Community-based distribution: the distributive potential and economics of a social marketing approach to family planning.
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Contraceptive Agents↗
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Community-based distribution of oral contraceptives in Rio Grande do Norte, northeastern Brazil.
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Brazil↗
Experimentation in family planning delivery systems: an overview.
Experiments in the delivery of family planning services are an important means of testing new approaches on a relatively small scale. Over the past 20 years, extensive experimental efforts have explored such key aspects of service delivery as personnel, the use of mass media, integration of family planning with other services, intensive efforts and camps, incentive payments to acceptors, and inudation or community-based distribution. Approaches that proved successful have often been incorporated into regular programs. An examination of the methodology and findings of family planning experiments, based on a survey of 96 projects testing various approaches, highlights successes, failures, and continuing problems. The discussion of past experience halps point to criteria that might be followed in formulating future experimental projects.
Allied Health Personnel↗
East Asia review, 1976-7: Thailand.
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Contraception↗
Comparison of quality of life in children with posterior urethral valves, isolated hydronephrosis and minor urologic conditions.
OBJECTIVE: To compare the quality of life (QoL) and family impact scores of children with posterior urethral valves (PUV), isolated hydronephrosis (HN), and those with minor urologic conditions, referred to here as minor urologic controls (MUC). METHODS: From December 2022 to April 2025, the PedsQL Inventory and Family Impact Module (FIM) questionnaires were distributed to patients in dedicated PUV, HN, and community-based urology clinics. Higher scores indicate better QoL. Children ≥8 years self-completed the questionnaires, while parents served as proxies for younger children. PUV patients were compared to HN patients and MUC. RESULTS: A total of 331 patients were included (124 PUV, 101 HN, and 106 MUC). The median age differed across groups, with HN patients being the youngest (median: 7 months), followed by MUC patients (median: 36 months) and PUV patients (median: 79.5 months). Overall, PUV patients scored similarly to HN patients and MUC in QoL and FIM scores. When stratified by age, however, PUV patients <2 years old had lower median scores in total QoL, psychosocial, and family functioning domains compared to other groups. CONCLUSION: Overall, PUV was not associated with lower QoL or family impact scores compared to comparator groups in this tertiary-care cohort; however, lower scores were observed among younger children with PUV, likely reflecting parent-perceived burden early in the disease course. This highlights the importance of age-tailored support and close monitoring, particularly for younger children and families navigating early post-diagnosis care.
Humans↗
Diarrhoeal mortality in two Bangladeshi villages with and without community-based oral rehydration therapy.
To combat dehydration from diarrhoea in Shamlapur, a village of 7021 people, multiple community-based points were set up by trained volunteers for the distribution of glucose-electrolyte oral rehydration salt (ORS) packets. The comparable adjoining village, Bordil, with a population of 3888, obtained its supply of ORS from Shamlapur. Surveilance for 2 years showed that although diarrhoeal attack-rates were equal, consumption of ORS after diarrhoea was 80% in Shamlapur and 38% in Bordil. There were 8 deaths in Shamlapur caused by diarrhoea and 23 in Bordil, showing an overall case fatality-rate of 0.5% and 2.4%, respectively, and a diarrhoeal mortality-rate per 1000 population of 0.6 and 2.9, respectively. The observation indicated that although it may not be possible to reduce diarrhoeal attack-rates, easy availability of rehydration solution and its early use after village-based training may save many lives, particularly those of children.
Administration, Oral↗
Frequent amyloid deposition without significant cognitive impairment among the elderly.
OBJECTIVE: To characterize the prevalence of amyloid deposition in a clinically unimpaired elderly population, as assessed by Pittsburgh Compound B (PiB) positron emission tomography (PET) imaging, and its relationship to cognitive function, measured with a battery of neuropsychological tests. DESIGN: Subjects underwent cognitive testing and PiB PET imaging (15 mCi for 90 minutes with an ECAT HR+ scanner). Logan graphical analysis was applied to estimate regional PiB retention distribution volume, normalized to a cerebellar reference region volume, to yield distribution volume ratios (DVRs). SETTING: University medical center. PARTICIPANTS: From a community-based sample of volunteers, 43 participants aged 65 to 88 years who did not meet diagnostic criteria for Alzheimer disease or mild cognitive impairment were included. MAIN OUTCOME MEASURES: Regional PiB retention and cognitive test performance. RESULTS: Of 43 clinically unimpaired elderly persons imaged, 9 (21%) showed evidence of early amyloid deposition in at least 1 brain area using an objectively determined DVR cutoff. Demographic characteristics did not differ significantly between amyloid-positive and amyloid-negative participants, and neurocognitive performance was not significantly worse among amyloid-positive compared with amyloid-negative participants. CONCLUSIONS: Amyloid deposition can be identified among cognitively normal elderly persons during life, and the prevalence of asymptomatic amyloid deposition may be similar to that of symptomatic amyloid deposition. In this group of participants without clinically significant impairment, amyloid deposition was not associated with worse cognitive function, suggesting that an elderly person with a significant amyloid burden can remain cognitively normal. However, this finding is based on relatively small numbers and needs to be replicated in larger cohorts. Longitudinal follow-up of these subjects will be required to support the potential of PiB imaging to identify preclinical Alzheimer disease, or, alternatively, to show that amyloid deposition is not sufficient to cause Alzheimer disease within some specified period.
Aged↗
Evaluating the petrol-sniffing prevention programs of the Healthy Aboriginal Life Team (HALT)
The evaluation of the Healthy Aboriginal Life Team's (HALT) petrol-sniffing prevention programs at Yuendumu, Kintore and the Pitjantjatjara Lands first required a specification of program outcome--which was not changed in the enumerated prevalence of petrol sniffing, but alteration in parental perceptions of the relevance and effectiveness of families' nurturant authority over recalcitrant youngsters. The evaluation then proceeded by a series of interviews with resident or ex-resident adults (Aboriginal and non-Aboriginal) of Yuendumu, Kintore, Kiwirrkurra, Ernabella, Indulkana and Fregon. Adults articulated their efficacy in different ways in each place. Some favoured the conclusion that HALT had helped them, others clearly identified HALT as an obstacle to or a distraction from the implementation of other preventive and curative community-based action. We discerned a ferment of cultural adjustment in the distribution of authority over children among parents and welfare agencies. We caution against finding in HALT's successes a model procedure for benign interventions into such cultural adjustment.
Adolescent↗
A social-psychological perspective on successful community control of high blood pressure: a review.
This review brings together studies dealing with factors that affect participation in screening, referral, and treatment for high blood pressure (HBP). Community-based screening programs are examined first, in order to describe the changing and the current distribution of hypertensives as "unaware," untreated, treated but uncontrolled, and controlled by treatment. Factors influencing this distribution are examined. Next, data on referral, acceptance of treatment, and staying in treatment are discussed, with a special reference to intervention studies. The review then brings in the broader social science literature on the psychosocial dynamics of health-maintaining and risk-reducing behaviors. The article concludes with an interpretive summary and some suggestions for further action.
Attitude to Health↗
Orthopedic problems in family practice: incidence, distribution, and curricular implications.
The spectrum of orthopedic problems encountered by family physicians in everyday practice has received little study in the past. This paper presents and analyzes the incidence and distribution of orthopedic problems in general/family practice based on four sources of secondary data. These sources include the National Ambulatory Medical Care Survey, a Family Practice Service in a large military teaching hospital, a state wide study in Virginia, and two community-based family practice settings in Washington State. Orthopedic problems constitute about ten percent of all office visits in family practice. Over one half of these involve chronic, nontraumatic musculoskeletal problems. Major differences are noted in the distribution of sprains, strains, and fractures in adults and children. Fractures of the hand, foot, forearm, lower leg, and clavicle comprise between 50 and 80 percent of fractures seen in the settings under study. This kind of information should be helpful in better defining goals and methods for graduate training of family practice residents in orthopedics.
Family Practice↗
Correlates of human immunodeficiency virus infection in intravenous drug users: are treatment-program samples misleading?
Using a community-based sample of 1632 intravenous drug users in Baltimore, Maryland, USA, this study evaluated a possible selection bias faced when studying risk factors for human immunodeficiency virus, type 1 (HIV-1) in intravenous drug users drawn solely from treatment programs. Consenting subjects, recruited by extensive distribution of brochures and word-of-mouth, underwent confidential interviews about drug use behaviors in a setting that was independent of community service agencies. Of 1632 subjects, 275 (17%) were currently enrolled in treatment programs. These subjects were similar in many respects to those not currently in treatment, including HIV-1 seroprevalence; however, they differed in that those not in treatment were more likely to be male, younger and black than those currently in treatment, and to have started injecting drugs more recently. However, associations between HIV-1 seropositivity and a series of demographic and drug-using characteristics were mostly similar in direction and magnitude among subjects currently in treatment and those not in treatment. These results suggest that one-time samples of drug users enrolled in treatment programs do not necessarily present a misleading picture of correlates of HIV-1 seropositivity.
Adult↗
Alzheimer's disease in Nigeria.
The age-related dementias of the elderly (those aged 65 years or more) are of major public health importance in developed countries. Developing countries, most of which are undergoing epidemiological transition and greying of population, currently contain more than half of the world's population of elderly, a proportion that would reach 75% by 2020. Apart from reports from China, there is little or no information on the dementias of the elderly in developing countries. Alzheimer's disease, which accounts for two-thirds of dementia of the elderly in Caucasian population, is under-documented and believed to be rare in black Africans. But black Americans who are of black African lineage commonly suffer from Alzheimer's disease. A recent autopsy survey of the brains of elderly Nigerians showed absence of senile plaques and neurofibrillary tangles, the pathognomonic histologic lesions of Alzheimer's disease and ageing found in 25% to 80% of normal undemented elderly Caucasians and Japanese. In a community-based door-to-door survey of a population of 9000, including 932 elderly Nigerians, no subject with dementia as defined by DSM-IIIR was found, although there was significant decline of cognition with age, female sex and less than 6 years of formal education. The distribution of cognitive scores is a highly skewed unimodal curve. We emphasize the potential value of cross-cultural epidemiological studies of ethnic groups in different environments and with different prevalence ratios of Alzheimer's disease, in identifying putative environmental factors for this disease.
Adult↗
Prenatal diagnosis and control strategies for beta-thalassaemia on the Indian subcontinent.
BACKGROUND: The control of beta-thalassaemia by prenatal diagnosis is an important option in India. The disease is common and resources are scarce for the treatment of affected children. Presently the most suitable approach for prenatal diagnosis is DNA analysis of a chorion villus sample by direct mutation detection. For the implementation of such a prenatal diagnosis programme it is essential to know the spectrum of beta-thalassaemia mutations in the population. METHOD: The beta-thalassaemia mutations of 708 unrelated carriers from seven different regions of the Indian subcontinent were characterized by the allele-specific polymerase chain reaction and DNA sequencing. RESULTS: Sixteen different beta-thalassaemia mutations were identified which could be divided into three groups according to their frequencies. Five common mutations accounted for 93% of alleles. Significant regional differences in the frequency and distribution of mutations were observed. CONCLUSIONS: The spectrum of mutations defined forms the basis for a beta-thalassaemia prenatal diagnosis programme in India. A strategy has been outlined for mutation detection which could be successfully applied. Since prenatal diagnosis has become comparatively simple, recommendations are made for a community-based thalassaemia control programme.
Base Sequence↗
Blood pressure studies in 14 communities. A two-stage screen for hypertension.
the Hypertension Detection and Follow-up Program (HDFP) is a community-based national trial to determine whether special programs can improve the treatment for persons with uncontrolled hypertension and reduce morbidity and mortality in wide strata of these patients. A total of 158,906 persons, aged 30 to 69 years, were screened to identify those with a diastolic blood pressure (DBP) of 95 mm Hg or higher. Age-sex-race means and distributions of DBP at a first and a second screen and prevalence rates or actual hypertension by sex, race, and level of control suggest a recently increased awareness of hypertension with more widespread and effective treatment, especially among women, although blacks under treatment had their DBP controlled less frequently. The response to this program of screening and initial follow-up offers encouragement for improved community control of high blood pressure.
Adult↗
Community-based survey on blood pressure, blood biochemistry and dietary habits in Pu-Li, Taiwan.
The target population of this study were all residents over the age of 30 in Pu-Li. Stratified cluster sampling was employed. Household visits were carried out in 1987 by the Yang-Ming Crusade, organized by well-trained medical students of the National Yang-Ming Medical College. A total of 1,738 persons out of a potential 2,573 eligible subjects were contacted by at least one of the two interviews or a blood draw. The crude and adjusted (for vacant households) rates were 68% and 84% respectively. Age, sex, and education were evenly distributed. The distribution of physiological variables and blood biochemistry were as follows: 23.0 +/- 3.2 for body mass index (BMI = kg/m2; men 22.8 +/- 3.0, women 23.2 +/- 3.3), 129.7 +/- 20.7 mmHg for systolic blood pressure (men 130.4 +/- 19.6 mmHg, women 128.9 +/- 21.8 mmHg), 81.9 +/- 12.9 mmHg for diastolic blood pressure (men 82.9 +/- 12.8 mmHg, women 80.9 +/- 12.9 mmHg), 103.6 +/- 29.6 mg/dl for fasting plasma glucose (men 101.8 +/- 21.9 mg/dl, women 105.2 +/- 35.2 mg/dl), 222.1 +/- 57.2 mg/dl for cholesterol (men 221.9 +/- 56.5 mg/dl, women 222.3 +/- 57.9 mg/dl), 162.7 +/- 115.5 mg/dl for triglyceride (men 170.3 +/- 117.1 mg/dl, women 155.7 +/- 113.6 mg/dl), 5.8 +/- 3.0 mg/dl for uric acid (men 6.5 +/- 4.8 mg/dl, women 5.2 +/- 1.5 mg/dl). Blood pressure and blood biochemistry variables were positively associated with age. Comparatively, men had much more unhealthy life styles than women; due to prevalences for cigarette smoking (56.0% vs. 3.0%), alcohol intake (43.8% vs. 6.6%) and betel-nut chewing (18.2% vs. 0.8%).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Sex, cardiac hypertrophy and diurnal blood pressure variations in essential hypertension.
OBJECTIVE: To test the hypothesis of a difference between men and women in the left ventricular hypertrophic response to diurnal variations of ambulatory blood pressure in essential hypertension. DESIGN: Non-invasive ambulatory blood pressure monitoring and echocardiography in untreated hypertensive patients and healthy normotensive subjects. SETTING: Community-based ambulatory population in tertiary care centers. PATIENTS: Two hundred and sixty hypertensive patients and sixty-three healthy normotensive subjects. MAIN OUTCOME MEASURE: Patients with average daytime systolic blood pressure (SBP) and diastolic blood pressure (DBP) falling by less than 10% during the night were defined as non-dippers, the others as dippers. RESULTS: In the hypertensive group, dippers and non-dippers did not differ, in either gender, in several covariates possibly affecting left ventricular structure, including daytime ambulatory blood pressure, prevalence of white coat hypertension, age, body mass index, family history and known duration of hypertension, funduscopic changes, diabetes, alcohol consumption and renal function. Left ventricular mass (LVM) did not differ between dippers and non-dippers in hypertensive men whilst in hypertensive women it was significantly lower in dippers than in non-dippers. This sex difference held for all quartiles of the distribution of mean daytime blood pressure. In hypertensive women there was an inverse correlation between LVM and the per cent reduction of SBP and DBP from day to night, but this relationship was absent in hypertensive men. Other indices of left ventricular structure differed between dippers and non-dippers in both genders, as did LVM. CONCLUSIONS: For any level of daytime ambulatory blood pressure, a reduction of SBP and DBP by less than 10% from day to night identifies a subset of hypertensive patients at increased risk of left ventricular hypertrophy only in the female gender. These data suggest that, compared with men, hypertensive women require a longer duration of exposure to high blood pressure levels during the 24 h to develop left ventricular hypertrophy.
Blood Pressure↗
Indigenous body image amid rapid social and economic change: A reflexive thematic analysis of Wayuu narratives.
The Wayuu, Colombia's largest Indigenous group, are experiencing rapid social, economic, and technological change, including expanding internet access, educational opportunities, and increasing exposure to globalised media. Though the harmful effects of appearance-idealised media imagery on body image are well documented, indigenous body image research remains unevenly distributed across global contexts, with Latin American Indigenous communities particularly underrepresented. This study explored how Wayuu people understand and experience appearance ideals and body image in the context of expanding digital media exposure and rapid sociocultural and economic change. Five focus groups of up to 9 participants were conducted with 29 Wayuu participants (18-68 years; 23 women, 6 men). Using reflexive thematic analysis, three overarching themes were identified: (1) Intersecting sources of appearance pressure: encompassing influences from social media, Wayuu family expectations, and discrimination from non-Indigenous peers; (2) Negotiating and resisting appearance ideals: from body dissatisfaction and restrictive eating to affirmation of cultural identity as protection; and (3) The changing role of appearance in today's Wayuu culture: participants linked globalised appearance ideals to expanding educational opportunities, migration, digital connectivity, and broader socioeconomic transformations occurring within Wayuu territories. While exposure to global ideals fostered comparison and dissatisfaction, cultural pride and collective belonging appeared to buffer against internalised colonial values. Culturally grounded media literacy and education initiatives co-developed with Wayuu communities could foster critical reflection while strengthening heritage. These results highlight the need for decolonial, community-based approaches to body image research and intervention in Indigenous contexts.
Adolescent↗
Patient outcomes in alternative long-term care settings.
The purpose of this study was to compare health status outcomes in three alternative long-term care settings in the Veterans Administration : 1) home care; 2) community-based nursing home care; and 3) hospital-based nursing home care. Patients were measured on a behavioral index of health status, at two points in time: when transferred from the acute care hospital to one of the three treatment programs (pretest and three months later (posttest). Since patients could not be randomly distributed to programs, two methods were employed to control for potential sample selection bias: the choice of a nonequivalent control group design, and multivariate analytic techniques. First, within each program type, patients were randomly selected from both a hospital that offered only that program as a long-term care alternative and from a hospital that provided all three treatment settings. Second, multiple regression analysis was used to control for pretest differences among patients. Patients placed in the home care program displayed the greatest mean improvement in functional health status, holding all other variables constant. This treatment effect was not uniform, however; patients showed differential rates of improvement across the three programs, based upon both initial health status and prognosis.
Adult↗