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PubMed2005

Development and testing of an audio-visual aid for improving infant oral health through primary caregiver education.

PURPOSE: To create and test an audio-visual (AV) aid for providing anticipatory guidance on infant oral health to caregivers. METHODS: A DVD-video containing evidence-based information about infant oral health care and prevention in accordance with the American Academy of Pediatric Dentistry guidelines has been developed (www.utoronto.ca/dentistry/newsresources/kids/). It contains comprehensive anticipatory guidance in the areas of pregnancy, oral development, teething, diet and nutrition, oral hygiene, fluoride use, acquisition of oral bacteria, feeding and oral habits, causes and sequelae of early childhood caries, trauma prevention, early dental visits and regular dental visits. A questionnaire was developed to test the knowledge of expectant and young mothers (n = 11) and early childhood educators (n = 16) before and after viewing the video. RESULTS: A significant lack of knowledge about infant oral health was indicated by the proportion of "I don"t know" (22%) and incorrect (19%) responses to the questionnaire before the viewing. Significant improvement in knowledge (32%; range -3% to 57%; p < 0.001) was indicated by the proportion of correct responses (91%) following a single viewing of the AV aid. CONCLUSION: This AV aid promises to be an effective tool in providing anticipatory guidance regarding infant oral health in high-risk populations. Unlike existing educational materials, this aid provides a comprehensive, self-directed, evidence-based approach to the promotion of infant oral health. Widespread application of this prevention protocol has the potential to result in greater awareness, increased use of dental services and reduced incidence of preventable oral disease in the target populations.

Audiovisual Aids↗
PubMedDate not supplied

A helping hand.

Medicaid beneficiaries can be a particularly challenging population to serve. Too often they experience exaggerated health problems that are exacerbated, in many instances, by a long history of being left behind by the health care system. They face an uphill battle getting to doctor's appointments because they lack transportation, or they have trouble negotiating the health delivery system because of limited knowledge about the process and their health conditions. At the same time, the Medicaid-eligible population continues to grow, straining state budgets. To help remove the barriers to care while keeping costs down, Medicaid program administrators have partnered with managed care plans. In response, Medicaid managed care plans have cultivated relationships with grassroots organizations to develop community-centric programs that more effectively reach out to this targeted population of mothers, underserved children and teens, individuals with chronic health conditions, and the culturally and linguistically diverse.

Community-Institutional Relations↗
PubMedDate not supplied

Community demonstration project initiative: technical support for program development at the community level.

Select population groups are at greater than average risk for cancer incidence and mortality. Lack of experience reaching high-risk populations, particularly those characterized by high proportions of the socioeconomically disadvantaged, presented a challenge to the American Cancer Society (ACS). A partial solution was to integrate outreach to high-risk populations into ACS national priorities and to fund community demonstration projects consistent with these priorities. Technical assistance (TA), which includes expert advice and problem solving, was provided during the first phase to facilitate the development of these projects into "model" projects to learn what initiatives can best be disseminated, or diffused, into target populations. TA also was used to assess how it can enhance the potential for replication. Evaluation of this initiative resulted in a plan to disseminate model projects to selected ACS divisions with varied resources and capabilities (e.g., outreach to high-risk populations, planning, program development, and evaluation) for replication. During the next phase, projects will be evaluated to document the role of TA in facilitating local empowerment and nationwide diffusion of effective cancer prevention and control programs.

Community Health Services↗
PubMed1997

[Information and education interventions on hygiene levels of a population in which trachoma exists in a hyperendemic and serious form].

The aim of this work is to develop information and education methods in order to obtain better hygienic conditions in Tissint Zaouia (Moroccan province of Ouarzazate). 41% of the population is affected by trachoma with a rate of 18% of active trachoma, 1.6% of the population has a blindness of corneal origin. Topical treatment and surgery of trichiasis must be associated to a better hygiene of the community. Until now mothers and families have not fully perceived the connection between flies and insufficiency of narsing and trachoma transmission. Our specific goals are the following: A--information of target population, B--better understanding of hygiene by mothers and families, C--incitation to face-washing of children, D--perfect identification of trachoma signs by health workers, E--official integration of this program by local authority, F--evaluation of trachoma incidence.

Adolescent↗
PubMedDate not supplied

Public health and disability: emerging opportunities.

The public health community has traditionally paid little attention to the health needs of people with disabilities. Recent activities, however, on the part of federal and international organizations mark a shift toward engaging the health concerns of this large and growing population. First, the World Health Organization published the International Classification of Functioning, Disability, and Health (ICF), a companion to the International Classification of Diseases. The ICF describes both a conceptual framework and a classification system, providing the foundation for public health science and policy. Second, a vision for the future of public health and disability is outlined in Healthy People 2010 that, for the first time, includes people with disabilities as a targeted population. The article briefly describes activities and emerging opportunities for a public health focus on people with disabilities with the ICF as a foundation and Healthy People 2010 as a vision. Public health has traditionally responded to emerging needs; people with disabilities are a group whose health needs should be targeted.

Chronic Disease↗
PubMedDate not supplied

Measles: summary of worldwide impact.

Nearly every measles infection results in well-recognized clinical disease. In nonimmunized populations almost every child will get measles early in life. The universality of the disease in nonimmunized communities, particularly those in the developing world, has led to a more or less passive acceptance of measles as an unavoidable risk of early life. The clinical spectrum of measles ranges from a mild, self-limiting illness to a fatal disease. Conditions encountered mainly in the developing world, e.g., unfavorable nutrition, high risk of concurrent infection, and inadequate case management -- particularly at home -- favor the development of complications and adverse outcome. Conversely, good clinical management of an otherwise healthy child, a situation seen mostly in the developed world, greatly influences the course of the disease. Hence many in the medical profession believe that measles is a mild disease except among populations living under particularly unfavorable conditions. Measles vaccine is effective in preventing disease in the individual and in controlling it in the community if it is given at the critical age when maternal antibodies wane and the risk of natural infection increases sharply and if a high immunization rate is maintained in the target population. The experience with immunization, particularly in sub-saharan Africa, is rewarding: mothers who had previously accepted measles as an unavoidable risk clamour for immunization of their children once its effectiveness has been demonstrated. No reason exists for measles to claim its present toll of morbidity and mortality. With extension of the Expanded Programme on Immunization of the World Health Organization, the impact of measles should progressively decline.

Adolescent↗
PubMed2003

Self-referred whole-body CT imaging: current implications for health care consumers.

PURPOSE: To conduct an empirical analysis of self-referred whole-body computed tomography (CT) and develop a profile of the geographic and demographic distribution of centers, types of services and modalities, costs, and procedures for reporting results. MATERIALS AND METHODS: An analysis was conducted of Web sites for imaging centers accepting self-referred patients identified by two widely used Internet search engines with large indexes. These Web sites were analyzed for geographic location, type of screening center, services, costs, and procedures for managing imaging results. Demographic data were extrapolated for analysis on the basis of center location. Descriptive statistics, such as frequencies, means, SDs, ranges, and CIs, were generated to describe the characteristics of the samples. Data were compared with national norms by using a distribution-free method for calculating a 95% CI (P <.05) for the median. RESULTS: Eighty-eight centers identified with the search methods were widely distributed across the United States, with a concentration on both coasts. Demographic analysis further situated them in areas of the country characterized by a population that consisted largely of European Americans (P <.05) and individuals of higher education (P <.05) and socioeconomic status (P <.05). Forty-seven centers offered whole-body screening; heart and lung examinations were most frequently offered. Procedures for reporting results were highly variable. CONCLUSION: The geographic distribution of the centers suggests target populations of educated health-conscious consumers who can assume high out-of-pocket costs. Guidelines developed from within the profession and further research are needed to ensure that benefits of these services outweigh risks to individuals and the health care system.

Humans↗
PubMed2002

Eye disease in multibacillary leprosy patients at the time of their leprosy diagnosis: findings from the Longitudinal Study of Ocular Leprosy (LOSOL) in India, the Philippines and Ethiopia.

Existing prevalence surveys do not provide adequate information to estimate the magnitude of ocular pathology or vision loss in leprosy patients. We sought to determine the prevalence of ocular findings and related risk factors in leprosy patients at the time of their disease diagnosis. We also sought to determine if there were geographic differences and whether these were due to different demographic characteristics of the populations. The study was undertaken at Schieffelin Leprosy Research & Training Centre (Karigiri, India), Leonard Wood Memorial Leprosy Institute (Cebu, Philippines), and (for 3 years only) ALERT (Addis Ababa, Ethiopia). Newly diagnosed multibacillary (MB) leprosy patients as well as MB cases relapsed after dapsone monotherapy were eligible for enrollment. In each study site, the target population was 300. Standardized examinations were conducted between 1991 and 1998. Patient enrollment included 301 patients in Karigiri, 289 patients in Cebu, and 101 patients in Addis Ababa. The age-adjusted prevalence of blindness (< 6/60 in the better eye) and visual impairment (6/24-6/60) was 2.8% and 5.2%, respectively. Lagophthalmos and leprosy related uveal changes were detected in 3.3% (95% CI 2.0-4.7%) and 4.1% (95% CI 2.4-5.7) of patients, respectively. Overall, 11% (95% CI 8.5-13.2%) of newly enrolled MB patients had potentially blinding leprosy related ocular pathology. Lagophthalmos was associated with increasing age, a short duration between onset and diagnosis, and a previous reaction involving the face. Uveal conditions were associated with increasing age. Overall, eye disease was more common in Indian and Ethiopian patients compared to Filipino patients; however, differences were not significant when controlling for age and clinical (non-ocular) factors. Patients with potentially blinding leprosy related pathology were over three times more likely to have other (hand and foot) disabilities than patients without pathology. Differences in the prevalence of blindness and potentially blinding leprosy related ocular pathology between the sites could be accounted for by the differences in age and other clinical factors of the patients at the different sites. Findings suggest that, even in the face of active leprosy control efforts, around 11% of patients will have potentially blinding pathology at the time of their diagnosis and 2.8% will be blind. If those patients with lagophthalmos or blindness are considered appropriate for referral for more detailed assessment, approximately 4% of newly diagnosed leprosy patients will require active follow-up for eye care; including those with reaction involving the face will result in 9.4% of patients requiring active follow-up. These people are likely to be older, with a reaction involving the face, and/or with other disabilities than those not requiring active follow-up.

Adult↗
PubMed2003

The influence of expanded unmethylated alleles for FRAXA/FRAXE loci in the intellectual performance among Brazilian mentally impaired males.

Both fragile X (FRAXA) syndrome and fragile XE (FRAXE) disorder are caused by an expansion of a polymorphic trinucleotide repeat and are associated with mental impairment. Based on the size and methylation status of the expansion, individuals are classified as having normal, intermediate, premutation or full mutation alleles. Unlike individuals with full mutations, carriers of intermediate and premutated alleles should not exhibit obvious clinical symptoms, since the FMR1 (FRAXA) or FMR2 (FRAXE) genes are not transcriptionally silenced. However, there are data suggesting a phenotype consequence of the FRAXA premutation alleles. We have investigated a population consisted of 276 males with idiopathic mental retardation or learning disability and a control sample of 207 non-affected boys in order to determine if there was a possible phenotype consequence of the expanded unmethylated alleles for FRAXA/FRAXE loci. Direct molecular diagnosis for the FRAXA/FRAXE loci were performed in both populations by using PCR technique and sizing of the amplification products by electrophoresis in denaturing polyacrilamide gels. No FRAXA/FRAXE premutations or FRAXE mutated alleles were observed. The 25 FRAXA full mutations alleles detected were confirmed by Southern blot analysis. We found an excess of intermediate alleles for both FRAXA and FRAXE in the target population, but it did not reach statistically significant difference. This suggests that relatively large unmethylated repeats may not be associated with an abnormal cognitive and/or behavioral phenotype. However, recent evidence that FRAXA premutation alleles in males have increased FMR1 message levels emphasizes the need of more studies using large sample sizes and proper control population to resolve this contradictory observation.

Adolescent↗
PubMed1992

Influenza virus vaccine: a need for emphasis.

Each year, there are more than 20,000 influenza associated deaths during influenza virus epidemics. There is an increase in hospital admission for patients with pneumonia, exacerbation of chronic obstructive pulmonary disease, croup, and congestive heart failure, and an increase in school and industrial absenteeism. Yet only 30% of the high-risk target population receives influenza vaccination annually. Health care providers and patients are reluctant to use vaccine despite its generally excellent record of safety and its approximately 70% efficacy when vaccine and epidemic strains match. The continuing change in antigenic composition of the influenza A virus and waning immunity requires annual vaccination. Vaccine composition and target groups are reviewed. Strategies for improving vaccine usage are emphasized.

Adolescent↗
PubMed1998

Prevalence of dementia in a rural Netherlands population and the influence of DSM-III-R and CAMDEX criteria for the prevalence of mild and more severe forms.

To obtain estimates of the prevalence of mild and moderate/severe dementia among people age 65 and over, applying criteria for severity of both DSM-III-R and CAMDEX, a two-stage community-based study was conducted in a rural area of the Netherlands. In the first stage, 2191 subjects (out of the target population of 2655) participated in an interview which included the Mini-Mental State Examination (MMSE). Based on MMSE score, a non-proportional random sample (n=496) was drawn for the second stage. A total of 421 subjects responded and were subsequently examined using the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX). In determining the severity of dementia, criteria of both DSM-III-R and CAMDEX were applied. Overall prevalence for both classification systems was 6.5%. There was a large discrepancy between the two classification systems with regard to the criteria for rating severity. The prevalence of moderate/severe dementia using DSM-III-R criteria was twice as high as the prevalence using CAMDEX criteria. These findings reflect the differences between DSM-III-R and CAMDEX in descriptions of dementia severity. Rating according to CAMDEX predicts institutionalization in specialized nursing homes somewhat better than staging according to DSM-III-R. Both content analysis and institutionalization data suggest that the CAMDEX operationalization of rating severity seems preferable.

Aged↗
PubMed2003

Exercise and injury prevention in older people.

This review aims to provide the reader with up to date evidence in relation to the role of exercise in the reduction of risk factors and the prevention of falls and injuries. Falls and injury may lead to a spiral of inactivity and decline that take older people close to or below the critical "thresholds" of performance necessary for everyday activities. Yet, low strength and power, poor balance, poor gait and functional ability, and fear of falling are all risk factors for falls modifiable with tailored exercise. Although the evidence on types, amounts and specificity of exercise to prevent falls is not complete, recommendations have been published that have been effective, either as an exercise stand-alone intervention or with exercise as part of a multifactorial intervention. It is clear that the target population must be at risk or already fallers, they must be "not too fit" and "not too frail". Supervised home-based exercise programs may be effective in those aged over 80 because they fall more frequently, injure more easily, and recover more slowly. In younger, community-dwelling, fallers multifactorial group interventions including targeting of balance, strength, power, gait, endurance, flexibility, co-ordination and reaction may be more effective. There are, however, research questions that still need answering - whether there are certain types of exercise harmful in certain subgroups of older people, what is the ideal intensity, frequency and duration of exercise for different subgroups of older people (primary and secondary prevention) and the relative value of the different components of fitness to prevention of falls and injuries. This review highlights the necessity of tailored, specific balance and strength exercise in the multidisciplinary prevention of falls and injuries.

Accidental Falls↗
PubMed1991

Neuroscience nursing research: human subjects considerations.

Permission to conduct research must be obtained from all institutions which will be involved. The special nature of our target population may result in a particularly detailed review. Specific suggestions to facilitate approval to conduct research address utilization of institutional personnel, informed consent and concerns of the IRB. Seek guidance from knowledgeable employees. You can obtain a great deal of useful information from IRB secretaries and nurses who are engaged in research in the target institution. Informing potential subjects about the research is critical, and is best done using strategies such as assuring the language used enhances comprehension. Finally, be prepared to discuss concerns of the IRB. The ability of impaired subjects to communicate with you, the researcher, seems to be of particular concern to many IRBs.

Ethics, Nursing↗
PubMed1994

Validity and reliability of the Winchester Disability Rating Scale (2). A comprehensive screening instrument for the elderly in the community.

Health and social services across the more developed countries in the world are facing the problem of providing care and support for an ever increasing elderly population. It has been suggested that this challenge would best be met by performing frequent 'assessment' of the total elderly population in a country. This would be very difficult and time consuming in a large country with a high number of elderly people. Screening using a broad coarse instrument aimed at identifying variations in dependency over time would be simpler, effective and more likely to be actually performed in the greatest majority of the target population. In developing firstly the Winchester Disability Rating Scale (WDRS) and then the WDRS-2, which includes a subscale for depression, we believe to have found an effective instrument to measure dependency and with it the means to limit hospitalization. We validated the WDRS-2 on a large sample of elderly people living in local authority housing schemes, and were able to demonstrate that our instrument has both high specificity and high sensitivity for the identification of depression in elderly people living in the community. This new instrument offers primary care physicians the opportunity to rapidly and successfully assess their elderly patients living in the community.

Aged↗
PubMed1997

Gene transfer and delivery in central nervous system disease.

Gene transfer offers the potential to explore basic physiological processes and to intervene in human disease. The central nervous system (CNS) presents a fertile field in which to develop novel therapeutic modalities to treat intractable and pervasive malignant tumors and neurodegenerative disease. The extension of gene therapy to the CNS, however, faces the delivery obstacles of a target population that is postmitotic and isolated behind a blood-brain barrier (BBB). Approaches to this problem have included grafting of genetically modified cells to deliver novel proteins or introducing genes by viral or synthetic vectors geared toward the CNS cell population. Direct inoculation and bulk flow, as well as osmotic and pharmacological disruption, have been used to circumvent the BBB's exclusionary role. Once the gene is delivered, myriad strategies have been used to affect a therapeutic result. Genes activating prodrugs are the most common antitumor approach. Other approaches focus on activating immune responses, targeting angiogenesis, and influencing apoptosis and tumor suppression. At this time, therapy directed at neurodegenerative diseases has centered on ex vivo gene therapy for supply of trophic factors to promote neuronal survival, axonal outgrowth, and target tissue function. Despite early promise, gene therapy for CNS disorders will require advancements in methods for delivery and long-term expression before becoming feasible for human disease.

Journal Article↗
PubMedDate not supplied

[The spread of human immunodeficiency virus infection (HIV-1/HIV-2) and of hepatitis B and C in non-drug-addicted prostitutes. Extremadura].

BACKGROUND: The proportion of cases of AIDS in Extremadura, in which sexual transmission has existed, is comparatively lower than the national one. The possibilities of the infection introduction in the general population may increase the relative importance of this way of transmission in the future. Penetration of HIV is unknown in prostitutes living and working in the Autonomous Community of Extremadura, as a collective associated to virus sexual transmission and to other socio-cultural risk factors involved. METHODS: Women exercising prostitution are established as "target" population; the existence of intravenous drug addiction in the last 5 years is the criterion for exclusion, the sample comes from 11 nodal populations of Extremadura, and is constituted by 95 persons, selected in their own working places and having previously obtained their informed consent. The city American bar, 37.9%, the prostitution house 32.6%, and the road American bar are the most frequent kinds of prostitution. Besides the socio-sanitary poll, infections by HIV-1, HIV-2, Hepatitis B,C, virus, associated to certain risk practices are investigated. RESULTS: The prevalence of infection by HIV-1 is 1.05% with confidence intervals of 0 and 3%; no seropositivity to HIV-2 was detected. In forty-two out of the women surveyed, 44, 21% show some positive marker of the hepatitis-B (HBV) (C.I. 95% 34.1-54.2). Antibodies to the Hepatitis C virus (Anti-HCV) are present in three women, 3.16% (C.I. 95% 0-6%). Among the risk practices studied, it stands out that 44% use condoms in their relations with clients and only in 2.54% because of clients demand. In unremunerated couples, between 50 and 70% never use preservatives in sexual relations. CONCLUSIONS: These results suggest that infections by HIV-1/HIV-2 are not prevalent in non drug-users prostitutes in Extremadura. Likewise, the low use of preservative, in professional relations as well as in couples, is significative; and it stands out the high frequency of refusal to use preservatives by clients or partners. It is considered necessary to increase health education of these collectives and general heterosexual population, in order to change attitudes in private or professional sexual relations.

Adult↗
PubMed1998

Cervical cancer awareness and risk factors among female university students.

Population cervical screening programmes are necessary for meaningfully reducing cervical cancer morbidity and mortality. Because of the high incidence of cervical cancer in South Africa, the need for a national screening programme has become evident. The success of such a programme will depend on, among others, the level of cervical cancer awareness among the target population, and their willingness to utilise cytological services and to comply with treatment and follow up protocols. We conducted a survey among female university students, as an elite group of women, to determine their level of cervical cancer awareness and the prevalence of the major risk factors for cervical cancer among them, their rate of utilisation of existing Pap smear services, and their attitudes to Pap smears in general. The majority of respondents were young, single (93.0%) and sexually active (86.9%,) having initiated sexual activity at a mean age of 17.27 +/- 2.18 years. There was a high prevalence of the major risk factors for cervical cancer among the respondents, and these included initiation of coitus before 18 years (53.3%), multiple sexual partners (73.6%), male partner with other partners (37.7%), and previous history of sexually transmitted diseases (42.2%) and vulval warts (4.7%). Their overall knowledge of cervical cancer was poor, although the majority of respondents were able to identify the major risk factors from a given list. This level of awareness of cervical cancer risk factors, however, did not translate into appreciation of personal risk of cervical cancer, safer sex practices or utilisation of Pap smear services. In conclusion, this elite group of women is at a high risk of cervical cancer and would benefit from cervical screening programmes. This would have to be coupled with measures to increase the level of awareness and knowledge of cervical cancer and its prevention.

Adolescent↗
PubMed2000

Using randomized controlled trials to evaluate socially complex services: problems, challenges and recommendations.

BACKGROUND: Following the lead of evidence-based medicine, practice based on effectiveness research has become the new gold standard of contemporary public policy. Studies of this sort are increasingly demanded to evaluate services provided by mental health, social services and criminal justice systems. AIMS: The paper questions whether the simple randomized controlled trial (RCT) paradigm as applied in clinical trials can be used "off the rack" to evaluate socially complex service (SCS) interventions. These are services that are characterized by complex, diverse and non-standardized staffing arrangements; ambiguous protocols; hard-to-define study samples and unevenly motivated subjects and dependence on broader social environments. The difficulty of ensuring precise protocols, equivalent groups (tied to a meaningful target population) and neutral and equivalent trial environments under real world conditions are explored, as are the implications of not achieving standardization and equivalence. METHODS: Limitations of effectiveness research as a research tool and information source are examined by comparing the assumptions underpinning the simple RCT to the characteristics of SCS interventions, as illustrated by programs targeted to mentally disordered offenders in Britain. RESULTS: SCSs violate the assumptions underpinning the simple RCT model in ways that draw into sharp question the validity, reliability and generalizability of inferences of SCS trials. DISCUSSION: The RCT is not a panacea. Effectiveness research of SCS interventions that is based on the RCT model is unlikely to yield valid, reliable and generalizable inferences without becoming more complex in design and more sensitive to issues of selection bias, unmeasured variables and endogeneity. Ten recommendations are offered for stylizing the RCT design to the characteristics of socially complex services. IMPLICATIONS: It remains an empirical issue whether RCT-based services effectiveness research can inform mental health policy. Without major design innovations, it is more likely that the information generated by this research will have limited practical use, especially if the RCT model is unable to control for the effect of social complexity and the interaction between social complexity and dynamic systemic change. Scientific evaluations of services make clinical and economic sense so long as they are designed to meet the challenges of the services of which they promise greater knowledge.

Journal Article↗