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Promotion of breast feeding in the community: impact of health education programme in rural communities in Nigeria.
Breast feeding has been recognized as a child survival strategy, while breast feeding programmes have been increasingly implemented in many communities. This study assesses the effectiveness of a breast feeding education programme launched through the primary health care programme in the rural communities of Nigeria. Late trimester pregnant women were enrolled into the study and given a questionnaire on knowledge, attitudes, and practices (KAP) about breast feeding. Women in the study group (n = 126) received breast feeding counselling before and after delivery, while those in control group (n = 130) did not receive any counselling. Both groups were monitored after delivery and followed with the KAP questionnaire. The results of the study showed marked improvements in the intervention group for colostrum feeding (p = 0.0000). Moreover, 31.6% of the mothers in the intervention group practised timely initiation of breast feeding compared to 5.6% of the controls, and the prevalence of exclusive breast feeding at 4 months was 39.8% in the intervention group compared to 13.9% for the controls. Multivariate analysis showed that the intervention was a powerful and the only significant predictor of the increase in breast feeding behaviours (p = 0.0000), and that an early initiation of breast feeding is a strong predictor of exclusive breast feeding at 4 months of age. It is concluded that breast feeding promotion in rural communities is feasible and can lead to behavioural changes.
Mortality among children with sickle cell disease identified by newborn screening during 1990-1994--California, Illinois, and New York.
Sickle cell disease (SCD) is an autosomal recessive disorder characterized by production of abnormal (sickle) hemoglobin, resulting in anemia, susceptibility to pneumococcal and other infections, pain, stroke, and multiple organ dysfunctions. The most common types include hemoglobin SS (homozygous) disease, sickle cell-hemoglobin C disease, and the sickle beta-thalassemia syndromes. A randomized controlled trial published in 1986 indicated that daily oral penicillin prophylaxis reduced the incidence of serious infection in young children with SCD and led to widespread adoption of newborn screening programs for SCD. To study the effectiveness and utilization of prevention programs among large populations of infants with SCD, several newborn screening programs in the United States are now attempting to determine rates of complications and actual use of early medical interventions (e.g., penicillin prophylaxis and pneumococcal vaccination). This report focuses on recent mortality in California, Illinois, and New York. In California and Illinois, mortality from all causes among black children born during 1990-1994 with SCD was slightly less than overall mortality for all black children born in the same time period.
Effectiveness of a specialized asthma clinic in reducing asthma morbidity in an inner-city minority population.
Asthma is the most common chronic disease of childhood and a leading cause of morbidity in adults. Despite significant advances in medical therapy, asthma morbidity and mortality rates have risen dramatically over the past two decades, especially in minority and socioeconomically disadvantaged populations. Numerous intervention programs have been designed in an attempt to reduce asthma morbidity but few have targeted poor or minority populations. The purpose of this study was to assess whether an outpatient intervention program specifically targeted at a high-minority population in East Harlem, in New York City, was successful in reducing asthma morbidity. A retrospective chart review of 84 patient records was conducted. The patients were divided into two groups, an intervention group (n = 45), who were followed by an asthma specialist (allergist/immunologist), and a nonintervention group, followed by a general internist or pediatrician. Outcome variables including clinic walk-in visits, emergency room visits, and hospitalizations were determined and compared in the pre- and postintervention period in both groups. Patients in the intervention group had reduced total walk-in visits (73 vs. 27, p < 0.001), emergency room visits (30 vs. 5, p < 0.001), and hospitalizations (16 vs. 2, p < 0.001). In contrast, patients in the nonintervention group had no change in total walk-in visits (88 vs. 72), increased emergency visits (7 vs. 22, p < 0.05), and no change in hospitalizations (5 vs. 2), respectively. The outpatient intervention program has been successful in reducing asthma morbidity in the high-risk minority community of East Harlem. Future larger studies are warranted to extend this pilot program to other high-risk minority populations.
A FORTRAN program to simulate the evolution of genetic variability in a small population.
This paper presents a FORTRAN-77 program that performs Monte Carlo simulation of the evolution of genetic structure in a small population under selection. The aim is to study the possibility of foreseeing a response plateau in a theoretical population, depending on population size and management, and to apply this to small populations actually selected, to predict a possible exhaustion of genetic variability. A set of subroutines describing the different steps in a selection cycle (birth, expression of phenotypic value, genetic evaluation, selection, reproduction, death) is available and the user can choose the sequence of subroutines, the characteristics of individuals submitted to each step, and also build more personal subroutines if necessary. The program is based on the generation of exact genotypes and their transmission from parents to offspring, through simulation of meiosis and pairing of gametes. Parameters concerning the genome, the initial structure of the population and its management are required. The genetic mean and variance of the population for each new cycle of selection are given as outputs. Examples of applications are given and discussed.
Retention of court-referred adolescents and young adults in the therapeutic community.
Client retention for Abraxas, a therapeutic community (TC) whose clients are almost exclusively court referred, was compared with that for nine other TCs that primarily accept clients not referred by the courts. Retention was found to be dramatically higher for Abraxas than for all nine comparison TCs during the first month of treatment. After the first month of treatment, discharge rates for Abraxas were lower than those for an aggregate of seven of the TCs but were comparable to rates for two others. At the end of 10 months, more residents remained at Abraxas than at eight of the nine comparison programs. These differences between Abraxas and the nine comparison TCs are particularly notable in that Abraxas' population is primarily juvenile whereas the comparison program populations are primarily adult. Analysis of the Abraxas sample showed that client retention was significantly higher for court referrals, adults, and males, and did not significantly vary according to ethnicity. The author conclude that court pressure can strongly enhance retention in therapeutic communities, particularly during the initial stage of treatment.
Educational intervention with multiply handicapped preschool children.
A study was conducted to objectively measure changes in functioning of multiply handicapped children in a specialized nursery school program. The study population consisted of the 18 children who entered the program in the study year. A quantitative teacher rating scale was developed, tested, and found to be reliable. Significant improvements were demonstrated in interaction, communication, and task orientation after 3 months and in self-care after 6 months. There was no measurable change in motor performance, and the intellectual functioning of the children remained in the same diagnostic category as at the outset. The study documented improvement on social competence of multiply handicapped children enrolled in a preschool program with minimal parental involvement. The teacher rating scale was found to be useful in measuring social functioning in a school setting for a young population with a limited range of possible achievements. Teachers proved to be reliable evaluators of their pupils. To measure social and interactional parameters, it appears necessary to have both a standardized instrument and an informed observer who knows the child's daily functioning.
Enrollment strategies in early home visitation to prevent physical child abuse and neglect and the "universal versus targeted" debate: a meta-analysis of population-based and screening-based programs.
OBJECTIVE: Seeking to discern optimal programmatic strategies and inform the "universal versus targeted" debate in early home visitation services to prevent physical child abuse and neglect, a meta-analysis was conducted examining enrollment approaches in early home visitation studies and their reported outcomes. METHOD: Quantitative meta-analytic techniques were used to compare effect sizes from 19 controlled outcome studies across screening-based and population-based enrollment strategies. Effect sizes were calculated on protective services data and on child maltreatment related measures of parenting. RESULTS: On protective services report data, population-based studies reported a weighted mean effect size attributable to early home visitation of +3.72%, in comparison to -.07% for screening-based studies. On child maltreatment related measures of parenting, population-based studies reported a weighted mean effect size (r) attributable to early home visitation of +.092, in comparison to +.020 for screening-based studies. CONCLUSIONS: The findings indicate that population-based enrollment strategies appear favorable to screening-based ones in early home visitation programs seeking to prevent physical child abuse and neglect. It may be that psychosocial risk screens serve to enroll higher proportions of families for which early home visitation services are less likely to leverage change, and to exacerbate a mismatch between early home visitation service aims and family needs.
Monitoring program of biological status of human populations related to environmental changes.
The paper aims at a synthesis of research carried out hitherto which might serve to evaluate the diagnostic value of human biological traits related to natural, economic and socio-cultural properties of the environment. The development of a monitoring program is the object of research of the Department of Human Ecology, the Polish Academy of Sciences, in the years 1986-1990 in Poland, and also of recommendations of the IUAES Human Ecology Commission for the last decade of the 20th century in various countries over the world. Generally, the stages of ontogenesis that are appropriate for monitoring are those which involve an intense proliferation of cells and a rapid growth. The appropriate subjects are the more ecosensitive individuals, that is the heterozygous ones as well as men. The more ecosensitive traits are those developed after birth in over 50 per cent of their adult value. Traits of the highest diagnostic (discriminant) value with respect to environmental conditions were selected. The results are based on the analysis of: 35 somatic traits in 1034 newborns from Białystok and Zambrów in relation to the traits of their families and parents; 21 somatic traits in 2461 of 11 year-old children from Lublin; 40 somatic, physiological and psychomotor traits in 1186 children, 6-19 years old from Poland; 26 morphological and physiological traits in 4771 subjects of 5-90 years of age in Poland; 9 somatic and 17 motor traits in 127,489 children, 7-19 years old, in relation to economic and demographic conditions in 98 regions of Poland; and 27 somatic, physiological and psychomotor traits in children and their parents from the ages of 3-80 years, from 3995 families from Poland. The age particularly important to the study includes: foetal growth effects recorded as newborn status, child development from about half a year (since weaning) to about 3 years of age, development at the early period of puberty, the period at adolescence, age at the peak value (maximal size, best results) of the main morphological and functional traits (usually between the age of 12 and 30), and finally, the rate of involution of these main traits in older age. For the "minimum program" (for public health and environmental conservation services) among somatic traits, 3 were selected for a minimum program: stature, Kaup index, and cephalic index. Among physiological traits, 2 were selected: forced respiratory volume per second and hemoglobin concentration. Among motor traits, 3 were selected for the minimum program: distant movement accuracy, grip strength, and standing long jump.(ABSTRACT TRUNCATED AT 400 WORDS)
A case-control study of the efficacy of a non-randomized breast cancer screening program in Florence (Italy).
In a rural area near Florence a population-based screening program for breast cancer was started in 1970, offering a mammography test every 2.5 years to all women between 40 and 70 years of age. In order to evaluate the efficacy of this program a case-control study has been carried out comparing the screening history of all women who died from breast cancer in this area in the years 1977-1984, and who had been diagnosed after the start of the program, with that of a matched group of living controls. The case-control study showed that the overall O.R. of dying from breast cancer in the study period for "screened" versus "never-screened" women was 0.53 (95% C.I. = 0.29-0.95). After evaluation of other variables as potential confounders the adjusted O.R. estimates were respectively 0.57 (95% C.I. = 0.35-0.92) and 0.32 (95% C.I. = 0.20-0.52) for women screened only once or at least twice. No significant protective effect was shown for women below the age of 50 years.
[Smoking prevention intervention among secondary school students in the Spanish province of Malaga].
OBJECTIVE: To assess the prevalence of smoking among 13- to 18-year-old students, analyze smoking-related factors in this population, and design an intervention program to reduce smoking. POPULATION AND METHODS: A 6-month smoking prevention intervention was designed for students at a public secondary school in the Spanish province of Malaga. The objective of the intervention was to inform students of the gravity of smoking and its deleterious effects on health. The efficacy of the intervention was subsequently assessed. RESULTS: Of the 337 students who completed the questionnaire, 27% declared they were smokers. Smoking prevalence was significantly higher among girls (36.1%) than boys (18.1%) (P<.001) and progressively increased with age. Initiation occurred at 13 to 14 years of age. The most common reason for starting was to try something new (52.2% of students). The greatest risk factor in the family environment was having a smoking sibling. After the program, 78% of smokers admitted that the intervention had not affected their smoking but had made them more aware of its detrimental effects, and 66.8% planned to quit in the future. CONCLUSIONS: The study shows the high prevalence of smoking among adolescents, particularly among girls. It also shows that health education increases understanding of the problems related to smoking, causing changes of attitude with regard to whether they will smoke in the future.
Evaluation of an early discharge program for infants after childbirth in a military population.
The objective of this study was to evaluate the outcome of an early discharge program for infants with regard to length of stay, patient safety, maternal satisfaction, and hospital expense in a military population. The study consisted of a retrospective analysis of data from two 6-month periods--March to August 1994 (before early discharge) and March to August 1996 (after early discharge)--in a military, tertiary care, teaching hospital. The criteria for early discharge included healthy term singleton newborns delivered by uncomplicated vaginal delivery with maternal support systems, transportation, and phone access. The interventions included maternal education regarding maternal and infant care and telephone follow-up at 48 hours and 5 days after discharge. The main outcome measures included length of hospital stay, inpatient cost, infant health services utilization, and maternal satisfaction (measured by survey). During the 6-month study periods in 1994 and 1996, a total of 1,911 deliveries were examined. The mean number (+/- SD) of hospital days per infant was 2.54 +/- 0.83 in 1994 compared with 1.88 +/- 1.03 in 1996. There was not a statistically significant difference in the number of readmissions between 1994 (9 of 1042, 0.86%) and 1996 (12 of 869, 1.38%) (odds ratio = 1.61, 95% confidence interval = 0.67, 3.83). A review of the infant health services utilization revealed a statistically significant increase in the total number of clinic visits (scheduled and unscheduled) before the 2-week well-child visit for the 1996 group. However, that group did not experience a change in the number of emergency room visits. Seventy-five percent of mothers were satisfied with the program as assessed by questionnaire. In addition, the program was able to save 599 inpatient hospital days, for a total cost savings of $442,903.23 in 1996. This reduction in inpatient hospital days netted an average cost savings of $509.67 per infant. By following strict discharge criteria, increasing parent education before discharge, implementing a phone follow-up system, and ensuring easy access to care, an early discharge program in our military population was not associated with increased adverse newborn outcomes and reduced costs.
Population characteristics of feral cats admitted to seven trap-neuter-return programs in the United States.
Internationally, large populations of feral cats constitute an important and controversial issue due to their impact on cat overpopulation, animal welfare, public health, and the environment, and to disagreement about what are the best methods for their control. Trap-neuter-return (TNR) programs are an increasingly popular alternative to mass euthanasia. The objective of this study was to determine the population characteristics of feral cats admitted to large-scale TNR programs from geographically diverse locations in the United States. Data from 103,643 feral cats admitted to TNR programs from 1993 to 2004 were evaluated. All groups reported more intact females (53.4%) than intact males (44.3%); only 2.3% of the cats were found to be previously sterilized. Overall, 15.9% of female cats were pregnant at the time of surgery. Pregnancy was highly seasonal and peaked between March and April for all of the groups. The average prenatal litter size was 4.1+/-0.1 fetuses per litter. Cryptorchidism was observed in 1.3% of male cats admitted for sterilization. A total of 0.4% of cats was euthanased because of the presence of debilitating conditions, and 0.4% died during the TNR clinics. Remarkably similar populations of cats with comparable seasonal variability were seen at each program, despite their wide geographical distribution. These results suggest that it is feasible to safely sterilize large numbers of feral cats and that the experiences of existing programs are a consistent source of information upon which to model new TNR programs.
Predictions of carbamazepine concentrations using a Bayesian program (PKS System, Abbott): a retrospective evaluation in an outpatient population.
This work evaluates the performance of a Bayesian program (PKS System, Abbott) for predicting carbamazepine concentrations in an outpatient population. The retrospective study involved 20 epileptic patients (12 adults and 8 children) receiving carbamazepine monotherapy orally. The program was used to predict measured serum levels after feedback of 0, 1 or 2 steady-state concentrations. A significant negative prediction bias was observed when no feedback concentration was used for estimation. However, the prediction bias (mean prediction error; m.e.) decreased as soon as one feedback concentration was used for estimation. Precision (mean absolute prediction error; m.a.e.) was significantly improved with one feedback concentration and was even better with two concentrations. Likewise, r.m.s.e. (root mean squared error; composite of bias and precision) regularly decreased when the number of feedback concentrations used was increased. Eleven percent of the estimates were unacceptable clinically (prediction error > 2 mg L-1) when 1 feedback concentration was used; less than 3% were unacceptable when two concentrations were used. Thus the performance of the Bayesian dosing program is acceptable when two feedback concentrations are known, and seems able to help the clinician adjust carbamazepine dosage in an outpatient population.
Building population pharmacokinetic--pharmacodynamic models. I. Models for covariate effects.
One major task in clinical pharmacology is to determine the pharmacokinetic-pharmacodynamic (PK-PD) parameters of a drug in a patient population. NONMEM is a program commonly used to build population PK-PD models, that is, models that characterize the relationship between a patient's PK-PD parameters and other patient specific covariates such as the patient's (patho) physiological condition, concomitant drug therapy, etc. This paper extends a previously described approach to efficiently find the relationships between the PK-PD parameters and covariates. In a first step, individual estimates of the PK-PD parameters are obtained as empirical Bayes estimates, based on a prior NONMEN fit using no covariates. In a second step, the individual PK-PD parameter estimates are regressed on the covariates using a generalized additive model. In a third and final step, NONMEM is used to optimize and finalize the population model. Four real-data examples are used to demonstrate the effectiveness of the approach. The examples show that the generalized additive model for the individual parameter estimates is a good initial guess for the NONMEM population model. In all four examples, the approach successfully selects the most important covariates and their functional representation. The great advantage of this approach is speed. The time required to derive a population model is markedly reduced because the number of necessary NONMEM runs is reduced. Furthermore, the approach provides a nice graphical representation of the relationships between the PK-PD parameters and covariates.
Health promotion programs related to the Athens 2004 Olympic and Para Olympic games.
BACKGROUND: The Olympic Games constitute a first-class opportunity to promote athleticism and health messages. Little is known, however on the impact of Olympic Games on the development of health-promotion programs for the general population. Our objective was to identify and describe the population-based health-promotion programs implemented in relation to the Athens 2004 Olympic and Para Olympic Games. METHODS: A cross-sectional survey of all stakeholders of the Games, including the Athens 2004 Organizing Committee, all ministries of the Greek government, the National School of Public Health, all municipalities hosting Olympic events and all official private sponsors of the Games, was conducted after the conclusion of the Games. RESULTS: A total of 44 agencies were surveyed, 40 responded (91%), and ten (10) health-promotion programs were identified. Two programs were implemented by the Athens 2004 Organizing Committee, 2 from the Greek ministries, 2 from the National School of Public Health, 1 from municipalities, and 3 from official private sponsors of the Games. The total cost of the programs was estimated at 943,000 Euros; a relatively small fraction (0.08%) of the overall cost of the Games. CONCLUSION: Greece has made a small, however, significant step forward, on health promotion, in the context of the Olympic Games. The International Olympic Committee and the future hosting countries, including China, are encouraged to elaborate on this idea and offer the world a promising future for public health.
Consumer-directed home and community services programs in eight states: policy issues for older people and government.
This study assesses consumer-directed home and community services for older persons by examining public programs that serve this population in eight states. These programs give beneficiaries, rather than agencies, the power to hire, train, supervise, and fire workers. Most stakeholders interviewed, in addition to the quantitative research, indicate that many older beneficiaries want to and can manage their services, although significant issues arise for persons with cognitive impairments. Research results suggest better, or, at least, no worse, quality of life for beneficiaries when they direct their services, although quality of services remains a contentious issue. For workers, consumer-directed care has some disadvantages, including fewer fringe benefits. With exceptions, state agencies have not provided extensive consumer or worker support or aggressively regulated quality of care.
Canine genomics and genetics: running with the pack.
The domestication of the dog from its wolf ancestors is perhaps the most complex genetic experiment in history, and certainly the most extensive. Beginning with the wolf, man has created dog breeds that are hunters or herders, big or small, lean or squat, and independent or loyal. Most breeds were established in the 1800s by dog fanciers, using a small number of founders that featured traits of particular interest. Popular sire effects, population bottlenecks, and strict breeding programs designed to expand populations with desirable traits led to the development of what are now closed breeding populations, with limited phenotypic and genetic heterogeneity, but which are ideal for genetic dissection of complex traits. In this review, we first discuss the advances in mapping and sequencing that accelerated the field in recent years. We then highlight findings of interest related to disease gene mapping and population structure. Finally, we summarize novel results on the genetics of morphologic variation.