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PubMed1995

The Health of the Nation target on syringe sharing: a role for routine surveillance in assessing progress and targeting interventions.

The Health of the Nation initiative in the United Kingdom includes a target aimed at reducing the proportion of current injecting drug users who share syringes. The PHLS Collaborative Survey of Salivary Antibodies to HIV and Hepatitis B core in injecting drug users is a comprehensive and national surveillance mechanism which routinely collects data that can be used to monitor progress toward this target. Nineteen per cent of injecting drug users (353/1876) in 1992 and 18% (375/2138) in 1993 shared previously used injecting equipment (difference of -1.3%, 95% Cl -3.7%, 1.1%). Only with further years of data collection will it be possible to tell if this decline represents a real change in behaviour. There was a substantial reduction in the proportion of sharers who received previously used needles and syringes from more than one person, from 45% (138/305) in 1992 to 27% (81/298) in 1993 (fall of 18%, 95% Cl 11%, 26%). This decline could indicate a real reduction in risk behaviour that is not reflected in the target. Monitoring this aspect of sharing could be an important supplementary measure. Women were more likely to have share (adjusted OR = 1.87, 95% Cl 1.53, 2.28) and the likelihood of sharing declined with age (adjusted OR of each 5-year age band = 0.75, 95% Cl 0.72, 0.79). Particular attention should be given to interventions which aim to reduce sharing among women and young people. Clients of agencies at which the main service provided was syringe exchange were less likely to have shared than attenders of other types of agencies (adjusted OR = 0.69, 95% Cl 0.51, 0.93). This suggests that syringe exchange schemes play a role in reducing the transmission of HIV infection.

Adolescent↗
PubMed1996

AIDS-related policies, legislation and programme implementation in India.

This paper traces the evolution of AIDS-related policy and legislation in India from an initial response characterized by conservatism and discrimination to the development of a coherent national programme which aims to prevent the transmission of HIV and to develop support structures for people with HIV and AIDS. Examining the strategies, achievements and problems of specific components of the National AIDS Control Programme (NACP), the paper finds that the very progressive approach of national-level policy makers has been countered by conservative forces at the state and local levels. Little progress has been made, moreover, in incorporating HIV/AIDS prevention efforts into broader development and empowerment strategies. The paper concludes by considering the wider social context of AIDS in India and the role of more far-reaching policy measures.

Acquired Immunodeficiency Syndrome↗
PubMed1996

The dynamic topology of sexually transmitted disease epidemics: implications for prevention strategies.

Each sexually transmitted disease (STD) epidemic evolves through predictable phases, shaped by a dynamic interplay among the pathogen, the behaviors of the subpopulations in which it emerges, and the prevention efforts that are developed to limit its impact. As STD epidemics move through these phases, the sexual and social networks that fuel them become located in subpopulations characterized by progressively higher rates of sex partner change and less contact with the health care system. As a result, phase-appropriate prevention strategies and research issues are essential to reducing STDs and their consequences.

Disease Outbreaks↗
PubMed1991

Prevention of coronary heart disease in black adults.

Development of strategies to prevent CHD in blacks is impeded by the virtual absence of clinical trials demonstrating the feasibility and effectiveness of interventions in blacks. The wholesale generalization that interventions effective (or ineffective) in whites are similarly effective in blacks may risk the employment of worthless or even dangerous interventions in blacks. Using available epidemiologic data, a number of risk factors may be more important in blacks than whites by virtue of higher prevalence, increased relative risk, or both. These may include hypertension, lipoprotein (a), smoking, diabetes, and obesity. Thus, health agencies might emphasize these risk factors when developing preventive programs targeted at black populations. Prevention programs may best seek to prevent the onset of risk factors found highly prevalent in black communities, rather than the costly and side-effect-prone interventions to treat risk factors once established. Thus, there is a role for community-based as well as a high-risk approaches. The community-based approaches should seek to work with organizations such as churches, which traditionally play strong roles in the black community. Physicians treating black patients should be aware of the potentially different roles played by risk factors, and treat aggressively those individuals identified to be at high risk. Risk factor management should be emphasized, rather than reduced, in patients with already established CHD. CHD has been clearly shown to be preventable; both blacks and whites should benefit from specific interventions aimed toward this worthy goal.

Adult↗
PubMed1994

Benefit of independent double reading in a population-based mammography screening program.

PURPOSE: To evaluate independent double reading in mammography screening and, specifically, the effect on breast cancer detection. MATERIALS AND METHODS: Mammographic studies of 11,343 women, aged 41-75 years, who participated in a population-based screening program were independently screened by two experienced radiologists. A retrospective analysis also was performed from notations made for patient recalls. RESULTS: Including follow-up of recalled women, 131 surgical biopsies were performed, which resulted in 76 histologically proved breast cancers. Fifty-six cancerous lesions were detected by both screeners. One screener detected 14 cancerous lesions alone, and the other detected six alone. Of the cancerous lesions detected by only one screener, 85% were stage 0 or 1, compared with 59% of those detected by both screeners. Double reading detected 15% (95% confidence interval, +/- 7%) more cancer cases with an almost unchanged positive predictive value of 0.6. CONCLUSION: Independent double reading does significantly increase sensitivity of mammography screening.

Adult↗
PubMedDate not supplied

Facilitating the shift to population-based public health programs: innovation through the use of framework and logic model tools.

Program planning and evaluation are critical steps in using a population health approach. This paper outlines how logic models have been adapted within a health promotion framework to guide public health programs and facilitate program description. It is important that we take the time to describe clearly what we are doing, reflect on practice and elaborate the conceptual base for the new public health programs so that we can evaluate the impact of our work. Ongoing research is required to identify appropriate and measurable indicators that capture the process, as well as the outcome, of population-based health promotion.

Canada↗
PubMed1989

Freedom from fat: a contemporary multi-component weight loss program for the general population of obese adults.

This report summarizes results for the first 2,037 participants in the Freedom from Fat (FFF) weight loss program. FFF combined nutrition education, a low-fat dietary pattern, exercise, behavioral self-management, and social support in a program designed to serve the general population of overweight and obese adults. Participants ranged in age from 18 to 84 and from ideal weight to massively obese. After enrolling, program participants attended professionally led weekly meetings as long as they wished. Participants were encouraged to keep daily food diaries, to reduce the proportion of calories from fat to 30% or less, to exercise at moderate intensity for 30 minutes a day 5 days a week, to keep graphic records of weight change and exercise, and to display their graphs at each weekly group meeting. Attrition rates were comparatively low for a large-scale program, with half of the participants still active in the fifth month and 22% still active after 1 year. Mean weight loss for obese participants (BMI 30 or greater) at 6 months was 7.3 kg (16.2 lb) for men and 5.3 kg (11.6 lb) for women. The best predictors of weight loss at 6 months were number of days per week in which food diaries were kept, baseline body mass index, number of minutes of exercise per week, and age.

Adult↗
PubMed1994

A prospective dosage adjustment program in a geriatric population.

This article describes the successful implementation of a prospective drug dosage adjustment program that has achieved cost-containment, improved quality of patient care, and optimum usage of clinical pharmacy services. It has significantly reduced the number of unnecessary doses administered and lowered the possibility of adverse drug reactions.

Aged↗
PubMed1998

State funding of comprehensive primary medical care service programs for medically underserved populations.

OBJECTIVES: This study examined the availability of state funding for comprehensive primary care programs and the need for primary care subsidies for medically underserved communities. METHODS: A brief questionnaire was used to ask health agencies in all 50 states whether their state funded a program that met our definition of comprehensive primary medical care practice programs. An in-depth written survey instrument was then administered to the states with programs. RESULTS: Almost half of all states provide some funds for the development and/or operation of comprehensive primary medical care practices. Expenditures in most states were found to be relatively modest in comparison with both federal funding and the total level of unmet need for primary care. States that subsidize primary care practices tend to follow the model established under the federal health centers program. CONCLUSIONS: The findings suggest the continued viability of the health center model of care, as well as the presence of some state support for such a program. However, in light of limited state resources for the development and operation of comprehensive practices, a continued and significant federal effort is imperative.

Comprehensive Health Care↗
PubMed1979

A general program for estimation of haplotype frequencies from population diploid data.

The program which is written in FORTRAN estimates haplotype frequencies in two-locus and three-locus genetic systems from population diploid data. It is based on the gene counting method which leads to maximum likelihood estimates, and can be used whenever the possible antigens (one or more) on each chromosome can be specified for each person and for each locus, i.e., ABO-like systems and inclusions are permitted. The number of alleles per locus may be rather large, and both grouped and ungrouped data can be used. Log likelihoods are calculated on the basis of various assumptions, so that likelihood ratio tests can be carried out.

Chromosome Mapping↗
PubMed1986

Effect of population screening for cancer of the uterine cervix in Nijmegen, The Netherlands.

Since the introduction of a population screening program for cervical cancer in 1976, more than 85% of the female population between the ages of 35 and 54 years in the region of the city of Nijmegen, The Netherlands, has been screened. At first screening, severe epithelial abnormalities were diagnosed in 4.4 per 1,000 women, at second screening, in 1.5 per 1,000; and at third screening, in 1.0 per 1,000. The population screening program led to a marked increase in the detected number of carcinomata in situ. The number of cases of squamous cell cancer diagnosed in the first screening period did not increase. Once the population was screened, the detection rate of invasive squamous cell cancer in the group of women ages 35 through 54 decreased from 18.6 per 10(5) during the period prior to the screening to 9.0 per 10(5) after the first screening and 3.3 per 10(5) after the second screening. For the women above age 54, the incidence of invasive cancer was reduced by 58% after the second screening. The number of invasive cancers diagnosed in women under age 35 remained relatively small in spite of the large number of cases of carcinoma in situ.

Adult↗
PubMed1990

Effectiveness of rehabilitation programs on a remainder population: a retrospective analysis.

Retrospective analyses were conducted on a remainder population of 361 individuals with mental retardation at a rehabilitation institute. Program effectiveness was determined by means of aggregate and individual changes in performance on several instruments. Psychometric tests showed no significant increases in test scores whereas gains were found on all adaptive functioning instruments. Programs dealing with daily living and more conceptual material appeared to be more effective than vocational programs. One third of the remainder clients gained from the institute's programs.

Activities of Daily Living↗
PubMed1995

Cairo: repackaging population control.

Aid agencies, charities, and other nongovernmental organizations once denounced population control programs as racist interference in the third world. Yet, at the United Nations Conference on Population and Development in Cairo last September, these same organizations endorsed very similar ideas. The U.N. can now claim that even its fiercest critics not only have muted their criticism of population control programs but now positively endorse them. Over the last 30 years, population control has been consciously repackaged by the U.S. establishment. The image of population control has changed from being overtly anti-third world to being about giving the people of the third world--especially women--basic rights in family planning. Wrapped up in the language of women's empowerment and environmentalism, the establishment's old arguments about there being too many nonwhite babies in the world, have, unfortunately, won the day.

Developing Countries↗
PubMed1985

Effects of biofeedback-assisted attention training in a college population.

A program of stress management employing open-focus attention-training workshops was developed at Baruch College to bring the benefits of stress reduction to students. The purpose of the research reported here was to evaluate the results of the open-focus attention-training technique. Open-focus technique without biofeedback training was used for two semesters. Biofeedback training was incorporated in the third semester. In the first study, changes in grade point average (GPA), stress-related symptoms, and physiological measures were examined. The experimental subjects' stress data for this study was reported previously (Valdés, 1985). In the second study, changes in the same variables for experimental and control subjects were evaluated. Students in the control group showed decreased GPA, while those who participated in open-focus training showed a trend toward improved GPA. Stress-related symptoms associated with anxiety and management of emotional problems showed significant posttraining improvement, as did physiological measures in all of the biofeedback modalities in which the experimental subjects were specifically trained. The results support the hypothesis that the workshops were successful in reducing stress levels, and suggest that further controlled research be conducted to verify these findings, and to identify the most effective components of the training procedure.

Achievement↗
PubMed1975

A comprehensive approach to dental health in a school population.

A program to provide school children with dental health education and preventive services was initiated by the Boston University School of Graduate Dentistry. This program utilized several generally untapped resources. The emphasis was on classroom education using teachers who were motivated by special workshops as well as students of dental auxiliary training programs. These dental auxiliary students under the supervision of a dental health educator were used to educate the classroom teachers as well as to teach children in the classroom. Direct dental services were also provided in the program in the form of preventive services utilizing an unused dental chair available at a school.

Boston↗