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PubMed1982

Preventive dental programs for school-age children in 8 countries: pilot survey, 1979.

This paper reports the results of a pilot project, sponsored by the FDI Working Group on Oral Health Promotion, which was designed to describe preventive dental programs for school-age children in 10 countries. A mail questionnaire was developed to obtain information about program philosophy, target population, preventive program components, promotion and educational methods, barriers to program development, program priorities and evaluation methods. In this pilot phase, a total of 27 questionnaires were returned from 8 countries (Argentina, Federal Republic of Germany, France, Japan, Singapore, Sweden, Thailand, United Kingdom). Respondents generally recognized the need to include three major program elements in order to build comprehensive programs, primary preventive measures, early detection and treatment services, and instructional activities for children and adults. Financial problems were cited most frequently as barriers to program development, followed by manpower, public acceptance, policy decisions, policy-maker attitudes, legal constraints and transportation. The domain of educational problems associated with initiating and maintaining children's preventive dental programs is broad and diverse. Educational problems, roles and methods seemed to be pervasive, cutting across all program components. Although the greatest educational emphasis appeared to be on oral hygiene, the need was also recognized to include educational components for each dental program element or service, such as fluoride rinsing. Educational needs related not only to children, but to policy-makers, dental and other health professionals and program and school personnel. The FDI Working Group has expanded the survey and collected data from a much larger number of countries during 1979-1981. Results of the larger survey will be presented at the Annual World Dental Congress of the FDI in Vienna, 1982.

Asia↗

PubMed1995

[Dental caries in a school population with a program of periodical rinses with sodium fluoride].

OBJECTIVE: To appraise the level of school-children's dental health after five years in operation of the buccal-dental health programme, in which children received fortnightly rinses of sodium fluoride at 0.2%. DESIGN: A crossover study. School survey of the 1993-4 academic year. PARTICIPANTS: A total of 1,674 school-children belonging to the first (6 years old), third (8), fifth (10) and eighth (13) years of EGB (basic) in the thirteen schools in this city. MEASUREMENTS AND MAIN RESULTS: Two odontologists checked the children according to the W.H.O. norms. The Index of individuals free of caries and the prevalence of caries were calculated. The first index showed its highest value at 10 (78.4%) and its lowest at 8 (53.34%). CAOD showed its lowest level at 6 years old (0.02%) and progressively rose to 13 (1.41). COD went up from 6 (0.96) to 8 (1.09) and afterwards went down till 13 years old (0.05). The restoration index was low in worn out teeth and particularly high in permanent ones (68.08%) at 13. CONCLUSIONS: The caries indexes are lower than in the majority of studies carried out in Spain, being most similar to a study carried out in the county of Mayorga de Campos (Valladolid) in 1988, where fluoridated water exists in a natural form (0.67-0.87 mg/litre), as well as to other areas in Catalonia where the same fluoride rinses were performed.

Adolescent↗

PubMed1996

Screening programs in the population at large and in high-risk groups.

Existing guidelines for colorectal cancer screening in standard risk patients are reviewed, as well as the data on which they are based. A family history of colorectal cancer or significant adenoma increases the risk above that of standard risk individuals. Risk assessment and surveillance in higher risk individuals are discussed.

Adenomatous Polyps↗

PubMedDate not supplied

The use and impact of incentives in population-based smoking cessation programs: a review.

PURPOSE: This review discusses current published literature on population-based smoking cessation interventions that involve incentives and examines whether such interventions are effective in reducing the prevalence of smoking. SEARCH METHOD: Studies published between 1975 and Spring 1997 were identified through a computerized search of four electronic databases (MEDLINE, HEALTH, CINAHL, and PSYCINFO) and reference lists of key articles using the following key words: (smoking cessation OR quit smoking) AND (contest OR competition OR incentive OR lottery OR quit and win). This search yielded 79 articles. To be included, studies had to be published in English and had to have presented either quit rates or participation rates for an incentive-based program that used population-based recruitment. Of the 79 articles, 17 met these criteria. FINDINGS: Population-based interventions generally attract 1 to 2% of the target population, but these participation rates can potentially be increased through the use of innovative recruitment techniques. No specific type of recruitment strategy was shown to be consistently more effective than others. There is no evidence that particular types of incentives are able to influence participation or quit rates, but the size of an incentive does appear to be important, with larger incentives viewed as more effectively motivating smokers to quit and stay smoke free than smaller ones. Estimates of the cost per quitter have ranged from less than $20 to over $400. There are some indications that the costs of such programs compare favorably with smoking cessation classes or clinic-based approaches. CONCLUSION: Incentive-based smoking cessation programs that target an entire community have the advantage of reaching a large and diverse group of smokers. They may, however, attract only smokers who are already motivated to quit. Realistically, incentive-based programs aimed at the general population can expect 1% of all their smokers to quit smoking. Quit rates among participants may initially be high (i.e., mean quit rate of 34% at 1-month follow-up) but decrease over time (i.e., mean rate of 23% at 1 year). The results of this review suggest a continued need to establish standard and valid criteria for the evaluation of smoking cessation interventions. Methodological differences among existing studies make them difficult to compare and interpret.

Canada↗

PubMedDate not supplied

The EPIGRAM computer program for analyzing mortality and population data sets.

EPIGRAM is a computer program designed to improve access to State-level underlying cause mortality data. The program produces results for population, deaths, death rate, age-adjusted death rate, years of potential life lost (YPLL), YPLL rate, and confidence intervals. Results can be compared variously among age groups, counties, causes of death, races, regions, and years. The program's menu-driven interface facilitates the selection or modification of analysis parameters. Current selections are retained so the user can modify one parameter at a time. Based on the parameters that the user selects, the program produces a series of tables, one for each instance of a particular parameter. Each output table has columns for male, female, and both sexes combined, and an indefinite number of user-defined rows for age groups, causes of death, counties, races, regions, or years. EPIGRAM has major advantages over other methods for analyzing mortality and population data. The program uses relatively small amounts of memory and disk space, executes rapidly, is flexible, can be used by inexperienced computer users, provides online help screens and tutorials, and runs under DOS or UNIX without modification. The program currently is used to analyze mortality and population data for Texas. Although it is not currently available for distribution, support is being sought for its evaluation and possible implementation in State health departments to analyze data for other States, or other data sets, such as hospital discharge data or cancer incidence data.

Cause of Death↗

PubMed1997

Factors related to non-attendance in a population based melanoma screening program.

A total of 127 non-attenders in a population-based melanoma screening program, 58 women and 69 men, were asked in a telephone interview about reasons for non-attendance. Of those, 105 also completed a mailed questionnaire, measuring perceived susceptibility to and knowledge about melanoma. During the same period, attenders (n = 286) at the screening clinic completed the same questionnaire. The most commonly reported reasons for non-attendance were 'I forgot about it', 'lack of time' and 'no need for examination'. A majority of non-attenders held a positive attitude towards preventive programs in general and to the present invitation. Most of the improvements suggested by the non-attenders were strategies to reduce practical barriers. Non-attenders scored lower than attenders on perceived susceptibility. High and equal levels of knowledge about melanoma were found among attenders and non-attenders. Men were more likely to be non-attenders. Higher perceived susceptibility and a higher level of knowledge about melanoma were found among women as compared to men. The results suggests that there is potential to increase attendance in future melanoma programs by reducing practical barriers.

Adult↗

PubMed1993

Two-year results of a randomized controlled trial of a health promotion program in a retiree population: the Bank of America Study.

OBJECTIVE: To evaluate the effectiveness of a health promotion program in a retiree population in terms of health risk reduction and reduction in medical costs. DESIGN: Randomized controlled trial. SUBJECTS: Bank of America retirees (n = 4,712), divided into 33 retiree club regions, were randomized into 3 groups and followed for 24 months by patient report and claims experience. Group 1, the intervention group, received a low-cost ($30/year), individualized, serially reinforcing health promotion program including risk appraisal, recommendation letters, and self-management materials, delivered entirely through the mail. Group 2 received risk appraisals only, without feedback, for the first 12 months and subsequently the full intervention for the second 12 months. Group 3 was followed with claims data only. Participation rates of 57% at 1 year and 47% at 2 years were achieved. MAIN RESULTS: Overall health risk scores improved by 12% at 12 months compared with control (p < 0.001) and by 23% (from baseline) at 24 months (p < 0.001). Individual health habit changes were favorable for all parameters studied, and were highly statistically significant for most variables. Similar health risk reductions were seen in age groups of 55 to 65 years, 65 to 75 years, and over 75. Cost reduction differences were more than 20% by self-report (p < 0.01) and 10% by claims experience (p = 0.02) at 12 months. For the randomized controlled period of the first 12 months, reductions averaged $164 in the intervention group contrasted with an average increase of $15 in the combined control groups. CONCLUSION: Risk reduction programs directed at retiree populations can improve health risk status and can reduce costs.

Age Factors↗

PubMed1992

Negative predictive value of a population-based preschool vision screening program.

BACKGROUND: The Enhanced Vision Screening Program is a population-based vision screening program that has, at present, examined 59,782 children. Its main goal is to detect amblyopia, strabismus, and high refractive errors. An average of 11,910 4 1/2- to 5 1/2-year-old children are screened yearly. The current study determines the negative predictive value of the screening program: For a subject having passed the vision screening test, what is the probability of not having amblyopia, strabismus, or high refractive errors? METHODS: Of the 11,734 subjects who passed the vision screening, 200 were randomly chosen to undergo a strictly defined gold standard examination by an orthoptist and an ophthalmologist. RESULTS: Of the 200 randomly chosen subjects, 157 underwent the gold standard evaluation. The negative predictive value of the Enhanced Vision Screening Program was 97.6% for any potentially vision-threatening ocular condition. It was 98.7% if we considered only the visually significant ocular problems that the test was designed to detect. CONCLUSION: Because the negative predictive value of the Enhanced Vision Screening Program is not 100%, some children with amblyopia, strabismus, or refractive errors are missed. Occasionally, a rare, potentially vision-threatening condition may go undetected. Parents should be made aware of this when they receive the results of the vision screening.

Child↗

PubMed1994

Cultural issues in the development of cancer control programs for American Indian populations.

Cancer is the third-leading cause of death among American Indians. The persistent disadvantage in cancer survival rates among American Indian populations emphasizes the importance of developing effective cancer control programs for prevention and early detection. However, substantial cultural differences between American Indians and whites can affect the success of these programs. This paper examines the concept of cultural sensitivity in the context of developing cancer control programs for American Indian populations. It explores fundamental differences in beliefs, behaviors, and values between American Indian and white majority cultures, and presents examples of culturally sensitive health education programs. The paper highlights insights and experiences gained in developing the North Carolina Native American Cervical Cancer Prevention Project, and gives recommendations for the development of future programs.

Cause of Death↗

PubMed1986

Population strategies to enhance physical activity: the Minnesota Heart Health Program.

A population-wide, community-based program in cardiovascular disease prevention, the Minnesota Heart Health Program (MHHP), has been designed to promote more frequent and vigorous physical activity in North American communities, along with improved eating and smoking patterns. The physical activity component of this broad-based education strategy is based on the facilitation which physical activity provides to lowering of other risk characteristics for heart disease and its enhancement of other healthy behaviors and on the potential for prevention of elevated risk in the first place. The rationale for a population strategy to complement medical approaches to prevention is that exercise patterns are largely socially learned and culturally determined. The MHHP Physical Activity Program is implemented through three major education strategies: direct education, community organization, and mass communications. Early results from this 10-year project indicate that it is feasible to enter U.S. communities and to involve their leadership actively in MHHP activities of health promotion. Moreover, attitudes, knowledge, awareness, participation, and behaviors related to exercise and eating patterns appear to be changed by the program. Nevertheless, there are problems in the design, implementation, analysis and interpretation of population changes in physical activity and other health behaviors in community demonstration programs. These issues, along with their solutions, should provide useful information for medical science and for the public health about population strategies of disease prevention and health promotion.

Adolescent↗

PubMed1995

Dietary behaviours of volunteers for a nutrition education program, compared with a population sample.

The dietary behaviours of and recent dietary change by volunteers for a nutrition education program were compared with those of a more population-representative sample. The population sample was randomly selected from the electoral rolls of three Australian cities. Those selected received questionnaires which were to be completed and returned by mail. The sample of volunteers was recruited from the electoral rolls of suburbs of either high or low social status in one of these cities. Volunteers were posted a questionnaire, to be returned in person. A quantified food frequency questionnaire was used to estimate relative intake of 19 nutrients, plus energy intake. Occupation, age, sex, reported recent dietary change and diet-related beliefs were also assessed. The population sample was weighted to the age and occupational distribution of the education program sample. Compared to the 874 respondents in the population sample (70.4 per cent response rate), the 487 volunteers (24.2 per cent response rate) for the nutrition education program had healthier nutrient intakes and reported more dietary behaviour changes. Recruitment in the education program was greater in areas of higher social status (32 per cent) than in areas of lower social status (20 per cent). The potential effect of such a program on the whole population was demonstrated by the proportions that volunteered and the characteristics of these volunteers. The need to provide a range of opportunities for changing dietary behaviour, according to the health-related behaviours and beliefs of target groups and their socio-economic circumstances, was highlighted.

Adolescent↗

PubMed1984

Two methods of estimating the target population for public maternity services programs.

One difficulty in estimating the target population for public health programs is identifying a current and appropriate indicator of the low-income population. Using data from Mississippi and Maryland, we determined that educational attainment of women giving birth is a feasible substitute for census data in estimating the low-income maternity population, and that vital statistics data offer several advantages for estimating the maternity services target population over census data.

Educational Status↗

PubMed2026

Artificial intelligence-supported double reading in European population breast cancer screening: A systematic review and meta-analysis of prospective programs.

BACKGROUND: Most European population mammography screening programs rely on double reading with arbitration, a model that delivers mortality benefit but is increasingly challenged by radiologist workload, variable specificity, and interval cancers. Artificial intelligence (AI) is being evaluated to support or optimize these established European screening pathways. PURPOSE: To synthesize prospective or program-embedded evaluations of AI conducted within European-style population screening programs and to estimate exploratory program-level absolute risk differences (RDs) per 1000 examinations for cancer detection rate (CDR) and recall. MATERIALS AND METHODS: We performed a prespecified, focused evidence synthesis of three large studies embedded within routine population screening programs operating under European-relevant workflows: MASAI (randomized AI-supported risk triage within a national program), ScreenTrustCAD (prospective paired-reader evaluation with AI as an independent reader in a double-reading framework), and PRAIM (nationwide decision-referral implementation). Outcomes were harmonized as AI-control RDs per 1000 examinations. Random-effects pooling used Hartung-Knapp-Sidik-Jonkman models. For the paired-reader design, sensitivity analyses applied a Kish effective sample-size approach across plausible within-examination correlations (ρ = 0.3-0.8). Positive predictive value (PPV) and workflow/time outcomes were summarized descriptively. RESULTS: Across 597,419 examinations, the pooled CDR RD was +0.9 per 1000 (95% CI -0.0 to +1.8; I2 ≈ 12%), consistent with a modest directional increase with borderline statistical uncertainty. The pooled recall RD was -0.6 per 1000 (95% CI -3.1 to +2.1; I2 ≈ 41-43%), indicating no consistent recall increase across screening programs. Where reported, PPV was higher with AI-supported screening. Efficiency signals included 44.3% fewer total readings in MASAI and shorter reading times for AI-normal examinations in PRAIM; in PRAIM, a program-level safety-net mechanism recovered 204 cancers that would otherwise have been missed. CONCLUSION: In European population screening programs characterized by double reading and arbitration, prospective program-embedded evidence suggests that AI integration may yield a small absolute increase in cancer detection (≈1/1000) without a consistent increase in recall, alongside improved PPV and efficiency signals. These findings suggestAI primarily as a complementary reader within European screening workflows, with implementation requiring explicit quality assurance and monitoring of interval cancers and stage distribution.

Humans↗

PubMed1998

Estimation of candidate gene effects in dairy cattle populations.

Standard programs for animal models can be modified to include the effect of a candidate gene, even if only a fraction of the population is genotyped. The elements of the incidence matrix for this effect is 0 or 1 for genotyped individuals and for the probabilities of the candidate gene genotypes for individuals that were not genotyped. The effects of a diallelic candidate gene that were estimated by this method were compared on simulated populations with three alternative estimation methods: analysis of genetic evaluations, yield deviations, and daughter yield deviations, all of which were derived from a standard animal model. The bases of comparison were mean squared error and bias. Four types of experimental designs were considered: genotyping sires only, genotyping cows only, genotyping half of the cows but no sires, and genotyping half of the sires and half of the cows. The estimates that were derived from the three alternative methods all underestimated the simulated effects. The genetic evaluations were more biased than were the yield deviations and the daughter yield deviations. The proposed method was significantly biased only for the design in which half of the daughters, but no sires, were genotyped. Bias and mean squared errors were always lowest by the proposed method.

Animals↗

PubMed1997

Compliance with the Australian Dietary Guidelines in the early 1990's: have population-based health promotion programs been effective?

In an attempt to change the dietary behaviours of the population (and reduce the incidence of diet-related disease), governments and health authorities in Australia have developed Dietary Guidelines. These guidelines have been communicated to the wider society through a range of channels, such as health promotion programs and education campaigns. Studies conducted during the 1980's suggested that up to 30 percent of the population were engaging in food-related behaviours consistent with dietary guideline recommendations, although the extent of compliance varied by population sub-group (eg women and high socioeconomic groups were more likely to comply). More recent research has suggested that compliance with some of the guideline recommendations has increased, although disparities between population sub-groups remain. The aim of this present study is to determine the extent of compliance with the Australian Dietary Guidelines in the early 1990's, and thereby (indirectly) assess the degree to which health promotion efforts have affected the dietary behaviours of the population. The study is based on a representative sample (n = 403, 80.6% response rate) of Brisbane city. Overall, it was estimated that between 40 and 60 percent of the population were regularly engaging in food behaviours consistent with guideline recommendations. This rate of compliance, however, differed markedly depending on the type of behaviour being examined, and it varied significantly (albeit modestly) across different population sub-groups. It is concluded that health promotion has influenced the population's dietary behaviours, although traditional beliefs and attitudes also inform our food behaviours to a considerable extent.

Adult↗

PubMed1997

Perspectives on a state enacted hearing screening assessment program in the newborn population.

OBJECTIVE: A review of the early performance of Ohio's statewide infant hearing screening program was performed to provide insight as to the impact of the current medical and socioeconomic climate on its implementation. BACKGROUND: In March 1988, the State of Ohio enacted a law that required universal screening of newborn children for hearing loss through a program known as the Infant Hearing Screening and Assessment Program (IHSAP). The program design consisted of a universally applied high-risk questionnaire followed by a screening auditory assessment for those who fail. Although the value of such a program engendered little early public debate, the institution of such a program represented a significant challenge from a public health perspective. STUDY DESIGN: The program performance was analyzed using data from the index population of 160,000 live births per annum and hospital surveys. RESULTS: The questionnaires were found to be failing twice the number of newborns as originally projected, whereas completion rates and compliance were excellent. The assessment arm was plagued with poor compliance rates and limited resources. Lack of resources for effective data management has prevented an accurate evaluation of the program's sensitivity and specificity. CONCLUSION: IHSAP performance is being hampered by poor assessment follow-up and resource limitations, both in terms of screening equipment and habilitative follow-up services for infants identified as hearing impaired. The reasons for these problems are discussed in relation to existing legislative guidelines and medicoeconomic realities.

Audiology↗

PubMed1995

The Health of the Nation target on syringe sharing: a role for routine surveillance in assessing progress and targeting interventions.

The Health of the Nation initiative in the United Kingdom includes a target aimed at reducing the proportion of current injecting drug users who share syringes. The PHLS Collaborative Survey of Salivary Antibodies to HIV and Hepatitis B core in injecting drug users is a comprehensive and national surveillance mechanism which routinely collects data that can be used to monitor progress toward this target. Nineteen per cent of injecting drug users (353/1876) in 1992 and 18% (375/2138) in 1993 shared previously used injecting equipment (difference of -1.3%, 95% Cl -3.7%, 1.1%). Only with further years of data collection will it be possible to tell if this decline represents a real change in behaviour. There was a substantial reduction in the proportion of sharers who received previously used needles and syringes from more than one person, from 45% (138/305) in 1992 to 27% (81/298) in 1993 (fall of 18%, 95% Cl 11%, 26%). This decline could indicate a real reduction in risk behaviour that is not reflected in the target. Monitoring this aspect of sharing could be an important supplementary measure. Women were more likely to have share (adjusted OR = 1.87, 95% Cl 1.53, 2.28) and the likelihood of sharing declined with age (adjusted OR of each 5-year age band = 0.75, 95% Cl 0.72, 0.79). Particular attention should be given to interventions which aim to reduce sharing among women and young people. Clients of agencies at which the main service provided was syringe exchange were less likely to have shared than attenders of other types of agencies (adjusted OR = 0.69, 95% Cl 0.51, 0.93). This suggests that syringe exchange schemes play a role in reducing the transmission of HIV infection.

Adolescent↗

PubMed1996

AIDS-related policies, legislation and programme implementation in India.

This paper traces the evolution of AIDS-related policy and legislation in India from an initial response characterized by conservatism and discrimination to the development of a coherent national programme which aims to prevent the transmission of HIV and to develop support structures for people with HIV and AIDS. Examining the strategies, achievements and problems of specific components of the National AIDS Control Programme (NACP), the paper finds that the very progressive approach of national-level policy makers has been countered by conservative forces at the state and local levels. Little progress has been made, moreover, in incorporating HIV/AIDS prevention efforts into broader development and empowerment strategies. The paper concludes by considering the wider social context of AIDS in India and the role of more far-reaching policy measures.

Acquired Immunodeficiency Syndrome↗