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PubMedDate not supplied

National campaign against hepatitis C in France (1999-2002).

Since 1988, several measures have been applied in France to control HCV infection. HCV seroprevalence in the adult population is estimated at 1.1% (500,000 to 650,000 persons) and the number of chronically infected at 400,000 to 500,000 persons. In 1994, most of them might not be aware of their infection. Blood products administration and injecting-drug use are identified as the main transmission routes. The national hepatitis C plan (1999-2002) was based on scientific data and developed after a consensus conference and several expert consultations. It involves six programs and quantified objectives: prevention of new infections, enforcement of screening access; improvement of care management; implementation of a surveillance system, clinical research and evaluation. Specific financial supports were attributed for the implementation of the plan. The 2001 progress report confirmed a major increase in national and regional actions. In 2000, considering the high proportion of persons still unaware of their infection (at least one third) and the increase of treatment efficacy, the target population of the screening strategy was considerably extended after scientific analysis. A national consciousness-raising campaign directed at general practitioners was launched in June 2000. In 2001, a media campaign directed to the general population was developed, in newspapers and on radio stations. Since the end of 1999, a national toll free phone number provides information to the public. In order to improve access to screening, a new regulation added HCV testing to the missions of anonymous and free HIV testing centres, as well as of family planning centres. The hepatitis C prevention strategy is still included in a national public health program and improved in view of its renewal.

Cost-Benefit Analysis↗
PubMed2006

Drugs and social exclusion in ten European cities.

AIM: To describe social characteristics seen among socially excluded drug users in 10 cities from 9 European countries, and identify which social exclusion indicators (i.e. housing, employment, education) are most closely linked to intravenous drug use. DESIGN: Cross-sectional survey. SETTING: Interviews were held in social services centers, town halls, streets, squares and other usual meeting points of the target population. PARTICIPANTS: The sample comprises 1,879 participants who have used heroin and/or cocaine and certain derivatives (92.3%) over the last year. Males accounted for 69.7% of the sample, and the mean age was 30.19 years. Participants were recruited in 10 cities: Seville and Granada, Spain; Cologne, Germany; Vienna, Austria; Brussels, Belgium; Athens, Greece; Dublin, Ireland; London, England; Lisbon, Portugal, and Perugia, Italy. MEASUREMENTS: Structured face-to-face questionnaire, conducted by privileged access interviewers. RESULTS: Cannabis, heroin and cocaine are the most widely used substances. In the total sample, 60.2% injected drugs during the last year, 45.9% reported having hepatitis C; 54.9% have been in prison; 14.2% are homeless; 11.3% have a regular job, and 35.2% are involved in illegal activities. Hierarchical logistic regression analysis (injectors and non-injectors) showed that older participants have a greater likelihood of injecting than younger ones. Social exclusion variables associated with intravenous drug use are incarceration, homelessness, irregular employment, and delinquency. Participants who abandoned or were expelled from a drug treatment program are at greater risk of injecting drugs than participants who have never had treatment, are currently in treatment or have been released. CONCLUSION: Personal, social, and economic conditions are all linked in a process of social exclusion that compounds problem drug misuse. Given the findings of this study, we believe that there is a clear need for specific programs targeting specific groups, i.e., distinct strategies must be set in place, in line with the profile and needs of the patient in each context.

Adult↗
PubMed1993

C-MOPP/ABV yields good results in a public hospital population with Hodgkin disease in Brazil.

BACKGROUND: Over the last 15 years, a number of combination chemotherapy regimens have been reported to induce more than 80% complete remissions (CR) in patients with advanced Hodgkin disease (HD). Almost all such studies have been conducted in large institutions from North America and Europe. It remains to be proven, however, that those regimens are equally effective for the larger population of patients with HD who live in very different social conditions in third-world countries. METHODS: Fifty-nine patients with advanced-stage or early bulky HD were treated in two public hospitals with the C-MOPP/ABV hybrid program, in which cyclophosphamide was substituted for mechlorethamine. RESULTS: The median number of cycles administered was six, and the median follow-up was 32 months. Fifty patients (85%) reached a CR. The actuarial failure-free survival (FFS) rate was 69%, and the actuarial overall survival rate was 78% at 68 months. The only significant prognostic factor that predicted for improved FFS rate was the absence of B symptoms (P = 0.02). Overall survival was better for patients who reached a CR (P = 0.0003) and those with no systemic symptoms (P = 0.007). Toxic effects were moderate, with one treatment-related death and six episodes of serious infection. CONCLUSIONS: The target population consisted of lower-class Brazilians, many living in poor social conditions. Nevertheless, these results compare equitably with other results reported in the literature. C-MOPP/ABV is an adequate treatment for HD in third-world populations.

Adolescent↗
PubMed2006

Postprandial serum folic acid response to multiple doses of folic acid in fortified bread.

The benefit of the introduction of mandatory folic acid fortification of all flour products in the USA in 1998 has been amply demonstrated in a reduction of neural tube defect births. Doubt has been cast on the actual level of fortification and recent calculations have shown that the level of folic acid fortification is likely to have been over twice the amount mandated. The implication of this is that a greater proportion of the population are likely to have consumed folic acid at >1 mg/d, the Food and Drug Administration safe upper level of intake. Using the criteria of appearance of synthetic folic acid in serum, the objective of this pilot study was to investigate the consequences of consumption of baked bread preparations containing 1 mg folic acid. Four healthy adult volunteers undertook each dosing schedule 2 weeks apart. This consisted of a single dose of 1000 microg, two doses of 500 microg, three doses of 333 microg, five doses of 200 microg and, finally, ten doses of 100 microg. Serum was collected pre- and postprandially and analysed for synthetic folic acid by a combined HPLC-microbiological assay for folic acid. Folic acid appeared in all subjects at all test doses, with the effect more pronounced as the standard dose was administered in smaller amounts over the test period. Approaches to optimise folic acid intake in target populations as part of a universal fortification strategy should take into consideration the potential hazard of over-exposure in groups consuming high amounts of flour-based products.

Adult↗
PubMed2002

Adolescent and young adult mortality by cause: age, gender, and country, 1955 to 1994.

PURPOSE: To compare mortality rates from motor vehicle accidents (MVA), homicide, and suicide across countries, age groups, and time. METHODS: The World Health Organization Mortality Database was used to construct age- and gender-specific rates in 26 countries for individuals aged 15 to 34 years during the period 1955 to 1994. The rates were adjusted for differences among countries in the age-and-gender distributions of their populations. Cause-specific rates were compared by country, 4-year age groups, 8-year time blocks, and male/female ratios. RESULTS: The proportion of deaths in 15-34-year-olds owing to MVA, homicide, and suicide increased from 26% to 43% over the 40-year study period. Mortality rates differ by country more than time block, peak at ages 15-29 years, and are higher in males than females. Compared to the United States, 24 countries had lower homicide rates and 23 had lower MVA-death rates. CONCLUSIONS: Despite declining rates of death from other causes, the rates of adolescent and young adult death from MVA, homicide, and suicide remain high in countries throughout the world. The proportion of deaths attributable to these causes increased steadily during the latter half of the 20th century. Fatal risk behaviors begin to increase during adolescence but do not peak until age 30 years, suggesting that the target population for prevention extends well beyond the teenage years.

Accidents, Traffic↗
PubMed1992

MHC and malaria: the relationship between HLA class II alleles and immune responses to Plasmodium falciparum.

In mice, immune responses to subunits of defined malaria antigens are regulated by genes mapping within the MHC and it has been suggested that such genetic restriction will be a major obstacle in the development of a human malaria vaccine. The relationship between class II human leukocyte antigen (HLA) genes and immune recognition of three candidate antigens for a vaccine against Plasmodium falciparum malaria has been investigated in a human population living in a malaria endemic area of West Africa. The study population was shown to be extremely heterogeneous for HLA class II alleles and marked differences in allelic frequency were detected between members of different ethnic groups. One class II DQA-DQB combination (serological specificity DQw2) was particularly common among members of the Fula ethnic group. This haplotype was significantly associated with higher than average levels of antibody to a peptide epitope, (EENV)6, of the malaria antigen Pf155/RESA. There was little evidence of association between HLA class II genotype and cellular proliferative or interferon gamma responses to the antigens tested. Overall, the number of significant associations between immune responses and specific HLA class II haplotypes was greater than would be expected by chance but less than would be expected if class II-dependent genetic restriction were a major factor governing human immune responses to malaria antigens. Thus, although some qualitative variation in the immune response to vaccine antigens may occur in ethnically different target populations, widespread HLA-associated nonresponsiveness to a multivalent subunit malaria vaccine is unlikely.

Adolescent↗
PubMed1996

Micronutrients (vitamins and minerals) as cancer-preventive agents.

Reduction of incidence and mortality of common cancers requires successful preventive interventions both in high-risk populations and in the population at large. Agents chosen for intervention trials must have been demonstrated to have significant and plausible biological activity in animal, in vitro, and short-term human studies, and these should be supported by observational epidemiological analyses. This chapter reviews evidence about vitamins and minerals as possible cancer-protective agents, emphasizing carotenoids (notably beta-carotene), natural vitamin A, vitamin E, selenium, vitamin C, calcium, vitamin D and folic acid. It is helpful to group agents according to apparent primary mechanism of effect, such as antioxidant (and/or pro-oxidant) effects for beta-carotene, vitamin C, vitamin E, selenium, zinc, copper, iron, manganese, phenolic compounds and isothiocyanates. Certain conditions associated with increased concentrations of free radicals and reactive oxygen species-like smoking, aging and reduced glutathione levels-must be assessed as confounders. However, these chemicals generally have multiple effects, which also may complicate reliance on intermediate end points. To choose target populations, dosages and durations for interventions, it is essential to distinguish between overcoming a relative deficiency of the micronutrient in the diet and the circulation and providing a pharmacological dose. Selenium and beta-carotene are important examples of agents that may be protective at the high end of the normal diet-based distribution of serum values, but may be toxic-somehow-at much higher levels. We are becoming more aware that it is a long leap from associations observed or deduced in epidemiological studies to the design and demonstration of successful chemopreventive interventions with single agents or with combinations or mixtures. When interventions fail to support the hypotheses from observational epidemiology, it may be necessary to reconsider the hypotheses. Furthermore, effects may vary remarkably at different tumour sites.

Anticarcinogenic Agents↗
PubMed2005

Empiric therapy of autoimmune hepatitis with mycophenolate mofetil: comparison with conventional treatment for refractory disease.

GOAL: To assess the outcomes of empiric therapy with mycophenolate mofetil in patients with autoimmune hepatitis. BACKGROUND: Mycophenolate mofetil is a purine antagonist that selectively inhibits immunocyte proliferation, and its empiric use in autoimmune hepatitis has been stimulated by small clinical experiences. STUDY: Eight patients received mycophenolate mofetil (0.5-3 g daily) for 19 +/- 7 months as frontline therapy or after adverse responses to conventional corticosteroid treatment. Seventeen patients who had been treated with high-dose corticosteroid regimens after treatment failure constituted a historical comparison population. RESULTS: Five of the 8 patients receiving mycophenolate mofetil and all 17 patients who had been treated with the conventional corticosteroid regimens for treatment failure responded to therapy. The frequency of response (62% vs. 100%, P = 0.02) was lower during longer intervals of treatment (19 +/- 7 months vs. 6 +/- 1 months, P = 0.02) in the patients receiving mycophenolate mofetil. None receiving mycophenolate mofetil resolved their laboratory abnormalities, whereas 6 patients in the comparison group improved to normal tests (0% vs. 35%, P = 0.1). Histologic resolution did not occur in 4 patients sampled during treatment, and successive specimens in 2 patients showed progressive fibrosis. Corticosteroids could not be withdrawn in the patients treated with mycophenolate mofetil, whereas discontinuation was possible in 7 patients in the comparison group (0% vs. 41%, P = 0.06). CONCLUSIONS: Mycophenolate mofetil did not induce laboratory resolution, prevent progressive fibrosis, or allow corticosteroid withdrawal. Clinical trials are needed to evaluate its role and target population.

Adrenal Cortex Hormones↗
PubMed2002

Choice of fecal occult blood tests for colorectal cancer screening: recommendations based on performance characteristics in population studies: a WHO (World Health Organization) and OMED (World Organization for Digestive Endoscopy) report.

OBJECTIVE: There is now strong evidence that screening for colorectal cancer with fecal occult blood tests (FOBTs) is effective in reducing the incidence and mortality of this disease. Various FOBTs are now available with a wide range of evidence supporting their use. The purpose of this study was to review published data on the performance of these FOBTs to provide recommendations for their effective use in screening. METHODS: A joint committee representing the World Health Organization and the World Organization for Digestive Endoscopy was established for this study. A process was designed that would search the literature systematically for evidence of FOBT performance. Criteria for including studies in this paper were established based on study design, cohort size, and performance variables reported. RESULTS: Of the guaiac tests, Hemoccult SENSA had the highest sensitivity for cancer and adenomas but a high test positivity. It had a better readability than the older Hemoccult II test. Immunochemical tests, HemeSelect, FlexSure OBT, and Immudia Hem Sp have acceptable performance characteristics and are easier for participants to use but are more expensive. These tests have been well studied in large cohorts, but only Immudia Hem Sp is commercially available. CONCLUSIONS: At present, there is no extensively studied FOBT that fulfills the needs for all target populations worldwide. Choice of FOBT should take into account population dietary compliance and colonoscopy resources: The more sensitive newer tests should be used if dietary compliance is good (in the case of guaiac tests) and colonoscopy resources are adequate for diagnostic workup of people who test positive. Immunochemical tests remove the difficulties created by diet and drug restrictions and are more amenable to standardized development and quality control.

Colorectal Neoplasms↗
PubMedDate not supplied

Recruiting and retaining young, sedentary, hypertension-prone African American women in a physical activity intervention study.

African American women have a high prevalence of hypertension and low level of physical activity compared with their counterparts. A sedentary lifestyle contributes to the development of hypertension, as well as other cardiovascular diseases, especially among African American women. Healthy People 2010 initiatives underscore the priority of reducing minority health disparities. To reduce health disparities, there has been recent emphasis on recruiting and retaining minority populations in clinical research studies. However, little information is available to guide researchers in the evaluation of impediments in successful recruitment and retention of young African American women. A first step is for researchers to report information concerning the efficacy of recruiting/retaining methods in order to facilitate minority participation in clinical trials and, ultimately, reduce health disparities. This report summarizes existing recruitment and retention methods from the literature, and describes how effective these strategies were in recruiting and retaining young, mildly hypertensive African American women to a physical activity intervention study. Multiple strategies, resources, and time were necessary to recruit and retain these women for the study. Among women enrolled, newspaper advertisements and flyers were the most effective recruiting strategies implemented (46% and 21%, respectively). Study retention was high (96%), which may have resulted from flexible scheduling, frequent contact, and a caring environment. Recruiting and retaining efforts need to be tailored to meet the needs of the target population.

Adolescent↗
PubMed2006

Omega-3 fatty acids and hypertension in humans.

1. Population studies and clinical trials provide compelling evidence that omega-3 (omega3) fatty acids have cardioprotective effects. The strongest evidence is from DART and GISSI-P, two secondary prevention trials in patients with previous myocardial infarctions. Data from these trials support a reduction in ventricular fibrillation as a primary mechanism for the decreased incidence of myocardial infarction. 2. Evidence suggests that w3 fatty acids may also provide protection against stroke, particularly ischaemic stroke. 3. The cardioprotective effects of omega3 fatty acids relate to improvements in blood pressure, cardiac function, arterial compliance and vascular function, as well as improved lipid metabolism, antiplatelet and anti-inflammatory effects. 4. Clinical trials in humans have shown that eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have different haemodynamic properties. Docosahexaenoic acid may be more favourable in lowering blood pressure and heart rate, as well as improving vascular function. However, the effects of EPA and DHA may also differ depending on the target population.

Antihypertensive Agents↗
PubMed1994

[Attitude of the French female population to cancer screening].

UNLABELLED: Attitudes of the French female population towards screening of different types of cancer were studied by means of a telephone survey conducted among a random sample of the French population aged 18 to 75 (n = 2,099). MAIN RESULTS: Cancer remains the most highly feared disease among the population. This fear is more apparent among women than men (61.5% average or strong fear vs 52.6%). In addition, women are more frequently prone to disclosing cancer cases among relatives. Over the last three years, respectively 28.4% and 70.5% of the 1,075 women in the sample had undergone a mammography and a Pap smear. Results suggest that there is still a discrepancy between current screening practices and official recommendations for systematic screening policies in France, as well as a trend towards "overutilization" among younger women and insufficient coverage among older women. Women living in French administrative districts where systematic screening campaigns for breast cancer are in place, had a better access to mammography (40.5% vs 26.2% in the rest of the sample). Multidimensional analysis confirms that social isolation is related with a poor access to either type of screening, although systematic screening campaigns have helped to reduce socio-cultural inequities in access to mammography for the target population of women aged 50 to 69. This analysis also suggests that when an individual adopts some preventive behaviors (such as giving up smoking), it may have a reassuring effect which in turn discourages access to screening; therefore the need for a greater coherence in the various sectors of preventive action against cancer is advocated by the authors.

Adult↗
PubMed2004

Special populations recruitment for the Women's Health Initiative: successes and limitations.

The Women's Health Initiative (WHI) is a study designed to examine the major causes of death and disability in women. This multi-arm, randomized, controlled trial of over 160,000 post-menopausal women of varying ethnic and socioeconomic backgrounds and a goal of 20% of the study participants from minority populations is perhaps one of the most challenging recruitment efforts ever undertaken. Of the two main study arms, the Clinical Trial (CT) and the Observational Study (OS), the CT arm recruitment goal was to randomize 64,500 postmenopausal women 50-79 years of age. Women enrolled in the study will be followed for a period of 8-12 years. Ten clinical centers, out of a total of 40 throughout the United States, were selected as minority recruitment centers on the basis of their history of interaction with and access to large numbers of women from certain population subgroups. WHI enrollment began in September 1993 and ended in December 1998, resulting in the randomization and enrollment of a total of 161,856 (17.5% minority) women participants (68,135 (18.5% minority) in the CT and 93,721 (16.7%) in the OS). Within the CT arm, WHI achieved 101.7% of the goal of 48,000 participants in the Dietary Modification (DM) component, and 99.4% of the goal of 27,500 in the hormone-replacement component (HRT), with 11.8% overlap between DM and HRT. Of those who expressed initial interest in WHI, African Americans had the highest randomization yields in the DM component and Hispanics had the highest in the HRT component (15.2% and 10.2%, respectively). Overall, mass mailing was the greatest source of randomized participants. In addition, minority clinics found community outreach, personal referrals, and culturally appropriate recruitment materials particularly effective recruitment tools. For minority recruitment, our findings suggest that the key to high yield is reaching the target population through appropriate recruitment strategies and study information that get their attention. Also, once minority subjects are reached, they tend to participate.

Aged↗
PubMed2002

Iron supplements: scientific issues concerning efficacy and implications for research and programs.

Iron supplementation remains an important strategy for the prevention and treatment of iron deficiency anemia and can produce substantial improvements in the functional performance of iron deficient individuals and populations. Many potential benefits of iron supplementation require further exploration, including its effect on vitamin A and iodine metabolism. There is strong evidence that vitamin A and riboflavin deficiencies affect iron utilization from supplements and are important on a global scale, but little evidence that folate and vitamin B-12 deficiencies play a major causal role in the global burden of anemia. The efficacy of multiple micronutrient supplements for the prevention and treatment of anemia must be further evaluated. Because weekly supplementation with iron is effective at improving iron status, this option should be thoroughly explored and evaluated in the context of programs for the prevention and the treatment of iron deficiency and anemia. More conformation is warranted concerning the number of tablets that must be consumed in different situations, and the efficacy of supplying other micronutrients weekly with iron. Weekly supplementation programs may improve the logistical and economic constraints that currently limit the provision of supplements to the many target population groups for whom they are recommended, but usually fail to reach. Further work is required to clarify the purpose, delivery and outcomes of iron supplementation programs.

Adult↗
PubMed1997

Transmission patterns and the epidemiology of hookworm infection.

BACKGROUND: This paper presents a suite of models of hookworm transmission dynamics which vary the mixing patterns and rates of contamination and infection between children and adults. In this context mixing refers to the degree of epidemiological communication between children and adults, for example, whether adults are likely to get infected from infective material passed by children. METHODS: Three models are described which represent random mixing, no mixing and restricted mixing respectively. Child, adult and population targeted chemotherapy programmes are examined and compared between these models. Data from a hookworm control programme in Zimbabwe were analysed with respect to their fit to the various models. RESULTS: The analysis suggests that some mixing does occur and that in this study location, the sites where adults deposit faeces are more likely to lead to subsequent contamination than the sites children use. CONCLUSIONS: Mixing patterns may have a profound effect on transmission dynamics and should be considered in relation to design of control programmes.

Adult↗
PubMed2006

Containing a large bioterrorist smallpox attack: a computer simulation approach.

BACKGROUND: A bioterrorist release of smallpox is a constant threat to the population of the USA and other countries. DESIGN: A stochastic simulation model of the spread of smallpox due to a large bioterrorist attack in a structured population was constructed. Disease natural history parameter estimates, time lines of behavioral activities, and control scenarios were based on the literature and on the consensus opinion of a panel of smallpox experts. RESULTS: The authors found that surveillance and containment, i.e., isolation of known cases and vaccination of their close contacts, would be sufficient to effectively contain a large intentional smallpox release. Given that surveillance and containment measures are in place, preemptive vaccination of hospital workers would further reduce the number of smallpox cases and deaths but would require large numbers of prevaccinations. High levels of reactive mass vaccination after the outbreak begins would further reduce smallpox cases and deaths to a minimum, but would require even larger numbers of vaccinations. Reactive closure of schools would have a minimal effect. CONCLUSION: A rapid and well-organized response to a bioterrorist attack would be necessary for effective surveillance and containment to control spread. Preemptive vaccination of hospital workers and reactive vaccination of the target population would further limit spread, but at a cost of many more vaccinated. This cost in resources and potential harm due to vaccination will have to be weighed against the potential benefits should an attack occur. Prevaccination of the general population is not necessary.

Bioterrorism↗
PubMed1999

A population-based study of age and gender differences in patterns of health-related behaviors.

PURPOSE: Most research on preventive health behaviors has focused on individual rather than groups of behaviors. This study examined interrelationships among multiple preventive health behaviors in different age and gender groups. METHODS: From 1990 to 1992, Maryland residents were surveyed by telephone through the Behavioral Risk Factor Surveillance System. The study sample of 4455 was divided into 8 groups based on age (18-24, 25-39, 40-54, and 55+) and gender. Correlation and oblique rotated factor analyses were used to examine patterns of 8 to 11 preventive health behaviors in each age-gender group. RESULTS: Medical checkup and cholesterol test formed one behavioral cluster in the four male age groups. Breast and cervical cancer screening (mammogram, clinical breast examination [CBE], and Pap Smear) did not form one cluster until age 55 or older; Pap smear, CBE formed one cluster for women of all ages. Risk-taking behaviors were only prominent in the youngest age group: Seatbelt non-use, smoking, and drinking formed one cluster in younger males, and drinking and driving after drinking clustered in younger females. CONCLUSION: Screening and risk-taking behaviors form distinct groups, and behavioral patterns differ by age and gender. Public health programs should consider multi-behavioral approaches, and be sensitive to the gender and age of the target population.

Adolescent↗
PubMed1992

[The evaluation of sexual behavior and knowledge of AIDS in the schools of Burkina Faso. A Knowledge, Attitude, Belief and Practice (KABP) survey in Banfora among 474 adolescents of 14-to-25-years old].

The results of a survey carried out in 1990 on the knowledge, attitudes, beliefs, and practice (KABP) concerning AIDS are presented and discussed. The population surveyed was a random sample of 474 secondary school students (SSS), aged 14-25, in Banfora (Burkina Faso). Among the SSS, a high level of general knowledge about AIDS as a sexually transmitted disease (92.2%) and about condoms (83.1%) is noted. More specific knowledges however, such as the notion of seropositivity, is less well understood (36.7%). Their sources of information are essentially the radio (57.8%) and newspapers (45.4%). The SSS are afraid of AIDS and report that they have changed their behaviour (71.7%). Sexual experiences at young age and risky sexual behaviour (no use of condoms) are however reported. The place of residence, religion, and job and income of their parents or other relatives they are living with, seem to have no effect on the age of the first sexual experience. At present, the SSS of Banfora are aware of the AIDS problem but have not changed their sexual behaviour accordingly, even if they report having done so. The SSS are a prime target population group for any AIDS prevention program.

Acquired Immunodeficiency Syndrome↗