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P Feldblum

Publications and source records attributed to P Feldblum.

8 recordsLinked to original sources
PubMed1997

Sexually transmitted disease risk assessment used among low-risk populations in east central Africa: a review.

In sub-Saharan Africa where sexually transmitted diseases (STDs) are prevalent but health resources are scarce, algorithms that act as STD/HIV risk assessment (RA) tools for family planning (FP) and maternal/child health (MCH) clinic attenders may be useful. These RA algorithms generally comprise questions about a person's social, economic, demographic, behavioural and clinical background. The answers can be scored or scaled to indicate a higher probability of current STD/HIV infection and thus the need for testing or treatment. RA can be done alone, or can be combined with clinical examination where laboratory diagnosis is not feasible. But how accurate are RA tools? We reviewed six studies at African sites that examined the use of RA combined with a clinical algorithm for STD screening of clinic attendees. Researchers reported the standard measures of test accuracy: sensitivity (per cent of infected women found positive by the tool); specificity (per cent of uninfected women found negative by the tool), and positive predictive value (per cent of women found positive by the tool who are truly infected). Most algorithms had low sensitivity (< 50%) and low positive predictive value (< 20%). The addition of clinical examination, and of leucocyte esterase (LE) testing, improved accuracy. But algorithms that performed well in one site were less accurate at other sites. For illustrative purposes, we considered a hypothetical population of 1,000 women attending a FP clinic. With a prevalence of cervical gonorrhoea of five per cent, algorithm sensitivity of 40%, and algorithm specificity of 75%, the positive predictive value of the RA tool would be 7.7%. In other words, 20 (7.7%) women diagnosed as infected would actually have gonorrhoea, and 237 false positive women would be treated needlessly, with the attendant costs and risks. However, with a disease prevalence above 50%, as might prevail for vaginal infections, and the same sensitivity and specificity figures, the positive predictive value may reach 70-80%. Risk assessment appears to be a relatively easy way to integrate STD management into family planning and MCH practice. However, there is no evidence to show its effectiveness for screening low-risk populations. We urge improvement of these tools, including information on the behaviour of male partners, and addition of simple screening tests such as leucocyte esterase dipsticks.

Algorithms↗
PubMed1991

Paraguayan pharmacies and the sale of pseudo-abortifacients.

This study was conducted in 1985 in Asunción, Paraguay, 6 years after the closure of the state supported family planning services. Data from national surveys in 1977 and 1987 permit a comparison of sources of contraceptive supplies before and after the elimination of government support for family planning. The purchase of pseudo-abortifacients from private pharmacies was used as an indication of induced abortion. After the loss of government clinics, it is suggested that some women turned to pharmacists to obtain pseudo-abortifacients when faced with unwanted pregnancy. There is an indication of increased pseudo-abortifacient use, particularly among unmarried women and those from poorer neighbourhoods.

Abortifacient Agents↗
PubMed1988

A comparison of two cause-of-death classification systems for deaths among women of reproductive age in Menoufia, Egypt.

Mortality data ascertained from sources other than a death registration system can validate the accuracy of the system, but this information is rarely obtained. Data on 1979 deaths among reproductive age women were collected in the 1981-1983 Reproductive Age Mortality Survey (RAMOS) in the governorate of Menoufia, Egypt, and compared with data on these deaths as recorded by the Egyptian death registration system. Although the distribution of the causes of death were similar, there were substantial differences between classification systems for deaths due to particular causes. Over half of the deaths classified differently by the systems were those assigned to circulatory disease on the death certificate. In contrast, there was a high rate of agreement between systems in the classification of trauma deaths. About half (52.4%) of cancer deaths had the same site-specific cancer diagnosis assigned by RAMOS. The percentage of deaths assigned to maternal causes was three times higher in RAMOS (19.2%) than on death certificates (6.1%). Reported mortality rates for this often-preventable cause of death have been substantially underestimated in national death registration systems. Such underreporting masks the need for additional prenatal care and maternal health programmes.

Adolescent↗
PubMed1983

Three neuroleptanalgesia schedules for laparoscopic sterilization by electrocoagulation.

Women undergoing interval laparoscopic electrocoagulation sterilization were randomly assigned to one of three neuroleptanalgesia regimens. The 299 women received either morphine (10 mg)/droperidol (2.5 mg)/atropine (0.3 mg) or pethidine (100 mg)/droperidol (2.5 mg)/atropine (0.3 mg) or pethidine (100 mg)/droperidol (2.5 mg). A significantly higher proportion of anesthesia complications were recorded in the morphine group. The amount of pain experienced by the women was similar in the three groups, as were the rates of early follow-up complications and complaints. The neuroleptanalgesia regimen containing pethidine/droperidol/atropine appears to be the safest and most effective of the three considered here.

Adult↗