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PubMed1999

HIV surveillance: a dynamic, not static, process to assure accurate local data.

BACKGROUND AND OBJECTIVES: Accurate human immunodeficiency virus (HIV) surveillance data is critical for the allocation of resources for care services and community prevention planning efforts. GOAL OF THIS STUDY: To validate HIV status of women and assess risk factor information on all persons reported with either heterosexual transmission or no identifiable risk factor. STUDY DESIGN: The surveillance database is updated continually as additional information is received on all cases allowing continual monitoring of pregnant and nonpregnant women. Repeated queries of various record systems were employed to validate or reclassify reported heterosexual or no identifiable risk factor information for both men and women. RESULTS: Four pregnant women (24%) and one nonpregnant woman (0.4%) initially meeting HIV surveillance criteria were demonstrated not to be infected. Risk factors were validated or reclassified for 77 (58%) patients initially reported with heterosexual transmission or no identifiable risk. CONCLUSION: HIV surveillance should be a dynamic process and continual updating of case reports provides the most accurate information on which to base service and prevention decisions.

Adult↗
PubMed1984

Health problems during the first year of life in infants born to adolescent mothers.

The role of maternal age at birth was investigated to determine its impact on an infant's health status during the first year of life. A sample population of 112 healthy term infants born to young primiparous mothers (less than or equal to 17 years) was compared using a chart audit with a population of 92 infants born to older primiparous mothers (greater than or equal to 18 years). There was no significant difference between the two groups in the number of missed clinic appointments, number of emergency room visits, number of hospitalizations, number of infants fully immunized, or incidence of child abuse. Poor weight gain and fewer outpatient visits for medical problems were more frequent in the infants of the younger population. Education programs designed for pregnant adolescents should stress the proper use of health professionals and appropriate methods of infant feeding.

Adolescent↗
PubMed2002

Continuing HIV transmission among injection drug users in Eastern Central Canada: the SurvUDI Study, 1995 to 2000.

OBJECTIVE: To document HIV prevalence/incidence trends from 1995-2000 and associated risk factors among injection drug users (IDUs) in Eastern Central Canada as an indication of harm reduction strategy effectiveness. METHODS: Nonnominal cross-sectional data (one-time participants) and longitudinal data (repeat participants) were collected using convenience sampling. Participants provided informed consent for face-to-face interviews focused on injection drug use and sexual practices during the previous 6 months; oral fluid samples were taken for HIV testing by enzyme immunoassay. Unique encrypted codes for initially HIV-negative repeat participants permitted incidence rate calculations. RESULTS: In all, 6387 IDUs (median age, 31 years; range, 13-67; males, 73.5%) participated on 9724 occasions. HIV prevalence ranged from 4.7% (95% confidence interval [CI], 2.9-6.5) in semiurban areas to 20.1% (95% CI, 17.6-22.7) in Ottawa, Ontario. HIV incidence was 6.0 (95%CI, 4.5-7.6) per 100 person-years (py) in Montréal, Québec, 3.2 (95% CI, 2.2-4.2) per 100 py in Québec City and 7.0 (95% CI, 4.1-9.8) per 100 py in Ottawa/Hull. Reusing other IDUs' needles was reported by 38.4%. In multivariate logistic regression, IDUs injecting for 6 or more years were more likely to be HIV positive, particularly if cocaine was the predominant drug injected. Multivariate Cox regression revealed higher HIV incidence among those who predominantly injected cocaine, reused others' needles, had injected 6 years or more, injected with strangers, or were men reporting commercial sex work. CONCLUSIONS: These results reveal a volatile situation of continuing HIV transmission among IDUs in Eastern Central Canada.

AIDS Serodiagnosis↗
PubMed2004

Gemcitabine in patients with solid tumors and renal impairment: a pharmacokinetic phase I study.

The purpose of this phase I study was to determine the pharmacokinetics and toxicity of gemcitabine in patients with advanced, recurrent, and/or metastatic cancer and renal impairment. Patients were entered in 4 groups estimated by EDTA-Cr plasma clearance (CLp, mL/min): > or =80; > or =60 and <80; > or =30 and <60; and > or =30 and <80 plus renal insufficiency induced by previous chemotherapy, respectively. Gemcitabine 500 to 1000 mg/m was administered intravenously on days 1, 8, and 15 every 4 weeks. Plasma concentration data were pooled and analyzed using a population pharmacokinetic program (NONMEM). Eighteen white patients (14 females, 4 males) entered the study with a median age of 55 years. Linear regression analyses revealed no significant relationship between gemcitabine CLp and indices of renal impairment (EDTA-Cr CL; p = 0.797 or beta2-microglobulin; p = 0.153). Hematologic and nonhematologic toxicities were mild. Thus, there seems to be no significant impact of mild to moderate renal insufficiency on gemcitabine pharmacokinetics in patients with advanced cancer.

Antimetabolites, Antineoplastic↗
PubMed2003

Imperfect vaccination: some epidemiological and evolutionary consequences.

An aim of some vaccination programmes is to reduce the prevalence of an infectious disease and ultimately to eradicate it. We show that eradication success depends on the type of vaccine as well as on the vaccination coverage. Vaccines that reduce the parasite within-host growth rate select for higher parasite virulence and this evolution may both increase the prevalence of the disease and prevent disease eradication. By contrast, vaccines that reduce the probability of infection select against virulence and may lead more easily to eradication. In some cases, epidemiological feedback on parasite evolution yields an evolutionary bistable situation where, for intermediate vaccination coverage, parasites can evolve towards either high or low virulence, depending on the initial conditions. These results have practical implications for the design and use of imperfect vaccines in public- and animal-health programmes.

Animals↗
PubMed2002

The cost of doing business: cost structure of electronic immunization registries.

OBJECTIVE: To predict the true cost of developing and maintaining an electronic immunization registry, and to set the framework for developing future cost-effective and cost-benefit analysis. DATA SOURCES/STUDY SETTING: Primary data collected at three immunization registries located in California, accounting for 90 percent of all immunization records in registries in the state during the study period. STUDY DESIGN: A parametric cost analysis compared registry development and maintenance expenditures to registry performance requirements. DATA COLLECTION/EXTRACTION METHODS: Data were collected at each registry through interviews, reviews of expenditure records, technical accomplishments development schedules, and immunization coverage rates. PRINCIPAL FINDINGS: The cost of building immunization registries is predictable and independent of the hardware/software combination employed. The effort requires four man-years of technical effort or approximately $250,000 in 1998 dollars. Costs for maintaining a registry were approximately $5,100 per end user per three-year period. CONCLUSIONS: There is a predictable cost structure for both developing and maintaining immunization registries. The cost structure can be used as a framework for examining the cost-effectiveness and cost-benefits of registries. The greatest factor effecting improvement in coverage rates was ongoing, user-based administrative investment.

California↗
PubMed1988

Suicidal death of rat chloroleukaemia cells by activation of the long interspersed repetitive DNA element (L1Rn).

Rat chloroleukaemia cells, maintained in suspension culture in different media, show rapid exponential growth without cell loss. At about half of the maximal population density the long interspersed repetitive DNA element (L1Rn) is suddenly transcriptionally activated without any obvious exogenous reason. Population growth is then inhibited and, within about 24 h after reaching the maximal density, the population undergoes programmed death (apoptosis). Suicidal cell death is caused by sudden incorporation, apparently by retroposition via an RNA intermediate, of about 300,000 copies of the L1Rn element into random locations in the cell genome, thus creating lethal mutations. The preceding growth inhibition is associated with repression, to an undetectable level, of c-Ki-ras expression. Up to the point of massive L1Rn incorporation and cell death, all phenomena are quickly reversible by subculturing; medium change alone is not sufficient. Biological implications of these surprising findings are discussed.

Animals↗
PubMed2004

Frequency of gastropathy and gastric varices in children with extrahepatic portal venous obstruction treated with sclerotherapy.

BACKGROUND: There are limited reports of the effect of endoscopic sclerotherapy (EST) on portal hypertensive gastropathy (PHG) and gastric varices (GV) in children with extrahepatic portal venous obstruction (EHPVO). We have studied the prevalence of PHG and GV in children with EHPVO and assessed the effect of EST on them on long-term follow-up. METHODS: From January 1992 to June 2002, consecutive children presenting with variceal bleeding due to EHPVO were included in this study. All children underwent EST at presentation and at 2-3 week intervals thereafter. During each session of endoscopy, gastric mucosa and fundus of the stomach was screened carefully to detect PHG and GV. Gastric varices were classified as gastroesophageal (GOV) and isolated gastric varices (IGV). RESULTS: In total, 274 cases of EHPVO were managed during the study period. The mean age was 7.4 +/- 3.5 years with a male to female ratio of 2.3:1. Of these 274 cases, 186 completed the EST program (study population), 60 were lost to follow-up, five died and 23 underwent surgery. At presentation (n = 274) 27% cases had PHG (3.6% severe) and 68.6% had GV (GOV 66.8%, IGV 1.8%). Following EST (n = 186) there was a significant (P < 0.001) decrease in GOV (45% from 64%) but an increase in IGV (14% from 1%) and PHG (51.6% from 24.7%). There was also a significant increase in severe PHG (15.6% from 3.2%, P < 0.05). On follow-up (mean follow-up 38 +/- 30 months) 19% children with IGV bled while none with PHG bled. CONCLUSIONS: Portal hypertensive gastropathy and gastric varices are quite common in children with EHPVO. Following EST, there is a chance of developing isolated gastric varices.

Adolescent↗
PubMed2005

Assessment of cardiovascular disease risk factors and diabetes mellitus in Australian prisons: is the prisoner population unhealthier than the rest of the Australian population?

INTRODUCTION: This paper compares the prevalence estimates of diabetes and cardiovascular disease (CVD) risk factors in the Indigenous and non-Indigenous New South Wales (NSW) prisoner population in 1996 and 2001, and also compares the 2001 prevalence estimates with Australian population data. METHODS: In 1996 and 2001, 789 and 916 prisoners, respectively, in NSW underwent a face-to-face interview covering behavioural risks and physical and mental health. Weight, height and blood pressure were recorded and blood was taken for measurement of cholesterol and random blood sugar. RESULTS: The prevalence of hypertension, hypercholesterolaemia and smoking were lower in the 2001 prison survey as compared with the 1996 survey but the prevalence of smoking was extremely high in both the prison surveys (88% in 1996 and 79% in 2001). There were no differences in the age and sex-adjusted prevalence estimates for any condition except that the prison sample had a higher standardised morbidity ratio for angina than the AusDiab population. CONCLUSION: This study highlights the high prevalence of CVD risk factors, particularly in younger prisoners, when compared with the Australian non-prison population. IMPLICATIONS: Programs should be put in place to routinely screen for chronic disease conditions and to educate Australian prisoners regarding CVD and diabetes risk factors and their long-term management.

Adolescent↗
PubMed1983

Oral hygiene instruction using a self inspection plaque index.

The need for proper oral hygiene requires large amounts of time and manpower, and relapse is still common. This paper describes a self instructional manual and self inspection plaque index that was tested in a periodontal recall population. The program was tested on 18 periodontal recall patients over a period of 6 weeks. Questionnaires were completed at the start, at 2 weeks, and at the end of the experimental period to evaluate patient opinions. Presence of plaque near the gingival margin was recorded at the start, at 2 weeks, and at 6 weeks. Patients were provided with a self instructional manual which taught them to recognize plaque on six teeth. Also, they were given a lighted mouth mirror, a toothbrush, and disclosing wafers. Initial, before-brushing plaque scores of 47% decreased to 18% during the 6 weeks of the study. After-brushing plaque scores also were significantly improved during the study. Patients were able to perform the plaque index without guidance to a high level of agreement with a dental hygienist (r = 0.72). Furthermore, the program was well accepted by the patients according to their answers on the questionnaire.

Adult↗
PubMed1998

Combined use of erythrocyte zinc protoporphyrin and mean corpuscular volume in differentiation of thalassemia from iron deficiency anemia.

In a retrospective study the diagnostic value of erythrocyte zinc protoporphyrin (ZPP) measurement as a means of distinguishing iron deficiency anemia from thalassemia syndromes in patients with microcytosis was explored. ZPP values were increased in all patients with iron deficiency and in part of the patients with thalassemia. The combined measurement of erythrocyte mean corpuscular volume (MCV) and ZPP resulted in a correct classification of patients with iron deficiency and with thalassemia in more than 95%. The predictive value of this method is better than the results obtained by using formulae derived from red cell indices. In population screening programs for thalassemia syndromes, in which MCV determination is used as the initial test, the ZPP test is recommended as a second test, in order to discriminate between patients with microcytosis due to iron deficiency and patients with microcytosis due to thalassemia syndromes.

Adult↗
PubMed1998

Resistance to antimicrobial agents used for animal therapy in pathogenic-, zoonotic- and indicator bacteria isolated from different food animals in Denmark: a baseline study for the Danish Integrated Antimicrobial Resistance Monitoring Programme (DANMAP).

This study describes the establishment and first results of a continuous surveillance system of antimicrobial resistance among bacteria isolated from pigs, cattle and broilers in Denmark. The three categories of bacteria tested were: 1) indicator bacteria (Escherichia coli, Enterococcus faecalis, Enterococcus faecium), 2) zoonotic bacteria (Campylobacter coli/jejuni, Salmonella enterica, Yersinia enterocolitica), and 3) animal pathogens (E. coli, Staphylococcus aureus, coagulase-negative staphylococci (CNS), Staphylococcus hyicus, Actinobacillus pleuropneumoniae). A total of 3304 bacterial isolates collected from October 1995 through December 1996 were tested for susceptibility to all major classes of antimicrobial agents used for therapy in Denmark. Bacterial species intrinsically resistant to an antimicrobial were not tested towards that antimicrobial. Acquired resistance to all antimicrobials was found. The occurrence of resistance varied by animal origin and bacterial species. In general, resistance was observed more frequently among isolates from pigs than from cattle and broilers. The association between the occurrence of resistance and the consumption of the antimicrobial is discussed, as is the occurrence of resistance in other countries. The results of this study show the present level of resistance to antimicrobial agents among a number of bacterial species isolated from food animals in Denmark. Thus, the baseline for comparison with future prospective studies has been established, enabling the determination of trends over time.

Animal Diseases↗
PubMed2002

China's family planning policy: an overview of its past and future.

This article provides a broad overview of China's family planning policy during the last three decades, highlighting key trends and goals of the program at national and provincial levels. It focuses on the administrative, economic, cultural, and other factors that have helped or hindered the family planning effort and reviews the impact of the program on the provincial population. A key question is whether the policy of strict fertility control will remain relevant and enforceable as population growth slows, as controlling private life becomes increasingly problematic for the government, and as new demographic problems (for example, aging) emerge.

Adult↗
PubMed1985

High school students' long-term retention of sex education information.

Ninth grade students in a rural South Carolina school were pretested about sexuality information, completed a 12-unit reproductive health course in eight months, and were posttested. A control group received the same pretest and posttest. Both groups were retested after the 10th and 11th grades and mean scores were calculated and compared. The difference between the experimental group's pretest and posttest mean scores was 8.49 (p less than .001); the difference between the control group's pretest and posttest mean scores was 1.0 (p = .003). The experimental group's mean score remained at least 5.2 points higher (p less than .001) than the control group's score on the same test one and two years after the course. Comparison of the mean gain between the pretest and posttest scores, and between the pretest and fourth test scores, confirmed the results obtained by mean test scores. The test scores indicated that the knowledge of the experimental students increased significantly and was sustained for two years. Their scores remained significantly higher than those of the control group on the posttest, and on tests one and two years later.

Adolescent↗
PubMed1991

Variability in interpretation of radiographs for asbestosis abnormalities: problems and solutions.

Interobserver variation continues to be a substantial problem for interpretation of asbestos-workers' X-rays, despite incremental improvements in the International Labour Office (ILO) classification system. The apparent degree of agreement/variability is affected by the population disease prevalence. For most populations, experts will be able to agree routinely about normal films. Yet designed trials show that selected experts exhibit a two-fold or greater range for perceived prevalence of abnormal profusions. This degree of variability would be adequate for many population studies were it achieved under real-life conditions of interpretation. Unfortunately, the realistic degree of interobserver variability is probably much higher under actual population surveillance conditions. Asbestos population surveillance programs have provided little or no quality assurance for ILO interpretations, so the very high variability suggested by available data are not surprising and are not the fault of the classification. Recommendations include required participation in quality-assurance panels for those who wish to be certified as interpreters, with consistent feedback and the dropping of outliers. If quality-assurance programs are implemented, the classification will achieve its intended epidemiologic purposes.

Asbestosis↗