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PubMed1996

[Drug consumption by people over 60 years of age in a rural area].

OBJECTIVES: To describe the frequency and distribution of the consumption of medicines in a census-based sample of people of 60 or over. To determine the association between the consumption of medicines and other socio-demographic and clinical (presence of disease) variables. DESIGN: An epidemiological crossover study based in the community. SETTING: Rural population: the Health District of Arévalo in Castilla y León. PARTICIPANTS: 825 subjects (446 women and 379 men) over 60, with an average age of 71,84. MEASUREMENTS: A standard questionnaire was used, containing medicine consumption, prescription, and clinical and demographic features. RESULTS: The consumption of medicines per person per day was 1,92. Therapeutic groups most consumed were, in this order, hypotension drugs, cardiotonics, antirheumatics, peripheral vasodilators, digestive system drugs, neurotropics and analgesics. The number of illnesses suffered by this age-group was 2,19. There is a strong connection between consumption of medicines and age, especially in the over 80's. CONCLUSIONS: 75% of the target population took some medicine each day. Consumption is higher among women than men. Cardiovascular drugs are the most frequently used therapeutic group. Consumption of medicines is directly related to age and the number of illnesses.

Age Factors↗
PubMed2003

Barriers to sun safety in a Canadian outpatient population.

BACKGROUND: It has long been recognized that compliance with recommended sun safety practices is suboptimal, yet few investigations have explored the barriers that people face in practicing good sun safety. In this context, barriers can exist at the following three levels: knowledge of sun safety, acquisition of sun safety information, and implementation of specific sun protective measures. OBJECTIVE: The investigation reported herein sought to elucidate barriers to sun safety that individuals face. Ultimately, this study aimed to qualify the possible barriers that lead to a misalignment of current recommendations and sun safety practices. METHODS: The study design was observational, and the instrument used for data collection was a self-administered questionnaire. Thirty-four outpatients of the RK Schachter Dermatology Centre of Sunnybrook and Women's College Health Sciences Centre (SWCHSC), Toronto, Ontario, as well as 27 outpatients of the Sport Care facility of SWCHSC were enrolled in the study. They represent the target population of those who are at greater risk of developing sun-related skin lesions. Data were analyzed using standard parametric and nonparametric techniques. Comparisons were made between the two outpatient groups and between other groups within the sample. RESULTS: In general, level of sun safety knowledge was fairly high, though compliance to sun safety measures was suboptimal in both populations. There were no significant differences regarding level of knowledge between the 2 outpatient groups. Deficiencies in knowledge centered around risk factors for skin cancer. Frequently cited barriers to sun safety include inconvenience (34% of respondents), forgetting to use sun safety measures (49%), a desire to be tanned (33%), and protective clothing being too hot to wear (56%). High compliers were notable for their great likelihood of being counseled by a physician about sun safety ( P < 0.025) and their slightly higher mean knowledge scores. CONCLUSIONS: These data support that knowledge alone does not predict compliance and that sun awareness campaigns should be evaluated based on their ability to affect behavior.

Adult↗
PubMed2005

Understanding non-compliance to colorectal cancer screening: a case control study, nested in a randomised trial [ISRCTN83029072].

BACKGROUND: The major limit to colorectal cancer screening effectiveness is often low compliance. We studied the reasons for non compliance and determinants of compliance to faecal occult blood tests in Lazio, Italy. METHODS: This is a case-control study nested within a trial that tested the effect of type of test and provider on colorectal cancer screening compliance. Non compliant trial subjects were classified as cases, and compliant subjects were classified as controls. We sampled 600 cases and 600 controls matched by their general practitioner, half were invited for screening at the hospital, and the other half directly at their general practitioner's office. Cases and controls answered questions on: distance from test provider, logistical problems, perception of colorectal cancer risk, confidence in screening efficacy, fear of results, presence of colorectal cancer in the family, and gastrointestinal symptoms. RESULTS: About 31% of cases never received the letter offering free screening, and 17% of the sampled population had already been screened. The first reported reason for non-compliance was "lack of time" (30%); the major determinant of compliance was the distance from the test provider: odds ratio > 30 minutes vs < 15 minutes 0.3 (95% CI = 0.2-0.7). The odds ratio for lack of time was 0.16 (95% IC 0.1-0.26). The effect was stronger if the hospital (0.03 95% CI = 0.01-0.1) rather than the general practitioner (0.3 95% CI = 0.2-0.6) was the provider. Twenty-two percent of controls were accompanied by someone to the test. CONCLUSION: To increase compliance, screening programmes must involve test providers who are geographically close to the target population.

Aged↗
PubMed2006

Incidence of stroke in women in Auckland, New Zealand. Ethnic trends over two decades: 1981-2003.

BACKGROUND AND PURPOSE: Although women have a greater lifetime risk of stroke than men, along with other gender differences in stroke, there is lack of reliable data on long-term trends in stroke in women. This paper presents the results of three population-based registers in Auckland (1981-1982, 1991-1992, and 2002-2003) which aimed to determine the trends in the incidence of stroke in New Zealand. This paper reports on the burden of stroke in women across different ethnic groups over the study period from 1981 to 2003. METHODS: Three studies using similar methodology and overlapping case finding methods have been conducted in New Zealand to estimate trends in the incidence and outcome of stroke. The studies are recognised as meeting the 'ideal' criteria for stroke incidence and identify all first-ever and recurrent strokes in residents (aged greater than and equal to 15 years) the population of Auckland, New Zealand in the 12-month periods from 1981-1982, 1991-1992, and 2002-2003. There were totals of 307,578 strokes among women in 1981, 372,642 in 1991, and 470,727 in 2001, according to each Census representing over 50% of the population at each period (51%-54%). The WHO standard world population was used for direct age standardisation of annual rates (per 100,000 population), reported with 95% confidence intervals (CI). RESULTS: The proportion of women who have experienced a stroke did not change markedly over the study period but there were ethnic differences emerging which were related to population changes within the New Zealand population. Standardised stroke incidence in women was relatively stable across the three study periods (1981-1982), 133 [95% CI 118-151]; (1991-1992), 143 [95% CI 116-241]; and (2002-2003), 124 [95% CI 115-134]). However, a significant decline of 14% (95% CI 2%-29%) in rates of first-ever stroke was found between 1991-1992 and 2002-2003 in women. In contrast to the significant declines in event rates in European women over two decades (Rate ratio 0.84, 95% CI 0.73-0.96), increasing trends in event rates in Pacific women were observed (2.71 95% CI 1.00-7.29). The rate of stroke for Maori women did not change significantly over time. Over half of the women who had a stroke event reported that they had high blood pressure; one in four reported that they had diabetes. The proportion of women who smoked declined over time but increases in body mass index (BMI) indicated weight gains in women over time. These trends were consistent across ethnic groups. Women's survival after 1 month following their stroke has improved by 39% (p<0.0001) over the 20-year period. Favourable changes in early survival were most pronounced in European women. CONCLUSIONS: There was a modest decline in stroke incidence in women (overall and for New Zealand European women in particular) in Auckland over the past 20 years but there also was a trend towards increasing stroke incidence in Maori, Pacific, and Asian women. These divergent trends are likely to be associated with different trends in the prevalence of risk factors in these ethnic populations. Targeted stroke prevention programmes are needed in New Zealand to meet the needs of specific ethnic groups as well as the needs of providing ongoing care and support to women following their stroke.

Adolescent↗
PubMed1992

Chemoprevention of prostate cancer: guidelines for possible intervention strategies.

The "natural history" of prostate cancer may bedevil the development of guidelines for chemoprevention interventions. Can strategies be designed to direct agents to those lesions which have the potential to develop localized extension that may become symptomatic or metastatic disease? Of necessity our interventions will focus on the identification and quantification of appropriate biomarkers as intermediate endpoints, although no reliable endpoints for prostate cancer have yet been identified. The reduction of prostate cancer incidence may be the ultimate objective, but a decrease in the progression of microfocal or "latent" cancer may well be just as effective as prevention when the age of the target population and competing causes of death are taken into account. Early intervention strategies must focus on the analysis of the interactions of the chosen chemopreventive agents upon precancerous and cancerous cellular dynamics in the prostate. Whether the requirements of such molecular epidemiology necessitate a more deliberate strategy of Phase II studies or a high risk-high gain strategy of a broad Phase III study is open to debate. Factorial designs for proposed randomized chemoprevention trials may be desirable to test multiple chemopreventive agents simultaneously, provided knowledge of the biochemical synergism of the agents is solid. Stratification of study participants by degree of risk will ameliorate concerns regarding the precision targeting of lesions at different stages in the precancer/cancer continuum.

Androstenes↗
PubMed2005

Association between subject factors and colorectal cancer screening participation in Ontario, Canada.

Colorectal cancer screening reduces colorectal cancer incidence and mortality. This population-based study was conducted to evaluate (i) the association between subject factors and colorectal screening participation and (ii) the lifetime prevalence of colorectal screening among the general population of Ontario, Canada. Population-based controls were recruited by the Ontario Familial Colorectal Cancer Registry during 1998-2000. The 1944 persons completed an epidemiologic questionnaire. Descriptive statistics were computed and step-wise multivariate logistic regression was used to estimate odds ratios and 95% confidence intervals. Overall, 23% of persons greater than 50 years of age reported ever having had colorectal cancer screening; 17% reported fecal occult blood test (FOBT), 6% sigmoidoscopy, and 4% colonoscopy. Family history of colorectal cancer, increased age, higher household income, and use of hormone replacement therapy (among women) were all significantly associated with ever having had colorectal cancer screening. The low prevalence of colorectal cancer screening among the target population suggests the need for an increased awareness of the public health importance of colorectal cancer screening.

Adult↗
PubMedDate not supplied

The costs of body mass index levels in an employed population.

We studied 3,066 First Chicago NBD employees by using health risk appraisals and personnel data to determine the direct and indirect costs (in 1996 dollars) associated with varying levels of body mass index (BMI). The BMI is the most widely used measure of weight adjusted by height. We found that as BMI increases, so do the number of sick days, medical claims and health care costs and that the mean annual health care costs for the BMI "at risk" population (men with a BMI of > or = 27.8 kg/m2, women > or = 27.3 kg/m2) was $2,274 versus $1,499 for the "not at risk" group. Major differences in health care costs were observed for employees 45 years old and older, particularly among the women in this age group. Analysis was completed for those employees with and without a risk for BMI. A "J-shaped" curve between medical claims costs and BMI exists, with the low point occurring at about 25 to 27 kg/m2. We conclude that indirect and direct costs to an employer increase with increasing BMI. Employers may benefit from helping employees achieve a healthier weight. The initial target population should be those who are at highest risk of complications from obesity.

Adult↗
PubMedDate not supplied

[Evaluation and epidemiologic surveillance of nutritional deficiencies. Principles and application to elementary health units].

The authors briefly describe some anthropometric, biologic and clinical nutrition indicators used to assess the severity of malnutrition. Problems related to selection of population samples and framework for possible action against malnutrition are also indicated. For transverse evaluation, they suggest to utilize the cluster sampling method recommended by W.H.O. for studying vaccine coverage. The main indicator of nutritional status is then the brachial perimeter qualitatively evaluated with Shakir's strip. To monitor epidemiological importance of malnutrition, they suggest to take into account: the figures indicated by the maternities (birth weight), the figures indicated by M.C.H. and school health (ratio of malnourished children--weight average by age and sex), the figures indicated by specialized hospital departments such as pediatrics, nurseries... They insist upon seasonal factors and evaluation of the rate of coverage of the target population by maternities, M.C.H. and school health, in order to correctly read the declared figures.

Adolescent↗
PubMed2005

Developing an HIV intervention for indigent women substance abusers in the United States Virgin Islands.

As the HIV/AIDS epidemic continues to expand and penetrate new communities around the globe, risk reduction intervention initiatives must continue to evolve and adapt to new challenges and populations. This is especially true in the Caribbean Basin, where the feminization of the HIV epidemic is tied to a cultural milieu characterized by pervasive gender inequality. HIV intervention programs in the Caribbean must treat women's risks as a function of the social context, standards, and meanings of sexual behaviors and practices in the local community. As such, this article describes an initiative to develop an HIV prevention-intervention protocol for the cultural context of substance abusing women in the US Virgin Islands. Through street-based survey research combined with focus groups and in-depth interviews with such "cultural insiders" as members of the substance-abusing target population, members of the local public health and social services system, and community leaders, a culturally sensitive HIV/AIDS protocol was developed which addresses the supports and barriers to risk reduction faced by substance abusing women in the Virgin Islands.

Culture↗
PubMed2006

An exploration of scenario discussion in a Web-based nursing course.

Complexity in nursing education has increased as it is challenged to meet the needs of diverse populations in rapidly evolving and highly technical health care settings. To accomplish or meet these societal wants, needs, and demands, nursing educators must prepare students successfully to become active, independent learners and problem solvers. The purpose of this study was to design a nursing course on the basis of scenario discussion, Web-based instruction (WBI), and the assessment of learning outcomes. The design of the study involved two stages. The first, beginning in 2001, developed the scenario discussion with the WBI system. The second evaluated learning outcomes within the context of a scenario discussion. Two instruments were examined in this study: a nursing assessment score and learning effectiveness survey. The target population in this study consisted of students enrolled in a two-year nursing program and registered for the course, Nursing I, during the fall semester of 2002. Using simple random sampling, 43 students were recruited and agreed to participate in the study. Most of the students chose "good" for learning effectiveness. Overall, the students gave higher learning effectiveness survey scores and nursing assessment scores. Due to their lack of previous exposure to scenario discussion, the students here felt frustration and anxiety while taking this course. Faculty should devote more time explaining the advantages of scenario discussion. In addition, in comparison with traditional teaching, Web-based instruction (WBI) imposes a heavier burden on the instructors and institutions involved. Nurse educators must continue to use innovative strategies to enhance student learning. Students registered both positive and negative feedback in open-ended questions on Web- based instruction. However in the future, special attention should be given to the learning software, Internet access speed, synchronous and asynchronous meetings, and the interaction interface.

Adult↗
PubMed2005

Designing cigarettes for women: new findings from the tobacco industry documents.

AIMS: To examine internal tobacco industry research on female smoking patterns and product preferences, and how this research has informed the design of female-targeted cigarettes and impacted smoking behavior among this target population. DESIGN: Research was conducted through a systematic web-based search of previously secret industry documents made publicly available through the 1998 Master Settlement Agreement. FINDINGS: This study provides evidence that the tobacco industry has conducted extensive research on female smoking patterns, needs and product preferences, and has intentionally modified product design for promotion of cigarette smoking among women. Cigarette manufacturers responded to changing female trends by focusing on social and health concerns as well as promoting dual-sex brands that also featured traditional female style characteristics. CONCLUSIONS: Product features responsive to female-identified needs and preferences may contribute to differences in female smoking patterns. Assessment of female-targeted product differences should inform smoking cessation and prevention programs tailored to women. Overall, these findings underscore the need for further investigation of effects of targeting on smoking behavior, health outcomes and regulation of tobacco products by public health agencies.

Advertising↗
PubMed2002

Standard scales for measurement of functional outcome for cervical pain or dysfunction: a systematic review.

STUDY DESIGN: A systematic review was conducted. OBJECTIVE: To identify, evaluate, and compare standard scales for assessing neck pain or dysfunction. SUMMARY OF BACKGROUND DATA: The degree of a patient's neck pain or dysfunction can be evaluated using standardized scales at the time of a clinical encounter or during the performance of clinical research protocols. The choice of a scale with the most appropriate characteristics, however, is always a challenge to clinicians and researchers. METHODS: Articles concerning scales for functional evaluation of neck pain or dysfunction were identified by computer searching of MEDLINE (January 1966 to June 1999) and CINAHL (1985 to 2000), citation tracking using the Citation Index, hand searching of relevant journals, and correspondence with experts. RESULTS: Five standard scales were found. Three scales were remarkably similar in terms of structure and psychometric properties: the Neck Disability Index, the Copenhagen Neck Functional Disability Scale, and the Northwick Park Scale. However, only the first instrument has been revalidated in different study populations. The Neck Pain and Disability Scale provides a visual template for collection of information, but its usefulness is limited if the questionnaire must be read to the patient. The Patient-Specific Functional Scale is very sensitive to functional changes in individual patients, but comparisons between patients are virtually impossible. CONCLUSIONS: The five scales identified in this study have similar characteristics. The Neck Disability Index, however, has been revalidated more times for evaluation of patient groups. For individual patient follow-up evaluation, the Patient-Specific Functional Scale has high sensitivity to change, and thus represents a good choice for clinical use. The final choice should be tailored according to the target population and the purpose of the evaluation.

Disability Evaluation↗
PubMed1986

[Psychotherapy of patients with hearing impairment].

The need for psychotherapy with hearing impaired persons, and its necessity, are undisputed among professional workers. Yet, hardly any theory-based, field-tested experience exists so far concerning the procedures to be employed. The present contribution delineates both potential and limitations of psychotherapy with this population. Four schools of psychotherapeutic thinking are investigated as to their specific potential for contributing to psychotherapeutic work with hearing impaired clients. The aspect of "communication channel" is picked out from systems theory; from psychoanalysis, the concepts of therapeutic contract and transference appear significant; Humanistic Psychology, with its contributions concerning extraverbal expression and verbalization of feelings, has opened major routes of access to the hearing impaired individual; the broadest range of concepts and intervention strategies is presented by behavioural therapy. Behavioural approaches--cognitive conditioning, self-control techniques, thought-stopping, cognitive re-structuring--may be of greatest use in working with deaf clients. Given the cognitive and communicative characteristics of the target population, therapeutic work needs to be performed in an eclectic and synoptical manner. Its prime objective lies in uncovering the "deaf identity", in developing and protecting it.

Behavior Therapy↗
PubMed1996

Antibody-based immunotherapeutic strategies in colorectal cancer.

Monoclonal antibodies may well be on their way to becoming an integral part of therapy after the most recent success in prolonging overall and recurrence-free survival in patients with stage III colorectal cancer after potentially curative surgery. After a median follow-up of 5 years, antibody treatment reduced the overall death rate by 30% and decreased the recurrence rate by 27%. These results are similar with regard to efficacy but there is less toxicity with those obtained in contemporary and more recent chemotherapy trials. The key to success with high-molecular-weight substances such as immunoglobulines lies in the careful selection of the appropriate target population, i.e., patients with minimal residual disease, where only isolated tumor cells which are readily accessible to therapy are present. An argument for combining immunotherapy with chemotherapy can be made on the basis of the phenotype of individual disseminated tumor cells, which by immunocytochemistry were found to only rarely express proliferation-associated antigens and therefore are independent of the cell cycle. Further efforts to improve immunotherapy have also led to the combined clinical use of antibodies with biologic response modifiers which are known to enhance effector cell-mediated antibody-dependent cytotoxicity. Additional rationally designed clinical trials are ongoing in which specific immunotherapy is directed towards known, readily accessible, and abundant cell target structures, either alone or combined with treatment modalities which employ different action mechanisms.

Animals↗
PubMed1997

Patterns of sexual behaviour in a rural population in north-western Tanzania.

The HIV epidemic in sub-Saharan Africa has been characterised by the predominance of heterosexual transmission. Patterns of sexual behaviour have been implicated in the spread of the epidemic, but few quantitative data are available on sexual behaviour in rural populations in Africa. This paper reports data from a survey of 1117 adults aged 15-54 years selected randomly from twelve rural communities in Mwanza Region, Tanzania. Sexual debut occurred early, 50% of women and 46% of men reporting first sex before age 16. On average, women married 1.8 years and men 6.1 years after their sexual debut. In women, age at sexual debut appears to have increased over time, in parallel with an increase in age at first marriage. Men were generally married later, to women around five to ten years younger than themselves. Marital dissolution and remarriage were common in both sexes. Reported numbers of sexual partners were compared with those recorded in a population survey in Britain. More men reported 10 or more lifetime partners, or three or more partners in the past year, in rural Mwanza (48% and 29%) than in Britain (24% and 6%). Women reported fewer partners, and results were broadly similar to British data. Casual sex during the past year was reported by 53% of the men and 15% of the women, but only 2% of men reported sexual contact with bar girls or commercial sex workers. Only 20% of men and 3% of women had ever used a condom. Interventions are needed to reduce the high levels of sexual partner change and casual sex, and low levels of condom use, recorded in this rural population. Targeting of interventions to traditional "core groups" may be of limited value in rural areas, and additional strategies are needed, focusing particularly on teenagers who are at high risk of HIV and other sexually transmitted diseases.

Adolescent↗
PubMed1999

NGOs in community health insurance schemes: examples from Guatemala and the Philippines.

In poor rural communities, access to basic health care is often severely limited by inadequate supply as well as financial barriers to seeking care. National policies may introduce social health insurance, but these are likely to begin with the salaried public and private sector workers while the informal sector population may be the last to be covered. Community initiatives to generate health care financing require a complex development process. This paper covers attempts to develop such schemes in rural populations in Guatemala and the Philippines through non-government organizations and notes the major factors which have contributed to unequal progress in the two schemes. The scheme of the Association por Salud de Barillas (ASSABA) in Guatemala was not sufficiently established as an administrative body at the conceptual stage and there was no clear national policy on health care financing. By the time the necessary action was taken, local conflicts hindered progress. In the Philippines, the ORT Health Plus Scheme (OHPS) was implemented during the period of legislation of a national health insurance act. The appraisal after three years of operation shows that OPHS has made health care affordable and accessible to the target population, composed mainly of low and often unstable income families in rural areas. The major success factors are probably the administrative structure provided by a cooperative and controls in the delivery system and in expenditures, through the salaried primary health care team, referral process and the capitation agreement for hospital-based services. The proliferation of such schemes could benefit from national guidelines, a formal accreditation process and an umbrella organization to provide assistance in design, training and information services, involving government, non-government and academic institutions as an integral part of the development process.

Accreditation↗
PubMed1994

Not all homeless women are alike: effects of motherhood and the presence of children.

Previous work suggests that the population of homeless women is a heterogeneous group, and that motherhood and the presence or absence of children define sub-groups that may be distinct. The current study is a systematic study of 300 homeless women (90% of whom were mothers) according to these suggested sub-groupings. Mothers whose children were with them, compared to other women, were younger and often unemployed and welfare dependent. Mothers without their children had higher rates of nonsubstance Axis I disorders (48%) and alcoholism (33%), and 72% had a lifetime psychiatric diagnosis. Homeless mothers whose children are not with them represent a deviant subgroup with more personal (and fewer social) vulnerabilities to homelessness and may represent a target population for focus of psychiatric treatment efforts. Mothers with their children may benefit more from increased attention to social services.

Adolescent↗
PubMed1997

Characteristics of antigens from an HCG alpha secreting cell line (ElCo) derived from human breast carcinoma in a Native American patient.

OBJECTIVE: Our purpose is to report a cell line derived from a Native American patients that could serve as a model for ethnic diversity in cell culture research. STUDY DESIGN: Tumor biopsy specimens from reproductive tract malignancies were explanted in the cell culture laboratory. Characterization of a successfully established line included a parameter commonly observed in minority populations in rapid moving Type A glucose-6-phosphate dehydrogenase enzyme (G6-PD). Multiple other standard characterization studies were carried out. RESULTS: A breast cancer cell line with a G6-PD-A enzyme was derived from an American Indian patient; this pattern is commonly observed in African-American populations. Results of lymphocyte-mediated cytotoxicity tests indicated that lymphocytes from patients with breast cancer were cytotoxic to ElCo cells. On the other hand, lymphocytes from patients with other types of cancer were not significantly different from healthy donor lymphocytes in their cytotoxicity. These studies indicate that ElCo cells express tumor-associated antigen(s). Many antigens of tumor cell origin were detected with use of antisera raised in rabbits in concentrates of ElCo cell culture fluid. One of these antigens was the alpha subunit of human chorionic gonadotropin. CONCLUSIONS: Chemotherapy testing, vaccine production, and various new treatment schemes are most commonly developed in cell culture systems. These systems should reflect characteristics of the target population so that desired outcomes best fit the population being served. Thus the cell line being reported, which was derived from a Native American woman, represents a tool that can be used in cell culture research as a model for diversity.

Animals↗