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PubMed2004

Entanglement of Australian sea lions and New Zealand fur seals in lost fishing gear and other marine debris before and after Government and industry attempts to reduce the problem.

In recent years, Australian governments and fishing industry associations have developed guiding principles aimed at reducing the impact of fishing on non-target species and the benthos and increasing community awareness of their efforts. To determine whether they reduced seal entanglement in lost fishing gear and other marine debris, we analysed Australian sea lion and New Zealand fur seal entanglement data collected from Kangaroo Island, South Australia. Contrary to our expectations, we found that entanglement rates did not decrease in recent years. The Australian sea lion entanglement rate (1.3% in 2002) and the New Zealand fur seal entanglement rate (0.9% in 2002) are the third and fourth highest reported for any seal species. Australian sea lions were most frequently entangled in monofilament gillnet that most likely originated from the shark fishery, which operates in the region where sea lions forage--south and east of Kangaroo Island. In contrast, New Zealand fur seals were most commonly entangled in loops of packing tape and trawl net fragments suspected to be from regional rock lobster and trawl fisheries. Based on recent entanglement studies, we estimate that 1478 seals die from entanglement each year in Australia. We discuss remedies such as education programs and government incentives that may reduce entanglements.

Animals↗
PubMed2001

[Cost of a national program to control human African trypanosomiasis in the high Mbomou region, Central African Republic].

An outbreak of human African trypanosiaisis is ongoing in the High Mbomou area of the Central African Republic. This area is located on the Sudanese border approximately 1,100 kilometers from the capital city of Bangui. According to current estimates, the cost of implementing the National Human African Trypanosomiasis Program is 754,000 United States Dollars, i.e., 4.1 dollars per protected inhabitant. However actual conditions in the field suggest that this estimate should be revised. Special field conditions include constant refugee movement across the border, lack of accurate epidemiological data concerning neighboring Haut Zaire, and low participation of village residents in mass screening operations (less than 50%). In response to these problems, the authors recommend the organization of more exploratory missions to allow better targeting of screening and therapy. In the initial plan, exploratory missions were to account for 1% of the total cost. This proportion will probably require upward adjustment.

Central African Republic↗
PubMed2006

Epidemiology of seasonal influenza: use of surveillance data and statistical models to estimate the burden of disease.

The US Centers for Disease Control and Prevention (CDC) uses a 7-component national surveillance system for influenza that includes virologic, influenza-like illness, hospitalization, and mortality data. In addition, some states and health organizations collect additional influenza surveillance data that complement the CDC's surveillance system. Current surveillance data from these programs, together with national hospitalization and mortality data, have been used in statistical models to estimate the annual burden of disease associated with influenza in the United States for many years. National influenza surveillance data also have been used in suitable models to estimate the possible impact of future pandemics. As part of the public health response to the 2003-2004 influenza season, which was noteworthy for its severe effect among children, new US surveillance activities were undertaken. Further improvements in national influenza surveillance systems will be needed to collect and analyze data in a timely manner during the next pandemic.

Adolescent↗
PubMed2005

Who uses safe ride programs: an examination of the dynamics of individuals who use a safe ride program instead of driving home while drunk.

Drinking and driving are still a serious concern on the roads, even though the last twenty years has seen an increase in exposure to various designated driver programs. Even though a majority of people have either been one or used one, most designated drivers have still consumed some alcohol. Another option is that of an outside driver, such as a safe ride program in which a safe ride is offered for free by taxis or volunteers. One such program under study, offers a ride home for both the driver as well as their vehicle. To examine the population who utilizes such a program two studies were conducted which included 1,985 participants (1206 male, 744 female) from two major California cities. The volunteer drivers gathered data during their rounds between January 2002 and September 2002. If the current safe ride program not been in place 632 Participants (44%) reported that they would have driven themselves home. 582 participants (40%) have used back roads in the past to evade being stopped by the police; on average they used back roads 3.4 times in the past month. When questioned about having control over not drinking and driving 455 (32%) participants didn't feel they had control over their choice to avoid drinking and driving. Participants who reported having driven back roads in the past to avoid confrontation with the police after drinking had significantly higher estimated BAC levels than those who said they had never done so. This sample reflected similar populations.

Accidents, Traffic↗
PubMed2005

Does WIC work? The effects of WIC on pregnancy and birth outcomes.

Support for WIC, the Special Supplemental Nutrition Program for Women, Infants, and Children, is based on the belief that "WIC works." This consensus has lately been questioned by researchers who point out that most WIC research fails to properly control for selection into the program. This paper evaluates the selection problem using rich data from the national Pregnancy Risk Assessment Monitoring System. We show that relative to Medicaid mothers, all of whom are eligible for WIC, WIC participants are negatively selected on a wide array of observable dimensions, and yet WIC participation is associated with improved birth outcomes, even after controlling for observables and for a full set of state-year interactions intended to capture unobservables that vary at the state-year level. The positive impacts of WIC are larger among subsets of even more disadvantaged women, such as those who received public assistance last year, single high school dropouts, and teen mothers.

Birth Weight↗
PubMed2000

['Number needed to screen': a tool for assessment of prevention programs].

The number needed to screen (NNS) is defined as the number of people that need to be screened for a given period to prevent one death or adverse event. The NNS is one of the criteria with which the efficacy of a screening programme can be determined. This article introduces the NNS to Dutch literature. The NNS may be calculated with mortality figures and the absolute risk reduction obtained by a prevention programme. Another method is to multiply the number needed to treat (NNT) with the number of people that have to be screened in order to find one patient with the disease. Based on published figures, the NNS's per year to prevent one death in current screening programmes within general practice in the Netherlands are approximately 2560 for cervical cancer screening, about 1000 for breast cancer screening, and circa 2340 for the detection of hypertension in patients aged 55-75 years.

Data Interpretation, Statistical↗
PubMed2006

[Integrated approach to the promotion of young academics in vision research at a European level].

The European Commission predicts a dramatic dearth of researchers and doctors in the near future. At the same time, highly qualified and motivated human resources form the only guarantee for further development of scientific knowledge for research and clinical application. This situation calls for an integrated approach to the promotion of young academics in vision research at a European level. The Marie Curie Program of the European Union is an ideal tool, which can be used particularly efficiently in vision research to promote international networking and dedicated advancement of young academics. The exemplary chances and opportunities of this strategy can be demonstrated by six specific measures of the University Eye Hospital in Tübingen. In particular, strictly defined medical areas will need to fully exploit their innovation potential in the future in order to secure their position in the global research area or even to expand it. New organizational concepts and long-term career options as well as a clear commitment to cutting-edge performance are the prerequisites for effective promotion of young academics.

Academic Medical Centers↗
PubMed2003

Hemangiosarcomas, medulloblastomas, and other tumors in Ink4c/p53-null mice.

Ink4 proteins inhibit the enzymatic activities of cyclin D-dependent kinases, thereby governing transcriptional programs that depend on the activities of the retinoblastoma protein and other retinoblastoma family members (p107 and p130). Mice lacking Ink4c and p53 spontaneously develop a broad spectrum of neoplasms, usually presenting with multiple tumors of different histological types and dying of cancer by 6 months of age. Whereas thymic lymphomas or pituitary tumors predominate in mice lacking p53 or Ink4c, respectively, animals lacking both genes develop many vascular tumors and also present with medulloblastomas not observed in the parental strains. Unlike p53, loss of the Arf tumor suppressor did not contribute to the appearance of vascular or cerebellar tumors. Vascular tumors ranged in severity from angiomas to hemangiosarcomas, some of which could be transplanted into immunocompromised mice. Intriguingly, loss of Ink4c but maintenance of at least one Ink4d allele was required for formation of medulloblastomas in p53-null mice. In situ hybridization revealed that, in newborn mice, Ink4c is detected in the pia mater and in an adjacent layer of rapidly dividing cells within the cerebellar external granule layer (EGL), whereas Ink4d is primarily expressed in Purkinje neurons. Because the pia mater and Purkinje cells sandwich the cerebellar EGL from which medulloblastomas are presumed to arise, Ink4 proteins might function in a cell-autonomous manner in governing neuronal cell cycle exit as well as in a non-cell-autonomous manner in controlling the production of diffusible mitogens and chemokines that influence postnatal development of the cerebellar EGL.

Animals↗
PubMed2004

The Medicare Prescription Drug, Improvement and Modernization Act and the impact on care of people with chronic illness: benefit design and implementation issues.

The Medicare Prescription Drug Improvement and Modernization Act represents the most far-reaching and one of the most controversial reforms of the Medicare program since its enactment in 1965. The Act ushers in a new Medicare prescription drug benefit, revitalizes Medicare Advantage plans and promotes new approaches to care of Medicare beneficiaries with chronic illness. However, while the Act evidences a commitment to improving the care of beneficiaries with chronic illness, reform may prove elusive. The basic benefit design is daunting in its complexity andfor certain beneficiaries, coverage may be less generous and less comprehensive than currently available coverage. To ensure appropriate transition and treatment for dual eligibles and others with chronic illness, both Congress and the Department of Health and Human Services must be prepared to address a number of important benefit design and operations issues and be willing to make mid-course corrections and adjustment as the process unfolds.

Aged↗
PubMed2001

Risk adjustment of Florida mental health outcomes data: concepts, methods, and results.

This article discusses outcome evaluation systems for mental health programs. It reviews and critically evaluates design and analysis methods for strengthening the validity of such uncontrolled comparisons. The article examines methods for statistically adjusting preexisting groups, now referred to as risk adjustment or case-mix adjustment, and offers guidelines for determining when this procedure is appropriate. Then, analyses on two dependent variables--a global rating of functioning and a consumer satisfaction measure--available from an outcomes evaluation system currently underway in Florida are used to demonstrate the proposed method of risk adjustment. Results for 24 providers of mental health services showed that while risk adjustment only made a small difference in the overall provider rankings, the ranking of some specific providers changed considerably. The article concludes with a discussion of the implications of this research.

Adult↗
PubMed2000

The French antibiotic resistance monitoring programs.

Surveillance of antimicrobial resistance in bacteria from animal origin in France is organised by the French Agency for Food Safety (Agence Française de Sécurité Sanitaire des Aliments, AFSSA) through two types of networks. The first collects non-human zoonotic Salmonella strains in one centre (AFSSA, Paris) where they are tested for their antimicrobial susceptibility. The others, managed by AFSSA Lyon, deal with bovine pathogenic strains and are multicentric, that is they collecting antibiotic sensitivity and other data from the local public veterinary diagnostic laboratories. This requires standardisation of the methods used in each partner laboratory. Statistical analysis of any change in French resistance patterns can be monitored by these three networks either as a function of strain pathogenicity and/or of the ecological origin of the isolate. The system also encourages efficient collaboration between veterinarians and the laboratory. Such collaboration improves both the quality of routine antibiotic testing and understanding of the molecular mechanisms underlying resistance.

Animals↗
PubMed2006

Patients with special health care needs in general and pediatric dental practices in Ontario.

The objective of this study was to determine the involvement of Ontario's general and pediatric dentists in providing care to patients with special health care needs (PSHCNs). A questionnaire was developed and sent to a randomly selected sample of general dentists and to all pediatric dentists in Ontario; response rates were 52% and 90%, respectively. Most general dentists and all pediatric dentists reported that they provided a full range of dental services to PSHCNs. Most (80%) general dentists treat PSHCNs of all ages, whereas 60% of pediatric dentists report only treating PSHCNs up to the age of 18 years. A majority of both groups report treating PSHCNs whose dental care is paid through various government-funded programs. Most general dentists received training in the treatment of PSHCNs in undergraduate dental school, and 40% reported taking continuing education courses in this area. Most pediatric dentists received this training during their advanced dental specialty training, and 29% reported taking continuing education courses in this area. The results of this survey appear to demonstrate that general and pediatric dentists in Ontario provide a full range of dental services to PSHCNs, treat patients with a variety of disabilities and of all ages and are interested in pursuing continuing education that focuses on the delivery of dental care to PSHCNs. However, the results may be inaccurate because of question design flaws and responder bias among the 52% of surveyed general dentists who returned their questionnaires.

Adolescent↗
PubMed2002

Factors related to client satisfaction with community-based respite services.

The goal of this study was to identify factors related to client satisfaction with respite services. Data were analyzed from interviews with 1183 family caregivers participating in the AoA Demonstration Grants to States program. Two groups of potential explanatory variables were examined: (1) characteristics of client families, and (2) caregivers' perceptions of service delivery. Separate regression models were estimated for users of in-home respite and adult day care. Factors related to satisfaction with in-home respite included elder's ADL, ethnicity, caregivers' expectations for what the respite worker would and would not do, access to services, and the amount of red tape. Factors related to satisfaction with adult day care included the caregiver's age and health, ethnicity, caregivers' expectations for what the respite worker would and would not do, access to services, and the amount of red tape. Differences be- tween the models are discussed in the context of how providers can improve client satisfaction with respite services.

Activities of Daily Living↗
PubMed2005

[Infectious disease epidemiology education and training Programs. FETP and EPIET].

The German Field Epidemiology Training Programme (FETP) and the European Programme for Intervention Epidemiology Training (EPIET) were founded to develop a network of epidemiologists for the surveillance and control of communicable diseases. During their 2-year training, FETP or EPIET fellows are based at the Robert Koch-Institut or other European host institutes and have to conduct outbreak investigations, carry out surveillance and research projects and publish the results. Since 1995, all 22 FETP and 94 EPIET fellows have conducted and published numerous outbreak investigations, surveillance and research projects, for example on pathogens inducing salmonellosis, influenza, SARS or avian influenza. Currently, 70% of FETP and EPIET alumni are working in key positions in communicable disease control on a regional, national or international level. The German FETP and the European EPIET programme offer high quality practical training in applied epidemiology. The expert knowledge of the alumni of both training programmes will be incorporated into the new European Centre for Disease Control (ECDC) and determine the future direction of infectious disease epidemiology in Germany and Europe.

Communicable Disease Control↗
PubMed2001

Ethics of rural health care.

One quarter of the US population live in areas designated as rural. Delivery of rural health care can be difficult with unique challenges including limited access to specialists such as oncologists. The Rural Cancer Outreach Program is an alliance between an academic medical center and five rural hospitals. Due to the presence of this program, the appropriate use of narcotics for chronic pain has increased, the number of breast conserving surgeries has more than doubled and accrual to clinical trials has gone from zero to nine over the survey period. An increase in adjuvant chemotherapy has been noted. The rural hospitals and the academic center have seen a positive financial impact. The most prominent ethical issues focus on justice, especially access to health care, privacy, confidentiality, medical competency, and the blurring of personal and profession boundaries in small communities. As medical care has become more complex with an increasing number of ethical issues intertwined, the rural hospitals have begun to develop mechanisms to provide help in difficult situations. The academic center has provided expertise and continued education for staff, both individually and within groups, regarding ethical dilemmas.

Academic Medical Centers↗
PubMed2007

Impact of supported housing on clinical outcomes: analysis of a randomized trial using multiple imputation technique.

In 1992, the US Department of Housing and Urban Development (HUD) and the US Department of Veterans Affairs (VA) established the HUD-VA Supported Housing (HUD-VASH) Program to provide integrated clinical and housing services to homeless veterans with psychiatric and/or substance abuse disorders at 19 sites. At four sites, 460 subjects were randomly assigned to one of the three groups: (1) HUD-VASH, with both Section 8 vouchers and intensive case management; (2) case management only; and (3) standard VA care. A previous publication found HUD-VASH resulted in superior housing outcomes but yielded no benefits on clinical outcomes. Since many participants missed prescheduled visits during the follow-up period and follow-up rates were quite different across the groups, we reanalyzed these data using multiple imputation statistical methods to account for the missing observations. Significant benefits were found for HUD-VASH in drug and alcohol abuse outcomes that had not previously been identified.

Alcoholism↗
PubMedDate not supplied

Effects of earnings-supplement policies on adult economic and middle-childhood outcomes differ for the "hardest to employ".

Data from the Minnesota Family Investment Program and the New Hope demonstration were used to determine whether experimental effects of antipoverty policies differ by parents' risk for nonemployment. Using propensity score analysis, increases in employment and income were largest in the harder-to-employ halves of both samples. However, only children in the moderately hard-to-employ quartiles (50th to 75th percentile) consistently showed improvements in school and behavior outcomes. The very-hardest-to-employ 25% experienced decreases in school engagement, and increases in aggressive behaviors, despite substantial increases in parental employment and income. In this group, increases in maternal depression, reductions in regular family routines, and smaller increases in job stability and center-based child care occurred. These factors may have counteracted the potential benefits of increased income on children.

Adult↗
PubMed2004

Development of national animal genetic resource programs.

Globally, animal genetic resources are contracting due to economic forces. As a result, during the 1990s there was a dramatic increase in national animal genetic resource activities. Many national programmes were initiated and the Food and Agriculture Organisation of the United Nations played a prominent role in coalescing national actions. Nationally, programmes have been initiated that comprise of in situ, ex situ and information-exchange efforts. A critical element to national conservation efforts is the development of cryopreserved collections of germplasm. Several countries have initiated substantial multispecies collections of cryopreserved germplasm. The selection of animals within breeds of interest is an important consideration in building cryopreserved collections. Animal selection should be based on a lack of genetic relationship, with sufficient numbers of animals to ensure the capture of rare alleles. Major issues facing repository development and genetic conservation are: (1) that all breeds are in need of genetic diversity management; (2) a better understanding of in situ breed population dynamics is needed; and (3) the concept that repository collections can be used by a broad range of clientele across time as well as during emergency situations.

Animals↗