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PubMed1996

Community-level prevention of human immunodeficiency virus infection among high-risk populations: the AIDS Community Demonstration Projects.

The AIDS Community Demonstration Projects (ACDPs) were community-level human immunodeficiency virus-prevention programs targeting high-risk populations in five U.S. cities. For the intervention design, researchers developed a common study protocol based on behavior-change theories and models. This report describes the common study protocol used in the ACDPs, the preliminary findings, and the conclusions regarding the design, implementation, and evaluation of a community-level intervention; specific case studies from each project site are also described.

Clinical Protocols↗
PubMed2003

Pathogen frequency in an age-structured population of Plantago lanceolata.

Life-history traits can play important roles in determining the course of ecological species interactions. We explored the consequences of host age on a host-pathogen interaction by quantifying pathogen frequency in an age-structured host population. Our project was motivated by an interest in whether the demographic structure of a host population has consequences for species interactions. In 2 successive years, we planted large cohorts of the perennial herb Plantago lanceolata in its natural environment and observed infection by Fusarium moniliforme, a non-lethal floral fungal pathogen, over 3 years. We documented substantial variation of pathogen frequency across years and between cohorts. Logistic regression revealed that pathogen frequency increased with the number of inflorescences produced and with evidence of prior pathogen presence, whereas it decreased with increasing plant longevity. In addition, interannual variation and an age-year interaction contributed to the observed pathogen frequencies. There was a significant positive effect of age on pathogen frequency overall, but this was not consistent over all ages. Pathogen frequency was higher in 2-year-old plants than in 1-year-olds, suggesting that age-structure can influence the host-pathogen interaction. This pattern did not continue into 3-year-old plants. A possible explanation for this is that selective mortality allows only generally robust plants, and consequently the most resistant plants, to survive to the oldest ages.

Ecology↗
PubMed1978

Life-support training in high-density population centers.

Death and disability from ischemic heart disease, trauma, and other medical emergencies may be reduced significantly by developing an Emergency Medical Services system based on training for the nonmedical population in basic life-support skills; this is particularly appropriate in high-density population centers where professional response time is complicated by confestion and traffic. A pilot project in New York City, which designed and implemented a first-response capability for medical emergencies in corporations, using employees in a system congruent with the fire warden plans in effect, was completed in May 1977. To obtain an initial assessment of the medical impact of such training and the effectiveness of such a medical emergency response system during the pilot phase, The Regional Emergency Medical Services Council of New York City, Inc., obtained reports from the 24 participating corporations on all reported medical and surgical emergencies occurring in the working environment. The authors conclude that this approach to development of a first response-capability can provide an effective community base for an effective Emergency Medical Services system in urban areas.

Adult↗
PubMed2005

Cardiovascular disease and risk factors in three Alaskan Eskimo populations: the Alaska-Siberia project.

OBJECTIVES: To determine the prevalence of CVD and to identify and characterize associated risk factors in three distinct Eskimo populations. STUDY DESIGN: Cross-sectional. METHODS: A slightly modified Strong Heart Study protocol was followed to examine 454 participants, aged 25-91, from four villages. RESULTS: Overall, 6% of the participants under 55 years of age and 26% of those > or = 55 years of age showed evidence of CHD by ECG, or in patient records. The prevalence of "definite coronary heart disease" (CHD) in women with glucose intolerance (GI) was 21.0%, compared to 2.4% in those with normal glucose tolerance (NGT). Men had comparable values of 26.7% and 6.3%. In addition, comparable values for "possible CHD" were 29.7% vs 6.0% for women and 21.4% vs 8.0% for men. GI was associated with relatively higher prevalences of CHD in women than in men (prevalence ratio = 8.5 vs 4.3). CHD was significantly related to age, glucose intolerance and insulin. Hypertension and obesity were significantly associated with CHD only in some ethnic groups. The prevalence of current smokers was 56%. CONCLUSIONS: Recent changes in lifestyle and diet of Alaskan Eskimos, leading to obesity, hypertension, insulin resistance and DM, contribute to an increased risk for cardiovascular disease.

Adult↗
PubMed1986

Living longer in the United States: health, social, and economic implications.

The age structure of the population of the United States has shifted with improvements in mortality rates and decreasing fertility rates, so that there are an increasing number and proportion of the population aged 65 and over. The elderly are at risk for chronic illness and disabling conditions that require considerable medical resources. The elderly population is projected to continue its rapid growth well into the 21st century, with the very old projected to increase at the fastest rate. These demographic projections will have significant implications on the medical care system in terms of the supply and distribution of health practitioners to meet their medical care needs. Alternative long-term care community services are required to prevent high cost institutionalization. The projected growth of the elderly will also place a larger burden on the working population to finance Social Security and Medicare.

Aged↗
PubMed1986

Projection of mean and variance functions for population processes with time-homogeneous laws of evolution.

This paper provides algorithms for projection of mean and covariance functions for stochastic population processes governed by time-homogeneous laws of fertility and mortality. The theoretical foundation of the algorithms is general age-dependent branching processes in discrete time. The algorithms are employed in several illustrative projections, based on 1982 Chinese data, of a population experiencing an abrupt transition to below replacement fertility. Methods of constructing confidence limits for total population size are illustrated. Also developed are procedures for projecting mean and variance functions for populations which may be heterogeneous with respect to mortality or fertility. The projections performed yield two observations. First, the coefficient of variation in population size appears to be inversely related to the Malthusian parameter of population growth. Second, the coefficient of variation for population size is negligible for large homogeneous initial populations. But when the initial population is heterogeneous with respect to fertility or mortality, then substantial coefficients of variation, exceeding 0.4, are observed in some of the projections performed.

Analysis of Variance↗
PubMed2001

Diversity in emergency medicine--a model program.

Emergency medicine's (EM's) development as a specialty has spanned the last 25 years, with the first certifying examination administered by the American Board of Emergency Medicine in 1980. National census data project that the new millennium will bring a U.S. population that will be 40% minority. In the year 2000, the U.S. population had a projected minority population of 28%. The diversity of the patients we treat demonstrates the need for EM programs to diversify their faculty and residency staff. Strategies include expanding recruitment and supporting retention of underrepresented students, faculty, and trainees, addressing barriers that may exist for promotion of underrepresented women and minorities, mentoring underrepresented minority (URM) faculty in research and education, providing opportunities for URMs to advance in the field, and mentoring URMs at the junior high and high school levels in the sciences to expand the applicant pool in the field. The authors describe an academic EM program that is a model program for diversity within our specialty.

Academic Medical Centers↗
PubMed2005

Influence of leisure-time physical activity on the relationship between C-reactive protein and hypertension in a community-based elderly population of Japan: the Tsurugaya project.

There are several studies indicating an association between C-reactive protein (CRP) and blood pressure (BP) in the Japanese population, but the influence of physical activity has not been considered. Therefore, we designed a cross-sectional survey to determine whether leisure-time physical activity (LTPA) modifies the relation between CRP and hypertension among Japanese elderly. Our study population comprised 643 subjects aged 70 years and over in whom CRP, home BP, and self-reported LTPA were measured. LPTA was categorized into three levels of intensity--walking, brisk walking, and sports-and a questionnaire was used to estimate the level in each patient. Hypertension was defined as a home systolic BP of 135 mmHg or over and/or home diastolic BP of 85 mmHg or over or current use of antihypertensive agents. LTPA levels were associated with both CRP and hypertension. After adjustment for factors affecting CRP and hypertension, and additional adjustment for LTPA levels, the odds ratio (95% confidence interval) of hypertension by CRP was 2.21 (range: 1.33-3.72), 1.99 (1.17-3.42), and 2.38 (1.36-4.21) times higher in subjects in the second, third, and fourth quartiles of CRP, as compared to subjects in the first quartile, respectively. A multiple regression model showed a positive and significant relation between log-transformed CRP and systolic BP after adjustment for potential confounding factors when participants taking antihypertensive medication were excluded. This is the first study to clarify that the positive significant relation between CRP and hypertension was independent of LTPA levels among Japanese elderly.

Aged↗
PubMed2005

Effect of population aging on proportionate mortality from heart disease and cancer, U.S. 2000-2050.

OBJECTIVE: One-fourth of all deaths in the United States occur after age 85 (646,900 of 2,392,619 total deaths in 1999). By 2050 (assuming 1999 age-specific death rates), 47.4% of all deaths will occur after age 85 (2,994,935 of 6,314,725 total deaths). As we age, heart disease becomes increasingly important relative to cancer as a cause of death. Thus, as age at death is postponed, future populations will be dying of different age-specific causes. The study objective was to project the effect of population aging on future proportionate mortality rates for heart disease and cancer. METHODS: Using Census Bureau population projections and assuming 1999 age-specific death rates, the authors calculated the number of deaths from heart disease, cancer, and all causes in 10-year intervals from 2000 to 2050. RESULT: During this period, the total number of deaths for heart disease and cancer will increase 2.8-fold and 2.3-fold, respectively. The proportionate mortality rate for heart disease will increase from 30% to 33%, and the rate for cancer will drop from 23% to 20%. DISCUSSION: Changes in age distribution between now and 2050 will cause heart disease to increase its dominance over all other causes of death, and proportionate mortality for cancer will decline.

Adolescent↗
PubMed1990

Extensive co-occurrence of substance P and dynorphin in striatal projection neurons: an evolutionarily conserved feature of basal ganglia organization.

A number of different neuroactive substances have been found in striatal projection neurons and in fibers and terminals in their target areas, including substance P (SP), enkephalin (ENK), and dynorphin (DYN). In a preliminary report on birds and reptiles, we have suggested that SP and DYN are to a large extent found in the same striatal projection neurons and that ENK is found in a separate population of striatal projection neurons. In the present study, we have examined this issue in more detail in pigeons and turtles. Further, we have also explored this issue in rats to determine whether this is a phylogenetically conserved feature of basal ganglia organization. Simultaneous immunofluorescence double-labeling procedures were employed to explore the colocalization of SP and DYN, SP and ENK, and ENK and DYN in striatal neurons and in striatal, nigral, and pallidal fibers in pigeons, turtles, and rats. To guard against possible cross-reactivity of DYN and ENK antisera with each others' antigens, separate double-label studies were carried out with several different antisera that were specific for DYN peptides (e.g., dynorphin A 1-17, dynorphin B, leumorphin) or ENK peptides (leucine-enkephalin, metenkephalin-arg6-gly7-leu8, methionine-enkephalin-arg6-phe7). The results showed that SP and DYN co-occur extensively in specific populations of striatal projection neurons, whereas ENK typically is present in different populations of striatal projection neurons. In pigeons, 95-99% of all striatal neurons containing DYN were found to contain SP and vice versa. In contrast, only 1-3% of the SP+ striatal neurons and no DYN neurons contained ENK. Similarly, in turtles, greater than 75% of the SP+ neurons were DYN+ and vice versa, whereas ENK was observed in fewer than 5% of the SP+ neurons and 2% of the DYN+ neurons. Finally, in rats, more than 70% of the SP+ neurons contained DYN and vice versa, but ENK was found in only 5% of the SP+ neurons and in none of the DYN+ perikarya. Fiber double-labeling in the striatum and its target areas (the pallidum and substantia nigra) was also consonant with these observations in pigeons, turtles, and rats. These results, in conjunction with studies in cats by M.-J. Besson, A.M. Graybiel, and B. Quinn (1986; Soc Neurosci. Abs. 12:876) strongly indicate that the co-occurrence of SP and DYN in large numbers of striatonigral and striatopallidal projection neurons in a phylogenetically widespread, and therefore evolutionarily conserved, feature of basal ganglia organization.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed2005

Predicted and observed cardiovascular disease in South Asians: application of FINRISK, Framingham and SCORE models to Newcastle Heart Project data.

BACKGROUND: South Asian populations in the United Kingdom have a high risk of cardiovascular disease (CVD) mortality. Risk prediction models appear to be inaccurate in South Asians. OBJECTIVE: To explore the predictive capacity of the FINRISK, Framingham (1991) and SCORE risk prediction models in the Newcastle Heart Project population (n = 1301). METHODS: Mortality data for England and Wales were used to define the expected ranking of CVD risk by country of birth. CVD mortality in the Newcastle Heart Project sample was examined. Risk factor measures were obtained from the Newcastle Heart Project, where 90 percent of South Asians were born in the Indian Subcontinent. The predicted outcomes for FINRISK were acute myocardial infarction and CHD mortality, for Framingham CHD mortality, myocardial infarction, new angina and coronary insufficiency and for SCORE CHD and non-CHD CVD mortality. RESULTS: The FINRISK model predicted in South Asian men combined, compared with Europeans, a risk ratio of 122 per cent (SMR 142) with substantial subgroup heterogeneity, e.g. 154 per cent in Bangladeshis (SMR 151), 129 per cent in Pakistanis (SMR 148), 99 per cent in Indians (SMR 142). The FINRISK risk ratios for South Asian women combined were 160 per cent (SMR 145), for Bangladeshis 184 per cent (SMR 91), Pakistanis 172 per cent (SMR 111) and for Indians 145 per cent (SMR 158). The Framingham model results were very similar to FINRISK, but the SCORE model showed comparatively low 10 year risk in all South Asian groups. Both the Framingham stroke model and the SCORE non-CHD CVD model predicted comparatively low rates, while national data showed these to be high. Control of the five major risk factors was modelled by FINRISK to reduce risk by about 59 per cent in South Asian men and 67 per cent in South Asian women, with some subgroup heterogeneity, compared to 50 per cent in European men and 48 per cent in European women. The Framingham model results were similar. The absolute rates for each ethnic group varied by model. CONCLUSION: The Framingham and FINRISK models gave similar results, mostly following expected patterns, but the SCORE model did not, probably reflecting its lack of inclusion of HDL and diabetes as risk factors. National mortality data and modelled predictions agreed reasonably well for South Asians combined, and Bangladeshi and Pakistani men, but not for Indian men and Pakistani and Bangladeshi women. The varying rates show the limits of modelling. The models suggest the potential gains from controlling major established risk factors could be substantial in South Asians and greater than in Europeans.

Adult↗
PubMed1989

A graphic representation of projection accuracy.

The author examines "the problem of measuring projection accuracy. Experience with applying the accuracy measure 'quality of prediction', as proposed by Keyfitz, leads the author to a critical evaluation and elaboration of this accuracy measure. Time series of prediction quality values may show a remarkable temporal instability, partly depending on the chosen bench mark, which seriously hinders interpretation. This interpretation problem may be solved by an easily applicable graphical solution, a convenient short-circuit device to assess a projection's accuracy without restrictions as to size of population or length of projection period." The concepts are illustrated with data used for population forecasts for the Netherlands during the 1970s. (SUMMARY IN FRE)

Demography↗
PubMed2000

An estimate of long-term care needs and identification of risk factors for institutionalization among Hong Kong Chinese aged 70 years and over.

BACKGROUND: The goal of this study is to estimate the long-term care needs of the Hong Kong Chinese population age 70 years and older, and to identify risk factors for institutionalization. METHODS: A three-year prospective follow-up study was carried out in Hong Kong Special Administrative Region, China. 2,032 subjects aged 70 years and older were recruited territory-wide by stratified random sampling of the Old Age and Disability Allowance register, covering over 90% of the elderly population. A questionnaire was administered at baseline to obtain information on social, functional, physical, and mental health status, and place of residence. A repeat interview was carried out at 36 months. The number of subjects moving from home to institution or vice versa, and the number who had died, were noted. Univariate analysis was performed to determine risk factors for institutionalization, and backward stepwise multiple logistic regression was used to identify independent factors predisposing to institutionalization. RESULTS: The institutionalization rate per year is estimated to be 0.7% for the 70-79 age group, and 1.5% for the 80+ age group. Using population figures projected by the Hong Kong Census, the corresponding number of places required will be 24,150 and 42,000, respectively, for the two age groups by 2005, whereas the number of government subvented places projected to be available is unlikely to be more than 40,000 for the whole population. Age, being a woman, being single, not having a formal education, cognitive impairment, physical dependency, and the presence of depressive symptoms were factors predisposing to institutionalization. In multivariate analysis, age, marital status, and dependency were identified as independent factors. CONCLUSION: The requirement for institutional places is unlikely to be met by government, the shortfall likely to be met by the private sector. Maintenance of functional independence, good social support network, engagement in social activities, and good informal carer support may reduce demand for institutional care.

Activities of Daily Living↗
PubMed2001

Geriatric oral health issues in the United States.

Of the more than 270 million people in the United States, about 13 per cent are aged 65 years or older. As in most other countries throughout the world, this proportion of the population is projected to increase in the coming years. To care for this ageing and racially/ethnically diverse population, health care professionals, especially dentists, must initiate changes in public policies, available resources and access to services. The dental profession especially must improve awareness among the general public and health care professionals of the link between oral health and general health. Immediate improvements should be made to increase the proportion of dentists who are willing and qualified to treat these patient groups. Increasing the reimbursement rates available through the Medicaid programme and expanding the types of services Medicaid recipients can seek are critical. Dental education programmes must continue to provide more training opportunities to prepare professionals to meet the needs of these patients.

Aged↗
PubMedDate not supplied

[Age-related changes in lipid metabolism parameters: screening studies on a population basis].

Measurement of concentrations of total cholesterol, high density lipoprotein (HDL)-cholesterol and Lp(a) was carried out within a screening project on population basis including 3014 men and 5529 women of the town Leipzig. The age of the participants varied from 18 to 99 years. The aim of this population-based strategy was to identify individuals with elevated risk with regard to atherosclerotic diseases. There is an age dependence with a maximum of the ratio total cholesterol/HDL cholesterol in the age group 61-70 years. Between the ages 50 and 70 years, mean total cholesterol levels in women exceed those of men. Postmenopausal women show higher Lp(a) concentrations than premenopausal women. The observed age dependence of lipid profile may be the result of both intrinsic as well as of environmental factors which are characteristic for industrialized societies.

Adolescent↗