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Biomedical subjects

J F Phillips

Publications and source records attributed to J F Phillips.

At least 19 recordsLinked to original sources
PubMed2001

Demographic surveillance and health equity in sub-Saharan Africa.

Accurate data are always needed to inform health policy, but are especially critical in tackling health inequities. The growing number of field research stations in sub-Saharan Africa are well-placed to generate relevant data and so support health policy action. Over the past 60 years, demographic surveillance systems have been crucial research tools for the evaluation of health interventions aimed at reducing socioeconomic differentials in mortality and morbidity in sub-Saharan Africa. The bulk of such work has been carried out by field research sites, often operating in remote, resource-constrained settings. The present paper reviews what we have learned since the pioneering work carried out in the field sites of Pholela (South Africa) and Niakhar (Senegal). It then focuses on current efforts to address health equity through INDEPTH, the international network of field sites with continuous demographic evaluation of population and their health in developing countries.

Africa South of the Sahara↗
PubMed2000

The Household Registration System: computer software for the rapid dissemination of demographic surveillance systems.

Although longitudinal experimental community health research is crucial to testing hypotheses about the demographic impact of health technologies, longitudinal demographic research field stations are rare, owing to the complexity and high cost of developing requisite computer software systems. This paper describes the Household Registration System (HRS), a software package that has been used for the rapid development of eleven surveillance systems in sub-Saharan Africa and Asia. Features of the HRS automate software generation for a family surveillance applications, obviating the need for new and complex computer software systems for each new longitudinal demographic study.

Africa↗
PubMed1999

Women's fears and men's anxieties: the impact of family planning on gender relations in northern Ghana.

The Navrongo experiment, a family planning and health project in northern Ghana, has demonstrated that an appropriately designed, community-based family planning program can produce a change in contraceptive practice that had been considered unattainable in such a setting. Simultaneously, however, evidence suggests that newly introduced family planning services and contraceptive availability can activate tension in gender relations. In this society, where payment of bridewealth signifies a woman's requirement to bear children, there are deeply ingrained expectations about women's reproductive obligations. Physical abuse and reprisals from the extended family pose substantial threats to women; men are anxious that women who practice contraception might be unfaithful. Data from focus-group discussions with men and women are examined in this report and highlight the strains on gender relations resulting from contraceptive use. The measures taken to address this problem and methods of minimizing the risk of adverse social consequences are discussed.

Adult↗
PubMed1999

Do managerial efficiency and social responsibility drive long-term financial performance of not-for-profit hospitals before acquisition?

Due to steep declines in charitable support and reduced demand for traditional hospital services, economic goals are increasingly important to not-for-profit hospitals. Effects of efficient management and effective pursuit of not-for-profit status (for example, levels of Medicare, indigent patients, and unprofitable services) on financial viability are explored. While previous research compared hospitals of different ownership status, not-for-profit hospital operations before acquisition by for-profit hospital chains are investigated--"neutral ground" relative to ownership. Results suggest minor links between efficiency and long-term profitability despite effectiveness in pursuit of non taxable status.

Bed Occupancy↗
PubMed1999

For-profit chains seek to acquire successful not-for-profit hospitals.

Over the last decade, investor-owned hospital corporations have grown primarily by acquiring other for-profit hospital chains or stand-alone for-profit institutions. Between 1990 and 1995, however, these corporations also acquired nearly 50 not-for-profit hospitals and converted them to for-profit status. An examination of the long-term financial condition of 39 not-for-profit hospitals acquired by various investor-owned hospital corporations between 1992 and 1996 was conducted using free-cash-flow accounting valuation. The results suggest that, initially, only not-for-profit hospitals in dire financial straits were candidates for acquisition and conversion to for-profit status. More recent acquisitions increasingly have involved more successful not-for-profit hospitals.

Accounts Payable and Receivable↗
PubMed1998

Serum retinol and HIV-1 RNA viral load in rapid and slow progressors.

Few studies have addressed the relation between serum vitamin A levels and HIV disease progression. Thirty HIV-infected women in Rwanda were studied over a time span of 26 to 99 months. Fourteen subjects seroconverted and died of HIV-related disease at a mean of 44 months (range, 26-69 months) after their first HIV-positive test and were termed "rapid progressors," (RPs). A comparison group of 16 "slow progressors" (SPs) were HIV-positive at the time of their first HIV serology and had asymptomatic HIV infections at a mean of 96 months (range, 93-99 months) after their first HIV serology. Baseline mean serum retinol values were the same in RPs and SPs: 0.65 + 0.08 micromol/L versus 0.67 + 0.09 micromol/L (p = .7). Lower serum retinol levels were observed in RPs compared with SPs for the second and third measurements, obtained at a median of 12 and 24 months past baseline: 0.51 + 0.07 micromol/L versus 0.76 + 0.14 micromol/L (p = .3) and 0.44 + 0.09 micromol/L versus 0.64 + 0.08 micromol/L (p = .08), respectively. Median retinol levels for the third sample measurement were similar in RPs with lower viral load (LVL) and SPs (0.49 micromol/L and 0.52 micromol/L, respectively) compared with only 0.19 micromol/L in RPs with higher viral load (HVL; p = .02). A trend toward decreasing serum retinol levels and increasing HIV-1 RNA viral load was observed at the third sample measurement (p = .04). Subjects with LVL, higher serum retinol levels (> or =0.70 micromol/L), or both had more favorable rates of survival than subjects with HVL, low serum retinol levels (<0.70 micromol/L), or both. Although sample size does not permit definitive conclusions, this study demonstrates an association of high HIV load, rapid progression, and low serum retinol late but not early in disease progression.

Adult↗
PubMed1998

Serum retinol and HIV-1 RNA viral load in rapid and slow progressors.

Few studies have addressed the relation between serum vitamin A level and HIV disease progression. Thirty HIV-infected women in Rwanda were studied over a time span of 26 to 99 months. Fourteen subjects seroconverted and died of HIV-related disease at a mean of 44 months (range, 26-69 months) after their first HIV-positive test and were termed "rapid progressors," (RPs). A comparison group of 16 "slow progressors" (SPs) were HIV-positive at the time of their first HIV serology and had asymptomatic HIV infections at a mean of 96 months (range, 93-99 months) after their first HIV serology. Baseline mean serum retinol values were the same in RPs and SPs: 0.65 + 0.08 mmol/L versus 0.67 + 0.09 micromol/L (p = .7). Lower serum retinol levels were observed in RPs compared with SPs for the second and third measurements, obtained at a median of 12 and 24 months past baseline: 0.51 + 0.07 mmol/L versus 0.76 + 0.14 mmol/L (p = .3) and 0.44 + 0.09 mmol/L versus 0.64 + 0.08 mmol/L (p = .08), respectively. Median retinol levels for the third sample measurement were similar in RPs with lower viral load (LVL) and SPs (0.49 mmol/L and 0.52 mmol/L, respectively) compared with only 0.19 mmol/L in RPs with higher viral load (HVL; p = .02). A trend toward decreasing serum retinol levels and increasing HIV-1 RNA viral load was observed at the third sample measurement (p = .04). Subjects with LVL, higher serum retinol levels (> or =0.70 mmol/L), or both had more favorable rates of survival than subjects with HVL, low serum retinol levels (<0.70 mmol/L), or both. Although sample size does not permit definitive conclusions, this study demonstrates an association of high HIV load, rapid progression, and low serum retinol late but not early in disease progression.

Adult↗
PubMed1998

The influence of traditional religion on fertility regulation among the Kassena-Nankana of northern Ghana.

This article presents findings from a study of the influence of traditional religion on reproductive preferences of Kassena-Nankana lineage heads in northern Ghana. Seven reproductive preference questions were administered to nine lineage heads who are primary practitioners of the cult of soothsaying. With the assistance of soothsayers, interviews were repeated in conjunction with the invocation of religious rites in order to determine the views of ancestral spirits on the seven questions. Pairs of lineage head and ancestral interviews are compared to determine the role of traditional religion in shaping male reproductive preferences. Interview pairs reflect a shared preference for sons, large compounds, and a growing lineage. Findings nonetheless show that some ancestral spirits want small families, some even wanting fewer children than corresponding lineage heads. Spiritual consultations are nondogmatic and open to external ideas and influences, suggesting that family planning introduction will not encounter systematic religious opposition among the Kassena-Nankana.

Adult↗
PubMed1997

Cultural factors constraining the introduction of family planning among the Kassena-Nankana of northern Ghana.

This study presents a focus group investigation of reasons why women in a rural, Sahelian community are reluctant to adopt family planning even when convenient services are made freely available. First, women opting to practice contraception must do so at considerable risk of social ostracism or familial conflict. Implementing individual preference is something that must be done without the support of others. Second, few women view personal decisions about contraceptives as theirs to make. Women and children are the property of the corporate family-kin and community militate against reproductive control. Third, although children are highly valued for a variety of economic, social, and cultural reasons, mortality risks remain extremely high. Low fertility imposes the unacceptable risk that a woman will have no surviving children at the end of her reproductive life. Taken together, these findings attest to the inadequacy of service strategies focused on the contribution of distribution, individual agency, or personal choice. Outreach should also build a sense of community legitimacy for the program, collective health action, and traditional leadership support for family planning behavior.

Attitude↗
PubMed1997

Serologic and phylogenetic characterization of HIV-1 subtypes in Uganda.

OBJECTIVES: To determine the HIV genetic subtypes present in HIV-1-infected asymptomatic blood donors in Uganda and to evaluate serologic detection of infection by commercial immunoassays; to evaluate samples for HIV-1 group O infections. METHODS: Sixty-four HIV-seropositive plasma samples were collected from the Nakasero Blood Bank, Kampala, Uganda. The plasma were evaluated using commercial HIV enzyme immunoassays (EIA) and a research immunoblot. HIV-1 group M and O infections were identified on the basis of discordant seroreactivity in EIA and reactivity to group M and O antigens on the immunoblot. Regions of gag p24 and env gp41 were amplified using reverse transcriptase polymerase chain reaction, and genetic subtypes were determined by phylogenetic analysis. RESULTS: Serologic testing confirmed that 63 out of 64 plasma units were positive for HIV-1 group M infection and showed no evidence of HIV-1 group O infections. Genetic subtyping determined that 25 samples were subtype A, three subtype C, 22 subtype D, and nine were heterogeneous for subtypes A and D. CONCLUSIONS: Despite the sequence variation observed in Uganda, commercial EIA based on HIV-1 subtype B proteins detected all the infections. In contrast, a peptide-based assay failed to detect three infections by subtype D viruses. This emphasizes the negative impact of HIV genetic variation on assays that rely on peptides to detect HIV infections. The number of infections with heterogeneous subtype (due to mixed infections or recombinant viruses) is high and reflects the growing complexity of the HIV epidemic in endemic regions where multiple subtypes are present in the population.

Genotype↗
PubMed1995

Natural history of HIV-1 cell-free viremia.

OBJECTIVE: To characterize the natural history of viremia with human immunodeficiency virus type 1 (HIV-1) and its association with disease progression from infection to acquired immunodeficiency syndrome (AIDS). DESIGN: Prospective cohort study. Annual specimens were tested for quantitative virion-associated HIV-1 RNA, p24 antigen, and CD4+ lymphocyte levels. PARTICIPANTS: A total of 42 homosexual men who seroconverted to HIV-1 between 1982 and 1985. MAIN OUTCOME MEASURES: Trends over time in serum HIV-1 RNA level, correlations between serum HIV-1 RNA and other markers, and prediction of AIDS using these markers. RESULTS: HIV-1 RNA levels were stable over time, increasing by 10-fold or more in only six (14%) of the 42 subjects during 3 to 11 years of follow-up. Mean HIV-1 RNA levels were 10(3.8) copies/mL if AIDS occurred in less than 4 years, 10(3.07) copies/mL if AIDS developed within 4 through 9 years, and 10(2.27) copies/mL if AIDS did not develop within 6 through 11 years. In both univariate and multivariate models, initial and subsequent HIV-1 RNA levels, p24 antigenemia, and percentage of CD4+ lymphocytes were independently predictive of AIDS. CONCLUSIONS: The stability of virion-associated HIV-1 RNA levels suggests that an equilibrium between HIV-1 replication rate and efficacy of immunologic response is established shortly after infection and persists throughout the asymptomatic period of the disease. Thus, defective immunologic control of HIV-1 infection may be as important as the viral replication rate for determining AIDS-free survival. Because individual steady-state levels of viremia were established soon after infection, HIV-1 RNA levels may be useful markers for predicting clinical outcome.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Reduction of self-injurious hand mouthing using response blocking.

We evaluated a response-blocking procedure for reducing the self-injurious hand mouthing of 2 adults with profound disabilities. The procedure reduced mouthing in both cases. The results suggest research is warranted to delineate the behavioral process responsible for the effect of response blocking and to determine the procedure's long-term utility.

Adult↗
PubMed1991

Relevance of major stress events as an indicator of disease activity prevalence in inflammatory bowel disease.

The impact of psychological stress in recurrence of inflammatory bowel disease (IBD) is unclear. Why some patients with ulcerative colitis (UC) or Crohn's disease (CD) have unrelenting relapses whereas other IBD patients experience long periods of quiescent disease remains an enigma. The authors examined the risk of exposure to major stress events in clinical episodes of IBD. They followed up on 124 persons in a prospective study that monitored behavioral and biological characteristics for a period of 6 months. Stress-exposed subjects demonstrated increased risk of clinical episodes of disease when compared with unexposed subjects (RR = 2.6, 95% CI: 1.3-4.9). Elevated effect measures were highest for the domain of health-related stress (RR = 3.8, 95% CI: 1.5-9.9). In the multiple regression analysis, major stress events remained the most significant indicator of disease activity in the presence of the covariables considered. Only 7% of the variation in disease activity was uniquely attributed to stress. Baseline activity was the other notable indicator of subsequent disease activity in the study sample. All variables considered together explained 52% of the variance observed and implicated factors of potential clinical importance in monitoring recurrence of the disease.

Adult↗
PubMed1991

Lag time between stress events and risk of recurrent episodes of inflammatory bowel disease.

We followed a cohort of 124 subjects with a history of inflammatory bowel disease to ascertain risk estimates for clinically active disease associated with exposure to recent stress events. We calculated risk estimates for three lag models (-1, 0, + 1 month). The data indicated a strong association between stress exposures and new clinical episodes of disease (RR = 2.9, 95% Cl: 2.0-4.1), most apparent in the immediate period (lag = 0). Risk estimates were also elevated for extended episodes of disease in subjects under stress compared with unexposed subjects. These results underscore the importance of monitoring stress exposures in prevention and treatment of recurrent disease.

Acute Disease↗
PubMed1991

Teaching persons with profound multiple handicaps: a review of the effects of behavioral research.

The behavioral research on teaching individuals who have profound multiple handicaps is reviewed. The primary focus is on determining the degree to which behavioral research has demonstrated the teaching of meaningful skills to this population. Results of the review indicate that investigations have demonstrated, albeit inconsistently, that behavior change has resulted from contingency management interventions with persons who have profound multiple handicaps. However, there is little evidence that such interventions have resulted in meaningful behavior change according to currently accepted criteria for beneficially affecting the quality of life of persons with serious handicaps. Potential explanations for the lack of such evidence are offered, including the relative lack of research attention given to this issue, the possible ineffectiveness of the components of the technology applied, and possible ineffective application of the potentially effective technology. Suggestions for future research are discussed in terms of developing more effective educational and habilitative services for persons with profound multiple handicaps. In particular, we suggest research on a wider variety of behavioral teaching procedures, providing more comprehensive evaluations of the applications of procedures and developing treatment programs that do not focus solely on traditional skill acquisition.

Activities of Daily Living↗
PubMed1991

The institutionalization of operations research.

When the conceptualization of OR is inappropriate, institutionalization will not take place. For this reason, the discussion here has focused as much on the pitfalls in OR design as on factors that facilitate institutionalization. Research that is inappropriately adapted to the societal or programmatic context will not be institutionalized, nor will OR lead to institutionalized research capabilities if theory is ignored or the research lacks credibility. The institutionalization of credible and scientifically sound OR requires well-trained social scientists who can carry out this task. Career opportunities must persist in OR so that well-trained scientists will find in an attractive and rewarding pursuit. Long-term projects facilitate institutionalization by providing a setting where work teams can be developed and career tracks defined. Academics and universities institutionalize OR by sponsoring training in applied research and developing high-level research leadership. For this reason, institutional linkages and mechanisms that nurture collaboration facilitate the institutionalization of OR. Finally, institutionalization of OR implies that research is being utilized for action by program management and the policy community. There is extensive literature on the determinants of research utilization, much of which is relevant to the question of how OR can be institutionalized.

Academies and Institutes↗
PubMed1990

The Sample Registration System: an innovative system for monitoring demographic dynamics.

"The International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) has been at the forefront of the development of longitudinal systems for demographic surveillance. The Demographic Surveillance System from the Matlab study area is internationally recognized as a unique source of accurate and complete demographic data for a large rural population within a developing setting. In this paper, an overview is presented of a second demographic surveillance system--the Sample Registration System (SRS)--which has been in operation for six years in two other areas of rural Bangladesh." Fertility and mortality rates for the period 1983-1988 are calculated from the SRS data.

Asia↗