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PubMed2006

Prevalence of alpha-papillomavirus genotypes in cervical squamous intraepithelial lesions and invasive cervical carcinoma in the Italian population.

The aim of the present investigation was to define the spectrum of mucosotropic human papillomaviruses among 414 Italian women with normal cervices (n = 183), low- and high-grade cervical squamous intraepithelial lesions (n = 101 and 65, respectively), and invasive squamous cervical carcinomas (n = 65). Human papillomaviruses were detected by broad spectrum consensus-primer-pairs MY09/MY11 and GP5+/GP6+-based polymerase chain reaction using three amplification methods and were characterized by nucleotide sequence analysis. The prevalence rates of HPV infections was 19.7%, 63.4%, 80%, and 81.5% in patients with normal cervices, low-grade, and high-grade squamous intraepithelial lesions, and cervical carcinomas, respectively. Among the 205 HPV-positive patients, a total of 31 mucosal HPV genotypes were identified of which 16 types, epidemiological classified as high-risk viruses (HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 66, 68, 73, and 82), have been found in 16.9%, 50.1%, 69.2%, and 78.5% of normal cervix, low-, and high-grade cervical squamous intraepithelial lesions, and cervical carcinoma groups, respectively. As expected, the HPV16 was the most represented viral type in all groups examined with frequency rates ranging from 8.7% in normal subjects to 58.5% in invasive carcinoma patients. Ten epidemiologically defined low-risk HPV types (HPV6, 11, 42, 54, 61, 70, 71, 72, 81, 83) were detected in 2.7%, 7.9%, and 6.1% of normal cervix, low-, and high-grade cervical squamous intraepithelial lesions, respectively, and in none of invasive carcinomas. Furthermore, five unknown risk viruses were detected in 3% of low-grade cervical squamous intraepithelial lesions (HPV30, 32, 67), in 3.1% of high-grade cervical squamous intraepithelial lesions (HPV62, 90), and in 1.5% of cervical carcinomas (HPV62). Larger epidemiological screening studies, with PCR amplification and followed by either hybridization-based procedures against sequence targets of all known HPV types or sequence analysis studies, are needed in order to assess the epidemiological risk of less represented HPV types, to identify unknown viruses, and to monitor the future eventual spread of unusual viral types related to vaccination programs and/or population mobility.

Adult↗
PubMed2002

Health care for the elderly: two cases of technology diffusion.

Diffusion of medical technology and the growing proportion of elderly people in the population are generally regarded as major contributors to the increasing health care expenditure in the industrialised world. This study explores the importance of one specific factor in this process, the change in the use of technology among elderly patients. In some instances, a new technology is first used among younger patients and then gradually extended to the elderly. Two such cases are studied, both representing costly procedures: coronary bypass surgery (treatment of coronary heart disease) and dialysis (treatment of uraemia). In both cases, we demonstrate significant diffusion to older age groups. It is also tentatively concluded that the diffusion of technology could have an important effect on per capita health care expenditure among the oldest of the old.

Adolescent↗
PubMed1992

Nutritional status of Brazilian children: trends from 1975 to 1989.

The prevalence of malnutrition among under-5-year-olds in Brazil fell by more than 60% between 1975 and 1989. The benefits were smaller for population strata that were more affected by malnutrition in the 1970s, i.e., children from the North and North-east regions and those from poor families in general. Regional and socioeconomic differentials in the prevalence of malnutrition therefore increased between 1975 and 1989. Trends in family income indicate extraordinary economic gains in the 1970s, some losses in the 1980s, and a modest net gain over the period 1975-89. The availability of sanitation, health, and education services, and the provision of preschool supplementary feeding programmes increased markedly in the 1970s and 1980s. Demographic trends were also positive, reducing the demand for services and programmes, increasing the economic efficiency of families, and concentrating the population in urban areas, where incomes, job opportunities, and social and material infrastructures are better. The observed nutritional improvement was therefore probably due to a moderate increase in family income associated with a substantial expansion in the provision of services and programmes, both of which were facilitated by favourable demographic trends. Also, the nutritional improvement was probably concentrated during the 1970s, while little, if any, occurred after 1980; prospects for the 1990s point to a stagnant situation. This is a reason for great concern particularly in the North and North-east regions of the country, where high rates of child malnutrition are still found.

Brazil↗
PubMed1993

Consequences of rapid fertility decline in the Republic of Korea: issues and solutions.

During the last 3 decades, efforts to deal with population problems in Korea have focused largely on reducing population growth. The national population control program has been a major means of achieving this goal. Between the early 1960s and 1990, evidence from a national survey indicates that the percent of current use of contraception rose from about 12% to 80% and the total fertility rate fell to 1.6. representing 1 of the most rapid fertility transitions in the developing world. In conjunction with this rapid reduction in fertility, mortality also improved significantly during this period. Thus, Korea has virtually completed the demographic transition from high birth and death rates to low birth and death rates during the same period. It is widely recognized that Korea has reached demographic maturity and has also achieved remarkable economic development at the same time. The world's demographic history shows that the demographic transition which almost every industrialized country has gone through from a predominantly rural, illiterate society with high birth and death rates, to a predominantly rural, illiterate society with high birth and death rates, to a predominantly urban, educated society with low birth and death rates usually takes well over a century, but in Korea, that process has taken only a few decades. On the other hand, the consequences of a rapid fertility decline bring about various demographic and social issues which we have to take into consideration for future socioeconomic development policy concerning the well-being of the Korean people. Some of issues for policy consideration can be broadly summarized as follows: 1) gradual imbalance of sex ratio at birth due to traditional son preference behavior; 2) latent effect of inevitable population aging and increasing dependency burden on behalf of the elderly for the public sector; 3) changes in family life cycle and rapid transformation form a large to a small family; 4) increasing demand for now social roles for women, supported by easing of child care burdens within households.

Asia↗
PubMed1993

Tetanus in Switzerland 1980-1989.

Tetanus cases that occurred in Switzerland between 1980 and 1989 have been reviewed with the help of three data surveillance systems: a) morbidity data from the Federal Office of Public Health (FOPH), b) mortality data from the Swiss Federal Statistical Office (SFSO), and c) data from the Association of Swiss Hospitals and Clinics (VESKA), completed by a written enquiry to clinics which did not (or only partly) participate in the VESKA system during the study period. For every case, a questionnaire was sent to the clinic to verify the diagnosis and to obtain additional information on the circumstances of occurrence. Ninety-one cases were identified. This corresponds to a yearly incidence of 1.93 per million population between 1980-84 and 0.88 for the 1985-89 period (p < 0.01). Eighty-one percent of the cases were older than 50 years of age and women were significantly more frequently affected than men. None of the cases identified had a documented primary immunization series. Data available at the FOPH and SFSO level have been compared to data obtained through the VESKA system using the Chandra Sekhar and Deming method. It is estimated that 134 tetanus cases (95% CI: 91-197) have occurred in Switzerland between 1980 and 1989, together with 28 deaths (95% CI: 27-31). Based on these estimates, FOPH appears to detect only 6-13% of tetanus cases occurring in Switzerland. By contrast, SFSO had fairly consistent data for 81-100% of tetanus associated deaths. The low rate of tetanus reported by physicians necessitates a sustained effort to increase the understanding of epidemiological surveillance by Swiss practitioners.

Adolescent↗
PubMed1993

Prolonged breast-feeding: no association with increased risk of clinical malnutrition in young children in Burkina Faso.

Reported are our findings from a case-control study of the association between prolonged breast-feeding and clinical malnutrition in an urban setting in West Africa. The cases were children aged 12-36 months who had been hospitalized with a diagnosis of clinical malnutrition. Children of a similar age who lived in neighbouring courtyards were recruited as controls. For 152 case-control pairs in which both children were receiving solid foods, non-breast-feeding was associated with an increased risk of clinical malnutrition (crude odds ratio = 2.37; 95% confidence interval = 1.24, 4.55). This association remained statistically significant after controlling for various potentially confounding variables (P = 0.03). Our findings suggest that either prolonged breast-feeding may offer substantial protection against clinical malnutrition in the study population or malnutrition leads mothers to stop breast-feeding. These results are inconsistent with those of a number of workers who have reported that prolonged breast-feeding is associated with an increased risk of malnutrition. This inconsistency might have arisen because of differences in the definition of malnutrition used or because of variations in the quantity and quality of weaning foods available in different settings. We found no evidence to support the hypothesis that prolonged breast-feeding may be detrimental to children.

Breast Feeding↗
PubMed2006

Disease management programs for heart failure: not just for the 'sick' heart failure population.

The development of disease management programs has been a major advance in heart failure care, bringing about significant improvements for the heart failure population, with reduction in readmission, better use of guideline therapy and improved survival. However, at present, the majority of such programs focus their attention only on the sicker segment of this population, with little application of this important service to the broader heart failure population, where potentially benefits may be even more impressive. This has led to an imbalance in the care of patients with heart failure, where aspects of management such as regular structured review and education are preferentially given to the group at the later stages of the natural history of the syndrome. This paper argues for a far wider application of the disease management program concept in heart failure care so as to bring the benefits of specialist care, patient education and follow-up to patients at an earlier stage in the natural history of heart failure.

Diffusion of Innovation↗
PubMed1995

Deoxynucleoside induces neuronal apoptosis independent of neurotrophic factors.

Postmitotic sympathetic neurons are known to undergo a programmed cell death (apoptosis) when they are deprived of nerve growth factor (NGF) or treated with arabinofuranosyl nucleoside antimetabolites. Here we report the existence of a biochemical mechanism for the induction of neuronal death by an endogenous nucleoside in the presence of NGF. In support of such a mechanism we show that 2-deoxyadenosine (dAdo) induces apoptosis in chick embryonic sympathetic neurons supported in culture by NGF, excess K+, phorbol 12,13-dibutyrate, or forskolin. Neuronal death was related to a dramatic increase in the dATP content of sympathetic neurons exposed to dAdo (34.96 +/- 5.98 versus 0.75 +/- 0.16 pmol/micrograms protein in untreated controls, n = 9), implicating dATP in the toxicity. Supportive evidence for a central role of dATP was gained by inhibition of kinases necessary for phosphorylation of dAdo. 5'-Iodotubercidin in nanomolar concentrations completely and dose-dependently inhibited formation of dATP and also protected against toxicity of submillimolar concentrations of dAdo in sympathetic neurons. Although some of these actions of dAdo were remarkably similar to those reported for human lymphoid cells, several were uniquely different. For example, [3H]dAdo was not transported into neurons by the nucleoside transporter, and therefore inhibition of the transporter (dilazep, nitrobenzylthioinosine) did not prevent neurotoxicity by dAdo. Precursors of pyrimidine synthesis (2'-deoxycytidine, uridine) or NAD+ synthesis (nicotinamide) were ineffective in protecting sympathetic neurons against dAdo toxicity. Finally, inhibition of adenosine deaminase by deoxycoformycin or erythro-9-(2-hydroxy-3-nonyl) adenine did not potentiate the toxic effects of dAdo. Our results provide evidence for the first time that neuronal cells are as susceptible to nucleoside lethality as human lymphocytes are, and provide a new model to study the salvage pathway of deoxyribonucleosides in controlling neuronal populations through programmed cell death.

Adenine↗
PubMed1995

The effect of copayments and income on the utilization of medical care by subscribers to Japan's National Health Insurance System.

This study uses cross-sectional data from Japan's 47 prefectures covering subscribers to Japan's National Health Insurance system to analyze the effects of income and copayment levels on the utilization of medical care. Multivariate regression models were run for the years 1984 and 1989, with the utilization ratio (number of health insurance claims per 100 insurance subscribers) for total, inpatient, outpatient, and dental services as the dependent variable. Independent variables included copayment per patient day, deflated per capita income, population density, percentage of subscribers over age 65, number of beds and clinics per 1,000 persons, and number of doctors and dentists per 1,000 persons. The data were then stratified according to per capita income and percentage of insurance subscribers over the age of 65 in each prefecture. The copayment amount exhibited a small, but significant negative effect on the utilization of all medical services. Utilization of outpatient care was most sensitive to the copayment rate. The per capita income stratification models revealed the greatest copayment effect on inpatient care for the lowest income group. The results of the age stratification models support popular notions about the use of hospitals by the elderly as substitutes for elderly care facilities. The effects of copayments and income vary not only among the type of medical care (inpatient, outpatient, and dental) but also among the income and age stratifications of groups in the National Health Insurance system.

Age Factors↗
PubMedDate not supplied

Population and family planning: an international perspective.

Since the 1960s, the U.S. government has supported population and family planning programs in Third World countries, on the grounds that rapid population growth impairs the ability of those countries to develop economically; family planning programs contribute to fertility decline; and such programs help improve the health of mothers and children. Although the United States remains the largest single donor of funding for international population programs, its support has weakened during the eight years of the Reagan administration and patterns of funding for those programs have changed substantially. Since the 1960s, however, contraceptive use has increased in the Third World and fertility has fallen substantially. The decline has been uneven, though--considerable in some countries, moderate in others but very small in many. The performance of family planning programs around the world has varied widely, and questions remain as to what, if anything, can be done to increase success. For the future, three aspects of population and fertility control in developing countries merit special attention: the supply of contraceptive commodities going to family planning programs; the maintenance and strengthening of the family planning infrastructure; and the need to examine the policy implications of differing patterns of fertility and population growth for national development and individual well-being.

Developing Countries↗
PubMed1991

Information systems for the analysis of drug prescriptions in Spain.

The Spanish National Health Service, largely represented by INSALUD, covers at present over 98% of the Spanish population. Services are free at the point of delivery with exception of prescription charges. The patients contribution towards the price of their medicines is approximately 40% of the cost of the drug for most ethical preparations. Non-prescription drugs are not reimbursed by the National Health Service. Pensioners and the disabled are exempt from prescription charges. Prescription analysis or monitoring is possible within INSALUD because of the necessity to reimburse pharmacists for the prescriptions they dispense, monthly batches of prescriptions are processed. The Drug Data Bank possesses three databases that may be used for prescription analysis, these are ESPES, ECOM and PACTIV. Information from these databases is used by external workers in: drug Monitoring Centres for Adverse Drug Reactions; the Spanish Collaborative Study on drug-induced birth effects; drug utilization research workers; INSALUD also produces reports on drug prescribing and these have a particular emphasis on expenditure; the General Directorate of Pharmacy also use these databases for their policy making on issues related to, and derived from prescribing.

Adverse Drug Reaction Reporting Systems↗
PubMed1994

[Evolution of child undernutrition in Chile and some of its conditioning factors: a time series analysis].

The objective of this study was to determine the evolution of the nutritional status of the population under five years of age during the period 1975-1990. Several conditioning factors were also assessed. The information was evaluated through time series analysis by using the AREG procedure. This procedure allows for the estimation of a regression model correcting by the autocorrelation of errors. Results indicates a significant trend to decreased undernutrition rates (p < 0.0001). A seasonal effect on undernutrition was observed, being higher the prevalences in summer. Analysis of selected conditioning factors, as well as the familiar buying capacity remained stable during the period. An exception to the lack of association among undernutrition and the conditioning factors evaluated, was seen during the period 1975-1982 when clear inverse relationship was evidenced. In conclusion, the decrease of infant undernutrition in Chile during the period 1975-1990 was not related to the changes observed in certain socioeconomic indices.

Child Nutrition Disorders↗
PubMed2002

Why is less money spent on health care for the elderly than for the rest of the population? Health care rationing in German hospitals.

The consequences of population ageing for the public health care system and health care costs may be less severe than is commonly assumed. Hospital discharge data from Germany's largest health insurer (AOK) show that the cost of caring for patients during their last year of life makes up a large part of total health expenditures. And this last year of life is less costly if patients die at an advanced age. As a multivariate analysis reveals, oldest old patients as a rule receive less costly treatment than younger patients for the same illness. Moreover, this pattern is more pronounced for elderly women than for elderly men. These findings suggest that health care is informally rationed according to the age and sex of the patient. The data also indicate that there may be more age-related rationing going on in Germany than in the United States. Future research should investigate the national, institutional, and individual factors behind health care rationing. In this paper, I discuss the physician's professional decision as one plausible determinant.

Adult↗
PubMed1994

Infant care in rural Malawi. A prospective study of morbidity and growth in relation to environmental factors.

In connection with the introduction of piped surface water delivered by community taps in a rural area of Malawi, 46 infants were studied prospectively during a 10-month period to monitor infant care and health. Compared with the reference population, newborn infants generally weighed less and were shorter. Breastfeeding was universal and appeared adequate for catch-up in weight during the 1st 3 months. Growth faltering occurred from the age of 3 months when the prevalence of infectious diseases gradually increased and suitable supplementary foods were lacking. Babies were given highly contaminated water from the 1st days of life, but, in spite of this, diarrhoea was infrequent during the 1st 5 months when respiratory tract infections and episodes of fever were the most common symptoms of disease. Diarrhoea became a problem from the age of 5-6 months. No differences in morbidity or growth patterns were observed between infants using piped and traditional water sources. Thus, the quality of drinking water seemed to have no substantial effect on the health of the studied infants during the 1st months of life.

Birth Weight↗
PubMedDate not supplied

Monitoring of antimicrobial resistance among food animals: principles and limitations.

Large amounts of antimicrobial agents are in the production of food animals used for therapy and prophylactics of bacterial infections and in feed to promote growth. The use of antimicrobial agents causes problems in the therapy of infections through the selection for resistance among bacteria pathogenic for animals or humans. Current knowledge regarding the occurrence of antimicrobial resistance in food animals, the quantitative impact of the use of different antimicrobial agents on selection for resistance and the most appropriate treatment regimes to limit the development of resistance is incomplete. Programmes monitoring the occurrence and development of resistance are essential to determine the most important areas for intervention and to monitor the effects of interventions. When designing a monitoring programme it is important to decide on the purpose of the programme. Thus, there are major differences between programmes designed to detect changes in a national population, individual herds or groups of animals. In addition, programmes have to be designed differently according to whether the aim is to determine changes in resistance for all antimicrobial agents or only the antimicrobial agents considered most important in relation to treatment of humans. In 1995 a continuous surveillance for antimicrobial resistance among bacteria isolated from food animals was established in Denmark. Three categories of bacteria, indicator bacteria, zoonotic bacteria and animal pathogens are continuously isolated from broilers, cattle and pigs and tested for susceptibility to antimicrobial agents used for therapy and growth promotion by disc diffusion or minimal inhibitory concentration determinations. This programme will only detect changes on a national level. However, isolating the bacteria and testing for several antimicrobial agents will enable us to determine the effect of linkage of resistance. Since 1995 major differences in the consumption pattern of different antimicrobial agents have occurred in Denmark. The Danish monitoring programme has enabled us to determine the effect of these changes on the occurrence of resistance. The Danish monitoring is, however, not suited to determine changes on a herd level or to detect emergence of new types of resistance only occurring at a low level.

Animals↗
PubMed2003

Predictive value and completeness of the registration of congenital abnormalities in three Danish population-based registries.

AIMS: The predictive value and completeness of data on congenital abnormalities (CAs) collected in three administrative health registries in the County of North Jutland, Denmark were compared. METHODS: The study included all singleton liveborn infants in the county during the period 1991-94 (n = 24,147). All infants recorded as having a CA in either the Medical Birth Registry (MBR), the Hospital Discharge Registry (HDR), or the National Registry of Congenital Abnormalities (NRCA) were identified, and the recordings in each registry were compared. Infants recorded in at least two registries were considered correctly diagnosed with a CA for the sake of the analyses. The predictive value was defined as the number of infants correctly diagnosed with a CA in the registry divided by the total number of infants recorded with a CA in the registry. In all cases with recording in one registry only, the predictive value of the registration with CA diagnosis was assessed through a review of a sample of medical records. The completeness was defined as the number of correctly diagnosed CAs in the registry divided by the total number of identified CAs. RESULTS: The predictive value and completeness were calculated as 89.1% (85.3-92.8) and 32.3% (28.9-35.7) in the MBR; 88.2% (85.9-90.5) and 89.9% (87.7-92.1) in the HDR; and 99.6% (98.9-100.0) and 36.0% (32.5-39.5) in the NRCA. CONCLUSIONS: The HDR seems to have a predictive value and completeness that are acceptable for general surveillance and epidemiological research regarding CAs. The NRCA may be suitable for case-control studies owing to a high predictive value.

Congenital Abnormalities↗
PubMed2004

Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS).

BACKGROUND: The German National Health Interview and Examination Survey (GHS) is the first government mandated nationwide study to investigate jointly the prevalence of somatic and mental disorders within one study in the general adult population in Germany. This paper reports results from its Mental Health Supplement (GHS-MHS) on 4-week 12-month, and selected lifetime prevalence of a broad range of DSM-IV mental disorders, their co-morbidity and correlates in the community. METHODS: The sample of the GHS-MHS (n=4181; multistage stratified random sample drawn from population registries; conditional response rate: 87.6%) can be regarded as representative for the German population aged 18-65. Diagnoses are based on fully structured computer assisted clinical interviews (M-CIDI), conducted by clinically trained interviewers. RESULTS: 12-month prevalence for any DSM-IV study disorder is 31% (lifetime: 43%; 4-week: 20%) with anxiety disorders, mood disorders and somatoform syndromes being the most frequent diagnoses. Retrospective age of onset information reveals that most disorders begin early in life. Co-morbidity rates among mental disorders range from 44% to 94%. Correlates of increased rates of mental disorders and co-morbidity were: female gender (except for substance disorders), not being married, low social class, and poor somatic health status. Health care utilization for mental disorders depended on co-morbidity (30% in 'pure', 76% in highly co-morbid cases) and varied from 33% for substance use disorders to 75% for panic disorder. CONCLUSIONS: Results confirm and extend results from other national studies using the same assessment instruments with regard to prevalence, co-morbidity and sociodemographic correlates, covering a broader range of DSM-IV disorders [i.e. somatoform disorders, all anxiety disorders (except PTSD), mental disorders due to substance or general medical factor, eating disorders]. Intervention rates were higher than in previous studies, yet still low overall.

Adolescent↗
PubMed2002

Analysis of tuberculosis surveillance in Hungary in 2000.

SETTING: Hungary, Central Europe, with a population of 10.3 million living in 20 administrative districts (19 counties and the capital). OBJECTIVE: To summarize the results of the first year of the revised National Tuberculosis Surveillance System. DESIGN: Retrospective survey of the National Tuberculosis Surveillance Center (NTSC) database. METHODS: Analysis of data on all tuberculosis cases reported to the NTSC in 2000. Drug susceptibility results were evaluated in line with WHO and IUATLD definitions. RESULTS: During 2000, a total of 3598 patients with tuberculosis were reported. Only 40% of these were bacteriologically confirmed. Although susceptibility testing has been required for previously untreated culture-positive cases, only 801 (67.8% of the bacteriologically confirmed cases) were tested in 2000. Drug resistance was detected in 10.7% of previously untreated and in 23.5% of previously treated patients. Multidrug-resistant (MDR) cases were not common: only 1.5% of the isolates from previously untreated patients and 4.9% of those from previously treated patients were MDR. CONCLUSIONS: The results suggest that the NTSC should work towards increasing the numbers of cases that are bacteriologically confirmed. In addition, some form of surveillance system should be instituted to ensure that mandatory susceptibility testing is performed on all isolates from previously untreated tuberculosis patients.

Adolescent↗