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Biomedical subjects

Shahul H Ebrahim

Publications and source records attributed to Shahul H Ebrahim.

9 recordsLinked to original sources
PubMed2006

Models of preconception care implementation in selected countries.

Globally, maternal and child health faces diverse challenges depending on the status of the development of the country. Some countries have introduced or explored preconception care for various reasons. Falling birth rates and increasing knowledge about risk factors for adverse pregnancy outcomes led to the introduction of preconception care in Hong Kong in 1998, and South Korea in 2004. In Hong Kong, comprehensive preconception care including laboratory tests are provided to over 4000 women each year at a cost of $75 per person. In Korea, about 60% of the women served have known medical risk history, and the challenge is to expand the program capacity to all women who plan pregnancy, and conducting social marketing. Belgium has established an ad hoc-committee to develop a comprehensive social marketing and professional training strategy for pilot testing preconception care models in the French speaking part of Belgium, an area that represents 5 million people and 50,000 births per year using prenatal care and pediatric clinics, gynecological departments, and the genetic centers. In China, Guangxi province piloted preconceptional HIV testing and counseling among couples who sought the then mandatory premarital medical examination as a component of the three-pronged approach to reduce mother to child transmission of HIV. HIV testing rates among couples increased from 38% to 62% over one year period. In October 2003, China changed the legal requirement of premarital medical examination from mandatory to "voluntary." This change was interpreted by most women that the premarital health examination was "unnecessary" and overall premarital health examination rates dropped. Social marketing efforts piloted in 2004 indicated that 95% of women were willing to pay up to RMB 100 (US$12) for preconception health care services. These case studies illustrate programmatic feasibility of preconception care services to address maternal and child health and other public health challenges in developed and emerging economies.

Belgium↗
PubMed2004

Use of cervical cancer screening among insured women: the extent of missed opportunities.

The objective of the study is to identify opportunities to improve cervical cancer screening among privately insured women. From MedStat's Marketscan database, we identified 735,181 women aged 21-64 years who remained in the same insurance plan during the entire period of 2000-2002. We obtained the percentages of women who had a Papanicolaou (Pap)-test reimbursement claim and any health-related claim during the 3-year period. For women without a Pap-test claim, we obtained information about the frequency of insurance claims, type of health-care provider, and type of insurance plan in which the women were enrolled. The multivariate logistic regression model was used to identify factors independently associated with not having a Pap test. Of the total sample, in the 3-year period, 96% had at least one health insurance reimbursement claim and 69% had at least one claim for a Pap test. Approximately, 87% of the women who had no Pap-test claim had a health claim; 44% of such claims were from primary care providers. In the multiple logistic regression model, factors that were independently associated with having no Pap test were old age, being dependents of employees, and enrollment in comprehensive insurance plans. Efforts to increase the use of cervical cancer screening service should consider additional risk factors besides lack of insurance coverage. Concerted efforts by insurance and health-care providers are needed to improve adherence to the recommended cervical cancer screening guidelines, both by consumers and service providers.

Adult↗
PubMed2004

Sexually transmitted infections in travelers: implications for prevention and control.

Sexually transmissible diseases (STDs), the most common notifiable infectious conditions, remain major threats to reproductive and public health worldwide. Travelers are particularly vulnerable to STDs, because of voluntary or involuntary sexual behavior while abroad, and are significant vectors who introduce new pathogens and resistant strains to unaffected parts of the world. This article outlines some key issues that travel medicine specialists and other clinicians should revisit when providing services to travelers. We discuss obstacles to promoting sexual health, including the diversity of the target group, unanticipated opportunities for sexual risk, ambivalent cooperation by the travel and tourism industries, poorly developed travel health sectors, illegal migration and sex tourism, and lack of research about the association between travel and STDs. We also outlined some programmatic aspects of public health that should be identified and addressed for the promotion of sexual health among travelers.

Humans↗
PubMed2004

Race/ethnic disparities in HIV testing and knowledge about treatment for HIV/AIDS: United States, 2001.

In the United States, access to HIV care has remained suboptimal for people of color. To assess racial disparities in HIV testing and knowledge about treatment for HIV/AIDS in the United States, we analyzed the 2001 Behavioral Risk Factor Surveillance System. We obtained the percentage of respondents aged 18 to 64 years who: (1) were tested for HIV ever and recently (in the past 12 months) excluding for blood donations and (2) responded "true" to the statement, "There are medical treatments available that are intended to help a person who is infected with HIV to live longer." We calculated the difference in rates of HIV testing and knowledge about treatment between blacks or Latinos compared to whites. Overall, of the 162,962 respondents, 44.7% had been tested for HIV and 12.8% were tested in the past year. Overall, 86.4% answered "true" to the statement on treatment for HIV/AIDS. HIV testing rates were significantly lower among whites (ever, 42.4%; recent, 10.8%) than blacks (ever, 59.7%; recent, 23.4%) or Latinos (ever 45.6%, recent 14.8%). Compared to knowledge among whites (89.6%), knowledge level was, lower among blacks (odds ratio [OR] = 0.58, 95% confidence interval [CI] = 0.52, 0.64) and Latinos (OR = 0.67, 95%CI = 0.59, 0.75) even after adjusting for sociodemographics and HIV testing status. The knowledge gap among blacks compared to whites decreased with increasing income and education. We conclude that knowledge about the availability of antiretroviral treatment was high overall. Compared to whites, blacks, and latinos had significantly higher HIV testing rates but significantly lower knowledge about antiretrovirals.

AIDS Serodiagnosis↗
PubMed2004

AIDS-defining cancers in Western Europe, 1994-2001.

To determine the recent trends in AIDS-defining cancers in Western Europe, we analyzed the June 2002 European Non-Aggregate AIDS Data Set. We obtained the percentage of people with AIDS aged 15 years or older (n = 125,691; males, 99,560, females, 26,131) who had cancers as the initial AIDS-defining illness in 17 European countries. Overall, from 1994 through 2001, declines were noted in the number of people with AIDS (25,324 to 8929), the proportion of people with AIDS who were homosexual/bisexuals (38.8% to 26.6%) or intravenous drug users (male, 41.7% to 34.8%; female, 50.2% to 26.4%). Among males, between 1994 and 2001, the percentage with any AIDS-defining, cancers declined (14.4% to 13.1%, p for trend = 0.091) because of a decline in Kaposi's sarcoma (KS; 10.7% to 7.9%) mostly among homosexual/bisexual men (22.7% to 18.8%) (p for trends < 0.05). Between 1994 and 2001, the percentage of males with all types of lymphomas increased (3.8% to 5.2%, p for trend = 0.012). Among females, AIDS-defining cancers increased (7.3% to 8.5%) due to increase in lymphomas (all types, 2.6% to 4.0%) (p for trend = 0.05). Cervical cancer remained the most common cancer among females, the percentage of which declined between 1994 and 2001 (2.8% to 2.0%, p for trend = 0.37) mostly among women who were 15 to 29 years old, most of whom acquired HIV heterosexually. In summary, declines were noted for the two leading AIDS-defining cancers at initial AIDS diagnosis among certain population groups. KS declined among men who had sexually transmitted HIV infection. Cervical cancer declined among young females and heterosexuals.

AIDS-Related Opportunistic Infections↗
PubMed2004

Women's knowledge about treatment to prevent mother-to-child human immunodeficiency virus transmission.

OBJECTIVE: To provide national estimates of knowledge about treatments available to reduce mother-to-infant human immunodeficiency virus (HIV) transmission among U.S. women of childbearing age. METHODS: We used data from 55712 women aged 18 to 44 years who responded to questions on antiretroviral treatment in the 2001 Behavioral Risk Factor Surveillance System. We obtained the percentage of women who correctly answered a question on treatment to prevent mother-to-child transmission of HIV and determined factors independently associated with such knowledge using a multiple logistic regression model. RESULTS: Overall, the percentage of women who correctly stated that treatment existed to help prevent mother-to-child transmission of HIV was 58.6% (95% confidence interval 57.9, 59.3). In the multiple logistic regression model that controlled for sociodemographics, having correct knowledge about treatment to prevent mother-to-child HIV transmission was independently associated with being black, younger age (18-34 years), college level education, and having been tested for HIV. Current pregnancy was not an independent predictor of having knowledge about the availability of treatment to prevent mother-to-child transmission. CONCLUSION: Among US women of childbearing age, just over one half had correct knowledge of effective perinatal HIV prevention strategies. Increasing the awareness of these treatments may lead to greater uptake of HIV testing among pregnant women.

Adolescent↗
PubMed2004

Determinants of HIV antibody testing among selected groups of Chinese residents in Hong Kong.

HIV testing is promoted to the public as a tool for HIV prevention in many countries. However, the patterns and determinants of HIV antibody testing among the Chinese people are unknown. To describe the prevalence and determinants of HIV antibody testing amongst the Hong Kong Chinese a cross-sectional anonymous survey was carried out among 1,027 subjects from different population groups (airport travellers, business sector workers, service sector workers, university staff, and STD clinic attendees). Subjects were categorized into either 'STD population' (respondents from STD clinics) versus 'all others' (respondents from other settings) groups. Forty-five percent of the respondents reported ever having had a test for HIV antibody. 'STD population' group members were almost three times more likely to have had an HIV test than were 'all others' group members (77% vs 20%). After adjustments, 'STD population' group members who reported having tested for HIV were more often aged 45 years or older, alcohol drinkers, with high self-efficacy scores, and inconsistent condom users; members in the 'all others' group, more often had had sex with strangers, drank alcohol, and favoured having multiple sex partners. Awareness among the public about the risk behaviours for HIV should be enhanced and efforts should be made to reduce high-risk behaviours among those tested by emphasizing the importance of maintaining safer sex behaviour and having follow-up tests during post-test counselling.

Adult↗
PubMed2003

Pregnancy-related substance use in the United States during 1996-1998.

OBJECTIVE: To provide a baseline estimate of the national prevalence of pregnancy-related illicit drug use and abstinence rates. METHODS: We analyzed data collected between 1996 and 1998 from the National Household Survey on Drug Abuse, a nationally representative sample survey of 22,303 noninstitutionalized women aged 18-44 years, of whom 1,249 were pregnant. RESULTS: During 1996-1998, 6.4% of nonpregnant women of childbearing age and 2.8% of pregnant women reported that they used illicit drugs. Of the women who used drugs, the relative proportion of women who abstained from illicit drugs after recognition of pregnancy increased from 28% during the first trimester of pregnancy to 93% by the third trimester. However, because of postpregnancy relapse, the net pregnancy-related reduction in illicit drug use at postpartum was only 24%. Marijuana accounted for three-fourths of illicit drug use, and cocaine accounted for one-tenth of illicit drug use. Of those who used illicit drugs, over half of pregnant and two-thirds of nonpregnant women also used cigarettes and alcohol. Among the sociodemographic subgroups, pregnant and nonpregnant women who were young (18-30 years) or unmarried, and pregnant women with less than high school education had the highest rates of illicit drug use. CONCLUSION: The continued burden of illicit drug use during pregnancy calls for policy efforts to enable primary care providers to identify and refer women who use substances to treatment and support services. Prevention of uptake of illicit drug use should be an integral part of public health programs for young women.

Adolescent↗