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PubMed1994

Survival after cardiac arrest outside hospital over a 12-year period in Gothenburg.

BACKGROUND: A two-tiered ambulance system with a mobile coronary care unit and standard ambulance has operated in Gothenburg (population 434,000) since 1980. Mass education in cardiopulmonary resuscitation (CPR) commenced in 1985 and in 1988 semiautomatic defibrillators were introduced. AIM: To describe early and late survival after cardiac arrest outside hospital over a 12-year period. TARGET POPULATION: All patients with prehospital cardiac arrest in Gothenburg reached by mobile coronary care unit or standard ambulance between 1980 and 1992. RESULTS: The number of patients with cardiac arrest remained fairly steady over time. Among patients with witnessed ventricular fibrillation, the time to defibrillation decreased over time. The proportion of patients in whom bystander initiated CPR was increased only moderately over time. The proportion of patients given medication such as lignocaine and adrenaline successively increased. The number of patients with cardiac arrest who were discharged from hospital per year remained steady between 1981 and 1990 (20 per year), but increased during 1991 and 1992 to 41 and 31 respectively. CONCLUSIONS: Improvements in the emergency medical service in Gothenburg over a 12-year period have lead to: (1) a shortened delay time between cardiac arrest and first defibrillation and (2) an improved survival of patients with cardiac arrest outside hospital probably explained by this shortened delay time.

Adult↗
PubMed1976

Comparative field cage tests of the population suppressing efficiency of three genetic control systems for Aedes Aegypti.

Cycling populations of Aedes aegypti were set up in cages and managed in such a way that the populations had a maximum of threefold recovery potential in response to control measures. Into three such populations daily releases were made of males which had been chemosterilised, or were double translocation heterozygotes (T1T3) or T1T3 with sex ration distortion (DT1T3). Eradication of the populations was achieved with all cases, but the rate of suppression was markedly slower with T1T3 than the other two systems, with which the rates were similar. T1T3 and DT1T3 releases introduced considerable inherited genetic loads into the target populations. The results were in general agreement with computer predictions.

Aedes↗
PubMed1996

Teens teach skin cancer prevention.

Cumulative sun exposure has been linked to about 95 percent of all skin cancers. Farmers and their families, by nature of their occupations, are exposed to an abundance of sun over a long period of time and, therefore, are at an increased risk for skin cancer. Because education is known to be a primary means of health, Future Farmers of America (FFA) peer facilitators (teen educators) provided third graders in rural communities sun protection education with the hope that the message would reach the entire family. The FFA facilitators (n = 217) from 39 FFA organizations throughout Wisconsin were trained with skin cancer and sun protection information. The FFA facilitators then gave presentations on sun protection to third graders (n = 2,007) in their school districts. Control schools included 57 facilitators and 669 third graders. Evaluation involved pre-, post-, and six-month follow-up surveys testing knowledge gained by the third graders. Students who correctly responded to a question on the post-survey after incorrectly answering it on the pre-survey were said to have had a knowledge gain for that question. By using chi-square tests, the intervention group demonstrated a statistically significant (P < 0.001) higher proportion of students experiencing knowledge gain than did the control group from pre- to post-surveys for nine of the 10 questions. Summary statistics were used to describe the study population. In addition to skin cancer knowledge questions, the survey of facilitators included sun protection behavior and attitude questions. This intervention was able to use peer educators as instructors to demonstrate knowledge gain in the youths of the target population. The pilot project materials costs were +0.55 per third grade student and +3.50 per facilitator. Using a school-based organization such as FFA provided a cost-effective means of reaching the rural population.

Adolescent↗
PubMed2005

Online surveys for BGLT research: issues and techniques.

Online surveys are becoming increasingly popular for accessing less visible and decentralized populations, including bisexual, gay, lesbian and transgender (BGLT) populations. Advances in technology and convenience for the both the researcher and the participant have facilitated this trend. In this paper, we explore issues related to conducting BGLT survey research online, such as making decisions about survey formats, target populations and recruitment, compensation, access.

Bisexuality↗
PubMed1999

Cystic fibrosis: molecular diagnosis, population screening, and public policy.

OBJECTIVE: To review the current status of scientific knowledge and opinion regarding molecular genetic testing of mutations in the CFTR gene for purposes of diagnosis and population carrier screening of cystic fibrosis (CF). DATA SOURCES: Published research findings on the nature of the CFTR gene, pilot population screening studies in the United States and Europe, and ongoing deliberations of professional and governmental agencies considering implementation of widespread testing. STUDY SELECTION: Findings relevant to the molecular heterogeneity of CFTR mutations and its implications for population carrier screening were considered. DATA EXTRACTION: Information was extracted from studies published by us and others, as made available to recent consensus panels and professional committees. DATA SYNTHESIS: These data were reevaluated in light of recent movements in professional and public policy regarding acceptability and desirability of widespread CF mutation testing. Effects to date of such testing on patient outcomes is reported. CONCLUSIONS: The ability to test for CFTR mutations at the molecular level has already improved the diagnosis of symptomatic patients and expanded the reproductive options of family members of CF patients. The same technology also holds promise of identifying asymptomatic carriers and at-risk couples without family history in the general population so that they too might be offered prenatal diagnosis or other options. However, a number of key questions remain to be worked out before a widespread national screening program can be put into practice. These include the target population to be offered testing (the entire population vs high-risk ethnic groups), the size and nature of the mutation test panel (universal vs ethnic specific), the inclusion or exclusion of CFTR variants that do not cause classical CF, the optimal testing technology, appropriate standards for laboratory quality assurance, and the development of sufficient educational materials and genetic counseling resources for test delivery, reporting, and interpretation. The answers to these questions will be relevant not only to CF testing but also to many other large-scale molecular genetic screening programs being considered in the future.

Cloning, Molecular↗
PubMed2001

Effective screening programmes for cervical cancer in low- and middle-income developing countries.

Cervical cancer is an important public health problem among adult women in developing countries in South and Central America, sub-Saharan Africa, and south and south-east Asia. Frequently repeated cytology screening programmes--either organized or opportunistic--have led to a large decline in cervical cancer incidence and mortality in developed countries. In contrast, cervical cancer remains largely uncontrolled in high-risk developing countries because of ineffective or no screening. This article briefly reviews the experience from existing screening and research initiatives in developing countries. Substantial costs are involved in providing the infrastructure, manpower, consumables, follow-up and surveillance for both organized and opportunistic screening programmes for cervical cancer. Owing to their limited health care resources, developing countries cannot afford the models of frequently repeated screening of women over a wide age range that are used in developed countries. Many low-income developing countries, including most in sub-Saharan Africa, have neither the resources nor the capacity for their health services to organize and sustain any kind of screening programme. Middle-income developing countries, which currently provide inefficient screening, should reorganize their programmes in the light of experiences from other countries and lessons from their past failures. Middle-income countries intending to organize a new screening programme should start first in a limited geographical area, before considering any expansion. It is also more realistic and effective to target the screening on high-risk women once or twice in their lifetime using a highly sensitive test, with an emphasis on high coverage (>80%) of the targeted population. Efforts to organize an effective screening programme in these developing countries will have to find adequate financial resources, develop the infrastructure, train the needed manpower, and elaborate surveillance mechanisms for screening, investigating, treating, and following up the targeted women. The findings from the large body of research on various screening approaches carried out in developing countries and from the available managerial guidelines should be taken into account when reorganizing existing programmes and when considering new screening initiatives.

Adult↗
PubMedDate not supplied

Is osteoporosis a pediatric disease? Peak bone mass attainment in the adolescent female.

Osteoporosis in the elderly woman is determined by the amount of peak bone mass in adolescence, the premenopausal maintenance of such peak bone mass, and the rate of postmenopausal bone mass loss. The majority of research efforts in the past have been directed at defining the pathogenesis and treatment of postmenopausal osteoporotic bone loss. A comparatively new, and potentially fertile, area of research deals with factors responsible for attaining and augmenting peak bone mass in the adolescent female. Determinants of peak bone mass include genetic, nutritional, weight loading (exercise), and environmental factors. Nutritional factors, especially calcium, are potentially most amenable to therapeutic manipulation. Current data suggest that calcium deficiency exists in the adolescent female; and, although the current data are preliminary and not conclusive, they suggest that increasing calcium intake may be of value in increasing peak bone mass. However, assurance of compliance in the teenage female population in increasing calcium intake is difficult; relating a disease of the elderly, such as osteoporosis, to a teenage female population, a population that may experience the disease 40-50 years later, is frequently frustrating. Nevertheless, increased attention must be directed toward increasing calcium intake in this population of females. The amount of bone mass in adolescence may determine the amount of bone mass postmenopausally; a high or low peak bone mass may, therefore, contribute to protection against, or risk of, subsequent fracture. The ultimate target population for osteoporosis prophylaxis may indeed be the young, rather than the elderly, female.

Adolescent↗
PubMed1995

[Hodgkin disease: should high-risk patients be selected and chemotherapy be intensified?].

Death still occurs in Hodgkin's disease (HD) patients with advanced stages, but also in early stages. Therefore, the identification of the population of HD patients who would best benefit from an intensification of treatment is a prerequisite in all stages. The best known prognostic factors are bulky mediastinum, B symptoms, and visceral involvement in advanced HD and, in early HD, the number of nodal areas. No satisfactory combination of these factors can clearly identify a group of patients requiring high dose- and potentially risky therapy. Therefore only a very small subgroup of patients with advanced disease (less than 5% of them) calls for intensified regimens, which makes randomized trials very difficult. A large data base, accrued through a cooperative effort and the addition of early stages to advanced stages, would help to clarify the prognostic analysis. In addition, the patient population needs to be selected on the basis of the best therapeutic approach to-date. The analysis parameter should take into account only the failures due to the tumor progression as opposed to those due to a combination of tumor progression and early plus late toxicities. Three successive steps are required to achieve the goal of high-risk patient's treatment optimization. The first is to define, on a well-defined tumor-risk scale, the kind of results that are to be considered as "unacceptable" when up-to-date conventional strategies are applied. The second is to infer the size of the "high-risk" population, in inverse ratio to the severity of the risk accepted for "normal-risk" patients. The third is to tailor the iatrogenic risk, ie the intensity of the high-dose treatment, to the size of the target population and to the anti-tumor benefit that is anticipated. Obviously, the definition of these parameters belongs to the medical decision-makers. Nevertheless, the availability of a quantified tumor-risk scale would allow to elaborate a reliable strategy in patients at risk for failure, lethal toxicity and unbearable health expenses. A collection of adequate recent trial is proposed through the Third International Symposium on Hodgkin's lymphoma in Köln (21-23 September 1995). This effort will be pursued through the International Data Base for Hodgkin's Disease (IDHD). Newer and more efficient strategies may then be designed.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2004

Selective mass treatment with ivermectin to control intestinal helminthiases and parasitic skin diseases in a severely affected population.

OBJECTIVE: To assess the short-term and long-term impact of selective mass treatment with ivermectin on the prevalence of intestinal helminthiases and parasitic skin diseases in an economically depressed community in north-east Brazil. METHODS: An intervention was carried out in a traditional fishing village in north-east Brazil where the population of 605 is heavily affected by ectoparasites and enteroparasites. The prevalence of intestinal helminths was determined by serial stool examination and the prevalence of parasitic skin diseases by clinical inspection. A total of 525 people out of a target population of 576 were treated at baseline. The majority of these were treated with ivermectin (200 microg/kg with a second dose given after 10 days). If ivermectin was contraindicated, participants were treated with albendazole or mebendazole for intestinal helminths or with topical deltamethrin for ectoparasites. Follow-up examinations were performed at 1 month and 9 months after treatment. FINDINGS: Prevalence rates of intestinal helminthiases before treatment and at 1 month and 9 months after mass treatment were: hookworm disease 28.5%, 16.4% and 7.7%; ascariasis 17.1%, 0.4% and 7.2%; trichuriasis 16.5%, 3.4% and 9.4%; strongyloidiasis 11.0%, 0.6% and 0.7%; and hymenolepiasis 0.6%; 0.4% and 0.5%, respectively. Prevalence rates of parasitic skin diseases before treatment and 1 month and 9 months after mass treatment were: active pediculosis 16.1%, 1.0% and 10.3%; scabies 3.8%, 1.0% and 1.5%; cutaneous larva migrans 0.7%, 0% and 0%; tungiasis 51.3%, 52.1% and 31.2%, respectively. Adverse events occurred in 9.4% of treatments. They were all of mild to moderate severity and were transient. CONCLUSION: Mass treatment with ivermectin was an effective and safe means of reducing the prevalence of most of the parasitic diseases prevalent in a poor community in north-east Brazil. The effects of treatment lasted for a prolonged period of time.

Adult↗
PubMed2006

Outcome of screening by clinical examination of the breast in a trial in the Philippines.

The value of screening by Clinical Examination of the Breast (CBE) as a means of reducing mortality from breast cancer (BC) is not established. The issue is relevant, as CBE may be a suitable option for countries in economic transition, where incidence rates are on the increase but limited resources do not permit screening by mammography. Our aims were to assess whether mass screening by CBE carried out by trained para-medical personnel is feasible in an urban population of a low-income country, and its efficacy in reducing BC mortality. Our study was designed as a randomised controlled trial of the effect on BC mortality of 5 annual CBE carried out by trained nurses. The target population was women aged 35-64 years, resident in 12 municipalities of the National Capital Region of Manila, Philippines. The units of randomization were the 202 health centres (HC) within the selected municipalities. During 1995 nurses and midwives were recruited and trained in performing CBE. The first round of screening took place in 1996-1997. The intervention however showed a refractory attitude of the population with respect to clinical follow-up and was discontinued after the completion of the first screening round. Cases of breast cancer occurring in the study population during 1996-1999 were identified by the 2 local population-based registries. In the single screening round 151,168 women were interviewed and offered CBE, 92% accepted (138,392), 3,479 were detected positive for a lump and referred for diagnosis. Of these only 1220 women (35%) completed diagnostic follow-up, whereas 42.4% actively refused further investigation even with home visits, and 22.5% were not traced. Of 53 cases that occurred among screen-positive women in the 2 years after CBE only 34 were diagnosed through the intervention. Eighty cases occurred among screen-negative women. The test sensitivity for CBE repeated annually was 53.2%. The actual sensitivity of the programme was 25.6% and positive predictive value 1%. Screen-detected cases were non-significantly less advanced than the others. Previous studies have shown that most breast cancer cases in the Philippines present at advanced stages and have an unfavourable outcome. Although CBE undertaken by health workers seems to offer a cost-effective approach to reducing mortality, the sensitivity of the screening programme in the real context was low. Moreover, in this relatively well-educated population, cultural and logistic barriers to seeking diagnosis and treatment persist and need to be addressed before any screening programme is introduced.

Adult↗
PubMed2005

Post-marketing surveillance using pharmacy-based cohorts: results of a pilot study.

PURPOSE: To assess the feasibility of recruiting subjects for follow-up studies of drug exposures using pharmacy records but without involving dispensing pharmacists. METHODS: Working with Eckerd Corporation, a large chain pharmacy, we attempted to enroll subjects taking either hyoscyamine (Levsin and others) or dicyclomine (Bentyl and others). Adults who filled prescriptions during the recruitment period were randomly assigned to one of four enrollment approaches that used a script and materials we provided: (1) an introductory phone call from an Eckerd pharmacy technician with an offer of a $5 payment; (2) an introductory phone call with no payment; (3) a questionnaire mailed from Eckerd with introductory letters enclosed and an offer of a $5 payment and (4) the same mailed packet but with no payment offered. Willing subjects responded directly to us; they received a follow-up questionnaire approximately 6 weeks following enrollment. This method also provided limited information about subjects who chose not to enroll, permitting us to assess the representativeness of the study population. RESULTS: The enrollment rates for the four groups were 35, 22, 21 and 17% respectively. Rates of completion of the follow-up questionnaire were 86, 83, 83 and 79% respectively. Participants appeared to be representative of the target population. The differential cost per enrolled subject in each group was $39.25, $50.45, $41.95 and $48.26 respectively. CONCLUSIONS: This method provides an efficient way to create cohorts of users of specific prescription medications, with enrollment and retention rates that compare favorably with other approaches, allows a limited evaluation of representativeness, and is logistically feasible.

Adolescent↗
PubMed1983

The prevalence distribution of hypertension: Connecticut adults 1978-1979.

The results of the first Connecticut Blood Pressure Survey are reported. It was found that sharp differences exist in the prevalence of hypertension by age and sex but that race differences are much less than previously reported for United States populations. Differences were also found between men and women with respect to the patterns of treatment and control. Age differences in treatment and control are noted. The findings reported are based on a statewide probability sample for which the target population exceeded 2 million persons. Because of the complexity of sampling such a population an extensive discussion of the survey method is given.

Black or African American↗
PubMed2006

Comparative pharmacogenomics of antiretroviral and cytotoxic treatments.

Few genetic markers are used routinely to predict clinical effectiveness and toxic effects despite the fact that physicians and their patients are consistently confronted with this balance. Because one of the goals of pharmacogenomics is to identify individuals and target populations that might have adverse outcomes, pharmaceutical companies have been reluctant to use a strategy that might identify patients who are not eligible for a particular treatment. This view is changing because drug-discovery programmes and treatments that target specific pathways, are showing improvements in surrogate and survival endpoints. HIV and cancer are now regarded as chronic diseases, which commonly need life-long systemic treatment from the time of diagnosis. HIV and cancer medicine have used pharmacogenomics to some extent in clinical care. Common and classic features of pharmacogenomics that are related to both antiretroviral treatment and to cytotoxic treatment are discussed in this review, providing a framework for individual treatment of these diseases.

Anti-Retroviral Agents↗
PubMed2003

The genetic impact of demographic decline and reintroduction in the wild boar (Sus scrofa): a microsatellite analysis.

The reintroduction of wild boar from central Europe after World War II has contributed substantially to the range expansion of this species in Italy, where indiscriminate hunting in earlier times resulted in extreme demographic reduction. However, the genetic impact of such processes is not well-understood. In this study, 105 individuals from Italian and Hungarian wild boar populations were characterized for nine autosomal microsatellite loci. The Hungarian samples, and two central Italian samples from protected areas (parks) where reintroduction is not documented, were assumed to be representative of the genetic composition of the source and the target populations in the reintroduction process, respectively. Animals hunted in the wild in the Florence area of Tuscany (Italy) were then studied to identify the effects of reintroduction. The results we obtained can be summarized as follows: (i) none of the populations analysed shows genetic evidence of demographic decline; (ii) the three parental populations from Italy and Hungary are genetically distinct; however, the low level of divergence appears in conflict with the naming of the Italian and the European subspecies (Sus scrofa majori and Sus scrofa scrofa, respectively); in addition, the Italian groups appear to be as divergent from each other as they are from the Hungarian population; (iii) most of the individuals hunted near Florence are genetically intermediate between the parental groups, suggesting that hybridization has occurred in this area, the average introgression of Hungarian genotypes is 13%, but approximately 45% of the genetic pool of these individuals can not be directly attributed to any of the parental populations we analysed; (iv) analysis of microsatellite loci, though in a limited number, is an important tool for estimating the genetic effect of reintroduction in the wild boar, and therefore for the development of conservation and management strategies for this species.

Alleles↗
PubMed2001

Community-acquired methicillin-resistant Staphylococcus aureus colonization in healthy children attending an outpatient pediatric clinic.

BACKGROUND: We previously showed that children attending an inner city pediatric emergency department were sometimes asymptomatically colonized with clindamycin-susceptible community-acquired methicillin-resistant Staphylococcus aureus (MRSA) and borderline methicillin-resistant S. aureus (BRSA) as well. We wished to ascertain whether healthy children attending an outpatient clinic were colonized with these organisms. Therefore to estimate the prevalence of community-acquired MRSA and BRSA nasal colonization in a well child population, we cultured children attending an inner city pediatric outpatient clinic. STUDY DESIGN: This was a prospective cross-sectional study conducted from January to August, 1999, at a primary care outpatient facility at the University of Chicago. The target population was 500 healthy children < or = 16 years of age who attended this facility to receive well child care. RESULTS: One hundred twenty-two (24.4%) children were colonized with S. aureus. Three of the 122 (2.5%) S. aureus isolates were MRSA; they came from children who lacked predisposing risk factors and were susceptible to clindamycin, gentamicin, trimethoprim-sulfamethoxazole, rifampin and ciprofloxacin. Two (1.6%) additional S. aureus isolates were BRSA; both children had predisposing risk factors for MRSA colonization. The mecA gene was present in the 3 MRSA isolates and absent in both BRSA isolates. CONCLUSIONS: These data document that a reservoir of asymptomatic MRSA colonization exists among healthy children who lack traditional risk factors for MRSA infections.

Adolescent↗
PubMed2001

Estimation of population attributable fractions from fitted incidence ratios and exposure survey data, with an application to electromagnetic fields and childhood leukemia.

Standard presentations of epidemiological results focus on incidence-ratio estimates derived from regression models fit to specialized study data. These data are often highly nonrepresentative of populations for which public-health impacts must be evaluated. Basic methods are provided for interval estimation of attributable fractions from model-based incidence-ratio estimates combined with independent survey estimates of the exposure distribution in the target population of interest. These methods are illustrated in estimation of the potential impact of magnetic-field exposures on childhood leukemia in the United States, based on pooled data from 11 case-control studies and a U.S. sample survey of magnetic-field exposures.

Biometry↗
PubMed2000

Community action research: who does what to whom and why? Lessons learned from local prevention efforts (international experiences).

This paper describes lessons learned about community action research, drawing upon papers written and presented at a recent international conference on community action research and the prevention of alcohol and other drug problems. Projects reflected both action and evaluation research traditions and focused on a variety of issues from moderation of drinking to alcohol-related violence, and on range of target populations from youth to specific ethnic groups. The interventions described ranged from policy-based prevention to education and training and to secondary prevention and treatment. Lessons identified in the papers are discussed within three broad areas: the community targeted for change; the implementation of community projects; and community action research projects generally. The common lessons emerging from these diverse projects provide useful lessons on which to base future progress in community action research.

Alcoholism↗
PubMed2001

Thoughts on the development, structure and evolution of the mammalian and avian telencephalic pallium.

Various lines of evidence suggest that the development and evolution of the mammalian isocortex cannot be easily explained without an understanding of correlative changes in surrounding areas of the telencephalic pallium and subpallium. These are close neighbours in a common morphogenetic field and are postulated as sources of some cortical neuron types (and even of whole cortical areas). There is equal need to explain relevant developmental evolutionary changes in the dorsal thalamus, the major source of afferent inputs to the telencephalon (to both the pallium and subpallium). The mammalian isocortex evolved within an initially small dorsal part of the pallium of vertebrates, surrounded by other pallial parts, including some with a non-cortical, nuclear structure. Nuclear pallial elements are markedly voluminous in reptiles and birds, where they build the dorsal ventricular ridge, or hypopallium, which has been recently divided molecularly and structurally into a lateral pallium and a ventral pallium. Afferent pallial connections are often simplified as consisting of thalamic fibres that project either to focal cell aggregates in the ventral pallium (predominant in reptiles and birds) or to corticoid areas in the dorsal pallium (predominant in mammals). Karten's hypothesis, put forward in 1969, on the formation of some isocortical areas postulates an embryonic translocation into the nascent isocortex of the ventropallial thalamorecipient foci and respective downstream ventropallial target populations, as specific layer IV, layers II- III, or layers V-VI neuron populations. This view is considered critically in the light of various recent data, contrasting with the alternative possibility of a parallel, separate evolution of the different pallial parts. The new scenario reveals as well a separately evolving tiered structure of the dorsal thalamus, some of whose parts receive input from midbrain sensory centres (collothalamic nuclei), whereas other parts receive oligosynaptic 'lemniscal' connections bypassing the midbrain (lemnothalamic nuclei). An ampler look into known hodological patterns from this viewpoint suggests that ancient collothalamic pathways, which target ventropallial foci, are largely conserved in mammals, while some emergent cortical connections can be established by means of new collaterals in some of these pathways. The lemnothalamic pathways, which typically target ancestrally the dorsopallial isocortex, show parallel increments of relative size and structural diversification of both the thalamic cell populations and the cortical recipient areas. The evolving lemnothalamic pathways may interact developmentally with collothalamic corticopetal collaterals in the modality-specific invasion of the emergent new areas of isocortex.

Animals↗