Poor uptake of self-sample collection kits for Chlamydia testing outside primary care

Objectives: New strategies are needed to reach at‐risk populations for Chlamydia screening. Method: Self‐sample collection kits containing instructions and all items required for testing were developed and piloted in a three‐month trial in primary care. Practice staff offered kits to young people receiving opportunistic Chlamydia screening to pass on to their ‘social contacts.’ Results: The ‘pass it on’ approach failed to reach adequate numbers of youth for testing: of 67 kits distributed, three specimens were sent to the laboratory (4.5%). Conclusions: The method of kit distribution trialled here was not successful in reaching at‐risk youth for testing outside the primary care setting. Implications: Use of self‐sample collection for chlamydia testing outside healthcare settings is likely to be important for increased access to testing. The importance of chlamydia testing needs to be widely promoted and methods for kit distribution to reach at‐risk youth identified.     

School-Based Mental Health Prevention Activities for Homeless and At-Risk Youth

Children who are homeless or who live in poverty face increased exposure to risk factors. Participating in mental health prevention activities may serve as a buffer against stress for these children. Schools are an optimal setting for providing prevention services. In this paper, we describe the implementation of and results from the Empowerment Zone (EZ) project, which involved providing mental health and health prevention services to children during small group and classroom activities. The EZ Project was incorporated into character education activities for a summer school program designed to improve reading and math skills for at risk elementary school age youth. The character education program is a key component in the Baltimore City schools where character traits, such as honesty, are taught through small group and classroom activities. Teachers were trained to implement mental health prevention activities; they also reported on the quality and utility of the program, after watching activities implemented by clinicians in their classrooms. Parents also had opportunities to participate in classes, which focused on teaching discipline techniques and discussing ways to improve parent-child relationships and foster children's socioemotional development. Results were positive, supporting project activities. Future empirical research evaluating the effectiveness of mental health prevention programs delivered in schools is needed.     

Estimating disease risks for individuals with a given family history in different populations with an application to breast cancer

For many chronic diseases, including most of the common cancers, a family history is known to be a strong independent risk factor. For breast cancer, estimation of risk as a function of family history is considered to provide useful risk assessment for women with a family history of breast cancer. Detailed tables that predict the cumulative risk of breast cancer at specific ages based on various combinations of family history have been constructed for the American white population. Most chronic diseases, however, have a multiple etiology, with multiple genetic and environmental factors. Family history can thus be a result of different susceptibility loci and the aggregation of sporadic cases by chance. Since the relative contribution of the genetic factor may differ in different populations, these tables may not be directly applicable to other populations. We present a method to decompose available estimates of risk based on family history for an arbitrary disease into probabilities for genotype frequency given a particular family history and for disease probabilities by genotype carrier status. These can be reconstructed to obtain risk estimates for different populations. Implicit assumptions are made in the estimation process. These are based on the current state of knowledge and can be updated as further knowledge accumulates. © 1996 Wiley-Liss, Inc.     

南通市慢性病基线调查分析

目的：了解南通市居民慢性病现状及其影响因素,方法：对2000年南通市慢性病基线调查资料进行统计分析。结果：35岁以上人群已知慢病患病率46.60%。主要病种为高血压,心脑血管疾病,消化系疾病,呼吸系疾病,恶性肿瘤,糖尿病等;主要危险因素为吸烟,超重等,结论：高血压,糖尿病,恶性肿瘤等应为南通市重点控制的主要慢性病。     

艾滋病高危人群利用自愿咨询检测服务影响因素研究

[目的]评价艾滋病高危人群对自愿咨询检测(VCT)服务的利用和需求,研究VCT服务利用影响因素;[方法]采用配额抽样和便利抽样,对838名暗娼、312名男-男同性恋、282名性病患者进行面对面匿名问卷调查,评估高危人群对VCT服务的利用和需求现状;采用Logistic回归分析,评价高危人群利用VCT服务的影响因素。[结果]3类高危人群中,60.96%的人既往未利用过VCT服务,30.31%的人不知晓VCT,59.99%的人担心自己感染艾滋病病毒(HIV),71.86%的人认为有必要做HIV检测,71.30%的人认为有必要找专家咨询艾滋病方面的问题;Logistic回归分析结果显示:医务人员进行过HIV检测动员、担心感染HIV等,是高危人群利用VCT服务的主要促进因素;[结论]高危人群对VCT服务有较大需求,但实际利用不够;为促进VCT的有效开展,需进一步加强针对场所的宣传和干预,提高高危人群利用VCT服务的意识和主动性。     

浙江省部分中小学教师胃病流行病学调查

[目的]探讨浙江省中小学教师胃病的患病现状及患病的危险因素。[方法]采用单纯随机抽样问卷方法对823名中小学教师进行胃病相关情况调查,对可疑相关因素进行Logistic回归模型单因素和多因素分析,计算OR值以筛选与胃病发生有关的危险因素。[结果]中小学教师的胃病患病率为30．79％,女性、年龄增高、中学教师、幽门螺旋杆菌（HP）感染、长期服用非甾体类消炎药、工作压力大、饮食无规律、家中有HP感染的胃病患者是引起胃病发生的危险因素。[结论]胃病已成为中小学教师的常见疾病,应积极避免或改善各种引起胃病发生的危险因素以有效降低胃病发病率。     

青岛市区居民慢性非传染性疾病调查

目的 了解青岛市市区居民慢性非传染性疾病(慢病)的患病现状及影响因素.方法 采取整群随机抽样法,对青岛市市区15个居委会的3057名居民进行问卷调查.结果 青岛市市区居民慢病患病率为24.58%(女性为26.50%,男性为22.77%),居民慢性病的患病率随年龄增加而增高(r_s=0.5629,P=0.0001).按病种排在前5位的疾病为高血压、冠心病、关节炎/风湿病、胆囊及胃肠炎和糖尿病.慢性病的患病率与文化程度呈负相关;吸烟、饮酒等不良生活行为可使居民患慢性病的危险性增加.结论 青岛市市区居民慢病患病率较高,应在居民中采取干预措施以预防和减少慢病的发生.     

沈阳市大东区2013年主要慢性病及其危险因素现况调查

目的 为了尽快完善沈阳市大东区慢性病综合防治体系,推动社区卫生服务与慢性病防治相结合的综合防治工作,为制定大东区慢性病防治对策提供参考依据.方法 采取多阶段分层整群随机抽样方法,随机抽取大东区28个社区2 449名18岁以上居民进行慢性病患病率及相关危险因素调查.结果 大东区居民高血压患病率为17.35％,糖尿病患病率为4.12％,男女性慢性病患病率均随着年龄的增长而上升;吸烟、饮酒、缺乏运动和超重等因素是社区慢性病的主要危险因素.结论 大东区高血压和糖尿病发病处于中等水平,随着年龄的增加患病率明显上升.因此,针对居民中的吸烟、有害饮酒及活动量不足等慢性病主要危险因素采取干预措施,加强健康教育,提高居民的健康知识水平、控制危险因素的技能和居民的生活质量,已经成为当前公共卫生面临的重大问题,也是疾病预防控制工作的重要内容.     

Respiratory symptoms in Swiss farmers: an epidemiological study of risk factors

BACKGROUND: The study was undertaken to assess the prevalence and risk factors of self-reported asthma, symptoms of chronic bronchitis, hay fever, and work-related respiratory symptoms in Swiss farmers as well as to compare the prevalence rates of respiratory symptoms with the Swiss population (SAPALDIA-Study). METHODS: An epidemiological study was performed with a representative sample of 1,542 Swiss farmers using a self-administered questionnaire. To investigate the effect of the type of farming on reported symptoms, the farmers were subdivided into seven groups according to the time farmers spent in different animal confinement buildings. A multivariate analysis was performed by the methods of binary and multivariate logistic regression adjusted for age and smoking habits. RESULTS: In farmers the prevalence rate was 16.0% for chronic bronchitis, 15.4% for asthma symptoms, and 42.0% for reporting at least one work-related symptom. Using logistic regression analysis, it was established that poultry farming and pig/cattle farming was a risk factor for reporting nasal irritation at work [OR 5.33, (1.57-18.0), OR 3.37 (1.04-10.87)]. Poultry farmers experienced the highest symptom rates. In crop farmers, the prevalence for chronic bronchitis was increased [OR 2.32 (1.03-5.23)]. Over 4 hr spent per day in animal confinement buildings more than doubled the risk for reporting chronic bronchitis [OR 2.61 (1.01-6.76)] and phlegm [OR 2.3 (0.99-5.4)] independent of the type of farming. The comparison of Swiss farmers with the Swiss population showed a twofold elevated risk of reporting chronic bronchitis [OR 1.89 (1.32-2.95)] and a 4.5-fold elevated risk for bringing up phlegm regularly [OR 4.5 (3.25-6.69)] in farmers. In contrast, the risk of farmers to report nasal allergies was less than half as high [OR 0.40 (0.29-0.56)] as that of the general population. CONCLUSIONS: This study shows that agricultural work in Switzerland is associated with an elevated risk for reporting symptoms of chronic bronchitis and chronic phlegm compared with the general Swiss population. These main results most likely indicate occupational disorders as the exposure-response relationship (hours spent in animal confinements) was particularly obvious for these symptoms.     

上海松江岳阳社区居民慢性病患病现状及行为危险因素分析

[目的]了解上海市松江区岳阳社区居民慢性非传染性疾病的流行现状及行为危险因素。[方法]采用分层随机抽样的方法，按国家卫生部“中国成人慢性病危险因素调查”的要求，抽取在该社区居住满1年的18～69岁常住居民1984名，进行问卷调查和体格检查。[结果]72．1％的样本人群具有≥1种危险因素，33．1％的样本人群患有≥1种慢性病。吸烟率、饮酒率、超重率、肥胖率分别为24．1％、21．5％、27．5％、6．6％；样本人群中，34．7％缺乏体力活动，49．1％钙质摄入不足，6．9％维生素B、C摄入不足，45．3％蛋白质摄入不足，9．7％嗜腌制品（苯丙胺类致癌物质及高钠食品）；高血压和糖尿病的患病率分别为26．6％、5．5％。Logistic回归分析显示：高血压、糖尿病的共同危险因素为40岁以上人群、高血脂、肥胖。[结论]行为危险因素的持续存在，已导致慢性病的高发。大力开展社区健康教育与健康促进，应采取综合性干预措施，遏止慢性病流行。     

Interpreting Outcomes: Using Focus Groups in Evaluation Research*

Although focus groups continue to gain popularity in marketing and social science research, their use in program evaluation has been limited. Here we demonstrate how focus groups can benefit evaluators, program staff, policy makers and administrators by providing an in‐depth understanding of program effectiveness from the perspective of participants as stakeholders in program outcomes. Using data from the Youth Action Program, a prevention program funded by the United States Air Force for military dependent adolescents at risk, our methodology included a narrative approach to data analysis, combining theme analysis with a systematic interpretive approach centering on how group members experienced the program within the contexts of their daily lives. We show that the parents benefited from the program beyond youth outcomes, and this was useful information for program improvement and expansion.     

The relationship between alcohol supply source and young people's risky drinking and alcohol‐related problem behaviours in Victoria,Australia

Objective: To determine whether source of alcohol supply is related to adolescent underage drinkers’ reports of risky drinking and alcohol‐related problem behaviours. Methods: In 2003/04, a cross‐sectional survey of 2,644 16–17 year‐olds were recruited from Victorian households and surveyed by phone as part of the Victorian Youth Alcohol and Drug Survey. The results were analysed to determine whether alcohol supply source was associated with weekly or more frequent risky single occasion drinking (RSOD) and reports of alcohol‐related problem behaviours. Results: Around 20% (524/2,644) of the sample reported weekly RSOD and 34% (904/2,644) of the sample reported engaging in at least one alcohol‐related problem behaviour. These outcomes were associated with reported usual source of alcohol supply, with reports of alcohol sources in addition to parents alone more than twice as likely to be accompanied by reports of RSOD (OR=2.53, 95%CI=1.85–3.46) and/or problem behaviours (OR=2.16, 95%CI=1.64–2.84), compared to when adolescents reported parents as their sole source of alcohol. Reports of alcohol supply only from sources other than parents were similarly more than twice as likely to be accompanied by reports of RSOD (OR=2.27, 95% CI=1.74–2.95) and/or problem behaviours (OR=2.27, 95%CI=1.82–2.82) compared to compared to parental supply alone. Conclusions and implications: The rate at which older adolescents report RSOD and alcohol‐related problem behaviour is increased when they obtain alcohol from sources other than their parents. Parents need to be equipped with strategies for managing the supply of alcohol to adolescents.     

我国中老年人群主要慢性病及危险因素分析

目的 了解我国中老年人群主要慢性病的患病情况及危险因素。方法 利用世界卫生组织\     

Harder,better, faster … Yet stronger? Working conditions and self‐declaration of chronic diseases

The role played by working conditions in worker health status has been widely acknowledged in the literature in general but has received less attention in economics, due to the inherent statistical biases and lack of data available to determine the role of simultaneous and chronic exposures. This study aims to estimate the causal impact of detrimental working conditions on the self‐declaration of chronic diseases in France. Using a rebuilt retrospective lifelong panel and defining indicators for physical and psychosocial strains, I implement a mixed econometric strategy that relies on difference‐in‐differences and matching methods to take into account for selection biases as well as unobserved heterogeneity. For men and women, I find deleterious effects of both types of working conditions on the declaration of chronic diseases after exposure, with varying patterns of impacts according to the nature and magnitude of the strains. These results provide insights into the debate on legal retirement age postponement and justify not only policies being enacted early in individuals' careers in order to prevent subsequent midcareer health repercussions, but also schemes that are more focused on psychosocial risk factors.     

Psychological Well‐being in Fathers of Adolescents and Young Adults With Down Syndrome,Fragile X Syndrome,and Autism

The psychological well‐being of fathers of children with developmental disabilities remains poorly understood. The present study examined depressive symptoms, pessimism, and coping in fathers of adolescents and young adults with Down syndrome (DS;n = 59), autism spectrum disorders (ASDs;n = 135), and Fragile X syndrome (n = 46). Fathers of sons or daughters with ASDs reported a higher level of depressive symptoms than the other groups of fathers. Fathers of sons or daughters with DS reported a lower level of pessimism than the other groups of fathers. There were no group differences in paternal coping style. Group differences in paternal depressive symptoms and pessimism were, in part, related to differences in paternal age, the child's behavior problems, risk of having additional children with a disability, and maternal depressive symptoms. Findings from this study can be used to educate providers and design services for fathers during the later parenting years.