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PubMed1994

Screening with total cholesterol: determining sensitivity and specificity of the National Cholesterol Education Program's guidelines from a population survey.

The objective of the study was to determine the sensitivity and specificity of the National Cholesterol Education Program (NCEP) guidelines in identifying at-risk individuals for hypercholesterolemia, using population-based data from the Manitoba Heart Health Survey (MHHS). The MHHS surveyed a representative sample of adult residents of the province of Manitoba, Canada, aged 18-74 (n = 2792), 2212 of whom underwent complete lipoprotein analyses: total cholesterol (TC), high-density (HDL) and low-density (LDL) lipoprotein cholesterol, and triglycerides (TG) after overnight fasting. Following NCEP criteria for risk categories, 618 individuals could be considered as "at risk" based on their HDL and/or LDL levels. However, if the NCEP algorithms were followed, i.e. initial screen for TC only, and determination of HDL and LDL for selected individuals with borderline and high TC, only 438 of the total "at risk" individuals would have been identified (sensitivity = 71%). 1203 of 1594 individuals with acceptable HDL and LDL levels were not considered "at risk" on screening (specificity = 76%). If "at risk" status was determined solely on LDL criteria, the NCEP guidelines result in a higher sensitivity (94%) and comparable specificity (76%). However, when only HDL criteria were used, the sensitivity and specificity declined to 38% and 63% respectively. Compared to a simulated screening study based on the Lipid Research Clinic data reported by Bush and Riedel (1991) the estimates of sensitivity from the MHHS were high. Current NCEP guidelines appear to balance optimally the sensitivity and specificity for selecting individuals based on TC levels for further complete lipoprotein analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2000

Health promotion in the city: a structured review of the literature on interventions to prevent heart disease, substance abuse, violence and HIV infection in US metropolitan areas, 1980-1995.

To achieve its national public health goals, the US must improve the health of low-income urban populations. To contribute to this process, this study reviewed published reports of health promotion interventions designed to prevent heart disease, HIV infection, substance abuse, and violence in US cities. The study's objectives were to describe the target populations, settings, and program characteristics of these interventions and to assess the extent to which these programs followed accepted principles for health promotion. Investigators searched five computerized databases and references of selected articles for articles published in peer-reviewed journals between 1980 and 1995. Selected articles listed as a main goal primary prevention of one of four index conditions; were carried out within a US city; included sufficient information to characterize the intervention; and organized at least 25% of its activities within a community setting. In general, programs reached a diverse population of low-income city residents in a variety of settings, employed multiple strategies, and recognized at least some of the principles of effective health promotion. Most programs reported a systematic evaluation. However, many programs did not involve participants in planning, intervene to change underlying social causes, last more than a year, or tailor for the subpopulations they targeted, limiting their potential effectiveness. Few programs addressed the unique characteristics of urban communities.

HIV Infections↗
PubMed1997

A clinical study of a cardiac rehabilitation program (phase II).

Little has been published concerning the practice of cardiac rehabilitation in Puerto Rico. The purpose of this paper was to study and analyze the clinical data collected at the Cardiac Rehabilitation Program Phase II, in order to determine how adequate has been this program in its population. It was intended in this clinical study to determine the characteristics that describe the cardiac population which enters a cardiac rehabilitation program in Puerto Rico. Also, it was the purpose of this study to compare the initial and final evaluation of the patients that completed the program. Seventy-one patients were evaluated and 17 of them finished the whole program. The general population had a low level of daily physical activity, vital capacity, low back and hamstring flexibility, and a high percent of body fat. The group that completed the program showed significant increase in low back and hamstring flexibility, vital capacity and estimated daily energy expenditure. Low density lipoprotein and estimated daily resting energy expenditure significantly decreased; the patients were more active and resting less at the end of the program. This data suggest that the patients evaluated present various risk factors of coronary disease that might predispose to a second cardiac or surgical event, or progression of the disease. Also, these results suggest that this program might help in improving the risk factors related to health related fitness and physical inactivity.

Adult↗
PubMed2005

[Implementation of State Policy in healthy nutrition of the population of the Russian Federation on the regional level: building-up regional policy and programs. Methodical aspects of development and implementation. Part 2. Recommendations were made development and realization of regional policy and programs in the healthy nutrition of the population].

Recommendations were made development and realization of regional policy and programs in the healthy nutrition of the population.

Food Supply↗
PubMed2005

Admixture mapping for hypertension loci with genome-scan markers.

Identification of genetic variants that contribute to risk of hypertension is challenging. As a complement to linkage and candidate gene association studies, we carried out admixture mapping using genome-scan microsatellite markers among the African American participants in the US National Heart, Lung, and Blood Institute's Family Blood Pressure Program. This population was assumed to have experienced recent admixture from ancestral groups originating in Africa and Europe. We used a set of unrelated individuals from Nigeria to represent the African ancestral population and used the European Americans in the Family Blood Pressure Program to provide estimates of allele frequencies for the European ancestors. We genotyped a common set of 269 microsatellite markers in the three groups at the same laboratory. The distribution of marker location-specific African ancestry, based on multipoint analysis, was shifted upward in hypertensive cases versus normotensive controls, consistent with linkage to genes conferring susceptibility. This shift was largely due to a small number of loci, including five adjacent markers on chromosome 6q and two on chromosome 21q. These results suggest that chromosome 6q24 and 21q21 may contain genes influencing risk of hypertension in African Americans.

Black People↗
PubMed2000

Herd characteristics and management practices associated with bulk-tank somatic cell counts in herds in official Dairy Herd Improvement Association programs in Ohio.

OBJECTIVE: To identify herd characteristics and management practices associated with bulk-tank somatic cell counts (BTSCC) in dairy herds in Ohio enrolled in official Dairy Herd Improvement Association (DHIA) programs. SAMPLE POPULATION: 186 dairies in Ohio. PROCEDURE: All herds in official DHIA programs in 9 counties were asked to participate. Extensive information regarding herd characteristics and management practices was obtained, using a standardized questionnaire. Bulk-tank milk samples were requested from all participating herds for bacterial culture. Official DHIA test-day records for January 1997 were obtained from all herds enrolled in official DHIA programs in the 9 counties. Potential associations were identified, using multivariable ANOVA. RESULTS: Participation was 186 of 479 (39%) herds. Streptococcus agalactiae and Mycoplasma spp were not isolated from bulk-tank milk samples. Staphylococcus aureus was isolated from 64 of 172 (37%) of the herds. The BTSCC were inversely associated with peak daily milk production, postmilking teat disinfection, percentage of eligible cows in the herd detected in estrus, and directly related to the extent to which BTSCC was perceived as a herd problem during the preceding 2 years. Type of housing for nonlactating cows and product used for treatment of nonlactating cows also were significantly associated with BTSCC. CONCLUSIONS AND CLINICAL RELEVANCE: Consideration of herd characteristics and implementation of management practices associated with BTSCC could result in increased milk yield and production of milk with lower BTSCC.

Animals↗
PubMed1994

Evolution of a computer program for classifying protein segments as transmembrane domains using genetic programming.

The recently-developed genetic programming paradigm is used to evolve a computer program to classify a given protein segment as being a transmembrane domain or non-transmembrane area of the protein. Genetic programming starts with a primordial ooze of randomly generated computer programs composed of available programmatic ingredients and then genetically breeds the population of programs using the Darwinian principle of survival of the fittest and an analog of the naturally occurring genetic operation of crossover (sexual recombination). Automatic function definition enables genetic programming to dynamically create subroutines dynamically during the run. Genetic programming is given a training set of differently-sized protein segments and their correct classification (but no biochemical knowledge, such as hydrophobicity values). Correlation is used as the fitness measure to drive the evolutionary process. The best genetically-evolved program achieves an out-of-sample correlation of 0.968 and an out-of-sample error rate of 1.6%. This error rate is better than that reported for four other algorithms reported at the First International Conference on Intelligent Systems for Molecular Biology. Our genetically evolved program is an instance of an algorithm discovered by an automated learning paradigm that is superior to that written by human investigators.

Amino Acid Sequence↗
PubMed2003

Case finding for HIV-positive youth: a special type of hidden population.

PURPOSE: To describe the HIV case finding strategies used by the Special Projects of National Significance (SPNS), Adolescent HIV Outreach and Treatment programs, the populations of youth they were able to reach, and the populations of HIV-positive youth they were able to identify. METHODS: Program specifications from five programs located in four major metropolitan centers were contrasted. Four of the programs also provided outcome data for HIV counseling and testing outcome numbers, demographic and risk profile data for youth who underwent HIV testing, and mode of infection of HIV-positive youth. RESULTS: The program outcomes were discussed in terms of similarities and differences in outreach methods (e.g., peer workers, time of outreach, etc.), geographic settings (i.e., mobile van, institutional settings, community locations), individual characteristics (e.g., pregnant women) and youth subcultures (i.e., gay/transgendered, incarcerated juveniles, homeless). CONCLUSIONS: Because HIV-positive adolescents will constitutionally remain a "hidden population," a great deal of time and effort will continue to need to go into the front end of outreach, counseling and testing. Specific guidance and recommendations for locating HIV-positive youth were provided to program designers for each type of outreach strategy.

AIDS Serodiagnosis↗
PubMed2006

Increasing access to clinical and educational studies.

In 2001, the National Cancer Institute (NCI) provided funds to support the Increasing Access to Clinical and Educational Studies (ACES) Project of the Thomas Jefferson University, Kimmel Cancer Center in Philadelphia. The ACES Project enabled the Center to engage in the systematic development of approaches for reducing cancer health disparities among African Americans in Philadelphia. This project brought together community partners, clinical partners, cancer prevention and control experts, and staff from an NCI-designated cancer center to develop and implement a community-based outreach education program, a special populations investigator (SPI) training program, and SPI pilot studies in cancer screening and clinical trials participation. At the end of 5 years, the ACES Project had 1) organized a steering committee, expert panel, and a network of community collaborators and clinical partners; 2) implemented a clinical trials education program for community-based nurses, lay health advocates active in community organizations, and health ministries in community churches; 3) mentored 4 SPIs in cancer prevention and control research; 4) completed SPI pilot studies; and 5) leveraged these activities to gain support for cancer health disparities related research. The Project established a successful dialogue between an NCI-designated cancer center and the African American population related to cancer research, and enabled SPIs from the community to adapt evidence-informed interventions for application in cancer prevention and control research. Lessons learned from the Project can guide the implementation of such projects in the future. Cancer 2006. (c) 2006 American Cancer Society.

Black or African American↗
PubMed2001

Hemochromatosis gene variants in three different ethnic populations: effects of admixture for screening programs.

Genetic testing for hemochromatosis may have important implications for diagnosis and screening of the disease. However, the relative importance of mutations in the gene for hereditary hemochromatosis, HFE, may vary among populations, when the mutant allele frequencies and their penetrance in a particular genetic and environmental background are taken into account. We present data on the allele and genotype frequencies and population structure of two HFE genetic variants in three different ethnic groups from a highly mixed urban population (São Paulo, Brazil). Allele frequencies for both the C282Y and H63D HFE mutations showed significant differences among the studied populations (for the C282Y mutation, Euro-Brazilian 3.7%, admixed 0.7%, Afro-Brazilian 0.5%; and for the H63D mutation, Euro-Brazilian 20.3%, admixed 13.0%, Afro-Brazilian 6.4). The data substantiate a European origin for these mutations. Furthermore, they provide a basis for a more rational strategic planning of population screening programs for the disease.

Analysis of Variance↗
PubMed1980

Common methods, different populations. The Lipid Research Clinics Program Prevalence Study.

The salient characteristics of the Lipid Research Clinics (LRC) Program Prevalence Study are presented, including an overview of its structure, the populations included and the common procedures used. Highlighted are the two sequential screening examinations that included 68,317 participants in 12 LRCs in the U.S. Canada and the U.S.S.R. for the first examination and 15,816 for the second. Several thousand more will be added as the thirteenth LRC completes its screening in Israel. Major data items are described briefly, as are data quality enhancement procedures. Procedures for plasma lipid determination, lipoprotein cholesterol, other clinical chemistries, nutritional intake assessment, and resting and stress electrocardiography are discussed. A discussion of the methodologic strengths and weaknesses of the findings of the LRC Program Prevalence Study is also included. This paper provides a frame of reference for the individual papers in this volume.

Adolescent↗
PubMed2005

Cost-effectiveness analysis of a kidney and cardiovascular disease treatment program in an Australian Aboriginal population.

The objective of the study was to assess, from a health service perspective, whether a systematic program to modify kidney and cardiovascular disease reduced the costs of treating end-stage kidney failure. The participants in the study were 1,800 aboriginal adults with hypertension, diabetes with microalbuminuria or overt albuminuria, and overt albuminuria, living on two islands in the Northern Territory of Australia during 1995 to 2000. Perindopril was the primary treatment agent, and other medications were also used to control blood pressure. Control of glucose and lipid levels were attempted, and health education was offered. Evaluation of program resource use and costs for follow-up periods was done at 3 and 4.7 years. On an intention-to-treat basis, the number of dialysis starts and dialysis-years avoided were estimated by comparing the fate of the treatment group with that of historical control subjects, matched for disease severity, who were followed in the before the treatment program began. For the first three years, an estimated 11.6 person-years of dialysis were avoided, and over 4.7 years, 27.7 person-years of dialysis were avoided. The net cost of the program was 1,210 dollars more per person per year than status quo care, and dialyses avoided gave net savings of 1.0 million dollars at 3 years and 3.4 million dollars at 4.6 years. The treatment program provided significant health benefit and impressive cost savings in dialysis avoided.

Adult↗
PubMed1997

A comparison of breast, colorectal, lung, and prostate cancers reported to the National Cancer Data Base and the Surveillance, Epidemiology, and End Results Program.

BACKGROUND: The National Cancer Data Base (NCDB) is an information resource and program evaluation tool of the American College of Surgeons Commission on Cancer and the American Cancer Society that uses a hospital-based cancer reporting system. The Surveillance, Epidemiology, and End Results (SEER) program is a population-based registry program of the National Cancer Institute. The purpose of this investigation was to compare the aggregate NCDB data for selected cancer types from a given year with comparable SEER data. METHODS: SEER data from 1992 on 18,322 breast, 13,427 colorectal, 15,276 lung, and 21,501 prostate cancers were compared with NCDB data on 96,323 breast, 69,456 colorectal, 108,702 lung, and 107,690 prostate cancers. RESULTS: Similar levels of data completeness were observed. The NCDB data tended to contain less complete information about the Spanish or Hispanic ethnicity of patients. Tumor grade data tended to be incomplete in both series. Stage information about lung and prostate cancer was more often missing in SEER data. Patient age, race, and gender in NCDB data differed little from corresponding SEER data, except that SEER data reported a greater proportion of patients in the "other" race category that included Asian-Americans and American Indians. Tumor laterality, anatomic site, tumor grade, and types of surgical treatment were similar in the NCDB and SEER data. Radical mastectomy was performed in 49.4% of SEER breast cancer cases compared with 49.2% of NCDB cases. Cancer-directed surgery was observed less often among SEER prostate cancer cases than among NCDB cases. The NCDB data also indicated greater use of radiation therapy than the SEER data for the four types of cancer reviewed. CONCLUSIONS: The 1992 NCDB data, in aggregate, described patient and disease treatment characteristics and patterns that differed only marginally from those described in the SEER data from the same year.

Adult↗
PubMedDate not supplied

Preschool vision screening for amblyopia and strabismus. Programs, methods, guidelines, 1983.

Amblyopia and strabismus, which afflict at least 5% of children, require treatment early in life for best visual results. At present, many such children are treated late or not at all. Mass screening at preschool age, and perhaps ultimately of infants, appears the only viable solution to this problem. To ascertain the present status of preschool screening in the United States, on-site visits, mail questionnaires and telephone interviews were used to study existing preschool vision screening programs at the federal, state and private organization levels. We estimate that, at most, 21% of preschool children receive any form of vision screening. Only two states, Michigan and Minnesota, have legislated requirements for such screening. Several organizations have attempted to establish screening guidelines, with suggestions of specific test and referral criteria. These guidelines are reviewed. The guidelines are of particular interest because screening programs following them typically indicate far lower prevalence rates than most studies indicate actually exist, suggesting that the guidelines result in underreferrals. In order to assess this matter, vision screening methods appropriate for preschoolers or infants, based on current evidence, are reviewed. Stereoscopic testing, utilizing a random dot stereogram format, appears the best instrument available for amblyopia and strabismus screening, but large scale comparative studies of the different test methods are needed to arrive at a final determination. Suggestions are made for the physician interested in initiating preschool vision screening programs.

Amblyopia↗