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Biomedical subjects

O Rahman

Publications and source records attributed to O Rahman.

16 recordsLinked to original sources
PubMed2001

Discontinuation of postmenopausal hormone therapy in a Massachusetts HMO.

Long-term postmenopausal hormone therapy alleviates menopausal symptoms, decreases women's risk of osteoporosis and has been shown to reduce cardiovascular morbidity and mortality in more than 30 observational studies. However, nearly half of all women initiating hormone therapy discontinue within the first year. This study was conducted to determine the rate and predictors of hormone therapy discontinuation in a clinical practice setting. We identified 992 women aged 45-59 who began hormone therapy between 1993 and 1995 in a Massachusetts health maintenance organization. Women were followed 2 years from the day they filled a prescription for estrogen. 53% discontinued hormone therapy by the end of the first year and one-fifth stopped after the first prescription. A prescription from a gynecologist (RR = 0.82, 95% CI: 0.68, 0.99) and a mammogram a year prior to initiation (RR = 0.75, 95% CI: 0.63, 0.89) were associated with a lower rate of discontinuation. Women who were using monoamine oxidase inhibitors (MAOI) or selective serotonin reuptake inhibitors (SSRI) antidepressants 3 months prior to initiation (RR = 2.07, 95% CI: 1.26, 3.39) or who had been enrolled in the health plan for less than 3 years (RR = 1.33, 95% CI: 1.10, 1.62) had an increased risk of discontinuing hormone therapy. The year a woman entered the cohort was also associated with a higher rate of discontinuation (RR = 1.40, 95% CI: 1.14, 1.74 for 1994 and RR = 1.95, 95% CI: 1.52, 2.50 for 1995). The results indicate that long-term hormone therapy use is uncommon in clinical practice, particularly when a woman or her physician attempts to use hormone therapy as an alternative to antidepressant therapy, and that the rates of discontinuation of hormone therapy were rising rapidly in the mid-1990s.

Adult↗
PubMed2001

Hungry for tobacco: an analysis of the economic impact of tobacco consumption on the poor in Bangladesh.

OBJECTIVE: To investigate the extent of tobacco expenditures in Bangladesh and to compare those costs with potential investment in food and other essential items. DESIGN: Review of available statistics and calculations based thereon. RESULTS: Expenditure on tobacco, particularly cigarettes, represents a major burden for impoverished Bangladeshis. The poorest (household income of less than $24/month) are twice as likely to smoke as the wealthiest (household income of more than $118/month). Average male cigarette smokers spend more than twice as much on cigarettes as per capita expenditure on clothing, housing, health and education combined. The typical poor smoker could easily add over 500 calories to the diet of one or two children with his or her daily tobacco expenditure. An estimated 10.5 million people currently malnourished could have an adequate diet if money on tobacco were spent on food instead. The lives of 350 children could be saved each day. CONCLUSION: Tobacco expenditures exacerbate the effects of poverty and cause significant deterioration in living standards among the poor. This aspect of tobacco use has been largely neglected by those working in poverty and tobacco control. Strong tobacco control measures could have immediate impact on the health of the poor by decreasing tobacco expenditures and thus significantly increasing the resources of the poor. Addressing the issue of tobacco and poverty together could make tobacco control a higher priority for poor countries.

Adolescent↗
PubMed1999

Alzheimer patients report less pain intensity and pain affect than non-demented elderly.

Pain assessment for patients with Alzheimer's disease (AD) is generally aimed at quantifying pain, i.e., the intensity and locations of pain. Based on the extensive neuropathology in limbic brain areas with this disorder, we hypothesized that, compared to control patients, AD patients would report an additional loss of qualitative aspects of pain, i.e., pain affect. This hypothesis was tested by administering specific parts of three pain questionnaires and comparing the use of analgesics in 19 AD patients with that of 18 elderly patients without dementia who were matched for the presence of painful conditions. Results reveal that AD patients, compared to controls, experience less intense pain and less pain affect. In contrast, the number of AD patients using analgesics did not differ from the number of controls. These findings suggest that pain assessment for patients with AD should be focused on both quantitative and qualitative aspects of pain.

Affect↗
PubMed1997

Hyperglycemia during childhood diarrhea.

OBJECTIVE: To determine the cause of hyperglycemia in childhood diarrhea. METHODS: During an 8-month period, patients admitted to a diarrhea treatment center in Bangladesh had their blood glucose concentrations determined. Sixteen patients aged 2 to 10 years with hyperglycemia (blood glucose concentration >10.0 mmol/L) and 20 patients in the same age group with a normal blood glucose concentration (3.3 to 9.0 mmol/L) had blood samples obtained on admission and 4 and 24 hours later for determination of glucoregulatory hormones and gluconeogenic substrates. RESULTS: Prevalence of hyperglycemia among patients aged 2 to 10 years was 9.4%. Compared with the normoglycemic patients, hyperglycemic patients more often had severe dehydration (100% versus 10%, p <0.001), infection with Vibrio cholerae 0 1 or toxigenic Escherichia coli (94% vs 25%, p <0.001), and had similar duration of fasting (16 vs 14 hours, p = 0.677). Concentrations of epinephrine (7.15 vs 2.00 micromol/L), norepinephrine (10.35 vs 3.50 micromol/L), cortisol (1.38 vs 0.82 micromol/L), glucagon (36 vs 14 pmol/L), and C-peptide (1.22 vs 0.35 nmol/L) were all significantly (p < or = 0.014) higher in patients with hyperglycemia than in normoglycemic patients. CONCLUSIONS: The development of hyperglycemia in diarrhea is caused by a stress response to hypovolemia.

Blood Glucose↗
PubMed1994

Gender differences in adult health: an international comparison.

This article uses data from the United States, Jamaica, Malaysia, and Bangladesh to explore gender differences in adult health. The results show that women fare worse than men across a variety of self-reported health measures in all four countries studies. These health status disparities between men and women persist even after appropriate corrections are made for the impact of (a) differential mortality selection by gender and (b) sociodemographic factors. Data from Jamaica indicate that gender disparities in adult health arise early and persist throughout the life cycle, with different age profiles for different measures.

Adolescent↗
PubMed1994

Quality of care in public and private primary health care facilities: structural comparisons in Jamaica.

This article examines the quality of care provided by Jamaican primary health care clinics by comparing various structural quality indexes derived from a nationwide 1990 survey of 366 public clinics and 189 private clinics. This comparison points up important differences in the quality of care being provided by public versus private and urban versus rural facilities that might not have been anticipated. Among other things, the study found that the public clinics provided better prenatal diagnosis and counseling and more family planning services than the private clinics. However, the private clinics tended to be better condition, better equipped and supplied, and better able to provide certain laboratory test results in a timely manner. Comparison of urban and rural public clinics indicated that the urban clinics were somewhat better provisioned with equipment, supplies, and pharmaceuticals. However, the rural clinics appeared to be in better repair. Comparison of basic and higher-level public clinics showed the basic clinics to be in better condition and more fully staffed than the higher-level clinics while having similar perinatal diagnostic capabilities. However, the higher-level public clinics tended to have an overall profile more resembling that of the private clinics, being better equipped and supplied than the basic clinics. While structural measures of quality such as those employed here tend to poorly estimate health outcomes, they do serve as good indicators of access to services where resources are severely constrained. For policy-makers, the results presented here could prove useful in guiding concrete interventions, summarizing the structural elements of health care quality at different types of facilities, and providing a method for less costly evaluation of programs designed to improve services at primary health care clinics.

Ambulatory Care Facilities↗
PubMed1993

Determinants of pregnancy outcomes and targeting of maternal health services in Jamaica.

Detailed nationally representative population level data were used to investigate the pre-natal care and delivery experiences of pregnant women in Jamaica. The results of this study show that: (a) demographic criteria (particularly first births) and self-reported clinical pregnancy complications are valid predictors of deleterious maternal health outcomes and can be used to stratify mothers into risk groups. (b) There appears to be a significant problem of under and inappropriate utilization of pre-natal care services by all women and in particular by demographically 'high risk' women, i.e. young, first time mothers. Significant proportions of the latter group report either no pre-natal care visits at all or visits which are later than the first trimester. The problems of delayed initiation of pre-natal care are specially exacerbated for poor, teenage mothers who happen to be living in the Kingston Metropolitan Area. (c) In terms of the content and quality of pre-natal care services the message is somewhat mixed. On the positive side the pre-natal care system is doing a moderately satisfactory job with regard to diagnostic tests and educational advice. On the negative side however, the fact that once women enter the health care system they all receive the same moderately adequate care (in terms of diagnostic evaluations and educational advice) with no attempt to focus particular attention on high risk mothers is troublesome. (d) With regard to appropriate delivery venues for pregnant women, pre-natal care visits do not appear to significantly influence the choice of delivery venues. Moreover, rich urban women are much more likely to deliver in a hospital than their rural peers. In conclusion, the study discusses the social and behavioral context of these results, addresses the policy implications and makes some recommendations to improve maternal health services.

Adult↗
PubMed1993

Excess mortality for the unmarried in rural Bangladesh.

Prospective data from the Matlab surveillance area in rural Bangladesh, 1974-1982, were used in this study to show that divorced and never-married adults (aged 15-44 years) had significantly higher mortality than their currently married peers with differences in disability status accounting for some of this excess risk. Widowed individuals on the other hand had no excess mortality relative to the currently married. A certain proportion of the sharp reduction in mortality associated with remarriage after divorce for men could be attributed to differences in disability between the remarried group and those who remained divorced. Household economic status indicators could account for little of the excess mortality of divorced and never-married individuals relative to their married counterparts. These findings provide support for the hypothesis that a certain proportion of mortality differentials by marital status in this population can be attributed to selection into marriage and remarriage on the basis of underlying disability status. The evidence for the protective effect of increased economic status associated with the currently married state is less convincing.

Adolescent↗
PubMed1992

Older widow mortality in rural Bangladesh.

Prospective data from rural Bangladesh are used to explore the adverse impact of widowhood on old age female mortality. The results indicate that widows aged 45 and above have significantly higher mortality than their currently married counterparts. Controlling for age and disability status, much of this excess mortality risk can be accounted for by patterns of living arrangements and household assets. An analysis of older widows suggests that the presence of adult male kin in the household (primarily sons), and to a lesser extent household headship (both of which may be interpreted as reflecting individual access to resources in this society) have a substantial impact on mortality risks for this group of women.

Aged↗
PubMed1990

Hypoglycemia during diarrhea in childhood. Prevalence, pathophysiology, and outcome.

To determine the frequency and outcome of hypoglycemia during diarrhea in childhood, we screened 2003 consecutive patients less than 15 years of age who were admitted to a diarrhea treatment center in Dhaka, Bangladesh. Hypoglycemia, defined as a blood glucose concentration less than 2.2 mmol per liter, was found in 91 patients (4.5 percent), 39 (42.9 percent) of whom died. We also measured the plasma concentrations of glucoregulatory hormones and gluconeogenetic substrates in 46 of the patients with hypoglycemia who were 2 to 15 years old and in 25 normoglycemic patients matched with them for age and weight. The patients with hypoglycemia had had diarrhea for less time than the normoglycemic patients (median, 12 vs. 72 hours; P less than 0.05), and their last feeding had been 18 hours before admission, as compared with 9 hours for the normoglycemic patients (P less than 0.05). The groups were similar in terms of nutritional status, the proportion of patients who had fever, and the types of pathogens recovered from stool samples. The plasma C-peptide concentrations were low (less than 0.30 nmol per liter) in all the hypoglycemic patients. As compared with the normoglycemic patients, the patients with hypoglycemia had elevated median plasma concentrations of glucagon (44 vs. 11 pmol per liter; P = 0.001), epinephrine (3400 vs. 1500 pmol per liter; P = 0.012), norepinephrine (7500 vs. 2900 pmol per liter; P = 0.002), and lactate (3.5 vs. 2.1 mmol per liter; P = 0.020) and similar alanine and beta-hydroxybutyrate concentrations. Eighteen hypoglycemic patients with severe malnutrition had been ill longer than 26 better-nourished patients with hypoglycemia (median duration of illness, 18 vs. 10 hours; P = 0.023) and had lower median plasma concentrations of lactate (1.9 vs. 3.9 mmol per liter; P = 0.021) and alanine (173 vs. 293 micromol per liter; P = 0.040). We conclude that hypoglycemia is a major cause of death in association with diarrhea. Because the glucose counterregulatory hormones were appropriately elevated in the children with diarrhea and hypoglycemia, whereas the gluconeogenetic substrates were inappropriately low, we further conclude that the hypoglycemia observed in such patients is most often due to the failure of gluconeogenesis.

Adolescent↗
PubMed1988

Rapid intravenous rehydration by means of a single polyelectrolyte solution with or without dextrose.

We compared the efficacy and safety of a single polyelectrolyte solution, Dhaka solution (DS), containing 133 mmol/L sodium, 13 mmol/L potassium, 98 mmol/L chloride, and 48 mmol/L acetate with and without 139 mmol/L (25 gm/L) dextrose in the rapid (4 hours) rehydration of 67 patients with diarrhea and moderate or severe dehydration requiring parenteral fluid therapy. Of the 67 patient, 31 were randomly assigned to receive the dextrose-containing solution (DS + D) and 36 DS without dextrose. On admission to the hospital, the two groups of patients were similar with respect to enteric pathogens detected, proportion with hyponatremia, magnitude of dehydration as assessed by clinical criteria, serum protein or creatinine concentration, and plasma glucose levels. At the end of the 4-hour infusion, both groups of patients had similar decreases in serum creatinine and protein levels and similar volume of urine output, but patients receiving DS + D had a significantly higher plasma glucose level than patients receiving DS (7.8 mmol/L (140 mg/dl) vs 5.39 mmol/L (97 mg/dl), P less than 0.01). One patient in the DS group had hypoglycemia (plasma glucose 2.0 mmol/L (36 mg/dl) at 4 hours. No other complications were noted. Serum protein values 24 hours after admission were little changed from 4-hour values, suggesting that rehydration was complete at the end of 4 hours. We conclude that, in our patients, rehydration can be carried out safely and rapidly with the use of a single solution and that adding 139 mmol/L (25 gm/L) of dextrose to the solution can prevent hypoglycemia without producing an osmotic diuresis.

Adolescent↗
PubMedDate not supplied

Red blood cell damage by wollastonite: in vitro study.

Asbestos is known to cause lung diseases in occupationally exposed workers. These properties have restricted its use. Industries have been exploring the possibility of other mineral fibres to replace the asbestos. In this direction, wollastonite has gained great attention owing to its high thermal resistance. In the present paper, the toxicity of three samples of Indian wollastonite was compared to that of chrysotile. Dust suspensions were added to the red blood cell suspensions to obtain a final dust concentration of 1.0-5.0 mg ml-1 in the system. The wollastonite varieties were found to have smaller haemolytic potential in human red blood cells than that of chrysotile in vitro. Chrysotile also was more effective in inducting peroxidative damage of polyunsaturated fatty acid (PUFA) than wollastonites in the present system. The peroxidative damage of PUFA and the haemolysis were both time and dose dependent. A higher value of malonaldehyde (a lipid peroxidation product) formation in low-speed supernatant of haemolysate was observed than in the intact cells. As the free-radical scavengers vitamin E and reduced glutathione prevent haemolysis and lipid peroxidation, these data are consistent with the involvement of lipid peroxidation in the haemolytic process.

Asbestos, Serpentine↗
PubMedDate not supplied

Aplastic anemia.

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Adolescent↗