Rupal Sanghvi

To examine the cost effectiveness of Papanicolaou screening for cancer after total hysterectomy for benign disease. Decision analysis including Markov modeling applied to women aged 40 or older with a history of total hysterectomy for benign disease. We derived expected discounted costs and life expectancy. Maximum gain in life expectancy between no screening and any screening strategy was approximately 3 weeks. Cost effectiveness in dollars per life-year gained was > or =$143,875 more than no screening for strategies starting at age 50, and over $12 million for aged 40 or more screening strategy. None of the sensitivity analyses caused the incremental cost effectiveness of any strategy to come to less than $100,000 per life year gained compared with no screening. Despite significant costs for any strategy, Pap smear screening after total hysterectomy for benign disease provides essentially no gain in life expectancy. In absence of risks for genital cancer, such screening is not ...

Adolescents are often vulnerable to particular health risks and face multiple barriers to accessing health care. School-based clinics and school-linked services represent an alternative model of care that has responded to the unique health issues of adolescents by offering preventive, comprehensive services, including mental health and other sensitive services. The current restructuring of the American health care delivery system presents a serious challenge to the continued existence of these services, which must link successfully with managed care organizations and adapt to significant changes in federal and state funding streams to remain viable. The continued success of school-based health services in improving adolescent health will largely depend on how well they can capitalize on their strategic position to reach adolescents, respond to their health needs, and reduce barriers to care, and how effectively they can integrate themselves into a rapidly evolving US health care del...

To examine the cost effectiveness of Papanicolaou screening for cancer after total hysterectomy for benign disease. Decision analysis including Markov modeling applied to women aged 40 or older with a history of total hysterectomy for benign disease. We derived expected discounted costs and life expectancy. Maximum gain in life expectancy between no screening and any screening strategy was approximately 3 weeks. Cost effectiveness in dollars per life-year gained was > or =$143,875 more than no screening for strategies starting at age 50, and over $12 million for aged 40 or more screening strategy. None of the sensitivity analyses caused the incremental cost effectiveness of any strategy to come to less than $100,000 per life year gained compared with no screening. Despite significant costs for any strategy, Pap smear screening after total hysterectomy for benign disease provides essentially no gain in life expectancy. In absence of risks for genital cancer, such screening is not ...

ABSTRACT With the highest HIV prevalence rates outside of Sub-saharan Africa, itis urgent that HIV prevention efforts in the Caribbean address the factors that drive the progression of the epidemic, such as provider stigma. In 2006, International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR) Member Associations in Jamaica, Haiti and Suriname that are in the process of integrating HIV testing into their sexual and reproductive health services have developed and implemented a tool which measures knowledge and attitudes toward HIV/AIDS in order to tailor training for their providers' needs. The survey includes a 9-item attitude scale to measure stigma towards people living with HIV/AIDS (PLWHA). All clinic staff was surveyed, however sample size was small due to clinic size. The baseline analysis revealed gaps in knowledge and attitudes towards PLWHA, which proved useful in defining training and sensitization needs, as well as some regional trends. Endline data will be collected prior to November 2007. Patient rights and confidentiality, stigmatizing attitudes, underlying provider concerns, and MTCT transmission were among the identified issues to target during staff training and sensitization. There were also trends reflecting higher stigmatizing attitudes, despite high levels of knowledge. This has indicated the need for trainings to focus sensitization as well as the need to follow up. The survey could be useful for other service-providing organizations or those interested in working around HIV/AIDS, to determine training needs. Additionally, certain survey indicators could be used as baseline and end-line measures to assess effectiveness of interventions.

The study was carried out on 22 patients with non-Hodgkin's lymphoma (NHL) who had received sequential infusions of two thymidine analogues iododeoxyuridine (IUdR) and bromodeoxyuridine (BrdU). Cell cycle kinetic studies seemed to differentiate distinctly between low grade lymphoma (n = 8, LI = 2.6%) compared to that of intermediate grade (n = 9, LI = 13%, p = 0.0001) and high grade NHL (n = 5, LI = 16.3%, p = 0.0062). While the majority of 14 intermediate and high grade lymphomas had a high labeling index there were 3/14 patients with a LI of 5.5%, 5.5% and 4.1% respectively. A decrease in the rate of programmed cell death (PCD) or apoptosis due to the overexpression of bcl-2 has been implicated as the possible pathogenesis for follicular lymphoma. We determined the presence of bcl-2 protein immunohistochemically and apoptosis by in situ end labeling of DNA which detects cells in early stages of PCD not recognized morphologically. Nine NHL patients demonstrated PCD ranging from 1%-40%, while it was undetectable in 13/22 patients. Of these 13 cases, 6 showed the presence of bcl-2 expression. To understand the relationship of the microenvironment to the lymphoma cells, the presence of transforming growth factor beta (TGF-beta) was determined immunohistochemically. TGF-beta was present in all the cases where bcl-2 was present, except one. This study highlights some of the key biological features of NHL cells and their microenvironment.

Amidst the backdrop of the Millennium Development Goals (MDGs), efforts to effectively address the poor health outcomes of vulnerable adolescents with high street exposure remain limited. At the nexus of police brutality, drug trafficking, sex trafficking, sexual assault and gang involvement, these adolescents experience poor health outcomes, with little access to services. Concomitant structural inequities place them at further risk of experiences that jeopardize healthy transitions to adulthood. International Planned Parenthood Federation (IPPF/WHR) Member Associations implemented an initiative, in Bolivia, Guatemala and Peru, to increase service access, improve health behavior and strengthen the policy landscape. Incorporating a peer-based, harm reduction approach, the project reached over 165,000 people ages 10-24 and providing over 360,998 services. The project was also successful in reaching younger adolescents (20% ages 10-14 and 63% under 19). A behavioral surveillance surve...

With the highest HIV prevalence rates outside of Sub-saharan Africa, itis urgent that HIV prevention efforts in the Caribbean address the factors that drive the progression of the epidemic, such as provider stigma. In 2006, International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR) Member Associations in Jamaica, Haiti and Suriname that are in the process of integrating HIV testing into their sexual and reproductive health services have developed and implemented a tool which measures knowledge and attitudes toward HIV/AIDS in order to tailor training for their providers' needs. The survey includes a 9-item attitude scale to measure stigma towards people living with HIV/AIDS (PLWHA). All clinic staff was surveyed, however sample size was small due to clinic size. The baseline analysis revealed gaps in knowledge and attitudes towards PLWHA, which proved useful in defining training and sensitization needs, as well as some regional trends. Endline data will be ...

To examine the cost effectiveness of Papanicolaou screening for cancer after total hysterectomy for benign disease. Decision analysis including Markov modeling applied to women aged 40 or older with a history of total hysterectomy for benign disease. We derived expected discounted costs and life expectancy. Maximum gain in life expectancy between no screening and any screening strategy was approximately 3 weeks. Cost effectiveness in dollars per life-year gained was > or =$143,875 more than no screening for strategies starting at age 50, and over $12 million for aged 40 or more screening strategy. None of the sensitivity analyses caused the incremental cost effectiveness of any strategy to come to less than $100,000 per life year gained compared with no screening. Despite significant costs for any strategy, Pap smear screening after total hysterectomy for benign disease provides essentially no gain in life expectancy. In absence of risks for genital cancer, such screening is not cost effective.

Adolescents are often vulnerable to particular health risks and face multiple barriers to accessing health care. School-based clinics and school-linked services represent an alternative model of care that has responded to the unique health issues of adolescents by offering preventive, comprehensive services, including mental health and other sensitive services. The current restructuring of the American health care delivery system presents a serious challenge to the continued existence of these services, which must link successfully with managed care organizations and adapt to significant changes in federal and state funding streams to remain viable. The continued success of school-based health services in improving adolescent health will largely depend on how well they can capitalize on their strategic position to reach adolescents, respond to their health needs, and reduce barriers to care, and how effectively they can integrate themselves into a rapidly evolving US health care delivery system.

The study was carried out on 22 patients with non-Hodgkin's lymphoma (NHL) who had received sequential infusions of two thymidine analogues iododeoxyuridine (IUdR) and bromodeoxyuridine (BrdU). Cell cycle kinetic studies seemed to differentiate distinctly between low grade lymphoma (n = 8, LI = 2.6%) compared to that of intermediate grade (n = 9, LI = 13%, p = 0.0001) and high grade NHL (n = 5, LI = 16.3%, p = 0.0062). While the majority of 14 intermediate and high grade lymphomas had a high labeling index there were 3/14 patients with a LI of 5.5%, 5.5% and 4.1% respectively. A decrease in the rate of programmed cell death (PCD) or apoptosis due to the overexpression of bcl-2 has been implicated as the possible pathogenesis for follicular lymphoma. We determined the presence of bcl-2 protein immunohistochemically and apoptosis by in situ end labeling of DNA which detects cells in early stages of PCD not recognized morphologically. Nine NHL patients demonstrated PCD ranging from 1%-40%, while it was undetectable in 13/22 patients. Of these 13 cases, 6 showed the presence of bcl-2 expression. To understand the relationship of the microenvironment to the lymphoma cells, the presence of transforming growth factor beta (TGF-beta) was determined immunohistochemically. TGF-beta was present in all the cases where bcl-2 was present, except one. This study highlights some of the key biological features of NHL cells and their microenvironment.