[Technical report: public health monitor: SERMO Study--significance for immunization programs].
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Austria↗
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Results for “Population Programs”
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Asking about access: challenges for surveys in a changing healthcare environment.
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Databases, Factual↗
A qualitative assessment of the referral system at district level in Zimbabwe: implications on efficiency and effective delivery of health services.
OBJECTIVE: To qualitatively assess the referral system at district level from the consumers' point of view and assess implications it had on efficiency and effectiveness of service delivery. DESIGN: Descriptive study. SETTING: Districts of Tsholotsho and Murewa. SUBJECTS: Subjects of the study included community members, ward health team members outpatient department (OPD). MAIN OUTCOME MEASURES: The nature and magnitude of the problem; health seeking behaviour; the perceived role of a hospital versus a health centre; knowledge on the referral system; user fees and the referral system and communication between the service and the community; and perceptions on the referral system. RESULTS: The community does not know the functional differences between a hospital and a clinic. What is clearly known is the physical differences that exist between the two. That is one of the reasons why the choice of a point of entry into the health care delivery system is not always correct. People do understand the mechanics of referring a patient to higher levels of care but they were not happy with the high hospital charges. Although the majority are eligible for free treatment the issues of high transport and other indirect costs were mentioned. There is no effective communication system between the service and the users. This manifested itself through the lack of knowledge or the existence and role of ward health teams or clinic committees. This lack of communication seems to be a major determinant in the failures of many a good policy. The impact of the new fee structure of January 1994 was minimal at district level because the communities felt that although referred patients do not pay hospital consultation fees, once admitted the patient still has to pay or at least prove that he/she is eligible for free services. The inconvenience of proving eligibility for free care still exists. CONCLUSION: In general, the community did not fully comprehend the purposes and intentions of the new user fees policy of January 1994 which was meant to rationalise the referral system. Generally, communities are seldom consulted in time to ensure effective policy implementation and realisation of the intended impact. Impressions generated on the impact of the problem of the referral system on resource use at hospital level show that it has been considerable, although this study did not quantify it. Unnecessary overloading of referral centres negatively affected the care of referral cases, which actually required hospital care, due to competition with primary care cases.
Adult↗
Integration of community-based trachoma control in primary health care in South Africa.
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Community Health Services↗
[Intramural hearing protection program as a response to health needs of working populations in the region of Swietokrysk].
The program of health promotion in the area of hearing protection (IHPP) is proposed as a part of Operational Target 8 of the National Health Program "Reducing exposure to harmful factors in the living, working and educational environment and mitigating their health effects" and corresponds with the aims of the Strategic Governmental Program on Health Protection and Safety at Work. Both in Poland and in the region of świetokrzyskie there is an urgent need to undertake appropriate steps to protect the hearing organ in the working population against harmful effects present in the work environment. It is estimated that 25% of diagnosed occupational diseases is associated with occupational hearing loss. The program is addressed to workers exposed to noise at work. To achieve the main goal of the program it is necessary: to reduce noise emissions and exposure to noise in the work environment; to promote behavior conducive to hearing protection among workers exposed to noise; to improve the quality of prevention in the occupational health services responsible for hearing protection. The Regional Center of Occupational Medicine in Kielce (coordinator) and primary units of occupational health service are involved in the implementation of the program, whereas, employers, occupational safety and health services, the State Labor Inspectorate and Sanitary Inspectorate participate in its implementation. It is expected that the program in the region of świetokrzyskie will yield the following expected results: the reduction of noise emission to safe levels; the increased awareness of using optimal hearing protectors among noise-exposed workers; the decreased number of workers with diagnosed noise-induced hearing loss, and the decrease in the number of new cases of occupational hearing impairment.
Deafness↗
The demographic impact of family planning programs.
In response to concerns about the adverse consequences of rapid population growth, family planning programs have been implemented in many developing countries. The aim of the present study is to assess the impact of this programmatic approach on long-range population growth. The result of a new and hypothetical population projection indicates that in the absence of family planning programs the population of the developing world could be expected to reach 14.6 billion in the year 2100 instead of the 10 billion that is currently projected by the World Bank. Despite the apparent success of existing interventions, fertility control is far from complete, as many women continue to bear unwanted births. To assess the impact of this unintended childbearing a second hypothetical projection is made. With perfect implementation of reproductive preferences, the population size of the developing world in 2100 would be reduced by an estimated 2.2 billion below the current projection. Further strengthening of family planning programs and improvements in birth control technology are therefore likely to provide important demographic benefits.
Contraception Behavior↗
Gambian government ready to tackle population.
According to UN sources, the Gambia is confronting population with renewed vigor. A multi-sectoral population policy was formulated in 1992, taking into account recommendations made by the 1991 joint government and UNFPA Program Review and Strategy Development project. It was approved only after it had been widely discussed in regional cities amongst local community leaders. In January 1993, the government agency responsible for the population program was transferred to the Gambian President Sir Dawda Kairaba Jawara's office, who now chairs the National Population Commission. At the first meeting of the Commission in April, the President re-emphasized the need to manage the country's population and the possible impact of rapid population growth on national development. "With a national policy and strong institutional structures in place, the Government of Gambia is poised to launch a major effort to achieve its targets in the area of population," he said. However, he emphasized the full complexity of the process and called for consensus on objectives to be achieved by the population program.
Africa↗
Teaching for life: integrating aging into the rehabilitation education program.
As the population with spinal cord injury (SCI) steadily ages, nurses find it more and more challenging to prevent secondary complications. SCI, an already complex topic, is made more so with the addition of the aging process. Aging need not be a negative occurrence, but can be viewed as a path in life that requires careful navigation along the way. Nurses need to incorporate the concepts of wellness and disease prevention education into the initial rehabilitation program to better prepare patients for a long and healthy life. This article briefly describes respiratory and genitourinary complications associated with aging with an SCI and some specific teaching strategies for prevention and management of these two complications.
Aging↗
The human CD77- B cell population represents a heterogeneous subset of cells comprising centroblasts, centrocytes, and plasmablasts, prompting phenotypical revision.
The process of becoming an Ig-producing plasma cell takes the mature B cell through the germinal center, where Ig genes are diversified through somatic hypermutation and class switch recombination. To more clearly define functional characteristics of the germinal center dark zone centroblasts and the light zone centrocytes, we have performed expression analysis of the CD77(+) and CD77(-) populations, because CD77 has been accepted as a discriminator of centroblasts and centrocytes. Our results demonstrated that the CD77(+) and the CD77(-) populations lack functional associated expression programs discriminating the two populations. Both populations are shown to be actively cycling and to share common features associated with cell cycle regulation and DNA maintenance. They are also shown to have an equally active DNA repair program, as well as components involved in somatic hypermutation and class switch recombination. Moreover, the data also demonstrated that the CD77(-) population comprises cells with an already initiated plasma cell differentiation program. Together this demonstrates that CD77 does not discriminate centroblasts and centrocytes and that the CD77(-) population represents a heterogeneous subset of cells, comprising centroblasts, centrocytes, and plasmablast.
B-Lymphocyte Subsets↗
Prevalence of Chlamydia trachomatis infection in a population of asymptomatic women in a screening program for cervical cancer.
The prevalence of Chlamydia trachomatis infection in a population of women with no symptoms of sexually transmitted disease was investigated. These women, aged 35-55 years, participated in a screening program for cervical cancer. With the use of a direct immunofluorescence method, 109 out of 2,470 smears tested were positive for Chlamydia trachomatis, indicating an overall prevalence of 4.4%. No changes in prevalence were found when five-year cohorts of this group were analyzed, indicating that age-dependent changes or epidemiological factors do not result in a different (decreased) prevalence over the ages 35 to 55 years. The prevalence of Trichomonas vaginalis and fungi, as detected by cytological screening, was lower than that observed for Chlamydia trachomatis: 3.1 and 2.1%, respectively. Of the 109 smears positive for Chlamydia trachomatis, 90 showed cervical cells with reactive changes (out of 1,490 smears with PAP II), whereas no cytological changes were found in 15 cases (out of 884 smears with PAP I). Changes suggestive of mild or moderate dysplasia were found in only four cases (out of 93 smears with PAP III). The results indicate that Chlamydia trachomatis is associated with reactive changes of endocervical cells and raise serious questions about whether prevention of possible secondary effects such as infertility and pelvic inflammatory disease can be achieved by a combined screening program for cervical cancer and Chlamydia trachomatis.
Adult↗
Population biology, evolution, and immunology of vaccination and vaccination programs.
The purpose of prophylactic vaccination is to reduce morbidity and mortality in a population. Many questions related to the design of vaccines and vaccination programs require a population standpoint for their sharp formulation and laboratory and field studies to understand their immunologic background. Practical suggestions of the workshop included increased studies of age-specific immunity, better immunoepidemiologic surveillance, better design of efficacy studies, and more systematic sampling of parasite strains to study the evolutionary pressure exerted by vaccines. Theoretical immunology has much to contribute. One of the realizations of the workshop was the value of a strong interdisciplinary approach in vaccine development, utilizing relevant contributions from immunology, population biology, mathematical modeling, epidemiology, molecular biology, and virology.
Animals↗
Adaptive Sports Exposure Across Physical Medicine and Rehabilitation Residency and Sports Medicine Fellowship Programs: A National Cross-Sectional Website Analysis.
Adaptive sports improve health and quality of life for people with disabilities, yet the extent of adaptive sports exposure in physical medicine and rehabilitation (PM&R) training is unclear. This cross-sectional study reviewed the public websites of 115 accredited physical medicine and rehabilitation residency programs and 26 sports medicine fellowship programs for any mention of adaptive sports, characterizing exposure type, target populations, and associated program characteristics. Adaptive sports were mentioned by 32 residency programs (27.8%) and 8 fellowship programs (30.8%). Mention varied significantly by geographic region in both cohorts (residency, West 64% vs. South 19%, P=.017; fellowship, Midwest 80% vs. South 0%, P=.035) and, among residencies, was associated with larger program size and a greater number of associated subspecialty fellowships. Residency exposure was predominantly volunteer-based, whereas fellowship exposure was exclusively clinical or undisclosed; target populations served were frequently unspecified. Programs have an opportunity to expand structured adaptive sports training and to clearly convey these opportunities to applicants and patients.
Adaptive sports↗
Cholesterol screening in a community health promotion program: epidemiologic results from a biracial population.
The prevalence and interrelationship of high blood cholesterol levels with other cardiovascular disease risk factors were studied in a biracial suburb of New York City. Participants in community-based screenings to determine blood cholesterol levels have been predominantly white women in older age groups, highly educated and nonsmokers. To reach a more representative segment of a local population and promote healthy lifestyle behaviors, cholesterol screenings were conducted within an ongoing health promotion program in Mount Vernon, NY. Plasma cholesterol levels were determined for 5,011 participants, including 2,308 whites and 1,778 blacks. Of the men, 29 percent had high cholesterol levels; among women, it was 27 percent. Of the men with high levels, half had levels greater than 200 milligrams per deciliter, as did 55 percent of the women. After statistical adjustments were made for age and other risk factors for high blood cholesterol, mean cholesterol levels were higher for whites than blacks. The level for white men was 204 milligrams per deciliter; for women, 212. For black men, the level was 199 milligrams per deciliter; for women, 208, P < .10. Hispanic men had levels of 199, P < .10. The levels for Hispanic women (203 milligrams per deciliter) were significantly lower than that of white women. Among whites who smoked more than 1 pack of cigarettes per day, mean cholesterol levels were 11 milligrams per deciliter higher than for those who never smoked or were light smokers (0, 1-20 cigarettes per day, P < .10). There were too few who smoked more than 1 pack to test this association adequately among blacks. The mean cholesterol levels for hypertensive black men were 10 milligrams per deciliter greater than for black men with normal blood pressure (P<.10).
Adult↗
Cervical screening attendance and its effectiveness in a rural population in China.
The results of a cervical cancer screening program in a population of 22,106 women aged over 25 years in a rural county of China are evaluated in a case-control analysis. The relative risk of cervix cancer was 0.33 in women with three or more negative tests (compared with one or less) and 11.4 for women whose last negative smear was 8 or more years previously (compared with 2 years or less). Attendance at the screening program was positively associated with some risk factors for cervix cancer (sexual behavior of the woman and her partner) and negatively associated with others (genital hygiene). Controlling for the confounding effect of these risk factors resulted in only small changes in the estimate of the protective effect of screening.
Adult↗
The health bus: healthcare for marginalized populations.
The Health Bus, an innovative outreach program, serves the marginalized population of a large Canadian city. In this article, a needs assessment/evaluation study of its services is discussed. Barriers to mainstream healthcare and solutions are examined. This study was qualitative, descriptive, and exploratory and surveyed 58 client volunteers of the program through semistructured interviews and focus groups. Thematic analysis of data was carried out. The Health Bus was found to provide basic healthcare and supplies effectively. Clients value respectful treatment, competency of healthcare professionals, and accessibility, whereas disrespectful treatments and lack of transportation are barriers to mainstream healthcare. A conclusion of this study is that Health Bus services should be expanded with clients' input. Mainstream institutions need flexibility and a change in attitudes toward the marginalized.
Adult↗
Nepal: ICPD spurs changes in policies.
The adoption of the International Conference on Population and Development (ICPD) Program of Action by Nepal has spurred a number of changes to improve the population situation in that country, according to the country report presented at the High-Level Meeting. One of the most important of these was the establishment of the Ministry for Population and Environment in 1995. As a result, a number of policies and programs concerning the population and health sector have been formulated and implemented. These are considered important because social and economic development is at a low level in Nepal. According to the 1991 census, the literacy rate for both sexes was 40% (males 55% and females 25%). The status of women in Nepal is very low and their role is confined to household chores. Some of the indicators of the status of women are the maternal mortality rate (MMR), life expectancy at birth, and age at marriage. MMR is estimated at 539/100,000 live births and life expectancy was an average of 53.5 years.
Asia↗
The population-based approach to chronic care.
Looking at the needs of a population rather than the episodes that land individuals in the hospital is one way to improve care. Find out the 10 steps to establishing population-based care programs, and learn some healthcare organizations' strategies for preventing acute episodes.
Chronic Disease↗
Epidemiologic determinants of the mammographic parenchymal pattern. A population-based study within a mammographic screening program.
Epidemiologic data and information on the mammographic parenchymal pattern (classified according to Wolfe (Cancer 1976;37:2486-92)) were obtained from 38,757 (89%) of all women who were invited to undergo mammography in a population-based screening program in Kopparberg County, Sweden, starting in October 1977. The prevalence of the high-risk patterns (P2 and DY) was significantly higher in women aged 46-50 years than in any younger or older age group. A univariate analysis revealed that the odds ratio (OR) of having a high-risk pattern increased regularly with increasing age at first birth and was highest in nulliparous women. These associations remained evident in all age groups and were most pronounced in the oldest women. A history of breast biopsy increased the likelihood of having a high-risk pattern (OR = 1.57), whereas a similar weak overall association with prior cancer in the contralateral breast (OR = 1.40) and with familiar occurrence of breast cancer (OR = 1.20) was eliminated when other confounding factors were considered in a multivariate analysis. The authors conclude that characteristics of the reproductive lives of women have a significant and lifelong impact on their mammographic parenchymal patterns.
Adult↗