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1دورية أكاديمية
المؤلفون: Sarah Huber-Krum, Duygu Karadon, Sebahat Kurutas, Julia Rohr, Simay Sevval Baykal, Bahar Ayca Okcuoglu, Yilmaz Esmer, David Canning, Iqbal Shah
المصدر: Women's Health, Vol 16 (2020)
مصطلحات موضوعية: Medicine
الوصف: Objectives: Abortions are difficult to measure; yet, accurate estimates are critical in developing health programs. We implemented and tested the validity of a list experiment of lifetime abortion prevalence in Istanbul, Turkey. We complemented our findings by understanding community perspectives using in-depth interviews with key informants. Methods: We conducted a household survey between March and June 2018. In a random sample of 4040 married women aged 16–44 years, we implemented a double list experiment. We averaged difference in mean values calculations between the average counts for each list to provide an estimated lifetime abortion prevalence. We conducted in-depth interviews with 16 key informants to provide insights into possible explanations for the quantitative results. Results: The abortion prevalence estimate from the list experiment was close to that of the direct question (3.25% vs 2.97%). Key informant narratives suggest that differing definitions of abortion, inaccessibility, provider bias, lack of knowledge of abortion laws and safety, and religious norms could contribute to under-reporting. Results from the qualitative study suggest that abortion is largely inaccessible and highly stigmatized. Conclusion: Measuring experiences of abortion is critical to understanding women’s needs and informing harm-reduction strategies; however, in highly stigmatized settings, researchers may face unique challenges in obtaining accurate reports.
وصف الملف: electronic resource
العلاقة: https://doaj.org/toc/1745-5065Test
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2دورية أكاديمية
المؤلفون: Thomas A. Gaziano, Shafika Abrahams-Gessel, F. Xavier Gomez-Olive, Alisha Wade, Nigel J. Crowther, Sartaj Alam, Jennifer Manne-Goehler, Chodziwadziwa W Kabudula, Ryan Wagner, Julia Rohr, Livia Montana, Kathleen Kahn, Till W. Bärnighausen, Lisa F. Berkman, Stephen Tollman
المصدر: BMC Public Health, Vol 17, Iss 1, Pp 1-10 (2017)
مصطلحات موضوعية: Cardiovascular, Cardiometabolic, HIV, Aging, Antiretrovirals, Hypertension, Public aspects of medicine, RA1-1270
الوصف: Abstract Background A consequence of the widespread uptake of anti-retroviral therapy (ART) is that the older South African population will experience an increase in life expectancy, increasing their risk for cardiometabolic diseases (CMD), and its risk factors. The long-term interactions between HIV infection, treatment, and CMD remain to be elucidated in the African population. The HAALSI cohort was established to investigate the impact of these interactions on CMD morbidity and mortality among middle-aged and older adults. Methods We recruited randomly selected adults aged 40 or older residing in the rural Agincourt sub-district in Mpumalanga Province. In-person interviews were conducted to collect baseline household and socioeconomic data, self-reported health, anthropometric measures, blood pressure, high-sensitivity C-reactive protein (hsCRP), HbA1c, HIV-status, and point-of-care glucose and lipid levels. Results Five thousand fifty nine persons (46.4% male) were enrolled with a mean age of 61.7 ± 13.06 years. Waist-to-hip ratio was high for men and women (0.92 ± 0.08 vs. 0.89 ± 0.08), with 70% of women and 44% of men being overweight or obese. Blood pressure was similar for men and women with a combined hypertension prevalence of 58.4% and statistically significant increases were observed with increasing age. High total cholesterol prevalence in women was twice that observed for men (8.5 vs. 4.1%). The prevalence of self-reported CMD conditions was higher among women, except for myocardial infarction, and women had a statistically significantly higher prevalence of angina (10.82 vs. 6.97%) using Rose Criteria. The HIV− persons were significantly more likely to have hypertension, diabetes, or be overweight or obese than HIV+ persons. Approximately 56% of the cohort had at least 2 measured or self-reported clinical co-morbidities, with HIV+ persons having a consistently lower prevalence of co-morbidities compared to those without HIV. Absolute 10-year risk cardiovascular risk scores ranged from 7.7–9.7% for women and from 12.5–15.3% for men, depending on the risk score equations used. Conclusions This cohort has high CMD risk based on both traditional risk factors and novel markers like hsCRP. Longitudinal follow-up of the cohort will allow us to determine the long-term impact of increased lifespan in a population with both high HIV infection and CMD risk.
وصف الملف: electronic resource
العلاقة: http://link.springer.com/article/10.1186/s12889-017-4117-yTest; https://doaj.org/toc/1471-2458Test
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3دورية أكاديمية
المؤلفون: Sydney Rosen, Mhairi Maskew, Matthew P Fox, Cynthia Nyoni, Constance Mongwenyana, Given Malete, Ian Sanne, Dorah Bokaba, Celeste Sauls, Julia Rohr, Lawrence Long
المصدر: PLoS Medicine, Vol 13, Iss 6, p e1002050 (2016)
مصطلحات موضوعية: Medicine
الوصف: [This corrects the article DOI: 10.1371/journal.pmed.1002015.].
وصف الملف: electronic resource
العلاقة: http://europepmc.org/articles/PMC4892484?pdf=renderTest; https://doaj.org/toc/1549-1277Test; https://doaj.org/toc/1549-1676Test
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4دورية أكاديمية
المؤلفون: Sydney Rosen, Mhairi Maskew, Matthew P Fox, Cynthia Nyoni, Constance Mongwenyana, Given Malete, Ian Sanne, Dorah Bokaba, Celeste Sauls, Julia Rohr, Lawrence Long
المصدر: PLoS Medicine, Vol 13, Iss 5, p e1002015 (2016)
مصطلحات موضوعية: Medicine
الوصف: BackgroundHigh rates of patient attrition from care between HIV testing and antiretroviral therapy (ART) initiation have been documented in sub-Saharan Africa, contributing to persistently low CD4 cell counts at treatment initiation. One reason for this is that starting ART in many countries is a lengthy and burdensome process, imposing long waits and multiple clinic visits on patients. We estimated the effect on uptake of ART and viral suppression of an accelerated initiation algorithm that allowed treatment-eligible patients to be dispensed their first supply of antiretroviral medications on the day of their first HIV-related clinic visit.Methods and findingsRapIT (Rapid Initiation of Treatment) was an unblinded randomized controlled trial of single-visit ART initiation in two public sector clinics in South Africa, a primary health clinic (PHC) and a hospital-based HIV clinic. Adult (≥18 y old), non-pregnant patients receiving a positive HIV test or first treatment-eligible CD4 count were randomized to standard or rapid initiation. Patients in the rapid-initiation arm of the study ("rapid arm") received a point-of-care (POC) CD4 count if needed; those who were ART-eligible received a POC tuberculosis (TB) test if symptomatic, POC blood tests, physical exam, education, counseling, and antiretroviral (ARV) dispensing. Patients in the standard-initiation arm of the study ("standard arm") followed standard clinic procedures (three to five additional clinic visits over 2-4 wk prior to ARV dispensing). Follow up was by record review only. The primary outcome was viral suppression, defined as initiated, retained in care, and suppressed (≤400 copies/ml) within 10 mo of study enrollment. Secondary outcomes included initiation of ART ≤90 d of study enrollment, retention in care, time to ART initiation, patient-level predictors of primary outcomes, prevalence of TB symptoms, and the feasibility and acceptability of the intervention. A survival analysis was conducted comparing attrition from care after ART initiation between the groups among those who initiated within 90 d. Three hundred and seventy-seven patients were enrolled in the study between May 8, 2013 and August 29, 2014 (median CD4 count 210 cells/mm3). In the rapid arm, 119/187 patients (64%) initiated treatment and were virally suppressed at 10 mo, compared to 96/190 (51%) in the standard arm (relative risk [RR] 1.26 [1.05-1.50]). In the rapid arm 182/187 (97%) initiated ART ≤90 d, compared to 136/190 (72%) in the standard arm (RR 1.36, 95% confidence interval [CI], 1.24-1.49). Among 318 patients who did initiate ART within 90 d, the hazard of attrition within the first 10 mo did not differ between the treatment arms (hazard ratio [HR] 1.06; 95% CI 0.61-1.84). The study was limited by the small number of sites and small sample size, and the generalizability of the results to other settings and to non-research conditions is uncertain.ConclusionsOffering single-visit ART initiation to adult patients in South Africa increased uptake of ART by 36% and viral suppression by 26%. This intervention should be considered for adoption in the public sector in Africa.Trial registrationClinicalTrials.gov NCT01710397, and South African National Clinical Trials Register DOH-27-0213-4177.
وصف الملف: electronic resource
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5دورية أكاديمية
المؤلفون: Christopher J Gill, Bao Le Ngoc, Nafisa Halim, Ha Nguyen Viet, Anna Larson Williams, Tan Nguyen Van, Marion McNabb, Lien Tran Thi Ngoc, Ariel Falconer, Hai An Phan Ha, Julia Rohr, Hai Hoang, James Michiel, Tam Nguyen Thi Thanh, Liat Bird, Hoang Pham Vu, Mahlet Yeshitla, Nhu Ha Van, Lora Sabin
المصدر: PLoS ONE, Vol 11, Iss 11, p e0166293 (2016)
الوصف: Community health workers (CHWs) provide critical services to underserved populations in low and middle-income countries, but maintaining CHW's clinical knowledge through formal continuing medical education (CME) activities is challenging and rarely occurs. We tested whether a Short Message Service (SMS)-based mobile CME (mCME) intervention could improve medical knowledge among a cadre of Vietnamese CHWs (Community Based Physician's Assistants-CBPAs) who are the leading providers of primary medical care for rural underserved populations.The mCME Project was a three arm randomized controlled trial. Group 1 served as controls while Groups 2 and 3 experienced two models of the mCME intervention. Group 2 (passive model) participants received a daily SMS bullet point, and were required to reply to the text to acknowledge receipt; Group 3 (interactive model) participants received an SMS in multiple choice question format addressing the same thematic area as Group 2, entering an answer (A, B, C or D) in their response. The server provided feedback immediately informing the participant whether the answer was correct. Effectiveness was based on standardized examination scores measured at baseline and endline (six months later). Secondary outcomes included job satisfaction and self-efficacy.638 CBPAs were enrolled, randomized, and tested at baseline, with 592 returning at endline (93.7%). Baseline scores were similar across all three groups. Over the next six months, participation of Groups 2 and 3 remained high; they responded to >75% of messages. Group 3 participants answered 43% of the daily SMS questions correctly, but their performance did not improve over time. At endline, the CBPAs reported high satisfaction with the mCME intervention, and deemed the SMS messages highly relevant. However, endline exam scores did not increase over baseline, and did not differ between the three groups. Job satisfaction and self-efficacy scores also did not improve. Average times spent on self-study per week did not increase, and the kinds of knowledge resources used by the CBPAs did not differ between the three groups; textbooks, while widely available, were seldom used.The SMS-based mCME intervention, while feasible and acceptable, did not result in increased medical knowledge. We hypothesize that this was because the intervention failed to stimulate lateral learning. For an intervention of this kind to be effective, it will be essential to find more effective ways to couple SMS as a stimulus to promote increased self-study behaviors.ClinicalTrials.gov NCT02381743.
وصف الملف: electronic resource
العلاقة: http://europepmc.org/articles/PMC5115715?pdf=renderTest; https://doaj.org/toc/1932-6203Test
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المؤلفون: Hae-Young Kim, Julia Rohr, Germana Henry Leyna, Japhet Killewo, Andrew Tomita, Frank Tanser, Till Bärnighausen
المصدر: Annals of Epidemiology.
مصطلحات موضوعية: Epidemiology
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::6635a6bdd8305c1c4abf20a08ccabf31Test
https://doi.org/10.1016/j.annepidem.2023.05.001Test -
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المؤلفون: Julia Rohr, Iqbal Shah, Yilmaz Esmer, Duygu Karadon, Simay Sevval Baykal, David Canning, Sebahat Kurutas, Bahar Ayca Okcuoglu, Sarah Huber-Krum
المصدر: The European Journal of Contraception & Reproductive Health Care. 26:479-485
مصطلحات موضوعية: Turkey, Turkish, media_common.quotation_subject, Ethnic group, Logistic regression, Contraceptive Agents, Ethnicity, Humans, Medicine, Pharmacology (medical), Contraception Behavior, Neighbourhood (mathematics), Minority Groups, media_common, business.industry, Obstetrics and Gynecology, Health equity, Confidence interval, language.human_language, Contraception, Cross-Sectional Studies, Reproductive Medicine, Relative risk, language, Female, business, Demography, Diversity (politics)
الوصف: OBJECTIVE The primary aim of the study was to examine the relationship between self-reported ethnic identity, region of birth and contraceptive use, in Istanbul, Turkey. METHODS Cross-sectional data from a random sample of 3038 married women of reproductive age living in two urban districts of Istanbul were used in a series of logistic regression models to assess key relationships. RESULTS Kurdish ethnic minority women were less likely than Turkish ethnic majority women to use traditional contraceptive methods over no method (relative risk ratio [RRR] 0.69; 95% confidence interval [CI] 0.50, 0.96). However, there were no significant differences between ethnicities (i.e., Turkish, Kurdish and other) and modern method use. Among Turkish women, those born in regions farther away from the western region were more likely to use traditional methods (RRRnorthern 2.06; 95% CI 1.31, 3.22). CONCLUSION While Kurdish ethnic minority women were less likely to use traditional methods, compared with Turkish ethnic majority women, the difference might have been due to the length of time living in a neighbourhood. Regional variations in contraceptive use were concentrated only among Turkish ethnic majority women and for traditional methods. Regional norms of traditional method use may be a barrier to modern contraceptive use in Turkey.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::6edd7909290aabf2568743eb3a94da4aTest
https://doi.org/10.1080/13625187.2021.1964466Test -
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المؤلفون: Chodziwadziwa W. Kabudula, Molly Rosenberg, Julia Rohr, Enid Schatz, Kathleen Kahn, Nicole Angotti, Brian Houle, F. Xavier Gómez-Olivé, Sanyu A. Mojola, Jane Menken, Samuel J. Clark, Till Bärnighausen
المصدر: Journal of Acquired Immune Deficiency Syndromes (1999)
مصطلحات موضوعية: Adult, Male, Rural Population, Epidemiology, HIV Infections, Logistic regression, South Africa, symbols.namesake, sexual behavior, Risk Factors, Prevalence, Humans, Medicine, Pharmacology (medical), Poisson regression, Seroconversion, Aged, Aged, 80 and over, business.industry, Transmission (medicine), Incidence, Hiv incidence, HIV, Middle Aged, older population, Confidence interval, Infectious Diseases, Sexual behavior, Cohort, symbols, Female, business, Demography
الوصف: Introduction: In South Africa, evidence shows high HIV prevalence in older populations, with sexual behavior consistent with high HIV acquisition and transmission risk. However, there is a dearth of evidence on older people's HIV incidence. Methods: We used a 2010–2011 cohort of HIV-negative adults in rural South Africa who were 40 years or older at retest in 2015–2016 to estimate HIV incidence over a 5-year period. We used Poisson regression to measure the association of HIV seroconversion with demographic and behavioral covariates. We used inverse probability sampling weights to adjust for nonresponse in 2015, based on a logistic regression with predictors of sex and age group at August 2010. Results: HIV prevalence increased from 21% at baseline to 23% in the follow-up survey. From a cohort of 1360 individuals, 33 seroconverted from HIV negative at baseline, giving an overall HIV incidence rate of 0.39 per 100 person-years [95% confidence interval (CI): 0.28 to 0.57]. The rate for women was 0.44 (95% CI: 0.30 to 0.67), double than that for men, 0.21 (95% CI: 0.10 to 0.51). Incidence rate ratios (IRRs) again show women's risk of seroconverting double than that of men (IRR = 2.04, P value = 0.098). In past age 60, the IRR of seroconversion was significantly lower than that for those in their 40s (60–69, IRR = 0.09, P value = 0.002; 70–79, IRR = 0.14, P value = 0.010). Conclusions: The risk of acquiring HIV is not zero for people older than 50 years, especially women. Our findings highlight the importance of acknowledging that older people are at high risk of HIV infection and that HIV prevention and treatment campaigns must take them into consideration.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::c866595423bdacad081ec58aee4f7e51Test
https://doi.org/10.1097/qai.0000000000002404Test -
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المؤلفون: Saugat Joshi, David Canning, Iqbal Shah, Mahesh Puri, Julia Rohr, Sarah Huber-Krum, Aayush Khadka, Dev Maharjan, Elina Pradhan
المصدر: Contraception. 101:384-392
مصطلحات موضوعية: Adult, Counseling, Postnatal Care, medicine.medical_specialty, Health Personnel, Prenatal care, Intrauterine device, Contraceptive counseling, law.invention, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Nepal, Randomized controlled trial, Pregnancy, law, Humans, Medicine, Maternal Health Services, 030212 general & internal medicine, 030219 obstetrics & reproductive medicine, business.industry, Obstetrics, Postpartum Period, Obstetrics and Gynecology, Contraception, Contraceptive use, Reproductive Medicine, Sterilization (medicine), Family planning, Family Planning Services, Female, business, Postpartum period, Intrauterine Devices
الوصف: Objective There is high unmet need for family planning in the postpartum period in Nepal. The current study assessed the effects of a contraceptive counseling and postpartum intrauterine device (PPIUD) insertion intervention on use of contraception in the postpartum period. Study design We utilized a cluster, stepped-wedge design to randomly assign two hospital clusters (compromised of six hospitals) to begin the intervention at time one or time two. From 2015 to 2017, women completed surveys after delivery but before discharge (n = 75,893), and then at one year and two years postpartum. We estimated the intent-to-treat effect of the intervention using weighted, linear probability models and the adherence-adjusted effect (antenatal counseling) using an instrumental variable approach. Outcomes included modern contraceptive use and method mix measured at one and two years postpartum in a sample of 19,298 women (year I follow-up sample) and a sample of 19,248 women (year II follow-up sample). We used inverse probability weights to adjust for incomplete follow-up and bootstrap methods to give correct causal inference with the small number of six clusters. Results The intervention increased use of modern contraceptives by 3.8 percentage points [95% CI: −0.1, 9.5] at one-year postpartum, but only 0.3 percentage points [95% CI: −3.7, 4.1] at two years. The intervention significantly increased the use of PPIUDs at one year and two years postpartum, but there was less use of sterilization. Only 42% of women were counseled during the intervention period. The adherence-adjusted effects (antenatal counseling) were four times larger than the intent-to-treat effects. Conclusions Providing counseling during the antenatal period and PPIUD services in hospitals increased use of PPIUDs in the one- and two-year postpartum period and shifted the contraceptive method mix. Implications In order for antenatal counseling to increase postpartum contraceptive use, counseling may need to be provided in a wider range of prenatal care settings and at multiple time points. Healthcare providers should be trained on contraceptive counseling and PPIUD insertion, with the goal of expanding the available method mix and meeting postpartum women’s contraceptive needs.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9e499688ba808e30238a6193b95557cbTest
https://doi.org/10.1016/j.contraception.2019.12.014Test -
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المؤلفون: Yilmaz Esmer, Bahar Ayca Okcuoglu, Duygu Karadon, David Canning, Ryoko Sato, Iqbal Shah, Julia Rohr, Sarah Huber-Krum
المصدر: The European journal of contraceptionreproductive health care : the official journal of the European Society of Contraception. 26(5)
مصطلحات موضوعية: Adult, medicine.medical_specialty, Adolescent, Turkey, Turkish, Health Services Accessibility, Unmet needs, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Contraceptive Agents, medicine, Humans, Pharmacology (medical), 030212 general & internal medicine, Contraception Behavior, 030219 obstetrics & reproductive medicine, business.industry, Obstetrics and Gynecology, language.human_language, Contraceptive use, Contraception, Reproductive Medicine, Family medicine, Family Planning Services, language, Female, Health Facilities, business, Facilities and Services Utilization
الوصف: Worldwide unmet need for contraception remains high at 21.6%. As access to health facilities is one of the potential barriers to contraceptive uptake, the aim of our study was to evaluate the effect of distance to a health facility, according to its service availability, on contraceptive uptake among married Turkish women.To calculate respondents' distance to a health facility, we used data from a household survey conducted among married women, as well as data from a health facility survey conducted among the facilities that were visited for contraceptive services by the respondents. The data were collected from the Istanbul area of Turkey under the Willows Impact Evaluation project in 2018. Health facilities were categorised according to contraceptive availability and the accurate distance from respondents' homes to each type of health facility was calculated. Logistic regression was used to estimate the effect of distance to each type of health facility on uptake of each type of contraception.The prevalence of overall contraceptive use among urban Turkish women was 71.9%. The most common method was withdrawal (32.5%), followed by the intrauterine device (IUD) (14.9%) and male condoms (12.4%). Distance to a health facility that did not provide long-acting contraception was not associated with any type of contraceptive use. On the other hand, distance to a health facility that provided long-acting contraception was negatively associated with the use of long-acting methods such as the IUD but was positively associated with the use of short-acting contraception such as condoms.The effect of distance to a health facility on contraceptive use significantly differed according to contraceptive availability at the facility. Further distance to a health facility that provided long-acting contraception decreased the use of long-acting contraception but had a substitute effect on the use of short-acting contraception. We conclude that when women face an accessibility barrier to the provision of long-acting contraception, they modify their behaviour by shifting from long- to short-acting contraception, which is less effective.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::1076b7abbc70436e9f717afd833469c2Test
https://pubmed.ncbi.nlm.nih.gov/33874821Test
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