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PubMed2005

Differences in the prevalence of self-reported risk factors for coronary heart disease among American women by race/ethnicity and age: Behavioral Risk Factor Surveillance System, 2001.

BACKGROUND: Heart disease is the leading cause of death among American women. Data are lacking on the prevalence of specific risk factors among women of various ethnic groups. We examined data from the 2001 Behavioral Risk Factor Surveillance System (BRFSS) for prevalence of self-reported risk factors among women by race/ethnicity and age. METHODS: The BRFSS is a state-based, random-digit-dialed telephone survey of the civilian non-institutionalized U.S. population aged > or = 18 years. In 2001, a total of 120,035 women reported whether (1) they had ever been told by a healthcare provider that they had high blood pressure, high cholesterol, or diabetes; (2) they smoked; and (3) they were physically inactive. Obesity status was determined by self-reported height and weight. Data were weighted to each state's population. RESULTS: Among all women, 26.3% had high blood pressure, 23.2% had high cholesterol levels, 21.1% currently smoked, 6.8% had diabetes, 25.4% were obese, and 28.6% physically inactive. Age-adjusted prevalence of high blood pressure was highest among African Americans (AA) (36.3%) and Hawaiian/Pacific Islanders (HPI) (33.7%), and lowest among Asians (18.0%). High blood cholesterol was highest among HPI (23.9%) and white (22.3%) women. American Indian/Alaska Natives (AI/AN) had the highest percentages of diabetes (12.7%) and current smoking (32.4%). Obesity was highest among AA (38.4%) and AI/AN (31.9%) women and lowest among Asian (7.8%) women. Physical inactivity was most common among Hispanic women (42.4%), and least common among Asian women (23.3%). Thirty-eight percent of women had two or more risk factors, ranging from 20.1% of Asian women to 48.8% of AA women. CONCLUSIONS: A substantial proportion of American women have two or more risk factors for heart disease, and the prevalence of individual risk factors varies by racial/ethnic background. Aggressive efforts to reduce and control risk factors, including population-specific programs, are crucial for limiting the incidence of heart disease.

Adolescent↗
PubMed2006

Population pharmacokinetic modeling and Monte Carlo simulation of varying doses of intravenous metronidazole.

Population pharmacokinetic modeling and Monte Carlo simulation (MCS) are approaches used to determine probability of target attainment (PTA) of antimicrobial therapy. The objectives of this study were 1) to determine a population pharmacokinetic model (PPM) using metronidazole and hydroxy-metronidazole concentrations from healthy subjects and critically ill patients, and 2) to determine the probability of attaining the pharmacodynamic target area under the plasma concentration (AUC)/MIC ratio >or=70 against 218 clinical isolates of Bacteroides fragilis using MCS. Eighteen healthy subjects were randomized to 3 dosages of intravenous metronidazole (500 mg every 8 h, 1000 mg day(-1), 1500 mg day(-1)) in an open-label 3-way crossover fashion. Serial blood samples were collected over 25.5 h on the 3rd day of each study period. An additional of 8 critically ill patients received intravenous metronidazole 500 mg every 8 h. Serial blood samples were collected over 8 h after the 2nd day of dosing. Plasma metronidazole and hydroxy-metronidazole concentrations were analyzed using a high-performance liquid chromatographic assay. The 834 plasma concentrations from 62 data sets were simultaneously modeled with Non-Parametric Adaptive Grid population modeling program. A 4-compartment model with a metabolite and zero-order infusion into the central compartment was used. The mean parameter vector and covariance matrix from PPM were inserted into the simulation module of ADAPT II. A 10,000-subject MCS was performed to determine the probability of PTA for a total drug AUC to MIC ratio >or=70 against 218 isolates of B. fragilis (MIC range, 0.125-2.0 mg L(-1)). Mean parameter values were CL(non-OH), 3.08 L h(-1); Vc, 35.4 L; K(OH), 0.04 h(-1); CL(OH), 2.78 L h(-1); and V(OH), 9.66 L. The regression values of the observed versus predicted concentrations (r2) of metronidazole and hydroxy-metronidazole were 0.972 and 0.980, respectively. The PTA for metronidazole 1500 mg day(-1) or 500 mg every 8 h (taken together) and 1000 mg day(-1) were 99.9% and 99.8%, respectively, over the reported MIC distribution range. For an MIC of 4 mg L(-1), the predicted PTA decreased to 80.0% and 28.5%, respectively. A PPM was determined by comodeling metronidazole and hydroxy-metronidazole concentrations from healthy subjects and critically ill patients. Based on this model, attainment of the target pharmacodynamic parameter (AUC/MIC ratio >or=70) against B. fragilis isolates is >99% when MICs are <2 mg L(-1), irrespective of the dosing interval of 24 h.

Administration, Intravesical↗
PubMed2004

Worldwide practices in child growth monitoring.

OBJECTIVE: To describe child growth monitoring practices worldwide in preparation for the construction and application of a new international growth reference. STUDY DESIGN: A questionnaire was sent to Ministries of Health in 202 countries requesting information on growth charts used in national programs, reference populations, classification systems, problems encountered, and actions taken against growth faltering. Countries also provided hard copies of charts in current use. This information was entered and analyzed in Microsoft Access. RESULTS: Responses were received from 178 (88%) countries, 154 of which included growth charts (n=806). Two thirds of the charts covered preschool age. All countries used weight-for-age, over half relying on this index alone. The reference most commonly used (68%) was the National Center for Health Statistics/World Health Organization population, with regional variations, where most European countries used local standards. Sixty-three percent of charts classified child growth on percentiles, whereas about one fifth used z scores. Problems reported were both conceptual (eg, interpreting growth trajectories) and practical (eg, lack of equipment). CONCLUSIONS: The survey demonstrates that growth charts are used universally in pediatric care. The information gathered on current use and interpretation of growth charts provides important guidance for constructing and applying the new reference.

Anthropometry↗
PubMed2005

Portrait of the national veterinary service as a surveillance continuum.

National veterinary services emerged in response to the animal disease challenges of centuries past. Their often singular preoccupation with exogenous disease preclusion yielded, by the early 1900s, to parallel commitments to control a number of serious indigenous, zoonotic infections. Advances in clinical pathology and epidemiology opened the door in many countries to disease, if not agent, eradication initiatives by the latter part of that century. The attending interval witnessed the explosive growth of international trade and the emerging or re-emerging conditions that threaten to accompany it. Animal disease agents, their hosts and the environments within which they interact vary considerably from nation to nation. Depicted as a medieval metaphor, the exogenous cluster around the walls of the castle, awaiting entry upon the next uninspected, unsuspecting fomite or beast. Some of these threats reside comfortably within the structure's bedding and detritus, sapping the vitality of its residents until detected and exterminated. Others emerge from the least expected crevices, growing insidiously or explosively in tandem with changes wrought by humans or nature. In anticipation of, or in response to, these myriad challenges, national veterinary services mount surveillance campaigns. From the national survey that denies the presence of exogenous disease to the post-eradication assessment that confirms its demise, surveillance forms the sensory acumen of the service. From the passive assessments that detect the emerging to the active regimens that plot progress against the indigenous, they form a continuum that defines the very nature of the national veterinary service.

Animal Diseases↗
PubMed2005

Gastroesophageal reflux and cancer.

The causal relationship between GERD and esophageal adenocarcinoma, although unclear just a few decades ago, now is established fairly well. The physiologic changes and the biocellular alterations of the damaged esophageal mucosa are documented better. Despite this knowledge, the dramatic increase in the incidence of esophageal cancer cannot be explained. The absolute risk of esophageal adenocarcinoma arising from GERD is low, and, at present, does not justify population-screening programs. Still, with the notion that adenocarcinoma of the esophagus is an aggressive cancer once documented, important questions still are in need of answers for patients suffering from reflux symptoms. Patients who have reflux disease are not necessarily symptomatic. It remains unclear if patients experiencing reflux symptoms should undergo mandatory endoscopy with biopsies at the esophagogastric junction. Furthermore, metaplasia of the lower esophagus often is not readily recognizable at endoscopy, and only biopsies can document abnormal histology. A severe and prolonged history of reflux always should orient to the possibility of a reflux-related columnar-lined esophagus. Once documented, Barrett's esophagus needs to be seen as a premalignant condition not necessarily leading to adenocarcinoma formation; despite their increased risk of tumor formation, most patients who have Barrett's esophagus die of other causes. During regular endoscopic follow-up, multilevel circumferential biopsies should document the evolution of the histologic changes in the lower esophagus and at the gastroesophageal junction of these patients. It is the only method available to document the appearance of dysplasia. It still is unclear if medicine or surgery provides the best quality of life and the best protection against the development of dysplasia and the possible progression toward adenocarcinoma formation when intestinal metaplasia is present in the esophagus.

Adenocarcinoma↗
PubMed2005

Beliefs and practices of Ontario midwives about influenza immunization.

With an increasing number of births in Ontario being conducted by midwives, we undertook a survey of the beliefs and practices of 256 licensed Ontario midwives and student midwives about immunization, particularly against influenza. Overall, 42.9% (48/112) of midwives considered that they knew a lot about immunization; however, 36.2% (38/105) reported no education about immunization during their training. A small majority (55.9%) were in favour of vaccination in general and only 2 of 113 reported spending more than 1h discussing vaccination with their clients. Only 26.9% reported having received influenza vaccine in the previous season (compared to 60% of all health care workers in Ontario). Overall, only 37% believed that influenza vaccine is effective, and 22% believed that the vaccine was a greater risk than influenza. Graduation in 1998 or prior was associated with belief in the effectiveness in vaccine, having been vaccinated, and recommending vaccine to clients. Midwives who reported being immunized themselves were more likely to believe in the safety and efficacy of influenza vaccine, and to recommend vaccination to their clients (26% versus 3%, p=0.001). If greater attention is not focused on promoting the utility of immunization to midwives, the success of population immunization programs may be compromised.

Confidence Intervals↗
PubMed2005

Surveillance system of vaccine adverse events and local data analysis--the experience in a middle-sized city in Brazil, 1999-2001.

We reviewed all vaccine adverse events (VAE) notified in a middle-sized Brazilian city (n=247) to the National Immunisation Program between January 1999 and December 2001. Vaccine doses used in that period were considered for rate estimates. Aspects of the surveillance system (SS) and their influences on collected data were considered, searching for contributions of local data analysis to investigation of VAE and to the monitoring of vaccine safety. Notification rates in our study were higher when compared to national data. Changes in the notification pattern were observed following vaccination campaign periods. An increase in aseptic meningitis cases temporally associated to yellow fever vaccine was detected. The analysis of local data provided information unperceived in national consolidated data. Through this analysis we detected: events related to application technique and handling; people's perception changes on VAE; and the local SS's ability to raise new hypothesis. We suggested changes to the notification form regarding data entry criteria and analysis.

Adolescent↗
PubMed2005

Abattoir surveillance: the U.S. experience.

Abattoir, or slaughter, surveillance has been an important component of bovine tuberculosis control and eradication programs in the U.S., and has adapted to changes in the livestock market from farm to table, and the threat of bovine tuberculosis from a wildlife reservoir. The purpose of this overview was to describe the current goals of U.S. bovine tuberculosis slaughter surveillance, describe the elements of slaughter surveillance in the U.S., describe enhancements to the slaughter surveillance system, and discuss future challenges for the U.S. bovine tuberculosis surveillance program. Government regulations and the scientific literature were examined to provide information for this paper. The control and eradication of bovine tuberculosis in livestock falls to the United States Department of Agriculture and two agencies within the Department: the Food Safety and Inspection Service (FSIS) and the Animal and Plant Health Inspection Service (APHIS). FSIS conducts routine slaughter surveillance for disease or conditions that render carcasses unsuitable for human consumption, while APHIS is involved in antemortem bovine tuberculosis testing, and necropsy and investigation of bovine tuberculosis cases identified through slaughter surveillance or antemortem testing. Results from the previous 5 years of surveillance are presented. Enhancements have been added to the current surveillance system to improve its performance. An incentive program has been used to increase the numbers of tissues submitted for laboratory examination, the state of Michigan is implementing electronic animal identification under a pilot program, and expansions to the current system are being developed to accommodate new livestock industries. The success of these programs and challenges for the future are discussed.

Abattoirs↗
PubMed1997

Immunochemical fecal occult blood test is not suitable for diagnosis of hemorrhoids.

PURPOSE: This study was conducted to clarify the diagnostic value of an immunochemical fecal occult blood test for hemorrhoids. PATIENTS AND METHODS: In a case-control study, an immunochemical fecal occult blood test with a 2-day method was carried out on 82 subjects with hemorrhoids, on 82 subjects with colorectal cancer, and on 82 healthy subjects. In a population-based cross-sectional study, 29,714 subjects who received an immunochemical occult blood screening with a 2-day method were divided into two groups, according to the results of a questionnaire on hemorrhoids, and the positivity rate of an immunochemical test as well as the predictive value for colorectal cancer were compared in the two groups. Moreover, both an immunochemical occult blood test with a 2-day method and colonoscopy were conducted at the same time on asymptomatic subjects during a medical checkup. RESULTS: In the case-control study, the test was positive in 13.4% subjects with hemorrhoids, in 84.1% subjects with colorectal cancer, and in 4.9% healthy subjects, respectively, showing a significant difference in the detection rate between the two diseases (P < 0.001). In the population screening program, the test was positive in 6.9% subjects with hemorrhoids and in 6.5% subjects without hemorrhoids, and the predictive value was 3.2% in subjects with and without hemorrhoids, respectively, indicating no significant difference in the positivity rate as well as the predictive value between the two groups. Among 232 subjects in a medical checkup, 28 patients with hemorrhoids and 21 patients with colorectal polyp 1 cm or larger were diagnosed by colonoscopy, and the occult blood test was positive in 16.7% patients with hemorrhoids and in 52.4% patients with colorectal polyp, respectively. There was a significant difference in the sensitivity between the two disease groups (P < 0.05). CONCLUSIONS: These findings indicate that the immunochemical fecal occult blood is unsuitable for the diagnosis of the patients with hemorrhoids and an examination of the colorectum is necessary in cases where the occult blood test is positive but there is a sign of hemorrhoids.

Aged↗
PubMed2003

Two years later: a prospective long-term follow-up of a training intervention in geriatric patients with a history of severe falls.

OBJECTIVE: To study the long-term outcome of a physical training regimen of ambulant postward rehabilitation in community-dwelling geriatric patients with a history of injurious falls. DESIGN: Prospective 2-year follow-up of a randomized placebo-controlled intervention trial. SETTING: Postward rehabilitation in a geriatric hospital in Germany. PARTICIPANTS: Fifty-seven geriatric patients (mean age, 84.3+/-4.4 y) with a history of severe falls. INTERVENTION: Ambulatory training of strength, functional performance, and balance 3 times a week for 3 months for 31 patients versus placebo activities for 26 patients. MAIN OUTCOME MEASURES: Strength, functional performance, fall-related psychologic parameters, and physical activity assessed by standardized protocols 2 years after the training intervention, compared with baseline results. RESULTS: Motor performance decreased substantially in both groups. As patients in the intervention group declined from significantly improved motor performance levels achieved in the initial training intervention, differences between the groups were still significant in most functional performances 2 years later. Functional decline was greater in persons who were institutionalized or being cared for by family members. Physical activity, which increased during the exercise intervention, returned to low baseline levels. CONCLUSIONS: Improved functional performance in the training group did not lead to an increased level of physical activity after training, which might have preserved the functional improvements. In mobility-restricted, frail, geriatric patients such as our study population, training programs should continue to keep patients active and to prevent the decline in strength and functional performance that precedes loss of autonomy.

Accidental Falls↗
PubMed2000

Effects of hospital policies based on 1996 group B streptococcal disease consensus guidelines. The Active Bacterial Core Surveillance Team.

OBJECTIVE: To determine whether the 1996 consensus guidelines for prevention of early-onset group B streptococcal disease developed by the Centers for Disease Control and Prevention, ACOG, and the American Academy of Pediatrics are affecting obstetric practice and disease occurrence. METHODS: Personnel in hospitals with obstetric services in seven surveillance areas completed surveys about their programs, patient populations, and group B streptococcal disease prevention policies. Survey results were linked to group B streptococcal disease cases identified by active surveillance in 1996 and 1997. An early onset case was defined as a case in which group B streptococci were isolated from a sterile site in the 1st 6 days of life. The number of cases in 1996 and 1997 were compared using a paired t test. Linear regression was used to assess hospital characteristics associated with group B streptococcal disease cases. RESULTS: Of 177 hospitals, 165 (93%) responded, and 96 (58%) of those had group B streptococcal disease prevention policies. Hospitals that established or revised their policies in 1996 had a lower mean number of cases in 1997 than in 1996 (0.58 versus 1.29, P = .006). Linear regression analysis, controlling for number of births, indicated that a hospital's having more black mothers and location in particular states were associated with more cases of disease. Citing the 1996 ACOG reference as the source for hospital group B streptococcal disease prevention policy was associated with fewer cases of group B streptococcal disease (P = .038). CONCLUSION: The publication and adoption of the guidelines were associated with decreasing occurrence of group B streptococcal disease.

Guideline Adherence↗
PubMed2000

Cytological recognition of invasive squamous cancer of the uterine cervix: comparison of conventional light-microscopical screening and neural network-based screening.

Cytologic recognition of invasive or microinvasive cancer of the uterine cervix may present substantial difficulties. In this study, we compared conventional light-microscopical screening of 109,104 cervical smears and neural network-based screening (NNS) of 245,527 smears, all obtained by the spatula-Cytobrush method. Two populations of Dutch women were included in the study: those receiving smears within the framework of the Dutch population screening program ("routine smears") and those receiving smears for other reasons, discussed in the text ("interval smears"). There were 71 smears, from an equal number of biopsy-confirmed invasive squamous carcinomas, 28 of which were microinvasive. The "interval smears" yielded a statistical valid higher prevalence of invasive cancer than "routine smears." Except for 5 smears that contained no evidence of abnormality ("sampling errors"), no false-negative errors occurred in the 52 NNS cases, whereas 4 such errors occurred in the 19 conventionally screened cases. By measuring the amount of cancerous material present in each smear (mapping), it could be documented that NNS was effective even in smears with a small number of cancer cells, whereas the 4 conventional false-negative screening errors occurred in smears of this type. The study showed that cells derived from invasive cancer of the cervix may have large bland nuclei that do not fit the images commonly associated with squamous cancer cells. Neural network-based screening of cervical smears was more effective than conventional screening in the diagnosis of invasive squamous cancer of the uterine cervix.

Carcinoma, Squamous Cell↗
PubMed2006

How prepared is Europe for pandemic influenza? Analysis of national plans.

BACKGROUND: The threat of a human pandemic of influenza has prompted urgent development of national preparedness plans. We assessed these plans, to judge Europe's preparedness for pandemic influenza. METHODS: Published national pandemic influenza preparedness plans from the European Union countries, the two acceding countries (Bulgaria and Romania), Norway, and Switzerland, were evaluated against criteria taken from a WHO checklist. Plans were eligible for inclusion if formally published between Jan 1, 2002, and Nov 30, 2005. FINDINGS: 21 national plans were eligible for inclusion for analysis. Although preparation for surveillance, planning and coordination, and communication were good, maintenance of essential services, putting plans into action, and public-health interventions were probably inadequate. Few countries have addressed in their plans the need for collaboration with adjacent countries, despite this being an acknowledged imperative. Similarly, plans for the timely distribution of available medical supplies are notably absent. INTERPRETATION: Governmental commitment in most European countries is strong, and levels of preparedness are broadly good. However, gaps in preparedness planning remain, and substantial variations exist between countries, with important implications for the region and nation states. Improved cooperation between countries may be needed to share experience, and to ensure coherence of approaches.

Animals↗