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PubMedDate not supplied

Identification of women at increased risk for breast cancer in a population-based screening program.

A multivariate model to assess breast cancer risk was developed by Gail et al. (M. H. Gail, L. A. Brinton, D. B. Byar, D. K. Corle, S. B. Green, C. Schairer, and J. J. Mulvihill, J. Natl. Cancer Inst., 81: 1879-1886, 1989) based on data analysis of the Breast Cancer Detection and Demonstration Project. We evaluated the model's usefulness for assigning women to risk groups for counseling and follow-up by applying it to the 1987 Texas Breast Screening Project data. We identified 3165 women with one or more first-degree relatives affected with breast cancer. The mean risk score for the group was 3.3 (range, 2.7-11.8), indicating a greater than 3-fold elevated risk. The mean risk score for the remaining 27,439 women without affected first-degree relatives was 1.5 (range, 1.24-3.2). Risk perception was found to be a motivator for participation. Women with a risk score greater than 5 perceived themselves to be at high risk for breast cancer. The perception of risk was related to the type of affected first-degree relatives: 80.0% of the women with three affected first-degree relatives and 71.5% of women whose mother and sister were both affected with breast cancer perceived themselves to be at high risk. The Gail model is potentially useful in the clinical setting because women at high risk for breast cancer can be entered into etiological studies, enrolled in primary prevention trials, or referred to programs seeking to improve compliance with screening mammography. The Gail model needs validation, but it is useful for estimating the risk of breast cancer in large populations.

Adult↗
PubMed1980

Paving the way: training the influentials in population education.

A number of countries in Far East Asia are in the process of launching national population education programs. To get them off the ground and to keep them working needs the support of key personnel in the program. This means that basic training in population education should be given to key personnel to enable them to promote and efficiently run the population education programs. The Sub-Regional Group Training Course in Population Education organized by the Mobile Team of the Unesco Regional Office for Education in Asia and Oceania to be held in Bangkok from 18 August to 5 September is a response to this need. Training will be given to key personnel from Afghanistan, India, Nepal, and Pakistan. The specific objectives of the course are to provide the participants with: 1) opportunities for exchanges of information and experience; exposure to and involvement in developing population education curricula, teaching units and sample instructional materials; 2) an understanding of various strategies for curriculum development and methodologies used for designing and implementing programs; and 3) preparation as teams from each Member State able to contribute to the promotion of population education in school and out of school in their countries. The training course has 5 main thrusts, namely: 1) sharing of experiences and clarification of the concepts of population education; 2) development of population education curriculum; 3) development of teaching units; 4) development of sample alternative instructional materials; and 5) field visit to ongoing population education programs in Thailand. The content will cover: 1) the knowledge base which includes concepts, nature, issues and status of population education; demographic concepts, population and development; and 2) strategies and approaches such as those used in curriculum development and teaching units, methods of teaching, and instructional materials development. The training methodologies will include lecture and panel discussions, film shows, and practicum.

Community Health Workers↗
PubMed1984

Is wide availability of abortion essential to national population growth control programs? Experiences of 116 countries.

No nation wanting to reduce its growth rate to less than or equal to 1% can expect to do so without the widespread use of abortion. This study, based on the experience of 116 of the world's largest countries, supports the contention that abortion is essential to any national population growth control effort. Existing circumstances in developed countries have facilitated reduction of growth rates to less than 1%, with abortion rates generally in the range of 200 to 500 per 1000 live births. However, developing countries are faced with a different and more difficult set of circumstances that require even greater reliance on abortion. These obstacles include a young population with resultant rapidly growing numbers of young fertile women, poor contraceptive use-effectiveness, low prevalence of contraception, and poor or nonexistent systems for providing contraceptives. By virtue of their profession, physicians play a critical role in family planning and carry a special responsibility in ensuring that abortion services are available to all women who need them.

Abortion, Induced↗
PubMed1991

[Epidemiologic foundation for population studies of program MZ-XVII].

Epidemiological foundation included: aim of studies, knowledge about epidemiology of thyroid disorders in Poland, evaluation of radioiodine dose accumulated in thyroids of inhabitants of different age living in different par of Poland, information about relative diet iodine deficiency in different parts of Poland and identification of research teams (manpower) capable to carry on population studies. The final identification of epidemiological foundation was proceeded by pilot studies performed in 4 different regions of Poland. Finally it was decided that population studies would be performed in so called Regions of 6 different University Medical Schools (Białystok, Kraków, Lódź, Poznań, Szczecin, Wrocław). The sample will be selected randomly on the base of information from the voting lists (random selection of vovoidoship, then towns and villages, then streets and number of houses, then number of flats. All living in selected flat or house during Czernobyl accident and born between January 1974 and December 1985 (children) and between January 1926 and December 1973 (adults) will be considered "the sample". In all cases the sample will be examined by means of unified questionnaire and protocol of medical and laboratory examination. The same kits (of the same producers) will be used to evaluate serum TSH, T4, T3 and thyroid autoantibodies. The data obtained will be evaluated by unified computerized system. Separate studies involved the sample of newborns exposed to radioiodine during last trimester of pregnancy, found to be euthyroid and given potassium iodide in first days of life. Separate system was also used to investigate effect of radioiodine and of prophylactic dose of potassium iodide in those with past history of thyroid disorders.

Adult↗
PubMed1994

The Waianae Diet Program: a culturally sensitive, community-based obesity and clinical intervention program for the Native Hawaiian population.

The Waianae Diet Program (WDP) is a community-based program designed at the Waianae Coast Comprehensive Health Center in response to the high rates of obesity and chronic disease among Native Hawaiians. Its foundation is a 3-week program of traditional Hawaiian diet and cultural teachings. It employs 8 innovations in clinical nutrition and health promotion theory: 1. Non-calorie restricted weight loss protocol, 2. Dietary clinical intervention, 3. Cultural sensitivity, 4. Transition diet, 5. Whole-person approach, 6. Group ohana (family) support, 7. Community intervention, and 8. Role modeling. It has demonstrated significant weight loss with no calorie restriction, improvement in blood pressure, serum glucose, and serum lipids. It appears to have wide acceptance in the Hawaiian community. More studies are warranted to determine the long-term effect of this program.

Community Health Services↗
PubMed1997

Complications of transrectal ultrasound-guided systematic sextant biopsies of the prostate: evaluation of complication rates and risk factors within a population-based screening program.

OBJECTIVES: Screening for prostate cancer to reduce the mortality and morbidity from this disease has become an important issue in recent years. Of all procedures used to diagnose prostate cancer, biopsy of the prostate is the cause of most complications. To evaluate the safety of the screening procedure, we have studied the complications and risk factors for complications within the screened population of the European Randomized Study of Screening for Prostate Cancer (ERSPC), Rotterdam section. METHODS: Between June 1994 and July 1996, 1687 transrectal ultrasound-guided systematic sextant biopsies were performed after screening 6198 men through prostate-specific antigen level, digital rectal examination, and transrectal ultrasonography. RESULTS: From these 1687 biopsies, 302 cases of prostate cancer were diagnosed. Mild complications such as hematuria and hematospermia were reported frequently with rates of 23.6% and 45.3%, respectively. More severe complications were far less frequently seen. Fever, usually of low grade, was seen after 4.2% of biopsies. Seven men (0.4%) were admitted to a hospital after biopsy. Risk factors for complications could not be identified. CONCLUSIONS: Review of the literature concerning transrectal biopsies of the prostate shows that the complication rates within this screened population are comparable to those reported within referred patients. The admittance rate is slightly lower. Transrectal ultrasound-guided systematic sextant biopsy of the prostate is a safe procedure for the diagnosis of prostate cancer within the general population; however, identification of risk factors for complications might further improve the safety of the screening procedure.

Age Factors↗
PubMed2002

Upper gastrointestinal cancer in a population-based screening program with fecal occult blood test for colorectal cancer.

BACKGROUND: Screening with Hemoccult-II (H-II) followed by colonoscopy, when fecal occult blood is demonstrated, reduces mortality from colorectal cancer. Whether upper gastrointestinal investigation is necessary when colonoscopy does not reveal any significant colorectal lesion is doubtful, and is the subject of this study. MATERIAL: In 1985, 30,967 persons from the general population register of Funen were randomized to biennial H-II screening. A positive test was followed by colonoscopy and no attempt was made to evaluate the upper gastrointestinal tract. Based on the information from the Funen Patient Database, the National Board of Health's Register of Death Causes, the Cancer Register and the National Register of Patients, all persons with malignancy of the gastrointestinal tract were identified. RESULTS: During 15 years and 8 screening rounds, 1,767 tests were positive; 1,536 complete colonic investigations detected colorectal cancer in 182 persons, adenoma > or = 10 mm in 440 persons, and in 879 investigations no colorectal lesion was found. Upper GI cancers were diagnosed in 209 persons within 2 years of the H-II test (199 after a negative H-II and no more than 10 persons within 2 years of a positive test). Among the 10, two were diagnosed as a consequence of symptoms at the time of screening. CONCLUSION: It is unjustified to perform upper gastrointestinal investigation in asymptomatic persons with a positive H-II in a Danish population screening for colorectal cancer.

Adenoma↗
PubMed1993

Population pharmacokinetics: development of a medical intensive care unit-specific gentamicin dosing nomogram.

OBJECTIVE: This study was designed to develop a population-specific dosing nomogram for gentamicin in medical intensive care unit (MICU) patients using the population pharmacokinetic program nonparametric expectation maximization (NPEM). DESIGN: Observational clinical gentamicin dosing data were collected, entered into the USC*PACK database program PASTRX, and downloaded into the population pharmacokinetic program NPEM. NPEM generated population pharmacokinetic parameter values that were used to develop a gentamicin dosing nomogram. The nomogram was tested in the next 15 patients admitted to MICU to determine accuracy. Doses given per the MICU and the Hull-Sarubbi nomograms were compared with doses based on actual patient-specific pharmacokinetic parameter values. Reliability coefficients (intraclass correlation coefficients) were calculated to assess the agreement between observations. SETTING: Data were gathered from patients receiving gentamicin therapy in the MICU, Presbyterian University Hospital, Pittsburgh. PATIENTS: Baseline population pharmacokinetic parameter values were determined in 36 MICU patients receiving gentamicin therapy. Patients with renal failure receiving hemodialysis or another mechanical method of blood clearance or fluid removal were excluded. The population parameter values in the form of a dosing nomogram were then used prospectively to dose gentamicin in 15 patients. RESULTS: NPEM generated population parameter values similar to those previously published using the Sawchuk-Zaske method in ICU patients. The mean volume of distribution generated using NPEM was 0.34 +/- 0.12 L/kg. The relationship between creatinine clearance (Clcr) and elimination rate constant (Ke) was: Ke = 0.00218 x Clcr + 0.007. The nomogram-derived doses correlated with doses determined by using actual patient-specific pharmacokinetic values (p < 0.05). The Hull-Sarubbi derived doses, however, did not correlate with patient-specific doses (p > 0.05). Only one patient had a peak concentration < 6 mg/L. Two of 15 patients had trough concentrations prior to the first maintenance dose > 2 mg/L. CONCLUSIONS: The use of NPEM to generate population-specific pharmacokinetic parameter values has been previously described. Application of population-specific dosing nomograms can improve initial dosing regimens such that conventional therapeutic concentrations can be achieved early in therapy. This nomogram, however, does not preclude follow-up patient-specific pharmacokinetic analysis.

Adult↗