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PubMed2006

Can personality assessment predict future depression? A twelve-month follow-up of 631 subjects.

BACKGROUND: Personality assessment provides a description of a person's fundamental emotional needs and of the higher cognitive processes that modulate thoughts, feelings, and behavior. Prior studies by us examined personality and mood at the same time. Assessing personality may allow prediction of mood changes over time in a longitudinal study, as described in earlier prospective studies by Paula Clayton and others. METHOD: A group of 631 adults representative of the general population completed the Temperament and Character Inventory (TCI) and Center for Epidemiological Studies depression scale (CES-D) at baseline and one year later. RESULTS: TCI scores at baseline accounted for gender differences in levels of depression. TCI personality scores were strongly stable (range in r=.78 to .85 for each of seven dimensions) whereas mood was only moderately stable (r=.62) over the twelve-month follow-up. Baseline personality scores (particularly high Harm Avoidance and low Self-Directedness) explained 44% of the variance in the change in depression. Baseline levels and changes in Harm Avoidance and Self-Directedness explained 52% of the variance in the change in depression at follow-up. LIMITATIONS: The follow-up sample was representative of the target population except for slightly lower Novelty Seeking scores. CLINICAL RELEVANCE: Observable personality levels strongly predict mood changes. Personality development may reduce vulnerability to future depression.

Adolescent↗
PubMed1993

Risk factors for preterm delivery in Burkina Faso (west Africa).

The environmental and socioeconomic risk factors for preterm delivery were assessed in a West African urban population (Bobo-Dioulasso, Burkina Faso). The study population were 102 cases of preterm delivery matched with 102 controls obtained from 4124 sequential deliveries which occurred between May and October 1989 in the three maternity centres in the city. The univariate analysis identified the risk factors as age (< 20 years), primiparity, marital status (single), low frequency of antenatal visits, death of a previous child and level of education of the mother. The following risk factors identified by multivariate analysis (logistic regression) are consistent with those identified in previous studies: youth of the mother, primiparity (P = 0.01) and death of a previous child (P < 0.05). On the other hand, in this study, the level of education of the parent was identified as an independent risk factor (P < 0.001). This finding could be used to determine a target population for prevention programmes.

Adolescent↗
PubMed1995

The use of human ecology and epidemiology in nonorganic failure to thrive.

Children with nonorganic failure to thrive (NOFTT) comprise a population at risk for small stature, poor growth, slower development, and lower intellectual outcomes. These children are often seen in the Women, Infants, and Children Supplemental Nutrition Program (WIC) and child health clinics and in caseloads of high-risk families. Public health nurses may not be sure how to intervene in the problem of NOFTT because of its multifactorial etiology. A model of nursing care that addresses the many factors that affect the development of NOFTT can enable the public health nurse to appropriately care for the child with NOFTT. The Eco-Epi model, a combination of human ecology and epidemiology, is a conceptual model that can provide a framework for the public health nurse to plan interventions. Even though children with NOFTT are the target population for this model, it can be applied to other public health nursing populations at risk for multifactorial problems. In the Eco-Epi model, the epidemiological concepts of agent (food), host (child), and environment (home) are examined in the context of the microsystem (parent-child interaction, daily activities of the family), the mesosystem (interactions between different environments), and the exosystem (the child's community). The concepts of microsystem, mesosystem, and exosystem are from the theory of human ecology. Examples of how the model works to assess a family and design interventions are provided.

Ecology↗
PubMed1995

The Australian Capital Territory Injury Surveillance and Prevention Project.

OBJECTIVE: To identify the representativeness and sensitivity of the data collected by the Australian Capital Territory Injury Surveillance and Prevention Project (ACTISPP) for ED injury cases seen in the Australian Capital Territory (ACT). METHODS: A retrospective descriptive study was conducted using a systematic sample of people injured in the ACT between January 20 and September 19, 1992, and who received their first treatment for this injury in an ACT ED. The ACTISPP surveillance system is dependent on ED patient or family completion and return of a comprehensive injury survey. The following population variables in the ACTISPP database were compared with those of the injured ED population, as determined by ED and hospital record review: age, gender, postal code of residence, nature of injury, body part injured, and whether the patient had been admitted to hospital. RESULTS: The sensitivity of the surveillance system for injuries seen in the ED was 31% (95% CI = 30-32%). The distribution of the ACTISPP sample did not differ from the expected distribution for sex or socioeconomic status. The distributions differed by age only in the 5-14-year age group (p < 0.001). With respect to the nature of injury and body part injured, the difference was significant (p < 0.001) but was no greater than 7% for any of the categories. Two percent of the surveillance sample were admitted to hospital, compared with an estimated 4% of the target population (p < 0.001). CONCLUSIONS: Approximately one-third of all incident injuries managed in the EDs of the ACT are included in the ACTISPP database. Although some sampling bias is introduced in the surveillance process, it does not appear to be of sufficient magnitude to compromise the project's goals.

Adolescent↗
PubMed2004

Beliefs about schizophrenia in Italy: a comparative nationwide survey of the general public, mental health professionals, and patients' relatives.

OBJECTIVE: This study compared beliefs about the causes, treatments, and psychosocial consequences of schizophrenia in a sample of 714 lay respondents, 465 mental health professionals, and 709 key relatives of patients with this disorder. METHOD: We conducted the survey in 30 Italian geographic areas that we randomly selected after considering location and population density. We used the Questionnaire on the Opinions About Mental Illness (QO) to collect data. RESULTS: Of those surveyed, 34% of the lay respondents, 20% of the professionals, and 68% of the relatives stated that schizophrenia is exclusively caused by psychosocial factors. Lay respondents' opinions on patients' civil rights and social competence tended to be more similar to those expressed by professionals then to those reported by relatives. Lay respondents differed from the other 2 groups in their beliefs regarding the effectiveness of psychological treatments, patients' unpredictability, and whether patients should be admitted to asylums. CONCLUSIONS: These results suggest that the general public needs to be better informed about schizophrenia's main characteristics, available treatments, and risk for dangerous behaviours. The existing gap among the study's target populations could be reduced through campaigns aimed at increasing public awareness of the affective and civil rights of patients.

Adolescent↗
PubMed1999

Recombinant tissue-type plasminogen activator (Alteplase) for ischemic stroke 3 to 5 hours after symptom onset. The ATLANTIS Study: a randomized controlled trial. Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke.

CONTEXT: Recombinant tissue-type plasminogen activator (rt-PA) improves outcomes for patients with acute ischemic stroke, but current approved use is limited to within 3 hours of symptom onset. This restricts the number of patients who can be treated, since most stroke patients present more than 3 hours after symptom onset. OBJECTIVE: To test the efficacy and safety of rt-PA in patients with acute ischemic stroke when administered between 3 and 5 hours after symptom onset. DESIGN: The Alteplase ThromboLysis for Acute Noninterventional Therapy in Ischemic Stroke (ATLANTIS) study is a phase 3, placebo-controlled, double-blind randomized study conducted between December 1993 and July 1998, with up to 90 days of follow-up. SETTING: One hundred forty university and community hospitals in North America. PATIENTS: An intent-to-treat population of 613 acute ischemic stroke patients was enrolled, with 547 of these treated as assigned within 3 to 5 hours of symptom onset. A total of 39 others were treated within 3 hours of symptom onset, 24 were treated more than 5 hours after symptom onset, and 3 never received any study drug. INTERVENTION: Administration of 0.9 mg/kg of rt-PA (n = 272) or placebo (n = 275) intravenously over 1 hour. MAIN OUTCOME MEASURES: Primary efficacy was an excellent neurologic recovery at day 90 (National Institutes of Health Stroke Scale [NIHSS] score of < or =1); secondary end points included excellent recovery on functional outcome measures (Barthel index, modified Rankin scale, and Glasgow Outcome Scale) at days 30 and 90. Serious adverse events were also assessed. RESULTS: In the target population, 32% of the placebo and 34% of rt-PA patients had an excellent recovery at 90 days (P = .65). There were no differences on any of the secondary functional outcome measures. In the first 10 days treatment with rt-PA significantly increased the rate of symptomatic intracerebral hemorrhage (ICH) (1.1% vs 7.0% [P<.001]), a symptomatic ICH (4.7% vs 11.4% [P = .004]), and fatal ICH (0.3% vs 3.0% [P<.001]). Mortality at 90 days was 6.9% with placebo and 11.0% with rt-PA (P = .09). Results in the intent-to-treat population were similar. CONCLUSIONS: This study found no significant rt-PA benefit on the 90-day efficacy end points in patients treated between 3 and 5 hours. The risk of symptomatic ICH increased with rt-PA treatment. These results do not support the use of intravenous rt-PA for stroke treatment beyond 3 hours.

Aged↗
PubMed2006

National serosurvey of cytomegalovirus in Australia.

In anticipation of the development of a vaccine against cytomegalovirus (CMV), we conducted a large, nationally representative serosurvey to examine the seroprevalence of CMV in Australia. Sera were collected opportunistically from laboratories around Australia. Age- and gender-representative samples were tested for CMV antibody. The population-weighted rate of CMV seropositivity in subjects between 1 and 59 years of age was 57% (95% confidence interval, 55.2 to 58.6%). An association between CMV seroprevalence and increasing age was recognized; however, little overall difference in seroprevalence between the sexes was found. The finding that high levels of CMV exposure occur in the first few years of life suggests that for a universal vaccination program to have maximal impact, the vaccine would need to be delivered to infants and have a long duration of protective efficacy. This is the first national serosurvey looking at cytomegalovirus in the Australian community. This study provides valuable information that can be used to examine the incidence of infection in the community and help focus the administration of a future CMV vaccine to appropriate target populations.

Adolescent↗
PubMed1997

Barriers to prenatal care among Medicaid managed care enrollees: patient and provider perceptions.

To identify what patients and providers perceive as barriers to prenatal care among women enrolled in a Medicaid managed care plan, focus group discussions of: 1) women, 13 to 45 years of age, enrolled in a Medicaid managed care plan and 2) providers (physicians, nurse practitioners, nurses, and medical assistants) that serve this population were conducted at a location in the community by professional facilitators. Forty-two enrolled women and 22 providers participated. Based on an interpretive analysis of comments regarding perceived barriers towards receiving prenatal care by patients and providers, we found some perceived barriers that were similar for both groups. Both groups of respondents thought that problems with transportation, knowledge of TennCare, and substance abuse were barriers to receiving prenatal care. Providers mentioned lack of enrollee's education, need for child care, and limited hours of operation; and patients mentioned treatment by office personnel, lack of rapport with health providers and lack of recognition of pregnancy as additional barriers. Understanding both patient and provider perspectives of the barriers to receiving care is the first step towards meeting the needs of the target population. Health plans that serve the historically underserved population must take a specialized approach that adapts to the population's distinct needs.

Adolescent↗
PubMed1997

Structure detection: a statistically certified unsupervised learning procedure.

We present a class of structure detection procedures (SDPs) that can extract the characteristic structures in an arbitrary population of images. An SDP adaptively augments the power of a novel, statistical, structure test to reject the null hypothesis that a randomly chosen image is devoid of structure. The core of the structure test consists of an orthonormal basis B of receptive fields that is refined into an increasingly sensitive detector of characteristic image structures. Adaptive refinement is accomplished as follows: for each image x in a random training sequence, B is updated by a planar rotation that decreases the p-value of a statistical structure test for x. This image-by-image refinement procedure is very efficient, obeying time and space constraints similar to those that limit processes of perceptual organization in real organisms. SDPs' capabilities are demonstrated in three test populations: natural images, faulty random number generators, and artificial images composed of mixtures of basis functions. (1) An SDP succeeds in rejecting the null hypothesis that the UNIX random number generator rand() is truly random. (2) When images are composed by adding arbitrary pairs of orthogonal component images, an SDP extracts the components. (3) For a large set of natural image patches, an SDP yields a basis B1 that detects structure with p-value < 0.005 in 88% of a new set of patches. B1's elements resemble the receptive fields of V1 simple cells. (4) Of special interest are biconvergent SDPs that derive in parallel a basis B, as well as a pointwise transformation f, specifically sensitized to evaluate the response values that result from applying B to images in the target population. A biconvergent SDP applied to natural image patches yields a basis B2 similar to B1, as well as a pointwise transformation f with vastly heightened sensitivity to extreme response values. We conjecture that sensory neurons have evolved cooperatively to maximize their collective power to reject the null hypothesis that their input is devoid of structure, thereby evolving receptive fields that efficiently represent characteristic input structures.

Form Perception↗
PubMed1991

A critique of topical fluoride methods (dentifrices, mouthrinses, operator-, and self-applied gels) in an era of decreased caries and increased fluorosis prevalence.

Within the last 20 years there has been a decrease in the caries prevalence of US schoolchildren, a change in the intraoral caries pattern, and a slowing of the progress of lesions. Simultaneously, the prevalence of enamel milder, cosmetically acceptable forms and is more noticeable in fluoride-deficient communities than those with optimal or above-optimal water fluoride concentrations. Circumstantial evidence indicates that a principal contributor to the caries decline is the extensive use of fluoride dentifrices. Conversely, although use of a fluoride dentifrice can add to the total daily amount of ingested fluoride in preschool children, there is little evidence to suggest that dentifrice ingestion is a principal factor causing the fluorosis increase. The value of fluoride methods may be assessed in relative or absolute terms. The relative, or percentage, caries reduction attributed to fluoride mouthrinses and gels appears to be a property intrinsic to the methods themselves and generally is little affected by the caries activity of the population being treated. Conversely, the absolute, or numerical, caries reduction is dependent upon the level of disease in the population. Thus, the reported caries decline reduces the number of surfaces prevented from developing caries, even though the percentage reduction remains substantially unchanged. Although inadvertent ingestion of fluoride can result from the use of mouthrinses and gels, there is little evidence to suggest that they have contributed to the fluorosis increase. When using topical methods, prudence should prevail to avoid ingestion of fluoride. Fluoride dentifrices should continue to be used routinely, and although lower potency dentifrices may be considered, the literature does not provide strong support for their need. Use of fluoride mouthrinses and gels for individual patients should be predicted upon their caries activity or risk. Use of these methods in public health programs is a matter of cost-effectiveness, which will be influenced by the caries prevalence of the target population.

Adolescent↗
PubMed2006

[Early detection and brief intervention to reduce excessive drinking].

The high frequency of excessive drinking among populations of western countries justifies screening strategies by primary health care givers. The intervention following the identification of a problem drinker should be adjusted according to the nature and level of alcohol-related risk or harm. A non-judgmental and benevolent dialogue about alcohol consumption is to be carried out with every patient, for in most cases this is enough to identify anyone concerned by at-risk or harmful drinking and to assess any consequences and dependence levels. Standardized questionnaires have been conceived and validated to encourage practitioners to carry out this type of interview, taking into account two contradictory needs: a systematic approach of the screening and the need for rapidity. In the same objective, among all sorts of "brief interventions" the efficient ones have been adapted to target populations and to be acceptable to the clinicians' point of view. These tools have been conceived to help excessive drinkers reduce their alcohol consumptions, but they can be a model for a more general approach to secondary prevention, considering all risk factors, not only hazardous behaviour to health.

Alcoholic Intoxication↗
PubMed1996

Evaluation of preventive and health promotion activities in 166 primary care practices in Spain. The Coordinating Group For Prevention and Health Promotion in Primary Care in Spain.

BACKGROUND: Since January 1989 the Spanish Society of Family and Community Medicine has supported the Program of Prevention and Health Promotion (PAPPS) with the following objectives: to detect possible difficulties in the implementation of recommendations especially among asymptomatic low-risk adults and children in Spain, to disseminate those recommendations, and to encourage research in prevention and health promotion in primary care. OBJECTIVE: We wished to evaluate the implementation of PAPPS in primary care practices. METHODS: A retrospective audit of medical records in practices enrolled in the programme was carried out. From 166 primary care practices widely distributed in Spain 21,631 patients were selected using systematic sampling. RESULTS: Age was positively associated with correct performance in the adult population, while in the paediatric population it was negatively associated. Females had higher probability than males of having blood pressure measurement (OR 1.34, 95% CI 1.24-1.45) and smoking counselling (OR 1.38, 95% CI 1.33-1.43) correctly performed. Practices not using the preventive chart had a lower probability than user practices of correctly performing blood pressure measurement (OR 0.69, 95% CI 0.62-0.76), alcohol counselling (OR 0.66, 95% CI 0.60-0.73) and smoking counselling (OR 0.69, 95% CI 0.63-0.76). Non-teaching practices had a higher probability than teaching centres of correct performance of blood pressure measurement (OR 1.47, 95% CI 1.35 to 1.59), alcohol counselling (OR 1.67, 95% CI 1.54 to 1.79) and smoking counseling (OR 1.39, 95% CI 1.29 to 1.51). CONCLUSIONS: There is an unequal level of performance depending on the procedure and on the target population. A preventive chart might be useful in improving implementation of periodic health maintenance. Teaching centres with training physicians need to put more emphasis on prevention and health promotion activities.

Adolescent↗
PubMed1995

A kinetic model for subtractive hybridization.

Nucleic acid sequences that differ in abundance between two populations (target sequences) can be cloned by multiple rounds of subtractive hybridization and amplification by PCR. These sequences can be cDNAs representing up-regulated mRNAs, or genomic DNAs from deletion mutants. We have derived an equation that describes the recovery of such sequences, and have used this to simulate the outcome of up to 10 rounds of subtractive hybridization and PCR amplification. When the model was tested by comparing its predictions with the published results from genomic and cDNA subtractions, the predictions of the model were generally in good agreement with the published data. We have modelled the outcomes of genomic subtractions, for a variety of genomes, and have used it to compare various strategies for enriching targets. The model predicts that for genomes of less than 5 x 10(8) bp, deletions of as small as 1 kbp should represent > 99% of the DNA after three to six rounds of hybridization (depending on the enrichment procedure). As genomes increase in size, the kinetics of hybridization become an important limiting factor. However, even for genomes as large as 3 x 10(9) bp, it should be possible to isolate deletions of 5 kbp using the appropriate conditions. These simulations suggest that such methods offer a realistic alternative to chromosome walking for identifying genomic deletions for which there are known phenotypes, thereby considerably reducing time and effort. For cDNA subtractive hybridization, the model predicts that after six rounds of hybridization, sequences that do not differ in abundance between the tester and driver populations (the background) will represent < 1% of the subtracted population, and even quite modestly upregulated cDNAs should be successfully enriched. Where several up-regulated cDNAs are present, the predicted final representation is dependent on both the initial abundance and the degree of up-regulation.

Animals↗
PubMed2001

Satisfaction with innovative community and university health clinic programs for groups of traditionally underserved individuals with HIV/AIDS: empirical models.

As the demographics of the populations of affected individuals have changed, systems of care have needed to adapt to be responsive to client needs. This article examines client satisfaction data from seven national demonstration projects funded to enroll individuals from traditionally underserved groups and help them access services using different strategies. Data on client satisfaction ratings were related to indicators of traditionally underserved status, including demographic characteristics, behaviors, and other risk factors using the data modeling method of Exhaustive CHAID (Chi-squared Automatic Interaction Detector). Client groups that were most likely to experience relatively higher and lower levels of satisfaction with services are identified. Overall, all client groups were highly satisfied with the innovative HIV/AIDS services received. The findings illustrate the success of these innovative HIV care models in being responsive and sensitive to the needs of their target populations.

Adult↗
PubMed2003

Wandering behaviour in people with dementia.

BACKGROUND: Wandering has been described as one of the most challenging behaviours to manage and yet a search of the literature in the last two decades yields only a limited number of papers that specifically studied wandering. AIM: This paper reviews the current literature on wandering in relation to the nature of the phenomenon, attempts to classify the behaviour, the extent of the problem, the profile of those who wander, postulations about its aetiology, and intervention strategies being employed. METHOD: Eight literature databases were searched for the last 40 years up to February 2003 using 'wandering' and 'dementia' as combined keywords. A total of 133 articles was included in the review. FINDINGS: The prevalence of wandering behaviour was difficult to assess and no conclusions could be reached. The typical wanderer depicted in the literature was relatively young in the older population, more cognitively impaired, more likely to be a man, might have experienced sleep problems, had a more active premorbid lifestyle, and used more psychotropic medications. While studies agreed that wanderers are more cognitively impaired, their findings did not necessarily agree on other attributes. Three major approaches, namely the biomedical, psychosocial and person-environment interaction perspectives, in conceptualizing wandering behaviour can be identified from the literature. Medications, activity programmes, behavioural modification and environmental manipulation have been used as interventions but none has so far demonstrated unequivocal effectiveness. CONCLUSION: Knowledge generated through research remains insufficient to explain fully why and when wandering occurs. Variability in how the phenomenon was defined and studied, and the small size of the samples made generalizability of findings difficult. Future research should incorporate a clearer definition of wandering; a specific targeted population with representative sample size; appropriate subject identification strategies; focussed interventions, and better control conditions.

Dementia↗
PubMedDate not supplied

Interest in different forms of self-help in a general population sample of drinkers.

The study investigates: (1) the level of interest in self-help services for drinkers, and (2) the predictors of interest in these services. A representative sample of 1,557 Ontario respondents participated in a telephone survey. Current drinkers (n=1,247) were asked about their interest in getting: (a) a telephone call from a therapist to help them evaluate their drinking, (b) a self-help book, and (c) a computerized summary comparing their drinking to that of other Canadians. Bivariate comparisons of demographic and drinking-related variables were made between those interested and not interested in each of the offered services. Logistic regression analysis was used to find the best predictors of interest. The results revealed that 16% were interested in a telephone call, 26% in a self-help book, and 39% in computerized normative feedback. Negative consequences of drinking and indicators of lower societal resources increased interest in self-help services. Computerized feedback and self-help books serve as cheap and nonintrusive ways to provide incentive for change to early-stage problem drinkers due to the interest they raise in the intended target population.

Adult↗
PubMed1990

Evaluation of UNICEF/Arab Republic of Egypt/WHO schistosomiasis Control Project in Beheira Governorate.

We evaluated the UNICEF/Government of Egypt/WHO Schistosomiasis Control project in 2 districts of Beheira Governorate of the Nile Delta during 3 weeks in February 1988. The project, begun in 1983, was focused on reducing prevalence, intensity, and morbidity due to schistosomiasis by providing diagnosis and treatment with praziquantel to schoolchildren. Schools were visited twice. Following the completion of the school surveys, the program was extended into the community. Chemotherapy was delivered by mobile and static teams. The evaluation indicated that, with respect to accuracy of diagnosis, record-keeping, and coverage of targeted populations, project tasks were performed exceedingly well by highly motivated, well-supervised mobile teams. Static teams in rural health centers were less successful in providing diagnosis and chemotherapy to village populations. We resurveyed 6 randomly selected schools to assess the impact of chemotherapy. Overall, the prevalence of Schistosoma mansoni infection was reduced from 60.3% to 24.8% between the first and second surveys (approximately 1 year apart) and was still lower (41.1%) than initial levels up to 3 years after the last treatment with praziquantel. The percentages of those with greater than or equal to 34 S. mansoni eggs/slide using the Kato-Katz technique showed a marked and prolonged decrease (17.1% to 0.3% to 2.2%). The prevalence of S. haematobium infection dropped from 37.6% to 5.5% and was still 9.9% at the time of the evaluation. The percentages of those with greater than or equal to 50 S. haematobium eggs/10 ml urine dropped less dramatically (17% to 4.4% to 11.9%). Mobile teams conducting vigorous chemotherapy programs targeted at schoolchildren can have long-lasting benefits in terms of prevalence and intensity.

Child↗
PubMed2004

Invasive pneumococcal disease in Australia, 2003.

There were 2,174 cases of invasive pneumococcal disease (IPD) notified to the National Notifiable Diseases Surveillance System (NNDSS) in Australia in 2003; a rate of 10.9 per 100,000 population. The notification rate varied between states and territories and by geographical region with the highest rates in the north of the country. Invasive pneumococcal disease was reported most frequently in children aged less than two years (98.8 cases per 100,000 population). Enhanced surveillance for IPD in 2003 was carried out in all states and territories, providing additional data on 1,842 (85%) of all notified cases. Rates of IPD in Indigenous Australians were three times the rate in non-Indigenous Australians. There were 125 deaths attributed to IPD resulting in an overall case fatality rate of 6.8 per cent. Seventy-one percent of all pneumococcal isolates serotyped were serotypes in the seven-valent conjugate vaccine and 91 per cent were serotypes in the 23-valent polysaccharide pneumococcal vaccine. The clinical presentation and risk factors for IPD varied between Indigenous and non-Indigenous cases and non-vaccine serotypes occurred more frequently among Indigenous children and adults. Data from three years of surveillance indicate an early impact of the 7-valent vaccine in the target population.

Adolescent↗