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AIDS--dramatic surge in ex-Soviet Union, no respite worldwide, new data show.

https://arctichealth.org/en/permalink/ahliterature195656
Source
Bull World Health Organ. 2001;79(1):78
Publication Type
Article
Date
2001
Author
R. Dobson
Source
Bull World Health Organ. 2001;79(1):78
Date
2001
Language
English
Publication Type
Article
Keywords
Acquired Immunodeficiency Syndrome - epidemiology - mortality
Adolescent
Adult
Child
Child, Preschool
Europe, Eastern - epidemiology
Female
Humans
Infant
Infant, Newborn
Russia - epidemiology
Notes
Comment In: Bull World Health Organ. 2001;79(3):26911285679
PubMed ID
11217673 View in PubMed
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Past infection with hepatitis A virus among Vancouver street youth, injection drug users and men who have sex with men: implications for vaccination programs.

https://arctichealth.org/en/permalink/ahliterature193570
Source
CMAJ. 2001 Aug 7;165(3):293-7
Publication Type
Article
Date
Aug-7-2001
Author
J J Ochnio
D. Patrick
M. Ho
D N Talling
S R Dobson
Author Affiliation
Vaccine Evaluation Center, British Columbia's Children's Hospital and University of British Columbia. jochnio@interchange.ubc.ca
Source
CMAJ. 2001 Aug 7;165(3):293-7
Date
Aug-7-2001
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
British Columbia - epidemiology
Female
Hepatitis A - epidemiology - etiology - prevention & control
Homeless Youth - statistics & numerical data
Homosexuality, Male - statistics & numerical data
Humans
Immunization Programs
Logistic Models
Male
Middle Aged
Odds Ratio
Prevalence
Risk factors
Substance Abuse, Intravenous - epidemiology - virology
Abstract
In Canada, inactivated hepatitis A vaccines are targeted selectively at those at increased risk for infection or its complications. In order to evaluate the need for routine hepatitis A vaccination programs in Vancouver for street youth, injection drug users (IDUs) and men who have sex with men (MSM), we determined the prevalence of antibodies against hepatitis A virus (HAV) and risk factors for HAV in these groups.
The frequency of past HAV infection was measured in a sample of Vancouver street youth, IDUs and MSM attending outreach and STD clinics and needle exchange facilities by testing their saliva for anti-HAV immunoglobulin G. A self-administered, structured questionnaire was used to gather sociodemographic data. Stepwise logistic regression was used to evaluate the association between presumed risk factors and groups and past HAV infection.
Of 494 study participants, 235 self-reported injection drug use, 51 were self-identified as MSM and 111 met street youth criteria. Positive test results for anti-HAV were found in 6.3% of street youth (95% confidence interval [CI] 2.6%-12.6%), 42.6% (95% CI 36.2%-48.9%) of IDUs and 14.7% (95% CI 10.4%-19.1%) of individuals who denied injection drug use. Among men who denied injection drug use, the prevalence was 26.3% (10/38) for MSM and 12% (21/175) for heterosexuals. Logistic regression showed that past HAV infection was associated with increased age and birth in a country with high rates of hepatitis infection. Injection drug use among young adults (25-34 years old) was a significant risk factor for a positive anti-HAV test (p = 0.009). MSM were also at higher risk for past HAV infection, although this association was nominally significant (p = 0.07).
Low rates of past HAV infection among Vancouver street youth indicate a low rate of virus circulation in this population, which is vulnerable to hepatitis A outbreaks. An increased risk for HAV infection in IDUs and MSM supports the need to develop routine vaccination programs for these groups also.
Notes
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PubMed ID
11517645 View in PubMed
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Routine prenatal screening for HIV in a low-prevalence setting.

https://arctichealth.org/en/permalink/ahliterature203791
Source
CMAJ. 1998 Oct 20;159(8):942-7
Publication Type
Article
Date
Oct-20-1998
Author
D M Patrick
D M Money
J. Forbes
S R Dobson
M L Rekart
D A Cook
P J Middleton
D R Burdge
Author Affiliation
British Columbia Centre for Disease Control Society, Vancouver. david.patrick@bccdc.hnet.bc.ca
Source
CMAJ. 1998 Oct 20;159(8):942-7
Date
Oct-20-1998
Language
English
Publication Type
Article
Keywords
British Columbia - epidemiology
Canada
Cost-Benefit Analysis
Female
HIV Infections - diagnosis - epidemiology - ethnology - prevention & control - transmission
Humans
Infectious Disease Transmission, Vertical - prevention & control
Mass Screening - economics - statistics & numerical data
Pregnancy
Pregnancy Complications, Infectious - diagnosis - epidemiology - ethnology - virology
Prenatal Care - economics - statistics & numerical data
Prevalence
Retrospective Studies
Risk factors
Abstract
The objectives of this study were to assess the effect of British Columbia's June 1994 guidelines for prenatal HIV screening on the rate of maternal-fetal HIV transmission and to estimate the cost-effectiveness of such screening.
The authors conducted a retrospective review of pregnancy and delivery statistics, HIV screening practices, laboratory testing volume, prenatal and labour management decisions of HIV-positive women, maternal-fetal transmission rates and associated costs.
Over 1995 and 1996, 135,681 women were pregnant and 92,645 carried to term. The rate of HIV testing increased from 55% to 76% of pregnancies on chart review at one hospital between November 1995 and November 1996. On the basis of seroprevalence studies, an estimated 50.2 pregnancies and 34.3 (95% confidence interval 17.6 to 51.0) live births to HIV-positive women were expected. Of 42 identified mother-infant pairs with an estimated date of delivery during 1995 or 1996, 25 were known only through screening. Of these 25 cases, there were 10 terminations, 1 spontaneous abortion and 14 cases in which the woman elected to carry the pregnancy to term with antiretroviral therapy. There was one stillbirth. One instance of maternal-fetal HIV transmission occurred among the 13 live births. The net savings attributable to prevented infections among babies carried to term were $165,586, with a saving per prevented case of $75,266.
A routine offer of pregnancy screening for HIV in a low-prevalence setting reduces the rate of maternal-fetal HIV transmission and may rival other widely accepted health care expenditures in terms of cost-effectiveness.
Notes
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Comment In: CMAJ. 1999 May 4;160(9):1286-710333827
PubMed ID
9834719 View in PubMed
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Wellness activities address inequities.

https://arctichealth.org/en/permalink/ahliterature199863
Source
Soc Sci Med. 2000 Jan;50(1):107-21
Publication Type
Article
Date
Jan-2000
Author
R. Dobson
R. Lepnurm
Author Affiliation
Institute for Health and Outcomes Research, Department of Physical Medicine and Rehabilitation, Royal University Hospital, Saskatoon, Sask., Canada. rtd124@mail.usask.ca
Source
Soc Sci Med. 2000 Jan;50(1):107-21
Date
Jan-2000
Language
English
Publication Type
Article
Keywords
Adult
Analysis of Variance
Attitude of Health Personnel
Cross-Sectional Studies
Fees, Medical - statistics & numerical data
Female
Health Promotion - economics - statistics & numerical data
Humans
Income - statistics & numerical data
Job Satisfaction
Male
Middle Aged
Physician's Practice Patterns - economics - statistics & numerical data
Physicians - economics - psychology
Questionnaires
Salaries and Fringe Benefits - statistics & numerical data
Saskatchewan
Social Support
Abstract
The medical model is no longer accepted by many as the best means of achieving optimal health. Financial constraints are pushing more efficient and effective ways to deliver services. In Saskatchewan, greater emphasis is being placed on wellness activities (preventive medical counselling, clinical work with other professionals, training, teaching and research and institutional medical administrative duties). We sought to determine if predicted support for these activities was related to equity of income as perceived by physicians. The study design was a cross-sectional study of all 1462 physicians actively practising in Saskatchewan during 1991/1992. The data were originally collected by Lepnurm and Henderson during the summer of 1992. ANOVA tests were conducted between predicted support for wellness activities and income equity to determine if there were significant interactions. Predicted support for wellness activities was measured by four items: preventive medicine counselling activities during office visits, clinical work with other health professionals, teaching and research, and, institutional medical administrative duties. The first income equity construct was based on: satisfaction with income, fairness of fee-for-service between general practitioners and specialists, fairness of fee-for-service between cognitive and procedural/technical specialists, and the current method of payment reflected factors important to physicians. To increase sample size a second equity construct was created by dropping fairness of fee-for-service between cognitive and procedural/technical specialists. The main effect and significant interactions with control variables were subjected to further analysis using Tukey's test. Significant relationships were found between changes in wellness activities under fee-for-service and income equity (p = 0.001 and p = 0.033) and between changes in wellness activities under salary and income equity (p = 0.002 and p = 0.037). No significant relationships (p = 0.858 and p = 0.610) were found between support for wellness activities under capitation and income equity. The findings of this study demonstrate a relationships between perceived equity of income and predicted support for wellness activities. The authors suggest that these findings were not merely a reflection of the desire by physicians to modify their tasks to accommodate perceived inequity associated with their method of remuneration. Physicians were given the option of considering which method of payment (fee-for-service, salary or capitation) best reflected factors important to them. We suggest that many physicians value wellness activities and would prefer to modify their current patterns of practice, whether they are paid by fee-for-service or by salaried methods.
PubMed ID
10622698 View in PubMed
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