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PubMed2003

[Increasing life expectancy--the big social issue of the 21st century?].

Due to the combined effects of a persistent low birth rate, the forthcoming retirement of the "baby-boom generation" and an increasing life expectancy, the German system of "social security" will face severe challenges in the coming decades. The foreseeable doubling of the ratio between pensioners and employees by 2050 would cause a strong increase in social security contributions and taxes for the "pay-as-you-go"-financed pension system. In addition, the expected tripling of highly aged people would increase the public expenditures for health care and nursing care of elder people, which also have to be financed by the future working generations. In order to lessen the increasing burden on future generations, social reforms are necessary soon. If these are not performed, the distributional conflict between young and old people could become worse over the forthcoming decades.

Aged↗
PubMed2001

Comparisons of cancer detection rate and costs of one cancer detected among different age-cohorts in immunochemical occult blood screening.

PURPOSE: This study was carried out to compare the detection rate for colorectal cancer and the average costs to detect one patient with colorectal cancer among three different age-cohorts in immunochemical occult blood screening by OC-Hemodia. METHODS: In a population-screening program, 17,432 subjects received an immunochemical fecal occult blood test. In a medical checkup for colorectal cancer 7,232 subjects received colonoscopy. They were divided into three groups according to their ages: younger (4,049 years); middle (50-59); and older (60+) groups. The detection rate for colorectal cancer and the average costs to detect one patient with colorectal cancer were evaluated among the three groups. RESULTS: In the screening program-based study, the cancer detection rate and the average costs for one colorectal cancer detected were calculated as 0.09% and $13,352, 0.28% and $4,555, 0.29% and $4,461 for the younger, middle, and older groups, respectively. In addition, in the medical checkup-based study, the detection rate and the average costs were calculated as 0.3% and $6,851, 1.5% and $1,517, 1.7% and $1,391 for the younger, middle, and older groups, respectively. In these two studies, the cancer detection rates were significantly different between the younger and middle groups (P < 0.05), and between the younger and older groups (P < 0.05). CONCLUSIONS: These findings indicate that the subjects aged under 50 have some disadvantage when carrying out the immunochemical fecal occult blood test--OC-Hemodia for colorectal cancer screening--from the viewpoint of screening efficiency as well as cost-effectiveness.

Adult↗
PubMed2002

[The ThinPrep Pap test in population screening].

The ThinPrep technique has been applied to Pap tests in a population screening program in Imola, Italy. A significative decrease in the number of inadequate tests has been observed, while the distribution of the Bethesda diagnostic categories was not different in comparison to the previous year, when conventional Pap tests were used with the adoption of the ThinPrep technique, the productivity of the screening program increased without any need to modify the screening protocol.

Adult↗
PubMed2006

Projecting the number of patients with colorectal carcinoma by phases of care in the US: 2000-2020.

OBJECTIVE: This study provides projections of colorectal cancer prevalence by phases of care (initial, monitoring, and last year of life) to the year 2020 and describes the estimation method. METHODS: Cancer prevalence by phase of care was estimated from colorectal cancer incidence and survival from the Surveillance, Epidemiology, and End Results (SEER) Program data, population estimates and projections from the US Census Bureau, and all cause mortality data from the Human Mortality Life Tables. Assumptions of constant incidence and survival were used for projections from 2000 to 2020. Modeled and directly observed patient months by phase of care were compared for 1996 -1998 to provide validation of estimates. RESULTS: Prevalence of colorectal cancer is estimated to increase from 1,002,786 (0.36%) patients to 1,522,348 (0.46%) patients between 2000 and 2020. The estimated number of person-months in the initial and last year of life phases of care will increase 43%, while the monitoring phase of care will increase 54%. Modeled person-months by phase of care were consistent with directly observed measures of person months by phase of care in 1996-1998. CONCLUSIONS: Under assumptions of current cancer control strategies we project that colorectal cancer prevalence will increase more rapidly than the US population, largely due to the aging of the US population. This suggests that considerable resources will be needed in the future for initial, continuing and last year of life treatment of colorectal cancer patients unless notable breakthroughs in primary prevention occur in the future years.

Age Distribution↗
PubMed2006

Newborn screening for cystic fibrosis: parents' preferences regarding counseling at the time of infants' sweat test.

Newborn screening (NBS) protocols for cystic fibrosis (CF) are the first regional population-based programs to incorporate DNA analysis into their procedures. Research about these programs can inform policy and practice regarding how best to counsel families with abnormal NBS results. The grounded theory method guided interviews with 33 families whose infants had abnormal CF NBS results. A dimensional analysis of these interviews provided a theoretical framework describing parents' preferences regarding counseling during their infant's sweat test appointment. This framework describes the contexts and characteristics of the two main dimensions of parents' preferences: factual information and emotional support. Factual information included learning about the probability of a CF diagnosis, CF disease facts, sweat test procedure, and CF genetics. Social support consisted of offering parents a choice about the timing and amount of CF information, showing empathy for their distress, instilling hope, personalizing counseling, and providing hospitality. This framework also explains the consequences of counseling that matched versus mismatched parental preferences in these domains. Counseling that matched parents preferences reduced parents' distress while mismatched counseling tended to increase parents' worry about their infant.

Adaptation, Psychological↗
PubMed2006

Prevalence and predictors of club drug use among club-going young adults in New York city.

"Club drugs" encompass a diverse range of substances. Although efforts have been made to determine the extent of club drug use among the general population, it is equally important to assess patterns of use among key target populations from which drug trends typically diffuse. This paper describes the results of a survey focused upon club drug use among club-going young adults in NYC. Time-space sampling generated a sample of 1,914 club-going young adults (ages 18-29) who provided data on their use of six key club drugs: ecstasy, ketamine, cocaine, methamphetamine, GHB, and LSD, as well as data on their gender, sexual orientation, race/ethnicity, and other demographic variables. Club-going young adults report drug use at high rates-70% report lifetime illicit drug use and 22% report recent club drug use. Rates of club drug use differ by gender, sexual orientation and race/ethnicity. Male gender is predictive of ketamine, GHB, and methamphetamine use, while female gender is predictive of cocaine use. Gay/bisexual orientation and White race are predictive of the use of several club drugs. Greater health promotion efforts are warranted among this population. Intervention programs and campaigns should tailor specific drug messages to differentially target various segments of dance club patrons.

Adolescent↗
PubMed1987

Antiarrhythmic effects of indecainide in a drug-resistant population with ventricular tachycardia at programmed electrical stimulation.

The antiarrhythmic properties of indecainide were studied in 15 patients with a history of a cardiac arrest or ventricular tachycardia. Programmed electrical stimulation studies were performed in nine men and six women with a mean age of 68 +/- 2 years and a mean left ventricular ejection fraction of 41 +/- 4%. All patients had inducible ventricular tachycardia by programmed electrical stimulation while off all antiarrhythmic therapy. Patients were then tested on procainamide, 1000 mg, administered intravenously, and ventricular tachycardia could be provoked in 10 of 15 patients. Indecainide was given intravenously, 1 mg/kg. Indecainide did not significantly change the baseline heart rate, blood pressure, and QTc interval from control values. The PR and QRS intervals were significantly prolonged. Twelve of 15 patients were still inducible for ventricular tachycardia on indecainide. Procainamide protected 5 of 15 patients against ventricular tachycardia induction. In patients still inducible on indecainide therapy, the ventricular tachycardia rate was significantly slowed, from 281 bpm to 224 bpm on indecainide and to 215 bpm on procainamide. The effects of this new class IC antiarrhythmic agent appears similar to procainamide in patients with serious life-threatening tachyarrhythmias.

Aged↗
PubMed1985

TOPPER, a software package in FORTRAN for scaling studies.

Scaling studies are concerned with the differences in structure, function, behaviour and life-history associated with differences in size in broadly similar organisms. These studies make extensive use of bivariate regression analysis. Often it is of interest to carry out such analyses on many different subpopulations within a given sample population. The programs described here allow these analyses to be carried out efficiently. The output gives a summary of taxonomic parameters in addition to the usual statistical parameters, such as standard deviations and mean percent deviation. Some improvements in the software which are currently being implemented are discussed briefly.

Animals↗
PubMed1989

Countrywide perinatal surveillance in Czechoslovakia.

Countrywide perinatal surveillance in four 10-year periods of Maternal Child Health (MCH) care development in Czechoslovakia is described. During this time maternal mortality decreased from 137 to 17/100,000 live births, and perinatal mortality (PMR) from 51 to 12/1000. On the basis of study results, countrywide intervention strategies concerning organization as well as medical measures were gradually drawn up. The greatest decrease in PMR was found through basic perinatal care for all; greatest efficiency followed employment of a risk approach.

Czechoslovakia↗
PubMed1995

Fertility control using intrauterine devices: an alternative for population control in wild horses.

The purpose of this study was to develop a contraceptive method for feral horses. The feral horse population has increased significantly in recent years despite attempts to control numbers. As in most wild animal population control programs, contraceptive methods must be easy to apply, cause minimal disruption to the social structure and be fully reversible. In the present study, we tested the effectiveness of an intrauterine device (IUD) for fertility control in mares. Six mares were fitted with a silastic O-ring-shaped IUD on July 1 of Year 1. The IUD-treated mares were turned out with 12 nontreated mares and a fertile stallion in a large pasture until October 20 (112 d). None of the IUD-treated mares and all the nontreated mares became pregnant. The IUD-treated mares were maintained separately from the stallion during the winter. Following removal of the IUD on April 27 of Year 2, the mares were again introduced to the pasture with the stallion together with 6 nontreated mares. For the 6 mares previously treated with an IUD, the mean interval from introduction to the stallion to conception was 17.5 +/- 5 d or 1.3 cycles per pregnancy, and all mares produced a normal foal at term. Subsequently, 19 recorded mare breeding seasons resulted in 18 foals. Uterine cytology and histopathology indicate that the IUD causes mild chronic endometritis without permanent changes in the endometrium. We conclude that based on our observations, the O-ring-shaped IUD is an effective, safe and practical contraceptive method for mares.

Journal Article↗
PubMed1992

Contraceptive efficacy of lactational amenorrhoea.

Pregnancy is rare among breastfeeding women with lactational amenorrhoea. The lactational amenorrhoea method (LAM) is the informed use of breastfeeding as a contraceptive method by a woman who is still amenorrhoeic, and who is not feeding her baby with supplements, for up to 6 months after delivery. Under these three conditions, LAM users are thought to have 98% protection from pregnancy. It can be difficult, however, to determine when supplementation of the baby's diet begins. We have analysed data from nine studies of the recovery of fertility in breastfeeding women to assess the effectiveness of lactational amenorrhoea alone, irrespective of whether supplements have been introduced, as a fertility regulation method post partum. Cumulative probabilities of ovulation during lactational amenorrhoea were 30.9 and 67.3 per 100 women at 6 and 12 months, respectively, compared with 27.2 at 6 months when all three criteria of the LAM were met. Cumulative pregnancy rates during lactational amenorrhoea were 2.9 and 5.9 per 100 women at 6 and 12 months, compared with 0.7 at 6 months for the LAM. The probability of pregnancy during lactational amenorrhoea calculated from these studies is similar to that of other modern contraceptive methods, and it seems reasonable for a woman to rely on lactational amenorrhoea without regard to whether she is fully or partly breastfeeding. So that amenorrhoea and fertility suppression can be maintained, counselling about good breastfeeding and weaning practices remains important.

Actuarial Analysis↗
PubMed1993

Variations in national infectious diseases surveillance in Europe.

Because the Maastricht treaty includes a chapter on public health in the European Community (EC) public health surveillance needs to be developed at EC level. To assess the feasibility of EC surveillance we did a survey of national systems in Europe in 1991-92. In seventeen countries (twelve EC plus Austria, Finland, Norway, Sweden, and Switzerland) the public health institution(s) responsible for surveillance were visited to collect standardised data on surveillance systems for sexually transmitted diseases (STD), hepatitis, and tuberculosis (TB). Surveillance systems varied widely by type, design, and quality. Although mandatory notification has a place in nearly all countries there is a trend towards voluntary systems based on samples of physicians, clinics, or laboratories. The time unit for reporting ranged from daily to once a year. For mandatory notification systems of STD completeness of reporting varied from over 90% to less than 10% and most countries did not use case definitions. Surveillance data were disseminated through national epidemiological bulletins in twelve countries, and the bulletin was a weekly one in six. The heterogeneity of national public health surveillance systems that this survey has revealed points to the need for a coordinated approach if surveillance at an EC level is to be developed.

Communicable Disease Control↗
PubMed1986

A "concerted" approach to health care financing in the Federal Republic of Germany.

An overview is given on how the German health care system is financed, on the 'concerted action approach to health care' and on the long-term perspectives of the statutory sickness fund system as the very heart of the financing system. In all three parts the effects of different ways of financing on the allocation of health care resources and their distributional effects are dealt with. As the concerted action appears as a 'third way' between a pro-competition strategy and a governmental approach to health care and differs from the way other countries organize the allocation of health care resources it is given special emphasis.

Data Collection↗
PubMed1990

Health locus of control beliefs and alcohol-related factors that may influence treatment outcomes.

Treatment programs have based their treatment approach on the premise that alcoholics should exert internal control over situations and events that affect them. Since chronic alcohol use affects the health of an individual, Walston and Walston's Multidimensional Health Locus of Control Scale was administered to 47 alcoholics in a treatment program. The population reflected a higher belief that health status is more under their own control than under the control of chance or powerful others. However, the results indicated that recovering alcoholics with a more powerful other health orientation tended to maintain membership longer with Alcoholics Anonymous, would seek help sooner, would begin heavy drinking at a later age, and would attempt formal treatment more often.

Adolescent↗