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At least 811 records · Page 45Linked to original sources
PubMed2000

A population pharmacokinetic analysis of the penetration of the prostate by levofloxacin.

Prostatitis has remained a pathological entity that is difficult to treat. Part of the difficulty revolves about the putative offending pathogens. For acute prostatitis, members of the Enterobacteriaceae, particularly Escherichia coli, play a central role, while intracellular pathogens such as Chlamydia are more frequently seen in chronic prostatitis. Consequently, a drug needs to be able to penetrate to this specialized site in both the acute and chronic infection forms of the disease and also have potent activity against the most common causative pathogens, both intracellular and extracellular. Levofloxacin has such an activity profile. We wished to document its ability to penetrate to the site of infection. Patients undergoing prostatectomies were administered 500 mg of levofloxacin orally every 24 h for 2 days prior to surgery, and then on the day of surgery, 500 mg was administered as an hour-long, constant-rate intravenous (i.v.) infusion. A set of blood samples was obtained as guided by stochastic optimal design theory. Prostate biopsy times were determined by randomizing subjects into one of four groups, based on the interval after the i.v. dose. All plasma and prostate drug concentrations were comodeled by a population modeling program, BigNPEM, implemented on the Cray T3E Supercomputer housed at the Supercomputer Center at the University of California at San Diego. Penetration was determined as the ratio of the area under the concentration-time curve (AUC) of levofloxacin in the prostate to the plasma levofloxacin AUC. When calculated from the mean population parameters, this penetration ratio was 2.96. We also performed a 1,000-subject Monte Carlo simulation from the mean parameter vector and covariance matrix. The mean penetration ratio here was 4.14 with a 95% confidence interval of 0.20 to 19.6. Over 70% of the population had a penetration ratio in excess of 1.0. Levofloxacin adequately penetrates a noninflamed prostate and should be evaluated for the therapy of prostatitis.

Aged↗
PubMed1999

National Surveillance System and Hib meningitis incidence in Italy.

In 1994, the Italian Ministry of Health implemented a National Surveillance System to obtain data on the incidence of bacterial meningitis and its causative agents, including Haemophilus influenzae type b (Hib). As a consequence, case reporting of Hib meningitis is increasing year by year; in 1996, there were 126 notifications, of which 73% were in children under 2 years of age. Although underreporting still exists, parallel prospective or retrospective epidemiological surveys conducted in some Italian Regions allowed for partial correction of the incidence of Hib meningitis (up to 18.5/100,000 population in 1994).

Age Distribution↗
PubMed1991

[Ultrasonographic diagnosis of tumors and non-tumor diseases in mass preventive examination of the rural population].

Ultrasound diagnostical examinations were performed during mass prophylactic check-ups in cotton-growing collective farms of Kashkadar'inskaya Region. Out of 903 examinees cancer was detected in 1 patient (0.11%), benign tumors in 11 (1.2%), precancer in 25 (2.7%), nontumor diseases in 298 (33.0%). The lesions were predominantly localized in the gastrointestinal and urogenital tracts. It is advisable to organize paid mobile teams at regional consultative and diagnostic centers for broad-scale check-ups of rural population. Screening programs of such teams are to include diagnostic ultrasound.

Adolescent↗
PubMed2006

The value of contraception to prevent perinatal HIV transmission.

OBJECTIVE: The objective of this study was to highlight the value of preventing unintended pregnancies among HIV-infected women as a strategy to prevent perinatal HIV transmission. GOAL: The goal of this study was to assess the cost-effectiveness of family planning programs to avert HIV-positive births with the current programmatic emphasis: prenatal care services that provide and promote nevirapine for prevention of mother-to-child transmission of HIV. STUDY DESIGN: Cost-effectiveness analyses were conducted from the health system perspective during 1 year with a hypothetical sub-Saharan African population. Expected program costs were combined with number of HIV-positive births averted for each strategy. RESULTS: At the same level of expenditure, the contraceptive strategy averts 28.6% more HIV-positive births than nevirapine for prevention of mother-to-child transmission of HIV. CONCLUSIONS: Increasing contraceptive use among nonusers of contraception who do not want to get pregnant is cost-effective and is an equally important strategy to prevent perinatal transmission as prenatal care programs that provide and promote nevirapine to HIV-infected mothers.

Adolescent↗
PubMed2006

Blindness and low vision in Cape Verde Islands: results of a national eye survey.

AIMS: Prior to establishing a national prevention of blindness program a population based survey was conducted in Cape Verde Islands in1998. The objectives of the survey were to estimate the overall and age-specific prevalence of blindness and low vision, to identify the main disorders causing blindness and low vision, and to estimate the population need for basic eye care services. METHODS: A two-level cluster random sampling procedure was used, selecting 30 clusters from the nine inhabited islands and 3,803 persons of all ages were included in the sample. RESULTS: 3,374 persons were examined (coverage 88.7%). The prevalence of bilateral blindness (visual acuity in the better eye less than 3/60) was 0.8% (95% confidence interval [CI] 0.5-1.1), of bilateral low vision (6/18 to 3/60 in the better eye) 1.7% (95% CI: 1.3-2.2) and of monocular blindness 1.5% (95% CI: 1.2-2.0). The major causes of blindness were age related cataract and glaucoma (57.7% and 15.4%, respectively, of blind people recruited). The major causes of bilateral low vision were cataract, refractive errors, and macular disorders (46.2%, 26.8%, and 8.9%, respectively, of persons with low vision). Nontrachomatous corneal opacities accounted for 7.7% of bilateral and for 11.5% of monocular blindness. Vascular retinopathy was responsible for 7.7% of bilateral and for 9.6% of monocular blindness. Trachoma is not a public health problem as only 2.3% of children less than 10 years of age were suffering from active trachoma. Palpebral or limbal vernal conjunctivitis were encountered in 4.5% of persons under 25. CONCLUSION: More than half of the visual impairments are treatable by provision of cataract surgery and cataract has been indicated as a priority target in the recently designed National Blindness Program of the Cape Verde Republic. Pathologic conditions such as diabetes are emerging as serious burden for ageing populations and account for most of the retinal vascular disease.

Adolescent↗
PubMed1999

Identification of families with hereditary breast and ovarian cancer for clinical and mammographic surveillance: the Modena Study Group proposal.

Hereditary factors play a fundamental role in the pathogenesis of breast cancer (BC). Approximately 15-20% of all BCs have been reported to show familial clustering. In spite of the recent demonstration and chromosomal localization of BC predisposing genes, clinical clues and careful inspection of pedigree still remain major instruments in HBC diagnosis. The aim of the present study was to develop minimum operational criteria for the selection of family groups at high risk of developing BC. Following a stepwise procedure, families were stratified into four clusters with increasing probability of genetic involvement. So far, 317 BC-prone families have been identified and distributed in the four groups, and 151 high risk women underwent our clinical and mammographic surveillance program. Among these, after a mean follow-up of 24 months, six BCs and one OC were diagnosed (one BC and one OC occurred in the same woman) and one 'interval' BC was observed. Since the prevalence rate so far detected is dramatically higher than that seen at the first round of Italian population-screening programs, our preliminary data support the usefulness of the proposed procedure in selecting high risk individuals.

Adult↗
PubMed1976

Doxepin: a useful adjunct in the treatment of heroin addicts in a methadone program.

An uncontrolled trial of doxepin as an adjunct to treatment of heroin addicts in a methadone program was performed over a 14-month period. Approximately 10% (27) of the program's population utilized a mean of 73 mg of doxepin, usually briefly, and beneficial results were noted in 93% (25). One adverse reaction occurred. No instance of habituation or addiction was noted. A controlled study is warranted to confirm the impression that doxepin represents a useful adjunct in the treatment of heroin addicts in a methadone program.

Adult↗
PubMed1990

Methodology of ECG interpretation in the Dalhousie program; NOVACODE ECG classification procedures for clinical trials and population health surveys.

The Dalhousie ECG Program was designed specifically for the needs of epidemiologic studies, health surveys, and clinical trials. The program logic is dynamic in that it can accommodate any combination of ECG leads, record length and sampling rate. The NOVACODE module of the program classifies ECGs according to the Minnesota Code, supplemented with new sets of logic criteria for conduction defects, acute myocardial infarction, and serial ECG changes. Improved statistical models are incorporated for enhanced detection of myocardial infarction using the Cardiac Infarction Injury Score, and for quantification of left ventricular mass estimation. It is anticipated that these program improvements will enhance its utility particularly in monitoring progression and regression of cardiac involvement in hypertensive and ischemic heart disease, and in the assessment of the effectiveness of intervention on cardiovascular disease risk factors.

Adolescent↗
PubMedDate not supplied

An unexpected wide population variation of the G1733A polymorphism of the androgen receptor gene: data on the Mediterranean region.

The androgen receptor (AR) has been proposed as a candidate gene for several cancers (breast, prostate, uterine endometrium, colon, and esophagus). Ethnicity is considered an associated risk factor for some of these cancers. Several case-control genetic studies have been focused in samples of the main ethnic groups, but little is known about the distribution of risk polymorphisms in current populations with accurate ethnic and/or geographic origins. The A allele of the G1733A polymorphism of the AR gene has been associated with increased risk of prostate cancer. We provide data from this marker in 12 samples from 7 Mediterranean countries such as Spain, Italy (Sardinia), Greece, Turkey, Morocco, Algeria, and Egypt. A sample from Ivory Coast has also been analyzed. The A allele distribution shows a frequency in the Ivory Coast population (65.17%) that contrasts with the low values found in Northern Mediterraneans (mean average value of 13.98%). North African populations present two-times higher frequencies (average value of 27.19%) than Europeans. The wide population variation range found for the A allele strengthens the potential interest of further screening as a baseline to the design of future preventive and population health programs.

Alleles↗
PubMed2001

Evaluation of effectiveness of a vaccination program against an infectious disease at the population level.

OBJECTIVE: To evaluate the application of a vaccine in a population of animals. SAMPLE POPULATION: Field-trial data from the literature. PROCEDURE: A spreadsheet simulation model was constructed to estimate the impact of a vaccination program, assuming various population sizes, transmission rates, and vaccine efficacies. RESULTS: Total effectiveness (proportion of affected animals [ie, cases] avoided) increased with the vaccinated proportion of the population. However, with a highly efficacious vaccine, this relationship discontinued after a sufficient vaccination proportion was reached, reflecting herd immunity. Evaluation of a case study indicated that what may be considered a poor vaccine on the basis of its low efficacy may protect a substantial portion of the population if the vaccine is administered to a sufficient number of susceptible animals. Further investigation of a case study of horses indicated that evaluating a vaccine based solely on its efficacy could greatly underestimate its value. CONCLUSIONS AND CLINICAL RELEVANCE: When evaluating a vaccine applied to a population, in addition to the vaccine efficacy, the vaccination rate, cost of the vaccine, potential disease transmission rate, and number and cost of cases avoided must also be considered. Efficacy may underestimate vaccine value in terms of the reduction of indirect cases typically avoided when vaccination is applied in a population.

Animals↗
PubMedDate not supplied

The accessibility of abortion services in the United States.

Abortion services are provided in hospitals, doctors' offices and various types of clinics, but about two-thirds of procedures are performed in specialized abortion clinics. While this system appears to work well for most women, some women seeking abortion face obstacles related to distance, cost, harassment and special medical conditions. Nine percent of nonhospital abortion patients must travel more than 100 miles and 18 percent travel 50 to 100 miles for services. The average woman having a first-trimester nonhospital abortion paid $251 in 1989. Fees were higher in facilities with small abortion caseloads. An abortion at 10 weeks' gestation in a hospital cost an average of $1,757. Charges for abortions at 16 weeks averaged $509 in abortion clinics, compared with $1,539 in hospitals for curettage and $2,246 for instillation procedures. Some women face other barriers: Only 43 percent of all abortion facilities offer services past 12 weeks, and 27-37 percent of nonhospital facilities say they do not treat patients who test positive for the human immunodeficiency virus (HIV), the virus that causes AIDS. Women who need special services such as an administration of Rh immunoglobulin, general anesthesia or HIV testing usually pay extra for these services. In addition, 85 percent of nonhospital facilities that serve 400 or more abortion patients a year reported some form of antiabortion harassment in 1988, most commonly picketing; there was virtually no change in this proportion between 1985 and 1988.

Abortion, Legal↗
PubMed1999

[Evolution of health care in France: comparison elements with foreign countries].

This article reviews the financial growth reports of five health systems: France, Germany, United Kingdom, United States and Canada. It is designed to provide descriptive elements related to expenditure: medical demographics and health care professionals in general, hospital densities, availability of sophisticated medical equipment, medical approach to evaluate the needs for specialists, responsible for ordering expensive technologies (especially cardiologists). The results are presented in summary table form and show that debates on health system reforms too often forget these basic descriptive elements able to diagnose a crisis situation in the system, whether it is financial and/or social and consequently the possible remedies than can be applied. Finally, these discussions also often forget the significantly different epidemiological situations observed between rich countries, as illustrated by the situation of cardiovascular diseases in the countries used as examples. In conclusion, the data presented provide a basis for reforms of health systems, which have been converging since the beginning of the 1990s: closure of short-stay hospital beds, control of medical demographics, specialties and technical procedures, attempts to take the morbidity of the population into account.

Canada↗
PubMed1994

Face-to-face training emerges as most effective. New Delhi.

Three training modalities used for upgrading the knowledge and skills of teachers in population education were compared in a study undertaken by S.V. Yadav of the National Population Education Project of the National Council of Educational Research and Training. The 3 training modalities compared included face-to-face training, self-learning individual mode and self-learning paired mode. The study employed pre-test and post-test designs using control groups consisting of 96 secondary school teachers teaching in rural schools in 1 district. The 3 modalities were compared according to their effectiveness in terms of gains in awareness, knowledge and attitude as well as cost effectiveness. The study showed that the face-to-face modality is still the most effective in terms of gains in knowledge and attitude. It is, however, costlier, the report points out. When cost per unit and outcomes were taken together, the study found out that the self-learning, paired mode proved to be the most effective. The self-learning paired mode is also found to be more effective than the individual self-instruction mode because in the paired mode modality, the opportunity to discuss and share learning with a colleague improves their understanding of the issues in an area in which attitude and values are important. The study recommends on this basis that policy makers consider the combination of face-to-face and self-learning paired modalities in designing their teacher-training program on population education.

Asia↗
PubMed1987

Prevention of tap water scald burns: evaluation of a multi-media injury control program.

A prospective study was designed to evaluate a mass media injury prevention program reaching two million people to determine its impact on risk awareness of hot tap water burns and injury-prevention behavior. Liquid-crystal thermometers for testing hot water temperature were offered at no cost; 140,000 were requested. Pre- and post-program general population random surveys (N = 337 and 318, respectively) found increased awareness of the danger of hot tap water, from 72 per cent to 89 per cent, but no increase in testing or lowering of water heater temperatures. A third random sample survey (N = 325) among thermometer requesters found a higher rate of testing (difference 58.1 per cent, 95 per cent CL 55.3 per cent, 60.9 per cent) than in the general population. Of those who tested, 43 per cent reported temperatures in the dangerous range of 54.4 degrees C (130 degrees F) or greater; 52 per cent of this group lowered their water heater thermostat. These findings indicate that: more than 25 per cent of the public is unaware of the potential danger of hot tap water; a safety education program which increases awareness will not necessarily result in injury-control behavior; and most people motivated to request a free thermometer will test their hot water temperature and lower it if necessary. As a result of this effort, thermostats of an estimated 20,000 water heaters were lowered from dangerously high levels.

Adult↗
PubMed2001

The Department of Defense Birth Defects Registry: overview of a new surveillance system.

BACKGROUND: The U.S. Department of Defense (DoD) is challenged with monitoring and protecting the health and wellbeing of its service members. The growing number of women on active duty and the diverse hazardous exposures associated with military service make reproductive health issues a special concern of DoD. To address this concern, the DoD Birth Defects Registry was established at the DoD Center for Deployment Health Research located at the Naval Health Research Center, San Diego, California. METHODS: The registry captures comprehensive data on healthcare utilization to calculate the prevalence of birth defects in the children of military beneficiaries. Population-based electronic surveillance is supplemented by active case validation efforts. RESULTS: Since its establishment in 1998, the registry has captured data on more than 90,000 births that occur in military families each year. Detailed analyses, to include linking registry data with military occupational exposure data (e.g., anthrax vaccination), are underway. CONCLUSIONS: The DoD Birth Defects Registry provides important reproductive health information on the geographically dispersed military population. This program is expected to complement civilian public health programs and be especially valuable to military members and their families.

Congenital Abnormalities↗
PubMed1995

Understanding productivity, a key to Aedes aegypti surveillance.

The objective of this work was to define criteria that could be applied to achieve faster, more economical, and accurate assessment of vector populations for control of dengue viruses. During 1989-1990, 1,349 premises were surveyed in Townsville, Charters Towers and Mingela/Ravenswood, Queensland, Australia. In each locality, 1.9-8.4% of premises contained three or more containers with Aedes aegypti immature forms and were designated as key premises. Comparison of surveys in Townsville from 1989 to 1990 indicated that positive premises (i.e., those with at least one container with Ae. aegypti present) were 3.22 times more likely to remain positive than negative houses to become positive the following year. The Ae. aegypti population in Townsville was seen to be totally associated with garden receptacles, discarded household items, and trash but one well and one rainwater tank were responsible for 28% of all immature forms recorded in the 1,349 premises inspected. These breeding sites of high productivity were designated as key containers. At Charters Towers, Mingela, and Ravenswood, rainwater tanks were seen as the most important key container because although they constituted 13-29% of positive containers, they supported 60-63% of the immature forms. This study demonstrates that there is a certain degree of stability with regard to positive premises and that some of these, or some container types, contribute disproportionately to the Ae. aegypti population. Control programs could be made more efficient if efforts were concentrated on these sites of key vector productivity.

Aedes↗
PubMedDate not supplied

User's perspective of counseling training in Ghana: the "mystery client" trial.

Evaluating counseling training programs from the client's perspective has posed a methodological challenge for family planning researchers. This report describes an evaluation method that combines clinic observation with an exit interview methodology. Eighteen women posing as clients were requested to visit three clinics with trained and three clinics with untrained family planning counselors. These clients (called "mystery clients" in Ghana) were later interviewed to uncover any perceived differences between the consultations. The effect of training was evident. Trained counselors consistently provided more complete information about all available contraceptives. However, both trained and untrained counselors often treated younger clients with disrespect or refused to give them the information they requested. This behavior indicated the need to strengthen the values clarification section of the counselors' training sessions, which has now been done.

Adolescent↗