Family Medicine Commons^™

Análisis De Las Políticas Públicas De Prevención Del Cáncer De Cuello Uterino Vinculadas Al Control Del Virus Del Papiloma Humano (Vph) En Argentina / An Analysis Of Argentina’S Public Health Prevention Strategies Of Cervical Cancer Related To The Control Of The Human Papiloma Virus (Hpv), Caroline Seman

Independent Study Project (ISP) Collection

El objetivo general de este estudio es analizar las políticas públicas de prevención del cáncer de cuello uterino (CCU) basadas en la incorporación de nuevas tecnologías como el test de VPH (Virus del Papiloma Humano) y la vacuna contra el VPH en Argentina. Los objetivos específicos son 1) describir la implementación del test de VPH y la campaña de vacunación obligatoria contra el VPH como estrategias de prevención primaria del CCU a nivel nacional: 2) identificar los factores que las facilitan y las obstaculizan. El CCU es el segundo cáncer más diagnosticado en las mujeres de Argentina. Desde el año …

Knowledge, Attitudes, And Intentions Toward Fertility Awareness And Oocyte Cryopreservation Among Obstetrics And Gynecology Resident Physicians, L. Yu, Brennan Peterson, M. C. Inhorn, Julia K. Boehm, P. Patrizio

Marriage and Family Therapy Faculty Articles and Research

STUDY QUESTION What knowledge, attitudes and intentions do US obstetrics and gynecology (OB/GYN) residents have toward discussing age-related fertility decline and oocyte cryopreservation with their patients?

SUMMARY ANSWER Most OB/GYN residents believe that age-related fertility decline, but not oocyte cryopreservation, should be discussed during well-woman annual exams; furthermore, nearly half of residents overestimated the age at which female fertility markedly declines.

WHAT IS KNOWN ALREADY Oocyte cryopreservation can be utilized to preserve fertility potential. Currently, no studies of US OB/GYN residents exist that question their knowledge, attitudes, and intentions toward discussing age-related fertility decline and oocyte cryopreservation with patients.

STUDY …

Are Pre-School Girls More Likely To Be Under-Nourished In Rural Thatta, Pakistan?-A Cross-Sectional Study., Rozina Nuruddin, Wilbur C. Hadden

Community Health Sciences

BACKGROUND:

Pakistan ranks third lowest on a global gender index (2013) and 13(th) highest on the prevalence of underweight among under-five children (2010). Through this population-based study, we examined gender differentials in the prevalence of stunting, wasting and under-weight defined by World Health Organization (WHO) Growth Standard among rural pre-school Pakistani children.

METHODS:

We performed secondary analysis of data collected through a cross-sectional survey of Thatta district during 1992-93. Prevalence ratios were calculated for 1051 children aged 0-35 months from 95 randomly selected villages of rural Pakistan using a clustered adjusted log binomial model. Level 1 variables included child and …

The Environmental Profile Of A Community’S Health: A Cross-Sectional Study On Tobacco Marketing In 16 Countries., Emily Savell, Anna B. Gilmore, Michelle Sims, Prem K. Mony, Teo Koon, Khalid Yusoff, Scott A. Lear, Pamela Seron, Noorhassim Ismail, K Burcu Tumerdem Calik, Annik Rosengren, Ahmad Bahonar, Rajesh Kumar, Krishnapillai Vijayakumar, Annamarie Kruger, Hany Swidan, Rajeev Gupta, Ehimario Igumbor, Asad Ali Khan Afridi, Omar Rahman, Jephat Chifamba, Katarzyna Zatonska, V Mohan, Deepa Mohan, Patricio Lopez-Jaramillo, Alvaro Avezum, Paul Poirier, Andres Orlandini, Wei Li, Martin Mckee, Sumathy Rangarajan, Salim Yusuf, Clara K. Chow

Community Health Sciences

OBJECTIVE:

To examine and compare tobacco marketing in 16 countries while the Framework Convention on Tobacco Control requires parties to implement a comprehensive ban on such marketing.

METHODS:

Between 2009 and 2012, a kilometre-long walk was completed by trained investigators in 462 communities across 16 countries to collect data on tobacco marketing. We interviewed community members about their exposure to traditional and non-traditional marketing in the previous six months. To examine differences in marketing between urban and rural communities and between high-, middle- and low-income countries, we used multilevel regression models controlling for potential confounders.

FINDINGS:

Compared with high-income countries, …

Postpartum Contraceptive Use And Unmet Need For Family Planning In Five Low-Income Countries., Omrana Pasha, Shivaprasad S. Goudar, Archana Patel, Ana Garces, Fabian Esamai, Elwyn Chomba, Janet L. Moore, Bhalchandra S. Kodkany, Sarah Saleem, Richard J. Derman, Edward A. Liechty, Patricia L. Hibberd, K. Michael Hambidge, Nancy F. Krebs, Waldemar A. Carlo, Elizabeth M. Mcclure, Marion Koso-Thomas, Robert L. Goldenberg

Community Health Sciences

BACKGROUND:

During the post-partum period, most women wish to delay or prevent future pregnancies. Despite this, the unmet need for family planning up to a year after delivery is higher than at any other time. This study aims to assess fertility intention, contraceptive usage and unmet need for family planning amongst women who are six weeks postpartum, as well as to identify those at greatest risk of having an unmet need for family planning during this period.

METHODS:

Using the NICHD Global Network for Women's and Children's Health Research's multi-site, prospective, ongoing, active surveillance system to track pregnancies and births …

Quality Of Life Among Women With Symptoms Of Gynecological Morbidities: Results Of A Cross‐Sectional Study In Karachi, Pakistan, Neelofar Sami, Tazeen Saeed Ali, Muhammad Osama

Community Health Sciences

AIMS:

A population-based cross-sectional study design was used to study the effects of symptoms of various gynecological morbidities (GM) on health-related quality of life (HRQoL) of women, residents of squatter settlements of Karachi, Pakistan.

MATERIAL AND METHODS:

This cross-sectional study was conducted in squatter settlements of Karachi from September 2012 to August 2013, with 1002 married, non-pregnant women. After obtaining written informed consent from every participant, a structured questionnaire was used to collect information about symptoms of GM and their effect on four domains of HRQoL (physical, social, functional and financial domains).

RESULTS:

Of 1002 women who participated in the …

Family Preservation And Healthy Outcomes For Pregnant And Parenting Teens In Foster Care: The Inwood House Theory Of Change, Lisa D. Lieberman, Linda Lausell Bryant, Keneca Boyce

Department of Public Health Scholarship and Creative Works

Teens in foster care give birth at more than twice the rate of other teens in the United States. Significant challenges exist for these most vulnerable teens and their babies. To preserve teens’ families, programs and services need to be able to improve teens’ prospects for parenting success, delay subsequent pregnancies, and reduce intergenerational placement in care. The Inwood House theory of change for pregnant and parenting teens is a roadmap for providing the range and types of services that have the potential to improve outcomes for these most vulnerable families. The theory of change builds on insights and data …

Vaccine Effectiveness And Risk Factors Associated With Measles Among Children Presenting To The Hospitals Of Karachi, Pakistan., Aysha Zahidie, Saba Wasim, Zafar Fatmi

Community Health Sciences

OBJECTIVE:

To determine the risk factors regarding guardian's practices associated with development of Measles and also find out effectiveness of Measles vaccine among children less than 12 years of age presenting to the hospitals of Karachi.

STUDY DESIGN:

Matched case control study.

PLACE AND DURATION OF STUDY:

Multicenter surveillance was conducted in 11 public and private sector hospitals of Karachi from January 2011 to September 2012 in consultation with World Health Organization Measles Surveillance Cell.

METHODOLOGY:

Cases were children aged less than 12 years with Measles presenting to the hospitals. Controls for cases were enrolled from the same hospitals without …

Improving Community Case Management Of Diarrhoea And Pneumonia In District Badin, Pakistan Through A Cluster Randomised Study--The Nigraan Trial Protocol, Fauziah Rabbani, Aftab A. Ali Mukhi, Shagufta Perveen, Xaher Gul, Saleem Iqbal Perwaiz, Shamim Ahmed Qazi, Iqbal Azam Syed, Khalid Hussain Shaikh, Wafa Aftab

Community Health Sciences

BACKGROUND:

Diarrhoea and pneumonia contribute 30% of deaths in children under 5 in Pakistan. Pakistan's Lady Health Workers Programme (LHW-P) covers about 60% of the population but has had little impact in reducing morbidity and mortality related to these major childhood killers. An external evaluation of the LHW-P suggests that lack of supportive supervision of LHWs by lady health supervisors (LHSs) is a key determinant of this problem. Project NIGRAAN aims to improve knowledge and skills of LHWs and community caregivers through supervisory strategies employed by LHSs. Ultimately, community casemanagement (CCM) of childhood pneumonia and diarrhoea will improve.

METHODS/DESIGN:

NIGRAAN …

Epidemiology, Determinants And Dynamics Of Cholera In Pakistan: Gaps And Prospects For Future Research., Maliha Naseer, Tanzil Jamali

Community Health Sciences

Cholera is one of the notifiable endemic diseases in Pakistan, but the reporting of cholera cases is still unsatisfactory. Most of the diagnosed cases are never reported to the relevant authorities. In the year 1993 - 2005, the country did not report any single case of cholera to the WHO. The objectives of this review were to understand the epidemiology and to identify the possible determinants of cholera infection in Pakistan. Medscape, Medline, PakMedinet and PubMed, was searched, using key words, epidemiology and determinants of cholera infection in Pakistan during 1995 - 2010. Morbidity and mortality due to cholera infection …

Prevalence, Determinants, And Management Of Chronic Kidney Disease In Karachi, Pakistan - A Community Based Cross-Sectional Study., Saleem Jessani, Rasool Bux, Tazeen Jafar

Community Health Sciences

BACKGROUND:

Chronic kidney disease (CKD) is increasing being recognized as a global public health problem. However, there is dearth of information on the prevalence, determinants, and management of CKD from low- and middle-income countries. The objectives of the study were to determine the 1) prevalence of CKD; 2) socio-demographic and clinical factors associated with CKD; and 3) the existing management of these patients with regards to blood pressure control, and use of antihypertensive medications.

METHODS:

We conducted a cross-sectional study on 2873 participants aged ≥ 40 years in 12 representative communities in Karachi, Pakistan. The primary outcome was clinically significant …

Validation Of A Food Frequency Questionnaire For Assessing Macronutrient And Calcium Intake In Adult Pakistani Population., Romaina Iqbal, Mohammad Ali Haroon, Farhan Javed Dar, Mujtaba Bilgirami, Gulshan Bano, Aysha Habib

Community Health Sciences

OBJECTIVE:

To develop and validate a food frequency table (FFQ) for use in urban Pakistani population.

STUDY DESIGN:

A validation study.

PLACE AND DURATION OF STUDY:

The Aga Khan University, Karachi, from June to November 2008.

METHODOLOGY:

Healthy adult females, aged ³ 18 years who consented to be included in the study were inducted, while males, unhealthy females, aged below 18 years or who did not consent were excluded. The FFQ was administered once while 4, 24 hours recalls spread over a period of one year were administered as the reference method. Daily intakes for energy, protein, fat, and calcium …

Needle Stick Injuries--Risk And Preventive Factors: A Study Among Health Care Workers In Tertiary Care Hospitals In Pakistan., Asad Ali Khan Afridi, Ameet Kumar, Raza Sayani

Community Health Sciences

BACKGROUND:

Health care workers (HCWs) are at substantial risk of acquiring blood borne infections such as HIV, Hepatitis-B and Hepatitis-C through needle stick injuries (NSIs). This study aimed to assess the proportion of NSIs and their associated factors among HCWs and also to identify the areas in which preventive efforts might be directed to protect against this occupational hazard.

METHODOLOGY:

A cross-sectional study was conducted in two tertiary care hospitals of Pakistan representing both private and public health sector. A total of 497 HCWs (doctors and nurses) were interviewed using a structured questionnaire. Data was collected from January to May …

Need For Multilevel Strategies And Enhanced Acceptance Of Contraceptive Use In Order To Combat The Spread Of Hiv/Aids In A Muslim Society: A Qualitative Study Of Young Adults In Urban Karachi, Pakistan, Syed Farid-Ul-Hasnain, Eva Johansson, Saleema A. Gulzar, Gunilla Krant

Community Health Sciences

This qualitative study explored knowledge, attitudes, beliefs and perceptions of sexual and reproductive health, focusing specifically on contraceptive use and HIV prevention among young unmarried men and women, 17-21 years, in urban Karachi, Pakistan. The main theme, identified as underlying meaning in the focus group discussions was "Societal norms and perceptions create barriers to knowledge and awareness about sexual and reproductive health matters among young adults". A knowledge gap was revealed concerning HIV/AIDS and contraceptive use among young males and females, who have to rely on media and peers for information seeking. Study participants perceived that HIV/AIDS is incurable and …

Correlation Of Respiratory Symptoms And Spirometric Lung Patterns In A Rural Community Setting, Sindh, Pakistan: A Cross Sectional Survey, Imran Naeem Abbasi, Adeel Ahsan, Asaad Ahmed Nafees

Community Health Sciences

Background: Symptom-based questionnaires can be a cost effective tool enabling identification and diagnosis of patients with respiratory illnesses in resource limited setting. This study aimed to determine the correlation of respiratory symptoms and spirometric lung patterns and validity of ATS respiratory questionnaire in a rural community setting.
Methods: This cross sectional survey was conducted between January - March 2009 on a sample of 200 adults selected from two villages of district Khairpur, Sindh, Pakistan. A modified version of the American thoracic society division of lung disease questionnaire was used to record the presence of respiratory symptoms. Predicted lung volumes i.e. …

Respiratory Symptoms And Illnesses Among Brick Kiln Workers: A Cross Sectional Study From Rural Districts Of Pakistan, Shiraz Shaikh, Asaad Ahmed Nafees, Vikash Khetpal, Abid Ali Jamali, Abdul Manan Arain, Akram Yousuf

Community Health Sciences

Background: Occupational risk factors are one of the major causes of respiratory illnesses and symptoms, and account for 13% of chronic obstructive pulmonary disease and 11% of asthma worldwide. Majority of brick kilns in Pakistan use wood and coal for baking the bricks which makes the brick kiln workers susceptible to high exposure of air pollution. This study was designed to describe frequency of chronic respiratory symptoms and illnesses and study the association between these symptoms and different types of work.
Methods: This was a questionnaire based cross sectional survey conducted among the brick kiln workers in Larkana and Dadu …

The Effects Of A Group Visit Program On Outcomes Of Diabetes Care In An Urban Family Practice., Jeffrey A Reitz, Mona Sarfaty, James Diamond, Brooke Salzman

Department of Family & Community Medicine Faculty Papers

Diabetes mellitus is a prevalent chronic health condition associated with significant morbidity and mortality. Those with diabetes must acquire self-efficacy in the tasks necessary for them to successfully manage their disease. In this study, a controlled pre- and post-design was used to determine the effect of an adult support and education group visit program embedded in an urban academic family medicine practice on weight and the achievement of treatment goals for hemoglobin A1C, low-density lipoprotein (LDL) blood concentration, and blood pressure (BP) several months after it was implemented. Participants in the program were matched to a comparison group based on …

Experience Of Devolution In District Health System Of Pakistan: Perspectives Regarding Needed Reforms, Shiraz Shaikh, Imran Naeem Abbasi, Asaad Ahmed Nafees, Aysha Zahidie, Zafar Fatmi, Ambreen Kazi

Community Health Sciences

Objective: To identify the strengths and weaknesses of the devolved district health system from the experiences of different stakeholders, and recommend direction for reforms in the existing system.
Methods: Using qualitative exploratory design, the study was conducted in 3 cities of the province of Sindh in Pakistan--Karachi, Khairpur and Larkana--from January to March 2010. Nine in-depth interviews were conducted with multiple stakeholders (District Coordination Officer, Executive District Officer, Medical Superintendent, Medical officers, Health system experts) of the district health system. Interviews included questions on autonomy in decision-making at the district level and the effectiveness of the devolved health system. Data …

Retrospective Analysis Of Metabolic Syndrome: Prevalence And Distribution In Executive Population In Urban Pakistan., Niloufer Sultan Ali, Ali Khan Khuwaja, Adnan Ur Rahman, Kashmira Nanji

Department of Family Medicine

Background. Metabolic Syndrome (MetS) is a major public health concern.

Objective. The aim of this study was to estimate the frequency of MetS, its components, and factors associated with MetS amongst apparently healthy individuals in Pakistan.

Methods. A retrospective cross-sectional study was conducted at the executive Clinics of Aga Khan Hospital, Pakistan. Medical records of patients aged ≥18 years visiting the clinics from July 2011 to December 2011 were consecutively reviewed. Records in which either MetS components data or 10% of overall data was missing were excluded. A total of 1329 participants’ records was included in final analysis. Data was …

Cervical Cancer Screening Outcomes In A Refugee Population, Sarah Pickle, Md, Marc Altshuler, Md, Kevin Scott, Md, Christina Hillson, Md, R. Patrick Mcmanus, Md, Mazvita Nyamukapa, Michael Walker

Department of Family & Community Medicine Presentations and Grand Rounds

The purpose of our study was to determine the prevalence of abnormal Pap smears and high-risk HPV genotypes within our refugee population.

Obesity And Other Predictors Of Absenteeism In Philadelphia School Children., Elizabeth B Rappaport, Constantine Daskalakis, Jocelyn Andrel

Department of Family & Community Medicine Faculty Papers

BACKGROUND: Limited data indicate that obese children are absent from school more than their normal-weight peers. We analyzed administrative data from a large urban school district to investigate the association of obesity and student sociodemographic characteristics with absenteeism.

METHODS: We analyzed 291,040 records, representing 165,056 unique students (grades 1-12). Obesity status was classified according to Centers for Disease Control and Prevention age- and sex-specific percentiles for body mass index (BMI) and analyses were based on negative binomial regression.

RESULTS: Overall rates of overweight and obesity were 17% and 20%, respectively, and the estimated absence rate was 17 absences per 180 …

Screening Of Hepatitis B And C Among People Visiting General Practice Clinics In A Rural District Of Sindh, Pakistan., Ameet Kumar, Saima Lalani, Asad Ali Khan Afridi, Ali Khan Khuwaja

Community Health Sciences

BACKGROUND:

Hepatitis B (HB), Hepatitis C (HC) and their risk factors are amongst the major health problems in developing countries including Pakistan. This study aimed to screen for HB and HC among people who visited General Practice clinics and also to identify the differences of screening positive cases by age and sex.

METHODS:

This was a retrospective study conducted in Tando Muhammad Khan city, one of the rural districts of Sindh. All together we reviewed 5989 laboratory reports of people for hepatitis B and C on consecutive basis from two laboratories. A pre-designed and structured perform was used to collect …

National Health Accounts: Lessons For Pakistan., Ashar Muhammad Malik

Community Health Sciences

No abstract provided.

Psycho-Social Consequences Of Secondary Infertility In Karachi., Neelofar Sami, Tazeen Saeed Ali

Community Health Sciences

OBJECTIVE:

To explore the experiences of social consequences among women suffering from secondary infertility.

METHODS:

Descriptive case series of 400 women with secondary infertility attending tertiary care hospitals in Karachi, Pakistan.

RESULTS:

More than two thirds (67.7%) of women stated that their inability to give live births or give birth to sons had resulted in marital dissonance. The respondents had been threatened for divorce (20%), husband's remarrying (38%) or to be returned to their parent's home (26%) by their in laws or husbands. Majority (68%) of the women threatened did not have any live births. However, those who had live …

Behind The Counter: Pharmacies And Dispensing Patterns Of Pharmacy Attendants In Karachi., Fauziah Rabbani, F. H. Cheema, N. Talati, S. Siddiqui, S. Syed, S. Bashir, L. Z. Zuberi, A. Shamim, Q. Mumtaz

Community Health Sciences

BACKGROUND:

There is little literature available on dispensing patterns and unsupervised sale of medicines from pharmacies in developing countries.

OBJECTIVE:

This study obtained background information on pharmacies assessed the level of training, knowledge and dispensing patterns of pharmacy attendants in Karachi.

METHODOLOGY:

This is a descriptive cross sectional study with convenient sampling. A structured questionnaire was used to interview pharmacy attendants.

RESULTS:

Of the 219 pharmacies surveyed, 62% reported more than 50 customers daily and 20% also sold items of general provision. Mean operating hours were 13. Only 24 (11%) had a visible license. On an average 3 attendants were …

Clinical Spectrum Of Systemic Lupus Erythematosus At The Aga Khan University Hospital., K. Sulaiman, N. Sohail, A. A. Sheikh, F. Raza, F. Shahzad, A. Siddique, T. Shakir, Fauziah Rabbani

Community Health Sciences

BACKGROUND:

Systemic lupus erythematosus is a disease of unknown etiology, which at onest may involve only one organ system or be multisystemic. The aim of our study is to determine the clinical presentation of SLE patients presenting to AKUH to establish whether guidelines laid down about this disease are in agreement with our experience.

METHODS:

A retrospective log review was carried out at AKUH, based on data obtained from 165 files of individuals admitted to the hospital over a period of 12 years with a confirmed diagnosis of SLE.

RESULTS:

From the sample size of 165, 143 (86.7%) were females …

The Minds Of Mothers: Maternal Mental Health In An Urban Squatter Settlement Of Karachi., Fauziah Rabbani, Furqan Farooq Raja

Community Health Sciences

BACKGROUND:

Community-based information on maternal mental health in developing countries is meager and nearly non-existent in Pakistan.

OBJECTIVE:

To determine the proportion of probable cases of women with mental disorders and examine the associated conditions and risk factors which contribute to maternal mental ill-health.

METHODS:

With convenient sampling 260 mothers in an urban squatter settlement of Karachi were interviewed. The tools consisted of a household questionnaire collecting information on basic demographic and other characteristics and the Aga Khan University Anxiety and Depression Scale (AKUADS), an instrument to assess psychiatric morbidity.

RESULTS:

The proportion of probable cases of mental disorder was …

Views About Women's Mental Health: Study In A Squatter Settlement Of Karachi., Fauziah Rabbani

Community Health Sciences

OBJECTIVE:

Mental health of women is globally receiving particular attention. This study assessed community's view on certain aspects of women's mental health prior to introducing an intervention.

SETTING:

The study was conducted in an urban squatter settlement located in District West of Karachi in 1997 where the Aga Khan University has set up a Primary Health Care program in partnership with the communities.

METHODS:

Using convenient sampling, door to door household survey was conducted by medical students.

RESULTS:

Two hundred and eighty one residents were interviewed. Respondents were asked to list contributory factors which lead to mental distress in women. …

Economic Development And Health Status Among The Poor In Squatter Settlements Of Karachi., Fauziah Rabbani, Anwer T. Merchant

Community Health Sciences

OBJECTIVE:

Socioeconomic status is an important determinant of health outcome measures. This study examines and presents some of the important health outcomes amongst the higher and lower socioeconomic groups within the urban poor.

SETTING:

Data analysis is based on a Health and Demographic Survey conducted in urban squatter settlements of Karachi in 1996.

METHODS:

A structured questionnaire was administered to all households in the catchment area. The indicator used to assess economic status is ownership of assets.

RESULTS:

Comparison between the two economic levels shows that the lower socio-economic group was more likely to experience child mortality, (CI; 1.02-1.29, p …