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Risk Population (risk + population)
Kinds of Risk Population Selected AbstractsProviding early intervention services for the primary care sector: the PMHT approachACTA PSYCHIATRICA SCANDINAVICA, Issue 2002A. McGovern Primary Mental Health Teams are a state-wide initiative of the government of Victoria to address identified gaps in mental health service delivery namely early intervention for psychosis and mental health services for high prevalence disorders. This poster will outline this dynamic community based approach to supporting and enhancing services for clients with mental health issues that are currently provided by the primary care sector. Specifically, the poster will focus on the development of a local cross sectorial approach to early psychosis with the dual aims of decreasing the duration of untreated psychosis and adopting best practice guidelines for improved outcomes for this high risk population. [source] Host,bacterial interaction in the development of gastric precancerous lesions in a high risk population for gastric cancer in Venezuela,INTERNATIONAL JOURNAL OF CANCER, Issue 7 2006Ikuko Kato Abstract Helicobacter pylori (HP) infection affects over 50% of the world's population. The prevalence is over 90% in populations at high risk for gastric cancer, but clinical outcomes of the infection are highly variable and thus host genetic factors have been suggested to play a role in its outcomes in addition to bacterial factors. In this study, we examined the effects of common functional genetic polymorphisms of several proinflammatory cytokines known to be overexpressed in HP-infected gastric mucosa on the risk of various stages of gastric premalignant lesions. The odds ratios (ORs) and 95% confidence intervals (CI) for atrophic gastritis, intestinal metaplasia and dysplasia were estimated by multinominal logistic regression analysis among 2,033 Venezuelan subjects. There was a significant effect of IL8 -251A allele on the prevalence of dysplasia (p = 0.021). The OR associated with the A-allele was 1.34 (95% CI: 0.82,2.18) for heterozygotes and 2.00 (95% CI: 1.13,3.56) for homozygotes, compared with the TT genotype. Furthermore, there was a statistically significant interaction between the number of A-alleles and HP cag A genotype (p = 0.009), suggesting that the A-allele increased the risk of dysplasia only when cag A was present. The OR for the AA compared with TT genotype was 3.22 (95% CI: 1.60,6.52) in this group. There were no associations with other proinflammatory cytokines studied, i.e., IL1,, IL6, monocyte chemoattractant protein 1 (MCP1) and TNF,, or with other stages of premalignant lesions. The present study provides important evidence suggesting host,bacterial interactions in the development of gastric precancerous lesions. © 2006 Wiley-Liss, Inc. [source] Faecal screening of colorectal cancerINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 3 2008A. Loganayagam Summary Aims:, Screening and prevention of colorectal cancer (CRC) is a public health priority. Recent progress in understanding the biology of CRC has lead to possible new approaches to screening. In particular, assay of faecal molecular markers represents a promising non-invasive approach to screening, with improved safety, accuracy and patient compliance. Methods:, MEDLINE/PubMed searches were used to identify key articles relating to faecal-based screening with secondary review of cited publications. Results:, Faecal markers of CRC can be broadly divided into DNA based and non-DNA based. Conclusions:, Faecal occult blood testing for CRC screening has been advocated for decades for its non-invasiveness and low cost. It has exhibited a 15,33% decrease in mortality, despite drawbacks with sensitivity and compliance. Other non-DNA markers have the adequate sensitivity for inflammatory lesions but do not have the required specificity for screening average-risk populations. Faecal DNA testing has the potential to enhance the performance characteristics of stool testing. Because of molecular heterogeneity of cancer, no single DNA marker has yielded adequate sensitivity. Analysis of several combinations of markers in studies have produced high detection rates of both CRC and advanced adenomas in selected patient groups. However, the currently available markers, both non-DNA and DNA, have not yet been validated in large-scale studies screening average -risk population nor have they so far shown the necessary sensitivity and specificity required for large-scale screening programmes. Another major drawback with the DNA-based markers is the cost-effectiveness. Issues regarding implementation and compliance remain unanswered. These critical problems have to be rectified before these techniques can be recommended for large-scale CRC screening. [source] A School-Community Partnership for At-Risk Students in PennsylvaniaJOURNAL OF SCHOOL HEALTH, Issue 2 2001Beth McMahon ABSTRACT: This four-year, school-community health improvement project addressed fragmentation and under-utilization of services of an at risk population in a county in central Pennsylvania. A population profile was developed that included demographic, attitudinal, and behavioral information as well as information related to liabilities and assets that affect resiliency and decrease or increase the likelihood of academic success. The profile was used in the planning and implementation of risk-reduction strategies that promote a healthy family and, in turn, a healthy community. More than 50 local, state, and national organizations as well as individuals volunteered or provided services at each school. The project produced a 22% increase in parental involvement in school activities; a 15% increase in parental involvement in educational sessions; a 22% increase in volunteers within the school; and a 75% decrease in truancy. (J Sch Health. 2001;71(2):53-55) [source] Bone Mineral Density in Postmenopausal Breast Cancer SurvivorsJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 6 2001APRN, Janice J. Twiss PhD Purpose The overall purpose of this longitudinal 18-month study was to test the feasibility and effectiveness of a multicomponent intervention for prevention and treatment of osteoporosis. The purpose of this article is to describe the baseline bone mineral density (BMD) findings for 30 postmenopausal women and to compare these BMD findings to time since menopause, body mass index, and tamoxifen use. Data Sources Baseline data of BMD findings for 30 post-menopausal women, who have had a variety of treatments including surgery, adjuvant chemotherapy and or tamoxifen, and are enrolled in the 18-month longitudinal study. A demographic questionnaire and a three day dietary record were used to collect baseline data. Conclusions Eighty percent of the women with breast cancer history had abnormal BMDs at baseline (t-scores below -1.00 SD). Thinner women showed a greater risk for accelerated trabecular bone loss at the spine and hip. Implications for Practice These findings suggest the need for early BMD assessments and for aggressive health promotion intervention strategies that include a multifaceted protocol of drug therapy for bone remodeling, 1500 mg of daily calcium, 400 IU vitamin D and a strength weight training program that is implemented immediately following chemotherapy treatment and menopause in this high risk population of women. [source] A Mediterranean diet rich in virgin olive oil may reverse the effects of the -174G/C IL6 gene variant on 3-year body weight changeMOLECULAR NUTRITION & FOOD RESEARCH (FORMERLY NAHRUNG/FOOD), Issue S1 2010Cristina Razquin Abstract Only a few studies have analyzed the effects of the potential interaction between the -174G/C polymorphism of IL6 gene and the adherence to the Mediterranean diet (MD) on adiposity indexes. Our aim was to investigate the interplay between the -174G/C polymorphism of the IL6 gene and a Mediterranean-style diet on body weight changes after 3 years of nutritional intervention in a high cardiovascular risk population. A total of 737 participants, aged 55,80 years were assigned to a low-fat diet or to a Mediterranean-style diet group with high intake of virgin olive oil (VOO) or nuts. Anthropometric measurements were taken at baseline and after 3-year follow-up. The -174G/C polymorphism of the IL6 gene was genotyped. Minor allele frequency (C) was 0.39. At baseline, the CC genotype was associated with higher measures of adiposity. After 3 years, a significant interaction (p=0.028) was found between the polymorphism (GG+GC versus CC) and the nutritional intervention: CC subjects following the MD+VOO had the lowest body weight gain. In conclusion, at baseline, CC subjects for the -174G/C polymorphism of IL6 had the highest body weight and BMI. However, after 3 years of nutritional intervention with MD+VOO, these subjects were predicted to have the greatest reduction in body weight. [source] Emergent excision of a prenatally diagnosed sacrococcygeal teratomaPEDIATRIC ANESTHESIA, Issue 5 2008KHA M. TRAN MD Summary Prenatally diagnosed sacrococcygeal teratomas (SCT) have higher mortality rates than those diagnosed in the neonatal period. Natural history of SCT varies, and management depends on pathophysiology. Treatment may be minimally invasive or require open surgery. Intervention may take place in the prenatal period, or it may occur within minutes to days after birth. Optimal care requires close follow up and communication between members of a multidisciplinary team. We present a case of prenatally diagnosed SCT and address the evaluation, anesthetic considerations, and mechanisms needed to care for this high risk population. [source] Hyperhomocysteinemia in pediatric and young adult renal transplant recipientsPEDIATRIC TRANSPLANTATION, Issue 2 2004Amir Belson Abstract:, Hyperhomocysteinemia (HHcy) has been recently identified as an important and reversible cardiovascular risk factor in adult and pediatric renal transplant recipients. A retrospective cross-sectional analysis of 70 pediatric and young adult renal transplant recipients was performed to determine the prevalence, and important clinical and laboratory correlates of HHcy. Total homocysteine concentration, free and protein bound, was determined by fluorescence polarization immunoassay using an IMX analyzer. Hyperhomocysteinemia was defined as a serum homocysteine (Hcy) level above the 95th percentile for age. Fifty-four of 70 patients (77%) had HHcy. Comparison of patients with HHcy with patients without HHcy demonstrated no statistical difference in age (p = 0.35), gender (p = 0.76) or donor type (p = 0.20). Patients with HHcy had significantly lower calculated creatinine clearance values (Ccr) (p = 0.02), 67.3 ± 21.2 mL/min/1.73 m2 vs. 90.7 ± 32.3 mL/min/1.73 m2 for patients without HHcy. Immunosuppression did not correlate with the diagnosis of HHcy. Stepwise logistic regression identified patient age (0.18, p = 0.013) and Ccr (,0.04, p = 0.011) as significant variables. In conclusion, HHcy is more common than expected in pediatric renal transplant recipients. Patients with Ccr <80 mL/min/1.73 m2 were statistically more likely to have a diagnosis of HHcy. We recommend that Hcy levels should be evaluated in this high risk population. [source] First report of prenatal diagnosis of genetic congenital deafness in a routine prenatal genetic testPRENATAL DIAGNOSIS, Issue 13 2003M. L. Santoro Abstract Objective We aimed to screen for connexin26 gene (GJB2) mutations associated with autosomal recessive non-syndromic neurosensory deafness (NSRD) in a general risk population. Methods Screening for the most common connexin26 gene mutations was offered to all women undergoing a second-trimester amniocentesis for fetal karyotype analysis in our Center. After rapid DNA extraction from amniotic fluid, PCR amplification was performed and products analysed to detect mutations of GJB2 gene by a sequencing technique. In particular, we searched for the 20 most frequently reported mutations (out of the approximately 90 so far described) and for which there are commercially available tests. Results From a total of 4819 consecutive amniotic fluids examined, the following five different heterozygous mutations were detected: 35delG in 80 cases, 167delT in 3 cases and 1 occurrence of each of the following mutations: M34T, 35insG and W77R. From these data, a prevalence of 1 : 56 (1.78%) for the heterozygous condition can be estimated in the Mediterranean general risk population. The striking predominance of 35delG mutation is confirmed. In addition, we detected a homozygous 35delG mutation condition in a foetus of no risk parents. In this case, the early diagnosis permitted prompt application of an acoustic prosthesis allowing for cochlear implantation in due time, with significant improvement of the prognosis. Conclusions In a general risk population, a carrier status for congenital deafness can be observed in 1 : 56 (1.78%) amniotic fluids; this is mostly due to the presence of a 35delG mutation of the connexin26 gene. Occasional identification of homozygous states, although rare, allows the best therapeutic approach. Copyright © 2003 John Wiley & Sons, Ltd. [source] Universal newborn screening and adverse medical outcomes: A historical noteDEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 4 2006Jeffrey P. Brosco Abstract Universal newborn screening programs for metabolic disorders are typically described as a triumph of medicine and public policy in the US over the last 50 years. Advances in science and technology, including the Human Genome Project, offer the opportunity to expand universal newborn screening programs to include many additional metabolic and genetic conditions. Although the benefits of such screening programs appear to outweigh their costs, some critics have claimed that historical examples of inadvertent harm ensuing from false-positive screening results and subsequent inappropriate medical treatment should make us wary of expanding universal newborn screening. In this essay, we report the results of a review of the published literature to assess whether the extension of screening from at risk populations to all newborns led to substantial morbidity and mortality from misguided medical treatment. We provide a historical overview of universal newborn screening programs in the United States, and then focus on six early NBS programs: congenital hypothyroidism, phenylketonuria, congenital adrenal hyperplasia, galactosemia, sickle cell disease, and maple syrup urine disease. Our comprehensive search of published sources did not reveal a widespread problem of harm ensuing from medical treatment of children with false positive screening test results. © 2006 Wiley-Liss, Inc. MRDD Research Reviews 2006;12:262,269. [source] Minimal residual disease monitoring after allogeneic transplantation may help to individualize post-transplant therapeutic strategies in acute myeloid malignancies,AMERICAN JOURNAL OF HEMATOLOGY, Issue 3 2009María Díez-Campelo This study evaluates the prognostic value of minimal residual disease (MRD) monitoring by multiparametric flow cytometry in 41 patients with acute myeloid leukemia or myelodysplastic syndrome undergoing allogeneic transplantation. MRD assessment after transplant (day +100) allowed to discriminate different risk populations, being the most significant cut-off value for outcome level of MRD [source] Population-based waist circumference and waist-to-height ratio reference values in preschool childrenACTA PAEDIATRICA, Issue 10 2009Josefine Roswall Abstract Aim:, To establish new reference values for measurements of waist circumference and waist-to-height ratio in preschool children. Methods:, A population-based, cross-sectional study of 4502 children aged 0,5 years derived from child health care in a Swedish county. Measurements of weight, height and waist circumference were recorded using a standardized procedure. Results:, New reference values for waist circumference and waist-to-height ratio for preschool children are presented. Reference charts were constructed and are presented. Waist circumference increased with age (r = 0.80, p < 0.001). After adjustment to the individual height, expressed as waist-to-height ratio, there was an inverse correlation to age during the first 5 years of age (r = ,0.87, p < 0.001). Conclusion:, The new reference values for waist circumference and waist-to-height ratio for Swedish preschool children enable future identification of new risk populations for childhood obesity. For clinicians, new reference charts for these two variables are provided for practical use. [source] Knowledge of heart attack symptoms in a community survey of VictoriaEMERGENCY MEDICINE AUSTRALASIA, Issue 3 2002Karen L Smith Abstract Objective: To ascertain the level of knowledge of heart attack symptoms in the Victorian public. Methods: This was a cross sectional telephone survey conducted during 2000,01. The questionnaire contained sections regarding participant demographics and knowledge of heart attack symptoms. Results: A total of 1489 people completed the questionnaire (79% of eligible participants). The mean number of correct heart attack symptoms was 2.5 (95% CI 2.45, 2.60) (median three out of 10). Only 4.2% of participants reported at least five correct symptoms and 4.1% could not report any symptoms. A total of 84.6% of respondents reported chest pain as a symptom of heart attack. Conclusions: The Victorian public appears to lack the knowledge of the varied range of heart attack symptoms. Methods of disseminating information regarding symptoms and ways to reduce prehospital delay need to be devised, particularly methods which target the older ,at risk' population. [source] Cardiac side effects of psychiatric drugs,HUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue S1 2008Paul Mackin Abstract This review describes the common effects of psychotropic drugs on the cardiovascular system and offers guidance for practical management. Selected reports from the literature describing common side effects associated with psychotropic drugs are reviewed, and suggestions for further reading are given throughout the text. Orthostatic hypotension is the most common adverse autonomic side effect of antipsychotic drugs. Among the atypical antipsychotics the risk of orthostatic hypotension is highest with clozapine and among the conventional drugs the risk is highest with low potency agents. Rarely, orthostatic hypotension may result in neurocardiogenic syncope. QTc prolongation can occur with all antipsychotics but an increased risk is seen with pimozide, thioridazine, sertindole and zotepine. QTc prolongation is a marker of arrhythmic risk. Torsade de pointe, a specific arrhythmia, may lead to syncope, dizziness or ventricular fibrillation and sudden death. Heart muscle disease presents most commonly in the elderly as chronic heart failure, but myocarditis and cardiomyopathy, although relatively rare, are devastating, but potentially reversible complications of psychotropic drug therapy have been particularly linked to clozapine treatment. Patients with severe mental illness (SMI) are a ,high risk' population with regard to cardiovascular morbidity and mortality. It is probable that many patients accumulate an excess of ,traditional' risk factors for the development of cardiovascular disease, but other mechanisms including psychotropic drugs may also be influential in increasing risk in this vulnerable group. These risks need to be seen in the context of the undoubted therapeutic efficacy of the psychotropic armamentarium and the relief that these drugs bring to those suffering from mental disorder. Copyright © 2007 John Wiley & Sons, Ltd. [source] Cerebral dominance and schizophrenia-spectrum disorders in adults with intellectual disabilityJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 6 2000D. Rowe Abstract Studies of the general population without intellectual disability have suggested an association between atypical handedness and schizophrenia-spectrum disorders (SSDs). Mixed handedness is taken as an index of diminished cerebral dominance or laterality. The present study addressed the question of whether such findings extend to the neurodevelopmentally ,at risk' population of adults with intellectual disability and SSDs compared with appropriate controls. Fourteen patients with a dual diagnosis of intellectual disability and SSD were compared with 14 controls with intellectual disability alone. Assessments of self-reported hand preference and relative hand skill were completed. Self-report of hand preference revealed highly significantly greater mixed-handedness in the SSD group. Furthermore, relative hand skill performance was significantly diminished for the dominant hand. The discrepancy between dominant and non-dominant hand functioning was lower in the SSD group and this association was highly significant. The results of the present study support the usefulness of such detailed laterality assessment in this population. Mixed laterality, over and above that of the population with general intellectual disability and developmental disorder, was associated with SSD. These results are consistent with the neurodevelopmental hypothesis of schizophrenia and its cognitive neuropsychiatric/neuropsychological sequelae. [source] | ||||||||||||||||||||||