Medicine and Health Sciences Commons^™

Demographic Profile, Geographic Distribution, Disability Prevalence, And Likelihood Of Being In-Poverty Amongst Grandparents Responsible For Grandchildren, Carlos Siordia, Mary E. Rauktis

GrandFamilies: The Contemporary Journal of Research, Practice and Policy

Evidence-based research on Grandparents Responsible for Grandchildren (GRfG) continues to grow in recent decades. This brief report expands global knowledge on custodial grandparents by making use of a large data resource in the United States (US). The specific aim was to delineate the demographic profile, geographic distribution, and prevalence of specific-disabilities for the GRFG population in the US mainland. We also explore how demographic factors are associated with likelihood of being in-poverty. The analysis used data from the 2009-2013 American Community Survey (ACS) 5-year Public Use Microdata Sample (PUMS) file. The ACS is a nationally representative, yearly, statistical survey administered …

Summer Dehydration, Rodney Richmond

Faculty Research ​and Publications

No abstract provided.

Glycaemic Control In Type 1 Diabetes Mellitus Among Children And Adolescents In A Resource Limited Setting In Dar Es Salaam - Tanzania, Mariam Noorani, Kaushik Ramaiya, Karim Manji

Faculty of Health Sciences, East Africa

Background

Type 1 Diabetes Mellitus is a rapidly growing problem in Tanzania. Children and adolescents with type 1 diabetes have previously been found to have poor glycaemic control and high prevalence of complications. Strict glycaemic control reduces the incidence and progression of chronic complications. The aim of this study was to identify the factors associated with glycaemic control among children and adolescents.

Methods

A cross sectional study was done at the diabetes clinic for children and adolescents. Data on socioeconomic, demographic and diabetes specific variables including adherence, diabetes knowledge, caregivers knowledge and their involvement in the care of the child …

Husband’S Support Towards Unmet Need Of Hiv Positive-Infected Women Of Childbearing Age, Sophia Sophia, Anita Deborah Anwar, Bony Wiem Lestari

Kesmas

Jutaan wanita usia subur (WUS) dengan HIV positif di negara berkembang saat ini tidak menggunakan kontrasepsi untuk menunda atau mengakhiri kehamilan. Pencegahan kehamilan yang tidak diinginkan pada WUS dengan HIV positif sangat penting untuk meningkatkan kualitas hidup ibu dan anak. Tujuan penelitian ini untuk menganalisis faktor-faktor yang berpengaruh terhadap unmet need pada WUS dengan HIV positif. Metode penelitian adalah cross sectional dengan sampel berjumlah 130 WUS dengan HIV positif yang diambil secara consecutive sampling. Penelitian dilakukan pada 24 Maret - 30 Juni 2015 di Klinik Mawar Kota Bandung. Pengumpulan data dilakukan melalui wawancara dengan menggunakan kuesioner, kemudian data dianalisis dengan …

Impact Of Husband’S Participation In Antenatal Care On The Use Of Skilled Birth Attendant, Febri Wicaksono

Kesmas

Pendekatan alternatif diperlukan untuk mengatasi persoalan kesehatan reproduksi, salah satunya dengan meningkatkan partisipasi laki-laki pada kesehatan reproduksi perempuan. Penelitian ini bertujuan untuk menelusuri dampak partisipasi suami dalam pelayanan antenatal pada penggunaan tenaga persalinan terlatih setelah mengontrol karakteristik sosial demografi. Sampel sebanyak 4.000 perempuan berusia 15 – 49 tahun yang memiliki persalinan terakhir pada tahun lalu sebelum survei diambil dari Survei Demografi dan Kesehatan Indonesia tahun 2012. Penelitian menggunakan model regresi logistik biner untuk mengidentifikasi dampak partisipasi suami dalam pelayanan antenatal pada penggunaan tenaga persalinan terlatih setelah mengontrol karakteristik ibu dan sosial demografi. Peluang setelah mengontrol faktor lainnya mengindikasikan perempuan yang …

The Effect Of Structured Counseling Towards Knowledge, Attitude, And Participation Of Modern Contraceptive Among Unmet Need Couples, Herlina Simanjuntak, Bony Wiem Lestari, Anita Debora Anwar

Kesmas

Unmet need Keluarga Berencana (KB) masih tinggi di negara berkembang termasuk di Indonesia. Konseling kontrasepsi terstruktur berpotensi meningkatkan penggunaan kontrasepsi secara efektif, menjaga keberlangsungan penggunaan dan meningkatkan kepuasan klien. Selama ini seling kontrasepsi yang dilakukan belum optimal, sehingga penelitian ini bertujuan untuk menganalisis pengaruh konseling terstruktur terhadap peningkatan pengetahuan, sikap dan partisipasi kontrasepsi modern pada pasangan usia subur (PUS) yang unmet need. Penelitian ini merupakan eksperimen semu dengan rancangan pretest-posttest dengan kelompok kontrol. Penelitian ini dilakukan pada periode Maret – Juni 2015. Pengambilan sampel dilakukan dengan stratified random sampling pada 48 orang untuk kelompok perlakuan (konseling terstruktur) dan 48 orang …

Glycaemic Control In Type 1 Diabetes Mellitus Among Children And Adolescents In A Resource Limited Setting In Dar Es Salaam - Tanzania, Mariam Noorani, Kaushik Ramaiya, Karim Manji

Paediatrics and Child Health, East Africa

Background, Type 1 Diabetes Mellitus is a rapidly growing problem in Tanzania. Children and adolescents with type 1 diabetes have previously been found to have poor glycaemic control and high prevalence of complications. Strict glycaemic control reduces the incidence and progression of chronic complications. The aim of this study was to identify the factors associated with glycaemic control among children and adolescents.

Methods, A cross sectional study was done at the diabetes clinic for children and adolescents. Data on socioeconomic, demographic and diabetes specific variables including adherence, diabetes knowledge, caregivers knowledge and their involvement in the care of the child …

Accuracy Of Icd-9-Cm Codes By Hospital Characteristics And Stroke Severity: Paul Coverdell National Acute Stroke Program, Tiffany E. Chang, Judith H. Lichtman, Larry B. Goldstein, Mary G. George

Neurology Faculty Publications

Background—Epidemiological and health services research often use International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) codes to identify patients with clinical conditions in administrative databases. We determined whether there are systematic variations between stroke patient clinical diagnoses and ICD‐9‐CM codes, stratified by hospital characteristics and stroke severity.

Methods and Results—We used the records of patients discharged from hospitals participating in the Paul Coverdell National Acute Stroke Program in 2013. Within this stroke‐enriched cohort, we compared agreement between the attending physician's clinical diagnosis and principal ICD‐9‐CM code and determined whether disagreements varied by hospital characteristics (presence of a …

Identification And Use Of Indicator Data To Develop Models For Marine-Sourced Risks In Massachusetts Bay, Marin M. Kress

Graduate Doctoral Dissertations

The coastal watersheds around Massachusetts Bay are home to millions of people, many of whom recreate in coastal waters and consume locally harvested shellfish. Epidemiological data on food-borne illness and illnesses associated with recreational water exposure are known to be incomplete. Of major food categories, seafood has the highest recorded rate of associated foodborne illness. In total, the health impacts from these marine-sourced risks are estimated to cost millions of dollars each year in medical expenses or lost productivity. When recorded epidemiological data is incomplete it may be possible to estimate abundance or prevalence of specific pathogens or toxins in …

Effect Of Ambient Particulate Matter 2.5 Micrometer (Pm2.5) To Prevalence Of Impaired Lung Function And Asthma In Tangerang And Makassar, Budi Haryanto, Budy Resosoedarmo, Sri Tjahjani Budi Utami, Budi Hartono, Ema Hermawati

Kesmas

Emisi partikel debu 2,5 mikrometer (PM2.5) meningkat dengan bertambahnya jumlah penduduk kota akibat peningkatan angka kendaraan bermotor sebagai transportasi penduduk sehari-hari. Penelitian ini bertujuan untuk mengetahui tingkat gangguan fungsi paru dan asma serta hubungannya dengan kadar ambien PM2.5 pada masyarakat migran di Tangerang dan Makassar dan kondisi sosial ekonomi. Desain potong lintang digunakan dengan melibatkan 4.250 dan 2.900 responden di Tangerang dan Makassar pada bulan April sampai September 2010. Pendekatan cluster sampling diterapkan. Pengukuran ambien PM2.5 di masing-masing kota berdasarkan koordinat 40 lokasi Global Positioning System (GPS). Kadar PM2.5 ditemukan lebih tinggi pada pagi hari dibandingkan siang hari di kedua …

Birth Intervals Among Multiparous Women In Indonesia, Dini Kurniawati, Sabarinah Prasetyo

Kesmas

Angka kematian ibu dan angka kematian bayi di Indonesia masih tinggi. Salah satu faktor yang menyebabkan tingginya risiko kematian pada ibu dan bayi adalah kelahiran terlalu dekat. Penelitian ini bertujuan untuk mempelajari determinan jarak antarkelahiran pada perempuan multipara di Indonesia. Penelitian ini menggunakan data Survei Demografi Kesehatan Indonesia tahun 2012 pada 9.945 perempuan multipara. Analisis data menggunakan uji Mann Whitney, Kruskal Wallis, dan regresi logistik. Median jarak antarkelahiran sebesar 62 bulan dan 22,8% perempuan memiliki jarak antarkelahiran kurang dari tiga tahun. Hasil menunjukkan determinan jarak antarkelahiran pendek meliputi pendidikan ibu, usia terakhir melahirkan, ukuran ideal keluarga, pemakaian kontrasepsi, riwayat kematian …

Child Health Improvement Through Implementation Of Food Safety Model, Arief Safari, Machfud Machfud, Eriyatno Eriyatno, Heny Kuswanti Daryanto

Kesmas

Pemenuhan akan pangan merupakan komponen dasar untuk mewujudkan sumber daya manusia yang berkualitas. Namun, masih terdapat permasalahan dalam mewujudkannya, di antaranya masalah keamanan pangan dengan persentase kasus keracunan makanan masih tinggi. Penelitian ini bertujuan untuk menganalisis situasi pelaksanaan keamanan Pangan Jajanan Anak Sekolah (PJAS) yang ada saat ini dan memilih alternatif model keamanan pangan yang paling efektif dan efisien diterapkan di usaha mikro kecil (UMK) guna meningkatkan keamanan pangan yang dihasilkannya sehingga terjadi peningkatan kesehatan anak. Penelitian dilakukan pada kuartal II tahun 2015 sampai dengan awal kuartal III tahun 2015 melalui survei lapangan dan survei pakar dengan mengambil studi kasus …

Housewives’ Compliance In Reading Food Labels In Gorontalo City, Imran Tumenggung, Lucky Herawati, Sofyawati Talibo

Kesmas

Di Indonesia, masalah label pada kemasan makanan kurang mendapat perhatian konsumen. Penelitian ini bertujuan untuk mempelajari determinan kepatuhan membaca label pada kemasan makanan oleh ibu rumah tangga di Kota Gorontalo. Penelitian dengan metode survei ini dilakukan dari bulan Juni sampai Agustus 2013. Data dikumpulkan secara potong lintang dengan menggunakan angket. Variabel terikat adalah kepatuhan membaca label pada kemasan makanan yang terdiri dari label informasi nilai gizi, komposisi makanan, masa kedaluwarsa, harga, dan status halal. Variabel bebas adalah usia, tingkat pendidikan, dan keterpaparan dengan media informasi. Besar sampel 262 orang ditentukan secara accidental technique. Analisis data menggunakan uji kai kuadrat. Hasil …

Week Of May 31, 2016, New York Medical College

InTouch

• Class of 2016 Gets a Rousing Sendoff at Carnegie Hall
• College Hosts 6th Annual Paul K. Woolf, M.D., Pediatric Trainee Research Symposium
• NYMC Mentees Take Awards at Intel ISWEEP and ISEF
• Reflections on Graduation
• Office of Development Update

External Validation And Cost Effectiveness Analysis Of The Non-Lb Framingham Cardiovascular Disease Risk Assessment Algorithm In The Atherosclerosis Risk In Communities Dataset, Jacob K. Kariuki

Graduate Doctoral Dissertations

Background: In recent years, non-Laboratory based (non-LB) risk assessment algorithms have been developed to facilitate absolute cardiovascular disease (CVD) risk assessment in resource constrained primary care settings. The non-LB Framingham algorithm, which substitutes body mass index (BMI) for lipids, has the best discrimination and calibration among the published algorithms, but its external validity and cost-effectiveness have not been determined.

Purpose: External validation and comparative effectiveness analysis of the non-LB versus laboratory based (LB) Framingham algorithm in a racially diverse population, and simulated cost-effectiveness analysis focusing on a black sample.

Methods: Secondary data analysis was performed using the Atherosclerosis Risk in …

Assessment Of Air Force Providers’ Adherence To Overweight And Obesity Guidelines, Dale Harrell

Doctor of Nursing Practice Scholarly Projects

Despite the existence of obesity treatment guidelines, Air Force healthcare providers may offer suboptimal weight management. The purpose of this quality improvement project is to assess adherence by healthcare practitioners with adult overweight and obesity guidelines before and after an educational session on the optimal management of the overweight or obese patient. Overweight or obese adults treated in Military Treatment Facilities (MTF) may not be properly identified and controlled, as providers may not be adhering to the American College of Cardiology (ACC) and the American Heart Association (AHA) guidelines for the management of obesity.

What's Happening: May 30, 2016, Maine Medical Center

What's Happening

No abstract provided.

Factors That Influence Advance Directives Completion Amongst Terminally Ill Patients At Akuhn, Stephen Omondi Otieno

Master of Medicine in Internal Medicine

Background: An advance directive is a written or verbal document that legally stipulates a person’s health care preference while they are competent to make decisions for themselves, and which is then used to guide decisions on life-sustaining treatment in the event that they become incapacitated. Advance directives can take one of four forms: a living will, a limitation of care document, a do-not-resuscitate order, and an appointment of a surrogate by durable power of attorney. The completion rate of advance directives varies from region to region, and it is influenced by different patient, caregiver, legal, institutional, cultural, and religious factors. …

Outcomes In Patients With Acute Coronary Syndromes At The Aga Khan University Hospital, Nairobi, Mohamed Hasham Varwani

Master of Medicine in Internal Medicine

Background: As the prevalence of cardiovascular diseases in Sub-Saharan Africa rises, coronary artery disease, with its acute presentations, is being increasingly recognized in Kenyans and treated at tertiary level hospitals. It is just over a decade since the introduction and wide availability of modern cardiology services, including interventional cardiology in Kenya. Following an acute coronary syndrome (ACS), patients remain at high risk of death and other adverse events such as heart failure, recurrent myocardial infarction, stroke, and bleeding. Local and regional data on long-term outcomes following ACS are lacking. These data are important to clinicians for prognostication and to health …

The Association Between Asymptomatic And Mild Neurocognitive Impairment And Adherence To Antiretroviral Therapy Amongst People Living With Hiv, Violet Maloba Awori

Master of Medicine in Internal Medicine

Background: HIV disease is associated with neurocognitive impairment which is one of the neurological complications of the viral infection. The spectrum of HIV Associated neurocognitive impairment has significantly changed since the advent of ART. The inclusion of the asymptomatic but cognitively impaired population of patients has changed the dynamics of this population, and requires further research to identify the impact it has on the progression of the disease as well as on any other aspects. Poor adherence to ART is one of the main causes of treatment failure and studies done previously point towards the milder forms of Neurocognitive Impairment …

Prevalence Of Bladder Dysfunction In Children With Primary Nocturnal Enuresis Presenting To The Hospital, Nikita Pravin Jethwa

Master of Medicine in Paediatrics and Child Health

Introduction: Bladder dysfunction is thought to be a common cause of nocturnal enuresis. It can either be overactive, underactive or dysfunctional. Currently, there is a paucity of data on what proportions of children with nocturnal enuresis have bladder dysfunction. Studies have shown the prevalence of bladder dysfunction to be as high as 77-94.5% (28), and children with bladder dysfunction have poor response to treatment. There are currently no protocols for investigating and managing children with nocturnal enuresis. The decision for bladder ultrasound is usually made by the primary physician, and at times after the child has been on treatment for …

Comparison Of Weight Adjusted Dose Versus Fixed Dose Ondansetron In Preventing Shivering Following Spinal Anesthesia For Cesarean Deliveries, Moses Kimuri Gicheru

Master of Medicine in Anaesthesiology

Background: Spinal anesthesia is an effective regional anesthesia technique, which is preferred in almost 86% of cesarean sections in the United States and United Kingdom. Eighty percent of cesarean sections done at the Aga Khan University hospital are under spinal anesthesia. Shivering is a common complication of spinal anesthesia, it occurs in 40%-64% of patients after neuraxial anesthesia. Shivering may cause maternal and fetal hypoxemia, maternal discomfort and a problem to the anesthesiologists when it comes to monitoring the patient during cesarean sections. Ondansetron a 5-HT3 receptor antagonist is effective in treatment and prevention of post spinal anesthesia shivering. In …

The Exceptionally High Reactivity Of Cys 621 Is Critical For Electrophilic Activation Of The Sensory Nerve Ion Channel Trpa1, Parmvir K. Bahia, Thomas A. Parks, Katherine R. Stanford, David A. Mitchell, Sameer Varma, Stanley M. Stevens Jr., Thomas E. Taylor-Clark

Molecular Biosciences Faculty Publications

Activation of the sensory nerve ion channel TRPA1 by electrophiles is the key mechanism that initiates nociceptive signaling, and leads to defensive reflexes and avoidance behaviors, during oxidative stress in mammals. TRPA1 is rapidly activated by subtoxic levels of electrophiles, but it is unclear how TRPA1 outcompetes cellular antioxidants that protect cytosolic proteins from electrophiles. Here, using physiologically relevant exposures, we demonstrate that electrophiles react with cysteine residues on mammalian TRPA1 at rates that exceed the reactivity of typical cysteines by 6,000-fold and that also exceed the reactivity of antioxidant enzymes. We show that TRPA1 possesses a complex reactive cysteine …

Effect Of Laryngeal Mask Airway Manometry On Post-Operative Sore Throat In Spontaneously Breathing Adult Patients Presenting For Surgery At Aga Khan University Hospital, Nairobi, David Njoroge Waruingi

Master of Medicine in Anaesthesiology

Background: Laryngeal mask airways (LMAs) are widely used in anaesthesia and are considered to be generally safe. Postoperative sore throat (POST) is a frequent complication following LMA use and can be very distressing to patients. The use of an LMA cuff pressure of between 30 and 32cm of H20 in alleviating postoperative sore throat has not been investigated. Primary objective: To compare the occurrence of POST between the intervention group in which LMA cuff pressures will be adjusted to 30-32cm of H20 and the control group in which only monitoring of LMA cuff pressures will be done. Secondary Objectives: To …

Effect Of Low-Dose Ketamine Versus Fentanyl On Attenuating The Haemodynamic Response To Laryngoscopy And Endotracheal Intubation In Patients Undergoing General Anaesthesia At The Aga Khan University Hospital, Nairobi, Angela Ongewe

Master of Medicine in Anaesthesiology

Background: The use of drugs to attenuate the haemodynamic response to laryngoscopy and endotracheal intubation is the standard of care during elective surgery. Current evidence is conflicting concerning the best agent and optimal dose for this purpose. In the majority of cases, Fentanyl is widely utilized to attenuate haemodynamic responses. Ketamine, an established available drug, has been scarcely studied in this regard at low doses and against varying doses of other common agents. Objective: The primary objective was to compare the overall occurrence of hypertension and tachycardia immediately pre-intubation (post-induction) until 10 minutes post intubation between the study group receiving …

Risk Factors, Clinico-Pathologic Characteristics And Outcomes In Young Kenyan Female Patients With Breast Cancer In Akuh-N, Gilford Mutwiri Mwikamba

Master of Medicine in Internal Medicine

Background: Breast cancer in the young refers to a diagnosis of breast cancer in a female under the age of forty years. This is considered a distinct disease with different risk factors, biology, and prognosis. Young age at breast cancer diagnosis is reportedly more common among African-Americans. The highest proportion of breast cancer in the young has been reported in Africa. Early detection of breast cancer in Africa is hampered by lack of access to health care services, appropriate screening tools, and high cost of magnetic resonance imaging for the high risk groups. Despite a worse prognosis, management of breast …

Maternal Inflammatory Markers In The Diagnosis Of Chorioamnionitis And Prediction Of Neonatal Sepsis In Preterm Pre-Labour Rupture Of Membranes: A Systematic Review, Angela Koech Etyang

Master of Medicine in Obstetrics and Gynecology

Background: There is no consensus on the potential role of inflammatory markers in identifying chorioamnionitis in women with Preterm Pre-labour Rupture of Membranes (PPROM) or in predicting Early Onset Neonatal Sepsis (EONS) in their neonates. Objectives: To perform a quantitative review on the accuracy of maternal C reactive protein (CRP), Procalcitonin (PCT) and Interleukin 6 (IL6) in the diagnosis of Histological Chorioamnionitis and/or Funisitis (HCA/Funisitis) and their role in the prediction of EONS in PPROM. Methods: MEDLINE, EMBASE and The Cochrane Library databases were searched from inception to October 2015, for studies where these markers were assessed against a reference …

Increasing Colorectal Cancer Screening Rates In A Rural Health Clinic Through Practice Change, Kirsten S. Johanson

Doctor of Nursing Practice Scholarly Projects

Colorectal cancer (CRC) is the third leading cause of cancer deaths in the United States (Siegel, DeSantis, & Jemal, 2014). The United States Preventative Services Task Force (2008) “recommends screening for CRC using fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults, beginning at age 50 years and continuing until age 75 years” to decrease CRC rates (p. 627). In May 2015, CRC screening rates were 70.65% at the Monroe Clinic-Durand Primary Care branch (D. Dubs, personal communication, May 18, 2015). Increasing CRC screening rates in the Monroe Clinic-Primary Care branch office could decrease CRC rates and deaths in the …

Cerebral Aspergillosis And Pulmonary Tuberculosis In A Child With Chronic Granulomatous Disease, Muhammad Waqas, Sidra Zafar, Tooba Rehman, Muhammed Riyaz, Muhammad Ehsan Bari, Romana Idress

Section of Neurosurgery

Background: Chronic granulomatous disease (CGD) is an immune disorder that affects phagocytes. It is characterized by recurrent or persistent bacterial and fungal infections. Reports of tuberculosis (TB) in patients with CGD are rare. In developing countries, where TB is endemic, possibility of other chronic infections is often overlooked by physicians.
Case description: We report the case of a 4-year-old boy who had recurrent respiratory infections and episodes of headache. He was put on antituberculosis (ATT) drugs without microbiological or pathological evidence 2 months prior to presentation. The child did not improve and was brought to our hospital where a computed …

Residents’ Perception On The Need For Clinical Leadership Training At The Aga Khan University, Nairobi, Lance Mayabi

Master of Medicine in General Surgery

Background:The healthcare environment is becoming increasingly complex with physicians undertaking more leadership roles. The majority of physicians are not prepared to take up these roles, despite evolving evidence that good clinical leadership yields better clinical outcomes for both patients and healthcare organizations. Further, few residency programs explicitly embed leadership training for their students despite their positions at the forefront of healthcare delivery. This deficit ultimately leaves a multilevel healthcare “leadership” gap in a sector that depends heavily on the education process to improve clinical outcomes. A pre-study survey of residency graduates at the Aga Khan University, Nairobi (AKU,N) undertaken by …