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PubMed1981

Screening for hypertension in an elderly population: report from the Dunedin Program.

Hypertension detection and follow-up programs have recently received increased attention. The authors studied the effect of screening for hypertension in a geriatric screening program for a large ambulatory elderly population in Dunedin, Florida, over a three-year period. Of the 4,247 participants initially screened, 39 percent had some form of hypertension, and 15.6 percent of these had not received any form of treatment. At the time of the first year follow-up, the proportion of participants with treated, controlled hypertension had increased from 14.7 to 21 percent. These data lend support to the value of hypertension screening among persons over 65 years of age.

Aged↗
PubMed2004

[A qualitative approach to nutritional programs for low-income populations].

This paper, based on a qualitative social research methodology, aims to analyze two nutritional programs through the users' perceptions. The study population consisted of frequent versus infrequent users of the program to identify similarities and differences and grasp various perspectives towards the phenomenon. Two main themes appeared in the discourse analysis: "routine functioning (of the program)" and "program user status". These themes gave rise to different categories demonstrating an association between the respective programs and poverty, as well as feelings related to this status, such as resignation, humiliation, and embarrassment. The study highlights the need to consider subjective aspects that influence social experiences and provide the basis for individual uniqueness, so that an effective dialogue between government planners and the population can be achieved.

Government Programs↗
PubMed2001

Population pharmacokinetics of free carbamazepine in adult Omani epileptic patients.

OBJECTIVE: The aim of this study was to define the pharmacokinetic profile of free carbamazepine (F-CBZ) in adult Omani epileptic patients in order to improve on dosing schedules through population pharmacokinetic analysis using the NONMEM program. METHOD: Steady-state trough F-CBZ serum concentrations, carbamazepine (CBZ) dosing history and associated information were collected prospectively. RESULTS: Forty-eight patients with two or more available F-CBZ serum concentrations (total of 149 dose/serum concentration pairs) met our inclusion criteria. Patients were taking CBZ (200-1200 mg/day) in monotherapy. The analysis assumed a one-compartmental open model with first-order absorption and elimination. The apparent clearance (CL/F) and apparent volume of distribution (V/F) and their interindividual variabilities were estimated using the program. The population estimates for clearance (CL; modelled independently of dose) and volume of distribution were 13.2 +/- 0.6 l/h and 525 +/- 44 1, respectively. However, CL increased as a function of dosing rate and consequently was modelled as a linear function of steady-state concentration. In order to validate these results, the predictions of the population model were tested against data from 13 further patients subjected to the same inclusion criteria but who were not included in the original analysis. The predictions were good, being unbiased (P=0.31), and had an average deviation from the observed values of 18%. CONCLUSION: In order to establish steady-state dosage regimens, a population pharmacokinetic model is proposed, based on the patient's dose, to estimate the individual CL for an Omani epileptic patient receiving CBZ in monotherapy.

Adult↗
PubMed1994

Development of species-specific enzyme-linked immunosorbent assay for diagnosis of Johne's disease in cattle.

The previously described (M. De Kesel, P. Gilot, M.-C. Misonne, M. Coene, and C. Cocito, J. Clin. Microbiol., 31:947-954, 1993) a362 recombinant polypeptide of Mycobacterium paratuberculosis was used as reagent for an enzyme-linked immunosorbent assay (ELISA). This ELISA, which is endowed with species specificity with respect to the other mycobacteria, was applied to the analysis of bovine paratuberculosis (Johne's disease), an endemic mycobacteriosis of cattle caused by M. paratuberculosis. The distribution of anti-a362 antibodies in the cattle population was analyzed by a computer program (mixture population model) to determine a cutoff value for the test. The prevalence of a362 seropositivity in the Belgian bovine population was estimated to be 12%. The sensitivity of the a362 assay was 70%, as determined with reference sera from the U.S. National Repository of Paratuberculosis Specimens. Some 40% of the animals in the herds with paratuberculosis analyzed were found to be positive by the a362 assay. The latter proved to be 95% specific with respect to both healthy and tuberculous cattle.

Animals↗
PubMed1990

Practice of early diagnosis of breast and uterine cervix cancer in a northern Italian town.

We studied the practice of screening for breast and uterine cervix cancer in Torino where, currently, no kind of organized program exists and two projects of population screening programs, based on pap smear and mammography, have been developed. Fifty-two percent (95% confidence limits (C.L.): 47%-58%) of women 18-69 years old had had a pap test or colposcopy in the absence of symptoms during their lifetime. Among them 50% had had their last pap test within 18 months of the interview, 77% within 3 and 1/2 years, and only 14% was screened 5 and 1/2 years before or earlier. Thirty percent of never-screened women (95% C.L.: 25-35%) would not accept any of the proposed modalities for screening. Overall, 15% of women had had a mammography for screening purposes. Among women 50 to 59 years old, 23% (95% C.L.: 17-30%) had had at least one mammography for screening purposes in their lifetime, but only 18% (95% C.L.: 13-24%) had had at least 1 screening test at age 50 or after. Half of ever-screened women age 50-69 years had had the last mammography within 2 and 1/2 years. Among all respondents in the same age group this figure was 11% (95% C.L.: 7-15%). Forty-one percent of respondents reported to currently practice BSE (95% C.L.: 36-45%), but this proportion dropped to 10% in the age group 19-39 years and to 4% among women 40-69 years old when only those who had 10-13 examinations each year and judged their performance to be good were considered. Thirty-nine percent (95% C.L.: 34-44%) had had a physical examination of the breast performed by a medical doctor in the absence of symptoms within the last 18 months. Thirty-five percent (95% C.L.: 31-38%) of all women had never had a mammography, did not practice BSE, and had never consulted a physician for control in the absence of symptoms. Analysis by age, birth cohort, education, marital status and place of birth is presented.

Adolescent↗
PubMed2003

Utilisation of outpatient cardiac rehabilitation in Queensland.

OBJECTIVES: To determine patient participation rates in outpatient cardiac rehabilitation (OCR) programs; ascertain the barriers to participation; and evaluate the quality of OCR programs. DESIGN AND SETTING: Retrospective cohort study of patient separations from selected public and private Queensland hospitals; questionnaire survey of hospitals and all registered OCR programs. PARTICIPANTS: Patients discharged with cardiac diagnoses between 1 July 1999 and 30 June 2000 from 31 hospitals (24 public; 7 private). MAIN OUTCOME MEASURES: Rates of referral of hospitalised patients to OCR programs; rates of program attendance and completion; barriers to OCR referral and attendance. RESULTS: 15 186 patients were discharged with cardiac diagnoses from participating hospitals, of whom 4346 (29%) were referred to an OCR program after discharge, compared with an estimated 59% (8895/15 186) of patients who were eligible for such a program. Proportionately more patients were referred from secondary (38% [1720/4500]) and private (52% [2116/4031]; P < 0.001) hospitals than from tertiary (25% [2626/10 686]) and public (20% [2230/11 155]) hospitals. Patients undergoing coronary revascularisation procedures comprised 35% of discharges, but accounted for 56% of all program attendances. Fewer than a third of all referred patients completed OCR programs, and only 39% of available OCR program places were fully utilised. Catchment populations of programs with unused places had excess coronary mortality. CONCLUSION: There is significant underutilisation of facility-based OCR programs in Queensland. Procedures are required for identifying and referring eligible patients to existing programs and improving program compliance. Alternative OCR models are also required.

Aged↗
PubMed2001

[Population pharmacokinetic model for gentamycin and its predictive value].

AIM: To construct a population pharmacokinetic model to describe gentamycin concentrations in serum in newborn infants and to validate the predictive ability of this model. METHODS: Data used in this study were obtained from 30 neonates with 80 serum samples. A one-compartment open model was used to describe the kinetics of gentamycin after intravenous infusion. Following Sheiner's idea of population pharmacokinetics, a programs to estimate population parameter and individual parameter of gentamycin was made. The target function minimality was obtained from Monte Carlo algorithm. The predictive ability of the developed model was evaluated by computing precision and accuracy of serum concentration predicted using the parameter estimates. RESULTS: Fitted population pharmacokinetic parameters (mean +/- standard deviation) were as follows: Ke: 0.220 +/- 0.022 h-1, Vd: 0.51 +/- 0.06 L.kg-1, Cl: 112 +/- 10 mL.h-1.kg-1. For the population analysis sample and the predictive sample, predicted and observed concentrations were all close with correlation coefficient 0.920 and 0.946, respectively. Mean prediction error (ME) and root mean squared error (RMSE) were 0.001 mg.L-1 and 0.84 mg.L-1 for the predictive sample, respectively. CONCLUSION: Observed gentamycin serum concentrations were explained very well by this model. We propose the use of this population pharmacokinetic model to optimize gentamycin clinical therapies in our institution and others with similar patient population characteristics.

Anti-Bacterial Agents↗
PubMed1989

Clinical-epidemiologic assessment of pattern of birth defects associated with human teratogens: application to diabetic embryopathy.

The concepts of sensitivity, specificity, and predictive value can be used to assess patterns of birth defects associated with human teratogens. Although sensitivity of any single defect is generally low for many known teratogens, the presence of specific defect combinations is usually predictive of the teratogen. To evaluate the patterns of birth defects associated with diabetic embryopathy, a sensitivity-specificity analysis was performed on 4929 infants with major defects ascertained by the population-based Metropolitan Atlanta Congenital Defects Program between 1968 and 1980. By reviewing hospital records, maternal insulin-dependent diabetes mellitus was confirmed in 26 infants. Patterns of defects were evaluated among infants born to mothers with insulin-dependent diabetes mellitus and compared with the rest of the Metropolitan Atlanta Congenital Defects Program case population. Multiple logistic regression analysis was used to assess defect combinations that predict for insulin-dependent diabetes mellitus. Of 26 infants, 8 had multiple defects. However, most defects and their combinations were poorly sensitive and predictive for insulin-dependent diabetes mellitus. The predictive value for insulin-dependent diabetes mellitus was greatest for the combination of vertebral and cardiovascular anomalies (6.5%). Also, several pathogenetic mechanisms were noted among patients with insulin-dependent diabetes mellitus, such as cell migration defects, cell death events, deformations, and cardiac flow lesions. The inability to find a clear-cut phenotype for diabetic embryopathy may be due to several etiologic factors and mechanisms associated with diabetic embryopathy.

Abnormalities, Drug-Induced↗
PubMed1998

Rates of tuberculosis infection in healthcare workers providing services to HIV-infected populations. Terry Beirn Community Programs for Clinical Research on AIDS.

OBJECTIVE: To assess the prevalence of tuberculosis (TB) or a positive skin test in healthcare workers (HCWs) providing services to human immunodeficiency virus (HIV)-infected individuals and to determine prospectively the incidence of new infections in this population. DESIGN: This prospective cohort study enrolled 1,014 HCWs working with HIV-infected populations from 10 metropolitan areas. Purified protein derivative (PPD) tuberculin skin tests were placed at baseline and every 6 months afterwards on those without a history of TB or a positive PPD. Demographic, occupational, and TB exposure data also were collected. SETTING: Outpatient clinics, hospitals, private practice offices, and drug treatment programs providing HIV-related healthcare and research programs. PARTICIPANTS: A voluntary sample of staff and volunteers from 16 Community Programs for Clinical Research on AIDS units. RESULTS: Factors related to prior TB or a positive skin test at baseline included being foreign-born, increased length of time in health care, living in New York City, or previous bacille Calmette-Guerin vaccination. The rate of PPD conversion was 1.8 per 100 person years of follow-up. No independent relation was found between the amount or type of contact with HIV-infected populations and the risk of TB infection. CONCLUSION: These data provide some reassurance that caring for HIV-infected patients is not related to an increased rate of TB infection among HCWs in these settings.

AIDS-Related Opportunistic Infections↗
PubMed2006

The impact of public insurance expansions on children's access and use of care.

OBJECTIVE: Our goal was to examine the impact of the State Children's Health Insurance Program nationally on children's access and use of health care. OBJECTIVE: Our data source was the National Health Interview Survey, using 1997 as a baseline, which predates the implementation of the State Children's Health Insurance Program, and 2003 as the end point of the analysis. We analyzed 25,734 children aged 0 to 18 years (1997 and 2003 combined) to examine changes in health insurance coverage rates, health care access, and utilization for children in the State Children's Health Insurance Program target population, defined here as those living in families with incomes between 100% and 199% of the federal poverty level. RESULTS: Children in the State Children's Health Insurance Program target income group showed the largest reduction in rates of uninsurance among 3 income groups (< 100%, 100%-199%, and > or = 200% of the federal poverty level) between 1997 and 2003 (15.1%-8.7%). Significant reductions occurred in the proportion of children without a usual source of care in the target income group (9.4%-7.3%) and in the proportion of children without a provider visit in the past year (10.8%-9.8%). Other measures (unmet needs, delayed care, volume of provider visits, receipt of well-child care, and dental care) showed no significant changes over this time period. A separate multivariate analysis restricted to the State Children's Health Insurance Program target population in 2003 showed that children with continuous public coverage had significantly better access and utilization on all measures studied when compared with uninsured children and performed as well or better than children with continuous private coverage. CONCLUSIONS: Implementation of the State Children's Health Insurance Program is associated with substantial gains in public coverage for children in the target income group. Although some of these gains were offset by losses in private coverage, our findings demonstrate that public health insurance provides significant benefits in terms of access and utilization for children living in the target income group.

Adolescent↗
PubMed2005

Economic evaluation of vaccination against influenza in the elderly: an experience from a population-based influenza vaccination program in Taiwan.

Due to viral strains, influenza season, and consultations and admission rates varying from country to country, the continued economic evaluation of influenza vaccination for the elderly people aged 65 years and above is paramount, particularly in areas with dense population. Efficacy and cost-effective analysis of influenza vaccination in reducing all-cause mortality and hospitalization was therefore elucidated based on a prospective and population-based study targeted to 226,997 elderly people aged 65 years and above residing in Taipei county, Taiwan between 1 October 2000 and 31 March 2001. Vaccination against influenza for the elderly persons can lead to a 29% (95% CI: 23-35%) significant reduction of all-cause deaths. Approximately, 20% (95% CI: 9-30%) significant reduction in hospitalization was observed for average-risk group but 4% (95% CI: -4-11%) non-significant reduction for high-risk group. Community-based influenza vaccination program for elderly people aged 65 years and above was demonstrated to be effective in reducing mortality in all elderly people but not significantly in reducing hospitalization. Universal vaccination program for the elderly people seems cost-effective in averting death or gaining life years.

Aged↗
PubMed2006

Is family history of premature cardiovascular diseases appropriate for detection of dyslipidemic children in population-based preventive medicine programs? CASPIAN study.

The objectives of this study were to determine the prevalence of dyslipidemia and the usefulness of self-report family history (FH) of premature cardiovascular disease (CVD) for identifying children with lipid disorders. This study was conducted on a representative, population-based sample of 4811 Iranian children and adolescents (2248 boys and 2563 girls) aged 6-18 years. We compared the obtained serum lipid profile with that of the Lipid Research Clinic (LRC) and calculated the predictive value of FH for detecting those children with dyslipidemia.Overall, for both genders and for age groups, the mean serum triglycerides (TG) and its percentiles were significantly higher, and the mean and percentiles of total, low-density, and high-density cholesterol (TC, LDL-C, and HDL-C respectively) were significantly lower than the LRC values. In total, 45.7% of participants had dyslipidemia; the most frequent ones were low HDL-C (24.8%) and hypertriglyceridemia (24.5%), followed by hypercholesterolemia (6.4%) and high LDL-C (6.3%), respectively. The mean serum lipid levels and the anthropometric measures were not significantly different among those with or without positive FH. The sensitivity, and specificity, positive and negative predictive values for FH in detecting those children with dyslipidemia were 28.4, 70.3. 44.7, and 53.8%, respectively. The usefulness of FH in identifying dyslipidemic children was relatively low. The common lipid disorders in our community were the components of the metabolic syndrome. We suggest that the current guidelines for screening lipid disorders in youths, which are based on cholesterol, should consider such ethnic differences.

Adolescent↗
PubMed1989

Screening using National Cholesterol Education Program guidelines in a population of urban Hispanic mothers.

We measured serum total cholesterol, high-density lipoprotein cholesterol, and triglycerides and calculated low-density lipoprotein cholesterol in 217 urban Hispanic mothers. On the basis of total cholesterol values, as recommended by the Expert Panel of the National Cholesterol Education Program, 6 subjects (2.8%) had high blood cholesterol (greater than or equal to 240 mg/dl), 27 (12.4%) had borderline-high blood cholesterol (200-239 mg/dl), and 184 (84.8%) had desirable blood cholesterol (less than 200 mg/dl). One of the 27 with borderline-high total cholesterol had two other coronary risk factors. Thus 7 of the 217 (3.2%, 95% confidence interval 1.4 to 6.8%) met Expert Panel criteria for lipoprotein measurement. Six of the seven had high-risk low-density lipoprotein cholesterol (greater than or equal to 160 mg/dl). Four additional subjects with borderline-high total cholesterol, not identified by this sequential screening strategy, also had high-risk low-density lipoprotein cholesterol. Thus a total of 10 of 217 (4.6%, 95% confidence interval 2.4 to 8.6%) met Expert Panel criteria for high-risk low-density lipoprotein cholesterol and initiation of cholesterol-lowering treatment. None of these 10 had been previously identified as having high-risk low-density lipoprotein cholesterol. Two years later subjects with high or borderline-high total cholesterol were rescreened. Seven of 22 subjects completing the second screening were classified differently with regard to having high-risk low-density lipoprotein cholesterol, illustrating the potential for misclassification of individuals on the basis of a single measurement. The prevalence of women with high-risk low-density lipoprotein cholesterol was not significantly different at the two screenings.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2000

Early programming of T cell populations responding to bacterial infection.

The duration of infection and the quantity of Ag presented in vivo are commonly assumed to influence, if not determine, the magnitude of T cell responses. Although the cessation of in vivo T cell expansion coincides with bacterial clearance in mice infected with Listeria monocytogenes, closer analysis suggests that control of T cell expansion and contraction is more complex. In this report, we show that the magnitude and kinetics of Ag-specific T cell responses are determined during the first day of bacterial infection. Expansion of Ag-specific T lymphocyte populations and generation of T cell memory are independent of the duration and severity of in vivo bacterial infection. Our studies indicate that the Ag-specific T cell response to L. monocytogenes is programmed before the peak of the innate inflammatory response and in vivo bacterial replication.

Adoptive Transfer↗
PubMed1994

[Intervention with community health agents in immunization programs in the gypsy population].

OBJECTIVE: To measure how the vaccination coverage of the Gypsy child population in the Cartuja and Almanjayar quarters evolved throughout a Health Education Intervention using Community Health workers belonging to the Gypsy community. DESIGN: A descriptive study, pre-test/post-test, with no control group. SETTING: Community level. Primary Care. PATIENTS AND OTHER PARTICIPANTS: The whole of the Gypsy child population under 14, consisting of 1,073 children, and four Community Health workers. INTERVENTIONS: Health Education for mothers and carers, by means of home visits carried out by four Health workers, previously trained and contracted for this purpose for a year by the Andalusian School of Public Health. MEASUREMENTS AND MAIN RESULTS: We measured the Vaccination Coverage in September 1988 (42.2%) in order to establish the situation both at the start of the intervention in March 1990 (46.2%) and at its end in March 1991 (68.2%). We measured Vaccination Coverage of the different vaccine doses through frequency allocations. CONCLUSIONS: The Health Centre increased Vaccination Coverage by 4% in 18 months. The intervention increased it by 22.2% in 12 months. This demonstrates the intervention's effectiveness and underlines the importance of carrying out this kind of intervention when working with at-risk population groups.

Adolescent↗