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PubMed1996

[The limits of health reporting in health planning].

Health reporting differs from traditional health statistics in (1) its claim to prospectively determine priorities and goals in the health sector, and (2) the expansion of the target group to include political decision makers and interested citizens. To date, neither has the prognostic element of health reporting been developed to satisfaction, nor has satisfactory access to the target population been gained. Forecasting requires suitable methods, an in-focus description of problems and targets, and performance control with regard to its aims. Effective access to a target population is a general problem not unique to health reporting. Forecasting and successful communication with target groups are crucial to the influence of health reporting on health planning. Both factors should be prominent goals in the future development of health reporting.

Germany↗
PubMed2004

Model building and quantitative analysis of a tandem immuno-capturing assay as a screening tool for breast cancer.

The onset of breast cancer appears to occur, on average, a decade earlier in Mexican women in comparison to American or European women. Early detection and prevention of breast cancer are of crucial importance to increase survival and improve quality of life. Based on the molecular elucidation of critical events leading to breast carcinogenesis, a tandem immuno-capturing blood test was developed as a quantitative population screening assay in view of providing a cost-effective and non-invasive alternative to population screening. Clinical analysis of 63 Mexican women within an age group of 35-70, revealed that Interstron activity increases from 800+/-65 IUJPA (Interstron Units) in the asymptomatic normal women to 994+/-100 IUJPA in the symptomatic/benign group, reaching 1289+/-81 IUJPA in the cancerous group. Accordingly, activity thresholds were established at 800 and 1200 IUJPA respectively, encompassing three risk groups: (i) Healthy Otherwise Normal (<800 IUJPA); (ii) Grey Risk Area (>800 and <1200 IUJPA), and (iii) At Risk group (>1200 IUJPA). Taking into account both baseline and clinical case reports, the Healthy Otherwise Normal group and the At Risk group were mostly homogeneous in nature, comprising a population of normal and cancer patients respectively. The Grey Risk group is heterogeneous, likely reflecting a transitional nature towards a potential early stage of breast disease development. Based on these results, a screening algorithm was developed as the underlining principle for population surveillance encompassing over 30,000 Mexican women. The current screening results have enabled us to objectively prioritize medical attention to approximately 1 in 8 women out of the general population mapped within the At Risk group. Overall, our findings suggest that monitoring Interstron activity units provides a valuable quantitative screening analysis as to selectively streamline the population of women in need of early medical counseling and/or mammography, thereby enhancing both the quality and cost-effectiveness of preventative population surveillance programs targeting breast cancer.

Adult↗
PubMedDate not supplied

Microhematuria found by mass screening of apparently healthy males.

Preparation of urinary sediments was adapted for mass screening purposes. The procedure, characterized by most careful collection and transfer of the sediment and by a rigidly controlled work scheme, was tested in a limited population screening program with 446 healthy male participants. A capacity of 100 samples per 12 manhours was achieved. The procedure was found effective in collecting the cellular content, but there was serious cytolysis due to a 11 hours delay between micturition and processing. An unexpected finding was the presence of erythrocytes in all the samples. In 8.8 per cent of the smears more than ten RBC/hpf were present. The significance of this feature is still in study, but it might prove to be a useful prescreening criterion in the cytologic assessment of bladder cancer in large populations.

Hematuria↗
PubMed1997

Severe combined immunodeficiency mice engrafted with human T cells, B cells, and myeloid cells after transplantation with human fetal bone marrow or liver cells and implanted with human fetal thymus: a model for studying human gene therapy.

To develop an in vivo model wherein human hematopoiesis occurs, we transplanted severe combined immunodeficiency (SCID) mice with either human fetal bone marrow (HFBM) or human fetal liver (HFL). After transplantation of SCID mice with cultured HFBM (BM-SCID-hu mice) or HFL cells (Liv-SCID-hu mice), significant engraftment of the mouse bone marrow (BM) and population of the peripheral blood with human leukocytes was detected. Human colony-forming unit-granulocyte macrophage and burst forming unit-erythroid were detected in the BM of the BM-SCID-hu and Liv-SCID-hu mice up to 8 months after transplantation. When the HFBM or HFL cells were transduced with a retroviral vector before transplantation, integrated retroviral sequences were detected in human precursor cells present in the SCID mouse BM and in leukocytes circulating in the peripheral blood (PB) up to 7 months after transplantation. The PB of the BM-SCID-hu mice also became populated with human T cells after implantation with human thymic tissue, which provided a human microenvironment wherein human pre-T cells from the BM could mature. When the HFBM was retrovirally transduced before transplantation, integrated retrovirus was detected in sorted CD4+CD8+ double positive and CD4+ single positive cells from the thymic implant and CD4+ cells from the PB. Taken together, these data indicated that the BM of our BM-SCID-hu and Liv-SCID-hu mice became engrafted with retrovirally transduced human hematopoietic precursors that undergo the normal human hematopoietic program and populate the mouse PB with human cells containing integrated retroviral sequences. In addition to being a model for studying in vivo human hematopoiesis, these mice should also prove to be a useful model for investigating in vivo gene therapy using human stem/precursor cells.

Animals↗
PubMed2000

Epidemic diphtheria in the Kyrgyz Republic, 1994-1998.

The Kyrgyz Republic experienced a widespread diphtheria epidemic during 1994-1998. National diphtheria surveillance and vaccination coverage information were used to describe the course of the epidemic. The epidemic began in August 1994, reached a peak in 1995 with 704 cases (incidence rate: 15.4/100,000 population) and 30 deaths, and declined to an incidence rate of 4.0/100,000 during the first 8 months of 1998. Age-specific incidence was highest in 1995 among persons 15-19 and 20-29 years old. Three rounds of mass vaccination with tetanus and diphtheria toxoids for adult use (Td) were conducted; reported coverage was 69% in 1995 and >95% in 1996 and 1997. Reported routine vaccination coverage with three doses of diphtheria toxoid by age 12 months increased from 62% in 1989 to 98% in 1997. Mass vaccination of the adult population with Td and improvements in childhood vaccination coverage played a major role in controlling the epidemic.

Adolescent↗
PubMed2006

Regional variations in prenatal screening across Australia: stepping towards a national policy framework.

BACKGROUND: A relatively few centres across Australia provide screening tests for maternal serum markers or ultrasound measurement of fetal nuchal translucency to assess risk of fetal anomalies such as Down syndrome. While providers engage in external accreditation and quality assurance programs, state and federal governments have been slow to formulate relevant policies and standards. AIM: In this paper we review the current practices across Australian states and territories and propose recommendations for developing a national policy framework. METHODS: Data on the number and types of screening tests provided as well as state policies, where they are available, were obtained from government reports and supplemented by a mail survey to selected stakeholders in each state or territory. RESULTS: At a jurisdictional level, our results highlight the need to integrate the collection and monitoring of antenatal population-screening programs to assess clinical effectiveness and program performance (detection and screen-positive rates, uptake of diagnostic tests as a result of screening). Women's expectations and satisfaction with the information they are provided should be evaluated and used to adjust education resources. At a local level, collaboration between providers of the separate tests, both public and private, would enable the ascertainment of outcomes of integrated screening programs. To complete the cycle, these data should inform decisions to improve antenatal screening programs at a national level. CONCLUSIONS: A primary goal at a national level would be to develop a consensus on key performance indicators for programs that clarify best practice guidelines and establish optimal performance and accreditation standards.

Adult↗
PubMed2004

Cost-effectiveness analysis of fecal occult blood screening for colorectal cancer.

OBJECTIVES: Clinical trials have demonstrated that fecal occult blood screening for colorectal cancer can significantly reduce mortality. However, to be deemed a priority from a public health policy perspective, any new program must prove itself to be cost-effective. The objective of this study was to assess the cost-effectiveness of screening for colorectal cancer using a fecal occult blood screening test, the Hemoccult-II, in a cohort of 100,000 asymptomatic individuals 50-74 years of age. METHODS: A decision analysis model using a Markov approach simulates the trajectory of the cohort allocated either to screening or no screening over a 20-year period through several health states. Clinical and economic data used in the model came from the Burgundy trial, French population-based studies, and Registry data. RESULTS: Modeling biennial screening versus the absence of screening over a 20-year period resulted in a 17.7 percent mortality reduction and a discounted incremental cost-effectiveness ratio of 3357 Euro per life-year gained among individuals 50-74 years of age. Sensitivity analyses performed on epidemiological and economic data showed the strong impact on the results of colonoscopy cost, of compliance to screening, and of specificity of the screening test. CONCLUSIONS: Cost-effectiveness estimates and sensitivity analyses suggest that biennial screening for colorectal cancer with fecal occult blood test could be recommended from the age of 50 until 74. Our findings support the attempts to introduce large-scale population screening programs.

Aged↗
PubMed1999

The impact of family planning service provision on contraceptive-use dynamics in Morocco.

This article uses linked data from the 1995 Morocco DHS calendar and the 1992 Morocco DHS service-availability module to study the effect of service environment on contraceptive discontinuation, switching, and adoption of a modern method following a birth. The 1995 Morocco DHS also collected information on the source of supply for each episode of use of a modern method recorded in the calendar, allowing study of the association between the source of supply and discontinuation and switching rates. Multilevel event-history models are used to evaluate the impact of individual-level sociodemographic characteristics and community-level indicators of family planning service provision. The findings show that the presence of a nearby public health center is associated with higher modern-method adoption after a birth and lower method-failure rates; the presence of a pharmacy is associated with lower discontinuation due to side effects or health concerns. The degree of method-choice potential has a positive impact on both the rate of switching from the pill to another modern method and on modern-method adoption after a birth.

Adolescent↗
PubMed2003

Challenging aging stereotypes: strategies for creating a more active society.

BACKGROUND: The myths of aging provide a partial explanation for why older people have not been primary targets for health promotion and disease-prevention programs. Accelerated population aging signals an urgent need for increased attention to health promotion and disease-prevention interventions across the entire life course. OBJECTIVE: The purpose of this article is to review what is known about: (1). the prevalence and nature of ageist stereotypes; (2). the varied ways in which ageist stereotypes are harmful to health, functioning, and well-being; and (3). strategies for effective communication with older adults around lifestyle issues, with particular emphasis on physical activity. RESULTS: This article reviews literature on current myths and reality of aging in the context of designing health promotion programs for older adults. Strategies for combating ageist stereotypes are based on a multilevel view of determinants of health and aging. CONCLUSIONS: Ageist stereotypes are pervasive in U.S. society and harmful to older adults' psychological well-being, physical and cognitive functioning, and survival. Concrete strategies for communicating with older adults can increase the effectiveness of health promotion programs. Strategies for combating ageism and creating a healthier society must address all segments of society, and include educational and media campaigns, an expansion of current research foci, greater sensitivity from care providers, more opportunities for intergenerational linkages, the design of productive roles for older adults, a retrofit of the built environment, and intensified and collaborative action from both the public and private sectors.

Aged↗
PubMedDate not supplied

A health department's response to AIDS. Condomania: a public education intervention.

Experience gleaned from no smoking campaigns, seatbelt safety crusades, dental hygiene programs and other health promotion efforts, have pointed to the usefulness of social marketing principles in formulating and implementing broad-based behaviour change programs. Using social marketing as a tool of health promotion, the Vancouver Health Department, in cooperation with the Vancouver Women and AIDS Project and the Positive Women's Support Network, implemented a three-year plan for six one-month condom awareness campaigns. Two of these campaigns have been successfully completed; the third is in the planning stage. The purpose of these campaigns is to make condoms a more acceptable feature of everyday sexual activity with 19-30 year-olds; women in particular have been targeted because of the increasing incidence of HIV among this population. The program consists of six major components. They are: design and production of campaign materials; public promotion-advertising; focused community education; volunteer recruitment and training; media relations; and program evaluation.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Malaria in Sri Lanka: one year post-tsunami.

One year ago, the authors of this article reported in this journal on the malaria situation in Sri Lanka prior to the tsunami that hit on 26 December 2004, and estimated the likelihood of a post-tsunami malaria outbreak to be low. Malaria incidence has decreased in 2005 as compared to 2004 in most districts, including the ones that were hit hardest by the tsunami. The malaria incidence (aggregated for the whole country) in 2005 followed the downward trend that started in 2000. However, surveillance was somewhat affected by the tsunami in some coastal areas and the actual incidence in these areas may have been higher than recorded, although there were no indications of this and it is unlikely to have affected the overall trend significantly. The focus of national and international post tsunami malaria control efforts was supply of antimalarials, distribution of impregnated mosquito nets and increased monitoring in the affected area. Internationally donated antimalarials were either redundant or did not comply with national drug policy, however, few seem to have entered circulation outside government control. Despite distribution of mosquito nets, still a large population is relatively exposed to mosquito bites due to inadequate housing. There were no indications of increased malaria vector abundance. Overall it is concluded that the tsunami has not negatively influenced the malaria situation in Sri Lanka.

Animals↗
PubMedDate not supplied

[Breast cancer prevention program in Valenciana community. Assessment 1992-1993].

BACKGROUND: In 1992, a breast cancer screening program was implemented by the General Directorate of Health of the Autonomous Government of Valencia. This program was aimed to decrease the mortality caused by breast cancer in a 30% on those women submitted to the program. The program was implemented, in 1992 and 1993, and with this purpose five units of breast cancer screening were set up in five Health Areas. This paper presents our preliminary results of this program, from april 1992 to december 1993. METHODS: The program target population consisted on 125,000 healthy women aged from 45 to 65 years. Each woman recruited, a two-view (cranio-caudal and medio-lateral oblique) screen-film mammograms were performed as the primary and only film-screening examination with two years interval. Additionally and according to the criteria of the physician charged to inform the mammography a physical examination could be practised. RESULTS: 52,843 women were invited to participate. The participation rate was of 70.78%. The number of breast cancer detected was of 141, corresponding to a rate of 3.90/1000 women under screening program. CONCLUSIONS: The objectives stated, in relation to participation rate, methods applied and early time of detection, were achieved in this period of assessment.

Aged↗
PubMed2000

Epidemic diphtheria in the 1990s: Azerbaijan.

The diphtheria epidemic in the former Soviet Union reached Azerbaijan in 1991, when 66 cases of diphtheria were reported, a number that compared with 4 cases in 1990. From 1990-1996, 2182 cases of diphtheria and 286 diphtheria fatalities (case fatality rate: 13.1%) were reported in Azerbaijan, primarily among persons 5-39 years of age. Almost 45% of cases and 61% of deaths occurred among children 5-14 years of age. The high burden of severe disease among children and young adults suggested a different pattern of preexisting immunity against diphtheria in the Azerbaijani population than was observed in the concurrent diphtheria epidemic in Russia. Because resources were limited in Azerbaijan, mass immunization of the population was carried out in stages, focusing initially on school-aged children. Mass immunization campaigns targeting children were moderately successful in stabilizing the epidemic; mass immunization campaigns targeting both adults and children were eventually needed to fully stop the epidemic.

Adolescent↗
PubMed1998

Automated covariate model building within NONMEM.

PURPOSE: One important task in population pharmacokinetic/pharmacodynamic model building is to identify the relationships between the parameters and demographic factors (covariates). The purpose of this study is to present an automated procedure that accomplishes this. The benefits of the proposed procedure over other commonly used methods are (i) the covariate model is built for all parameters simultaneously, (ii) the covariate model is built within the population modeling program (NONMEM) giving familiar meaning to the significance levels used, (iii) it can appropriately handle covariates that varies over time and (iv) it is not dependent on the quality of the posterior Bayes estimates of the individual parameter values. For situations in which the computer run-times are a limiting factor, a linearization of the non-linear mixed effects model is proposed and evaluated. METHODS: The covariate model is built in a stepwise fashion in which both linear and non-linear relationships between the parameters and covariates are considered. The linearization is basically a linear mixed effects model in which the population predictions and their derivatives with respect to the parameters are fixed from a model without covariates. The stepwise procedure as well as the linearization was evaluated using simulations in which the covariates were taken from a real data set. RESULTS: The covariate models identified agreed well with what could be expected based on the covariates that were actually supported in each of the simulated data sets. The predictive performance of the linearized model was close to that of the non-linearized model. CONCLUSIONS: The proposed procedure identifies covariate models that are close to the model supported by the data set as well as being useful in the prediction of new data. The linearized model performs nearly as well as the non-linearized model.

Mathematical Computing↗
PubMed2000

Diphtheria epidemic in the Republic of Uzbekistan, 1993-1996.

The Republic of Uzbekistan, like the other Newly Independent States in the 1990s, experienced epidemic diphtheria during the 1990s. The outbreak in Uzbekistan began in 1993 in southern regions that bordered areas of Tajikistan that were experiencing a very intense diphtheria epidemic. However, the Uzbek epidemic rapidly spread and threatened to involve the entire country. From 1993-1996, 1169 cases of diphtheria were reported, compared with 58 in 1990-1992. Unvaccinated or only partially vaccinated cases were more likely to have clinically severe forms of diphtheria than those who were fully vaccinated. Strong epidemiologic links with the Tajik diphtheria epidemic and the predominance of mitis biotype strains of Corynebacterium diphtheriae in Uzbekistan make it likely that the Uzbek outbreak arose independently of the predominantly biotype gravis epidemic that began in Russia. The epidemic appeared to be due to low population immunity and the large-scale reintroduction of toxigenic strains of C. diphtheriae. Several mass vaccination campaigns and general enhancement of routine immunization procedures led to control of the epidemic in 1996.

Adolescent↗
PubMed1994

Family welfare and health practices increase after exposure to population education.

Since 1987, the State Resource Center of Jamia Millia Islamia of New Delhi has been implementing a program which integrates population education contents into its literacy education classes for adult learners. Using the core messages on family size, spacing of children, responsible parenthood, right age of marriage, population-related beliefs and customs and population and development, the Center undertook many activities such as: i) integrating population contents in literacy primers, readers and supplementary reading books; ii) development of teaching aids and instructor's resource materials; iii) organization of training for instructors and iv) holding outreach activities such as street corner plays, fairs, etc. To evaluate the impact of the program, the Center undertook an impact survey to measure the level of knowledge, attitude and practices of randomly selected beneficiaries of the project, i.e. 934 learners from 85 literacy learning centers, 5 years after the introduction of the population education program. The study used pre-test and post-test method for collecting data and to compare results. In terms of practice, the study has shown that the respondents having knowledge about family planning methods increased from 67 to 87%, after being exposed to the project's activities. There was also an increase of 61% in cases adopting family planning methods over the pre-measurement level. More importantly, there was not only an increase in awareness of public health and family welfare services but a 137% increase was registered in the use of public health and family welfare facilities for family planning counseling and services. With regard to knowledge and attitude on the various population education messages promoted by the project, the study has shown a 40% increase in "high" knowledge category and 25% increase in favorable attitude after the exposure to the project.

Asia↗
PubMed2006

[Prospects in light of the Catalan survey of 23,136 anesthetic procedures (ANESCAT 2003)].

The ANESCAT 2003 survey has provided reliable information on all practices within the specialty of anesthesiology in a community comprising 6.7 million inhabitants (namely Catalonia, Spain). In a situation in which official statistics are lacking, the findings allow us to make predictions and plan the clinical and organizational needs of the specialty. We discovered that 9 of every 100 residents of Catalonia received anesthesia in 2003 and that the proportion of elderly and high risk patients among them is high. The rates of obstetric and nonsurgical anesthesia were also high. New information on the characteristics of surgical uses of anesthesia that has emerged can now be used for health care planning. Based on population trends--both overall increase and gradual aging--we can foresee increases in demand for anesthesia of around 12% and 20% in the years 2008 and 2013, respectively, although demand may also rise unpredictably if new health care policy measures are introduced suddenly. A growing demand for anesthesia in nonsurgical interventions, perioperative medicine, critical care, and pain therapy was also documented. The workload of anesthesiologists in developing areas exceeds the volume in surgical anesthesia by 30%. Practice in such areas of anesthesiology is comprised of a large range of techniques that differ substantially in complexity and that require reorganization of human resources, equipment and medical resident training programs. The population density observed was 12.7 anesthesiologists per 100,000 inhabitants, reflecting a current deficit that will probably persist over the next 5 years and lead to a serious human resources availability crisis within 10 years, given the age pyramid and the number of residents in training at present. The ANESCAT 2003 survey demonstrates the ability of a scientific society and its members to analyze health care practices in their field and to foresee the effects of expected trends.

Anesthesia↗