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Biomedical subjects

John Stevenson

Publications and source records attributed to John Stevenson.

At least 19 recordsLinked to original sources
PubMed2006

Cultivating systemic capacity: the Rhode Island tobacco control enhancement project.

This paper describes the Rhode Island Tobacco Control Enhancement Project (TCEP), a state-university-community technical assistance system. TCEP was developed under the auspices of the Rhode Island Department of Health's Tobacco Control program and was designed to build capacity among nine community-based organizations to mount comprehensive tobacco control interventions in five diverse communities within the state. This paper: (1) provides a description of community mobilization; (2) presents a logic model for planning and decision making used by state-university-community partners; (3) describes training, technical assistance services and implementation; and, (4) describes the evaluation and program improvement activities used to support on-going project development.

Comprehensive Health Care↗
PubMed2006

The effect of medroxyprogesterone acetate on estrogen-dependent risks and benefits--an attempt to interpret the Women's Health Initiative results.

The results of the two arms of the Women's Health Initiative (WHI) study allow a comparative assessment of the contribution of the progestogen component to the changes in risk of cardiovascular disease and cancer during treatment of postmenopausal women with conjugated equine estrogens and medroxyprogesterone acetate (CEE/MPA). However, the high proportion of older and overweight or obese women compromises any conclusions, since we estimate that 50% of the women would have the metabolic syndrome. In overweight postmenopausal women with hyperinsulinemia, the risk of breast cancer is elevated and cannot be increased further by hormone replacement therapy (HRT). Therefore, the non-significant, but consistent reduction in breast cancer risk during treatment with CEE alone might be based on an improvement of hyperinsulinemia. The 24% increase in breast cancer risk in the CEE/MPA group can be regarded as an artifact due to very low numbers of breast cancer diagnoses in the placebo group of women who had received HRT prior to the WHI study. The elevated risk of venous thromboembolism and the transient increase in the risk of coronary heart disease (CHD) during treatment with CEE/MPA but not CEE alone suggests a direct effect of MPA on the vessel wall. MPA has been demonstrated to upregulate the thrombin receptor, the thrombin-induced production of tissue factor and procoagulatory activity in the vessel wall owing to its glucocorticoid activity. In contrast, CEE alone reduced non-significantly the risk of CHD in women aged 50-59 years, suggesting that primary prevention is possible if estrogen replacement therapy is initiated early. As clinical studies on the effect of different progestogens combined with estrogens are scarce, a possible superiority of progestogens other than MPA remains to be proven.

Aged↗
PubMed2006

Associations between childhood vaccination coverage, insurance type, and breaks in health insurance coverage.

OBJECTIVES: This study explored how vaccination coverage is associated with not being insured and with insurance type among children who are insured and to show how these associations are modified by race/ethnicity. METHODS: We determined whether 8324 children sampled in the National Immunization Survey in 2001 and 2002 were covered by private insurance only, Medicaid/State Children's Health Insurance Program, or another insurance type or were uninsured at the time of the National Immunization Survey interview or were uninsured at some time before the interview. Children were up to date if, by the date of the interview, their vaccination providers had administered > or =4 doses of diphtheria-tetanus toxoids-acellular pertussis vaccine, > or =3 doses of polio vaccine, > or =1 dose of measles-mumps-rubella vaccine, > or =3 doses of Haemophilus influenzae type b vaccine, and > or =3 doses of hepatitis B vaccine. To evaluate the association between insurance type and breaks in insurance with timely completion of the recommended vaccination schedule soon after 19 months of age, we restricted our analyses to children 19 to 24 months of age. RESULTS: Nationally, 12.6 +/- 1.6% of all children 19 to 24 months of age were uninsured at some time. Children who were uninsured at the time of the National Immunization Survey interview had significantly lower vaccination coverage than did children with Medicaid/State Children's Health Insurance Program coverage or children with private insurance only (52.6% vs 70.0% and 75.6%). Children who had never been insured and children who were insured but had a break in insurance coverage in the 12 months immediately preceding the National Immunization Survey interview had significantly lower vaccination coverage than did children who had been insured continuously (47.4% and 64.8% vs 73.5%). CONCLUSIONS: Approximately 1 of 8 children were uninsured at some time, and those children were at greater risk of not being vaccinated on time as recommended.

Black or African American↗
PubMed2005

Which progestogen is more likely to increase the risk of fatal myocardial infarction: a combination of epidemiological and trial evidence.

OBJECTIVES: To evaluate the impact of metabolic effects of different progestogens on the risk of fatal myocardial infarction is evaluated. METHODS: The changes in (apo)lipoproteins obtained from a randomized trial of three hormone therapy regimens were applied to three models for predicting fatal myocardial infarction derived from the apolipoprotein-related mortality risk (AMORIS) study. In our trial, 487 postmenopausal women were randomized to oral estradiol, with sequential addition of two trimegestone (TMG) doses or norethisterone acetate (NETA), and studied at baseline and after 3, 6, and 12 months. RESULTS: The change from baseline in risk of fatal myocardial infarction, using AMORIS model 3, containing total cholesterol, triglycerides, and apolipoprotein AI, was a 10% reduction for the two TMG doses; NETA had no apparent impact. The differences between treatments were significant at all three time points. When apoB was added in AMORIS model 4, the difference between treatments (5% reduction in the two doses of TMG, compared to NETA) decreased over time, probably due to the effect of dropouts in the NETA group. CONCLUSIONS: This analysis shows different metabolic responses to progestogens in terms of risk of fatal myocardial infarction. Generalization of health benefits or adverse effects seen in trials of hormone therapy to other progestogens could be misleading.

Aged↗
PubMed2005

Why do not patients receive influenza vaccine in December and January?

BACKGROUND: Influenza vaccination levels in older patients have changed little since the mid-1990s. Despite frequent health care visits by a majority of older persons, many missed opportunities continue to occur. METHODS: Patients were eligible for the study if they were age 50 and older, had not received influenza vaccine during the current season and were making a scheduled visit to one of the 13 study sites in California, New York, or New Mexico for purposes other than vaccination. Through direct observation, we determined if office staff inquired about vaccination status, discussed vaccination, or both. We defined missed opportunities as failure to administer influenza vaccine to patients for whom it was indicated. RESULTS: Missed opportunities increased steadily from October to January (P < 0.0001), and were more common when there was no inquiry or discussion (P < 0.00001), among patients aged 50-64 (P < 0.0001) and in California and New Mexico (P = 0.001). A classification tree analysis revealed that lack of inquiry and week of visit contributed most to missed opportunities. DISCUSSION: Early in the vaccination season, missed opportunities were uncommon and specific inquiries into or discussion of vaccination did not appear necessary. In December and January, patients tended to be vaccinated only when vaccination was addressed during the visit. Efforts to remind patients about vaccination later in the vaccination season may be essential to achieving higher coverage in the U.S.

Aged↗
PubMed2005

Managing the menopause: British Menopause Society Council consensus statement on hormone replacement therapy.

The British Menopause Society Council aims to help health professionals inform and advise women about the menopause. This guidance regarding estrogen-based hormone replacement therapy (HRT), including tibolone, which is classified in the British National Formulary as HRT, responds to the results and analysis of the randomized Women's Health Initiative studies and the observational Million Women Study. Treatment choice should be based on up-to-date information and targeted to individual women's needs. HRT still offers the potential for benefit to outweigh harm, providing the appropriate regimen has been instigated in terms of dose, route and combination.

Estrogen Replacement Therapy↗
PubMed2005

Oxygen heresy.

Explore the source record for details and available documents.

Air↗
PubMed2004

Measles hospitalizations, United States, 1985-2002.

Cases of measles that require hospitalization are a good marker of the burden of clinically severe measles in the United States. Measles hospitalizations routinely are monitored by the National Notifiable Disease Surveillance System (NNDSS). Our objectives were to describe measles hospitalizations reported to the NNDSS in 1985-2002, to use hospital discharge data from independent data sets (the National Hospital Discharge Survey [NHDS] [data available for 1985-1999] and the Health Care Investment Analysts [HCIA] hospital discharge database [data available for 1985-1996]) to provide additional estimates of total measles hospitalizations, and to compare trends in measles-associated hospitalizations. In 1985-2002, a total of 13621 patients with measles reported to the NNDSS were hospitalized (annual average, 757; range, 19-5856 patients). In 1985-1996, a total of 13472 measles hospitalizations were reported from NNDSS, compared with 28047 estimated from the NHDS and 19352 extrapolated from HCIA data. In the NNDSS, the annual total number declined after 1992 to <or=45 measles hospitalizations per year; this trend was closely paralleled by both the NHDS and the HCIA data. We demonstrate a decline in reported measles hospitalizations since the 1989-1991 measles resurgence, with the lowest numbers ever reported in the NNDSS. These numbers are corroborated by the very low numbers of measles hospitalizations in the NHDS and HCIA data.

Disease Notification↗
PubMed2004

Managing the menopause: BMS Council Consensus statement on HRT.

The British Menopause Society Council aims to help health professionals to inform and advise women about the menopause. The oestrogen plus progestogen arm of the Women's Health Initiative was stopped in July 2002. This guidance regarding hormone replacement therapy (HRT) use responds to the results and analysis that have been published since then, as well as the Million Women Study published in August 2003. Because there are few effective alternatives to HRT for vasomotor and urogenital symptoms, oestrogen-based treatments still have a major role. HRT is also most effective for the prevention of osteoporosis. Unopposed oestrogens are contraindicated in women with an intact uterus, and hence a range of oestrogen and progestogen combinations, with differing routes of delivery, now exists under the title of "HRT". Treatment choice should be based on up to date information and targeted to individual women's needs. Hormone replacement still offers the potential for benefit to outweigh harm, providing the appropriate regimen has been instigated in terms of dose, route and combination.

Estrogen Replacement Therapy↗
PubMed2003

Managing the menopause - British Menopause Society Council consensus statement on hormone replacement therapy.

The British Menopause Society Council aims to aid health professionals to inform and advise women about the menopause. The oestrogen plus progestogen arm of the Women's Health Initiative was stopped in July 2002. This guidance regarding hormone replacement therapy (HRT) use responds to the results and analysis that have been published since then. Because there are few effective alternatives to HRT for vasomotor and urogenital symptoms, oestrogen-based treatments still have a major role. HRT is also most effective for prevention of osteoporosis. Unopposed oestrogens are contraindicated in women with an intact uterus, and hence a range of oestrogen and progestogen combinations, with differing routes of delivery, now exists under the title of "HRT". Treatment choice should be based on up to date information and targeted to individual women's needs. Hormone replacement still offers the potential for benefit to outweigh harm, providing the appropriate regimen has been instigated in terms of dose, route and combination.

Estrogen Replacement Therapy↗
PubMed2002

Linking WIC and immunization services to improve preventive health care among low-income children in WIC.

Children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are at risk for low immunization coverage and other adverse health-related outcomes. Immunization-promoting strategies in WIC have been shown to produce dramatic improvements in immunization coverage. This evaluation of a local WIC initiative in Milwaukee is the first study to evaluate the impact of these strategies on improving the utilization of other clinical preventive services at the medical home. The use of more intensive immunization-promoting strategies in WIC may improve utilization of well child care visits and receipt of other clinical preventive services in the medical home.

Child↗