517 research outputs found
Family planning methods and fertility preferences according to HIV status among women in Cameroon
We investigated whether HIV-positive women differ from HIV-negative women in their fertility, fertility intentions, and use of family planning (FP) among 16,202 women who received services through the Cameroon Baptist Convention Health Services’ Women’s Health Program from 2015 to 2017. The 13% of women who were HIV-positive had similar rates of modern FP usage and unmet need compared to HIV-negative women (26% versus 29% for modern FP usage, and 20% versus 21% for unmet need). However, HIV-positive women were more likely to be satisfied with their FP method (aOR = 1.70, p < .001). There were no significant differences in usage by HIV status for most FP methods, but HIV-positive women were more likely to use condoms (aOR = 1.85, p < .01) and less likely to use IUDs (aOR = 0.77, p < .05). HIV-positive women had fewer living children and also desired fewer children (both associations significant at p < .001 in multivariate linear regression). These findings highlight low FP usage and high unmet need among all women, and the need for integrated HIV and FP services for HIV-positive women, particularly aimed at increasing use of more reliable FP methods in addition to condoms. (Afr J Reprod Health 2021; 25[5]: 25-36)
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Knowledge and Awareness of HPV Vaccine and Acceptability to Vaccinate in Sub-Saharan Africa: A Systematic Review
Objectives: We assessed the knowledge and awareness of cervical cancer, HPV and HPV vaccine, and willingness and acceptability to vaccinate in sub-Saharan African (SSA) countries. We further identified countries that fulfill the two GAVI Alliance eligibility criteria to support nationwide HPV vaccination. Methods: We conducted a systematic review of peer-reviewed studies on the knowledge and awareness of cervical cancer, HPV and HPV vaccine, and willingness and acceptability to vaccinate. Trends in Diphtheria-tetanus-pertussis (DTP3) vaccine coverage in SSA countries from 1990–2011 were extracted from the World Health Organization database. Findings: The review revealed high levels of willingness and acceptability of HPV vaccine but low levels of knowledge and awareness of cervical cancer, HPV or HPV vaccine. We identified only six countries to have met the two GAVI Alliance requirements for supporting introduction of HPV vaccine: 1) the ability to deliver multi-dose vaccines for no less than 50% of the target vaccination cohort in an average size district, and 2) achieving over 70% coverage of DTP3 vaccine nationally. From 2008 through 2011 all SSA countries, with the exception of Mauritania and Nigeria, have reached or maintained DTP3 coverage at 70% or above. Conclusion: There is an urgent need for more education to inform the public about HPV, HPV vaccine, and cervical cancer, particularly to key demographics, (adolescents, parents and healthcare professionals), to leverage high levels of willingness and acceptability of HPV vaccine towards successful implementation of HPV vaccination programs. There is unpreparedness in most SSA countries to roll out national HPV vaccination as per the GAVI Alliance eligibility criteria for supporting introduction of the vaccine. In countries that have met 70% DTP3 coverage, pilot programs need to be rolled out to identify the best practice and strategies for delivering HPV vaccines to adolescents and also to qualify for GAVI Alliance support
Tobacco Use and Cardiovascular Disease among American Indians: The Strong Heart Study
Tobacco use among American Indians has a long and complicated history ranging from its utilization in spiritual ceremonies to its importance as an economic factor for survival. Despite this cultural tradition and long history, there are few studies of the health effects of tobacco in this population. The Strong Heart Study is a prospective observational study of cardiovascular disease (CVD) in 13 American Indian tribes in Arizona, Oklahoma, and North and South Dakota with 4,549 participants. Baseline examinations were followed by two examinations at regular intervals and 16 years of morbidity and mortality follow-up. Hazard ratios (HRs) for non-fatal CVD for current smokers vs. non-smokers after adjusting for other risk factors were significant in women (HR = 1.94, 95% CI 1.54 to 2.45) and men (HR = 1.59, 95% CI 1.16 to 2.18). Hazard ratios for fatal CVD for current smokers vs. non-smokers after adjusting for other risk factors were significant in women (HR = 1.64, 95% CI 1.04 to 2.58), but not in men. Individuals who smoked and who were diagnosed with diabetes mellitus, hypertension or renal insufficiency were more likely to quit smoking than those without these conditions. On average, American Indians smoke fewer cigarettes per day than other racial/ethnic groups; nevertheless, the ill effects of habitual tobacco use are evident in this population
Risk Factors for Arterial Hypertension in Adults With Initial Optimal Blood Pressure
Whether metabolic factors and their change over time influence development of arterial hypertension in adults with initially optimal blood pressure (BP) is unknown. We analyzed associations of BP in the optimal range (<120/80 mm Hg), metabolic risk factors, and their changes over 4-year follow-up, with 8-year incident hypertension, in a cohort of American Indians with a high prevalence of obesity. At baseline, 967 participants with optimal BP and no prevalent cardiovascular disease (69.5% women; mean age, 54±7 years) were evaluated and reexamined after 4 (second examination) and 8 years to evaluate predictors of 8-year incident arterial hypertension. In participants with normal glucose tolerance, baseline BP and decrease in high-density lipoprotein cholesterol from baseline to the second examination were the most potent predictors of 8-year arterial hypertension (both
P
<0.0001), with additional effects of baseline waist circumference and its increase, increase in BP, and presence of diabetes at the second examination (all
P
<0.04). In participants with impaired glucose tolerance or diabetes, the most potent predictor of 8-year incident hypertension was diabetes at the second examination (
P
<0.0001) followed by a increase in BP and LDL cholesterol over the first 4 years (both
P
<0.001). Thus, incident arterial hypertension can be predicted by initial metabolic profile and unfavorable metabolic variations over time, in addition to initial BP. At optimal levels of initial BP, increasing abdominal obesity, and abnormal lipid profile are major predictors of development of arterial hypertension. Possible implications of these findings for primary cardiovascular prevention should be tested in prospective studies
Using HbA1c to improve efficacy of the American Diabetes Association fasting plasma glucose criterion in screening for new type 2 diabetes in American Indians. The Strong Heart Study
WSTĘP. Celem badania jest określenie optymalnej krytycznej linii
FPG-HbA1c, umożliwiającej rozpoznanie cukrzycy w grupie chorych z nieprawidłowym
stężeniem glukozy na czczo (IFG, impaired fasting glucose) i poprawa
skuteczności oznaczenia glikemii na czczo (FPG, fasting plasma glucose),
stosowanego jako samodzielne badanie przesiewowe w kierunku cukrzycy u Indian
amerykańskich.
MATERIAŁ I METODY. Analizowano oznaczenia stężenia glukozy na
czczo i 2 godziny po doustnym obciążeniu glukozą (2hPG) oraz HbA1c
w grupie 2389 Indian amerykańskich w wieku 45-74 lat, którzy dotychczas nie byli
leczeni z powodu cukrzycy, u których wcześniej nie rozpoznawano cukrzycy, a których poddano wyjściowej i powtórnej ocenie w ramach badania SHS (Strong
Heart Study). Zgodnie z kryteriami American Diabetes Association
cukrzycę rozpoznawano, gdy stężenie glukozy na czczo było równe lub wyższe niż
126 mg/dl lub gdy wartość 2hPG wynosiła 200 mg/dl lub więcej. Nieprawidłowe stężenie
glukozy na czczo rozpoznawano, gdy mieściło się ono w przedziale 110 Ł
FPG < 126 mg/dl, a jako wartość prawidłową (NFG, normal fasting glucose)
przyjęto stężenie glukozy na czczo niższe niż 110 mg/dl. Do rozpoznawania cukrzycy
w grupie badanych z IFG (2hPG ł 200 mg/dl) zastosowano
modele regresji logistycznej. Najlepszy model wybrano na podstawie porównania
pól pod krzywymi ROC (receiver operating characteristic) utworzonymi
w oparciu o różne modele regresji logistycznej. Do wyznaczenia optymalnych wartości
krytycznych użyto funkcji przydatności opartej na najlepszym modelu oraz współczynniku
koszt/korzyść. Dane z drugiego badania wykorzystano do oceny wpływu czasu, jaki
upłynął pomiędzy dwoma kolejnymi badaniami przesiewowymi, zarówno na kryterium
FPG, jak i na optymalną krytyczną linię FPG-HbA1c.
WYNIKI. W grupie chorych z nowo rozpoznaną cukrzycą, u 37% w
badaniu wyjściowym oraz u 55,2% w badaniu powtórnym stwierdzono wartości 2hPG
większe bądź równe 200 mg/dl, przy wartościach FPG mniejszych niż 126 mg/dl. Zarówno
w wyjściowym, jak i w drugim oznaczeniu u znacznej części pacjentów z IFG rozpoznano
cukrzycę (odpowiednio: 19,3 i 22,9%). Porównanie pól pod krzywymi ROC dla poszczególnych
modeli regresji logistycznej wykazało, że największa wartość pola odpowiada łącznemu
oznaczeniu FPG i HbA1c. Wartość ta była znamiennie wyższa od wartości
pola dla oznaczenia FPG (p = 0,0008). Dla współczynnika koszt/korzyść = 0,23888
optymalna linia krytyczna o największej użyteczności miała wartość równą 0,89 × HbA1c + 0,11 × FPG = 17,92. U chorych, u których wartości FPG i HbA1c
znajdowały się na tej linii lub powyżej, zalecano wykonanie doustnego testu tolerancji
glukozy (OGTT, oral glucose tolerance test) w celu rozpoznania lub wykluczenia
cukrzycy. Optymalne wartości krytyczne w badaniu powtórzonym po 4 latach były
mniejsze.
WNIOSKI. Według kryteriów American Diabetes Association cukrzycę
rozpoznaje się, gdy wartość FPG jest większa lub równa 126 mg/dl albo gdy wartość
2hPG wynosi 200 mg/dl lub więcej. Wykonanie badania FPG jest proste i zaleca się
je jako badanie przesiewowe. Natomiast stosowanie w praktyce OGTT w celu uzyskania
wartości 2hPG jest kłopotliwe, szczególnie u chorych, u których stwierdza się
wartość FPG poniżej 126 mg/dl. Wykonywanie OGTT jako badania przesiewowego u każdego
pacjenta również jest niepraktyczne. Uzyskane dane wskazują, że u 37% osób z nowo
wykrytą cukrzycą w badaniu wyjściowym i u 55,2% w oznaczeniu drugim stężenie glukozy
w OGTT wynosiło 200 mg/dl lub więcej, podczas gdy wartość FPG była niższa niż
126 mg/dl. W takich wypadkach, na podstawie oznaczenia wyłącznie FPG jako badania
przesiewowego, cukrzyca nie zostałaby rozpoznana. Mimo że odsetek chorych na cukrzycę
w grupie NFG jest mały i może zostać zignorowany (4,7% w pierwszym i 6,5% w drugim
oznaczeniu), to częstość przypadków cukrzycy stwierdzonych w grupie IFG w trakcie
niniejszego badania (ok. 20%) wymaga uwzględnienia w dyskusji na temat metody
badań przesiewowych. Wydaje się, że u części chorych z nieprawidłowym stężeniem
glukozy na czczo, wybranych na podstawie optymalnych krytycznych wartości FPG-HbA1c,
warto wykonać OGTT. Wyznaczenie optymalnej linii krytycznej i odstępu między kolejnymi
testami przesiewowymi wymaga dalszych badań.INTRODUCTION. To find an optimal critical line in the
fasting plasma glucose (FPG)-HbA1c plane for identifying
diabetes in participants with impaired fasting
glucose (IFG) and thereby improve the efficacy of
using FPG alone in diabetes screening among American
Indians.
RESEARCH DESIGN AND METHODS. We used FPG, 2-h
postload glucose (2hPG), and HbA1c measured in the
2,389 American Indians (aged 45–74 years, without
diabetes treatment or prior history of diabetes) in
the Strong Heart Study (SHS) baseline (second) examination.
Participants were classified as having diabetes
if they had either FPG £ 126 mg/dl or 2hPG
≥ 200 mg/dl, as having IFG if they had 110 £ FPG
< 126 mg/dl, and as having normal fasting glucose
(NFG) if they had FPG < 110, according to the American
Diabetes Association (ADA) definition. Logistic
regression models were used for identifying diabetes
(2hPG ≥ 200 mg/dl) in IFG participants. The areas
under the receiver operating characteristic (ROC) curves
generated by different logistic regression models
were evaluated and compared to select the best
model. A utility function based on the best model
and the cost-to-benefit ratio was used to find the
optimal critical line. The data from the second examination
were used to study the effect of the time
interval between the successive diabetes screenings
on both the FPG criterion and the optimal critical line.
RESULTS. A total of 37% of all subjects with new
diabetes at baseline and 55.2% of those in the second
exam had 2hPG ≥ 200 but FPG < 126. There
was a very large portion of IFG participants with diabetes
(19.3 and 22.9% in the baseline and second
exam, respectively). Among the areas under the ROC
curves, the area generated by the logistic regression
model on FPG plus HbA1c is the largest and is
significantly larger than that based on FPG (P =
= 0.0008). For a cost-to-benefit ratio of 0.23888, the
optimal critical line that has the highest utility is:
0.89 × HbA1c + 0.11 × FPG = 17.92. Those IFG participants
whose FPG and HbA1c were above or on the
line were referred to take an oral glucose tolerance
test (OGTT) to diagnose diabetes. The optimal critical
line is lower if a successive diabetes screening will be
conducted 4 years after the previous screening.
CONCLUSIONS. FPG ≥ 126 and 2hPG ≥ 200, as suggested
by the ADA, are used in-dependently to define diabetes. The FPG level is easy to obtain, and using
FPG alone is suggested for diabetes screening. It is
difficult to get physicians and patients to perform
an OGTT to get a 2hPG level because of the many
drawbacks of the OGTT, especially in those patients
who already have FPG < 126. It is also impractical
to conduct an OGTT for everyone in a diabetes screening.
Our data show that 37% of all subjects with
new diabetes in the SHS baseline exam and 55.2%
of those in the second exam have 2hPG ≥ 200 but
FPG < 126. These cases of diabetes cannot be detected
if FPG is used alone in a diabetes screening.
Therefore, although the small portion of diabetes in
the NFG group (4.7% in the base-line and 6.9% in
the second exam) may be ignored, those cases of
diabetes among IFG participants (~20% in our data)
need further consideration in a diabetes screening.
It may be worthwhile for those IFG participants identified
by the optimal critical line to take an OGTT.
The optimal critical line and time interval between
successive diabetes screenings need further study
Scale-Up and Case-Finding Effectiveness of an HIV Partner Services Program in Cameroon: An Innovative HIV Prevention Intervention for Developing Countries
Partner services (PSs) are a long-standing component of HIV control programs in the United States and some parts of Europe. Small randomized trials suggest that HIV PS can be effective in identifying persons with undiagnosed HIV infection. However, the scalability and effectiveness of HIV PS in low-income countries are unknown
Health Facility Characteristics and Their Relationship to Coverage of PMTCT of HIV Services across Four African Countries: The PEARL Study
Background: Health facility characteristics associated with effective prevention of mother-to-child transmission of HIV (PMTCT) coverage in sub-Saharan are poorly understood. Methodology/Principal Findings: We conducted surveys in health facilities with active PMTCT services in Cameroon, Cote d’Ivoire, South Africa, and Zambia. Data was compiled via direct observation and exit interviews. We constructed composite scores to describe provision of PMTCT services across seven topical areas: antenatal quality, PMTCT quality, supplies available, patient satisfaction, patient understanding of medication, and infrastructure quality. Pearson correlations and Generalized Estimating Equations (GEE) to account for clustering of facilities within countries were used to evaluate the relationship between the composite scores, total time of visit and select individual variables with PMTCT coverage among women delivering. Between July 2008 and May 2009, we collected data from 32 facilities; 78 % were managed by the government health system. An opt-out approach for HIV testing was used in 100 % of facilities in Zambia, 63 % in Cameroon, and none in Côte d’Ivoire or South Africa. Using Pearson correlations, PMTCT coverage (median of 55%, (IQR: 33–68) was correlated with PMTCT quality score (rho = 0.51; p = 0.003); infrastructure quality score (rho = 0.43; p = 0.017); time spent at clinic (rho = 0.47
Millimeter dust continuum emission unveiling the true mass of giant molecular clouds in the Small Magellanic Cloud
CO observations have been so far the best way to trace molecular gas in
external galaxies, but at low metallicity the gas mass deduced could be largely
underestimated. At present, the kinematic information of CO data cubes are used
to estimate virial masses and trace the total mass of the molecular clouds.
Millimeter dust emission can also be used as a dense gas tracer and could
unveil H2 envelopes lacking CO. These different tracers must be compared in
different environments. This study compares virial masses to masses deduced
from millimeter emission, in two GMC samples: the local molecular clouds in our
Galaxy and their equivalents in the Small Magellanic Cloud (SMC), one of the
nearest low metallicity dwarf galaxy. In our Galaxy, mass estimates deduced
from millimeter emission are consistent with masses deduced from gamma ray
analysis and trace the total mass of the clouds. Virial masses are
systematically larger (twice on average) than mass estimates from millimeter
dust emission. This difference decreases toward high masses and has already
been reported in previous studies. In the SMC however, molecular cloud masses
deduced from SIMBA millimeter observations are systematically higher (twice on
average for conservative values of the dust to gas ratio and dust emissivity)
than the virial masses from SEST CO observations. The observed excess can not
be accounted for by any plausible change of dust properties. Taking a general
form for the virial theorem, we show that a magnetic field strength of ~15
micro Gauss in SMC clouds could provide additional support to the clouds and
explain the difference observed. Masses of SMC molecular clouds have therefore
been underestimated so far. Magnetic pressure may contribute significantly to
their support.Comment: 10 pages, 2 figures, Astronomy & Astrophysics accepte
The Boundary Conditions of the Heliosphere: Photoionization Models Constrained by Interstellar and In Situ Data
The boundary conditions of the heliosphere are set by the ionization, density
and composition of inflowing interstellar matter. Constraining the properties
of the Local Interstellar Cloud (LIC) at the heliosphere requires radiative
transfer ionization models. We model the background interstellar radiation
field using observed stellar FUV and EUV emission and the diffuse soft X-ray
background. We also model the emission from the boundary between the LIC and
the hot Local Bubble (LB) plasma, assuming that the cloud is evaporating
because of thermal conduction. We create a grid of models covering a plausible
range of LIC and LB properties, and use the modeled radiation field as input to
radiative transfer/thermal equilibrium calculations using the Cloudy code. Data
from in situ observations of He^O, pickup ions and anomalous cosmic rays in the
heliosphere, and absorption line measurements towards epsilon CMa were used to
constrain the input parameters. A restricted range of assumed LIC HI column
densities and LB plasma temperatures produce models that match all the
observational constraints. The relative weakness of the constraints on N(HI)
and T_h contrast with the narrow limits predicted for the H^O and electron
density in the LIC at the Sun, n(H^0) = 0.19 - 0.20 cm^-3, and n(e) = 0.07 +/-
0.01 cm^-3. Derived abundances are mostly typical for low density gas, with
sub-solar Mg, Si and Fe, possibly subsolar O and N, and S about solar; however
C is supersolar. The interstellar gas at the Sun is warm, low density, and
partially ionized, with n(H) = 0.23 - 0.27 cm^-3, T = 6300 K, X(H^+) ~ 0.2, and
X(He^+) ~ 0.4. These results appear to be robust since acceptable models are
found for substantially different input radiation fields. Our results favor low
values for the reference solar abundances for the LIC composition.Comment: 14 pages, 4 figures, submitted to Astronomy & Astrophysics together
with papers from the International Space Sciences Institute workshop on
Interstellar Hydrogen in the Heliospher
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