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PubMed1996

Cost-effectiveness of screening for asymptomatic carotid atherosclerotic disease.

BACKGROUND AND PURPOSE: The value of screening for asymptomatic carotid stenosis has become an important issue with the recently reported beneficial effect of endarterectomy. The purpose of this study is to evaluate the cost-effectiveness of using Doppler ultrasound as a screening tool to select subjects for arteriography and subsequent surgery. METHODS: A computer model was developed to simulate the cost-effectiveness of screening a cohort of 1000 men during a 20-year period. The primary outcome measure was incremental present-value dollar expenditures for screening and treatment per incremental present-value quality-adjusted life-year (QALY) saved. Estimates of disease prevalence and arteriographic and surgical complication rates were obtained from the literature. Probabilities of stroke and death with surgical and medical treatment were obtained from published clinical trials. Doppler ultrasound sensitivity and specificity were obtained through review of local experience. Estimates of costs were obtained from local Medicare reimbursement data. RESULTS: A one-time screening program of a population with a high prevalence (20%) of > or = 60% stenosis cost $35130 per incremental QALY gained. Decreased surgical benefit or increased annual discount rate was detrimental, resulting in lost QALYs. Annual screening cost $457773 per incremental QALY gained. In a low-prevalence (4%) population, one-time screening cost $52588 per QALY gained, while annual screening was detrimental. CONCLUSIONS: The cost-effectiveness of a one-time screening program for an asymptomatic population with a high prevalence of carotid stenosis may be cost-effective. Annual screening is detrimental. The most sensitive variables in this simulation model were long-term stroke risk reduction after surgery and annual discount rate for accumulated costs and QALYs.

Angiography↗
PubMed1995

A cognitive-behavioral program to improve geriatric rehabilitation outcome.

A program of cognitive-behavioral interventions was applied on a hospital geriatric rehabilitation unit. Unique features were the tailoring of the program to the population and each participant, and the immediate application of the program with distressed patients in a proactive manner designed to maximize rehabilitation outcome. The program was successful in that initially distressed participants achieved rehabilitation goals to the same extent as the nondistressed comparison group, and participant scores on measures of distress and coping, except for anxiety, matched those of comparison patients at discharge.

Aged↗
PubMed2004

The professional socialization of graduating students in generic and two-plus-two baccalaureate completion nursing programs.

This non-experimental, descriptive study explored the differences in professional socialization between graduating students of two-plus-two baccalaureate completion nursing programs and generic baccalaureate nursing (BSN) programs. The survey population was graduating students from NLN-accredited baccalaureate nursing programs in a 15-state region. Autonomy, noted as a mark of professionalism, was measured by the Nursing Activity Scale developed by Schutzenhofer. No significant difference was found between the level of professional socialization of graduating students of two-plus-two baccalaureate completion nursing programs and generic BSN programs. No significant difference was found in professional socialization between students from the two basic RN education programs prior to BSN completion. A positive, but not significant, correlation was found between professional socialization and years of employment as an RN. No significant relationship was found between professional role socialization and area of major nursing experience for the baccalaureate completion nursing students.

Adult↗
PubMedDate not supplied

A mentoring pyramid for African American nursing students.

The purpose of this investigation was to ascertain the African American nursing students' perception of a need for a mentoring program for this population. The percentage of ethnic minorities graduating from baccalaureate nursing programs has continued to decline since 1990 (National League of Nursing, 1995). The March 1996 National Sample Survey of Registered Nurses estimated there were 2,559,000 registered nurses in the United States. Only 107,500 of these nurses were African American. Data from the 1996 U.S. Census revealed African Americans to be the largest ethnic minority group in the country (14 percent). Based upon the number of racially and culturally diverse clients seeking healthcare, there is a gross underrepresentation of racially and culturally diverse nurses available to administer that care. The attrition rate for African American nursing students is high. Some of the reasons for this failure to retain and graduate African American students from schools of nursing are associated with the lack of mentoring relationships with persons whom students can relate to, feel comfortable with, learn from, and emulate. This study examined the perceptions of African American nursing students enrolled at a predominantly European-American public university in the Southeast United States. The students identified certain categories of needs they felt could be met in a mentoring relationship with a nurse educator.

Black or African American↗
PubMed2001

[The general practitioner and screening reproductive age women].

All women in age of procreation might benefit of well established screening tests. The latter being conduct to identify, in this apparently healthy population, diseased or carrier women of an affection. This screening program might be realised by a general practitioner and must be encouraged. Actually, in Belgium, there is no national screening program for this population. Recommendations might be proposed for all screening tests that can be realised in preconceptual period. These concern screening of diseases which affect all women like cervical cancer, which might influence the pregnancy or infant outcome, like an infection or an hereditary disease, or which could be adversely affected by the pregnancy, like diabetes.

Adult↗
PubMed2006

A randomized controlled trial of two treatment programs for homeless adults with latent tuberculosis infection.

SETTING: Few studies have examined strategies for optimizing adherence to latent tuberculosis infection (LTBI) treatment programs in homeless populations. OBJECTIVES: 1) To compare the effectiveness of an intervention program employing nurse case management and incentives (NCMI) vs. a control program with standard care and incentives on completion of LTBI treatment; and 2) to compare the impact of the two programs on tuberculosis (TB) knowledge among participants. DESIGN: A prospective, two-group site-randomized design conducted among 520 homeless adults residing in the Skid Row region of Los Angeles from 1998 to 2003, assessing completion rates of a 6-month isoniazid (INH) treatment program and change in TB knowledge. RESULTS: Using intent-to-treat analysis, 62% of participants in the intervention program, compared with 39% of controls, completed the full 6-month course of LTBI treatment with INH. Logistic regression modeling revealed that intervention participants had three times greater odds of completing INH treatment than controls. TB knowledge improved in both programs, but the increase was greater among the intervention participants (P < 0.001). CONCLUSIONS: Nurse case management combined with education, incentives, and tracking dramatically improves both adherence to LTBI treatment and TB knowledge in homeless persons compared to a standard approach of outreach and incentives.

Adult↗
PubMed2000

[Information program applied to the temporal study of pathological processes in animal populations].

WinEpi Tasas 2.0 is a new, globally accessible computer program, which has been developed as a research tool for the epidemiological study of the pathological processes which affect animal populations. This new version of the program, based on the experimental version, WinEpi Tasas 1.0, enables users to study the distribution and evolution of diseases in affected populations, over time. This information, combined with data on spatial distribution, is of fundamental importance for the establishment of appropriate control strategies and health policies. Such disease control measures are of particular significance in the current context of emerging and re-emerging diseases. The program can be run in either English or Spanish.

Animal Diseases↗
PubMed2000

The politics of population policy in the Islamic Republic of Iran.

The Islamic Republic of Iran arguably has one of the most successful family planning programs in the developing world. This success is all the more interesting for advocates of population programs because the political leaders of the Islamic regime were once strongly opposed to family planning. Indeed, after gaining power following the 1979 revolution, they were responsible for dismantling Iran's relatively new family planning program and introducing pronatalist policies. This article provides an account of the different phases of the population policy in Iran and examines the diverse elements that led politico-religious leaders to revise their views about fertility control and to participate in creating a workable family planning program. The complex formal and informal strategies that the political experts, the media, the religious authorities, and the government of the Islamic Republic adopted in order to achieve this about-face are described. The analysis is based on data collected by the first author during anthropological field research in 1993-96, by means of informal interviews with officials, with medical personnel, with family planning clients, and with religious leaders.

Family Planning Policy↗
PubMed1998

Active detection of chronic obstructive pulmonary disease and asthma in the general population. Results and economic consequences of the DIMCA program.

The aim of this prospective study was to detect subjects in the general population with objective signs of chronic obstructive pulmonary disease (COPD) or asthma at an early stage. This was done by means of a two-stage protocol involving screening and a subsequent 2-yr monitoring of all subjects with positive results of screening. The study was done in 10 general practices located in the eastern part of the Netherlands. A random sample was taken from the general population aged 25 to 70 yr. All known COPD and asthma patients were excluded. A total of 1,749 subjects met the inclusion criteria: 1,155 subjects (66%) agreed to participate in the screening stage of the study. A total of 604 subjects (52.3%) showed symptoms or objective signs of COPD or asthma during the screening and were considered "positive." Of those with positive screening results, 384 subjects (64%) agreed to participate in the second, 2-yr monitoring stage of the study. The costs involved in detection were calculated for three different scenarios, as follows: (1) The detection of subjects with persistently decreased lung function or an increased level of bronchial hyperresponsiveness (BHR) during 6 mo of monitoring; (2) Scenario 1 plus the detection of subjects with a rapid decline in lung function with signs of BHR during 12 mo of monitoring; (3) Scenario 2 plus the detection of subjects with a moderate increase in the decline in lung function or signs of BHR during 24 mo of monitoring. The costs of lung function assessments, organization, transportation, and patient time were included. The costs were converted to United States dollars on the basis of purchasing power (1 United States dollar = 2.08 Netherlands guilders). During the second stage, 252 subjects were detected with objective signs of COPD or asthma at an early stage. Smoking status as a screening criterion was neither sensitive nor specific. Because there was no evidence of biased recruitment or selection during the program, the proportions of subjects found to have objective signs of COPD or asthma at an early stage could be extrapolated to the general population. Of the general population, 7.7% showed persistently reduced lung function or increased BHR. Another 12.5 % of the general population showed a rapid decline in lung function (> 80 ml/yr) in combination with signs of BHR, and a further 19.4% of the general population showed mild objective signs of COPD or asthma. The average costs per detected case varied from US$953 (Scenario 1) to US$469 (Scenario 3). In conclusion, detection of COPD or asthma at an early stage by means of a two-stage protocol was feasible at relatively little expense in comparison with other mass screening programs. Persistently decreased lung function or a rapid decline in lung function (Scenario 2) was observed in approximately 20% of the general adult population.

Adult↗
PubMed2000

Mortality among women with ductal carcinoma in situ of the breast in the population-based surveillance, epidemiology and end results program.

BACKGROUND: Over 14% of breast cancers diagnosed in the United States annually are ductal carcinomas in situ (DCIS). There are no published population-based reports of the likelihood of breast cancer death among US women with DCIS. METHODS: We used data from the Surveillance, Epidemiology and End Results program to determine the likelihood of breast cancer death at 5 and 10 years among US women aged 40 and older diagnosed with DCIS from 1978 to 1983 (before screening mammography was common; n = 1525) and from 1984 to 1989 (when screening mammography became common; n = 5547). We also calculated standardized mortality ratios (SMRs) to compare observed deaths from breast cancer, cardiovascular disease, and all causes combined among women with DCIS with deaths expected based on general population mortality rates. RESULTS: Among women diagnosed with DCIS from 1978 to 1983, 1.5% died of breast cancer within 5 years and 3.4% within 10 years. Among women diagnosed from 1984 to 1989, 0.7% died of breast cancer within 5 years and 1.9% within 10 years. Relative to the general population, risk of breast cancer death was greater for women diagnosed from 1978 to 1983 (SMR, 3.4; 95% confidence interval [CI], 2.5-4.5) than for women diagnosed from 1984 to 1989 (10-year SMR, 1.9; 95% CI, 1.5-2.3). Women diagnosed from 1984 to 1989 were significantly less likely than women in the general population to have died of cardiovascular diseases (10-year SMR, 0.6; 95% CI, 0.5-0.7) or of all causes combined (SMR, 0.8; 95% CI, 0.7-0.8). CONCLUSIONS: Among women diagnosed with DCIS, risk of death from breast cancer was low, at least within the 10 years following diagnosis. This may reflect the effectiveness of treatment for DCIS, the "benign" nature of DCIS, or both. At 10 years, women diagnosed from 1984 to 1989 were less likely than women diagnosed from 1978 to 1983 to have died of breast cancer, and their risk of dying of all causes combined was lower than that in the general population.

Adult↗
PubMed1999

Efficiency of fluoride programs in the light of reduced caries levels in young populations.

Since the late 1930s, when the efficacy of fluoride in caries prevention was first detected, various efficient methods for fluoride delivery have been developed. Nowadays, fluoride is used for caries prevention on a global scale, the most widely used methods being fluoridated toothpaste and water fluoridation. The latter is a typical community-based prevention method, whereas the former method relies on individual motivation. The goal of an efficient community-based fluoride program is to maintain a constant low level of fluoride in as many mouths as possible at as low a cost as possible. Initially, water fluoridation and other community-based programs were highly efficient, but nowadays in societies in which the major part of the population is using fluoride toothpaste and caries levels are low, population-based programs show a low efficiency. As an example, even though water fluoridation was withdrawn in Kuopio, there have been no dramatic effects on the dental health of children and youths. In societies with well-attended, community-based, free dental health care for children and youths, the dental motivation of individuals is, in general, very high and the use of fluoride for caries prevention may be taken care of at the individual level.

Cariostatic Agents↗
PubMed1998

Modeling measles, mumps, and rubella: implications for the design of vaccination programs.

Mathematical models of disease transmission are being used increasingly in the design of population-based vaccination programs. Their use is illustrated in a review of some modeling studies that have implications for the use of measles, mumps, and rubella vaccine. Investigations of vaccination strategy options yield predictions for effectiveness and cost-effectiveness analyses. A quantitative understanding of the factors affecting disease transmission enables the setting of targets for vaccination programs and underpins disease elimination initiatives.

Carrier State↗
PubMed1989

The family center--a new form of organization for rural family planning.

The history and functions of rural family planning centers in China are reviewed, with a focus on a center in Liaoning Province. "To date, more than 8,500 such centers have been established in 92.2 percent of the rural resident's groups. What the centers do is to give rural residents education and services in family planning, and help them educate themselves.... According to statistics, 99.3 per cent of the babies born in Liaoning Province in 1986 were planned. More than half of the counties and districts and over 90 per cent of the villages reported no unplanned births. The Province now leads the nation in fulfillment of family-planning goals."

Asia↗