Biology subjects

Tsui, A.

Publications and source records attributed to Tsui, A..

3 recordsLinked to original sources

bioRxiv2020

The aggregate effect of implementation strength of family planning programs on modern contraceptive use at the health systems level in rural Malawi

Background To explore the association between the strength of implementation of family planning (FP) programs on the use of modern contraceptives. Specifically, how strongly these programs are being implemented across a health facility’s catchment area in Malawi and the odds of a woman in that catchment area is using modern contraceptives. This information can be used to assess whether the combined impact of multiple large-scale FP programs is leading to change in the health outcomes they aim to improve.Methods and findings We used data from the 2017 Implementation Strength Assessment (ISA) that quantified how much of family planning programs at the health facility and community health worker levels were being implemented across every district of Malawi. We used a summary measure developed in a previous study that employs quantitative methods to combine data across FP domains and health system levels. We tested the association of this summary measure for implementation strength with household data from the 2015 Malawi Demographic Health Survey (DHS). We found that areas with stronger implementation of FP programs had higher odds of women using modern contraceptives compared with areas with weaker implementation. The association of ISA with use of modern contraception was different by education, marital status, and geography. After controlling for these factors, we found that the adjusted odds of using a modern contraceptive was three times higher in catchment areas with high implementation strength compared to those with lower strength.Conclusion Metrics that summarize how strongly FP programs are being implemented were used to show a statistically significantly positive relationship between increasing implementation strength and higher rates of modern contraceptive use. Decisionmakers at the various levels of health authority can use this type of summary measure to better understand the combined impact of their diverse FP programming and inform future programmatic and policy decisions. The findings also reinforce the idea that having a well-supported and supplied cadre of community health workers supplementing FP provision at the health facility can be an important health systems mechanism, especially in rural settings and to target youth populations.View Full Text

scientific communication and education↗

bioRxiv2018

Vascular risk factors for male and female urgency urinary incontinence at age 68 from a British birth cohort study

ObjectiveTo investigate the prevalence of UUI at age 68 and the contribution of vascular risk factors to male and female UUI pathogenesis in addition to the associations with raised BMI\n\nSubjects and methods1762 participants were from the MRC National Survey for Health and Development (NSHD) birth cohort, who answered the International Consultation on Incontinence Questionnaire short form (ICIQ-SF) at age 68. Logistic regression was used to estimate associations between UUI and earlier life vascular risk factors including: lipid status, diabetes, hypertension, body mass index (BMI), previous stroke or transient ischaemic attack (TIA) diagnosis; adjusting for smoking status, physical activity, co-presentation of SUI symptoms, educational attainment and in women only, type of menopause, age at period cessation and use of hormone replacement therapy.\n\nResultsUUI was reported by 12% of men and 19% of women at 68. Female sex, previous stroke or TIA diagnosis, increased BMI and hypertension (in men only) at age 60-64 were independent risk factors for UUI. Female sex, increased BMI and a previous diagnosis of stroke/ TIA increased the relative risk of more severe UUI symptoms. Type and timing of menopause and HRT use did not alter the estimated associations between UUI and vascular risk factors in women.\n\nConclusionMultifactorial mechanisms lead to UUI and vascular risk factors may contribute to pathogenesis of bladder overactivity in addition to higher BMI. Severe UUI appears to be a distinct presentation with more specific contributory mechanisms than milder UUI.

epidemiology↗

bioRxiv2017

Delirium symptoms are associated with decline in cognitive function between ages 53 to 69: findings from a British birth cohort study.

INTRODUCTIONFew population studies have investigated whether longitudinal decline after delirium in mid-to-late life might affect specific cognitive domains.\n\nMETHODSParticipants from a birth cohort completing assessments of search speed, verbal memory and the Addenbrookes Cognitive Examination at age 69 were asked about delirium symptoms between ages 60-69. Linear regression models estimated associations between delirium symptoms and cognitive outcomes.\n\nRESULTSPeriod prevalence of delirium between 60 and 69 was 4% (95% CI 3.2%,4.9%). Self-reported symptoms of delirium over the seventh decade were associated with worse scores in the Addenbrookes Cognitive Examination (-1.7 points, 95% CI -3.2, -0.1, p=0.04). In association with delirium symptoms, verbal memory scores were initially lower, with subsequent decline in search speed by age 69. These effects were independent of other Alzheimers risk factors.\n\nDISCUSSIONDelirium symptoms may be common even at relatively younger ages, and their presence may herald cognitive decline, particularly in search speed, over this time period.

epidemiology↗