Medicine and Health Sciences Commons^™

Glycaemic Index, Glycaemic Load And Ovarian Cancer Risk: A Prospective Cohort, Stephanie A. Navarro Silvera, Meera Jain, Geoffrey R. Howe, Anthony B. Miller, Thomas E. Rohan

Department of Public Health Scholarship and Creative Works

Background

There is some evidence that plasma insulin levels might influence ovarian cancer risk. Glyacemic index (GI) and glycaemic load (GL) are measures that allow the carbohydrate content of individual foods to be classified according to their postprandial glycaemic effects and hence their effects on circulating insulin levels. Therefore, we examined ovarian cancer risk in association with GI and GL, and intake of dietary carbohydrate and sugar. Methods

The study was conducted in a prospective cohort of 49 613 Canadian women enrolled in the National Breast Screening Study (NBSS) who completed a self-administered food-frequency questionnaire (FFQ) between 1980 and 1985. …

Glycaemic Index, Glycaemic Load And Ovarian Cancer Risk: A Prospective Cohort Study, Stephanie A. Navarro Silvera, Meera Jain, Geoffrey R. Howe, Anthony B. Miller, Thomas E. Rohan

Department of Public Health Scholarship and Creative Works

Background

There is some evidence that plasma insulin levels might influence ovarian cancer risk. The glycaemic index (GI) and glycaemic load (GL) are measures that allow the carbohydrate content of individual foods to be classified according to their postprandial glycaemic effects and hence their effects on circulating insulin levels. Therefore, we examined ovarian cancer risk in association with GI and GL, and intake of dietary carbohydrate and sugar.

Methods

The study was conducted in a prospective cohort of 49 613 Canadian women enrolled in the National Breast Screening Study (NBSS) who completed a self-administered food-frequency questionnaire (FFQ) between 1980 and …

Benign Proliferative Epithelial Disorders Of The Breast: A Review Of The Epidemiologic Evidence, Stephanie A. Navarro Silvera, Thomas E. Rohan

Department of Public Health Scholarship and Creative Works

Nearly one in four breast cancers is diagnosed before the age of 50, and many early-stage premalignant lesions are present but not yet diagnosed. Therefore, we review evidence to support the strategy that breast cancer prevention efforts must begin early in life. This study follows the literature review methods and format. Exposures during childhood and adolescence affect a woman’s long-term risk of breast cancer, but have received far less research attention than exposures that occur later in life. Breast tissue undergoes rapid cellular proliferation between menarche and first full-term pregnancy, and risk accumulates rapidly until the terminal differentiation that accompanies …

A Medical Mission: Healing Wounds, Improving Health, And Discovering Hope In Honduras, Michaela Maynard

Senior Honors Projects

According to the United Nations, less than one-sixth of the world’s population is made up of the industrialized world. In contrast, the developing world, consisting of approximately 125 low and middle-income countries, is home to about 5.1 billion people. It is in these developing counties that there is an insatiable need for improved public health. In January of 2007, I spent a week working in a medical clinic in Guaimaca, Honduras. I witnessed first hand the suffering, poverty, and injustice of one small town. Yet, what struck me the most was that despite the hardships and the lack of basic …

A Cohort Study Of Reproductive And Hormonal Factors And Renal Cell Cancer Risk In Women, Gc Kabat, Stephanie A. Navarro Silvera, Ab Miller, Te Rohan

Department of Public Health Scholarship and Creative Works

We examined the association of reproductive and hormonal factors with renal cell cancer risk in a cohort study of 89 835 Canadian women. Compared with nulliparous women, parous women were at increased risk (hazard ratio (HR) 1.78, 95% confidence interval (CI) 1.02–3.09), and there was a significant gradient of risk with increasing levels of parity: relative to nulliparous women, women who had X5 pregnancies lasting 4 months or more had a 2.4-fold risk (HR 1⁄4 2.41, 95% CI 1⁄4 1.27–4.59, P for trend 0.01). Ever use of oral contraceptives was associated with a modest reduction in risk. No associations were …

Dietary Fiber Intake And Ovarian Cancer Risk: A Prospective Cohort Study, Stephanie A. Navarro Silvera, Meera Jain, Geoffrey R. Howe, Anthony B. Miller, Thomas E. Rohan

Department of Public Health Scholarship and Creative Works

There is some evidence from case–control studies that dietary fiber intake might be inversely associated with ovarian cancer risk, but there are limited prospective data. Therefore, we examined ovarian cancer risk in association with intake of dietary fiber in a prospective cohort of 49,613 Canadian women enrolled in the National Breast Screening Study (NBSS), who completed a self-administered food frequency questionnaire between 1980 and 1985. Linkages to national mortality and cancer databases yielded data on deaths and cancer incidence, with follow-up ending between 1998 and 2000. Data from the food frequency questionnaire were used to estimate intake of total dietary …

Trace Elements And Cancer Risk: A Review Of The Epidemiologic Evidence, Stephanie A. Navarro Silvera, Thomas E. Rohan

Department of Public Health Scholarship and Creative Works

Worldwide, there are more than 10 million new cancer cases each year, and cancer is the cause of approximately 12% of all deaths. Given this, a large number of epidemiologic studies have been undertaken to identify potential risk factors for cancer, amongst which the association with trace elements has received considerable attention. Trace elements, such as selenium, zinc, arsenic, cadmium, and nickel, are found naturally in the environment, and human exposure derives from a variety of sources, including air, drinking water, and food. Trace elements are of particular interest given that the levels of exposure to them are potentially modifiable. …

Enhancement Of Claims Data To Improve Risk Adjustment Of Hospital Mortality, Michael Pine, Harmon S. Jordan, Anne Elixhauser, Donald E. Fry, David C. Hoaglin, Barbara Jones, Roger Meimban, David Warner, Junius Gonzales

Publications from Provost Junius J. Gonzales

Context Comparisons of risk-adjusted hospital performance often are important components of public reports, pay-for-performance programs, and quality improvement initiatives. Risk-adjustment equations used in these analyses must contain sufficient clinical detail to ensure accurate measurements of hospital quality.

Objective To assess the effect on risk-adjusted hospital mortality rates of adding present on admission codes and numerical laboratory data to administrative claims data.

Design, Setting, and Patients Comparison of risk-adjustment equations for inpatient mortality from July 2000 through June 2003 derived by sequentially adding increasingly difficult-to-obtain clinical data to an administrative database of 188 Pennsylvania hospitals. Patients were hospitalized for acute myocardial …

Glycaemic Index, Glycaemic Load And Risk Of Endometrial Cancer: A Prospective Cohort Study, Stephanie A. Navarro Silvera, Thomas E. Rohan, Meera Jain, Paul D. Terry, Geoffrey R. Howe, Anthony B. Miller

Department of Public Health Scholarship and Creative Works

Objective

High-glycaemic-load diets may increase endometrial cancer risk by increasing circulating insulin levels and, as a consequence, circulating oestrogen levels. Given the paucity of epidemiological data regarding the relationship between the dietary glycaemic index and glycaemic load and endometrial cancer risk, we sought to examine these associations using data from a prospective cohort study. Design, setting, and subjects

We examined the association between dietary glycaemic load and endometrial cancer risk in a cohort of 49 613 Canadian women aged between 40 and 59 years at baseline who completed self-administered food-frequency questionnaires between 1982 and 1985. Linkages to national mortality and …

Addressing Gupt Rog: Narrative Prevention Counselling For Sti/Hiv Prevention—A Guide To Ayush And Allopathic Practitioners, Bonnie K. Nastasi, Niranjan Saggurti, Stephen L. Schensul, Ravi K. Verma, Meena Gandhi

HIV and AIDS

Although India has over 600,000 registered AYUSH practitioners who are engaged in homeopathic, Ayurvedic, and Unani systems of medicine, they have not been integrated into the country’s national health system. While practitioners of these systems of medicine treat all illnesses, they have a special niche in providing services to address men’s sexual health concerns (Gupt Rog). A project on Research and Intervention in Sexual Health: Theory to Action was undertaken by the International Institute for Population Sciences/Mumbai, the Population Council/New Delhi, and partners, in three slum communities in Mumbai, from 2001–07. The objective was to control the spread of sexually …

Knowledge, Practice, And Coverage (Kpc) Survey: Baseline Report, Bagh District, Munir Afridi, Saman Naz, Nayyer Munir

Reproductive Health

The Primary Healthcare Revitalization, Integration, and Decentralization in Earthquake-affected Areas (PRIDE) program is designed to improve primary health-care services and health outcomes for populations in Bagh and Mansehra districts in northern Pakistan that were affected by the devastating earthquake that struck on October 8, 2005. The project aims to strengthen the financial and human resource management capacities of district health authorities and primary health-care providers. Access to and quality of primary health-care services will be improved through an essential package of health services and improved skills of primary health-care personnel. Community demand for quality services will be improved through an …

How Much Will It Cost To Scale Up A Reproductive Health Pilot Project?, Barbara Janowitz, John H. Bratt, Rick Homan, James R. Foreit

Reproductive Health

Most service-delivery interventions begin as pilot projects. When a pilot study of an intervention is successful, managers begin to think about scaling up the project to new areas. Cost is a critical factor influencing the extent and pace of scale-up. This brief explains how to adapt and modify cost information obtained from a pilot project to estimate scale-up costs. The brief shows why the costs of a pilot project alone are not sufficient to predict costs of scale-up and gives examples of how costs are influenced by factors like economies and diseconomies of scale, resource substitution, and intervention modification. The …

Avances En La Atención Postaborto En América Latina Y El Caribe: Investigando, Aplicando Y Expandiendo, Deborah L. Billings, Ricardo Vernon

Reproductive Health

This work by the Population Council and Ipas documents the intellectual, financial, and managerial effort that many organizations and institutions in Latin America and the Caribbean have made to achieve the objective of improving the quality and effectiveness of postabortion care services. This volume is a contribution to the preparation of directors, owners, and service providers, and to the creation and implementation of policies and programs based on scientific evidence, which will benefit women and the services themselves. Its five sections include an overview; results from country studies, and information about providers and program components; clinical care with various technologies, …

Contributing Towards Efforts To Abandon Female Genital Mutilation/Cutting In Kenya: A Situation Analysis, Humphres Evelia, Maryam Sheikh Abdi, Carolyne Njue, Ian Askew

Reproductive Health

The Kenyan Ministry of Gender, Sports, Culture and Social Services, with support from UNFPA/Kenya, commissioned the Population Council to conduct a situation analysis of female genital mutilation/cutting (FGM/C) programs in Kenya, with the overall objective of documenting the current status of and trends in FGM/C programming and to help identify crucial elements that need to be prioritized for support. Results show marked declines in prevalence nationally between generations, suggesting a decline in the practice as well as trends toward “medicalization” in recent years. The practice still continues for different reasons, such as rite of passage, for marriageability, controlling sexuality, religious …

From Pilots To Regional Programs: Expanding Contraceptive Choice And Improving Quality Of Care In Zambia's Copperbelt, Jill Keesbury

Reproductive Health

Between 2002 and 2005, the Pilots to Regional Programs (PRP) initiative was implemented in eight rural and periurban districts of Zambia’s Copperbelt region. Implemented by the Zambian Ministry of Health/Central Board of Health in collaboration with the Copperbelt Provincial Health Office and with technical assistance from the Population Council, the PRP initiative had two objectives: to expand contraceptive choice and increase the availability of high-quality reproductive health services, and to field-test a model for scaling up reproductive health interventions. The resulting project was structured around three activities: (1) expanding the method mix, (2) training healthcare workers, and (3) linking the …

Assessing The Feasibility, Acceptability And Cost Of Introducing Postabortion Care In Health Centres And Dispensaries In Rural Tanzania, Monica Wanjiru, Ian Askew, Nzoya Munguti, Saumya Ramarao, Rick Homan, Reheme Kahando, John M. Pile

Reproductive Health

The EngenderHealth ACQUIRE Project has been supporting the Tanzanian Ministry of Health (MOH) since early 2005 to decentralize the management of postabortion care (PAC) services to primary healthcare facilities (health centers and dispensaries), with the intention of bringing services closer to women who are unable to access them at district hospitals. Findings from this study were provided to the MOH and ACQUIRE to address issues arising from introduction of the intervention; and in September 2006, to assess the feasibility, cost, and effectiveness of the intervention. Findings show that the intervention appears to have broadened service providers’ range of clinical skills …

Addressing The Needs Of Seasonal Migrants In Nashik, Maharashtra, Anjali B. Borhade

Reproductive Health

In order to identify the opportunities and options available to address the vulnerabilities of and socioeconomic needs of seasonal migrants, an intervention project was launched by the Disha Foundation, a nongovernmental organization in Nashik city, Maharashtra, India. This report intends to use the project experience as a case study to provide a blueprint for interventions for seasonal migrants to access a range of basic services in areas of destination and to exercise their rights to access available services. The report documents the array of strategies used to enable seasonal migrants to recognize their entitlement and to access available public sector …

Provider Perspectives On Informed Consent In Female Sterilisation Services: Findings From A Facility-Based Study In Chennai, Raja Lakshmi

Reproductive Health

The objective of this paper is to explore the perceptions and experiences of providers with regard to the process of informed consent in the provision of female sterilization services in Chennai, south India. It describes the quality of information provided to clients of sterilization, providers’ attitudes toward clients and the quality of decisionmaking, as well as the quality of the consent-taking process in this setting. In addition, providers’ perceptions of the importance of informed consent are discussed. Findings strongly suggest the need to train and sensitize providers in public as well as private facilities on their ethical responsibilities of ensuring …

Informed Consent In Sterilisation Services: Evidence From Public And Private Health Care Institutions In Chennai, Raja Lakshmi

Reproductive Health

The objective of this paper is to explore the experiences of women undergoing a particular form of fertility regulation, namely sterilization or tubal ligation, in a variety of facilities in Chennai, India. The paper examines specifically the nature of information provided to clients, the consent-taking process, the nature of its documentation, and the extent to which clients made an informed choice. The findings underscore that although all the women respondents did wish to practice a method of contraception, and did want to adopt sterilization, several limitations were noted in the process of providing informed consent: inadequate information was provided to …

Young People's Sexual And Reproductive Health In India: Policies, Programmes And Realities, K.G. Santhya, Shireen J. Jejeebhoy

Reproductive Health

This paper presents an overview of key policies and government programmes intended to reduce HIV vulnerability and improve sexual and reproductive health among young people in India, and identifies the extent to which these policies and programmes have addressed the gamut of unique sexual and reproductive needs of young women and men. It also explores the extent to which programmes have been adapted to accommodate state-level differences in the sexual and reproductive vulnerability of youth; the review takes the examples of two states, namely, Andhra Pradesh, characterised by both early marriage and high HIV prevalence, and Madhya Pradesh, characterised by …

Preparedness Of Kenyan Health Workers To Deliver Hiv/Aids Services, National Aids And Std Control Programme, Ministry Of Health Kenya, Centers For Disease Control And Prevention, Horizons Program

HIV and AIDS

Most Kenyan adults do not know their HIV status. Patients who present to a health facility can learn their status as part of a diagnostic assessment, enabling health-care personnel to provide a more accurate clinical evaluation and accelerate access to comprehensive care. This is particularly relevant in Kenya because up to 60 percent of all medical ward hospital beds are occupied by HIV-infected patients. Therefore provider-initiated HIV testing and counseling, which includes diagnostic testing and counseling (DTC), provides an opportunity to interrupt the cycle of HIV transmission to patients’ partners and children. In 2004, the Kenya Ministry of Health launched …

Supporting Volunteer Mentors: Insights From A Mentorship Program For Youth-Headed Households In Rwanda, Lisanne Brown, Tonya R. Thurman, Edward Kalisa, Janet C. Rice, Jean De Dieu Bizimana, Neil W. Boris, Leslie M. Snider, Joseph Ntaganira

HIV and AIDS

In 2004, World Vision Rwanda (WVR), in collaboration with Tulane University and the Rwanda School of Public Health, implemented a program to provide support through regular visits by an adult mentor to youth living without adult care. After completion of baseline quantitative and qualitative research, WVR implemented the program in two areas of a province in southwestern Rwanda. Over an 18-month period, 156 trained adult mentors visited and supported 441 youth-headed households. The mentor training covered key aspects of child development and skills for addressing key psychosocial issues that were identified through the baseline research. Specifically, the training addressed how …

Reaching Truckers In Brazil With Non-Stigmatizing And Effective Hiv/Sti Services, Magda Chinaglia, Sheri A. Lippman, Julie Pulerwitz, Maeve De Mello, Rick Homan, Juan Diaz

HIV and AIDS

A study conducted by the Population Council in 2001 found that truckers crossing Brazil’s southern border had easy access to commercial sex and extremely limited access to health services, condoms, HIV testing and counseling, and HIV/STI prevention messages. In response, the Population Council’s Horizons Program conducted an intervention study from 2002 to 2005. The study examined the feasibility, acceptability, and impact of providing a range of health services to truckers at a health post inside a customs station, where truckers wait anywhere from one day to a week for documents and cargo to clear customs. As noted in this brief, …

Changes In Stigma Among A Cohort Of People On Antiretroviral Therapy: Findings From Mombasa, Kenya, Susan Kaai, Avina Sarna, Stanley Luchters, Scott Geibel, Paul Munyao, Kishorchandra N. Mandaliya, Khadija Shikely, Marleen Temmerman, Naomi Rutenberg

HIV and AIDS

Stigma has been a reality in the lives of people living with HIV (PLHIV) since the inception of the AIDS epidemic, and it can have profound implications for health, psychosocial well-being, and utilization of health services. In the industrialized world, the availability of antiretroviral therapy (ART) and a subsequent change in perception of AIDS as a chronic manageable disease has coincided with a decrease in stigma and discrimination directed toward PLHIV. However, little is known in developing countries about whether perceptions and experiences of stigma among PLHIV have changed following increased access to ART. The Horizons Program and the International …

Implementing Sti/Hiv Prevention And Care Interventions For Men Who Have Sex With Men In Senegal, Amadou Moreau, Placide Tapsoba, Abdoulaye Ly, Cheikh Ibrahima Niang, Abdou Khoudia Diop

HIV and AIDS

Exploratory research conducted by the Horizons Program in 2002 revealed that men who have sex with men (MSM) in Dakar, Senegal, are particularly vulnerable to sexually transmitted infections (STIs) and HIV. Further, the stigma and discrimination suffered by many MSM result in the concealment of sexual behaviors from health-care providers, making it difficult to receive appropriate services. Finally, there is a lack of HIV-prevention campaigns geared to this group. Key stakeholders in Dakar developed and implemented an intervention to meet the STI/HIV prevention needs of MSM and address prevailing stigma that effectively serves as a barrier to care. The intervention …

Building The Capacity Of Faith-Based Organizations To Promote Mutual Monogamy In South Africa, Waimar Tun, Nathi Sohaba, Unathi Malinzi, Matthew Nqono, Osborne Mzilikazi, Bonisiwa Mgujulwa, Moses Madywabe, Mbulelo Fatyeni, Christine Fontecchio

HIV and AIDS

In South Africa, where sex partnerships outside primary relationships are common even among church members, HIV-prevention programs focusing on mutual monogamy (MM) are needed. Church leaders, highly regarded by the community, may be effective in reaching congregation members with HIV-prevention messages. However, implementing programs that promote faithfulness pose several challenges. In response to a lack of research on effective strategies to promote MM, the Horizons Program, in partnership with the Eastern Cape Provincial Council of Churches and the South African Council of Churches, piloted an intervention to promote MM. A curriculum was developed covering topics including HIV transmission, personal relationships, …

Patterns And Implications Of Male Migration For Hiv Prevention Strategies In Andhra Pradesh, Ravi K. Verma, Niranjan Saggurti, Madhumita Das, Saumya Ramarao, Anrudh K. Jain

HIV and AIDS

HIV is widespread in Andhra Pradesh, with high HIV prevalence among pregnant women receiving antenatal care and patients receiving treatment for sexually transmitted infections. High HIV prevalence among women indicates that the infection, rather than being restricted to groups at high risk, is present in the general population. Districts with high HIV prevalence are also destinations for large numbers of male migrants. Migration may be a major contributor to the spread of HIV in the state, however empirical evidence is limited. Furthermore, evidence is required to maximize the impact of programmatic inputs intended to contain the spread of the epidemic. …

Sexual Risk Behaviors Of Hiv-Positive Persons Receiving Art In Mombasa, Kenya: Longitudinal Study Findings, Stanley Luchters, Avina Sarna, Scott Geibel, Matthew F. Chersich, Paul Munyao, Susan Kaai, Kishorchandra N. Mandaliya, Naomi Rutenberg, Marleen Temmerman

HIV and AIDS

As a result of the success of antiretroviral therapy (ART) in dramatically decreasing morbidity and mortality due to HIV, many HIV-infected individuals are now living longer, healthier, and more sexually active lives. However, unprotected sex by people living with HIV is an area of concern because of the risk of transmission to sero-discordant partners and reinfection with new, drug-resistant viral strains. There is evidence to suggest that some sero-positive individuals continue to engage in unprotected sex that places others at risk for infection and places themselves at risk for contracting secondary infections. To learn more about the impact of ART …

The Hiv/Aids Prevention Project For Vulnerable Youth In Northern Nigeria: Community Advocates Training Manual, Population Council, Adolescent Health And Information Projects, Federation Of Muslim Women's Associations In Nigeria, Islamic Education Trust

HIV and AIDS

This Community Advocates training manual contains a curriculum developed by the Population Council, Nigeria, under the HIV Prevention Project for Vulnerable Youth in Northern Nigeria funded by USAID/Nigeria. The curriculum was developed as a tool for training community advocates in conducting advocacy activities on the issues of early marriage, HIV/AIDS, and reproductive health. The curriculum aims to improve knowledge and strengthen the skills of community representatives from the northern region of Nigeria so they can openly discuss sensitive issues relating to HIV/AIDS, reproductive health, and marriage. Designed to be adapted or implemented as written, the curriculum is based on the …

Our Stories: Women Speak Out Against Hiv And Aids—An Interactive Communication Package For Rural Low-Literate Women, Vijaya Nidadavolu, Moumita Saha, Vijaya Usha Rani

HIV and AIDS

The National AIDS Control Organisation (NACO) estimates that there are over 5.1 million people living with HIV and AIDS in India. Among new infections reported in 2006, 88 percent were reported in the reproductive age group (15–49 years). The virus is spreading rapidly among women, including married and monogamous women, and adolescent girls. Existing literature shows that women's vulnerability is compounded due to their gendered disadvantage in information access, literacy, and decision-making. This disadvantage is particularly acute in the case of married women in rural India. NACO has indicated the need to develop audience-appropriate strategies for communicating HIV-related information. To …