Medicine and Health Commons^™

Challenges Faced By Households In Caring For Orphans And Vulnerable Children, Population Council

HIV and AIDS

South Africa has seen a rapid increase in HIV prevalence among the general population over the past ten years, from less than 1 percent in 1990 to 20 percent in 2001. As the HIV/AIDS epidemic increases, so do the number of orphans and vulnerable children (OVC). In 2002, an estimated five million people were living with HIV/AIDS. Because of the average 10-year period between infection and death, even if HIV prevalence declined rapidly, South Africa would still experience an increasing orphan burden for many years to come. By 2010, 16 percent of all children in South Africa will be orphans …

The Implications Of Early Marriage For Hiv/Aids Policy, Judith Bruce, Shelley Clark

Poverty, Gender, and Youth

This brief is based on a background paper prepared for the WHO/UNFPA/Population Council Technical Consultation on Married Adolescents, held in Geneva, Switzerland, December 9–12, 2003. The final paper is entitled “Including married adolescents in adolescent reproductive health and HIV/AIDS policy.” The consultation brought together experts from the United Nations, donors, and nongovernmental agencies to consider the evidence regarding married adolescent girls’ reproductive health, vulnerability to HIV infection, social and economic disadvantage, and rights. The relationships to major policy initiatives—including safe motherhood, HIV, adolescent sexual and reproductive health, and reproductive rights—were explored, and emerging findings from the still relatively rare programs …

Including Married Adolescents In Adolescent Reproductive Health And Hiv/Aids Policy, Judith Bruce, Shelley Clark

Poverty, Gender, and Youth

The majority of sexually active girls aged 15–19 in developing countries are married, and married adolescent girls tend to have higher rates of HIV infection than their sexually active, unmarried peers. Married adolescent girls represent a sizable fraction of adolescents at risk and experience some of the highest rates of HIV prevalence of any group. Nonetheless, married adolescents have been marginal in adolescent HIV/AIDS policies and programs and have not been the central subjects for programs aimed at adult married women. This paper offers a partial explanation for why married adolescents have so often been overlooked, the reasons why marriage …

Les Implications Du Mariage Précoce Pour Les Politiques De Vih/Sida, Judith Bruce, Shelley Clark

Poverty, Gender, and Youth

Ce dossier est basé sur un document contextuel préparé pour la Consultation Technique OMS/ FNUAP/Population Council sur les Adolescentes Mariées, tenue à Genève en Suisse du 09 au 12 Décembre 2003 (le document final intitulé "Inclure les adolescentes mariées dans les politiques de santé reproductive des adolescents et de VIH/SIDA"). La Consultation a réuni des experts provenant des Nations Unies, des bailleurs de fonds et des agences non gouvernementales pour examiner les faits concernant la santé reproductive des adolescentes mariées, leur vulnérabilité face à l’infection du VIH, leurs inégalités sociales et économiques ainsi que leurs droits. Les rapports avec des …

Testing The Effectiveness Of Integrating Community-Based Approaches For Encouraging Abandonment Of Female Genital Cutting Into Care's Reproductive Health Programs In Ethiopia And Kenya, Jane Chege, Ian Askew, Susan Igras, Jacinta Muteshi-Strachan

Reproductive Health

CARE International, with technical support from the Frontiers in Reproductive Health Program completed a study in Ethiopia and Kenya designed to test the effectiveness of education activities using behavior change communication (BCC) approaches and advocacy activities by religious and other key leaders to abandon female genital cutting (FGC). In Ethiopia, the increased knowledge of harmful FGC effects and human rights issues translated to a positive attitude in support of FGC abandonment and an intention not to cut their daughters in the future. In Kenya, the analysis indicated mixed results in attitude and intended behavior change.

Next-Of-Kin Perceptions Of Physician Responsiveness To Symptoms Of Hospitalized Patients Near Death, Joel C. Cantor, Jan Blustein, Matthew J. Carlson, David A. Gould

Sociology Faculty Publications and Presentations

Many different medical providers visit critically ill patients during a hospitalization, and patients and family members may not feel any physician is truly in charge of care. This study explores whether perceiving that a physician was clearly in charge is associated with reports by surviving next of kin about the responsiveness of physicians to symptoms in hospitalized patients near the end of life. We conducted telephone interviews with surviving next of kin of adult patients (n = 1107) who died in one of five New York City teaching hospitals between April 1998 and June 1999 after a minimum 3-day inpatient …

Introduction Of A Waterless Alcohol-Based Hand Rub In A Long-Term Care Facility, Lona Mody, Mcneil A. Shelly, Rongjun Sun, Bradley Suzanne, Carol A. Kauffman

Sociology & Criminology Faculty Publications

OBJECTIVE:

To examine the impact of introduction of an alcohol-based hand rub on hand hygiene knowledge and compliance and hand colonization of healthcare workers (HCWs) in a long-term-care facility (LTCF).

METHODS:

Two floors of an LTCF participated. Ward A used the hand rub as an adjunct to soap and water; ward B was the control. HCWs' hands were cultured using the bag-broth technique for Staphylococcus aureus, gram-negative bacilli (GNB), Candida, and vancomycin-resistant enterococci (VRE). HCWs completed a questionnaire at baseline and after an educational intervention and introduction of rub.

RESULTS:

Hand hygiene practices, knowledge, and opinions did not change after …

Expanding Self-Direction In Services For The Aged And People With Disabilities, Ruth A. Burgess

Theses, Dissertations and Capstones

Medicaid-funded long-term care services are traditionally delivered in nursing homes. States may apply for waivers which allow them to provide home and community based services with Medicaid funds. Because these services are by definition an alternative to nursing home care, waiver services are generally based upon a medical model which emphasizes medical deficits and tends to restrict consumers’ movements to inside the home. Recent developments such as the Olmstead Decision and federal New Freedom Initiatives have caused states to recognize that consumers desire and have a legal right to be part of a community rather than institutionalized or homebound. These …

Reproductive Health Services In Kwazulu Natal, South Africa: A Situation Analysis Study Focusing On Hiv/Aids Services, Lewis Ndhlovu, Catherine Searle, Robert A. Miller, Andrew A. Fisher, Ester Snyman, Nancy L. Sloan

HIV and AIDS

This Horizons report examines the readiness of reproductive health services in South Africa, which are primarily geared to women, to deliver HIV and AIDS treatment, care, and prevention services. The goal of the study was to obtain information from a representative sample of provincial health care facilities offering reproductive health services in KwaZulu Natal to meet the growing demand for HIV/AIDS-related services. Ninety-eight hospitals, community health centers, and clinics participated in the situation analysis that identified gaps in service delivery and determined priorities for service integration. Results of the study were presented to a large audience of Department of Health, …

Empowering Communities To Respond To Hiv/Aids: Ndola Demonstration Project On Maternal And Child Health: Operations Research Final Report, Hope Humana, Linkages, National Food And Nutrition Commission, Ndola District Health Management Team, Horizons Program, Zambia Integrated Health Project

HIV and AIDS

A pre–post intervention study conducted in Zambia by Horizons and local NGOs and governmental organizations demonstrated that HIV voluntary counseling and testing (VCT) and infant feeding counseling (IFC) to mothers attending maternal and child health (MCH) clinics are vital components of any mother-to-child transmission (MTCT) reduction strategy, whether or not antiretrovirals (ARVs) are available. These interventions enable mothers to make informed and healthy decisions. Data from the Ndola Demonstration Project yielded encouraging results from efforts to improve the capacity of mothers to make informed decisions about their own health and the health of their infant. The interventions succeeded in raising …

Microfinance And Households Coping With Hiv/Aids In Zimbabwe: An Exploratory Study, Carolyn Barnes, Erica Keogh, Nontokozo Nemarundwe, Loveness Nyikahadzoi, Ellen Weiss

HIV and AIDS

This study, conducted in Zimbabwe, sought to better understand the relationship between a microfinance program, Zambuko Trust, and how microentrepreneurs’ households cope with the impact of HIV/AIDS. The study examined how HIV/AIDS is affecting Zambuko’s operations and what microfinance institutions (MFIs) can do to lessen the impact of HIV/AIDS on their clients and operations. The findings indicate several small yet important ways that MFI programs help microentrepreneurs and their families respond to these impacts through access to credit and business management training. Participation in a microfinance program led to income smoothing and better financial management, which can help households mitigate …

Evaluating Operations Research Utilization: Guidelines For Assessing Process And Impact, M. Celeste Marin, Jane T. Bertrand

Reproductive Health

The Population Council has been providing technical assistance and conducting Operations Research (OR) studies in family planning and reproductive health for over two decades. These studies are designed to identify problems and test strategies to resolve those problems, providing program managers, administrators, and policymakers with the information they need to improve service-delivery systems. The ultimate goal is that strategies tested through OR will be adopted, leading to changes in policy or operational procedures at institutional, national, or international levels. These changes are what we refer to as impact. The purpose of the new approach to evaluation described in this Evaluation …

A Comparison Of Human Energy Fields Among Children, Youth, Adults, & Dahn Masters, Geoffrey K. Leigh, Karen A. Polonko, Catherine D. Leigh

Sociology & Criminal Justice Faculty Publications

While concepts and investigations of human energy fields have been developed for centuries, there has been little systematic work comparing the fields of children, adolescents, and adults. In addition, general fields have had little comparison between average adults and those participating in an intense practice that may affect the field. Using the GDV machine, this research compared small groups of children, adolescents, average adults, and Dahn Hak Masters on measures of 20 basic aspects of the human energy fields, including the seven chakras. Differences were found in seven of the 13 field parameters as well as all seven measures of …

Update - September 2002, Loma Linda University Center For Christian Bioethics

Update

In this issue:

-- Just Put Me to Sleep . . . PLEASE!: Ethical Issues in Palliative and "Terminal" Sedation
-- Terminal Sedation: A Jewish Perspective
-- Terminal Sedation: A Catholic Perspective
-- Announcing the Center for Christian Bioethics Nation Conference in 2003: "Promise and Peril of the New Genetics"
-- Center news . . .

Meeting The Sexual Health Needs Of Men Who Have Sex With Men In Senegal, Cheikh Ibrahima Niang, Moustapha Diagne, Youssoupha Niang, Amadou Moreau, Dominique Gomis, Maye Diouf, Karim Seck, Abdoulaye Sidibe Wade, Placide Tapsoba, Christopher Castle

HIV and AIDS

A study conducted in Dakar, Senegal by researchers from the National AIDS Council, Cheikh Anta Diop University, and the Horizons program obtained information on the needs, behaviors, knowledge, and attitudes of men who have sex with men (MSM). This study offers important insights into the sexuality of MSM, their vulnerability to STI/HIV, and the role of violence and stigma in their lives. The results also highlight the lack of sexual health services and information available to cover the specific needs of MSM. The results of this study were summarized during a meeting held in April 2001 in Dakar and raised …

Hiv/Aids Prevention Guidance For Reproductive Health Professionals In Developing-Country Settings, Helen Epstein, Daniel Whelan, Janneke Van De Wijgert, Purnima Mane, Suman Mehta

HIV and AIDS

While the integration of information, technologies, and services to respond to HIV/AIDS may seem closely related, there are a variety of issues that continue to create obstacles to integration. Among these are the stigmatizing nature of HIV infection and AIDS and discrimination faced by those who are infected or perceived to be infected; sexual practices and identities that remain socially unacceptable; gender roles and relations that make it difficult for women and men to access information, services, and technologies on HIV prevention; reluctance to recognize the special needs of young people; and barriers to service delivery created by broader economic, …

Physician-Related Determinants Of Cervical Cancer Screening Among Caribbean Women In Toronto, Ilene Hyman, Punam Mony Singh, Marta Meana, Usha George, Lilian M. Wells, Donna E. Stewart

Psychology Faculty Research

BACKGROUND: Minority women in Canada are less likely to be screened for cervical cancer than their counterparts in the general population, despite the fact that the proportion of these women who consult a general practitioner about their health each year is similar to minority women. This study examined the physician and practice characteristics associated with Pap testing and perceived barriers to Pap testing of family physicians serving the Caribbean community of Toronto.

METHODS: A mail-back questionnaire was sent to Toronto family physicians practicing in neighborhoods with a high proportion of Caribbean Canadians.

RESULTS: Although 79.7% of the 64 participating physicians …

Update - November 2001, Loma Linda University Center For Christian Bioethics

Update

In this issue:

[ Too Risky for Research? ]
-- Human Research with Vulnerable Humans
-- Why Did Jesus Die?

-- Earn a Master's degree from Loma Linda University
-- Center for Christian Bioethics News & Events

Effects Of Professional Interpreter Services On The Utilization Of Health Care Services Of Different Language/Cultural Groups, Amanda Fleming Petrik

Dissertations and Theses

Immigration has affected the number of U.S. residents who speak little or no English. These residents have limited English proficiency. Research studies have indicated discrepancies in medical interpretation and medical care. However, differences in health care between the language/ cultural groups are rarely recognized as health discrepancies.

This research project is a quasi-experimental design, testing differences between the four major language groups in the greater Portland, Oregon area. These four major language/cultural groups speak Chinese, Vietnamese, Spanish and Russian.

A secondary data analysis was used to compare the differences in utilization of emergency room services, routine services, and urgent care …

An Analysis Of The Changing Forces Behind Health Insurance Coverage Of Homebirth, Christina Anne Gasbarro

Dissertations and Theses

The expansion of managed care, which is premised on containing costs while maintaining market share, represents a radical transformation of the U.S. health care system. A central question for medical sociologists is to determine how the changes brought by managed care influence health insurance and health care options. In evaluating the impacts of managed care, obstetrics is a particularly important site of study. Part of this agenda involves gathering baseline data on a specific transformation in obstetrics practice new to the managed care scene: the emergence of health insurance coverage for the option of home birth. The research project detailed …

Review Of: Health And Disease In Human History (Robert I. Rotberg Ed.), Terry Cromwell

RISK: Health, Safety & Environment (1990-2002)

Review of the book: Health and Disease in Human History: A Journal of Interdisciplinary History Reader (Robert I. Rotberg ed., MIT Press 2000). ISBN 0- 262-18207-6 [345 pp. $25.00 Paper, 5 Cambridge Street, Cambridge, MA 02142].

Transitions To Adulthood In The Context Of Aids In South Africa: Report Of Wave I, Naomi Rutenberg, Cathrien Kehus-Alons, Lisanne Brown, Kate Macintyre, Anthea Dallimore, Carol E. Kaufman

HIV and AIDS

This is a prospective study of reproductive behavior and sexual health of adolescents in South Africa as well as their education and employment experiences, family and environmental conditions, and other factors in their lives that may influence their sexual behavior and choices. This report is designed to inform educators, policymakers, and the public in South Africa and beyond of the initial findings of the study, with the ultimate goal of helping to design and refine policies and programs that will improve opportunities and capacities of adolescents and may contribute to changing behaviors and choices. The report focuses on describing the …

Prevention Of Trafficking And The Care And Support Of Trafficked Persons In The Context Of An Emerging Hiv/Aids Epidemic In Nepal, Celine Daly

HIV and AIDS

This study is a collaborative effort between the Asia Foundation (Kathmandu) and the Horizons project of the Population Council (New Delhi) to document the current intervention models and community-based study of human trafficking in the context of an emerging HIV/AIDS epidemic in Nepal. To address the human rights component of trafficking, the three components of this study focus on the rights and needs of trafficked persons as well as those who are vulnerable to trafficking. An analysis and assessment of the effectiveness of laws, policies, and interventions in the apprehension, prosecution, and conviction of alleged traffickers is not included in …

Hiv And Partner Violence: Implications For Hiv Voluntary Counseling And Testing Programs In Dar Es Salaam, Tanzania, Suzanne Maman, Jessie K. Mbwambo, Margaret Hogan, Gad P. Kilonzo, Michael D. Sweat, Ellen Weiss

HIV and AIDS

This study explored the links between HIV infection, serostatus disclosure, and partner violence among women attending a VCT clinic in Dar es Salaam, Tanzania. Men and women both perceive HIV testing as a way to plan for the future but are motivated to undergo testing by a number of different individual, relationship, and environmental factors. The women in our study described more barriers to HIV testing than did men, and women who have communicated with their partners about VCT before seeking services are significantly more likely to share their HIV test results than those who have not talked with their …

The Case For Microbicides: A Global Priority, Kathy Attawell

HIV and AIDS

The HIV/AIDS epidemic continues to spread, undermining development, reversing health gains, and exacerbating poverty. It will be some time before a vaccine is available and accessible, thus there is an urgent need to identify additional prevention options, in particular a method that women control, which could save millions of lives. This report from the Population Council and International Family Health presents the case for microbicides—products used vaginally to prevent infection from HIV and other STIs in women and their sexual partners—and discusses recent progress and developments, outstanding challenges, and the action required to ensure that products will be made available …

Eating, Nutrition And Of Health Diagnostic Of The Elementary Schools Of The Communities Of Guambo And The Rinconada, Province Of Imbabura 2002-2001, Ruth Muriel

Theses and Dissertations

The rural communities of the province of Imbabura present multiple problems of environmental, educational, and economic kind. Previous studies show that the rural communities of the Ecuadorian population present serious problems of health and nutrition, among those that excel are: poliparasitosis, respiratory infections and diarrheal, malnutrition, deficiency of micro nutrients, sanitary deficiency, scarce economic resources and low level of instruction. All these factors have caused a decrease in the productive capacity of the country and affected their level of development. In addition, delay exists in size in the students, which leads to a decrease in the capacity for physical work, …

Benin: Diríjase A Los Hombres Para Aumentar El Uso De Los Servicios De Salud, Frontiers In Reproductive Health

Reproductive Health

Después del inicio de las reformas del sector salud en 1994, el gobierno de Benin creó el Proyecto de Salud Familiar Integral, conocido localmente como PROSAF. Este proyecto opera en la región de Borgou, bajo el patrocinio de la Agencia de los Estados Unidos para el Desarrollo Internacional. Dicha región es en su mayoría rural y en ella se observan los problemas de salud más severos del país. Los gerentes de PROSAF deseaban entender por qué la gente no estaba utilizando los servicios a pesar de tener una salud deficiente, por lo que solicitaron al Centro Africano de Investigación en …

Medical Students And Their Attitudes Toward Abortion: An Assessment Of Which Factors Influence Medical Students' Willingness Or Unwillingness To Perform Abortions, Katherine M. Krupa

Sociology & Criminal Justice Theses & Dissertations

The purpose of this research is to determine which factors, if any, influence medical students' willingness or unwillingness to perform abortions. Ample research has been conducted evaluating both the general population's and college students' attitudes toward abortion; however, limited research has been collected on medical students. The present research study attempts to fill this void. The following research questions will be reviewed and evaluated throughout the current study: (1) What personal factors if any influence medical students' willingness or unwillingness to terminate a pregnancy; (2) Are medical students willing to perform abortions for the reasons that women are requesting them; …

Relation Between Internal Parasites With Basic Services And The Nutritional Status Of Children Five Years Of Age In The Indigenous, Black And Mestizo Communities Of The Rural Area, Imbabura Province, R. Patricio Paguay Ruiz

Theses and Dissertations

Various studies have been done to determine the prevalence of anemia in our country, but these studies don't reflect the true magnitude of this sickness, considered in Ecuador a problem of public health since these investigations correspond to urban sectors and margins and not to rural places where the care is very deficient and in certain cases useless, mainly because of the difficult access and the lack of economic resources of the government institutions. The current work was realized in coordination with the school of Nutrition and Dietetics and with the help of the Benson Agriculture and Food Institute was …

Patient Preference For The Management Of Mildly Abnormal Papanicolau Smears, Marta Meana, Donna E. Stewart, Gordon M. Lickrish, Joan Murphy, Barry Rosen

Psychology Faculty Research

The article provides information on a study that investigated management preference and desire for decision-making involvement in women who have received a first mildly abnormal Papanicolaou smear. The majority of women in this highly educated sample preferred active management of their mildly abnormal Pap smears, although a substantial minority either opted for the surveillance strategy or reported no strong preference. Furthermore, management preference in this sample was not related to knowledge but rather to level of state anxiety. This indicates that these decisions may be guided more by emotions than by facts. Research has shown repeatedly that abnormal Pap smears …