Training for empowerment? A comparative study of nonformal education for women in small island countries.
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Americas↗
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Results for “Population Programs”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
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Measures of American Indian traditionality and its relationship to cervical cancer screening.
The goal of this study was to evaluate the relationship between culture and attitudes about cervical cancer screening among young American Indian women living and working in northeast Oklahoma. A cohort of 199 American Indian women, ages 18-40, were surveyed to determine their blood quantum, self-identification, and beliefs and practices regarding traditional behavior in order to develop a traditional behavior scale (the degree to which an individual maintained traditional tribal ways or behaviors). The use of this scale indicated that the degree of American Indian blood quantum, blood quantum for primary tribe, and self-identification are correlated to the traditional behavior scale. The scale, however, was unable to predict intention to get a Pap test. Results indicate that it is useful to understand the variation of traditional behavior within the specific population group to be served when planning and implementing culturally appropriate interventions for American Indian women. It is also useful to evaluate which segments of the population current programs are reaching.
Acculturation↗
Principles for development of multi-disciplinary, mental health learning modules for undergraduate, postgraduate and continuing education.
BACKGROUND: People experiencing mental health problems have greater contact with health and welfare professionals in generalist settings than with specialist mental health services. Yet the capacity for generalist professionals to respond effectively to mental health problems is often compromised by inadequate mental health training. The Discipline of Psychiatry at the University of Newcastle developed a series of CD-Rom mental health learning modules for professionals working in non-mental health settings. The paper describes the principles that guided the development of a series and how those principles were applied. DEVELOPMENT PRINCIPLES: The following development principles were adopted. The series should: (i) have a multi-disciplinary application; (ii) be adaptable for presentation in multiple educational domains; (iii) be accessible for rural and remote practitioners; (iv) combine structured solutions-focused lessons (directed learning) with elements of problem-based learning; (v) include working problems that are authentic and relevant; and (vi) describe normal, abnormal and cross-cultural manifestations of problems. APPLICATION OF PRINCIPLES: The model guided the development of a short course series on professional engagement with people who have personality problems. The learning modules provide generic, multi-disciplinary training for a range of practitioners, including nurses, primary care physicians, social workers, psychologists and magistrates. The modules have been adapted for use in undergraduate medical education, postgraduate programs (in population health, nursing, psychology and drug and alcohol studies) and continuing education. CONCLUSION: In contrast to traditional diagnostic-focussed psychiatry training, the model directly addresses the mental health training needs of health and welfare professionals using a multi-disciplinary, problem-based approach.
CD-ROM↗
The PMI local site demonstration project: lessons in technical assistance.
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Americas↗
Interruption of measles transmission in Brazil, 2000-2001.
In 1992, Brazil adopted the goal of measles elimination by the year 2000; however, in 1997, after a 4-year period of good control, there was a resurgence of measles in Brazil. In 1999, to achieve the elimination goal, Brazil implemented the Supplementary Emergency Measles Action plan, with one measles surveillance technician designated to each state. Of 10,007 suspected measles cases reported during 1999, 908 (9.1%) were confirmed, and of them 378 (42%) were confirmed by laboratory analysis. Of 8358 suspected measles cases reported in 2000, 36 (0.4%) were confirmed (30 [83%] by laboratory); 92% of the discarded cases were classified on the basis of laboratory testing. In 2001, only 1 of 5599 suspected measles cases was confirmed, and it was an imported case from Japan. The last outbreak occurred in February 2000, with 15 cases. Current data suggest interruption of indigenous measles transmission in Brazil.
Adolescent↗
The changing face of surveillance for health care-associated infections.
Surveillance of health care-associated infections and antimicrobial resistance is an important aspect of prevention. In 2004, the Centers for Disease Control and Prevention had 3 national health care surveillance systems. During 2004-2005, these will be combined into a single Internet-based system, the National Healthcare Safety Network (NHSN). The NHSN will feature a number of enhancements, and ultimately, all US hospitals and other health care facilities will be encouraged to participate. Health care surveillance using standard methods has been very useful and is cited as a model for prevention. However, alternative approaches may improve health care surveillance by reducing complexity, decreasing the burden of data collection, and improving accuracy. These alternative approaches include adopting simpler methods and more-objective definitions, using sampling and estimation, substituting information in computer databases for manually collected data, and increasing surveillance for process measures with known prevention efficacy. Maintaining successful features of standard systems, adopting alternate surveillance approaches, and exploiting new technologies, such as the Internet, will make health care surveillance an even better tool for prevention.
Centers for Disease Control and Prevention, U.S.↗
Standardized infection ratios for three general surgery procedures: a comparison between Spanish hospitals and U.S. centers participating in the National Nosocomial Infections Surveillance System.
OBJECTIVES: To compare Spanish surgical wound infection (SWI) rates for three procedures with those published by the U.S. NNIS System, and to analyze quarterly trends. DESIGN: This was a 4-year prospective analysis of SWI using data from a Spanish nosocomial infection surveillance network based on CDC classification criteria. SWI rates were computed as standardized infection ratios (SIRs). Trends for both SWIs and SIRs were evaluated by linear regression. SETTING: Forty-three Spanish hospitals during 1997 through 2000. PATIENTS: Those undergoing cholecystectomy (n = 7,631), appendectomy (n = 5,780), and herniorrhaphy (n = 9,864). RESULTS: For cholecystectomy patients, the SWI rate was 4.38% and the SIR was 3.32. Both of these variables showed a slightly rising, although nonsignificant, linear trend during the study period. For appendectomy patients, the SWI rate was 7.94% and the SIR was 2.86. The linear trend was increasing for both, but only the SWI rate attained significance. For herniorrhaphy patients, the SWI rate was 1.77% and the SIR was 1.64. Both of these variables showed a significant descending tendency during the 4 years. CONCLUSIONS: Because the SIR takes into account the patient risk category, it is the best indicator of the trend shown by the SWI rate over time for a given surgical procedure. According to our comparison of SIRs with reference NNIS System values, SWI rates for cholecystectomy and appendectomy were high. Monitoring of the SIR will provide a basis for the design of infection control measures and the assessment of their effectiveness.
Appendectomy↗
Adequacy of surveillance to detect endemic rubella transmission in the United States.
BACKGROUND: Reported rubella cases in the United States are at the lowest numbers since the introduction of vaccine, suggesting that endemic transmission may have been interrupted. It is necessary to validate that the observed absence of rubella is due to the disappearance of disease rather than a failure of rubella surveillance. METHODS: Adequate rubella surveillance to detect ongoing transmission is characterized by evidence that rubella investigations are being conducted, detection of importations, and lack of spread from confirmed cases. We reviewed rubella surveillance data and activities from 5 sources: (1) data reported to the national surveillance system; (2) a survey of health departments and public health laboratories, including questions regarding any links between measles and rubella surveillance; (3) enhanced rubella surveillance activities in California and in New York City; (4) sentinel surveillance along the US-Mexico border; and (5) case detection in 8 large health maintenance organizations (HMOs). RESULTS: During 2002-2004, 35 cases of rubella were reported to the national system, including 12 (34%) imported cases. The 39 programs that responded to our survey reported conducting 1482 investigations for rubella; according to another national survey, 1921 investigations were conducted for measles. Forty-one laboratories responded to our survey and reported conducting 6428 tests for acute rubella. No previously undetected (or unreported) cases of rubella or congenital rubella syndrome were identified by our survey or reviews of surveillance in California, New York, and along the US-Mexico border, and no additional cases were detected in the HMO database. CONCLUSIONS: No previously unrecognized spread cases or outbreaks of rubella were detected. Surveillance in the United States is sufficiently sensitive to identify indigenous cases of rubella, if they were occurring, supporting the contention that rubella has been eliminated from the United States.
Disease Notification↗
AIDS in India: incidence, prevalence, and prevention,.
With 3.7 million human immunodeficiency virus (HIV)-positive in India, many predict that this nation of 1 billion people will soon see infection rates soar if successful prevention programs are not implemented. The majority of infections occur through sexual contact, with blood banks, intravenous drug use, and mother-to-child transmission also spreading the virus. Those in India who are HIV-positive are highly stigmatized and often have difficulty finding physicians who are willing to treat them. Nongovernment organizations provide various services, including physician referrals and legal help for those who are HIV-positive and programs to raise awareness and education. Although the Government of India has designed various programs to help prevent the further spread of HIV, lack of funding and poor regulatory systems are further barriers to their implementation. India is also at war with poverty, illiteracy, and gender inequality, all of which make the fight against acquired immune deficiency syndrome (AIDS) a more difficult battle. India's AIDS control strategy must take these issues into account in order to design successful programs to prevent infection rates from multiplying rapidly.
Acquired Immunodeficiency Syndrome↗
Sexual activities of patients with STDs in the interval between noticing symptoms and presenting for treatment.
Examining the patterns of and reasons for sexual behaviors of patients with sexually transmitted diseases (STDs) while symptomatic may help to develop effective prevention strategies for both STDs and AIDS. However, little is known about patients' sexual activities after noticing STD symptoms in China, where AIDS and STDs are spreading rapidly. We conducted a cross-sectional study at four STD clinics in Hefei, China. Patients' reported sexual activities were queried, using a tape recorder and earphones. A consecutive sample of 406 male patients with STDs were interviewed. One hundred sixty-four (40%) men reported having sex after having STD symptoms; 45% were married, 27% were single, and 47% cohabiting or divorced. Their sex partners included spouses, girlfriends, and prostitutes. Only 10% of patients with STDs who had sex after noticing STDs reported frequently using condoms or using them for every act of sex. Approximately 60% had never used a condom. Logistic regression analysis indicated that having sex after noticing STD symptoms was associated with lower education, having a previous STD episode, having low HIV/STD knowledge, and having other urethral discharge not caused by C. trachomatis or gonorrhea. Our findings suggest that male patients with STDs may serve as a bridge population linking the STD, and potentially, HIV epidemic from individuals at higher risk to the general population. Intervention programs including health education and condom promotion need to target both those at high risk and those at apparently lower risk.
Adolescent↗
Managing hyperlipidemia: current and future roles of HMG-CoA reductase inhibitors.
The current and future roles of statins as antilipemic agents for the prevention and management of coronary artery disease (CAD) are reviewed. Therapy with hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins) substantially reduces total cholesterol and low-density-lipoprotein (LDL) cholesterol concentrations. Large clinical trials have documented the efficacy of statin therapy for both primary and secondary prevention of CAD. Nevertheless, many eligible patients are either untreated or inadequately treated with these agents. In one study, 61% of patients with documented CAD were not treated with a lipid-lowering agent. Large percentages of high-risk patients receiving such agents are not meeting cholesterol goals set by the National Cholesterol Education Program (NCEP). Populations at increased risk for coronary events include patients with diabetes, women, the elderly, and patients with established CAD. Comparative studies have not shown any one agent as clearly superior to the others. Future possibilities for statin use include early treatment of hypercholesterolemia and acute coronary syndromes consistent with guidelines established by NCEP. Many clinicians now believe that an aggressive approach to lowering LDL cholesterol may yield even greater reductions in coronary events. Treatment may reduce the risk of recurrent ischemic events when initiated within 96 hours of hospitalization for acute myocardial infarction or unstable angina and continued for up to four months. Another use may be the management of atherosclerotic cerebrovascular disease. Closer attention to potential adverse effects will be necessary before any expansion in statin use. Statins are highly effective for improving cardiovascular outcomes in high-risk patients but are frequently underused. Pharmacists can help extend the benefits of statins to more patients.
Animals↗
P2BAT: a massive parallel implementation of PBAT for genome-wide association studies in R.
UNLABELLED: The software tool P2BAT provides a massive parallel and user friendly implementation of the PBAT-analysis tools for family-based association tests (FBATs) in large-scale studies, including genome-wide association studies with several thousand subjects. Built on the original PBAT-implementation of the Lange-Van Steen algorithm to bypass the multiple testing problem in family-based association studies, P2BAT integrates all PBAT-analysis tools for binary and complex traits into R and makes them accessible through a user-friendly GUI. The genome-wide analysis tools are fully automated and can be ran massively parallel directly through the GUI. P2BAT is fully documented and contains graphical output tools for time-to-onset analysis. P2BAT also features the ability to test for gene and environment/drug interaction. AVAILABILITY: The P2BAT package is available as the R package 'pbatR' which can be downloaded from http://cran.r-project.org/. The PBAT-software is available at http://www.biostat.harvard.edu/~clange/.
Algorithms↗
A not quite as quick but much cleaner alternative to the Expanded Programme on Immunization (EPI) Cluster Survey design.
BACKGROUND: Although the Expanded Programme on Immunization (EPI) cluster survey methodology has been successfully used for assessing levels of immunization programme coverage in developing country settings, certain features of the methodology, as it is usually carried out, make it less-than-optimal choice for large, national surveys and/or surveys with multiple measurement objectives. What is needed is a 'middle ground' between rigorous cluster sampling methods, which are seen as unfeasible for routine use in many developing country settings, and the EPI cluster survey approach. METHODS: This article suggests some fairly straightforward modifications to the basic EPI cluster survey design that put it on a solid probability footing and render it easily adaptable to differing and/or multiple measurement objectives, without incurring prohibitive costs or adding appreciably to the complexity of survey operations. The proposed modifications concern primarily the manner in which households are chosen at the second stage of sample selection. CONCLUSIONS: Because the modified sampling strategy maintains the scientific rigor of conventional cluster sampling methods while retaining many of the desirable features of the EPI survey methodology, the methodology is likely to be a preferred 'middle ground' survey design, relevant for many applications, particularly surveys designed to monitor multiple health indicators over time. The fieldwork burden in the modified design is only marginally higher than in EPI cluster surveys, and considerably lower than in conventional cluster surveys.
Humans↗
Smallpox surveillance in Bangladesh: I - Development of surveillance containment strategy.
A major epidemic of Variola major with an estimated 90 000 cases and 18 000 deaths occurred in Bangladesh in 1972. During a 3-year period methods of active surveillance (market search, outbreak investigation, and house-to-house search) were developed to supplement the passive reporting system. The percentage of smallpox cases detected increased from 11.8% in 1972 to 83% in 1975. Together with the implementation of improved methods of outbreak control, smallpox transmission was interrupted in October 1975.
Bangladesh↗
Research in nondomestic species: experiences in reproductive physiology research for conservation of endangered felids.
Tremendous strides have been made in recent years to broaden our understanding of reproductive processes in nondomestic felid species and further our capacity to use this basic knowledge to control and manipulate reproduction of endangered cats. Much of that progress has culminated from detailed scientific studies conducted in nontraditional laboratory settings, frequently at collaborating zoological parks but also under more primitive conditions, including in the field. A mobile laboratory approach is described, which incorporates a diverse array of disciplines and research techniques. This approach has been extremely useful, especially for conducting gamete characterization and function studies as well as reproductive surveys, and for facilitating the development of assisted reproductive technology. With continuing advances in assisted reproduction in rare felids, more procedures are being conducted primarily as service-related activities, targeted to increase effectiveness of species propagation and population management. It can be a challenge for both investigators and institutional animal care and use committees (IACUCs) to differentiate these service-based procedures from traditional research studies (that require IACUC oversight). For research with rare cat species, multi-institutional collaboration frequently is necessary to gain access to scientifically meaningful numbers of study subjects. Similarly, for service-based efforts, the ability to perform reproductive procedures across institutions under nonstandard laboratory conditions is critical to applying reproductive sciences for managing and preserving threatened cat populations. Reproductive sciences can most effectively assist population management programs (e.g., Species Survival Plans) in addressing conservation priorities if these research and service-related procedures can be conducted "on the road" at distant national and international locales. This mobile laboratory approach has applications beyond endangered species research, notably for other scientific fields (e.g., studies of hereditary disease in domestic cat models) in which bringing the laboratory to the subject is of value.
Animals↗
The pharmacokinetics of meropenem in infants and children: a population analysis.
Plasma meropenem concentration versus time data collected during a single dose, pharmacokinetic study in infants and children were analysed using the population pharmacokinetics program NONMEM. A total of 300 meropenem concentrations was obtained from 65 patients ranging from 2 months to 12 years of age; weighing between 3.7 and 46 kg. A two-compartment open pharmacokinetic model with a zero-order infusion over 30 min was fitted to the data. The most important determinant of meropenem clearance was the creatinine clearance but an additional improvement occurred when a nonlinear dependence upon age was included. The most important determinant of the volume of distribution in the central and peripheral compartments was the body weight. The distributional clearance showed a nonlinear dependence on body weight. Demographic factors other than weight and age were not found to be influential in the model. Both clearance and distributional clearance were markedly different in the younger (< 2 years) or lighter (< 10 kg) patients, respectively. Thereafter the parameter values slowly approached those found in adults. In this study, a mean of 4.6 samples per patient was used to provide information on the pharmacokinetics and the determinants of the pharmacokinetic variability in infants and children. The findings in the younger, lighter patients, if generally applicable, might have significance for the dosage recommendations for drugs with narrow therapeutic indices.
Age Factors↗
MolKin v2.0: a computer program for genetic analysis of populations using molecular coancestry information.
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Animals↗