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JSI staff publish their research and results from work in peer-reviewed journals on a regular basis. This section provides a brief abstract with a link to the journal where you can read more and either order or download the article, depending on the journal in question.
December 2009
Expanding uterotonic protection following childbirth through community-based distribution of misoprostol: Operations research study in Nepal, in International Journal of Gynecology & Obstetrics
The article 'Expanding uterotonic protection following childbirth through community-based distribution of misoprostol: Operations research study in Nepal' looks at the feasibility of community-based distribution of misoprostol for preventing postpartum hemorrhage (PPH) to pregnant woman through community volunteers working under government health services. The research was implemented in one district in Nepal.
The research concluded that community-based distribution of misoprostol for PPH prevention can be successfully implemented under government health services in a low-resource, geographically challenging setting, resulting in much increased population-level protection against PPH, with particularly large gains among the disadvantaged. Rajbhandari S, Hodgins S, Sanghvi H, McPherson R, Pradhan Y, Baqui AH.
Read the article in International Journal of Gynecology & Obstetrics
The Impact of the African Youth Alliance Program on the Sexual Behavior of Young People in Uganda in the Studies in Family Planning
The article The Impact of the African Youth Alliance Program
on the Sexual Behavior of Young People in Uganda looks at
the impact of the African Youth Alliance (AYA)
program on the sexual behavior of young people aged 17-22
in Uganda. The importance of protecting the health of young
people and encouraging and promoting safe sexual behaviors
is particularly great in sub-Saharan Africa. About one-third
of the population in sub-Sahara Africa is in the 15-24 age
group, and about half of all new infections occur within
that age group.
Between 2000 and 2005, the comprehensive multicomponent AYA program
implemented behavior-change communication and youth-friendly
clinical services, and it coordinated policy and advocacy.
The program provided institutional capacity building and
established coordination mechanisms between agencies that
implemented programs for young people. Ali Mehryar Karim,
Timothy Williams, Leslie Patykewich, Disha Ali, Charlotte
E. Colvin, Jessica Posner, and Gideon Rutaremwa.
Read the abstract in the Studies in Family Planning
November 2009
Has routine immunization in Africa become endangered? in The Lancet Infectious Diseases, November 2009
Many advances have been made in immunization in Africa in the past decade; there has been a large drop in mortality due to measles and the three-dose regimen of DPT3 provides coverage of at least 80% in all districts. Yet, the coverage goals of the Global Immunization Vision & Strategy remain elusive, and many children continue to be unimmunized. This article from in The Lancet Infectious Diseases looks at this issue in more depth and recommends that Africa needs to accelerate and sustain efforts to improve routine immunization services, with a focus on unimmunized children. The authors maintain that routine immunization is an integral part of all eradication activities, and greater emphasis beyond lip service needs to be placed on strengthening it. Routine immunization should not be considered simply as an end strategy once campaigns have halted transmission. Yermaine Berhane, John C. Clements, Jean Michael Ndiaye, and Patricia Taylor.
Read the article in the The Lancet Infectious Diseases
October 2009
Testing a scalable community-based approach to improve maternal and neonatal health in rural Nepal in the Journal of Perinatology
The aim of the study was to determine the feasibility of improved maternal neonatal care-seeking and household practices using an approach scalable under Nepal's primary health-care services. The intervention consisted primarily of community-based antenatal counseling and dispensing and an early postnatal home visit; most activities were carried out by community-based health volunteers. There were notable improvements in most household practice and service utilization indicators, although results regarding care-seeking for danger signs were mixed.
The study concluded that it is feasible in Nepal to significantly improve utilization of maternal neonatal services and household practices, using the resources available under the government primary health-care system. This has the potential to significantly reduce neonatal mortality. Hodgins S, McPherson R, Suvedi BK, Shrestha RB, Silwal RC, Ban B, Neupane S, Baqui AH.
Read the abstract in the Journal of Perinatology
Using Small-Area Estimation to Describe County-Level Disparities in Mammography in Preventing Chronic Disease Journal
Breast cancer control in the United States is a research area that could benefit
from estimating prevalence at the substate level. Most of
the data available on the use of preventive services, like
mammography, are national and state data, and studies have
identified correlates of cancer screening on these geographic
levels by using national health survey data.
Research is needed on subpopulations defined by geographic
units smaller than the state because findings from the national
or even state level often do not translate to the contextual
experience of women on the county or neighborhood level.
Substate variation in mammography prevalence has been found
for metropolitan statistical areas and counties with adequate
sample size (>= 50). Geographic gaps exist in mammography interventions;
certain areas disproportionately receive funds and outreach.
Women who are not screened may be concentrated in locations
with particular screening barriers.
The purpose of this study, "Using Small-Area Estimation
to Describe County-Level Disparities in Mammography," was
to determine the extent to which geographic disparities exist
in mammography and the extent to which the magnitude and
distribution of geographic disparities vary by race and age.
Karen Schneider, PhD, Kate L. Lapane, PhD, Melissa A Clark,
PhD, and William Rakowski, PhD.
Read the abstract in Preventing Chronic Disease.
September 2009
Implementing an integrated nutrition package at large scale in Madagascar: the Essential Nutrition Actions framework in Food & Nutrition Bulletin
Madagascar has some of the highest rates of child stunting, maternal malnutrition, and infant mortality in sub-Saharan Africa. The implementation of the Essential Nutrition Actions (ENA) framework in Madagascar aimed to improve infant and young child feeding practices, increase uptake of micronutrient supplements, and improve women's dietary practices.
This paper shows that nutritional practices can significantly improve when providing consistent messages through existing health systems. Changes in practices were assessed through a comparison of data for children under 2 from representative cross-sectional household surveys collected at baseline in 2000 and at the end of program implementation in 2005. The surveys were conducted in six districts with a population of 1.4 million.
As detailed in the paper, the implementation of ENA in Madagascar dramatically improved breastfeeding rates, iron-folic acid supplementation during pregnancy and postpartum vitamin A supplementation. Guyon AB, Quinn VJ, Hainsworth M, Ravonimanantsoa P, Ravel Joana V, Rambeloson Z, Martin L
Read the abstract in PubMed (a service of the U.S. National Library of Medicine)
June 2009
Reaching Every District (RED) Approach to Strengthen Routine Immunization Services: Evaluation in the African Region, 2005 in The Journal of Public Health
This evaluation of the RED implementation process provided evidence of improvement and challenges in delivery of routine immunization services. In June 2005, a convenience sample of five countries was selected to evaluate the implementation of RED. Evaluation teams consisting of key partners visited sites at national, district and health facility levels using standardized qualitative questionnaires. The findings showed that RED was implemented in a similar manner in all five countries and that all five RED components were implemented to some degree in the countries. Common implementation factors included development of plans, expanding outreach services (defined as services provided in sites outside of fixed immunization locations), planning of supervisory visits and efforts to link with communities and utilize community volunteers. Monitoring tools such as wall charts and maps were observed and reportedly used. The evaluation concluded that the RED framework should continue to be used to strengthen the immunization delivery system to meet continuing new demands, such as the introduction of new vaccines and integrated delivery of other child survival interventions. T. Ryman, R. Macauley, D. Nshimirimana, P. Taylor, L. Shimp, K. Wilkins.
Read the abstract in The Journal of Public Health
Cultural Theories of Postpartum Bleeding in Matlab, Bangladesh: Implications for Community Health Intervention in the Journal of Health, Population and Nutrition
Early recognition can reduce maternal disability and death due to postpartum hemorrhage. This study identified cultural theories of postpartum bleeding that may lead to inappropriate recognition and delayed care-seeking. Data obtained through interviews with 149 participants living in Matlab, Bangladesh—including women aged 18-49 years, women aged 50+ years, traditional birth attendants (TBAs), and skilled birth attendants (SBAs)—were subjected to cultural domain. General consensus existed among the TBAs and lay women regarding signs, causes, and treatments of postpartum bleeding. Yet, the TBAs and lay women differed significantly from the SBAs in beliefs about normal amount of blood loss, causal role of the retained placenta and malevolent spirits, and care practices critical to survival. Cultural domain analysis captured variation in theories with specificity and representativeness necessary to inform community health intervention. Lynn M. Sibley, Daniel Hruschka, Nahid Kalim, Jasmin Khan, Moni Paul, Joyce K. Edmonds, Marjorie A. Koblinsky.
Read the article in the Journal of Health, Population and Nutrition
May 2009
Reported care quality in federal Ryan White HIV/AIDS Program supported networks of HIV/AIDS care in AIDS Care
This paper is based upon the EQITI project (Evaluation of Quality Improvement in Title I Programs) conducted by JSI in collaboration with Harvard Medical School. The Ryan White Program supports networks of care which include medical care providers and support services for people living with HIV and AIDS (PLWHA) in 51 Eligible Metropolitan Areas (EMAs). In the 2000 reauthorization of the Ryan White Program, quality management programs were required for all sites receiving funding.
To facilitate quality management and improvement activities in EMAs, a set of surveys was developed to measure characteristics of care networks and the quality, accessibility, and coordination of services from the perspectives of case management and medical providers, administrators and consumers. The surveys measured the entire network's quality management and support activities and reported on the quality of services at individual care sites. The article summarizes the findings of these surveys. Lisa R. Hirschhorn, Stewart Landers, D. Keith McInnes, Faye Malitz, Lin Ding, Rebecca Joyce, Paul D. Cleary.
Read the abstract in AIDS Care
April 2009
Safe Motherhood Case Studies: Learning with Stakeholders in South Asia—An Introduction in the Journal of Health, Population and Nutrition
The international community resolved in 1987 to reduce maternal mortality around the world. This resolution was strengthened in 2001 when 189 countries signed the Millennium Declaration, committing themselves to Millennium Development Goal (MDG) 5 towards improvement of maternal health. To accelerate national progress towards achieving MDG 5, a deeper understanding of what works at scale is needed. This article introduces a series of case studies that initiated a response to the growing call for evidence to support improved local implementation, gathering lessons from practice within and across more and less successful areas of South Asian countries. The aim is to build a body of knowledge by looking at patterns of problems and solutions to improve safe motherhood implementation at the national and subcountry levels. Highlighted within these case studies are lessons for the implementation of safe motherhood programs, stakeholders' dialogue, programmatic elements of successful safe motherhood programs, and selected context-specific innovations highlighted by national leadership in regional meetings of stakeholders.
Read the article in the Journal of Health, Population and Nutrition
Improving Maternal Survival in South Asia—What Can We Learn from Case Studies? in the Journal of Health, Population and Nutrition
Technical interventions for maternal healthcare are implemented through a dynamic social process, and peoples' behaviors influence the outcomes. Given the complexity inherent in these processes, a cause-and-effect relationship in one context cannot be directly transferred to another. While this is true of all health services, its importance is magnified in maternal healthcare because of the need to involve multiple levels of the health system, multiple types of care providers, and multiple technical interventions—without the ability to measure significant change in the outcome, the maternal mortality ratio.
This case study observes the implementation of maternal health programs across five states in India, Pakistan, and Bangladesh. Patterns that stand out and seem to apply throughout are discussed, as well as others that require more data to understand the observed patterns. Results from this study can provide guidance to program managers as to what aspects of the process to track and micro-manage, to policy-makers as to what features of a context may particularly influence impacts of alternative maternal health strategies; and to governments as to the factors shaping dynamic responses that might themselves warrant intervention. Barbara McPake, Marge Koblinsky.
Read the article in the Journal of Health, Population and Nutrition
Causes of Maternal Mortality Decline in Matlab, Bangladesh in the Journal of Health, Population and Nutrition
Bangladesh is distinct among developing countries in achieving a low maternal mortality ratio (MMR), despite the lack of skilled care at delivery. This study investigates the possible causes of the maternal mortality decline in one rural area of Bangladesh—Matlab—where maternal mortality data has been available since the mid-1970s. Findings from this study show that improved comprehensive emergency obstetric care, stronger family-planning services, and expanded education for women are essential for maternal mortality decline. Mahbub Elahi Chowdhury, Anisuddin Ahmed, Nahid Kalim, Marge Koblinsky.
Read the article in the Journal of Health, Population and Nutrition
Public-sector Maternal Health Programmes and Services for Rural Bangladesh in the Journal of Health, Population and Nutrition
This paper assesses the development of public sector maternal health services and policies since independence in 1971, with primary focus on rural areas where 3/4 of the population of Bangladesh reside. Since 1971, the health infrastructure has developed, though not in a uniform pattern, despite policy shifts. Indicators are substantially lower for those in poorer areas, and a wide variation exists in the availability of comprehensive essential obstetric care (EOC) facilities in the public sector among Bangladesh's six divisions. The WHO 2005 recommendation (1 comprehensive EOC for 3,500 births) suggests that there is a need for significantly more comprehensive EOC facilities. This study provides recommended actions for the Government of Bangladesh, based on the WHO recommendation. Malay Kanti Mridha, Iqbal Anwar, Marge Koblinsky.
Read the article in the Journal of Health, Population and Nutrition
Quality of Obstetric Care in Public-sector Facilities and Constraints to Implementing Emergency Obstetric Care Services: Evidence from High- and Low-performing Districts of Bangladesh in the Journal of Health, Population and Nutrition
This study explored the quality of obstetric care in public-sector facilities and the constraints to programming comprehensive essential obstetric care (EOC) services in the rural areas of Khulna and Sylhet divisions—relatively high and low-performing areas of Bangladesh respectively. Areas examined include the distribution of functional EOC facilities throughout the districts, human resource constraints as a barrier to maternal health, sanctioned posts for nurses, unavailability of blood, lack of evidence-based techniques, and literacy and sociocultural barriers as they pertain to context of care. This study also suggests ways these facilities and constraints can be improved to further develop maternal healthcare in these divisions. Iqbal Anwar, Nahid Kalim, Marge Koblinsky.
Read the article in the Journal of Health, Population and Nutrition
Postpartum Hemorrhage and Eclampsia: Differences in Knowledge and Care-seeking Behaviour in Two Districts of Bangladesh in the Journal of Health, Population and Nutrition
Hemorrhage and eclampsia are two major causes of maternal mortality in Bangladesh. This study, conducted from July 2006 to December 2007, examines the differences in perceived knowledge and care-seeking behaviors of women in relation to these problems, in both high and low-performing districts of Bangladesh. Results show differences in care-seeking practices among women in the two different areas, which may reflect sociocultural differences, disparities in economic and educational opportunities, and discrimination in the availability of care. This gap could contribute to the high rate of maternal deaths associated with these conditions. Nahid Kalim, Iqbal Anwar, Jasmin Khan, Lauren S. Blum, Allisyn C. Moran, Roslin Botlero, Marge Koblinsky.
Read the article in the Journal of Health, Population and Nutrition
Verbal Autopsy of Maternal Deaths in Two Districts of Pakistan—Filling Information Gaps in the Journal of Health, Population and Nutrition
In Pakistan, the vital registration system is weak, and population-based data on the maternal mortality ratio (MMR) are limited. This study was conducted from 2005 to 2007 to collect information from various sources on maternal deaths, identify gaps in information, and critically analyze maternal deaths at the community and health-facility levels in two districts in Pakistan. Risk factors identified were low socioeconomic status, illiteracy, low-earning jobs, parity, and poor obstetric history. The study identified gaps in reporting of maternal deaths, and also provided profiles of the dead women, and their causes of death. Sadiqua N. Jafarey, Talat Rizvi, Marge Koblinsky, Nazo Kureshy.
Read the article in the Journal of Health, Population and Nutrition
March 2009
Communicating Hospital Infection Data to the Public: A Study of Consumer Responses and Preferences in the American Journal of Medical Quality
The study evaluated different approaches for reporting hospital-level comparative data on hospital-associated infections (HAIs) and the extent to which such data might influence hospital choice. Findings suggest that public reporting of comparative data on HAIs could influence hospital choice, but other factors including prior experience, reputation, physicians recommendations, and insurance coverage are also influential. Kathleen M. Mazor, EdD, Katherine S. Dodd, BS, Laureen Kunches, ANP, PhD.
Read the abstract in the American Journal of Medical Quality
Use of Computer Modeling for Emergency Preparedness Functions by Local and State Health Officials: A Needs Assessment in the Journal of Public Health Management and Practice
The article presents the methodology, results, and lessons learned from a multistate needs assessment of local and state public health and safety officials regarding their familiarity and use of formal computer modeling for preparedness activities. The study was undertaken to provide information to the newly formed Preparedness Modeling Unit within the Centers for Disease Control and Prevention.
Use of preparedness modeling would enhance the planning for vulnerable and at-risk populations, all-hazard emergencies and infectious disease containment strategies, as well as for response functions including evacuation, sheltering, quarantine, and distribution of medications and supplies. Rosenfeld, Lisa A.; Fox, Claude Earl; Kerr, Debora; Marziale, Erin; Cullum, Amy; Lota, Kanchan; Stewart, Jonathan; Thompson, Mary Zack
Read the abstract in the Journal of Public Health Management and Practice
February 2009
Female Community Volunteers Save Children from Pneumonia Deaths in Nepal in Global Health magazine
Pneumonia is a leading cause of mortality in children under-five in Nepal. In 1991, the Ministry of Health estimated the proportion of deaths due to pneumonia was between 30 to 40 percent. Today there are over 54,000 Female Community Health Volunteers (FCHVs) who have been trained to recognize key health issues and provide life-saving treatments, including providing Vitamin A, treating diarrhea with oral rehydration solution (ORS) and zinc, and recognizing and referring seriously ill children to health facilities.
JSI worked with the Nepal government to develop a community-based pneumonia treatment training package that FCHVs, many of whom are illiterate, could understand and implement in their communities. The results of this approach have been dramatic. Community-based pneumonia treatment has doubled the total number of cases treated as compared to districts with facility-based treatment only. Penny Dawson.
Read the article in Global Health
2009
Improving the capacity of the health workforce through pre-service medical education reform in the World Health Organization's (WHO) European Magazine for Sexual and Reproductive Health 'Entre Nous'
The article 'Improving the capacity of the health workforce through pre-service medical education reform' focuses on the need to ensure stronger pre-service education and in-service training systems in order to develop a well-performing health workforce and meet the increasing need for quality services.
In October 2008, the Europe and Eurasia Regional Family Planning Activity (EERFPA), funded by the U.S. Agency for International Development (USAID) and implemented by JSI, launched the initiative to address the scarcity of family planning topics in the curricula of medical and nursing schools in the region. EERFPA worked to reform medical and nursing school curricula by increasing evidence-based family planning teaching in pre-service medical education curricula and working within the systems that govern curriculum content. Berdzuli N.
December 2008
Cost of Hospital-Associated Infections in Massachusetts in the American Journal of Infection Control
The Massachusetts Department of Public Health appointed an expert panel to assess the problem of hospital-associated infections (HAI) in the state and make recommendations regarding mandatory reporting. At the panel's request, a cost-of-illness study was conducted using available data sources. In Massachusetts, the excess hospital costs attributed to HAIs were estimated at approximately $233 to $275 million in 2006. Patricia W. Stone, PhD, MPH, RN; Laureen Kunches, ANP, PhD; Lisa Hirschhorn, MD, MPH.
Read the abstract in the American Journal of Infection Control
Research Priorities to Reduce Global Mortality from Newborn Infections by 2015 in Pediatric Infectious Disease Journal
The article, "Research Priorities to Reduce Global Mortality From Newborn Infections by 2015," examines the types of questions researchers pose—and the responses they get in return—as a critical way to close the gap in delivering services in developing countries.
Given the lack of progress in improving newborn survival despite the existence of effective interventions, it is not surprising that of the top ranked research priorities in this article the majority are in the domain of health systems and policy research. The article urges funding agencies and investigators to invest in key research priorities to accelerate reduction of neonatal deaths, particularly those due to infections. Co-authored by Dr. Nabeela Ali, JSI Chief of Party in Pakistan
Read the abstract in the Pediatric Infectious Disease Journal
October 2008
Hospital Staffing and Health Care-Associated Infections: A Systematic Review of the Literature in Clinical Infectious Diseases
JSI senior staff, Laurie Kunches and Lisa Hirschhorn, have co-authored "Hospital Staffing and Health Care-Associated Infections: A Systematic Review of the Literature," an article in the October issue of Clinical Infectious Diseases (2008; 47:937-44). The article is part of the evidence review that the JSI team has done for the Massachusetts Department of Public Health's Healthcare Associated Infection project. The efforts are focused on eliminating preventable infections through application of clinical 'best practices' and other incentives across Massachusetts hospitals.
Read the abstract in Clinical Infectious Diseases
June 2008
Sexual and Gender Minority Health: What We Know and What Needs to be Done in the American Journal of Public Health
JSI Health Services Senior Consultant Stewart Landers co-authored an article in the American Journal of Public Health. The article is both a primer on sexual and gender minorities and their particular health care needs, and an outline on how health care practitioners can better serve these special populations by helping to meet those needs.
Read the abstract in the American Journal of Public Health
May 2008
From research to national expansion: 20 years' experience of community-based management of childhood pneumonia in Nepal in WHO Bulletin
Pneumonia is a leading cause of mortality of children aged under five in Nepal. Research conducted by JSI in the 1980s determined that pneumonia case management by community-based workers decreased under-five mortality by 28%.
The paper highlights the use of female community health volunteers to manage childhood pneumonia at community level using oral antibiotics.
The paper was written by JSI's Penny Dawson in collaboration with YV Pradhan, the Director of the Child Health Division, MOHP/Nepal, Robin Houston an independent consultant, Sushil Karki, Dilip Poudel, and Steve Hodgins, Chief of Party of the Nepal Family Health Project.
Learn more about JSI's work in Nepal
Read the abstract in the Bulletin of the World Health Organization, Volume 86, Number 5, May 2008.
April 2008
Improving the Management of Hypertension in Kazakhstan: Implications for improving clinical practice, patient behaviours and health outcomes in Global Public Health Journal
The article presents findings from the assessment of a strategy aimed at improving case-finding and management of hypertension patients. It was written by staff from the ZdravPlus Project, including Gita Pillai, the JSI Regional Director of Maternal and Child Health, and Deputy Chief of Party of the ZdravPlus Project, in collaboration with staff from Abt Associates and the Kazakhstan Association of Family Physicians and Family Medicine, Department of Almaty Postgraduate Institute for Physicians, Almaty, Kazakhstan.
Read the abstract in the Global Public Health Journal
October 2007
An On-going Burden: Chlamydial Infections among Young American Indian Women in the Maternal Child Health Journal
Yvonne Hamby, JSI Project Director of the Region VIII Infertility Prevention Project (IPP), collaborated with Centers for Disease Control and Prevention (CDC) and Indian Health Service (IHS) to contribute to the article, "An On-going Burden: Chlamydial Infections among Young American Indian Women," for the Maternal Child Health Journal (2008) 12:S25-29. The purpose of the study was to determine the chlamydia positivity and risk factors for chlamydia among women screened in Indian Health Service clinics participating in the Region VIII IPP in 2003.
Read the abstract in the Maternal Child Health Journal
Rural Community Members' Perceptions of Harm from Medical Mistakes: A High Plains Research Network (HPRN) Study in the American Board of Family Medicine
Over the past fiv years, there has been a push to improve patient safety. The aim of this study was to learn about community members' definitions and types of harm from medical mistakes.
The researchers used a mixed-methods study using community-based participatory research. Reported types of harm included emotional, financial, and physical harm. Reports suggest that perceived clinician indifference to unanticipated outcomes may lead to patients' loss of trust and belief that the unexpected outcome was a result of an error. By Rebecca F. Van Vorst, MSPH, Rodrigo Araya-Guerra, BA, Maret Felzien, MA, Douglas Fernald, MA, Nancy Elder, MD, MSPH, Christine Duclos, PhD, MPH and John M. Westfall, MD, MPH.
Read the article in the American Board of Family Medicine
August 2007
Promoting Unity of Purpose in District Health Service Delivery in Uganda through Partnerships, Trust Building and Evidence-based Decisionmaking in Education for Health
This paper examines how evidence-based decisionmaking and partnership-oriented implementation led to programmatic results and institutional behavior change in Ugandan districts through synergetic relationships between local governments and civil society organizations. Profiling the work of the Uganda Program for Human and Holistic Development (UPHOLD), this paper focuses on how the program addressed fragmentation to improve service delivery in the health sector.
The pillars of 'evidence-based decisionmaking' and 'partnerships,' together with approaches which strengthen existing synergies, produced more results, faster. Programs designed to work with fragmented settings should consider using the same pillars and blocks to ultimately make a difference in the lives of program beneficiaries. Authors: Orobaton N, Nsabagasani X, Ekochu E, Oki J, Kironde S, Lippeveld T.
Read the abstract in Education for Health
June 2007
An evaluation of infant immunization in Africa: is a transformation in progress? in the Bulletin of the World Health Organization
This article presents the findings from a review of data from national infant immunization programs in the 46 countries of WHO's African Region, to assess the progress made towards meeting the goals of the African Regional Strategic Plan of the Expanded Programme on Immunization between 2001 and 2005.
The authors found that rates of immunization coverage are improving dramatically in the WHO African Region, though countries did fall short of the target for 80% of countries to achieve at least 80% immunization coverage by 2005. The huge increases in spending on immunization and the related improvements in program performance are linked predominantly to increases in donor funding. L Arevshatian, CJ Clements, SK Lwanga, AO Misore, P Ndumbe, JF Seward, P Taylor.
Read the abstract in Bulletin of the World Health Organization
January 2007
Alcohol Consumption Among Older Adults in Primary Care in the Journal of General Internal Medicine
This study explored alcohol consumption patterns and the characteristics associated with at-risk drinking in a large sample of elderly primary care patients. The cross-sectional analysis of more than 24,000 patients from multiple sites and looked at the quantity and frequency of alcohol use, demographics, social support measures, and measures of depression/anxiety.
The majority of participants were nondrinkers; among alcohol users, at-risk drinkers did not differ significantly from moderate drinkers in their characteristics or for the 3 health parameters evaluated. In contrast, heavy drinking was associated with depression and anxiety and less social support, and heavy drinking combined with binge drinking was associated with depressive/anxiety symptoms and perceived poor health. Authors: Joann E Kirchner, Cynthia Zubritsky, Marisue Cody, Eugenie Coakley, Hongtu Chen, James H Ware, David W Oslin, Herman A Sanchez, U Nalla B Durai, Keith M Miles, Maria D Llorente, Giuseppe Costantino, Sue Levkoff
Read the abstract in the Journal of General Internal Medicine