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PubMed1977

Dental education in relation to the needs of the South African community.

The dental needs of a heterogeneous South African community are not being fully met because the majority of the already deficient dentist population is in private practice, mostly in urban areas, where they are rendering services to a small minority of the population who can afford comprehensive dental care. Contrary to public health services in general, public dental services are inadequate in extent and provide a limited range of treatment to some eighty-five per cent of the population. Millions of under-privileged people, particularly in rural areas, are not within range of any professional dental care whatsoever. Organized community preventive programmes and dental health education on a national basis are non-existent. Water fluoridation has not yet become a reality. Realizing the shortcomings in community dental services the Government recently adopted a national dental health policy which is aimed at limiting and preventing dental diseases and also at expanding the public dental service to bring it within reach of all sections of the community. In order to meet the dental needs of the community and also to give momentum to the national dental health policy, the following steps are being taken as far as dental education is concerned: (i) The Department of Health is planning to assist universities to establish departments of community dentistry with the object of promoting extended education in community dentistry at under-graduate and post-graduate level. (ii) Consideration is being given to a scheme whereby dental students will have to do one year compulsory intership. (iii) Additional dental schools are being established to enable more non-White dentists to qualify. (iv) With the extended education in community dentistry it is hoped to draw more dentists into community dental services. (v) Dental therapists are being educated to perform duties such as extractions, simple fillings, prevention and dental health education, under the supervision of dentists, in areas where the shortage of dentists is most crucial.

Community Dentistry↗
PubMedDate not supplied

[Effects of the health care model of the Mexican Social Security Institute-COPLAMAR program on the health status of the underprivileged rural population of Mexico].

In 1983 the IMSS-COPLAMAR Program (administrated by the Mexican Institute of Social Security since 1979) established an integral health care model aimed at preparing both the clinical workers and the people of the communities to their care, so they could: 1) Identify the most frequent diseases in their town, together with their conditional causes; 2) Plan, program and execute activities oriented to reduce the morbi-mortality of those ailments; 3) Evaluate the results and, based on them decide to continue or to modify the program. The application of this pattern has made possible to maintain or intensify the improvements obtained since the beginning by the IMSS-COPLAMAR Program (low frequency of preventable disease, a decrease in the consultation demand rate, an increase in the health promotion activities), but additionally it has promoted the adoption of measures to resolve the common health problems in the Mexican rural population. Since the beginning of this program (1983) a decrease in the frequency of digestive infections has been observed and we remark progresses in the control of pregnancy, childbirth and puerperium complications, and malnutrition. An important decrease in consultation demand rate has been registered and a big increase in the promotional activities, in accordance to the increase of the community participation through the health committees, voluntary promotors, traditional therapeutics, and rural assistants. The rural population covered by the IMSS-COPLAMAR Program increased from 11.5 millions in 1983 to 13.7 millions in 1985.

Delivery of Health Care↗
PubMed1999

Use of simple measures of physical activity to predict stress fractures in young men undergoing a rigorous physical training program.

Among a population of randomly selected US Marine Corps recruits at Marine Corps Recruit Depot, San Diego, California, the authors developed a screening tool to identify individuals at high risk for lower extremity stress fracture when beginning a rigorous physical training program. The screening tool was developed among 1,286 recruits, then tested and refined among 1,078 additional recruits. The refined algorithm, consisting of five physical activity questions and a 1.5-mi (2.4-km) run time, revealed that 21.6% of "high risk" subjects suffered more than three times as many stress fractures as "low risk" subjects. These data suggest that risk of stress fracture during rigorous physical training is increased by poor physical fitness and low levels of physical activity prior to their entry into the program.

Adolescent↗
PubMedDate not supplied

The presence of endometrial cells in cervical smears in relation to the day of the menstrual cycle and the method of contraception.

The presence of endometrial cells in cervical smears was studied in a large series of women participating in a population screening program for cervical cancer, in relation to different time periods of the menstrual cycle and to the method of contraception practiced. In the total group of women studied, endometrial cells were present in an average of 12% of the cervical smears. In women who were menstruating cyclically, the percentage of cervical smears containing endometrial cells was not age dependent. Only in women over 52 years was a lower number of endometrium-positive cervical smears found: in postmenopausal women, 0.6% of smears were found to contain endometrial cells. In menstruating women, the frequency of endometrial cells in cervical smears was highest during the menses. After day four, through the proliferative phase, the percentages of cervical smears containing endometrial cells markedly decreased. During the secretory phase, an average of 2% of the smears contained endometrial cells; in the premenstrual phase (after day 25), the percentages of endometrial cell-positive smears rose again. When related to the method of contraception practiced, significant differences in the percentages of cervical smears with endometrial cells appeared. In women using oral hormonal contraceptives, the average numbers of smears containing endometrial cells for the whole cycle as well as for each period of the cycle were significantly lower. This phenomenon might be due to endometrial atrophy on the basis of prolonged use of oral hormonal contraceptives. In women wearing an intrauterine device, at any moment the frequencies of smears with endometrial cells present were significantly higher than the values found in women using any other method of contraception or not using contraceptives. The evaluation of cells originating from the endometrium requires considerable experience. The identification of endometrial cells can be made with greater confidence when the cytologist is aware of the exact date of the menstrual cycle and of the impact on the presence of endometrial cells in cervical smears caused by different methods of contraception.

Adult↗
PubMed1997

Prognosis of epilepsy: a review and further analysis of the first nine years of the British National General Practice Study of Epilepsy, a prospective population-based study.

PURPOSE: To understand the prognosis of newly diagnosed epilepsy to provide rational therapy and advice for patients and their physicians. METHODS: The National General Practice Study of Epilepsy (NGPSE) is the first large population-based study that has assessed the prognosis of patients with newly diagnosed epilepsy prospectively over a prolonged period. We review the previously published data on the prognosis of epilepsy after 9 years of follow-up. One thousand ninety-one patients with newly diagnosed or suspected epilepsy who were attending 1 of 275 general practices throughout the United Kingdom between 1984 and 1987 were ascertained. Cases in this study were defined as the occurrence of one or more seizures, including provoked seizures. Prognosis in terms of remission of seizures, and mortality, was analyzed in the patients who were classified 6 months after recruitment as having definite epilepsy (n = 564) or possible/probable epilepsy (n = 228). RESULTS: Only 33 patients were completely lost to follow-up. After 9 years, 86% [95% confidence interval (CI) 81, 90] of patients with definite epilepsy had achieved a remission of 3 years, and 68% (CI 61, 75), had achieved a remission of 5 years. For the complete cohort, with possible/probable epilepsy included, the rates increased to 87% (CI 83, 91) for 3-year remission and 71% (CI 65, 77) for 5-year remission. The proportion of patients with definite epilepsy who were still in remission at 9-year follow-up (terminal remission) was 68% (CI 62, 74) for 3-year remission and 54% (CI 48, 60) for 5-year remission. When stratified by etiology, the proportions achieving 5-year remission by 9 years was 69% (CI 60, 77) for idiopathic seizures, and 61% (CI 46, 75) for remote symptomatic epilepsy. Age and seizure type had small effects on the chances of achieving remission, with children experiencing slightly lower rates than older patients, and partial seizures having lower remission rates than generalized seizures. The overall standardized mortality ratio (SMR) for patients with definite or possible/probable epilepsy was 2.5 (CI 2.1, 2.9), and 3.0 (CI 2.5, 3.7) for patients who were classified as having definite epilepsy. The SMR for patients with idiopathic epilepsy was 1.6 (CI 1.0, 2.4), for those with remote symptomatic epilepsy it was 4.3 (CI 3.3, 5.5), and for those with acute symptomatic epilepsy it was 2.9 (CI 1.7, 4.5). CONCLUSIONS: Overall, most patients with epilepsy will enter remission; however, there is a higher than expected risk of death, especially in those with symptomatic epilepsy.

Actuarial Analysis↗
PubMed1999

Population-based recruitment for quit-smoking programs: an analytic review of communication variables.

BACKGROUND: Attempts to reduce the prevalence of smoking through quit-smoking programs have been unsuccessful because they have not attracted large numbers of smokers to participate in them. METHOD: An analytic review of the literature was conducted to identify potential communication variables that might enhance recruitment for community-based quit-smoking programs. Recruitment was defined as the number of smokers who enroll in a quit-smoking program divided by the estimated number of smokers in the target population. RESULTS: Thirty-three publications reporting the results of 40 recruitment campaigns were located. The median recruitment rate was 2.0%. Logistic regression was used to examine the effect of six variables on recruitment rate: the type of program sponsor, the type of program, program costs, use of participation incentives, whether messages were segmented by stage of change, and the type of channel used to send messages. The only significant predictor of recruitment rate was channel type (i.e., the method used to deliver a message). Studies that used interactive recruitment channels (telephone, interpersonal communication) were 66.5 times more effective than those using passive recruitment strategies (mass media, direct mail). Results examining the segmentation of messages by stage of change on recruitment were inconclusive. CONCLUSIONS: Results suggest that researchers and practitioners interested in population-based smoking cessation programs should pay more attention to recruitment methods. The use of interpersonal channels has been underused and appears to be particularly promising for improving the population impact of quit-smoking programs.

Adolescent↗
PubMed1992

Long-term outcome of neonatal meningitis.

OBJECTIVE: To determine the long-term outcome of neonatal bacterial meningitis and the relationship between the outcome and specific features in the acute stage of the disease; and to compare the outcome between infants with neonatal meningitis and high-risk infants without meningitis. DESIGN: Prospective clinical evaluations of 21 survivors of meningitis and 21 matched controls who were retrospectively selected from a high-risk patient population. SETTING: Program of follow-up performed at the Children and Youth Project's High Risk Center of the Department of Pediatrics, University of Louisville, Louisville, Ky. Neonates were inborn at a university hospital with a high-risk obstetric unit and level III nursery. PATIENTS: Twenty-six consecutive neonates born between 1970 and 1980 with culture-proven bacterial meningitis, excluding neonates with congenital neurologic defects. Nineteen of 21 survivors and 21 controls matched by age, sex, race, birth weight, and gestational age were followed up from 1 to 14 years (mean, 7.8 years). Both survivors and controls fell below the federal poverty guidelines. RESULTS: Gram-positive meningitis was twice as common as gram-negative meningitis with co-occurrence of meningitis and sepsis in half of the cases. Neonates with gram-positive meningitis and higher birth weight had a higher survival rate, but this finding was not statistically significant. The mortality rate in neonates with gram-negative meningitis was almost three times higher than that of neonates with gram-positive meningitis, but no significant difference was observed between their morbidity rates. Eight (38%) of 21 survivors were normal, while another eight (38%) and five (24%) had mild and moderate to severe sequelae, respectively. Survivors of meningitis had lower IQ scores and more severe sequelae than matched controls. CONCLUSION: Neonatal bacterial meningitis results in poorer long-term outcome than in controls, but improved outcome compared with previous studies of neonatal meningitis.

Female↗
PubMed1988

One-month prevalence of mental disorders in the United States. Based on five Epidemiologic Catchment Area sites.

One-month prevalence results were determined from 18,571 persons interviewed in the first-wave community samples of all five sites that constituted the National Institute of Mental Health Epidemiologic Catchment Area Program. US population estimates, based on combined site data, were that 15.4% of the population 18 years of age and over fulfilled criteria for at least one alcohol, drug abuse, or other mental disorder during the period one month before interview. Higher prevalence rates of most mental disorders were found among younger people (less than age 45 years), with the exception of severe cognitive impairments. Men had higher rates of substance abuse and antisocial personality, whereas women had higher rates of affective, anxiety, and somatization disorders. When restricted to the diagnostic categories covered in international studies based on the Present State Examination, results fell within the range reported for European and Australian studies.

Adolescent↗
PubMed1997

Comparison of population pharmacokinetic modeling methods using simulated data: results from the Population Modeling Workgroup.

Statistical modeling methods have had increasing use in drug disposition studies, both to estimate pharmacokinetic parameters and to develop regression models that relate these parameter estimates to patient characteristics. These methods are particularly flexible as they allow non-linearity and sparse within-patient information. In the past few years, multiple analysis methods have become available, but there is a lack of systematic comparisons of their estimates on the same data sets. Two simulated data sets were therefore developed by the Population Modeling Workgroup of the Biopharmaceutical Section of the American Statistical Association. We analysed these data sets using seven population modeling programs, some of which contain multiple analysis methods. Although each data set represents a single replicate from a given model and data collection design, the results suggest that the behaviour of some methods differs from that of the others.

Anti-Arrhythmia Agents↗
PubMed1993

Trends in patterns of treatment of childhood cancer in Los Angeles County.

To assess the proportion of children with cancer who have been managed by mainstream pediatric cancer programs, population-based cancer incidence data for Los Angeles County (LAC) children (under 20 years of age) for the years 1972 through 1987 were linked with patient records of children registered with the two national cooperative pediatric oncology groups, Children's Cancer Study Group and Pediatric Oncology Group. The proportion of children with cancer who were registered by cooperative groups increased markedly over time: 9% of LAC children younger than 15 years of age who were diagnosed with cancer in 1972 were registered with cooperative groups, compared to 52% of those diagnosed in 1980 and 62% of those diagnosed in 1987. Registration rates decreased with increasing age at cancer diagnosis. In the most recent time period, 1984-1987, 66% of LAC children diagnosed with cancer under age 5 years were registered with cooperative groups compared to 62% of those who were 5 to 9 years old and 49% of those who were 10 to 14 years old; although they were frequently diagnosed with tumors considered to be childhood cancers, only 19% of older adolescents (aged 15-19 years) were registered. In LAC, there was no apparent bias in registration rates with regard to gender or racial-ethnic background. Among patients diagnosed in the period 1984-1987, children in the highest of five socioeconomic status categories were underrepresented among registrants. Registration rates were highest (70% or greater) for patients with acute lymphocytic and acute nonlymphocytic leukemia, medulloblastoma, hepatoblastoma, Wilms tumor, and rhabdomyosarcoma. Fewer than 50% of patients with other brain and central nervous system tumors, retinoblastoma, other soft tissue sarcomas, and bone tumors were registered with the cooperative groups.

Adolescent↗
PubMed1993

Pediatric cancer in the United States. A preliminary report of a collaborative study of the Childrens Cancer Group and the Pediatric Oncology Group.

BACKGROUND: Cancer is the second leading cause of death in children younger than 15 years. Although 5-year survival rates have increased dramatically for many childhood tumors, more than 100,000 person-years of life are lost to childhood cancer each year. The exact proportion of pediatric patients with cancer who receive care at centers that use up-to-date therapeutic protocols (such as those affiliated with the Childrens Cancer Group (CCG) or the Pediatric Oncology Group (POG) is unknown. METHODS: Based on residence at the time of diagnosis, observed numbers of pediatric cancer cases seen by member institutions of the CCG and the POG in 1989 and 1990 were compared with the expected number of cases. Expected values were calculated from incidence rates obtained from the Surveillance, Epidemiology and End Results Program and population counts obtained from the US Census Bureau. RESULTS: Results indicate that more than 90% of children younger than 15 years who have a diagnosis of malignant neoplasm are seen at an institution that is a member of either CCG or POG. The highest proportion seen occurs in the youngest (0-4 years) age group, and the proportion declines steadily with increasing age. CONCLUSIONS: There are specific regions within the United States where the observed number of cases was substantially less than the expected number, including areas of Texas, Idaho, and Virginia. Although the exact reasons for these potential deficits are unknown, additional study of these areas is recommended.

Adolescent↗
PubMed2000

Associations between community income and cancer incidence in Canada and the United States.

BACKGROUND: Associations between socioeconomic status (SES) and the incidence of cancer have been reported previously in the U.S. Canada has more comprehensive health care and social programs than the U.S. The purpose of this study was to compare the strength of associations between SES and cancer incidence in Canada and the U.S. METHODS: The regions studied were the Canadian province of Ontario and the areas of the U.S. covered by the Surveillance, Epidemiology, and End Results (SEER) program. The populations at risk were defined using the 1991 Canadian Census and the 1990 U.S. Census. The populations of Ontario and of the SEER areas of the U.S. were each divided into deciles on the basis of median household income. Population-based cancer registries were used to identify incident cases. Age-standardized incidence rates for all major groups of malignant diseases were calculated for each SES decile in Ontario and in the U.S. Income-associated incidence gradients observed in Ontario and the U.S. were compared. RESULTS: The incidence of most types of cancer was similar in Ontario and the U.S. In both countries, there were moderately strong, inverse associations between income level and the incidence of carcinomas of the cervix, the head and neck region, the lung, and the gastrointestinal tract. In both Ontario and the U.S., several of these diseases were twice as common in the bottom income decile than they were in the top decile. In contrast, carcinoma of the female breast and carcinoma of the prostate were more common among higher income communities in both countries, but the observed associations were weaker in Ontario. CONCLUSIONS: Despite Canada's universal health insurance and more comprehensive social security system, the association between lower socioeconomic status and the incidence of many common cancers is just as strong in Ontario as it is in the U.S. The mechanisms responsible for these associations require further investigation.

Age Factors↗
PubMed2003

The use of fine-needle aspiration cytology and core biopsy in the assessment of highly suspicious mammographic microcalcifications: analysis of outcome for 182 lesions detected in the setting of a population-based breast cancer screening program.

BACKGROUND: Fine-needle aspiration biopsy (FNAB) is used as the first-line diagnostic test for lesions that require morphologic assessment in the authors' breast cancer screening program. A positive cytologic diagnosis is an indication to proceed to definitive surgery. Core biopsy is used if FNAB is not diagnostic. In the context of increased use of core biopsy at other centers, the authors reviewed their experience with the cytologic assessment of highly suspicious microcalcifications. METHODS: Between January 1996 and June 2000, the dominant radiologic abnormality was classified prospectively as high-grade microcalcifications in 182 lesions. Data were recorded on patient demographics, radiologic features, and the findings of FNAB and core biopsy, if performed. The results of the screening assessment were then compared with the final histologic findings. RESULTS: Overall, 15.6% of all radiologically high-grade lesions were microcalcifications. The mean patient age was 58.76 years. The lesions had a mean size of 38.49 mm (range, 5-200 mm), and 92.31% of high-grade microcalcifications proved to be malignant. Among the cases evaluated by FNAB, a positive cytologic diagnosis of malignancy was made in 70.93% of lesions, without any false-positive diagnoses and obviating the need for diagnostic core biopsy. FNAB had a sensitivity of 77.22% and a positive predictive value (PPV) of 100%. When core biopsy was performed due to the absence of a positive cytologic diagnosis, it averted the need for open biopsy in 76% of lesions. CONCLUSIONS: Where there is access to skilled cytopathologists, FNAB can provide a highly accurate, rapid, and cost-effective means of triage of patients who would benefit most from the more expensive core biopsy.

Adult↗
PubMed2005

Mammographic screening reduces risk of breast carcinoma recurrence.

BACKGROUND: The current report is a long-term evaluation of breast carcinoma recurrence, factors predicting recurrence, and postrecurrence prognosis in relation to patients' use of service screening, which has been provided in Turku, Finland, since 1987 for women ages 40-74 years. METHODS: The current study included 527 invasive breast carcinomas: 418 in the screening group (which included screen-detected and interval malignancies) and 109 in the nonscreening group (which included breast carcinomas detected before initial screening and those detected in patients who chose not to undergo screening). These breast carcinomas were diagnosed among women ages 40-74 years between 1987 and 1993, with follow-up extending until the end of 2001. RESULTS: In the screening group, the risk of recurrence was only approximately half of the corresponding risk in the nonscreening group (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.39-0.83; P = 0.003). Five years after the primary diagnosis, 16% of patients in the screening group and 28% of patients in the nonscreening group (P = 0.001) had experienced recurrence; 10 years after diagnosis, the corresponding rates were 21% and 34%, respectively (P = 0.001). Postrecurrence prognosis was comparable for both detection groups (HR, 1.17; 95% CI, 0.70-1.94; P = 0.551), with approximately half of all patients dying of disease 5 years after recurrence. Detection of breast carcinoma via a method other than mammographic screening was associated with a high risk of recurrence on univariate analysis. On Cox multivariate analysis, risk factors for recurrence included lobular histologic type (HR, 2.23; 95% CI, 1.44-3.48; P < 0.001), poor histologic grade (HR, 2.02; 95% CI, 1.20-3.39; P = 0.008), and large tumor size (HR, 1.60; 95% CI, 1.07-2.37; P = 0.021). CONCLUSIONS: Long-term data from a population-based program demonstrated that mammographic screening reduced patients' risk of breast carcinoma recurrence. Specifically, the risk for patients with screen-detected disease was only approximately half of the risk for patients with non-screen-detected disease. Nonetheless, postrecurrence prognosis was comparable for patients in both detection groups.

Adult↗
PubMed2006

Vegetable cells in Papanicolaou-stained cervical smears.

Vegetable cells are unusual findings in Papanicolaou-stained cervical smears; these structures could be wrongly mistaken for abnormal human cells, worm eggs, or spores by a cytologist encountering the possibility of meeting those elements in cytological analysis. Five cervicovaginal smears showing similar vegetable cells have been detected over a 3-yr period (2002-2004) in the course of a population screening program for cancer of the uterine cervix in Modena (Italy) involving 32,500 women. According to the clinical histories of the patients, the vaginal pharmaceutical drugs or appliances used were of different types: vaginal lavages, pessaries, and vaginal creams. Following a careful investigation, the only substance that can lead to vegetal elements has been identified as polysaccharide galactomannan, which is one of the excipient present in the drugs used. The authors have identified the origin of these contaminants and the means of pollution, using cytological and pharmaceutical investigation.

Adolescent↗
PubMedDate not supplied

Considerations in assessing effectiveness and costs of diabetes care: lessons from DARTS.

Use of a population-based diabetes clinical information system is crucial to understanding the nature and magnitude of disease burden, effects of treatment, and personal and economic costs of diabetes. Information from the DARTS (Diabetes Audit and Research in Tayside Scotland) project has shown that patients with diabetes account for a disproportionate amount of cardiovascular disease, have a poorer associated prognosis, and do not receive effective secondary preventive therapies as frequently as do patients without diabetes. In addition, the prevalence of type 2 diabetes is associated with lower socioeconomic status - as, in turn, is significantly increased body mass index (BMI). The DARTS findings also revealed that much of the cost of diabetes treatment is accounted for by costs associated with treatment of coronary vascular disease and hospitalization. The vast majority of type 2 patients have inadequately controlled blood pressure, and many of these patients do not adhere to prescribed oral therapy. It is clear that much work remains to be done to implement and maintain standards of care that will improve outcome in diabetes. Efforts in this regard can best be monitored by effective population-based programs.

Costs and Cost Analysis↗