Public Health Commons^™

Male Circumcision For Hiv Prevention: Current Evidence And Implementation In Sub-Saharan Africa, Richard G. Wamai, Brian J. Morris, Stefan A. Bailis, David Sokal, Jeffrey D. Klausner, Ross Appleton, Nelson Sewankambo, David A. Cooper, John Bongaarts, Guy De Bruyn, Alex D. Wodak, Joya Banerjee

Richard G. Wamai

Heterosexual exposure accounts for most HIV transmission in sub-Saharan Africa, and this mode, as a proportion of new infections, is escalating globally. The scientific evidence accumulated over more than 20 years shows that among the strategies advocated during this period for HIV prevention, male circumcision is one of, if not, the most efficacious epidemiologically, as well as cost-wise. Despite this, and recommendation of the procedure by global policy makers, national implementation has been slow. Additionally, some are not convinced of the protective effect of male circumcision and there are also reports, unsupported by evidence, that non-sex-related drivers play a major …

Adjusting Medicare Capitation Payments Using Prior Hospitalization Data, Arlene Ash, Frank Porell, Leonard Gruenberg, Eric Sawitz, Alexa Beiser

Frank Porell

The diagnostic cost group approach to a reimbursement model for health maintenance organizations is presented. Diagnostic information about previous hospitalizations is used to create empirically determined risk groups, using only diagnoses involving little or no discretion in the decision to hospitalize. Diagnostic cost group and other models (including Medicare's current formula and other prior-use models) are tested for their ability to predict future costs, using R2 values and new measures of predictive performance. The diagnostic cost group models perform relatively well with respect to a range of criteria, including administrative feasibility, resistance to provider manipulation, and statistical accuracy.

When Is Informed Consent Required In Cluster Randomized Trials In Health Research?, Andrew Mcrae, Charles Weijer, Ariella Binik, Jeremy Grimshaw, Robert Boruch, Jamie Brehaut, Allan Donner, Martin P Eccles, Raphael Saginur, Angela White, Monica Taljaard

Charles Weijer

This article is part of a series of papers examining ethical issues in cluster randomized trials (CRTs) in health research. In the introductory paper in this series, we set out six areas of inquiry that must be addressed if the cluster trial is to be set on a firm ethical foundation. This paper addresses the second of the questions posed, namely, from whom, when, and how must informed consent be obtained in CRTs in health research? The ethical principle of respect for persons implies that researchers are generally obligated to obtain the informed consent of research subjects. Aspects of CRT …

Who Is The Research Subject In Cluster Randomized Trials In Health Research?, Andrew Mcrae, Charles Weijer, Ariella Binik, Angela White, Jeremy Grimshaw, Robert Boruch, Jamie Brehaut, Allan Donner, Martin Eccles, Raphael Saginur, Merrick Zwarenstein, Monica Taljaard

Charles Weijer

This article is part of a series of papers examining ethical issues in cluster randomized trials (CRTs) in health research. In the introductory paper in this series, we set out six areas of inquiry that must be addressed if the CRT is to be set on a firm ethical foundation. This paper addresses the first of the questions posed, namely, who is the research subject in a CRT in health research? The identification of human research subjects is logically prior to the application of protections as set out in research ethics and regulation. Aspects of CRT design, including the fact …

State-Level Influences On Buprenorphine Utilization: Variations In Opioid Addiction Treatment, Lisa M. Lines Mph, Robin E. Clark Phd

Lisa M. Lines

Research Objective: Buprenorphine is a medication used to treat opioid addiction. Physicians are required to have special Drug Enforcement Agency certification to prescribe buprenorphine. Although it is more accessible and potentially safer than methadone, the leading opioid addiction treatment modality, there appear to be state-to-state variations in rates of buprenorphine adoption and use. The purpose of this study was to identify state-level influences on the volume of buprenorphine prescribed, using a limited set of supply and demand measures. Study Design: We developed a database using data on buprenorphine prescribing and factors hypothesized to influence variations in prescribing obtained from the …

Building Capacity And Recruiting For Hiv Epidemiologic Studies With African, Caribbean And Other Black Communities In Understudied Urban-Rural Locales: The Blacch Study, Shamara M. Baidoobonso, Greta Bauer

Shamara M Baidoobonso, PhD

London reportedly has Ontario’s 3rd-highest HIV infection rate, and a small (2.2%) but growing African, Caribbean and other Black (ACB) population. Although targeted for HIV prevention efforts, ACB people are hard to reach for research and programming, especially in London and similar urban-rural locales with few ACB-specific resources. In Canada’s ACB population, HIV is most commonly spread through heterosexual contact, yet cultural and religious norms often discourage discussions about sex or sexuality. Homophobia, racism and stigma discourage ACB people from seeking information about HIV/AIDS. In addition, few researchers have worked with local ACB communities; trust is lacking between ACB communities …

Hiv Prevention Needs Of African, Caribbean And Other Black Men And Women: Findings From The Blacch Study Interviews, Shamara M. Baidoobonso, Daniel Pugh

Shamara M Baidoobonso, PhD

BACKGROUND: Definitions of masculinity and femininity and gender roles impact how individuals access, interpret and use HIV prevention messages in African, Caribbean and other Black (ACB) communities. These differences must be considered when designing prevention interventions. OBJECTIVE: To explore sex-based differences in ACB peoples’ HIV prevention needs. METHODS: Using a community-based approach, a purposive sample of 22 ACB community members (CM) and 8 service providers (SP) in London, Ontario was interviewed about health. Respondents represented a cross-section of ACB communities and SPs serving these communities. HIV-specific topics included: awareness, perceived risk, risk behaviours, barrier to accessing services and service needs. …

30-Year Trends In Heart Failure In Patients Hospitalized With Acute Myocardial Infarction, David Mcmanus, Marcello Chinali, Jane Saczynski, Joel Gore, Jorge Yarzebski, Frederick Spencer, Darleen Lessard, Robert Goldberg

Jorge L. Yarzebski

Despite significant advances in its treatment, acute myocardial infarction (AMI) remains an important cause of heart failure (HF). Contemporary data remain lacking, however, describing long-term trends in incidence rates, demographic and clinical profiles, and outcomes of patients who develop HF as a complication of AMI. Our study sample consisted of 11,061 residents of the Worcester (Massachusetts) metropolitan area hospitalized with AMI at all greater Worcester hospitals in 15 annual study periods from 1975 to 2005. Overall, 32.4% of patients (n = 3,582) with AMI developed new-onset HF during their acute hospitalization. Patients who developed HF were generally older, more likely …

Recent Trends In The Incidence, Treatment, And Outcomes Of Patients With Stemi And Nstemi, David Mcmanus, Joel Gore, Jorge Yarzebski, Frederick Spencer, Darleen Lessard, Robert Goldberg

Jorge L. Yarzebski

BACKGROUND: despite the widespread use of electrocardiographic changes to characterize patients presenting with acute myocardial infarction, little is known about recent trends in the incidence rates, treatment, and outcomes of patients admitted for acute myocardial infarction further classified according to the presence of ST-segment elevation. The objectives of this population-based study were to examine recent trends in the incidence and death rates associated with the 2 major types of acute myocardial infarction in residents of a large central Massachusetts metropolitan area. METHODS: We reviewed the medical records of 5383 residents of the Worcester (MA) metropolitan area hospitalized for either ST-segment …

Declining Length Of Stay For Patients Hospitalized With Ami: Impact On Mortality And Readmissions, Jane Saczynski, Darleen Lessard, Frederick Spencer, Jerry Gurwitz, Joel Gore, Jorge Yarzebski, Robert Goldberg

Jorge L. Yarzebski

BACKGROUND: Length of hospital stay after acute myocardial infarction decreased significantly in the 1980s and 1990s. Whether length of stay has continued to decrease during the 2000s, and the impact of decreasing length of stay on rehospitalization and mortality, is unclear. We describe decade-long (1995-2005) trends in length of stay after acute myocardial infarction, and examine whether declining length of stay has impacted early rehospitalization and postdischarge mortality in a population-based sample of hospitalized patients.

METHODS: The study sample consisted of 4184 patients hospitalized with acute myocardial infarction in a central New England metropolitan area during 6 annual periods (1995, …

Management And Outcomes Of Renal Disease And Acute Myocardial Infarction, Paul Santolucito, Dennis Tighe, David Mcmanus, Jorge Yarzebski, Darleen Lessard, Joel Gore, Robert Goldberg

Jorge L. Yarzebski

BACKGROUND: Contemporary trends in the management and outcomes of chronic kidney disease patients who develop an acute myocardial infarction have not been adequately described, particularly from the more generalizable perspective of a population-based investigation. METHODS: The study population consisted of 6219 residents of the Worcester, Massachusetts, metropolitan area who were hospitalized with acute myocardial infarction in 6 annual periods between 1995 and 2005. Patients were categorized as having preserved kidney function (n=3154), mild to moderate chronic kidney disease (n=2313), or severe chronic kidney disease (n=752) at the time of hospital admission. RESULTS: Patients with chronic kidney disease were more likely …

Spatial Distribution Of Commercial Banks In Ilorin Metropolis, Kwara State, Nigeria, I B. Abdullahi, M A. Ijaiya, A Abdulraheem, R I. Abdulkadir, R O. Ibrahim

Confluence Journal of Environmental Studies (CJES), Kogi State University, Nigeria

The spatial distribution of banks in any geographic entity determines the level of accessibility to its services by the public. This study examined the pattern of banks distribution in Ilorin metropolis. Field survey was employed in determining the number of available commercial banks and their respective distances between each other. The spatial analysis technique such as the nearest neighbour analysis as used ascertain the degree of clustering, density and the average distance taken to access these services. The study revealed that about 96% of the total number of banks are situated in the Central Business District which exhibited a very …

The Effect Of Aids Clinical Trials Group Protocol 5164 On The Time From Pneumocystis Jirovecii Pneumonia Diagnosis To Antiretroviral Initiation In Routine Clinical Practice: A Case Study Of Diffusion, Dissemination And Implementation, Elvin Geng

Elvin H Geng

No abstract provided.

Retention In Care And Connection To Care Among Hiv-Infected Patients On Antiretroviral Therapy In Africa: Estimation Via A Sampling-Based Approach, Elvin Geng

Elvin H Geng

No abstract provided.

Retention In Care For Hiv-Infected Patients In Resource-Limited Settings: Challenges And Opportunities, Elvin Geng

Elvin H Geng

No abstract provided.

Trends In Hiv-Infected Patients Accessing Antiretroviral Therapy In Kenya, Uganda And Tanzania Between 2002 And 2009, Elvin Geng

Elvin H Geng

No abstract provided.

Correcting Mortality For Loss To Follow-Up: A Nomogram Applied To Antiretroviral Treatment Programmes In Sub-Saharan Africa, Elvin Geng

Elvin H Geng

No abstract provided.

Factors Related To Poor Practice Of Pap Smear Screening Among Secondary School Teachers In Malaysia, Tin Tin Su

Tin Tin Su

Introduction: The Pap smear test has been regarded as a promising cervical screening tool since 1940s. Yet its importance has been overlooked by beneficiaries in Malaysia. This underlines the need to identify the prevalence of Pap smear practice and influencing factors towards the practice among educated working women. Methods: A survey was conducted with 403 female teachers from 40 public secondary schools in Malaysia selected by cluster random sampling. Data were collected from January to March 2010 using a self-administered questionnaire. Multivariate logistic regression was performed to identify the factors related to the Pap smear practice. Results: The rate for …

Postpartum Screening For Diabetes Among Women With A History Of Gestational Diabetes Mellitus, Lisa Chasan-Taber, A Tovar, E Eggleston, E Oken

Lisa Chasan-Taber

Introduction To make recommendations for future clinical, public health, and research practices for women with abnormal glucose tolerance during pregnancy, we reviewed the latest evidence regarding rates of postpartum diabetes screening and types of screening tests. Methods We searched PubMed for journal articles published from January 2008 through December 2010 that reported on postpartum screening and studies designed to prevent progression to type 2 diabetes among women with gestational diabetes mellitus (GDM). Two authors independently reviewed titles and abstracts from 265 articles. Results From 34% to 73% of women with GDM completed postpartum glucose screening. Predictors of higher screening rates …

Feasibility And Efficacy Of A Physical Activity Intervention Among Pregnant Women: The Behaviors Affecting Baby And You (B.A.B.Y.) Study, Lisa Chasan-Taber, Marushka Silveira, Bess H. Marcus, Barry Braun, Edward Stanek, Glenn Markenson

Lisa Chasan-Taber

Background: Physical activity during pregnancy is associated with reduced risk of adverse maternal and fetal outcomes. However, the majority of pregnant women are inactive and interventions designed to increase exercise during pregnancy are sparse. We evaluated the feasibility and preliminary efficacy of an exercise intervention among a diverse sample of pregnant women. Methods: The B.A.B.Y. (Behaviors Affecting Baby and You) Study is conducted at a large tertiary care facility in Western Massachusetts. We randomized 110 prenatal care patients (60% Hispanic) to an individually tailored 12-week exercise intervention arm (n = 58) or to a health and wellness control arm (n …

Caffeinated Coffee, Decaffeinated Coffee And Endometrial Cancer Risk: A Prospective Cohort Study Among U.S. Postmenopausal Women, Ayush Giri, Susan R. Sturgeon, Nicole Luisi, Elizabeth Bertone-Johnson, Raji Balasubramanian, Katherine W. Reeves

Raji Balasubramanian

There is plausible biological evidence as well as epidemiologic evidence to suggest coffee consumption may lower endometrial cancer risk. We evaluated the associations between self-reported total coffee, caffeinated coffee and decaffeinated coffee, and endometrial cancer risk using the Women’s Health Initiative Observational Study Research Materials obtained from the National Heart, Lung, and Blood Institute Biological Specimen and Data Repository Coordinating Center. Our primary analyses included 45,696 women and 427 incident endometrial cancer cases, diagnosed over a total of 342,927 person-years of follow-up. We used Cox-proportional hazard models to evaluate coffee consumption and endometrial cancer risk. Overall, we did not find …

An Exploratory Study Of Treated-Bed Nets In Timor-Leste: Patterns Of Intended And Alternative Usage, Andrew A. Lover, Brett A. Sutton, Angelina J. Asy, Annelies Wilder-Smith

Andrew Lover