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Biomedical subjects

A Rosenfield

Publications and source records attributed to A Rosenfield.

At least 19 recordsLinked to original sources
PubMed1999

Creating training opportunities for public health practitioners.

In response to several reports issued by the federal government and private foundations on the under-training of public health practitioners, Joseph L. Mailman School of Public Health of Columbia University (SPH) and the New York City Department of Health (NYC DOH) initiated the Public Health Scholars program (SPH-PHS) to make degree-level public health training available to NYC DOH employees. Public Health Scholars receive a 50% tuition scholarship and enroll part-time while working full-time at NYC DOH. Sixteen scholars have enrolled during the past three years. The SPH-PHS program is considered a success by both SPH and NYC DOH. This article details the history of the collaboration between the two agencies and the structure of the program and provides a critical analysis of the SPH-PHS program based on interviews with 16 scholars. It also examines the cost and benefit to other schools of public health of implementing such a program.

Cooperative Behavior↗
PubMed1999

The Safe Motherhood Initiative: why has it stalled?

Complications of pregnancy and childbirth are still the leading cause of death and disability among women of reproductive age in developing countries. After decades of neglect, the founding of the Safe Motherhood Initiative in 1987 promised action on this problem. A dozen years later, there is no evidence that maternal mortality has declined and there are still few sizeable programs. A major reason for this disappointing record is that the initiative lacks a clear, concise, feasible strategy. This article reviews the available options and proposes a strategy based on improving the availability and quality of medical treatment of obstetric complications. Once district hospitals and health centers provide such needed care, community mobilization to improve prove utilization may be beneficial. Substantial reductions in maternal deaths would be possible in a relatively short period of time if this strategy were embraced.

Developing Countries↗
PubMed1998

Research, introduction, and use: advancing from Norplant.

As the first real contraceptive innovation in over 20 years, and as a long-acting method requiring clinical intervention for insertion and removal, Norplant raised an especially wide range of issues. It also encountered a number of difficulties. In April 1997, an Institute of Medicine (IOM) workshop on implant contraceptives reviewed newly available data on Norplant's efficacy, safety, and use; considered lessons learned from the method's development, introduction, and market experience; and explored approaches based on those lessons that could improve the environment for contraceptive research and development and make market entry for new contraceptive technologies less troubled. In addition to presenting the IOM workshop findings, the present article calls attention to the rich scientific prospects available for development of the next generation of contraceptives, and notes signs of an evolving new paradigm, essential if those prospects are to be realized to any significant extent.

Clinical Trials, Phase IV as Topic↗
PubMed1998

Abortion and maternal health.

Since the beginning of recorded history, women have attempted to terminate unwanted pregnancies. Despite the safety of modern techniques of abortion, many women throughout the world still have to resort to unsafe abortions, placing themselves at considerable risk. The World Health Organization estimates that there are approximately 20 million unsafe abortions performed each year, and estimates of maternal deaths as a result of abortion range between 60,000 and 100,000 per year. With free and legal access to safe abortions, rates of complications and mortality drop dramatically. There is an urgent need for efforts to prevent unwanted pregnancies in order to reduce the need for abortion; for the early identification of abortion complications and easy access to treatment for women suffering those complications; for expansion of safe abortion availability; and for proper training and resources for providers of abortion services.

Abortion, Legal↗
PubMed1998

Computed tomography in the initial evaluation of hemodynamically stable patients with blunt abdominal trauma: impact of severity of injury scale and technical factors on efficacy.

BACKGROUND: Although computed tomography is used widely in evaluating injuries from blunt abdominal trauma, grading of injuries does not reliably predict the need for intervention. Objective reporting is essential to evaluate accuracy and facilitate patient triage. We established and tested a five-point grading system for overall severity of injury. METHODS: A total of 392 computed tomographic trauma cases were objectively classified according to the type and severity of abdominal injuries, by two experienced radiologists. Interobserver variability between the original interpretation and the consensus of the film reviewers was evaluated. The computed tomographic grading system was measured against rate of admission, exploratory laparotomy, and further imaging. RESULTS: Patients with higher grades of injury on computed tomography were increasingly likely to have surgical management (odds ratio, 3.99; 95% confidence interval, 1.86-8.58; p < 0.0006), with sensitivity 100%, specificity 89.5% for level 2 injuries and higher. Although there was almost perfect agreement between the official interpretation and the reviewers' blinded consensus interpretation (raw agreement 84%, weighted kappa 0.86), indeterminate studies were reduced from 23% (16 of 67) to 12% (8 of 67) on review: these were more likely to have metallic or motion artifacts (5 of 16 vs. 1 of 51 p < 0.002). CONCLUSIONS: Standardizing reporting of injuries enhances accuracy, and grading eliminates equivocation. Diagnostic certainty in computed tomography of blunt abdominal trauma is reduced by motion and metallic artifacts.

Abdominal Injuries↗
PubMed1996

Abortion and fertility regulation.

To achieve their desired fertility, women use a combination of contraception and abortion, and some societies also place constraints on marriage and sexual activity. The degree to which these means are adopted varies considerably, but for the foreseeable future abortion will remain an important element of fertility regulation. Globally, complications of unsafe abortion affect hundreds of thousands of women each year, and account for as many as 100,000 deaths annually (about two in ten maternal deaths), mainly in poor countries, where abortion typically remains illegal. Access to safe abortion is both essential and technically feasible and should be provided in combination with good quality family planning services.

Abortion, Illegal↗
PubMed1996

Population and women's reproductive health: an international perspective.

This paper gives a brief overview of current world population or demographic issues, followed by a discussion of the ICPD proceedings and various notable aspects of the ICPD Programme of Action. It then focuses on six of the most pressing reproductive health concerns facing women today: gender inequalities, access to contraceptive services, sexually transmitted diseases (including HIV), maternal mortality, unsafe abortion, and adolescent pregnancy. Because the ICPD Programme of Action is intended to have far-reaching consequences for each of these issues, it is taken as a focal point of analysis.

Abortion, Legal↗
PubMed1995

Standards of care in reproductive health services.

Standards of care for all medical services are designed by and for professionals and generally follow medical professional society guidelines. Most managed care organizations rely on professional medical standards of practice, which provide broad guidelines to providers. Family planning agencies, on the other hand, generally follow Title X program guidelines, which provide specific standards of care. The Title X guidelines include detailed instructions about service delivery and program content. The differences between these two sets of standards result in a wide variation in practice guidelines across the spectrum of health care providers. From the patient perspective, evaluation of care is generally not related to professional standards, but instead focuses on quality measures related to access and interpersonal aspects of care. The member satisfaction surveys developed by some managed care organizations now have a large enough sample size to provide meaningful measures of patient satisfaction at the individual provider level. A uniform set of practice guidelines is needed for family planning services that incorporates the strengths of all three approaches and that link performance to generally accepted practice guidelines.

Adolescent↗