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PubMed2002

Knowledge and attitudes about the Pap-smear screening program: a population-based study of women aged 20-59 years.

BACKGROUND: The aim of the Papanicolau (Pap)-smear screening program is to reduce morbidity and mortality resulting from cervix cancer. Compliance to screening has previously been suggested to be associated with women's knowledge. The aim of this study was to investigate knowledge about and attitudes to gynecologic Pap-smear screening among women in a Swedish region where a screening program has been in existence since 1970. MATERIAL AND METHODS: Questionnaires were mailed to a random sample of 400 women born 1940-79. Replies were received from 275 of the 392 (70%) available for evaluation. RESULTS: Ninety-five percent of the responders had a registered Pap smear in the pathology database. Women's knowledge and concerns were age-dependent. Ninety-five percent stated that they knew the purpose of screening but only 62% could indicate which type of cancer the screening actually examined. The majority (82%) did not experience anxiety while awaiting the test result. Almost all women knew that dysplasia may not give symptoms but 10% did not consider seeking a doctor when experiencing postcoital bleeding. Fifty percent thought that their life-style may be of importance for developing dysplasia but only 13% were aware of the protective effect of a condom. CONCLUSION: Although the vast majority of the women had experience of participating in the screening program, one in three of the women were unaware of which type of cancer she was being screened for and only half of the women were aware of the connection between dysplasia/cervix cancer and life-style factors. It is particularly important to provide better information about life-style factors in order to give women the opportunity of acting accordingly.

Adult↗
PubMed2004

Community-based cancer screening programs in older populations: making progress but can we do better?

BACKGROUND: Older individuals have higher rates of most types of cancer. Community-based cancer screening programs offer one avenue for addressing the need to prevent or detect cancers in early stages in this population. Identifying characteristics of successful interventions can assist researchers in the development of future studies. METHODS: A comprehensive literature review of community-based cancer screening interventions was undertaken and 114 behavioral interventions for breast, cervical and colorectal cancer screening published prior to 2000 and 42 studies published during 2000-2003 were identified. From these, 17 studies were identified as model interventions that were effective in significantly increasing screening rates among older populations. RESULTS: Effective interventions employed a variety of strategies including the use of social networks and lay health care workers, mass media, community-based education, reminder notices/behavioral cues, and health care provider assistance. CONCLUSION: Although subgroups of individuals still have lower rates of screening, the results indicate that older populations can be encouraged to engage in appropriate cancer screening behaviors through community-based interventions. The next round of interventions could be strengthened by evaluating intervention components, integrating theory and community participation into designs, focusing on those most at need, and considering program sustainability and costs.

Aged↗
PubMedDate not supplied

Motivating factors influencing participation in hepatitis B immunization programs in rural populations.

The emphasis on immunization of children aged 0-2 results in a large pocket of need within the school-aged population, particularly in regard to hepatitis B immunization. After implementing a school-based hepatitis B immunization program in a rural, west central Indiana county, a study was conducted to identify the factors that motivated rural families to participate in the program. A retrospective, descriptive design using a convenience sample of 553 elementary and middle-school students was used. Survey results were received from 41 percent (227) of the sample; 95 percent of the returned questionnaires (215) was used for analysis. Approximately 82 percent of the children immunized were between 11 and 19 years old, with the largest cluster (49 percent) in the 11-13 year age group. Benefit to health, convenience of location and time, and no financial cost to the family were the top three reasons for program participation. Recommendations from health care providers and other parents were ranked as least likely to influence participation. More than 70 percent of the respondents indicated that both parents were not immunized against hepatitis B, 11.6 percent had completed the series, while 14 percent were unsure of their immunization status. These findings corroborated previously held assumptions regarding barriers to appropriate immunization status in rural America and reveal implications for future immunization, health promotion and education programs for rural residents.

Adolescent↗
PubMed2005

CANSURV: A Windows program for population-based cancer survival analysis.

Patient survival is one of the most important measures of cancer patient care (the diagnosis and treatment of cancer). The optimal method for monitoring the progress of patient care across the full spectrum of provider settings is through the population-based study of cancer patient survival, which is only possible using data collected by population-based cancer registries. The probability of cure, "statistical cure", is defined for a cohort of cancer patients as the percent of patients whose annual death rate equals the death rate of general cancer-free population. Mixture cure models have been widely used to model failure time data. The models provide simultaneous estimates of the proportion of the patients cured from cancer and the distribution of the failure times for the uncured patients (latency distribution). CANSURV (CAN-cer SURVival) is a Windows software fitting both the standard survival models and the cure models to population-based cancer survival data. CANSURV can analyze both cause-specific survival data and, especially, relative survival data, which is the standard measure of net survival in population-based cancer studies. It can also fit parametric (cure) survival models to the individual data. The program is available at . The colorectal cancer survival data from the Surveillance, Epidemiology and End Results (SEER) program [Surveillance, Epidemiology and End Results Program, The Portable Survival System/Mainframe Survival System, National Cancer Institute, Bethesda, 1999.] of the National Cancer Institute, NIH is used to demonstrate the use of CANSURV program.

Computer Simulation↗
PubMed1996

A limited sampling method to estimate methotrexate pharmacokinetics in patients with rheumatoid arthritis using a Bayesian approach and the population data modeling program P-PHARM.

This paper describes a methodology to calculate methotrexate (MTX) pharmacokinetic parameters after intramuscular administration using two samples and the population parameters. Total and free MTX were measured over a 36-h period in 56 rheumatoid arthritis patients; 14 patients were studied after a two-dose scheme at 15-day intervals. The Hill equation was used to relate the free MTX to the total MTX changes in plasma concentrations, and a two-compartment open model was used to fit the total MTX plasma concentrations. A non-linear mixed effect procedure was used to estimate the population parameters and to explore the interindividual variability in relation to the following covariables: age, weight, height, haemoglobin, erythrocyte sedimentation rate, platelet count, creatinine clearance, rheumatoid factor, C-reactive protein, swelling joint count, and Ritchie's articular index. Population parameters were evaluated for 40 patients using a three-step approach. The population average parameters and the interindividual variabilities expressed as coefficients of variation (CV%) were: CL, 6.94 l center dot h-1 (20.5%); V, 34.8 l (32.2%); k12, 0.0838 h-1 (47.7%); k21, 0.0769 h-1 (61.6%); ka, 4.31 h-1 (58%); Emax, 1.12 mu mol center dot l-1 (19.7%); gamma, 0.932 (12.3%); and EC50, 2.14 mu mol center dot l-1 (27.3%). Thirty additional data sets (16 new patients and 14 patients of the previous population but treated on a separate occasion) were used to evaluate the predictive performance of the population parameters. Twelve blood samples were collected from each individual in order to calculate individual parameters using standard fitting procedures. These values were compared to the ones estimated using a Bayesian approach with population parameters as a priori information together with two samples, selected from the individual observations. The results show that the bias was not statistically different from zero and the precision of these parameters was excellent.

Adult↗
PubMed2003

Childhood cancer patients' access to cooperative group cancer programs: a population-based study.

BACKGROUND: The Children's Oncology Group (COG), a merger of the Children's Cancer Group (CCG) and the Pediatric Oncology Group (POG), conducts clinical trials for the treatment of childhood cancer. To assess the feasibility of developing a nationwide childhood cancer registry, the authors attempted to determine whether COG could serve as a resource for identifying all children with cancer. METHODS: A consolidated file of children age < 20 years who were diagnosed with cancer between 1992-1997 and registered with either CCG or POG was linked with records from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program. Age-specific registration rates and age-adjusted registration rates (AARR) were calculated overall and by year of diagnosis, gender, race/ethnicity, stage of disease at diagnosis, and type of cancer. RESULTS: Of 10,108 children age < 20 years with cancer who were identified by the 11 SEER registries between 1992-1997, 5796 were registered with CCG or POG. The AARR was 71% for children age < 15 years, 24% for adolescents ages 15-19 years, and 57% for children age < 20 years. Registration rates were stable over the years studied, varied by geographic region, and were found to be higher among children with more advanced disease. Registration rates were highest for children with leukemia, hepatic tumors, and renal tumors, and were lowest for carcinoma and retinoblastoma. CONCLUSIONS: The results of the current study demonstrate that not all children with cancer are registered by the cooperative groups; however, a national registry program can be achieved by supplementing cases identified through COG with data collected by statewide population-based cancer registries. Such a partnership would be mutually beneficial, allowing COG to achieve 100% registration of children with cancer and, for the statewide cancer registries, improving the timeliness of case-finding and follow-up information for cancer outcomes.

Child↗
PubMed2000

Building culturally sensitive substance use prevention and treatment programs for transgendered populations.

Studies show that transgendered individuals are at high risk for substance use problems. It is important to identify the unique needs and concerns of these individuals and culturally sensitive programs that will be successful in recruiting and retaining these individuals in drug abuse treatment services. This involves incorporating the needs of services from the perspectives of both the transgendered community and health-care professionals. It is the purpose of this article to discuss transgenderism as well as the substance use problems and difficulties within substance use treatment that transgendered men and women may face. This article presents guidelines for the design and evaluation of health-care services to transgendered populations.

Adolescent↗
PubMed1995

Down syndrome prevention program in a population with an older maternal age.

OBJECTIVE: To investigate the effect of a relatively high proportion of pregnant women 35 years and older on the efficacy of prenatal screening for Down syndrome. METHODS: We obtained information on normal and abnormal cytogenetic and maternal serum marker studies for 1990 and 1992 from all 11 public and two private cytogenetic laboratories operating in Israel. RESULTS: In the Jewish Israeli population, 16.2-17.1% of all pregnant women are at least 35 years old. Thus, prenatal testing of all pregnant women at least 35 years old could have identified 62.8-66.5% of all Down syndrome cases. Screening by maternal serum markers would classify 9.28% of pregnancies as being at high risk for Down syndrome (greater than 1:386 at birth). The percentage of Down syndrome cases detected prenatally increased from 78 of 147 (53%) to 123 of 163 (75%) as a result of the increased use of prenatal testing from 11.3% to 19.4% of all pregnancies in 1990 and 1992, respectively. CONCLUSIONS: In a population with a high proportion of mothers at least 35 years old, as in the Jewish population in Israel, screening by maternal serum markers instead of by maternal age alone would leave the Down syndrome detection rate unchanged, but would lower the amniocentesis rate from 16.2-17.1% to 9.28%. In addition to the reduction in the expected fetal loss as a result of post-amniocentesis spontaneous abortion, this policy would also pay the cost of maternal serum marker testing of the entire pregnant population.

Adult↗
PubMed2005

Prevalence of silent kidney disease in Hong Kong: the screening for Hong Kong Asymptomatic Renal Population and Evaluation (SHARE) program.

BACKGROUND: End-stage renal disease (ESRD) is epidemic worldwide. In Hong Kong, the annual incidence of ESRD has risen from 100 pmp (per million population) in 1996 to 140 pmp in 2003. SHARE (Screening for Hong Kong Asymptomatic Renal Population and Evaluation program) is a population-based screening program aimed at identifying the prevalence of unrecognized renal disease in asymptomatic individuals, allowing further evaluation and disease-modifying interventions. METHODS: From November to December 2003, SHARE was conducted in several large residential communities in Hong Kong. The screening tool included a questionnaire documenting demographics and history or family history of diabetes mellitus (DM), hypertension (HT), and chronic kidney disease (CKD), together with on-site measurements of blood pressure (BP) and urine dipstick for protein, blood, and glucose. RESULTS: There were a total of 1811 participants. One thousand two hundred and one subjects were entered into the final analysis. Among the 1201 who were apparently "healthy" (asymptomatic and without history of DM, HT, or CKD), the prevalence of positive (> or =1+) urine dipstick for protein, glucose, blood, protein or blood, any urine abnormality, and HT (BP> or =140/90) was 3.2%, 1.7%, 13.8%, 16%, 17.4%, and 8.7%, respectively. Thirty three percent of the age over 60 years old group had either hypertension or urine abnormalities, compared with 24.0% in the 41- to 60-year-old group and 9.7% in the 20- to 40-year-old group. Having a family history of diabetes or hypertension increases the risk of having urine abnormalities, while a family history of hypertension also increases the risk of high blood pressure. CONCLUSION: It is concluded that subclinical abnormalities in urinalysis or BP readings are prevalent across all age groups in the adult population. An effective screening program at the primary care level that identifies these subjects for further evaluation is warranted, and the public in Hong Kong should be educated toward the significance of such findings in order to have regular health check for asymptomatic renal diseases.

Adult↗