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At least 289 records · Page 16Linked to original sources
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↗
PubMedDate not supplied

Participation in a smoking cessation program: a population-based perspective.

We examined factors associated with participation in an HMO-based, self-help smoking cessation trial by comparing participants with nonparticipating smokers who responded to a prior health survey. Recruitment to the trial was accomplished through the HMO's monthly magazine sent to all enrollee households, and the health survey involved a random sample of the enrollee population. Participants were more likely to be female, older, better educated, and heavier smokers with more attempts to quit in the past. Participants consistently reported poorer levels of health status (self-perceived health and energy, life satisfaction, depression, and symptoms), less healthy lifestyles (exercise and dietary fat), and a greater conviction that smoking cessation would improve how they feel than nonparticipants. These findings confirm previous suggestions that formal cessation programs attract those with a more extensive history of addiction, prior failure, and pathophysiologic effects and may provide clues to increasing motivation among smokers with a greater likelihood of treatment success.

Adult↗
PubMedDate not supplied

Perceptions of population policy, development, and family planning programs in northern Nigeria.

In this article, local perceptions of family planning programs and federal population policy are examined, based on responses to a childbirth survey and on interviews with a range of individuals in one northern Nigerian town. The respondents' differing perceptions of the relationship between population and national development reflect distinctive ideas about political authority, population policy, and family planning programs, about development, and about domestic and international political affairs. Local suspicions about the Nigerian population policy and family planning programs suggest that they cannot be implemented in isolation from broader political and economic concerns. This distrust has ramifications for current family planning programs and reproductive health initiatives undertaken by Western-sponsored aid projects.

Adolescent↗
PubMed1979

The effects of a pesticide program on microbial populations from apple leaf litter.

The leaf litter microbial community was quantitatively and qualitatively changed when a standard pesticide schedule that comprised an insecticide, a bactericide, and a fungicide was applied to McIntosh apple trees in the summer. Effects were observed for two winters by four indirect assays and three direct methods. Populations were altered qualitatively both years, but the most striking difference was the quantitative impact from year to year. Bacteria, filamentous fungi, and yeasts from treated leaves were reduced 10- to 10 000-fold between November 1976 and April 1977 and did not recover until snow cover had melted in March. Reductions in 1977-1978 were negligible. The marked seasonal difference is attributed to meteorological influences. Fluorescent pseudomonads were among the bacteria depressed by chemicals. Of the 49 genera of fungi and yeasts isolated, Coniothyrium sp., Penicillium spp., Arthrobotrys spp., and Nodulisporium sp. were appreciably reduced, whereas Typhula spp., Pleurophomella sp., Sporobolomyces spp., and Rhodotorula spp. were substantially enhanced by the spray program.

Azinphosmethyl↗
PubMed1978

[How can the largest possible number of people be reached by a prophylaxis program in a country with a scattered population?].

Two prophylactic programs are described suited to Icelandic conditions: a basic program for the majority of children and youth, and an additional program for individuals who have unusually high caries activities, -called the risk-group. The basic program consists of a) information distributed to groups on diets, including a restricted use of carbohydrates, b) instructions in dental hygiene, c) regular use of fluoride in the form of mouth-wash or tooth-brushing with a fluoride-solution. The additional program aims at individual motivation, explanation of cause and effect and intensive fluorideutilization.

Feeding Behavior↗
PubMed2002

Complication rates and risk factors of 5802 transrectal ultrasound-guided sextant biopsies of the prostate within a population-based screening program.

OBJECTIVES: To evaluate the complication rates and possible risk factors of biopsy of the prostate, with the aim of improving patient counseling and the safety of the procedure. Biopsy of the prostate has to be a relatively safe procedure and the participants have to be well informed about the possible complications. METHODS: Within the biopsy protocol of the Rotterdam section of the European Randomized Study of Screening for Prostate Cancer, we evaluated 5802 transrectal ultrasound-guided systematic sextant biopsies. All participants received prophylactic antibiotic therapy. RESULTS: We performed 5802 biopsies. Hematuria lasting longer than 3 days and hematospermia were present after 22.6% and 50.4% of the procedures, respectively. More severe complications were far less frequent. Two hundred participants (3.5%) developed fever after biopsy. Urinary retention was seen 20 times (0.4%), and hospitalization was needed in 27 cases (0.5%). Twenty-five of these men were admitted because of signs of prostatitis and/or urosepsis. Risk factor analyses revealed that an earlier episode of prostatitis was significantly associated with hospital admission and pain after biopsy. Characteristics of prostatic hyperplasia, such as prostate volume, transition zone volume/total prostate volume ratio, and a higher International Prostate Symptom Score, were all predictors of urinary retention. CONCLUSIONS: Minor complications are frequently seen but major complications are rare after prostate biopsy. Assessment of the risk factors before biopsy can help to improve the adequacy of counseling, and precautionary measures can be taken to minimize the risk of complications after the procedure. Transrectal ultrasound-guided sextant biopsy remains a safe procedure for the diagnosis of prostate cancer within the general population.

Aged↗
PubMed1989

Cytometric characterization and clinical course of breast cancer diagnosed in a population-based screening program.

A randomized controlled trial evaluating mammographic screening was started in two Swedish counties in 1977. In one of these, Ostergötland county, the authors performed static cytofluorometry on 161 cancers detected at the second and third screening rounds, 50 interval cancers, and 219 cancers appearing in the nonscreened control group during the same time period. The median follow-up time was 42 months. No difference in mean S-phase was found between screening and control group cancers, but interval cancers, appearing between two screenings, had increased mean S-phase levels (P = 0.01) compared to both of the other groups. A high S-phase fraction was associated with distant recurrence in both node-negative and node-positive tumors. Aneuploid tumors were more often found in the control group (67%) and among interval cancers (72%) than among screening detected cancers (55%, P = 0.02). In Cox's multivariate analysis, including all patients, the lymph node status, tumor size, estrogen receptor content, and S-phase all contributed independent prognostic information about the clinical course. DNA ploidy predicted the outcome in simple but not in multivariate Cox's analysis. When analyzing screening-detected cancers separately, only the S-phase significantly predicted distant recurrence in multivariate analysis. In tumors with local recurrence, a high S-phase implicated an increased, although not statistically significant, risk for distant recurrence. Survival with metastatic disease was significantly influenced by the S-phase level (P = 0.002). The authors conclude that S-phase fraction provides valuable kinetic information related to the clinical outcome for all stages of the disease and serves as a prognostic factor in screened populations, which have tumors predominantly in early stages.

Adult↗
PubMed1997

[The effects of a cardiac rehabilitation program on 2 populations of coronary patients: acute myocardial infarct and coronary bypass surgery].

UNLABELLED: Cardiac rehabilitation programmes (CRP) have proven beneficial in coronary heart disease. The purpose of this study was to evaluate the effects of our CRP on two coronary heart disease populations: after acute myocardial infarction (AMI-CRP) and after coronary artery bypass surgery (CABG-CRP). Results were compared to control groups (AMI-C and CABG-C). POPULATION: Group AMI-CRP: n = 43 patients, mean age = 48.7 +/- 9.8 years; Group AMI-C: n = 20 patients, mean age = 59.2 +/- 11.5 years; Group CABG-CRP: n = 54 patients, mean age = 54.9 +/- 9.7 years; Group CABG-C: n = 20 patients, mean age = 56.5 +/- 9.9 years. All patients are male and there were no significant differences in ventricular function and coronary disease severity. Parameters were evaluated in the AMI groups at discharge, 3 and 12 months after acute episode; in the CABG groups 3 and 12 months after surgery. RESULTS: Both CRP groups improved their exercise capacity (significantly improved the peak values of METs and double product). A favorable lipid profile change (total cholesterol and HDL) was induced in the CABG-CRP group and more significant in the AMI-CRP group. No significant differences were observed in obesity indexes (body weight and BMI > or = 27.8 Kg/m2). A increase in nonsmokers was important in all groups. Professional reintegration was 91.7% in the AMI-CRP group and 84.4% in the CABG-CRP group. The CRP groups showed a better knowledge of the disease, and a beneficial change in relation to themselves and the world that resulted in a decrease in depression and anxiety. CONCLUSIONS: Participation in our cardiac rehabilitation program, either after AMI or after CABG, improves cardio-respiratory fitness, favorably influences blood lipid profiles, and improves self-reliance and quality of life.

Adult↗
PubMed1984

PHARM--an interactive graphic program for individual and population pharmacokinetic parameter estimation.

This paper describes a new computer program PHARM to estimate individual or population pharmacokinetic parameters in nonlinear models. PHARM is an interactive program which uses graphic facilities to display data and results. The structural model can be defined using differential or integrated equations. The user can also define an error model associated with experimental data. The nonlinear mixed effect model is used to estimate the mean population parameters and their interindividual variability. The maximum likelihood and Bayesian criteria are used to estimate simultaneously the error and structural model parameters.

Computers↗
PubMed1999

Delivering prevention: the role of public programs in delivering care to high-risk populations.

A successful program of prevention or early detection should have a high level of population coverage and should ensure that high-risk populations are targeted. In practice, relatively little attention has been paid to the tendency toward greater use of preventive care by populations at lower risk, in other words, for higher use by the wealthy than by the poor. Current delivery patterns of preventive care raise questions as to how to organize these services more effectively. Physician-based delivery of preventive care in a fee-for-service system seems to result in Canadian patterns of use that are fairly similar to those found in the United States. Universal free insurance alone does not appear to be enough to counteract the failure to target preventive care toward the least-healthy groups. Appropriately-run Canadian provincial programs may be able both to expand coverage and to target high-risk populations. The population coverage for three measures directed toward prevention or early detection--childhood immunization (which in Manitoba has been offered through a long-standing provincial program), screening mammography (a new provincial program), and cervical cancer screening (no provincial program)-are compared using longitudinal administrative data from Manitoba. The discussion emphasizes the role of provincial programs and the possibilities for using population-based data to help provide cost-effective care to high-risk populations.

Adolescent↗
PubMed1992

The relationship between age and incidence of breast cancer. Population and screening program data.

Despite extensive study of breast cancer incidence, including specific studies of the relationship between age and breast cancer incidence, the picture remains confusing. This article examines not only the relationship between age and breast cancer, but also trends over time related to this relationship to discern the underlying true age-incidence pattern. The age-incidence curve changes around the menopausal period, most likely due to hormonal changes 10 to 15 years earlier, flattens out in the 40 to 50 year old age range, and then increases as age increases. Recent data showing decreased risk of breast cancer incidence at older ages, e.g., older than 75 years of age, relative to younger ages, are likely an artifact of recent increases in breast cancer screening in the United States. This picture is consistent with increases in screening and with notions of lead time created by increased screening. The increase in screening that has changed the age-incidence relationship may eventually deliver benefits to United States women in terms of mortality deficits, but this is not guaranteed unless screening becomes routine practice and high-quality therapeutic intervention and follow-up occurs as well.

Age Factors↗