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PubMed1991

Opportunistic screening for hypercholesterolaemia with participants selected by the general practitioner. Inclusion and drop-out rate.

The objective of this study was to evaluate a method for opportunistic hypercholesterolaemia screening in primary care. At Lyckeby Primary Health Care Centre in Southern Sweden, where six general practitioners provide care to a population of 15,706 inhabitants, screening of patients aged 25-59 years was integrated with regular case-finding for hypertension. The specific characteristic of the programme was that the general practitioner adjusted, from day to day, the inclusion rate to actual resources. The study evaluated implementation during 3 years; after this time, 27 per cent of the target population was included. The included portion of those who visited the centre was 48% between ages 40 and 59 years, and 20% of those between 25 and 39 years. Compliance with the follow-up protocol differed according to age and risk group. The reattendance rates were better for those aged 40-59 years compared to the younger. It is concluded that opportunistic screening is most feasible in ages 40-59 years, while for younger people traditional population strategies may be preferable. If integrated with regular case-finding and treatment follow-up for hypertension, which are long well established components of general practice, no extra resources are needed for implementation.

Adult↗
PubMed1988

Analysis of geographic differentials in infant mortality rates. The Or Yehuda community.

Comprehensive evaluation of matched infant death certificate data and livebirth certificate data for 1977-1980 was performed for two areas in Israel: Or Yehuda, a small, low socioeconomic status community which had an infant mortality rate of 19.1 per 1,000, and the rest of Ramat Gan district, which had an infant mortality rate of 10.3 per 1,000. A method is presented which illuminates the role of statistical models in analyzing small area data, in evaluating twofold observed differences in crude and factor-specific mortality rates in two areas, in assessing heterogeneity in population stratum-specific mortality rate ratios, and in identifying causes for inter-area differences in infant mortality rate. Identical logistic models were fitted to each of the areas independently, and these were used to investigate effects due to birth weight, sex, parity, maternal age and education, and parental occupation. The differences in the distribution of risk level (number of risk factors) present in each population (or the proportion of multi-problem families) were identified as a single factor that can explain most of the disparity between the areas. The direction and magnitude of the relation between risk level and infant mortality rate were similar in both communities: the greater the number of risk factors, the higher the rate. Identification of a target population for intervention through only one or two specific risk factors would be unprofitable in reducing the overall community infant mortality rate since too many families with multiple risk would be excluded, and too many with single risk factors would be included.

Adult↗
PubMed1991

Comparison of questionnaire and biochemical markers to detect alcohol abuse in a West Indian population.

This study bears upon the respective validity of biochemical markers and questionnaires to detect alcohol abuse in a population with a high rate of alcohol-linked neurological complications. GammaGT and apoprotein AII were the most powerful of eight studied biochemical markers in detecting two-thirds of excessive drinkers. The CAGE questionnaire identified 74% of moderate drinkers and 94% of excessive drinkers with a life style and patterns of alcohol consumption different from previously tested target populations. The joint association of the CAGE questionnaire and apoprotein AII detected more than 9 out of 10 moderate or excessive drinkers defined on the basis of a quantity-frequency grid.

Adult↗
PubMed1995

Ethnocultural sensitivity and measurement of consumer satisfaction.

Stemming from the diversity in the U.S. population, ethnocultural factors no longer can be ignored when defining and assessing consumer satisfaction. Likewise, there is a critical need for process models that consider consumer heterogeneity. Continuous quality improvement (CQI) programs must look beyond whether or not services are accessible and cost-effective. The processes must also measure if services are acceptable and appropriate for a target population. This article describes how the discipline of anthropology can provide useful tools to obtain critically needed ethnocultural information.

Anthropology, Cultural↗
PubMed1999

Quit and Win campaigns as a long-term anti-smoking intervention in North Karelia and other parts of Finland.

OBJECTIVE: To evaluate Quit and Win campaigns repeated in North Karelia and rest of Finland. DESIGN: Repeated comparisons of participation rates, abstinence rates, and other measures between North Karelia and the rest of Finland. SUBJECTS: Adult daily smokers in Finland participating in the Quit and Win contests in 1986-1997. INTERVENTIONS: Quit and Win smoking cessation campaigns targeted at adult daily smokers throughout Finland in 1986, 1989, 1994, 1996, and 1997, including more intensive activities in North Karelia. MAIN OUTCOME MEASURES: Participation rates, self reported six-month abstinence rates, other effectiveness measures (% of smokers who attended, intended, tried, and succeeded in cessation). RESULTS: North Karelia's participation rates were significantly higher in each campaign compared with the rest of Finland. The abstinence rates in North Karelia were also higher, the difference being significant in 1986 and 1994 (p < 0.05). In the target population in 1996 over 75% of smokers in North Karelia, compared with 40% of smokers surveyed elsewhere, reported awareness of the campaign (p < 0.001). Approximately 9% of the smokers in North Karelia and 6% elsewhere intended to participate (p = NS). Over 2% in North Karelia, compared with less than 1% elsewhere, tried to quit (p < 0.001). Among the targeted group, 0.3% of North Karelian smokers were complete abstainers throughout the 12 months of follow up, compared with an average of 0.1% in other areas (p < 0.001). CONCLUSIONS: The Quit and Win campaign is a feasible cessation method in long-term community-wide programmes. Intensified community activities are associated with higher success. In repeat campaigns, high participation and abstinence rates can be maintained.

Adolescent↗
PubMed2002

Preventing schizophrenia and psychotic behaviour: definitions and methodological issues.

Although schizophrenia onset usually occurs in late adolescence or early adulthood, much research shows that its seeds are planted early in life and that eventual onset occurs at the end of a neurodevelopmental process leading to aberrant brain functioning. This idea, along with the fact that current therapies are far from fully effective, suggests that preventive treatments may be needed to achieve an ideal outcome for schizophrenia patients and those predisposed to the disorder. In this article, we review the methodological challenges that must be overcome before effective preventive interventions can be created. Prevention studies will need to define the target population. This requires the identification of risk factors that will be useful in selecting at-risk people for preventive treatment. We review currently identified risk factors for schizophrenia: genes, psychosocial factors, pregnancy and delivery complications, and viruses. We also review 3 different types of prevention programs: universal, indicated, and selective. For schizophrenia, we distinguish prevention programs that target prodromal cases and those that target the disorder's premorbid precursors. Although those targeting prodromal cases provide a useful framework for early treatment of the disorder, studies of premorbid individuals are needed to design a truly preventive treatment.

Affect↗
PubMed1995

Evaluation of utilisation of health workers for secondary prevention of oral cancer in Kerala, India.

The utilisation of primary health workers (HWs) for cancer control in developing countries has often been suggested, based on the experience of feasibility studies in India and Sri Lanka. We initiated a project in 1988 to evaluate the long-term feasibility of using trained HWs in secondary prevention of oral cancer, to bring about earlier detection of oral cancer in the communities served by them. Two hundred and eighty-two HWs attached to 14 primary health centres (PHCs), serving approximately 0.92 million rural population in the northern half of Trivandrum district in Kerala, India, were trained in oral visual inspection to detect precancerous, malignant and other suspicious lesions of the oral cavity and refer them for confirmation and treatment. They were asked to examine subjects aged 35 years and above and to give person to person health education on tobacco in their target population. The HWs belonging to the PHCs serving approximately 1 million rural population in the southern half of Trivandrum district were not trained, and this region served as the control area. In addition to several process measures, stage distribution of oral cancer in subjects reporting from the intervention and control areas, as well as oral cancers referred by the HWs, as a proportion of total oral cancers from the intervention area, were the outcome measures evaluated. Only 9/282 (3.2%) trained HWs were motivated and they examined 17,812 eligible subjects in 3 years and referred 408 subjects with lesions; 258/408 (63.2%) referred subjects reported for further examination and ten oral cancers were detected among them.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2003

Revision of the design of a standard for the dimensions of school furniture.

In this study an anthropometric design process was followed. The aim was to improve the fit of school furniture sizes for European children. It was demonstrated statistically that the draft of a European standard does not cover the target population. No literature on design criteria for sizes exists, and in practice it is common to calculate the fit for only the mean values (P50). The calculations reported here used body dimensions of Dutch children, measured by the authors' Department, and used data from German and British national standards. A design process was followed that contains several steps, including: Target group, Anthropometric model and Percentage exclusion. The criteria developed in this study are (1) a fit on the basis of 1% exclusion (P1 or P99), and (2) a prescription based on popliteal height. Based on this new approach it was concluded that prescription of a set size should be based on popliteal height rather than body height. The drafted standard, Pren 1729, can be improved with this approach. A European standard for school furniture should include the exception that for Dutch children an extra large size is required.

Anthropometry↗
PubMed1999

Immunization registries in the United States: implications for the practice of public health in a changing health care system.

Although immunization rates among children are rising across the country, rates in inner-city areas have remained at approximately 50%-60%, < or = 30% lower than corresponding suburban or state immunization levels. The failure to raise immunization levels in poor, underserved populations is caused in part by the lack of timely and accurate child-specific immunization information for providers and parents. Immunization registries are a new tool in health care that can be used to address these and other barriers to effective immunization delivery. Moreover, immunization registries have the potential to help health care officials track and improve delivery for a broad range of important child health services. An immunization registry is a computerized database of information on children (usually preschool-age children) in a defined population (e.g. those enrolled in a health maintenance organization or living in a specific geographic area), which is used to record and track all immunizations received by each child. The registry receives the information primarily from public and private providers that administer immunizations, as well as from parents, schools, and other agencies. A fully functioning immunization registry can be used to identify individual children in need of immunizations and to report on immunization rates by population characteristics such as child age, assigned provider, or geographic area (e.g. neighborhood, city). Today, > 250 local public health departments have immunization registries that are in various stages of planning or development. Only a small number of these registries meet the minimum functional criteria of maintaining records on 95% of all eligible 2-year-old children in the target population and providing an electronic immunization record that is accessible to providers. Nascent immunization registries represent innovative technologic solutions to the challenge of monitoring health problems and health care access on a population basis. This is a fundamental activity of public health agencies, but one that is increasingly shared by large health maintenance organizations. The study of the development of immunization registries across the United States provides an important case study for how public health agencies will use the rapidly developing health information infrastructure to perform health assessment and health assurance activities in a managed care environment.

Child, Preschool↗
PubMed1981

Adolescents' use of mental health services in a comprehensive treatment facility: age, sex and mode of entry.

Data are presented from the clinical records of 185 adolescents who were admitted to the mental health service of a youth health center serving a community of military dependents. Eight and one-half per cent of the population made a first visit to the center during an eight month period. Midadolescence (ages 15-16) was the age period when patients began to refer themselves to mental health services in significant numbers. The importance of parents as referral sources decreased with age, while medical and school sources were important in all ages. The psychological morbidity in the target population was greater in midadolescence than in early and late adolescence and higher in females than in males. Females presented with more somatic and family problems, males more often with aggressive behavior problems.

Adolescent↗
PubMed1998

Suicide prevention evaluation in a Western Athabaskan American Indian Tribe--New Mexico, 1988-1997.

Since 1979, suicide and homicide have alternated as the second and third leading causes of death among young American Indians and Alaska Natives (AI/ANs). From 1979 through 1992, suicide rates for AI/ANs in all age groups were approximately 1.5 times the rates for the overall U.S. population. During 1991-1993, suicide rates for AI/ANs aged 15-24 and 25-34 years were 31.7 and 26.6 per 100,000 population, respectively; males aged 15-34 years accounted for 64% of all AI/AN suicides. In the overall U.S. population during 1991-1993, the rates for persons in these same age groups were 13.0 and 14.5, respectively. Since 1980, suicide has been either the second or third leading cause of death for persons aged 15-24 years in the overall U.S. population. Although knowledge about suicide among AI/ANs has increased, information about the efficacy of suicide prevention and intervention programs in general, and specifically in AI/AN communities, is scarce. In January 1990, following concern raised by tribal officials in 1988 about suicide among youth, a Western Athabaskan tribe in rural New Mexico implemented a suicide prevention and intervention program that targeted tribal members aged 15-19 years. This report summarizes the results of the program through 1997 and indicates that rates of suicide and attempted suicide among this target population decreased substantially after the program was implemented.

Adolescent↗
PubMed2003

Sexuality and life skills education. A multistrategy intervention in Mexico.

This contribution presents a set of intervention programs in the area of reproductive health, sexuality, and life-skills education that are now widely used in Mexico and with Latin American populations elsewhere. First, the authors briefly indicate how a research-informed approach has been central to the development and implementation of these interventions. Thereafter they describe how the programs were initially designed, taking into consideration the Mexican cultural context and its implications for Mexican adolescents. They also mention subsequent evaluation-based extensions of the programs to reach other target populations, to broaden the range of issues addressed, to promote their dissemination, and to advocate society-wide sexuality and life-skills education.

Adolescent↗
PubMed1988

Public Law 100-202, Joint Resolution making further continuing appropriations for the fiscal year 1988, and for other purposes, 22 December 1987.

This US Act provides the following with respect to universal access to child immunization: "The Congress calls upon the President to direct the Agency for International Development, working through the Centers for Disease Control and other appropriate Federal agencies, to work in a global effort to provide enhanced support towards achieving the goal of universal access to childhood immunization by 1990 by 1) assisting in the delivery, distribution, and use of vaccines, including a) the building of locally sustainable systems and technical capacities in developing countries to reach, by the appropriate age, not less than 80% of their annually projected target population with the full schedule of required immunizations and b) the development of a sufficient network of indigenous professionals and institutions with responsibility for developing, monitoring, and assessing immunization program and continually adapting strategies to reach the goal of preventing immunizable diseases and 2) performing, supporting, and encouraging research and development activities, in both the public and the private sector, that will be targeted at developing new vaccines and at modifying and improving existing vaccines to make them more appropriate for use in developing countries. In support of this global effort, the President should appeal to the people of the US and the US private sector to support public and private efforts to provide the resources necessary to achieve universal access to childhood immunization by 1990." The Act also does the following with respect to various forms of bilateral assistance: 1) prohibits the use of funds for an organization or program that supports coercive abortion or involuntary sterilization; 2) prohibits the use of funds for the performance of abortion as a method of family planning (FP); 3) provides that in awarding grants for natural FP under section 104 of the Foreign Assistance Act no applicant shall be discriminated against because of such applicant's religious or conscientious commitment to offer only natural FP. In addition, the Act stipulates that with respect to appropriations for the Department of Health and Human Services no funds will be used to perform abortions except where the life of the mother would be endangered if the fetus were carried to term.

Abortion, Induced↗
PubMed1993

Maternal attitude to sweet eating habits and risk of overweight in offspring: a ten-year prospective population study.

The possible effect of maternal attitude to sweet eating habits on their offspring's risk of overweight is a common concern. This study addresses the influence of mothers' reports on and attitude to sweet eating habits on the subsequent risk of overweight of their offspring in young adulthood. A study of a randomly selected cohort of 9-10 year old children from schools in the Copenhagen municipality was performed in 1974. A decade later a follow-up was carried out, and 86% of the target population participated. Overweight was defined as the 90th percentile of body mass index distribution (weight/height2 (kg/m2)). The odds ratio of overweight in young adulthood was assessed by logistic regression analysis taking into account body mass index in childhood, gender and social background (both parents' school education, householder's occupational status, and quality of dwellings in childhood rearing areas). The results showed that the risk of overweight was significantly increased if the mother reported lacking knowledge about her offspring's sweet eating habits (OR = 4.5; 95% confidence limits: 1.7-12.1; P = 0.003). The risk was insignificantly increased if the mothers expressed acceptance of sweet eating habits (OR = 1.9; 0.8-4.2; P = 0.1), and if more than an average amount of money was given for sweets (OR = 2.0; 1.0-3.8; P = 0.06). On the other hand, how often the child was actually allowed to eat sweets, and the mother's acceptance of sugary food did not significantly influence the risk.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude to Health↗
PubMed2003

Estimating the cumulative number of human immunodeficiency virus diagnoses by cross-linking from four different sources.

BACKGROUND: We estimated the cumulative number of people diagnosed with human immunodeficiency virus (HIV) infection in a region of Italy by cross-linking data from four surveillance systems and applying capture-recapture methods. METHODS: The study was conducted using data referring to residents of the Veneto Region (population 4.4 million). We cross-linked data from the AIDS Registry (data 1983-2000), the HIV Registry (1988-2000), the Death Registry (1992-1999), and the Hospital-Discharge Registry (1997-2000), using a code based on name, birth date, and sex. A specific software for capture-recapture models (CARE-1) was used to estimate the size of the target population with two different statistical approaches (sample coverage and log-linear models). RESULTS: A total of 2801 people were reported to the AIDS Registry, 6415 to the HIV Registry, 1598 to the Death Registry as HIV/AIDS-related deaths, and 3330 to the Hospital-Discharge Registry with a diagnosis of HIV infection. Overall, 8723 people were present in at least one registry: 4896 people were present in only one registry, 2387 in two registries, 1286 in three registries, and 154 in all four registries. Using the sample coverage approach, we estimated that, since the beginning of the epidemic in Veneto, an estimated 11 281 people (95% CI: 10 981, 11 621) should have been reported to at least one registry; thus the estimated coverage of the four registries was 77.3% (i.e. 8723/11 281). Results obtained applying the log-linear approach were similar, although the fitting of this model was not adequate. CONCLUSIONS: Cross-linking data from four different sources and applying the capture-recapture method can improve the accuracy of the estimates of the dimensions of the HIV epidemic.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Targeted correction of single-base-pair mutations with adeno-associated virus vectors under nonselective conditions.

Recombinant adeno-associated virus (rAAV) vectors possess the unique ability to introduce genetic alterations at sites of homology in genomic DNA through a mechanism thought to predominantly involve homologous recombination. We have investigated the efficiency of this approach using a mutant enhanced green fluorescent protein (eGFP) fluorescence recovery assay that facilitates detection of gene correction events in living cells under nonselective conditions. Our data demonstrate that rAAV infection can correct a mutant eGFP transgene at an efficiency of 0.1% in 293 cells, as determined by fluorescence-activated cell-sorting analysis. Gene repair was also confirmed using clonal expansion of GFP-positive cells and sequencing of the eGFP transgene. These results support previous findings demonstrating the efficacy of rAAV for gene targeting. In an effort to improve gene-targeting efficiencies, we evaluated several agents known to increase rAAV transduction (i.e., expression of an expressed gene), including genotoxic stress and proteasome inhibitors, but observed no correlation between the level of gene repair and rAAV transduction. Interestingly, however, our results demonstrated that enrichment of G(1)/S-phase cells in the target population through the addition of thymidine moderately (approximately 2-fold) increased gene correction compared to cells in other cell cycle phases, including G(0)/G1, G(1), and G(2)/M. These results suggest that the S phase of the cell cycle may more efficiently facilitate gene repair by rAAV. Transgenic mice expressing the mutant GFP were used to evaluate rAAV targeting efficiencies in primary fetal fibroblast and tibialis muscles. However, targeting efficiencies in primary mouse fetal fibroblasts were significantly lower (approximately 0.006%) than in 293 cells, and no correction was seen in tibialis muscles following rAAV infection. To evaluate the molecular structures of rAAV genomes that might be responsible for gene repair, single-cell injection studies were performed with purified viral DNA in a mutant eGFP target cell line. However, the failure of direct cytoplasm- or nucleus-injected rAAV DNA to facilitate gene repair suggests that some aspect of intracellular viral processing may be required to prime recombinant viral genomes for gene repair events.

Animals↗
PubMed1981

Parity and obesity.

Parity was found to be closely related to adiposity and prevalence of obesity in a population sample of 17 688 non-pregnant women aged 25-84. The women took part in multiphasic screening examinations in various parts of Finland in 1966-72. The relationship between parity and obesity was independent of other factors such as +geographical area, region, marital status, occupation, smoking habits, or incapacity for work. Pregnant women were considered to be an important target population for nutritional education.

Adolescent↗
PubMed2002

Mass vaccination campaign following community outbreak of meningococcal disease.

During December 12-29, 1998, seven patients ages 2-18 years were diagnosed with serogroup C meningococcal disease in two neighboring Florida towns with 33,000 residents. We evaluated a mass vaccination campaign implemented to control the outbreak. We maintained vaccination logs and recorded the resources used in the campaign that targeted 2- to 22-year-old residents of the two towns. A total of 13,148 persons received the vaccinations in 3 days. Vaccination coverage in the target population was estimated to be 86% to 99%. Five additional cases of serogroup C meningococcal disease occurred in the community during the year after the campaign began, four in patients who had not received the vaccine. The cost of control efforts was approximately $370,000. Although cases continued to occur, the vaccination campaign appeared to control the outbreak. Rapid implementation, a targeted approach, and high coverage were important to the campaign's success.

Adolescent↗