Eligible Age Group Research Articles

PROYEKSI PENDUDUK INDONESIA 1990-2010

The conformity betweenpopulation projection and both the survey and census results depends very much on the assumption used. The fertility, mortality, and the migration dynamics may affect both the number and structure of the projection results of the population. In line with this, the population projection is formed by using several different assumptions to be able to obtain a clear description about the minimum and maximum conditions of the population in the years to come.The population growth rate of Indonesia in the coming years is estimated to remain high as a consequence of the population structure of the younger age group. The fertility reduction that has taken place has only affected the number of population aged less than ten years, whereas the growth rate of the population aged ten years and over will remain high because of the mortility reduction. The main challenge of the future could be that the population number of the teenage group and the adolescence may be higher than that of the previous period. The female population of the productive age group and the population of the old age group have also increased in number. This phenomenon is very closely related with the expansion of the employment opportunities, consumtion needs, health services, and of many other facilities. The number of population of the economically productive age group and the eligible female age group will, in the coming years, be much greater than that in 1990. This needs serious and effective planning to tackle the problem so that it may not become a burdento the country's development.

Cancer screening in Portugal: sex differences in prevalence, awareness of organized programmes and perception of benefits and adverse effects.

BackgroundCancer screening has contributed to downward trends in cancer mortality, but is also associated with adverse effects, which highlights the importance of promoting the participation based on informed decisions.ObjectivesWe aimed to describe the use of cancer screening (either in organized programmes or as opportunistic screening), awareness of organized programmes and perception of its potential benefits and adverse effects, depicting possible sex differences.Design and methodsWe evaluated 1624 Portuguese‐speaking dwellers, aged between 16 and 79 years, through face‐to‐face interviews. To quantify sex differences, adjusted prevalence ratios and respective 95% confidence intervals were computed using Poisson regression.ResultsAmong eligible age groups, the lifetime prevalence of screening for breast and cervical cancers was 89.8 and 71.9%, respectively. The prevalence was 23.7% for colorectal cancer and no significant sex differences were observed. Prostate cancer screening was reported by 63.8% of men. Over half of the participants referred that cancers such as prostate, skin, lung and stomach should be screened for, in addition to those for which organized programmes are recommended. Reassurance by negative results was identified as the main potential benefit of screening by nearly one‐third of men and women. Anxiety while waiting for results was the most mentioned potential adverse effect (60.4%); men refer less often this and financial costs, although statistical significance of these results was borderline.ConclusionsThis study provides a benchmark to plan and monitor the effects of awareness‐raising interventions, as well as for international comparisons across countries with different cancer prevention and control structures.

Epidemiology of serogroup C and Y invasive meningococcal disease (IMD) in Ontario, 2000–2013: Vaccine program impact assessment

ObjectivesA publicly-funded meningococcal serogroup C conjugate vaccine (MCCV) program was introduced in Ontario, in 2004/2005 for 1-year-old children as well as adolescents (approximately 12 years old). In 2009, quadrivalent meningococcal conjugate vaccine (MCV4) replaced MCCV for grade seven students. Our objective was to determine meningococcal vaccine program impact on reported cases of serogroup C and Y invasive meningococcal disease (IMD) at the population level in Ontario, Canada. MethodsData were obtained from the Ontario reportable diseases system, the integrated Public Health Information System (iPHIS), and Public Health Ontario Laboratories (PHOL) for 2000–2013. Descriptive epidemiologic analyses, including age-specific rates for age groups based on program eligibility, were conducted. Changes over the 14-year observation period and comparison of pre- and post-program periods for MCCV and MCV4 were assessed. Analyses were conducted using SAS 9.3. ResultsThere were 161 serogroup C IMD cases and its annual incidence decreased significantly over time (17.2% reduction per year [95% CI: 13.4 to 20.7]). The incidence of serogroup C IMD decreased significantly in children aged 1–17 years in the post-program period, based on age-specific incidence rate ratios (IRRs) and their 95% confidence intervals (CIs). Adolescents 12–16 years had the lowest serogroup C IRR (0.07 [95% CI: 0.01 to 0.55]); the rate decreased more than 14-fold between the pre- and post-periods. There were 187 serogroup Y IMD cases and there was a non-significant 1.6% reduction per year [95% CI: −1.9 to 5.1]) over the surveillance period. Likewise, there was a non-significant decrease in serogroup Y IMD among persons 12–16 years (MCV4 eligible) in the post-program period. ConclusionsReductions in serogroup C IMD among program eligible and ineligible age groups suggest both direct and indirect MCCV vaccine program impact. Continued surveillance of IMD in Ontario is important to further assess MCV4 program impact.

Gender-specific mortality in DTP-IPV- and MMR±MenC-eligible age groups to determine possible sex-differential effects of vaccination: an observational study.

BackgroundSeveral studies suggested that vaccines could have non-specific effects on mortality depending on the type of vaccine. Non-specific effects seem to be different in boys and girls. In this study we want to investigate whether there are differences in gender-specific mortality among Dutch children according to the last vaccination received. We tested the hypothesis that the mortality rate ratio for girls versus boys is more favourable for girls following MMR ± MenC vaccination (from 14 months of age) compared with the ratio following DTP-IPV vaccination (2–13 months of age). Secondarily, we investigated whether there were gender-specific changes in mortality following booster vaccination at 4 years of age.MethodsThis observational study included all Dutch children aged 0–11 years from 2000 until 2011. Age groups were classified according to the last vaccination offered. The mortality rates for all natural causes of death were calculated by gender and age group. Incidence rate ratios (IRRs) were computed using a multivariable Poisson analysis to compare mortality in boys and girls across different age groups.ResultsThe study population consisted of 6,261,472 children. During the study period, 14,038 children (0.22%) died, 91% of which were attributed to a known natural cause of death. The mortality rate for natural causes was higher among boys than girls in all age groups. Adjusted IRRs for girls compared with boys ranged between 0.81 (95% CI 0.74-0.89) and 0.91 (95% CI 0.77-1.07) over the age groups. The IRR did not significantly differ between all vaccine-related age groups (p = 0.723), between children 2–13 months (following DTP-IPV vaccination) and 14 months - 3 years (following MMR ± MenC vaccination) (p = 0.493) and between children 14 months - 3 years and 4–8 years old (following DTP-IPV vaccination) (p = 0.868).ConclusionsIn the Netherlands, a high income country, no differences in gender-specific mortality related to the type of last vaccination received were observed in DTP-IPV- and MMR ± MenC eligible age groups. The inability to detect this effect indicates that when non-specific effects were present the effects were not reflected in changes in the differences in mortality between boys and girls. The findings in this large population-based study are reassuring for the continued trust in the safety of the national vaccination programme.

Identifying human papillomavirus vaccination practices among primary care providers of minority, low-income and immigrant patient populations

ObjectiveMinority populations in the United States are disproportionally affected by human papillomavirus (HPV) infection and HPV-related cancer. We sought to understand physician practices, knowledge and beliefs that affect utilization of the HPV vaccine in primary care settings serving large minority populations in areas with increased rates of HPV-related cancer. Study designCross-sectional survey of randomly selected primary care providers, including pediatricians, family practice physicians and internists, serving large minority populations in Brooklyn, N.Y. and in areas with higher than average cervical cancer rates. ResultsOf 156 physicians randomly selected, 121 eligible providers responded to the survey; 64% were pediatricians, 19% were internists and 17% were family practitioners. Thirty-four percent of respondents reported that they routinely offered HPV vaccine to their eligible patients. Seventy percent of physicians reported that the lack of preventive care visits for patients in the eligible age group limited their ability to recommend the HPV vaccine and 70% of those who reported this barrier do not routinely recommend HPV vaccine. The lack of time to educate parents about the HPV vaccine and cost of the vaccine to their patients were two commonly reported barriers that affected whether providers offered the vaccine. ConclusionsOur study found that the majority of providers serving the highest risk populations for HPV infection and HPV-related cancers are not routinely recommending the HPV vaccine to their patients. Reasons for providers’ failure to recommend the HPV vaccine routinely are identified and possible areas for targeted interventions to increase HPV vaccination rates are discussed.

HPV self-sampling as primary screening test in sub-Saharan Africa: Implication for a triaging strategy

Our objective was (i) to assess if a self-collected test for human papillomavirus (HPV) may serve as a primary cervical cancer screening method in a low-resource setting, (ii) to evaluate its implication in a screen and treat approach and (iii) to identify the most eligible age group in a screening program. Women were recruited through a cervical cancer screening campaign conducted in Cameroon. Written and oral instructions were given to participants by a health-care professional to carry out an unsupervised self-collected HPV-test (Self-HPV), followed by a physician-collected cervical sample for HPV testing (Physician-HPV) and cytology. Differences in performance between Self-HPV versus Physician-HPV and their ability to detect abnormal cytology results (ASC-US+) were evaluated. Descriptive analyses were used to examine the correlation between HPV positivity and cervical abnormalities by age. A sample of 789 women was prospectively enrolled. HPV prevalence was 14.6% and 12.7% for Self-HPV and Physician-HPV, respectively (Cohen's kappa = 0.74). HPV positivity by cytological diagnosis for ASC-US+ was similar with the two tests. positive predictive value of the Self-HPV for ASC-US+ was 20.4; odds ratio and number needed to treat were 6.5 (3.2-13.4) and 6 (4.2-10.9), respectively. We observed a trend of increasing cytological abnormalities in 30-49 year-old women and a concomitant trend of decreasing HPV prevalence supporting that this age group might be the most eligible group for screening. In conclusion, Self-HPV can be used as a primary screening test but needs to be followed by a triaging test that would identify the subset of women affected by clinically significant precancer or cancer.

Indicators to Examine Quality of Large Scale Survey Data: An Example through District Level Household and Facility Survey

BackgroundLarge scale surveys are the main source of data pertaining to all the social and demographic indicators, hence its quality is also of great concern. In this paper, we discuss the indicators used to examine the quality of data. We focus on age misreporting, incompleteness and inconsistency of information; and skipping of questions on reproductive and sexual health related issues. In order to observe the practical consequences of errors in a survey; the District Level Household and Facility Survey (DLHS-3) is used as an example dataset.MethodsWhipple's and Myer's indices are used to identify age misreporting. Age displacements are identified by estimating downward and upward transfers for women from bordering age groups of the eligible age range. Skipping pattern is examined by recording the responses to the questions which precede the sections on birth history, immunization, and reproductive and sexual health.ResultsThe study observed errors in age reporting, in all the states, but the extent of misreporting differs by state and individual characteristics. Illiteracy, rural residence and poor economic condition are the major factors that lead to age misreporting. Female were excluded from the eligible age group, to reduce the duration of interview. The study further observed that respondents tend to skip questions on HIV/RTI and other questions which follow a set of questions.ConclusionThe study concludes that age misreporting, inconsistency and incomplete response are three sources of error that need to be considered carefully before drawing conclusions from any survey. DLHS-3 also suffers from age misreporting, particularly for female in the reproductive ages. In view of the coverage of the survey, it may not be possible to control age misreporting completely, but some extra effort to probe a better answer may help in improving the quality of data in the survey.

Asthma diagnosis and treatment – 1017. Prevalence and determinants of allergy and asthma amongst Indian children

Methods Schools at various centres were randomly selected. Children of eligible age group were included in the study after confirming with the school records. Two groups of children aged between 6-7 year and 13-14 year were selected and questionnaires were given. Parents of the younger age group children answered the questionnaire. The 13-14 year aged children answered the questions themselves along with an additional video questionnaire. The questionnaire included questions regarding exposure to traffic pollution and environmental tobacco smoke. Bivariate analysis was used to calculate the odds ratio.

Should income transfers be targeted or universal? Insights from public pension influences on elderly mortality in Canada, 1921–1966

Abstract. We investigate the impact of Canada's means‐tested and universal public pension programs on the mortality rates of age groups eligible for pension benefits for the period 1921–1966. We find that only the universal program significantly reduced pension eligible age group mortality rates. The implied social value of the mortality risk reduction from this program is one‐tenth of the value per statistical life associated with contemporary government policy, meaning that Canadians did not need to place a high value on the life of a senior to justify the higher cost of the universal program. JEL classification: I3, J1

Pentavalent Rotavirus Vaccine and Prevention of Gastroenteritis Hospitalizations in Australia

A publicly funded, universal infant pentavalent rotavirus vaccine (RV5) program was implemented in Queensland, Australia, in mid-2007. We sought to assess vaccine effectiveness (VE) of 3 doses of RV5 at preventing rotavirus and nonrotavirus acute gastroenteritis (AGE) hospitalizations in the first birth cohort and impact on hospitalizations in all age groups. Hospitalization rates for rotavirus and nonrotavirus AGE in all age groups before and after RV5 introduction were compared. Population vaccine coverage, hospitalization data, and individual vaccination status were obtained from routinely collected, publicly funded state- and nationally based data sets. Data linkage was performed to calculate 3-dose VE for preventing hospitalization in the eligible age group. RV5 coverage in the first eligible birth cohort was 89.6% for at least 1 dose and 73.1% for 3 doses. Three-dose VE for preventing nonrotavirus AGE hospitalization was 62.3% to 63.9% (any/primary diagnosis) and 89.3% to 93.9% (any/primary diagnosis) for rotavirus hospitalizations. After program implementation, there were immediate and sustained reductions in rotavirus hospitalizations for those who were younger than 20 years and nonrotavirus AGE-coded hospitalizations for those who were younger than 5 years. RV5 is highly effective at preventing rotavirus hospitalizations in a developed country setting, confirming efficacy figures from the pivotal clinical trial. Additional direct and indirect effects are substantial and include reductions in nonrotavirus AGE hospitalizations in vaccinated age groups and rotavirus and nonrotavirus AGE hospitalization rates in older age groups.

Women with learning disabilities and Read coding: lessons from a cohort study.

BackgroundThe aim was to examine any differences in the way that Read codes are applied to the records for female patients with learning disabilities across three PCT areas. To ascertain the most commonly used read codes for learning disability.MethodsThis was a retrospective cohort study carried out in Bury, Heywood-and-Middleton and Rochdale PCTs.All women in the eligible age-group (25–64) as of the 1st June, 2005, who were in contact with the Learning Disabilities Teams in the relevant PCT areas were identified from the Teams' lists. The appropriate Read Codes were then used to identify women on GP systems. Patient data is stored on the GP database systems (Vision, EMIS, EMIS PC4 and Torex) and it was possible to search for patients with learning disabilities.ResultsThe use of Read Codes varies across the three areas. The most commonly used Read codes were E3 (Mental Retardation) – 27%, PJ0. (Down's Syndrome) – 14% and Eu81z (Learning Disabilities) – 8%. In 24% of the records a Read Code had not been documented.ConclusionRead codes application varies between GP surgeries – dependent on PCT policy and the surgery's approach and also as a result of staff time.

Ensuring Equal Access for Medicaid Children

OBRA89: THE FIRST FOUR YEARS Since Medicaid began, the program has sought to provide equal access to medical care for the low-income beneficiaries it serves. The equal access regulation (42 C.F.R. 447.204) was included in the original set of Medicaid regulations promulgated in 1966. It was modified slightly in 1978, but remained largely without substantive policy impact until the enactment of the Omnibus Budget Reconciliation Act of 1989 (P.L. 101-239, OBRA89). OBRA89 was the capstone to a string of federal laws that began in 1984, which dramatically expanded Medicaid eligibility for children and pregnant women and transformed Medicaid from an in-kind, income maintenance program tied to public assistance to a public health insurance safety net now serving more than 50 million Americans, including more than one-fourth of the nation's children. (Kaiser Commission on Medicaid and the Uninsured, 2004). Through a three-pronged strategy, OBRA89 provided children and pregnant women with a special status among beneficiary groups in the Medicaid program. First, it dramatically broadened the mandated eligible age group from low-income pregnant women and children to age seven, to all poor children to age 18. But unlike predecessor legislation that established eligibility expansions through income and age standards only, the Congress went much further to ensure that these new beneficiaries would receive the mainstream care that it intended. It created requirements in two areas that historically had been the prerogative of the states--benefits and provider payment--changing the latter through a toughened equal access standard. The benefits revision centered on a requirement that states provide enhanced early and periodic screening, diagnosis, and treatment (EPSDT) services. The EPSDT program is the federal mandatory Medicaid service that requires states to provide children, to age 21, with a set of preventive care defined in consultation with established medical and dental groups. This benefits revision specified more comprehensive health screening and more important, required states to provide any treatment service needed to remediate a medical problem identified in an EPSDT screening. States were explicitly mandated to provide to children even if they exceeded the amount, duration, and scope of care identified in the state plan and were not provided to adults. Previously these discretionary services were optional. With respect to provider reimbursement, OBRA89 elevated the equal access requirements by shifting them from regulation to codified legislation. It also toughened the states' performance standards by requiring provider payments sufficient to enlist enough providers so that care and are available under the plan at least to the extent that such care and are available to the general population in the geographic (OBRA89, Section 6402). The notion of a geographic area baseline, with which Medicaid access to care would be compared and to which states would be held accountable, was entirely new. It also instituted comprehensive state reporting requirements to the Secretary of Health and Human Services (HHS) on the participation rates of obstetric and pediatric providers and payment rates for a long list of commonly provided pediatric and obstetric care services. The selection of only pediatric and OB services, as opposed to other possible groupings, such as all primary care or all federally mandated services, and its linkage to children's eligibility and benefits enhancements in the same legislation underscored the Congressional intent to ensure equal access to care specifically for children and pregnant women. These unprecedented legislative actions sent a clear message to the states that children and pregnant women must be furnished medically necessary care and created in the view of many, a special entitlement accorded to no other Medicaid-eligible subpopulations. …

Women with learning disability and uptake of screening: audit of screening uptake before and after one to one counselling

This study investigates the breast and cervical screening status of women with moderate to severe learning disability and whether uptake could be improved by one to one counselling. An audit of screening uptake of women in contact with the National Health Service (NHS) learning disability service within the eligible age groups for breast and cervical screening before and after one to one counselling by a learning disability team nurse. Of the eligible 48 women, 37 (77 per cent) had undergone breast screening indicating that uptake was excellent and comparable to the average national and local uptake. As for cervical screening, of the 160 women who were identified as eligible and were contactable, only 26 (16 per cent) were having regular smear tests. At the end of the project, which involved one to one counselling by the nurses to encourage uptake, nine additional women underwent smear tests bringing the uptake rate to 22 per cent. For the remaining 96 women (60 per cent) the reasons at the time for non-uptake were recognized as appropriate. Although the uptake of breast screening was found to be good, cervical screening uptake for women with learning disability was low and remained low after a supportive intervention designed to increase uptake. The greater acceptability of breast screening in women with moderate to severe learning disability compared to cervical screening has been confirmed.

Impact of news of celebrity illness on breast cancer screening: Kylie Minogue's breast cancer diagnosis

To describe the main media narratives in the reportage of singer Kylie Minogue's illness with breast cancer; and to assess the impact of this coverage on bookings for screening for breast cancer by mammography in four Australian states. Government sponsored BreastScreen programs in Queensland, Victoria, Tasmania and Western Australia. Narratives on breast cancer in television news programs 17-27 May 2005; initial and re-screening bookings for mammograms. Women aged > or = 40 years who booked for mammograms in BreastScreen programs in the 19 weeks before, the 2 weeks during, and the 6 weeks after the publicity. There was a 20-fold increase in news coverage of breast cancer, which emphasised that young women do get breast cancer and that early detection was critical. Overall screening bookings rose 40% in the 2 weeks of the publicity, with a 101% increase in non-screened women in the eligible age-group 40-69 years. Six weeks after the publicity, bookings remained more than a third higher in non-screened women. News coverage of Kylie Minogue's breast cancer diagnosis caused an unprecedented increase in bookings for mammography. Health advocates should develop anticipatory strategies for responding to news coverage of celebrity illness.

Bone mineral density measurement and treatment for osteoporosis in older individuals with fractures: a gap in evidence-based practice guideline implementation.

Osteoporosis evaluation and treatment guidelines state that, because of the high risk for future fractures, a fracture in an older individual warrants initiation of pharmacological treatment or bone mineral density (BMD) measurement followed by treatment according to BMD. We compared current practice with these guidelines. We used the electronic data systems of a health maintenance organization to collect fracture, BMD measurement, and pharmacy data for women aged 50 to 89 years and men aged 65 to 89 years who sustained a study-defined fracture during 1998 or 1999. We determined those who had BMD measurement or pharmacological treatment for osteoporosis (bisphosphonate or estrogen) during the 2 years. We compared the evaluation and treatment data with evidence-based clinical guidelines (for women) or expert consensus (for men). Of 70 513 members in the eligible age groups, 2804 persons sustained study-defined fractures. Overall, only 4.6% of those with fractures had treatment initiated after the fracture. Women sustained 80.7% of the study-defined fractures; 8.4% had BMD measurement and 42.4% received any treatment during the 2 years. Bone mineral density measurement and treatment frequency decrease significantly with age in women. In men, 1.5% had BMD measurement and 2.8% received any treatment. Approximately 51% (51.2%) of women and 95.5% of men in our study population were not evaluated or treated in accord with guideline or expert recommendations. Evaluation and treatment rates for osteoporosis in older individuals with fractures fall far below national recommendations, especially for men. Intervention strategies should be developed and evaluated to prevent refracture in older individuals with fractures.

The impact of vaccination against invasive Haemophilus influenzae type b disease in the Sydney region.

To evaluate the incidence of invasive Haemophilus influenzae type b (Hib) disease relative to rates of Hib vaccination in a well defined population. Cases of invasive Hib disease were identified by active laboratory surveillance for the period 1989-1994, and retrospectively for 1985-1987. Vaccination rates were determined by telephone interview of families with children aged 0-4 years, identified in a random telephone directory sample of 4000 households. The receipt and time of vaccination were validated from general practitioner records for a 50% subsample of children. Sydney Statistical Division, with a population of 263,758 children aged 0-4 years in 1990. Hib vaccination rates were relatively low before the introduction of government-funded vaccination programs in May 1993, especially for children under 18 months for whom multiple doses are required. Rates rose from fewer than 9% (95% CI, 4%-13%) in May 1993 to 48% (CI, 40%-56%) in August 1993 for children under 18 months, and from 31% (CI, 26%-36%) to 45% (CI, 40%-51%) for children aged 19-60 months. The age-specific incidence of Hib disease was inversely related to the vaccination rate. Forecasting of Hib disease incidence by the Box-Jenkins method showed that from September 1993, when about a 50% vaccine uptake was achieved in the eligible age group, overall incidence was substantially lower than expected. These data provide good evidence that the decrease in Hib disease incidence in 1993-1994 is an effect of vaccination, and not annual or seasonal variation. The impact of Hib vaccination appears to have been greater than would be expected from protection of vaccinated children alone. Invasive Hib disease is likely soon to become a rare cause of serious childhood infection in Australia.

Lack of Time as an Obstacle to Women's Education: The Case of Upper Volta

The neglected and disadvantaged position of rural girls and women has frequently been noted by scholars. The situation in Upper Volta is similar to that in the rest of subSaharan Africa. In 1974 only 10 percent of the eligible age group attended school at the primary level, 7.0 percent of the girls and 11.2 percent of the boys. A great disparity existed between rural and urban areas, with 70 percent of the children in urban areas attending school in contrast to 9 percent of those in rural areas.