Family Medicine Commons^™

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, …

Confirmatory Factor Analysis And Invariance Testing Between Blacks And Whites Of The Multidimensional Health Locus Of Control Scale., Marianna Lanoue, Abby Harvey, Dawn B. Mautner, Bon Ku, Kevin Scott

Department of Family & Community Medicine Faculty Papers

The factor structure of the Multidimensional Health Locus of Control scale remains in question. Additionally, research on health belief differences between Black and White respondents suggests that the Multidimensional Health Locus of Control scale may not be invariant. We reviewed the literature regarding the latent variable structure of the Multidimensional Health Locus of Control scale, used confirmatory factor analysis to confirm the three-factor structure of the Multidimensional Health Locus of Control, and analyzed between-group differences in the Multidimensional Health Locus of Control structure and means across Black and White respondents. Our results indicate differences in means and structure, indicating more …

Obsessive-Compulsive Disorder, Elizabeth Collins, Md

Department of Family & Community Medicine Presentations and Grand Rounds

PowerPoint only, no audio.

Presentation includes:

• Definitions
• Epidemiology and Pathology
• Diagnosis
• Dermatologic Manifestations
• Management

Hip Fragility Fractures: Anaemia, Calcium And Vitamin D Supplementation, Iqra Khan, Ambreen Jawaid, Khabir Ahmad, Shahryar Noordin

Department of Family Medicine

Objective: To assess the burden of anaemia and osteoporosis in hip fracture patients, to determine the rate of blood transfusion per-operatively, to assess the use of calcium and vitamin D supplements and the use of anti-osteoporotic medications postoperatively.
Methods: A retrospective study was conducted at Aga Khan University and Hospital (AKUH) between June 2009 and May 2011, and comprised record of patients treated for intertrochanteric and femur neck fractures. Patients with associated pathological, open or long bone fractures were excluded. The main study outcome measures were the use of pre-operative and post-operative calcium, vitamin D, bisphosphonates and management of anaemia …

Residual Barriers For Utilization Of Maternal And Child Health Services: Community Perceptions From Rural Pakistan., Zahid Memon, Shehla Zaidi, Atif Riaz

Community Health Sciences

Low utilization of maternal and child care services in rural areas has constrained Pakistan from meeting targets of Millennium Development Goals (MDGs) 4 and 5. This study explores community barriers in accessing Maternal and Child Health (MCH) services in ten remote rural districts of Pakistan. It further presents how the barriers differ across a range of MCH services, and also whether the presence of Community Health Workers (CHWs) reduces client barriers. Qualitative methods were used involving altogether sixty focus group discussions with mothers, their spouses and community health workers. Low awareness, formidable distances, expense, and poorly functional services were the …

Can Contracted Out Health Facilities Improve Access, Equity, And Quality Of Maternal And Newborn Health Services? Evidence From Pakistan., Shehla Zaidi, Atif Riaz, F. Rabbani, Iqbal Azam Syed, Syeda Nida Imran, Nousheen Pradhan, Gul Nawaz Khan Nawaz Khan

Community Health Sciences

BACKGROUND:

The case of contracting out government health services to non-governmental organizations (NGOs) has been weak for maternal, newborn, and child health (MNCH) services, with documented gains being mainly in curative services. We present an in-depth assessment of the comparative advantages of contracting out on MNCH access, quality, and equity, using a case study from Pakistan.

METHODS:

An end-line, cross-sectional assessment was conducted of government facilities contracted out to a large national NGO and government-managed centres serving as controls, in two remote rural districts of Pakistan. Contracting out was specific for augmenting MNCH services but without contractual performance incentives. A …

Isoniazid Induced Motor-Dominant Neuropathy, Rabeeya Arsalan, Saniya Sabzwari

Department of Family Medicine

Isoniazid though a very effective treatment for tuberculosis can cause severe motor-dominant neuropathy which can be reversible with pyridoxine supplementation. A 45-year-old female diagnosed with psoas abscess, culture positive for mycobacterium tuberculosis, was started on anti- tuberculous treatment with four drugs, including isoniazid at a dose of 5 mg/kg/day. Three months later she developed severe motor weakness of lower limbs with loss of ankle and knee reflexes. She was treated with vitamin B6 injections and isoniazid treatment was continued. Her motor weakness gradually improved in a few months, but mild sensory impairment persisted even after two years. There is need …

Effect Of Nutritional Deficiency On The Efficacy Of The Polio Vaccines In Pakistan., Aamir Abbas, Romaina Iqbal

Department of Medicine

No abstract provided.

Energy Drinks Consumption Practices Among Medical Students Of A Private Sector University Of Karachi, Pakistan, Asma Usman, Swaleha Tariq Bhombal, Ambreen Jawaid, Samar Zaki

Department of Family Medicine

Consumption of energy drinks has become popular among students and athletes over the past few years. To explore the phenomenon, a cross-sectional survey was conducted through a self-administered pilot-tested questionnaire. Frequency of energy drinks consumption was found to be 121(52%) in a sample of 233 medical students. Red bull was the most common brand consumed 101(43%). The major reasons reported for its usage were to gain/replenish energy by 36(15.4%), and studying for examination by 34(14.6%). Television was reported as the major source of information 153(66%) followed by friends 113(48%). There was a high frequency of energy drinks' consumption among medical …

Landscape Analysis Of Multi-Sectoral Initiatives For Under-Nutrition In Pakistan, Zulfiqar Ahmed Bhutta, Albertha Nyaku, Jane Keylock, Shehla Zaidi, Jai Das

Community Health Sciences

Mapping of Multi-Sectoral Initiatives for Nutrition in Pakistan, Challenges faced, Opportunities, and potential for Cross- Sectoral Synergies.

Can Doctors Change? Attempts To Improve Adherence To The 2013 Statin Guidelines For Diabetic Patients At An Urban Academic Family Medicine Clinic, Marshall Miller, Md, Victoria Rose, Md, Jill Kropa, Md, Rina Edi, Md, Margaret Crenshaw, Md, Emily Levy, Md, Christopher Hwang, Md, Elizabeth Collins, Md, Danielle Dang, Md, Lori Atkinson, Md

Department of Family & Community Medicine Presentations and Grand Rounds

In November 2013 new statin guidelines were released. Generally, physicians are slow to adopt new guidelines and adherence to new guidelines often remains low even years after they have been issued. In this study, multiple interventions, including patient handouts, email reminders, and education sessions were implemented to increase adherence with new statin prescribing guidelines in a large urban practice. The numbers of prescriptions were analyzed for 6 weeks prior to and 6 weeks after the interventions. Statin prescribing in diabetic patients not already on a statin pre-intervention was 11.7% and post-intervention was 13.0% (p-value 0.5936). There was a small increase …

Role Of Evidence-Based Public Health In Controlling Emerging Infectious Diseases, Tawfik A. M. Khoja, Waris Qidwai, Mohamed S. Hussein, Lesley Pocock

Department of Family Medicine

No abstract provided.

The Case For Family Medicine In Pakistan, Saniya Raghib Sabzwari

Department of Family Medicine

The specialty of Family Medicine enjoys a special position in the medical practice of the West, serving as one of the key primary care specialties. Family physicians act as providers of first contact catering to the medical needs of the entire family in all aspects of preventive, curative and rehabilitative stages of illness and to health maintenance. The growth of this specialty, however, has lagged behind in Pakistan for various reasons. Having both a high burden of communicable and non-communicable diseases in Pakistan; family physicians should form the frontline force in dealing with these health issues. Several success stories of …

Incidence, Remission And Mortality Of Convulsive Epilepsy In Rural Northeast South Africa, Ryan G. Wagner, Christian Bottomley, Anthony Ngugi, Fredrick Ibinda, F. Xavier Gómez-Olivé, Kathleen Kahn, Stephen Tollman, Charles R. Newton

Family Medicine, East Africa

Background: Epilepsy is one of the most common neurological conditions globally, estimated to constitute 0.75% of the global burden of disease, with the majority of this burden found in low- and middle- income countries (LMICs). Few studies from LMICs, including much of sub-Saharan Africa, have described the incidence, remission or mortality rates due to epilepsy, which are needed to quantify the burden and inform policy. This study investigates the epidemiological parameters of convulsive epilepsy within a context of high HIV prevalence and an emerging burden of cardiovascular disease.

Methods: A cross-sectional population survey of 82,818 individuals, in the Agincourt Health …

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 …

Characterization Of The Older Adult Refugee Population At Thomas Jefferson University’S Center For Refugee Health (Crh), Kathryn Beldowski, Md, Neesha Patel, Md, Brooke Salzman, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Background

• Established in 2007, the CRH has served over 1,000 refugees of all ages as they resettle in Philadelphia, PA.
• Research about refugee populations generally focuses on infectious disease, women’s health, pediatrics and mental health, with minimal research on the older adult refugee population.
• The objective of this study was to describe the characteristics of the older refugee population served by the CRH, focusing on chronic disease, smoking status, immunization and cancer screening rates, and presence of geriatric syndromes.

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 …

Delivering Healthcare Services In Resource Constraint Countries Like Pakistan: Sustainable Options, Waris Qidwai

Department of Family Medicine

No abstract provided.

Barriers, Challenges And Way Forward For Implementation Of Person Centered Care Model Of Patient And Physician Consultation: A Survey Of Patients’ Perspective From Eastern Mediterranean Countries, Waris Qidwai, Kashmira Nanji, Tawfik A M Khoja, Salman Rawaf, Nabil Yasin Al Kurashi, Faisal Alnasir, Mohammed Ali Al Shafaee, Mariam Al Shetti, Muntazar Bashir, Nagwa Eid Sobhy Saad, Sanaa Alkaisi, Wafa Halasa, Huda Al Duwaisan, Amal Al- Ali

Department of Family Medicine

Background: Person-Centered Care (PCC) is now considered a mandatory approach in Patient-Physician consultation. The aim of the study was to identify patients’ perception regarding barriers and possible remedies for implementation of PCC in Eastern Mediterranean Region (EMR).
Methods: A cross-sectional multi-country study was conducted in six countries of EMR during May 2014 to October 2014. Expert Family Physicians from each country were identified and asked to participate in the study. The Family Physicians then recruited Patients from their own clinics (>18 years). Data analysis was performed on SPSS 19 and results are reported in the form of …

Psychosocial Risk Factors For Acute Myocardial Infarction: Results Of A Case-Control Study In A Teaching Hospital At Karachi, Pakistan, Kiran Abdul Sattar, Waris Qidwai, Kashmira Nanji

Department of Family Medicine

Objective: To determine psychosocial risk factors for acute myocardial infarction at a teaching hospital in Karachi. Methods: One hundred and fifty three cases were recruited from cardiology clinics and 153 controls from internal medicine and family medicine clinics of Aga Khan University Hospital, Karachi, through non-probability sampling using a structured questionnaire. Cases were those who were diagnosed with acute myocardial infarction for the first time in past month. Controls were selected from family medicine and internal medicine clinics of the same hospital and included patients above the age of 40 years without acute myocardial infarction. Associations between psychosocial risk …

Health Promotion, Disease Prevention And Periodic Health Checks: Perceptions And Practice Among Family Physicians In Eastern Mediterranean Region, Waris Qidwai, Kashmira Nanji, Tawfik A M Khoja, Salman Rawaf, Nabil Yasin Al Kurashi, Faisal Alnasir, Mohammed Ali Al Shafaee, Mariam Al Shetti, Muntazar Bashir, Nagwa Eid Sobhy Saad, Sanaa Alkaisi, Wafa Halasa, Huda Al L-Duwaisan, Amal Al - Ali, Taghreed M. Faraha

Department of Family Medicine

Introduction: The aim of this study was to identify the current practices and perceptions of family physicians regarding health promotion, disease prevention including periodic screening and health checks in Eastern Mediterranean Region.
Methods: A multi-country cross-sectional study was conducted in six countries of EMR, from September 2014 to March 2015. Family Physicians who were currently practicing in different countries of EMR were invited to participate in the study through email. A pre-tested structured questionnaire was used for data collection. Data was entered and analyzed on SPSS 19 and logistic regression analysis was performed.
Results: A total of 100 physicians’ …

Unreliable Bodies: A Follow-Up Twenty Years Later By A Mother And Daughter About The Impact Of Illness And Disability On Their Lives, Kaethe Weingarten, Miranda Worthen

Faculty Publications

We are a mother and daughter, both health care professionals, who offer a follow-up to an article we published twenty years ago about the impact of each other’s ongoing, serious medical problems on our relationship. In this article, we contribute a long-term perspective on the differences between having an illness that is well or poorly understood by medical professionals and the lay community. We also discuss health in the cont ext of identity formation and life stage, as during this interval the daughter left home, graduated college, married, and had two children. Also in this period, the mother survived a …

Experiences Of Parents Caring For Infants With Rare Scalp Mass As Identified Through A Disease-Specific Blog, Miranda Worthen, Tara Leonard, Thomas Blair, Nalin Gupta

Faculty Publications

Background: Delayed subaponeurotic fluid collection (DSFC) is a self-limited disorder of unknown etiology characterized by a benign, fluid-filled mass in the subaponeurotic layer of an infant's scalp. While a few case series describe DSFC, the experiences of families whose infants develop this condition have not previously been reported.Methods: We used a disease-specific blog to evaluate the experiences of 69 families affected by DSFC. We identified self-reported clinical features of DSFC and qualitatively analyzed the families' experiences with obtaining a diagnosis and care for their infants.Results: Infants presented in several clinical settings, and multiple diagnostic procedures were administered, including ultrasound (46%), …

Can Trained Field Community Workers Identify Stroke Using A Stroke Symptom Questionnaire As Well As Neurologists? Adaptation And Validation Of A Community Worker Administered Stroke Symptom Questionnaire In A Peri-Urban Pakistani Community., Maria Khan,, Ayeesha Kamran Kamal, Muhammad S. Ilyas, Muhammad Islam, Iqbal Azam Syed, Azam Virk,, Alia Nasir, Hasan Rehman,, Anita Arif,, Muhammad Jan,, Anjum Akhtar,, Minaz Mawani, Junaid Abdul Razzak,, Omrana Pasha

Department of Medicine

Background: Stroke is a leading cause of morbidity and mortality worldwide. There is a paucity of data from South Asia where stroke is highly prevalent. Validated tools administrable by Community Health Workers (CHWs) are required to identify stroke in the community in a resource strapped region such as this.

Methods: The study was conducted in a transitional slum in Karachi, Pakistan. Questionnaire for Verifying Stroke-Free Status (QVSFS) was adapted and translated into Urdu. Two CHWs, trained by a neurologist, selected 322 community dwelling subjects using purposive sampling. Each CHW collected data independently which was validated by a vascular neurologist who …

Influencing Student Specialty Choice: The 4 Pillars For Primary Care Physician Workforce Development, C. Matson, A. Davis, J. Epling, J. Freeman, T. Iroku-Malize, M. Stephens, A. Wilke, A. Arendale, A. Weidner, +4 Additional Authors

Journal Articles

No abstract provided.

Prevalence And Risk Factors For Active Convulsive Epilepsy In Kintampo, Ghana, Kenneth Ayuurebobi Ae-Ngibise, Bright Akpalu, Anthony Ngugi, Albert Akpalu, Francis Agbokey, Patrick Adjei, Damien Punguyire, Christian Bottomley, Charles Newton, Seth Owusu-Agyei

Family Medicine, East Africa

Introduction: epilepsy is common in sub-Saharan Africa, but there is little data in West Africa, to develop public health measures for epilepsy in this region.

Methods: we conducted a three-stage cross-sectional survey to determine the prevalence and risk factors for active convulsive epilepsy (ACE), and estimated the treatment gap in Kintampo situated in the middle of Ghana.

Results: 249 people with ACE were identified in a study population of 113,796 individuals. After adjusting for attrition and the sensitivity of the screening method, the prevalence of ACE was 10.1/1000 (95% Confidence Interval (95%CI) 9.5-10.7). In children aged <18 years, risk factors for ACE were: family history of seizures (OR=3.31; 95%CI: 1.83-5.96), abnormal delivery (OR=2.99; 95%CI: 1.07-8.34), problems after birth (OR=3.51; 95%CI: 1.02-12.06), and exposure to Onchocerca volvulus (OR=2.32; 95%CI: 1.12-4.78). In adults, a family history of seizures (OR=1.83; 95%CI: 1.05-3.20), never attended school (OR=11.68; 95%CI: 4.80-28.40), cassava consumption (OR=3.92; 95%CI: 1.14-13.54), pork consumption (OR=1.68; 95%CI: 1.09-2.58), history of snoring at least 3 nights per week (OR=3.40: 95%CI: 1.56-7.41), exposure to Toxoplasma gondii (OR=1.99; 95%CI: 1.15-3.45) and Onchocerca volvulus (OR=2.09: 95%CI: 1.29-3.40) were significant risk factors for the development of ACE. The self-reported treatment gap was 86.9% (95%CI: 83.5%-90.3%).

Conclusion: ACE is common …