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Biomedical subjects

D Bishai

Publications and source records attributed to D Bishai.

13 recordsLinked to original sources
PubMed2007

The cost-effectiveness of DOTS in urban Brazil.

SETTING: Rio de Janeiro, Brazil, is a middle-income setting with an estimated 1% adult human immunodeficiency virus (HIV) seroprevalence. OBJECTIVE: To examine the cost-effectiveness of DOTS in Rio de Janeiro. DESIGN: Cost-effectiveness analysis based on cost data and an epidemiological model based on programmatic outcomes from the Health Department in Rio de Janeiro, cost data from the retail market sector and epidemiological data from published studies. RESULTS: The 10-year cost of a tuberculosis program treating a population of 262 000 based on self-administered therapy (SAT) was estimated to be $580 271 compared to $1047 886 for DOTS. The largest portion of the DOTS budget was for staff costs and costs incurred by patients, both at 28%. For SAT, the largest percentage of the budget was allocated to medication costs, at 34%. Upgrading from SAT to DOTS averted 1558 cases of tuberculosis (TB, uncertainty range [UR] 1418-1704) and 143 TB deaths (UR 131-155). The incremental cost effectiveness ratio (ICER) for DOTS was $300 per case averted (UR $289-$312) and $3270 per death averted (UR $3123-$3435). In terms of disability adjusted life years (DALYs), DOTS saved 5426 DALYs (UR 4908-5961). The ICER for DOTS was $86 per DALY saved (UR $74-$100). CONCLUSIONS: DOTS is a highly cost-effective intervention in Brazil.

Antitubercular Agents↗
PubMed2005

Changes in utilization of TB health services in Nepal.

SETTING: Nepal. OBJECTIVE: To assess the impact of community mobilization and health worker training on tuberculosis (TB) health services utilization. DESIGN: Questionnaire. METHODS: The Japan International Cooperation Agency and the Nepal Ministry of Health launched a set of interventions to increase awareness and availability of treatment at government facilities. In 2001 and 2003, a questionnaire was administered to TB patients. RESULTS: In 2001-2002, 77.3% of women and 80.0% of men with TB symptoms consulted at government facilities, compared to 30% of men and 32% of women in 1997-1999. CONCLUSION: In the absence of any secular causes, this change can be attributed to the increasing community awareness of availability and quality of DOTS.

Adult↗
PubMed2003

How willing are parents to improve pedestrian safety in their community?

STUDY OBJECTIVE: To determine how likely parents would be to contribute to strategies to reduce pedestrian injury risks and how much they valued such interventions. DESIGN: A single referendum willingness to pay survey. Each parent was randomised to respond to one of five requested contributions towards each of the following activities: constructing speed bumps, volunteering as a crossing guard, attending a neighbourhood meeting, or attending a safety workshop. SETTING: Community survey. PARTICIPANTS: A sample of 723 Baltimore parents from four neighbourhoods stratified by income and child pedestrian injury risk. Eligible parents had a child enrolled in one of four elementary schools in Baltimore City in May 2001. MAIN RESULTS: The more parents were asked to contribute, the less likely they were to do so. Parents were more likely to contribute in neighbourhoods with higher ratings of solidarity. The median willingness to pay money for speed bumps was conservatively estimated at $6.43. The median willingness to contribute time was 2.5 hours for attending workshops, 2.8 hours in community discussion groups, and 30 hours as a volunteer crossing guard. CONCLUSIONS: Parents place a high value on physical and social interventions to improve child pedestrian safety.

Accidents, Traffic↗
PubMed2002

Interventions for control of road traffic injuries: review of effectiveness literature.

OBJECTIVE: In 1998, road traffic injuries were estimated to be the 9th leading cause of loss of healthy life globally and are projected to become the 3rd leading cause by 2020. The majority of this burden can be located in the developing world where most of the projected increase will occur. Yet health systems are least prepared to meet this challenge in these countries. At the same time, there are effective interventions for road traffic injuries being implemented in the developed world. An extensive review of the literature reveals more than 16 different interventions in four categories that have been implemented. Renewed testing of these and new interventions will take both time and funds--resources that are scarce in developing countries. As a result, it is imperative to study the effectiveness of those interventions already tested and attempt to evaluate their potential implementation in developing countries. METHOD: Literature review to identify effective interventions and the magnitude of the effects. RESULTS: Four broad classes of interventions can be identified from the literature; health education/awareness, legislation, product design and environmental modifications. CONCLUSION: The issues for the developing countries are affordable, infrastructure and sociocultural in implementation of these strategies. The road traffic injuries are also underreported and hence under represented at the priority setting stage. Road safety should be high on the agenda as it can save a lot of lives and disability. Public health professionals should assess and advocate road safety in developing countries.

Accidents, Traffic↗
PubMed2001

Modeling the economic benefits of an AIDS vaccine.

Economic models were used to describe the potential for an AIDS vaccine to prevent medical spending and lost productivity throughout the world. In terms of avoided medical spending, preventing 75% of the AIDS risk for 10 years in one adult male is estimated to be worth US$ 343 in western Europe, US$ 4.59 in south and SE Asia, and US$ 2.67 in sub-Saharan Africa. The expected medical savings from a 75% effective vaccine would exceed US$ 25.00 per person for over 700 million people. Although an AIDS vaccine would save more lives in poverty stricken areas, it would save more money in developed countries. The mismatch between the public health needs and market forces is highlighted by this model.

AIDS Vaccines↗
PubMed2001

Newspaper reports as a source for injury data in developing countries.

Injuries are an important public health problem and a leading cause of death among adults and children. In most of the developing world, with rapid changes in lifestyle, rural development, urbanization, an increase in number of vehicles, introduction of mechanized farming and pesticides in agriculture, the effect of injuries on mortality and morbidity is expected to increase. Injuries have been infrequently studied in developing countries; their importance is incompletely understood and they are seriously neglected in health research and policy. The reasons for this situation may be many, but one important reason is the unavailability of data in countries to assess the magnitude of the problem. Hospital and police records are the primary data source for injuries in the majority of the developing world. Newspaper reports may be an alternative source for injury data. This hypothesis was tested in the Rawalpindi Division of Pakistan by collecting data from newspaper reports for both intentional and unintentional injuries for 6 months (January-June 1999). This was compared with police data for the same time period. The results revealed that newspapers report more injury-related events and for some categories, such as suicides, the reporting was far greater by newspapers than the police. We conclude that the current system of police data collection needs to be strengthened. Newspapers may serve as a comparative source of information to evaluate the coverage of police data.

Bibliometrics↗
PubMed2001

How much outpatient care is provided for injuries?

OBJECTIVE: To estimate the average number of outpatient visits, emergency department visits, and hospitalizations for injured patients. METHODS: The Medical Expenditure Panel Survey Household Component of 1996 is a weighted sample designed to represent the United States population. For each episode of injury the average number of office visits or outpatient contacts, emergency department visits, and hospitalizations were computed. Subsequently the ratio of outpatient to inpatient contacts for each type of injury was estimated. RESULTS: When asked to report on their medical problems for the previous six months, the majority of respondents who recalled injuries did not report contact with emergency departments or hospitalization. The average injury is associated with only 0.2 to 0.3 emergency department visits. Sports related injuries were associated with 0.03 hospitalizations. Gun related injuries were associated with 0.12 hospitalizations. All types of injury were related with more than one episode of outpatient or office based care. The ratio of emergency department visits and outpatient visits to hospitalizations varies according to the nature of the injury. CONCLUSION: Policymakers interested in the cost of injury should account for the extensive outpatient utilization of injured patients.

Accidents↗
PubMed2000

The cost of juvenile-onset recurrent respiratory papillomatosis.

OBJECTIVE: To assess the medical costs and the number of quality-adjusted life years lost owing to juvenile-onset recurrent respiratory papillomatosis (JORRP). DESIGN: We examined hospital and physician charges for JORRP surgical procedures in Maryland in 1994 adjusting for inflation and the cost-charge ratio. Centers for Disease Control and Prevention data on treatment intensity for JORRP were augmented with a review of treatment records for 18 patients with JORRP. Sensitivity analyses were performed. To illustrate the application of our cost estimates, we compare the costs of JORRP to the costs of the surgical procedures that would be necessary to prevent it. RESULTS: We find that the present value at birth of the cost of a single case of JORRP is $201,724 (range, $61,822-$474,334). The annual cost for a single case of JORRP is $57,996 (range, $32,407-$94,114). The annual cost of JORRP in the United States is between $40 million and $123 million depending on the prevalence. Cesarean section (CS) for women with condyloma has been suggested as a potential strategy to prevent JORRP, but its efficacy remains to be determined. Our results suggest that if only 1% of the CSs actually prevented JORRP, this strategy would be a cost-effective means to prevent JORRP. CONCLUSIONS: Studies to reduce the uncertainty surrounding the efficacy of CS and the effect of both CS and JORRP on families need to precede consideration of a policy of CS for women with clinically evident genital condyloma. Patients should be kept thoroughly informed about the role of CS for the prevention of JORRP and the nature of the remaining uncertainties.

Adolescent↗
PubMed1998

Risk factors for juvenile onset recurrent respiratory papillomatosis.

BACKGROUND: Children born to condylomatous mothers are at risk for developing juvenile onset recurrent respiratory papillomatosis (JORRP). We inquired whether the triad of vaginal delivery, being firstborn and maternal age of <20 years are also risk factors for JORRP. METHODS: Data for JORRP and adult onset recurrent respiratory papillomatosis cases were obtained from questionnaires answered by patients or their parents for the Recurrent Respiratory Papillomatosis Foundation. The observed numbers of cesarean births, first order births and births to mothers <20 years old were compared with expected numbers for the same variables, which were computed by distributing the cases by year of birth and then applying to them national annual statistics for the year of birth. In addition observed and expected numbers of first order births to mothers <20 years old were compared with corresponding numbers in mothers 20 years old or older. RESULTS: In JORRP cases the relationships be tween observed and expected numbers of cases were as follows: cesarean births, 4.6-fold less; first order births, 1.6-fold greater; maternal age <20 years old, 2.6-fold greater. All these differences were statistically highly significant. The observed parity effect was mediated to a large extent by maternal age. In contrast there were no significant differences between observed and expected numbers of adult onset recurrent respiratory papillomatosis cases with respect to any of the above variables. CONCLUSIONS: Young primiparous mothers with condylomas are at a high risk for transmission of JORRP to their infants. The option of cesarean delivery should be discussed with a mother who has condyloma at the time of delivery.

Adult↗
PubMed1991

Medical tourists.

Explore the source record for details and available documents.

Developing Countries↗
PubMedDate not supplied

Quality time: how parents' schooling affects child health through its interaction with childcare time in Bangladesh.

A child health production function is presented with the key feature being an interaction term between a caregiver's schooling and their exposure time to the child. The production function is estimated using a 2SLS fixed effects model with lagged childcare time, resource allocation and child health as instruments for the first differences of these same endogenous variables. The 1978 Intrafamily Food Distribution and Feeding Practices Survey dataset from Bangladesh is used together with census data. The production function estimates indicate that part of the salutary effects of parental education on child health require that the child actually be exposed to the educated parent. Given the demographic makeup of the study sample and the assumption that age education and gender completely account for productivity, teenage brothers and fathers would have the highest marginal productivity for child health and mothers and grandmothers the least. If economic opportunity draws mothers away from childcare, the presence of other household members with higher schooling levels offers the potential for an improvement in the overall quality of childcare time. In the present study the households failed to set the marginal labour product of child health for each of the caregivers equal. Thus, the quality of childcare may not be the household's sole concern in determining time allocation.

Adolescent↗