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PubMed2003

Food fortification: issues on quality assurance and impact evaluation in developing countries.

Quality assurance and impact evaluation are essential components of a food fortification program and should be integrated in the fortification process. Quality assurance will ensure that the micronutrient meant to be delivered is indeed reaching the target population at the correct level. Impact evaluation will determine the effectiveness of food fortification as a strategy in controlling micronutrient deficiency and enable program planners to make decisions on the future of the program. In developing countries, both quality assurance and impact evaluation are often constrained not only by inadequacy of facilities as well as financial and manpower resources, but by unclear definition of objectives and inappropriate design. It is therefore necessary to consider the target audience for the quality assurance monitoring and impact evaluation in order to clearly define their objectives and in turn suit the design to these objectives, at the same time as the limitations in financial and manpower resources are considered.

Deficiency Diseases↗
PubMed2006

The Deep South Network for cancer control. Building a community infrastructure to reduce cancer health disparities.

Given the recent advances in cancer treatment, cancer disparity between whites and African-Americans continues as an unacceptable health problem. African-Americans face a considerable disparity with regard to cancer incidence, survival, and mortality when compared with the majority white population. On the basis of prior research findings, the Deep South Network (DSN) chose to address cancer disparities by using the Community Health Advisor (CHA) model, the Empowerment Theory developed by Paulo Freire, and the Community Development Theory to build a community and coalition infrastructure. The CHA model and empowerment theory were used to develop a motivated volunteer, grassroots community infrastructure of Community Health Advisors as Research Partners (CHARPs), while the coalition-building model was used to build partnerships within communities and at a statewide level. With 883 volunteers trained as CHARPs spreading cancer awareness messages, both African-Americans and whites showed an increase in breast and cervical cancer screening utilization in Mississippi and Alabama. In Mississippi, taking into account the increase for the state as a whole, the proportion that might be attributable to the CHARP intervention was 23% of the increase in pap smears and 117% of the increase in mammograms. The DSN has been effective in raising cancer awareness, improving both education and outreach to its target populations, and increasing the use of cancer screening services. The National Cancer Institute has funded the Network for an additional 5 years. The goal of eliminating cancer health disparities will be pursued in the targeted rural and urban counties in Mississippi and Alabama using Community-Based Participatory Research. Cancer 2006. (c) 2006 American Cancer Society.

Black or African American↗
PubMedDate not supplied

Testicular self-examination: a public awareness program.

Testicular cancer is responsible for one out of seven deaths among late adolescent and young adult males. It is the number one cancer killer of men in the second and third decade of life. However, the population at risk, men between the ages 15 and 35, is singularly unaware of this cancer's existence and its potential danger. A public awareness program has been designed to increase consciousness about this possibly fatal disease and to enhance early detection and cure through a program of testicular self-examination (TSE). This proposal incorporates intervention at local, State, and national levels. It contemplates an innovative campaign beginning at the local level, focusing on the target population and utilizing a collaboration between nonprofessionals and professionals. The aim is for a grass-roots beginning and continued public interest to culminate in a national campaign, similar to that of breast self-examination. The ultimate goal of the program is to prevent the loss of lives to testicular cancer through public education and through use of TSE.

Adolescent↗
PubMed1996

Progress toward poliomyelitis eradication--Indonesia, 1995.

In 1988, Indonesia (1991 population: 181 million) adopted the goal of eradicating poliomyelitis by the year 2000. Although routine coverage with three doses or oral poliovirus vaccine (OPV3) has been >90% among 1-year-old children since 1991, cases of polio continue to be reported. To interrupt poliovirus transmission, National Immunization Days (NIDs) were conducted during September 13-17 and October 18-22, 1995, resulting in vaccination of >22 million children aged <5 years (representing approximately 100% of the target population). NIDs are planned for September 10-14 and October 15-19, 1996, and in 1997. This report presents the polio surveillance data for Indonesia for 1995, which indicate that substantial improvements are necessary to meet the objectives of the polio-eradication initiative. Activities are under way to intensify surveillance for acute flaccid paralysis (AFP) and to identify the remaining reservoirs of wild poliovirus transmission.

Adolescent↗
PubMed1978

Differences between respondents and non-respondents in a population-based cardiovascular disease study.

The differences in cardiovascular health status between participants and non-participants were examined in a population-based cardiovascular study. Telephone interviews with non-respondents revealed generally more cardiovascular disease but less hyperlipidemia and family history of cardiovascular disease. Non-respondents did not differ regarding known hypertension, diet or drug therapy for hyperlipidemia, or egg use. Non-respondents were more likely to be cigarette smokers. Because the amount of non-respondent bias in the study was small while the response rate was high, respondents were generally representative of the target population. However, the observed differences could have produced spuriously high estimates of risk factor prevalence, low estimates of disease prevalence, and biased relative risks if the non-response rate and/or the baseline differences had been considerably larger.

Adult↗
PubMed1990

The Dubbo study: an Australian prospective community study of the health of elderly.

The proportion of Australian population over 60 years has risen progressively over the last 40 years and this growth is projected to continue. Major health problems of the elderly include coronary heart disease, cerebro-vascular disease, osteoporosis and fracture. The risk factors for coronary heart disease and stroke in middle-aged subjects have been extensively documented in prospective studies in Australia and elsewhere, and include lipid disorders, hypertension, cigarette smoking, diabetes and family history. Few prospective studies have been targeted exclusively on the elderly and information available with respect to vascular risk factors is fragmentary and contradictory. This is the background to a new prospective study of the health of elderly Australians now under way in Dubbo, NSW. The goals of the Dubbo Study are to identify predictors of mortality, hospitalisation and placement in long-term care, while specific aims are the study of risk factors for chronic diseases and disability. This report describes the study rationale, reasons for selecting Dubbo as the study site, methods and measures, participation rates and demography. The target population included all non-institutionalised subjects 60 years and over, domiciled in Dubbo, and is comprised of 1693 males and 2167 females. The attendance rate for an extensive medical and sociological baseline assessment over a 13 months' period was 73% for both sexes. The prospective study is now in place and within three to five years will be generating definitive information in the elderly.

Aged↗
PubMed2006

Working with a Head Start population with asthma: lessons learned.

The Early Childhood Asthma Project involved asthma case identification in 35 Head Start centers in Detroit, MI, and attempted implementation of an intervention designed to help families manage a child's asthma more effectively. Surveys were distributed to the parents of all Head Start children (3408), and 2198 complete surveys were returned. Case detection found probable asthma in 30% of the children whose parent returned a sufficiently complete survey. Implementation of the intervention was unsuccessful in this setting. Obstacles to effective implementation included the sample's low participation and high attrition, limited involvement of Head Start personnel, factors related to the program approach, and the target population's beliefs about asthma.

Asthma↗
PubMed2003

Formative evaluation of an intervention to increase compliance to HIV therapies: the ALP project.

Non-adherence to highly effective antiretroviral medications can lead to treatment failure and the development of drug-resistant strains of HIV, and may result in an epidemic of treatment resistant HIV. This article describes a theory-based intervention (ALP) that was developed to increase adherence to HIV therapies among low-literacy populations of HIV positive African American women. The ALP intervention consists of a cartoon book and a cassette tape suitable for individuals with less than a 3rd-grade reading level. Qualitative data were collected through focus groups and expert panel interviews to conduct a formative evaluation. The results indicated that constructs of the Health Belief Model and Social Cognitive Theory were recognizable by behavioral scientists and that the materials would be used as intended by the target population to achieve the desired behavior change. This type of evaluation is a cost-effective method that can be used to develop effective interventions and obtain community buy-in.

Black or African American↗
PubMed2003

[The weight of school children and its relationship to performance in studies and well-being.].

OBJECTIVE: There has been significant weight gain among Western populations during the past few decades, including children and adolescents. The aim of this research was to investigate the possibility of discovering a correlation between the weight of primary school children and their well-being and performance in studies. There was also an interest in determining the weight development of children and adolescents during a period of thirty years and attempting to answer the question whether they were still putting on weight. METHODS AND MATERIALS: The target population of the research project comprised pupils in the 4th, 7th and 10th grades of primary schools within the service area of Akureyri Health Centre during the winter of 2000-2001. The above classes were chosen on the basis of the fact that they all sat the national coordinated examination. Data were collected to discover Body Mass Index (BMI, weight/height_, kg/m_), measure performance in studies (the results in nationally coordinated examinations in Icelandic and arithmetic) and assess well-being by means of a questionnaire (Youth Self Report, YSR), which was only presented to the 7th and 10th grade. Furthermore, BMI was determined for corresponding groups from the school years 1970-71, 1980-81 and 1990-91, using information obtained from school health reports for the pupils in question. RESULTS: This group consisted of 819 pupils and information was available on 568 of those, or about 70%. The weight gain which turned out to have occurred between the years 1970 and 1990 did not occur in the final decade of the 20th century and this applies to all three year groups. No difference was between those living in urban and rural areas. This was found to be the case, both when comparing the average BMI of the year groups and the proportion of children who are above a certain threshold of criteria. Furthermore, it was found that excessive weight/obesity is related to slack study results and a poor state of well-being among pupils in the 10th grade of the primary school. Such a relationship, however, did not exist among students in the 7th grade. Heavier pupils in the 4th grade perform better in their studies than their lighter peers, although this difference is not statistically significant. CONCLUSIONS: The unfavourable trend towards weight gain that we have seen in the past may now be changing. Other research pointing in the same direction has not been found, however, and more results are needed before this can be stated as a fact. Weight has a stronger influence on the well-being of adolescents in their upper teens, or towards the end of primary school, than is the case with younger pupils. This research does not explain why, although it may be assumed that the social environment of older children and adolescents is a significant factor in this respect. As the children grow older, a correlation begins to appear between being overweight and having less performance in studies and none of the heavier pupils show excellent school performance.

English Abstract↗
PubMed1991

Splenic cell targets in gallium arsenide-induced suppression of the primary antibody response.

In vivo exposure of female B6C3F1 mice to gallium arsenide (GaAs) was evaluated for its effect on the in vitro IgM antibody-forming cell (AFC) response. In vivo exposure to a single intratracheal dose of GaAs (2.5-200 mg/kg) resulted in a dose-dependent decrease in the in vitro IgM AFC response to the T-dependent antigen sheep red blood cells (SRBC) with a 97% decrease at 200 mg/kg when compared to vehicle controls. The response to the T-independent antigen DNP-Ficoll was significantly reduced at 100 and 200 mg/kg. Spleen cellularity decreased in a dose-related manner with a 54% decrease at 200 mg/kg. Enumeration of splenic subpopulations following GaAs (200 mg/kg) indicated a 58, 61, and 30% decrease in the total number of Thy 1.2 (T cells), Ig (B cells), and F4/80 (macrophages) positive cells, respectively, with no alterations in the percentages of these cells. Mitogenic responsiveness of splenocytes from GaAs-exposed mice was unaltered. To identify the splenic cell populations targeted by GaAs, the AFC response to SRBC was evaluated following cell separation/reconstitution of splenocytes from GaAs- (200 mg/kg, 24-hr exposure) and vehicle-exposed mice. Results demonstrated AFC suppression was due to functional alterations in both adherent (AD; macrophages) and nonadherent, (both T and B lymphocytes) cell populations. Further investigation focused on alterations in the AD population. Separation/reconstitution experiments demonstrated AFC suppression to SRBC was dependent on the concentration of macrophages from GaAs-exposed mice. This macrophage-mediated suppression of the in vitro AFC response could not be attributed to the presence of suppressor macrophages or release of prostaglandins.

Animals↗
PubMed2004

Recruiting Black/African American men for research on prostate cancer prevention.

BACKGROUND: Black/African American men die of prostate cancer at a greater rate relative to other males. During the period from 1992 to 1998, prostate cancer incidence rates in the United States were 234.2 per 100,000 persons among non-Hispanic black males and 144.6 per 100,000 persons among white males. The reasons for these increased rates of prostate cancer among black males are largely unknown, but increased mortality is associated with late detection. The authors conducted a longitudinal study of black men that investigated prostate cancer prevention behaviors within this population. The purpose of the current article is to identify successful recruitment strategies that were reported by participants in this study of prevention behaviors. METHODS: Qualitative research methods were used to elucidate men's thoughts, attitudes, beliefs, and practices regarding prostate cancer prevention behaviors and to identify strategies for attracting black men to research programs and retaining them in these programs. RESULTS: Ethnocentric recruitment strategies that were identified included the development of tailored printed materials; the use of targeted locations; and a personalized, participatory approach for engaging potential participants. We contacted 498 black men and enrolled a cohort of 277 non-Hispanic black males (75% of whom were recruited within a 9-week period) in the current study. CONCLUSIONS: Unlike other studies that reported difficulty in recruiting African American men, the current study did not encounter such difficulties. The authors attribute their success to culturally attractive Afrocentric materials; cultural sensitivity; a caring, professional, personalized ethnic approach; respect; and participatory involvement of the target population. Nonetheless, the authors did encounter barriers, such as lack of physician interest and lack of trust in quality medical care. These barriers must be overcome before black males can be engaged and retained in research studies on prostate cancer prevention.

Black or African American↗
PubMed1992

The Midfield High School Safety Belt Incentive Program.

Motor vehicle accidents constitute the leading cause of death among children and youth ages 15-24. The Year 2000 Health Objectives for the Nation call for reduction in fatalities in this population through increasing occupant restraint measures. This article provides an overview of how one school district developed a school and community safety belt incentive program to increase safety belt use among high school students. The intervention program followed a seven-step process, involving community leaders, school officials, students, and local law enforcement personnel in its design, implementation, and evaluation. Local merchants and the Alabama Dept. of Health donated program incentives. Measurement of safety belt use among the target population revealed increased use throughout the program.

Adolescent↗
PubMed2003

[Evaluation of nutritional adequacy of the food intake in an Integrated Center of Public Education (CIEP)].

The paper's general objective is to evaluate the nutritional adequacy of the food consumed in an Integrated Center of Public Education in the city of Americana, state of Sao Paulo. The data on food consumption in the city of seven to 15 years old was obtained through a recordatory inquiry. To transform the food consumption in energy and nutrients intake a food composition table was used. The establishment of nutritional recommendations was based in the defined standard for the Brazilian population. It was verified that the food consumption is insufficient to attend the energy requirements of children of eight years old or older. It was shown that the protein intake is much higher than the requirements. For all ages, the iron intake is adequated. It is also shown that school meals contribute with 72% of vitamin C requirement. The paper stress that the school meals program should be based on previous diagnoses of the nutritional status of the target population and the food consumption at home.

English Abstract↗
PubMed1992

Availability of quality vaccines: policies of a non-government organization.

The availability of vaccines, or any other health service, depends upon, first, the existence of a reliable system of delivery, and the effective management of this system to reach the target population and, second, the acceptance by parents or guardians of the value of the vaccine in preventing death and disability in young children and their mothers. This system must be fully funded and resourced for the foreseeable future if the service is to be sustainable. Today the major obstacles to effective immunization of young children in developing countries is the inadequate, insecure and unpredictable availability of funds and their management. Unless these problems are addressed and solved, the immunization targets set by the World Health Assembly (WHA) will not be met.

Child↗
PubMed2001

The burden of trachoma in the rural Nile Delta of Egypt: a survey of Menofiya governorate.

BACKGROUND: Evidence of widespread distribution of trachoma in Egypt had not been clarified as previous surveys were limited to individual communities which may not have been representative of the general population. The Nile Delta of Egypt presents a unique environment for trachoma to persist. Economic improvements in the past decade have affected even the poorest rural environments; availability of electricity is now found in many rural communities. Availability of water in Nile Delta has always been good but poor hygienic conditions have been the primary factor in trachoma transmission. A survey of trachoma was undertaken in Menofiya governorate to determine if Egypt should be identified as trachoma endemic and targeted for trachoma control efforts. METHODS: A multistage random cluster study design was used with the target population defined as adults aged 50 and over and children aged 2-6 years from throughout the governorate. Among preschool children only trachoma was graded while among adults presenting visual acuity and cause of vision loss or blindness were also recorded. Adults were interviewed regarding past trichiasis surgery; those currently with trichiasis or a history of trichiasis surgery were also interviewed regarding outcome of surgery. RESULTS: A total of 3272 children aged 2-6 and 3322 adults age 50+ were enumerated. Among the children 81.3% were examined and among the adults 73.0% were examined. Active trachoma (follicles (TF) and/or intense inflammation (TI)) was found among 36.5% (95% confidence interval (CI) 34.7-38.3%) of the children. TI was 1.89 (95% CI 1.22-2.94) times more common in rural children compared to urban children. The prevalence of trichiasis (TT) in adults was 6.5%; women had an age adjusted odds of trichiasis of 1.68 (95% CI 1.18-2.39) compared to men. Trichiasis was 2.11 times (95% CI 1.33-3.37) more common in rural Menofiya compared to urban Menofiya. TT accounts for blindness (presenting vision <3/60) in 8% of patients and accounts for 13.2% of visual impairment. Overall, trichiasis surgical coverage was 34.4%, slightly higher among men than women. The outcome of trichiasis surgery was poor in 44.4% of cases. CONCLUSION: Trachoma is a serious public health problem in Menofiya governorate and a significant contributor to vision loss. These findings would suggest that continued poor hygienic conditions in rural Egypt have limited the reduction of active trachoma even in the face of significant improvements in socioeconomic status. Furthermore, the high proportion of trichiasis surgery cases with a poor outcome would indicate a need to reassess current surgical practices in Egypt and improve training and monitoring.

Aged↗
PubMed2006

Patients consulting outside of funded practices within primary health organisations: implications for utilisation reporting.

AIM: To consider two definitions for utilisation reporting in primary care in New Zealand and to assess the affect of two reporting methods on volumes of utilisation in four primary health organisations (PHOs). METHODS: Utilisation data was analysed for a 6-month period from 60 practices across four PHOs. Analysis was based on comparing the expected volumes from two alternative collection and reporting methods, named "matched" and "unmatched" reporting. The "unmatched" method is potentially sensitive to patients consulting outside of the practice in which they are funded. Volumes were grouped into categories based on those used for reporting. RESULTS: There was up to 25% difference in volumes in some reporting groups depending on the matching method used. Several of these were for high deprivation, New Zealand Maori, Pacific Islanders, and Community Service Card (CSC) holders--all potentially target populations within PHOs. Two PHOs were more affected having a total of 7.6% and 6.4% fewer reported encounters using the "unmatched" method. Data implies that some groups of patients may not be receiving continuity of care. CONCLUSIONS: There were differences in reporting volumes between the two methods. The Ministry of Health (MOH), district health boards (DHBs), and PHOs should be aware of how these results may potentially apply to them, especially where they have after-hours services or target groups as minorities.

Adolescent↗
PubMed1998

The use of the SelfCARE(D) as a screening tool for depression in the clients of local authority home care services--a preliminary study.

BACKGROUND: The home care population has high levels of depressive disorder which is unrecognized and untreated. In the UK, social services are charged with a full assessment of need but there appears to be little systematic assessment of depressed mood in their assessment and review procedures. The performance of the SelfCARE(D), a 12-item self-administered depression rating scale, was tested in this population. METHOD: Home care recipients in Lewisham East were invited to complete the SelfCARE(D). Random samples of groups scoring at different levels on the SelfCARE(D) were then interviewed using the GMS/AGECAT system in order to make a standardized psychiatric diagnosis. The sensitivity and specificity, and positive and negative predictive values (PPV and NPV) of the tests were calculated along with the area under ROC curves for different SelfCARE(D) cutpoints and definitions of disorder. RESULTS: 75% of the target population completed the SelfCARE(D). The data suggest that the most efficient cutpoint to use in this population appears to be 7/8, since this gave an NPV of 0.90, a PPV of 0.50 and a yield of 83% of cases of depression. This was achieved with having to complete a second-stage assessment on 17% less of the total population when compared with the 5/6 cutpoint and 9% less than the 6/7 cutpoint. CONCLUSIONS: This study suggests that the SelfCARE(D) may be an acceptable and effective tool for the screening of depression in the home care population. The data presented here support an evaluation of its incorporation into social service assessment and review packages for their elderly home care clients.

Aged↗
PubMed1999

Prevalence of diabetic eye disease in an inner city population: the Liverpool Diabetic Eye Study.

PURPOSE: To measure the population prevalence of diabetic eye disease in an inner city setting. METHODS: As part of a systematic screening programme all adult diabetic patients in four general practices were invited to attend for slit-lamp biomicroscopy by a retinal specialist. Data on non-attenders were available from community-based photography. RESULTS: Of 395 diabetic patients identified, 326 attended biomicroscopy with photographic data available on a further 31, giving a 90% compliance rate. Point prevalence of diabetes in the target population was 12.4/ 1000. Demographic data included: mean age 60 years (range 13-92 years); type of control: type I 49, type II insulin-requiring (IR) 40, type II non-insulin-requiring (NIR) 268. Prevalences were as follows: any retinopathy: of all diabetic patients 33.6%, type I 36.7%, type II IR 45.0%, type II NIR 31.3%; proliferative/ advanced: all 1.1%, type I 2.0%, type II IR 0, type II NIR 1.1%; clinically significant macular oedema: all 6.4%, type I 2.3%, type II IR 16.2%, type II NIR 5.7%. The percentage of patients with retinopathy requiring follow-up by an opthalmologist was 4.5%, and 9.2% had macular exudates within 1 disc diameter of fixation or significant circinate maculopathy. Sight-threatening diabetic eye disease (STED) was found in 13.4%. A visual acuity of < or = 6/24 in the better eye occurred in 12 (3.4%) patients and of < or = 6/60 in the better eye in 3 (0.8%). CONCLUSIONS: Compared with previous population studies, prevalences appear to have declined in type I, but remain high in type II diabetic patients and especially in those requiring insulin.

Adolescent↗