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School and family planning nurses are well placed to promote high quality sex education to children and young people. Parents and teachers are often seen as authority figures whereas the nurse is an independent health professional. Government guidelines encourage liaison with teachers and this article--the second in a series on sexual health--gives examples of such a collaboration, as well as interviews with nurses who use innovative methods to put their message across.
An evaluation was made of the effectiveness of an urban community health volunteer programme in Pokhara, Nepal, in sensitizing and motivating people for the improvement of health knowledge and skills and the use of services. Despite weaknesses and inadequate management support, there has been a sharp increase in coverage by the health services. If management support were properly developed the programme could undoubtedly play a vital role in raising health standards. It was clearly demonstrated that the utilization of services can be increased if access to them is improved.
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One of the goals of Sierra Leone's primary care programme, established in the 1980s, was to reduce maternal mortality by 30% by the end of the twentieth century, but no significant progress has been made in this direction. The reasons are examined below in the light of a study conducted in one of the country's Chiefdoms.
Mutations in 4 genes associated with DNA repair have been shown to be associated with hereditary non-polyposis colon cancer (HNPCC) in families which display unusually high risk for colorectal cancer. Laboratory tests for mutations in these genes will soon be commercially available, raising the possibility that population-wide gene testing to identify individuals with an inherited susceptibility to colorectal cancer could be conducted. The purpose of our report is to explore the economic implications of conducting a program of population-wide screening for HNPCC compared with alternative programs which would be restricted to families already known to be at high risk for HNPCC. Rather than provide a definitive answer to these questions, our purpose is to indicate priority areas of research which need to be conducted before such a definitive analysis can be done. An exploratory analysis has been conducted to determine which factors are most important in determining the cost-effectiveness of a genetic testing program for HNPCC. The base case analysis focuses on current uncertainty about the population prevalence of the HNPCC genotype and phenotype, factors which are central to the cost-effectiveness of population-wide screening. Uncertainty in parameters related to the cost and effectiveness of screening and preventive interventions for HNPCC were explored using additional sensitivity analyses. Favorable levels of cost-effectiveness for population-wide screening are achieved only when the most favorable assumptions about HNPCC prevalence and the cost and effectiveness of screening and preventive interventions are made.
PURPOSE: The increasing premature mortality due to cancer has made population based screening programs for cervical,breast and colorectal cancers inevitable in Hungary. However, when confronted with limited resources, the aim is that, within the budget constrain, the greatest possible health gain should be "produced". METHODS: The authors made a systematic review of the international literature concerning the cost-effectiveness of screening programs for the above tumours. RESULTS: In case of cervical cancer the Papanicolaou test, in case of breast cancer the mammography meet the WHO criteria for population-based mass screening. The well-designed organised screening programs are more cost-effective than the opportunistic screening. Among sexually active women, according to structure the mobile screening buses, according to age group screening of the 30-39 years old women seems the most favourable. For breast cancer, screening the 60-70 years old population every second year is the reference strategy from a health economic perspective. The cost-effectiveness results of either increasing the frequency of screening, extending the program for other age groups, or selecting a high-risk population are contradictory. In case of colorectal cancer there is no screening method, which would meet the WHO criteria. The two-day FOBT seems the most favourable, followed by colonoscopy for positive results, in the 55-74 years old population every second year. CONCLUSION: In addition to fulfilling requirements for a population-based screening method, the cost-effectiveness perspective should be taken into account.
Cancer screening may be offered to a population opportunistically, as part of an organized program, or as some combination of the preceding two options. Organized screening is distinguished from opportunistic screening primarily on the basis of how invitations to screening are extended. In organized screening, invitations are issued from centralized population registers. In opportunistic screening, however, due to the lack of central registers, invitations to screening depend on the individual's decision or on encounters with health care providers. The current article outlines key differences between organized and opportunistic screening. In the current study, literature searches were performed using PubMed and MEDLINE. Additional data were assembled from interviews with health officials in the five countries investigated and from the authors' personal files. Opportunistic screening was found to be distinguishable from organized screening on the basis of whether screening invitations were issued from centralized population registers. Organized screening programs also assumed centralized responsibility for other key elements of screening, such as eligibility requirements, quality assurance, follow-up, and evaluation. Organized programs focused on reducing mortality and morbidity at the level of the population rather than at the level of the individual. Thus, programs did not necessarily offer the most sensitive screening test for a particular cancer, and tests sometimes were offered at suboptimal intervals with respect to individual-level protection. Nonetheless, organized systems paid greater attention to the quality of screening, as measured by factors such as cancer detection rates, tumor characteristics, and false-positive biopsy rates. As a result, participants in organized screening programs received greater protection from the harmful effects associated with screening. In addition, organized programs worked more systematically toward providing value for money in an inevitably resource-limited environment. Although organized and opportunistic models of screening can yield similar uptake rates, organized programs exhibited greater potential ability to reduce cancer incidence and mortality, because of the higher levels of population coverage and centralized commitment to quality and monitoring; were more likely to be cost-effective; and offered greater protection against the harmful effects associated with poor quality or overly frequent screening.
The relationship to treatment outcome, as measured by reduction in drug use, of specific characteristics and elements of 30 drug-free outpatient programs for adolescents is reported. Admission and discharge data were obtained from National Institute on Drug Abuse-Client Oriented Data Acquisition Process on 5789 adolescents in the 30 programs. A partial cross-validation study was conducted by analyzing separately for two annual client subsamples. The program, not the individual clients, was the unit of analysis. While controlling for differences between programs on their client populations, multiple regression analysis indicated that the following characteristics of programs were found to predict the outcome criterion variable, to a statistically significant degree: treat a large number of adolescent clients; have a special school for school dropouts; have a relatively large budget; employ counselors or therapists who have at least 2 years' experience in working with adolescent drug abusers; provide special services such as vocational counseling, recreational services, and birth control services; use such therapy methods as crisis intervention, gestalt therapy, music/art therapy, and group confrontation; and be perceived by the clients as allowing and encouraging free expression and spontaneous action by clients. There was a high degree of replication of these findings across the two annual subsamples of clients; and the amount of variance in the treatment outcome criterion variable accounted for by the above-listed program characteristics was quite impressive.
The predictive performance of Bayesian estimates incorporating pharmacokinetic values for hematology-oncology patients was compared with that of Bayesian estimates incorporating general population values. In study phase 1, medical records were reviewed for 50 adult patients with a hematologic or oncologic diagnosis who had received i.v. gentamicin or tobramycin. Aminoglycoside pharmacokinetic values were calculated for the patients by using a modified two-point Sawchuk-Zaske method, and the subpopulation mean for each variable was determined. In phase 2, data for 10 other hematology-oncology patients receiving aminoglycosides were entered into the Abbottbase Bayesian pharmacokinetics program. Aminoglycoside pharmacokinetic values and serum concentrations for each of these 10 patients were estimated, first using the program's general population values and then repeating the analysis using the subpopulation means for volume of distribution and renal clearance slope obtained in phase 1. The serum aminoglycoside concentrations predicted by each Bayesian method were compared with the actual peaks and troughs. Both the peak and trough predictions of the Abbottbase program using the subpopulation values for volume of distribution and renal clearance slope were significantly less biased than those predicted by the Abbottbase program incorporating the general population values. The methods did not differ significantly in precision. Use of subpopulation pharmacokinetic values in Bayesian predictions of serum aminoglycoside concentrations in hematology-oncology patients reduced bias significantly but had no significant effect on precision.
Thank you Mr. Chairman, for the opportunity to speak out not only as a Japanese parliamentarian, but also as a member of GLOBE International, Global Legislators Organization for a Balanced Environment, consisting of legislators from the US Congress, EC Parliament, USSR Assembly and Japanese Diet who have joined together to compare, improve and coordinate our respective legislative activities in an effort to effectively address the complex issues surrounding environment and development. Mr. Chairman, world population--which reached 5.4 billion in mid-1991--is growing exponentially. According to 1 UNFPA report 3 people are born every second, a total of 250,000 people every day or 95-100 million people every year. At this rate, world population will reach 6.4 billion by year 2001, and if this rate continues to go unchecked, world population will reach 14-15 billion by the end of the 21st century. GLOBE is highly aware of the relationship between rapidly growing human populations, environmental degradation and sustainable development. We urge UNCED negotiators to address population growth rates and the integrally linked concerns of resource consumption levels, particularly in the industrialized world, in their search for solutions to the conflict between environment and development. Negotiators should also seriously consider ways in which to broaden educational and economic opportunities for women to ease population growth rates, and to alleviate poverty and stresses on the environment that result from population pressures. Social and economic factors must be integrated into population planning. It is saddening to note that almost 40,000 children die every day due to malnutrition, lack of fresh water and access to resources. Over 100 million children do not receive a primary education. Mr. Chairman, worldwide demand for a range of family planning services is increasing faster than supply. Recent studies indicate that if quality family planning information, training and services were made readily available by government and other groups, population rates would drop to manageable levels. Widespread access to family planning services is essential to population stabilization. The health of mothers, children and general quality of life is also improved through the implementation of family planning programs. At the present time many women cannot make use of the limited available services because of cultural constraints, lack of status and self-confidence. Unless complementary efforts are made to expand economic and educational opportunities for women, family planning and other reproductive health services will not reach their full potential for stabilizing population. Although family planning is an individual decision, and implementation of population programs is a sovereign matter in each country, I would urge developed countries to help their neighbors in developing countries who are in need of support for family planning and health services. Investment in family planning programs is 1 of the best ways to contribute to environmental protection and improvement. A greater portion of our foreign aid monies should be allocated for direct population assistance programs that will reach people at the grassroots level. To achieve this, a cooperative working relationship with local nongovernmental organization (NGOs) is essential. The members of GLOBE hope to facilitate cooperation between NGOs and governments so that we might stabilize human population.
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Incidence rates and standardized incidence ratios (SIRs) for invasive and in situ cervical cancers diagnosed in 1982-87 were analyzed according to total population size of 148 towns, using data from the population-based Connecticut Tumor Registry. Previous studies have not considered socioeconomic or sociodemographic variables in analyzing cervical cancer rates in urban-rural or population density groups. In multiple regression analyses, increases in SIRs for invasive and in situ cancer from medium-sized to large towns were explained by differences in poverty prevalence or other socio-demographic variables. Nevertheless, cancer screening programs (aimed at preventing invasive cancer through early detection) could be targeted to some extent on the basis of town size category, because larger towns include large numbers of poorer and minority women with higher rates of invasive cervical cancer. SIRs for in situ cancer were significantly elevated in the largest towns (100,000 + total population), and primary prevention programs could target these larger towns with a higher prevalence of poverty.