of 150 million doses for a population of 455 million. However, the current vaccine usage in Europe is 79 million doses, meaning that only 40% of ESWI's recommended target population is being vaccinated in the EU-25. Indeed, the EU's current risk groups equal about 28% of its population, but it is estimated that less than 62% are being vaccinated with the current vaccine supply--the equivalent of 17% of the total population. Clearly, as ESWI noted in its concluding position paper at the Malta conference, "a large proportion of those traditionally assumed to be at most risk from influenza are not being vaccinated." How to change this and minimize the consequences of a pandemic? "It's very interesting how the arithmetic works, given the goal of immunizing 75 percent of Europe's high-risk group, " said Dr K.Nichol of the University of Minnesota Medical Center who chaired the session. "If you go from a trivalent vaccine to a monovalent one, then you triple the number of doses you can manufacture. Thus, you could produce enough doses for the entire population of the EU." However, there is no coordinated approach in Europe, meaning such an optimistic scenario is unlikely in the medium-term. For the time being, emphasis must be on raising public awareness and raising vaccination rates at the local level, starting with health care workers themselves. Here the role and attitude of health policy officials and--critically--health care workers are crucial. These front-line policy and healthcare professionals constitute both the problem and the solution to a more effective influenza vaccine effort in Europe: they know first-hand the institutional obstacles blocking progress--i.e., lack of resources, poorly focused public information campaigns, etc.--but their own work practices and attitudes can be misdirected, too. To identify the issues and help the participants produce a set of recommendations, ESWI brought in Penny Lawson from to facilitate Dr.K. Nichol to steer this session's workshop debate. The participants were a diverse group of 35 health care workers from Australia, Finland, France, Germany, Malaysia, Malta, Netherlands, Norway, Poland, Portugal, Spain, Sweden and the UK.

Health Knowledge, Attitudes, Practice↗
PubMed2005

Delivery of influenza vaccine to non-elderly persons with cardiovascular disease, with varying national supply of vaccine: a decision analysis.

Influenza immunization rates among non-elderly persons at high-risk for influenza are far below target levels in the United States. Provision of influenza vaccine at subspecialty practices can target high-risk patients, particularly during influenza vaccine shortages. We conducted a decision analysis to explore the potential effects on non-elderly cardiac patients' immunization rates of improving vaccine availability, standing orders rates, and physicians' vaccine recommendation rates in cardiology, primary care, and other medical subspecialty outpatient practices. We considered two supply circumstances (sufficient versus 50% of needed supply), and also incorporated community and hospital based vaccine delivery as well as patient acceptance in the model. With sufficient vaccine supply, optimized performance of cardiology practices (maximum vaccine availability, strong physician recommendations, and standing orders) yielded greater improvement in vaccine coverage rate than with separately optimized performance in primary care, pulmonology, or endocrinology practices. With only 50% of needed vaccine supply, reallocation of doses from community sites to primary care and cardiology, pulmonology, and endocrine offices yielded higher estimated immunization rates in the target population than strategies without reallocation. Only with simultaneous interventions across primary care, subspecialty care, inpatient, and community domains did immunization rates exceed 60%. Targeted interventions to optimize delivery of influenza vaccine in cardiology practices may be the most effective means of raising vaccine coverage levels among non-elderly cardiovascular patients, in times of varying national vaccine supply.

Adolescent↗
PubMed1998

[Campaign for the detection of minor beta-thalassemia and prevention of major beta-thalassemia in the isle of Menorca. 10-year experience].

BACKGROUND: The high prevalence of betathalassemia minor and the presence of several cases of thalassemia major in Menorca (Spain) led us, ten years ago, to set up a population based prevention campaign, following the basic schedule of those already taking place in other areas, specially in Italy. PATIENTS AND METHODS: The target population was the children in the last year of mandatory school, when they are 13 to 14 years old. The campaign started in the school year 1986-1987 and in the 1995-1996 course we reached the tenth yearly campaign. The campaign was structured in three stages: the first one included all information and educational aspects; the second step corresponded to blood sampling and detection of carriers; finally, results were reported to the individuals and genetic counseling was given. For evaluation purposes, we have monitored participation rates, the proportion of detected carriers which present to haematology visit and the trend in the proportion of carriers which previously knew their status. RESULTS: A total of 8,591 children were screened, accounting for a 83.8% participation rate. The observed prevalence was 26.7/1000 (95% CI, 23.5-29.9/1000). We also detected 9 cases of alfathalassemia and 4 cases of deltabetathalassemia. CONCLUSIONS: Our results show that participation rates may be reached through school screening campaigns for thalassemia. After ten years of campaign, the number of not previously known cases has become small, indicating that the campaign screening to relatives of detected carriers and a higher consciousness level in the general population have given the expected effect. In the last 14 years, not a single homozigote case has been born, although we cannot conclude that this has been only due to the campaign.

Adolescent↗
PubMedDate not supplied

A template for cultural diversity workshops.

PURPOSE/OBJECTIVES: To present a model for a series of workshops designed to improve the ability of oncology nurses to understand and fulfill culturally based needs of racially and ethnically diverse patients with cancer. DATA SOURCES: Published literature and author experience. DATA SYNTHESIS: Most nurses work with patients from a variety of ethnic or cultural backgrounds yet know little of how this affects patients' cancer experiences. Four workshops were presented that focused on the most common ethnic groups in the geographic area. A content template was developed that worked well to ensure complete topic coverage. CONCLUSIONS: Workshops were well-received. Nurses identified barriers to care and interventions that are appropriate for diverse patient populations. The follow-up survey indicated that some anticipated program outcomes may not be feasible if attendees do not regularly work with target populations. IMPLICATIONS FOR NURSING PRACTICE: The model can be modified for use in any geographic area. Such workshops should be repeated at regular intervals.

Black or African American↗
PubMed1997

The Kinmen Neurological Disorders Survey (KINDS): a study of a Chinese population.

We conducted an epidemiological study of several neurological disorders among the Chinese aged 50 years or older on the islet of Kinmen. All participants were interviewed and examined by neurologists. From the targeted population of 5,061 individuals, 3,915 (77.4%) of them completed the evaluations. Among the 4,087 individuals with whom face-to-face contact was made, the refusal rate was 4.2%. The disorders of interest were dementia, Parkinson's disease, essential tremor, stroke, transient ischemic attacks, and migraine. Among the 3,915 participants, 366 cases were found with 1 or more of the surveyed neurological disorders on the prevalence day, August 1, 1993, yielding a prevalence of 93.5/1,000. The purpose of this study, the general methodology, and some overall findings are presented in this communication in order to provide a common background for detailed findings on each disorder to be reported separately.

Age Factors↗
PubMed1996

A data-based approach for designing a semiquantitative food frequency questionnaire for a population-based prospective study in Japan.

A self-administered food frequency questionnaire (FFQ) has been used commonly in epidemiologic studies of diet and chronic diseases. The analysis of dietary data in the target population is useful for designing a new questionnaire. The authors studied the major food sources of nutrient intakes in the Japanese population in order to develop a FFQ for a population-based prospective study. Subjects were 180 men aged 40-49 years and their 155 spouses who were sampled from four Public Health Center districts. Weighed food records over three consecutive weekdays were collected during the winters of 1989-1991. All foods reported were grouped into 154 items, and the percent contribution of each food to the total population intake of 15 nutrients was computed. Based on these data, a FFQ with 138 items was developed. The food list covered well the population intake of most nutrients (median = 83%, range = 55-91%), except for lipid (70%) and sodium (55%). The questionnaire was applied to the prospective study conducted in the same areas where the dietary data were collected, and an investigation to assess its reproducibility and validity is currently underway.

Adult↗
PubMedDate not supplied

[Prevalence of risk factors for ischemic heart disease in a northern Italian adult population].

The aim of this study is to measure the prevalence of cardiovascular risk factors in Tavazzano (Lodi) inhabitants, in order to implement efficacious and preventive strategies at community level. In 1998 the target population consisted of 2055 adults (males and females) aged 35-64, living in Tavazzano (Lodi province). The examined population was made of 856 subjects (399 males and 457 females), with a participation rate equal to 41,6%. A questionnaire concerning medical history and life habits such as: smoking, alcohol consumption and physical activity was administered to each participant. Height, Weight, Systolic and Diastolic Blood Pressure, Fasting Blood Glucose, Total Cholesterol and triglycerides were collected. A 12-leads electrocardiogram, evaluated both with standard clinical criteria and Minnesota Code, was done for each subject. The results show a high prevalence of modifiable cardiovascular risk factors: hypertension (25,2%), smoking (26,1%), obesity (14,6%), hypercholesterolemia (27,5%), low physical activity (39,6%) mainly in males and with an increasing trend with age. These data indicate the need of preventive programmes addressed to the general population and to "subjects at risk", according to the National Health Plan 2003-2005.

Adult↗
PubMed2005

Medicaid waiver programs for traumatic brain and spinal cord injury.

With policy makers facing the competing challenges of budget crises and pressures to expand Medicaid home and community- based service programs to populations including those with traumatic brain and spinal cord injuries (TBI/SCI), this paper addresses the need for information about the development of waiver programs for this target population. This study draws from the most recent and comprehensive available dataset to present national participation and expenditure trends for all TBI/SCI waivers for the period 1995-2002, it reports findings from a national survey of policies (e.g., eligibility criteria and cost controls) used on these waiver programs in 2002, and compares the Medicaid cost of serving this target group through institutional care and waiver programs.

Brain Injuries↗
PubMedDate not supplied

Enumeration procedure for monitoring test microbe populations on inoculated carriers in AOAC use-dilution methods.

The AOAC Use-Dilution methods do not provide procedures to enumerate the test microbe on stainless steel carriers (penicylinders) or guidance on the expected target populations of the test microbe (i.e., a performance standard). This report describes the procedures used by the U.S. Environmental Protection Agency to enumerate the test microbe (carrier counts) associated with conducting the Use-Dilution method with Staphylococcus aureus (Method 955.15) and Pseudomonas aeruginosa (Method 964.02) and the examination of historical data. The carrier count procedure involves the random selection of carriers, shearing bacterial cells from the carrier surface through sonication, and plating of serially diluted inoculum on trypticase soy agar. For each Use-Dilution test conducted, the official AOAC method was strictly followed for carrier preparation, culture initiation, test culture preparation, and carrier inoculation steps. Carrier count data from 78 Use-Dilution tests conducted over a 6-year period were compiled and analyzed. A mean carrier count of 6.6 logs (approximately 4.0 x 10(6) colony-forming units/carrier) was calculated for both S. aureus and P. aeruginosa. Of the mean values, 95% fell within +/- 2 repeatability standard deviations. The enumeration procedure and target carrier counts are desirable for standardizing the Use-Dilution methods, increasing their reproducibility, and ensuring the quality of the data.

Colony Count, Microbial↗
PubMed2004

Graft-versus-host disease after allogeneic hematopoietic stem cell transplantation induces a CD8+ T cell-mediated graft-versus-tumor effect that is independent of the recognition of alloantigenic tumor targets.

Cure of hematologic malignancies after allogeneic hematopoietic stem cell transplantation is partially attributable to immunocellular antitumor reactions termed graft-versus-tumor (GvT) effect. GvT effects are heterogeneous with respect to effector cell populations, target antigens, and their interrelation with graft-versus-host disease (GvHD). In the present study, allogeneic parent-into-F1 murine transplantation models (BALB/c or C57BL/6 --> [C57BL/6 x BALB/c]F1) with different tumors derived from either parental strain were used to evaluate tumor-specific GvT effects. Compared with syngeneic F1-into-F1 controls, significant CD8+ T cell-mediated GvT effects occurred in both allogeneic transplantation models, even in the absence of histoincompatibilities between donor cells and host tumor. Identical genetic background of donor and tumor precluded allorecognition of tumor cells, indicating that tumor-associated antigens (TAAs) were targeted. With allowance made for selective major histocompatibility complex (MHC) disparities between donor cells and normal host tissue, GvHD was identified as a driving force for TAA-specific GvT effects. Adoptive transfer of the effector cells into secondary tumor-bearing recipients confirmed sustained antitumor activity and specificity of the T-cell response. The results provide experimental proof of a donor CD8+ T cell-mediated TAA-specific antitumor response in vivo that is driven by GvHD. It may represent one of the mechanisms contributing to GvT effects observed in allogeneic transplant recipients.

Adoptive Transfer↗
PubMedDate not supplied

Acute respiratory infections in children from a deprived urban population from Uruguay.

To obtain base line data on incidence, duration, clinical characteristics and etiology of acute respiratory infections (ARI), 276 children from deprived families living in Montevideo were followed during 32 months. The target population was divided into two groups for the analysis of the results: children aged less than 12 months and those older than this age. During the follow-up period 1.056 ARI episodes were recorded. ARI incidence was 5.2 per child/year. It was 87% higher in infants than in the older group, as was the duration of the episodes. Most of the diseases were mild. Tachypnea and retractions were seldom observed, but 12 children were referred to the hospital, and 2 infants died. Viral etiology was identified in 15.3% of the episodes. RSV was the predominant agent producing annual outbreaks. Moderate to heavy colonization of the upper respiratory tract by Streptococcus pneumoniae (32.3%) and Hemophilus sp. (18.9%) was recorded during ARI episodes. This community-based study furnish original data on ARI in Uruguay. It enabled to assess the impact of these infections on childhood.

Acute Disease↗
PubMed2002

Factors associated with unintended pregnancy in Yamagata, Japan.

Data on unintended pregnancy are scarce in Japan. The purpose of this study is to examine the association of sociodemographic, reproductive, and other health behavioral factors with unintended pregnancy. A survey was conducted from May through November 1999 in Yamagata, Japan. We distributed anonymous self-administered questionnaires to cervical and breast cancer screening participants aged 35-49 years. There were 564 eligible women, and the number of respondents was 421 (74.6%). The proportion of women who had experienced unintended pregnancy was 46.2%, and 40.1% of them had repeated experiences. Among 312 pre-menopausal married women who did not want to become pregnant, 15.4% were not using any contraception. Factors that were significantly associated with the experience of unintended pregnancy were age of husband being 4 or more years older [Odds ratio (OR) = 1.83], and age at initiation of sexual intercourse (OR = 1.86) and marriage during teens (OR = 11.14). Analysis of 1255 pregnancies that the subjects had experienced showed that 51.2% and 25.9% of mistimed and unwanted pregnancies occurred as a result of no contraceptive use, and 39.5% and 71.1% of these ended in abortions. The number of past unintended pregnancies was significantly (p < 0.001) correlated with the number of pregnancies (r(s) = 0.49), live births 0.20) and abortions (r(s) = 0.63). This is the first epidemiological study in Japan to examine factors associated with unintended pregnancy, and also contraceptive use and pregnancy outcome for each of the unintended pregnancy women had experienced. Unintended pregnancy is not a rare event among our target population, and many unintended pregnancies leading to abortion could be prevented by effective contraceptive use. Results suggest that Yamagata's family planning strategies need to target both the younger and older generations, and address the role of men. A woman's pregnancy history reflecting her past experience of unintended pregnancy could be used as an indicator for recognizing the woman's need for appropriate contraceptive counseling for the prevention of repeated unintended pregnancies.

Abortion, Induced↗
PubMed1999

Challenges in translating the efficacy of neuroprotective agents in experimental models into knowledge of clinical benefits in head injured patients.

Many agents have been shown to reduce brain damage in experimental models of brain injury; this is proving difficult to translate into improved outcome of patients for reasons that are reviewed in this article. It is possible that, even if fundamental mechanisms are similar, injury processes modelled experimentally may be proportionately less important in human cases, and there also may have been insufficient attention to ensuring that dosage regimens for patients are therapeutically appropriate both in terms of concentration and time window. The distribution of outcomes after head injury means that, in unselected populations, a proportional improvement to the extent usually sought may be difficult to achieve. Future studies may need to consider more extensive work in "targeted populations" (selected by type and severity of damage) as a preliminary step before proceeding to definitive studies of efficacy, in which expectations of effect need to be lower and correspondingly large numbers of patients studied. Recant experience in the evaluation of glutamate NMDA antagonists is reviewed.

Clinical Trials as Topic↗
PubMed2001

Selection bias in epidemiological studies of infectious disease using Escherichia coli and avian cellulitis as an example.

In epidemiological studies of infectious disease, researchers often rely on specific cues of the host, such as clinical signs, as surrogate indicators of pathogen presence. A selection bias would manifest if the specific visual cues used in sampling for the pathogen were not representative of the full range of signs caused by the strains of that pathogen. In our molecular epidemiological studies of Escherichia coli associated with avian cellulitis in broilers, we collect carcasses at the processing plant based on visual cues of lesion morphology. Therefore, the objectives of this study were to: (1) explore the potential impacts of selection bias in an application of infectious disease epidemiology, and (2) utilize a validation protocol to assess the potential for selection bias in our molecular epidemiological studies of E. coli and avian cellulitis. In two different trials, E. coli DNA fingerprints were compared between birds that our observers collected and the birds that the observers missed. Using Fisher's exact tests and simulation models, we determined that the isolates collected by the observers were not significantly different from the isolates missed by the observers (P > 0.60 in both trials). Our method of selecting birds suspected of having cellulitis did not significantly bias our inferences about the population of E. coli associated with cellulitis in the flock. We encourage more investigators to critically assess the relationship of the sample to the target population in epidemiological studies of infectious disease.

Animals↗
PubMed2004

Effect of life-style factors on incidence of erectile dysfunction.

We estimated the incidence of erectile dysfunction (ED) in a population-based sample during 5-y follow-up and determined how the rate was affected by sociodemographic and life-style factors. The target population comprised all men aged 50, 60 or 70 y residing in the city of Tampere or 11 surrounding municipalities in Finland at the start of follow-up. A questionnaire was mailed to 3143 men in 1994 and to 2864 in 1999. The follow-up sample consisted of 1442 men who responded to both baseline and follow-up questionnaires. We estimated the effect of sociodemographic and life-style factors on the incidence of ED among the 1130 men free of ED at baseline. We found no differences in the incidence of ED by the level of education, marital status, urban/rural place of residence, amount of alcohol and coffee consumption. Obesity (rate ratio (RR)=1.7, 95% confidence interval (CI): 1.1-2.5) and current smoking (RR=1.5, 95% CI: 0.9-2.2) increased the incidence of ED. Current smokers free of comorbidity were also at higher risk of ED (RR=1.3, 95% CI: 0.8-2.1), but no effect was observed among past smokers. Our results indicate that sociodemographic and life-style factors, except age and obesity, have little influence on ED.

Aged↗