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PubMed1992

[Community health workers are capable of determining reliably the target population for health programs].

The target population is a key concept for the planning and evaluation of health services. However, in developing countries, health professionals in the field are often uneasy with the determination of the population denominator. In Zaire, where reliable demographic data are hardly available, we make use of two different methods aimed to the determination of the size of the target population: (1) an exhaustive population based survey performed by trained interviewers, and (2) a rapid census of the target population performed by community health workers. This paper presents both the results of a demographic survey organized in 1984, and two consecutive census performed by community health workers in 1986 an 1988, in the same area (Northern-Kivu, Zaire). Our results suggest that community health workers under close supervision are able to perform rapidly and at low cost a reliable collection of the demographic data needed for the implementation and monitoring of health programmes at the local level.

Adolescent↗
PubMed2005

Epidemiological, clinical and histopathologic characteristics of celiac disease: results of a case-finding population-based program in an Italian community.

OBJECTIVE: Celiac disease (CD) is underdiagnosed mainly because of lack of awareness of its heterogeneous clinical presentation. The Center for Surveillance and Control of Celiac Disease (CCD) was set up in June 2000 in the province of Brescia, Northern Italy (1,016,426) inhabitants to enhance case-finding, to standardize diagnostic criteria and to collect epidemiological data. MATERIAL AND METHODS: The CCD has prompted an educational "celiac awareness program" in the primary-care setting focusing on selective serological screening of high-risk groups, and has reviewed by standardized criteria all diagnoses made in the province since 1984. RESULTS: A total of 1437 CD patients have been identified by the CCD, 508 of them diagnosed after June 2000 during the 3 years of activity of the Center (M:F 2:1). Annual incidence was 0.11/1000 before and increased to 0.17/1000 during CCD activity, and this increase was greater for adult (from 0.07/1000 to 0.12/1000) than for pediatric CD (from 0.04/1000 to 0.05/1000). Mean age at diagnosis also increased from 20.2+/-17.7 years to 27.2+/-19.3 years (p<0.0001) as did the proportion of asymptomatic patients (8% versus 15%) before and during CCD activity. There was a linear trend towards increasing proportions of symptomatic patients with increasing severity of histopathologic lesions (p<0.03). CONCLUSIONS: Our results indicate that educational programs promoting serological screening of CD in high-risk groups are effective for case-finding in large communities, particularly among the adult population, and suggest that primary-care doctors caring for adults should be particularly targeted by "celiac awareness programs".

Adolescent↗
PubMed2001

Mental health screening in a refugee population: a program report.

Over the past 10 years the United States has resettled an average of 106,500 refugees annually (U.S. Committee for Refugees: Refugee Rep 1999; 20(12):1-12), relocating them to various cities across the country. Upon arrival, some states offer refugees physical health screening, specifically for communicable diseases such as tuberculosis, intestinal parasites and Hepatitis B, and for general preexisting medical problems. Unfortunately, the same attention is rarely given to potential mental health needs. Research has shown that refugees are at greater risk for depression, anxiety, and posttraumatic stress syndrome than the general U.S. population, yet they are not routinely screened. The purpose of this paper is to describe the addition of an innovative program for mental health screening in a refugee population. The current study found that mental health screening was more effective when done in a home visit situation. A 23.8% rate of depression was found amongst those refugees screened.

Journal Article↗
PubMed2001

[Screening for breast cancer on basis of individual risk assessment for women ineligible for the national population screening program].

For healthy women, without malignancies in their personal histories, a positive family history for breast cancer is the single indication for individual breast surveillance outside the population screening. Management of women is based on individual risk assessment. A cumulative risk of 20% and more, as a result of a positive family history, will in practice be an indication for breast surveillance. This threshold is not evidence-based yet, nor are data available on the benefits of this surveillance efficacy. When a personal cumulative risk of more than 30% exists to develop breast cancer, a consultation with a clinical geneticist involved in a family cancer clinic should be offered. Surveillance of women with a high-risk cumulative risk should preferably be included in a prospective study design. Only in this way will data about compliance and the estimates of different ways of surveillance become available. There is no convincing evidence that population screening for women aged 40-49 years does lead to important mortality reduction in combination with a good balance between pros and cons for the women involved. Women in the age category 50-75 years, with breast cancer in their personal histories, who are not followed anymore, should be informed by their specialist about participating (again) in the population breast screening. There is no evidence of mortality reduction as a result of breast self-examination nor of palpation performed by a physician. However, awareness of the own body can be useful for early recognition of breast abnormalities; it may reduce the delay between the first recognizable symptom and the subsequently initiated therapy.

Adult↗
PubMed2006

Computer programs for population genetics data analysis: a survival guide.

The analysis of genetic diversity within species is vital for understanding evolutionary processes at the population level and at the genomic level. A large quantity of data can now be produced at an unprecedented rate, requiring the use of dedicated computer programs to extract all embedded information. Several statistical packages have been recently developed, which offer a panel of standard and more sophisticated analyses. We describe here the functionalities, special features and assumptions of more than 20 such programs, indicate how they can interoperate, and discuss new directions that could lead to improved software and analyses.

Computers↗
PubMedDate not supplied

Population dynamics and rural poverty.

An overview of the relationship between demographic factors and rural poverty in developing countries is presented. The author examines both the micro- and macro-level perspectives of this relationship and the determinants and consequences of population growth. The author notes the prospects for a rapid increase in the rural labor force and considers its implications for the agricultural production structure and the need for institutional change. Consideration is also given to the continuing demand for high fertility at the family level and the role of infant and child mortality in the poverty cycle. "The paper concludes by drawing attention to the need for developing the mechanism for reconciliation of social and individual optima with respect to family size and population growth." The need for rural development projects that take demographic factors into account is stressed as is the need for effective population programs. (summary in FRE, ITA)

Agriculture↗
PubMed1991

[Use of social marketing in population health programs (literature review)].

At present health education programmes abroad make wide use of social marketing strategy. Unlike commercial marketing whose purpose is competition and struggle for the expansion of commodity markets, social marketing is aimed at disseminating certain ideas or introducing certain practices, using largely the technological base and strategy of commercial marketing. The authors give 8 fundamental principles of social marketing (consumer orientation, the theory of barter, the analysis of audience and segmentation, special surveys to detect the orientation of population, the choice of channels for information transmission application of "marketing mixture", control of ongoing programme and marketing management). Application fields of social marketing in public health are discussed.

Health Education↗
PubMed2003

Effectiveness and cost of screening for abdominal aortic aneurysm: results of a population screening program.

OBJECTIVES: We undertook this study to calculate the cost per life-year gained in the first round of a screening program for abdominal aortic aneurysm (AAA) and to estimate the costs in a subsequent round. METHODS: This was an intervention study, with follow-up for ruptured aneurysms. Men older than 50 years were screened for asymptomatic AAA. Outcome measures included cost per life-year saved and number of men needed to be screened to save one life. RESULTS: The incidence of ruptured AAA was 2.6 per 10,000 person- years in the screening group and 7.1 per 10,000 person-years in the control group. Screening is estimated to have prevented 10.8 ruptured AAA and 8 deaths per year, gaining 51 life-years per year for the study population, and to have reduced the incidence of ruptured AAA by 64% (95% CI, 42%-77%). Each life-year gained during the first screening round cost $1107. To save one life, 1000 men need to be screened and 5 elective operations performed. We predict that a second round of screening can be cost neutral. CONCLUSIONS: The cost-effectiveness of screening for AAA compares favorably with screening programs for other disorders in adults.

Aged↗
PubMed2004

A nationwide population screening program for diabetes in Brazil.

OBJECTIVES: In 2001, persons throughout Brazil who were 40 years old or older were invited to participate in community screening for diabetes as part of the Brazilian Ministry of Health's Plan for the Reorganization of Care for Arterial Hypertension and Diabetes Mellitus. This report describes the overall participation rate and positivity rate of the screening campaign, as well as factors associated with the level of participation among the municipalities in Brazil. METHODS: Screening test positivity was defined as a fasting glucose of > or = 100 mg/dL or a casual glucose of > or = 140 mg/dL. Screening data were obtained from the Ministry of Health and were analyzed for each municipality. RESULTS: Out of the 5 561 municipalities in Brazil, 5 301 of them (95.3%) participated and reported results. Of the 30.2 million persons in the target population, 22.1 million of them (73.0%) were tested, and 3.5 million of the persons tested (15.7%) were positive. Higher odds of a high population participation rate (> or = 80%) were seen in municipalities that were of small size (risk ratio (RR) = 5.0, comparing extremes), were located in the North region of the country (RR = 1.8), were located outside of a metropolitan region (RR = 1.4), and had a higher proportion of their population who had completed elementary school (RR = 1.2) (P < 0.05). There was a parallel increase in glucose testing nationwide during and immediately after the campaign, presumably in part for diagnostic confirmation of cases identified during screening. CONCLUSIONS: The massive response to the campaign attests to the potential that this type of program has to raise diabetes awareness and to set the stage for capacity-building at the primary care level.

Adult↗
PubMed2002

Cancer survival among US whites and minorities: a SEER (Surveillance, Epidemiology, and End Results) Program population-based study.

BACKGROUND: Available cancer statistics pertain primarily to white and African American populations. This study describes racial or ethnic patterns of cancer-specific survival and relative risks (RRs) of cancer death for all cancers combined and for cancers of the colon and rectum, lung and bronchus, prostate, and female breast for the 6 major US racial or ethnic groups. METHODS: Cancer-specific survival rates were analyzed for more than 1.78 million patients who resided in the 9 SEER (Surveillance, Epidemiology, and End Results) Program geographic areas and were diagnosed between 1975 and 1997 as having an incident invasive cancer, by 6 racial or ethnic groups (non-Hispanic whites, Hispanic whites, African Americans, Asian Americans, Hawaiian natives, and American Indians and Alaskan natives). RESULTS: Survival rates improved between 1988 to 1997 for virtually all racial or ethnic groups. However, racial or ethnic differences in RRs of cancer death persisted after controlling for age for all cancers combined and for age and stage for specific cancer sites (P<.01). African American, American Indian and Alaskan native, and Hawaiian native patients tended to have higher RRs of cancer death than the other groups. American Indians and Alaskan natives generally exhibited the highest RRs of cancer death, except for colorectal cancer in males. CONCLUSIONS: Survival rates in patients with cancer have improved in recent years, but racial or ethnic differences in survival rates and in RRs of cancer death persist. Additional studies are needed to clarify the socioeconomic, medical, biological, cultural, and other determinants of these findings.

Aged↗