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von Steinbuechel N, Zeldovich M, Timmermann D, Krenz U, Koerte IK, Bonfert MV, Berweck S, Kieslich M, Henrich M, Brockmann K, Buchheim A, Roediger M, Lendt M, Auer C, Neu A, Kaiser A, Driemeyer J, Greving S, Wartemann U, Pinggera D, Thomé C, Suss J, Muehlan H, Cunitz K. Final Validation of the Quality of Life after Brain Injury for Children and Adolescents (QOLIBRI-KID/ADO) Questionnaire. Children (Basel) 2024; 11:438. [PMID: 38671655 PMCID: PMC11049366 DOI: 10.3390/children11040438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/18/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024]
Abstract
Until recently, no disease-specific health-related quality of life (HRQoL) questionnaire existed for pediatric traumatic brain injuries (TBIs). In this revalidation study, the psychometric properties and the validity of the 35-item QOLIBRI-KID/ADO questionnaire in its final German version were examined in 300 children and adolescents. It is the first self-reported TBI-specific tool for measuring pediatric HRQoL in individuals aged between 8 and 17 years. The six-factor model fits the data adequately. The questionnaire's internal consistency was excellent for the total score and satisfactory to excellent for the scale scores. Intraclass correlations indicated good test-retest reliability, and the measure's construct validity was supported by the overlap between the QOLBRI-KID/ADO and the PedsQL, which measures generic HRQoL. The discriminant validity tests showed that older children and girls reported a significantly lower HRQoL than comparison groups, and this was also true of children who were anxious or depressed, or who suffered from post-concussion symptoms, replicating the results of the questionnaire's first developmental study. Our results suggest that the QOLIBRI-KID/ADO is a reliable and valid multidimensional tool that can be used together with the adult version in clinical contexts and research to measure disease-specific HRQoL after pediatric TBI throughout a person's life. This may help improve care, treatment, daily functioning, and HRQoL after TBI.
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Affiliation(s)
- Nicole von Steinbuechel
- Institute of Psychology, University of Innsbruck, Universitaetsstr. 5-7, 6020 Innsbruck, Austria; (N.v.S.); (M.Z.); (A.B.)
| | - Marina Zeldovich
- Institute of Psychology, University of Innsbruck, Universitaetsstr. 5-7, 6020 Innsbruck, Austria; (N.v.S.); (M.Z.); (A.B.)
- Faculty of Psychotherapy Science, Sigmund Freud University Vienna, 1020 Vienna, Austria
| | - Dagmar Timmermann
- Department of Psychosomatic Medicine and Psychotherapy, Division of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Waldweg 37A, 37073 Goettingen, Germany;
| | - Ugne Krenz
- University Medical Center Goettingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (U.K.); (S.G.)
| | - Inga K. Koerte
- cBRAIN/Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilian University Hospital, LMU University, Nussbaumstrasse 5, 80336 Munich, Germany;
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Mass General Brigham, 55 Fruit Street, Boston, MA 02114, USA
| | - Michaela V. Bonfert
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, Dr. Von Hauner Children’s Hospital, LMU University Hospital, Haydnstr. 5, 80336 Munich, Germany;
| | - Steffen Berweck
- Specialist Center for Paediatric Neurology, Neurorehabilitation and Epileptology, Schoen Klinik, Krankenhausstraße 20, 83569 Vogtareuth, Germany;
| | - Matthias Kieslich
- Department of Paediatric Neurology, Hospital of Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (M.K.); (M.H.)
| | - Marlene Henrich
- Department of Paediatric Neurology, Hospital of Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (M.K.); (M.H.)
| | - Knut Brockmann
- Interdisciplinary Pediatric Center for Children with Developmental Disabilities and Severe Chronic Disorders, Department of Pediatrics and Adolescent Medicine, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany;
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Universitaetsstr. 5-7, 6020 Innsbruck, Austria; (N.v.S.); (M.Z.); (A.B.)
| | - Maike Roediger
- Department of Pediatrics and Adolescent Medicine, General Pediatrics, Intensive Care Medicine and Neonatology & Department of Pediatric Cardiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany;
| | - Michael Lendt
- Neuropediatrics, St. Mauritius Therapeutic Clinic, Strümper Straße 111, 40670 Meerbusch, Germany;
| | - Christian Auer
- Johannes Kepler University Linz, Altenberger Straße 69, 4020 Linz, Austria;
- Department of Neurosurgery, Kepler Univesity Hospital GmbH, Wagner-Jauregg-Weg 15, 4020 Linz, Austria
| | - Axel Neu
- Department of Neurology and Neuropediatry, VAMED Klinik Geesthacht GmbH, Johannes-Ritter-Straße 100, 21502 Geesthacht, Germany; (A.N.); (A.K.)
| | - Alexander Kaiser
- Department of Neurology and Neuropediatry, VAMED Klinik Geesthacht GmbH, Johannes-Ritter-Straße 100, 21502 Geesthacht, Germany; (A.N.); (A.K.)
| | - Joenna Driemeyer
- Department of Pediatrics, University of Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany;
| | - Sven Greving
- University Medical Center Goettingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (U.K.); (S.G.)
| | - Ulrike Wartemann
- Department of Neuropediatrics, VAMED Klinik Hohenstücken GmbH, Brahmsstraße 38, 14772 Brandenburg an der Havel, Germany;
| | - Daniel Pinggera
- Department of Neurosurgery, Tirol Kliniken GmbH, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (D.P.); (C.T.)
| | - Claudius Thomé
- Department of Neurosurgery, Tirol Kliniken GmbH, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (D.P.); (C.T.)
| | - Joachim Suss
- Department of Pediatric Surgery, Wilhelmstift Catholic Children’s Hospital, Liliencronstraße 130, 22149 Hamburg, Germany;
| | - Holger Muehlan
- Department of Health and Prevention, University of Greifswald, Robert-Blum-Str. 13, 17487 Greifswald, Germany;
| | - Katrin Cunitz
- Institute of Psychology, University of Innsbruck, Universitaetsstr. 5-7, 6020 Innsbruck, Austria; (N.v.S.); (M.Z.); (A.B.)
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Von-Siebold-Str. 5, 37075 Goettingen, Germany
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Bosch-Capblanch X, Esu E, Oringanje CM, Dongus S, Jalilian H, Eyers J, Auer C, Meremikwu M, Röösli M. The effects of radiofrequency electromagnetic fields exposure on human self-reported symptoms: A systematic review of human experimental studies. Environ Int 2024; 187:108612. [PMID: 38640611 DOI: 10.1016/j.envint.2024.108612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/21/2024] [Accepted: 03/27/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND The technological applications of radiofrequency electromagnetic fields (RF-EMF) have been steadily increasing since the 1950s exposing large proportions of the population. The World Health Organization (WHO) is assessing the potential health effects of exposure to RF-EMF. OBJECTIVES To systematically assess the effects of exposure to RF-EMF on self-reported non-specific symptoms in human subjects and to assess the accuracy of perceptions of presence or absence of RF-EMF exposure. METHODS Eligibility criteria: experimental studies carried out in the general population and in individuals with idiopathic environmental intolerance attributed to EMF (IEI-EMF), in any language. INFORMATION SOURCES Medline, Web of Science, PsycInfo, Cochrane Library, Epistemonikos, Embase and EMF portal, searched till April 2022. Risk of Bias (ROB): we used the RoB tool developed by OHAT adapted to the topic of this review. SYNTHESIS OF RESULTS we synthesized studies using random effects meta-analysis and sensitivity analyses, where appropriate. RESULTS Included studies: 41 studies were included, mostly cross over trials and from Europe, with a total of 2,874 participants. SYNTHESIS OF RESULTS considering the primary outcomes, we carried out meta-analyses of 10 exposure-outcomes pairs. All evidence suggested no or small non-significant effects of exposure on symptoms with high (three comparisons), moderate (four comparisons), low (one comparison) and very low (two comparisons) certainty of evidence. The effects (standard mean difference, where positive values indicate presence of symptom being exposed) in the general population for head exposure were (95% confidence intervals) 0.08 (-0.07 to 0.22) for headache, -0.01 (-0.22 to 0.20) for sleeping disturbances and 0.13 (-0.51 to 0.76) for composite symptoms; and for whole-body exposure: 0.09 (-0.35 to 0.54), 0.00 (-0.15 to 0.15) for sleeping disturbances and -0.05 (-0.17 to 0.07) for composite symptoms. For IEI-EMF individuals SMD ranged from -0.19 to 0.11, all of them with confidence intervals crossing the value of zero. Further, the available evidence suggested that study volunteers could not perceive the EMF exposure status better than what is expected by chance and that IEI-EMF individuals could not determine EMF conditions better than the general population. DISCUSSION Limitations of evidence: experimental conditions are substantially different from real-life situations in the duration, frequency, distance and position of the exposure. Most studies were conducted in young, healthy volunteers, who might be more resilient to RF-EMF than the general population. The outcomes of interest in this systematic review were symptoms, which are self-reported. The available information did not allow to assess the potential effects of exposures beyond acute exposure and in elderly or in chronically ill people. It cannot be ruled out that a real EMF effect in IEI-EMF groups is masked by a mix with insensitive subjects. However, studies on symptoms reporting and/or field perceptions did not find any evidence that there were particularly vulnerable individuals in the IEI-EMF group, although in open provocation studies, when volunteers were informed about the presence or absence of EMF exposure, such differences were consistently observed. INTERPRETATION available evidence suggests that acute RF-EMF below regulatory limits does not cause symptoms and corresponding claims in the everyday life are related to perceived and not to real EMF exposure status.
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Affiliation(s)
- Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Ekpereonne Esu
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
| | - Chioma Moses Oringanje
- Department of Biology, College of Art & Sciences, Xavier University, Cincinnati, OH 45247, USA.
| | - Stefan Dongus
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Hamed Jalilian
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - John Eyers
- Independent Consultant & Senior Research Fellow, 3ie, c/o LIDC, 20 Bloomsbury Square, London WC1A 2NS, United Kingdom.
| | - Christian Auer
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Martin Meremikwu
- Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
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Massimi L, Cinalli G, Frassanito P, Arcangeli V, Auer C, Baro V, Bartoli A, Bianchi F, Dietvorst S, Di Rocco F, Gallo P, Giordano F, Hinojosa J, Iglesias S, Jecko V, Kahilogullari G, Knerlich-Lukoschus F, Laera R, Locatelli D, Luglietto D, Luzi M, Messing-Jünger M, Mura R, Ragazzi P, Riffaud L, Roth J, Sagarribay A, Pinheiro MS, Spazzapan P, Spennato P, Syrmos N, Talamonti G, Valentini L, Van Veelen ML, Zucchelli M, Tamburrini G. Intracranial complications of sinogenic and otogenic infections in children: an ESPN survey on their occurrence in the pre-COVID and post-COVID era. Childs Nerv Syst 2024; 40:1221-1237. [PMID: 38456922 DOI: 10.1007/s00381-024-06332-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/21/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND COVID-19 pandemic is thought to have changed the epidemiology of some pediatric neurosurgical disease: among them are the intracranial complications of sinusitis and otitis (ICSO). According to some studies on a limited number of cases, both streptococci-related sinusitis and ICSO would have increased immediately after the pandemic, although the reason is not clear yet (seasonal changes versus pandemic-related effects). The goal of the present survey of the European Society for Pediatric Neurosurgery (ESPN) was to collect a large number of cases from different European countries encompassing the pre-COVID (2017-2019), COVID (2020-2021), and post-COVID period (2022-June 2023) looking for possible epidemiological and/or clinical changes. MATERIAL AND METHODS An English language questionnaire was sent to ESPN members about year of the event, patient's age and gender, presence of immune-deficit or other favoring risk factors, COVID infection, signs and symptoms at onset, site of primary infection, type of intracranial complication, identified germ, type and number of surgical operations, type and duration of medical treatment, clinical and radiological outcome, duration of the follow-up. RESULTS Two hundred fifty-four cases were collected by 30 centers coming from 14 different European countries. There was a statistically significant difference between the post-COVID period (129 children, 86 cases/year, 50.7% of the whole series) and the COVID (40 children, 20 cases/year, 15.7%) or the pre-COVID period (85 children, 28.3 cases/year, 33.5%). Other significant differences concerned the presence of predisposing factors/concurrent diseases (higher in the pre-COVID period) and previous COVID infection (higher in the post-COVID period). No relevant differences occurred as far as demographic, microbiological, clinical, radiological, outcome, morbidity, and mortality data were concerned. Paranasal sinuses and middle ear/mastoid were the most involved primary site of infection (71% and 27%, respectively), while extradural or subdural empyema and brain abscess were the most common ICSO (73% and 17%, respectively). Surgery was required in 95% of cases (neurosurgical and ENT procedure in 71% and 62% of cases, respectively) while antibiotics in 99% of cases. After a 12.4-month follow-up, a full clinical and radiological recovery was obtained in 85% and 84% of cases, respectively. The mortality rate was 2.7%. CONCLUSIONS These results suggest that the occurrence of ICSO was significantly increased after the pandemic. Such an increase seems to be related to the indirect effects of the pandemic (e.g., immunity debt) rather than to a direct effect of COVID infection or to seasonal fluctuations. ICSO remain challenging diseases but the pandemic did not affect the management strategies nor their prognosis. The epidemiological change of sinusitis/otitis and ICSO should alert about the appropriate follow-up of children with sinusitis/otitis.
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Affiliation(s)
- L Massimi
- Pediatric Neurosurgery, Neuroscience-Sense Organs-Chest Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Catholic University Medical School, Rome, Italy
| | - G Cinalli
- Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy
| | - P Frassanito
- Pediatric Neurosurgery, Neuroscience-Sense Organs-Chest Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - V Arcangeli
- Clinical Psychology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - C Auer
- Department of Neurosurgery, Johannes Kepler University Linz, Kepler University Hospital GmbH, Linz, Austria
| | - V Baro
- Pediatric and Functional Neurosurgery, Department of Neurosciences, University of Padova, Padua, Italy
| | - A Bartoli
- Department of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
| | - F Bianchi
- Pediatric Neurosurgery, Neuroscience-Sense Organs-Chest Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - S Dietvorst
- University Hospitals Leuven, Leuven, Belgium
| | - F Di Rocco
- Hôpital Femme-Mère-Enfant, Université de Lyon, Lyon, France
| | - P Gallo
- Birmingham Children's Hospital, Birmingham, UK
| | - F Giordano
- University of Florence, Florence, Italy
- Meyer Children's Hospital IRCCS, Florence, Italy
| | - J Hinojosa
- Hospital Sant Joan de Déu, Barcelona, Spain
| | - S Iglesias
- Hospital Regional Universitario de Malaga, Malaga, Spain
| | - V Jecko
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - G Kahilogullari
- Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - F Knerlich-Lukoschus
- Division Pediatric Neurosurgery, Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - R Laera
- Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy
| | - D Locatelli
- Neurosurgery Department, Università Dell'Insubria, Ospedale di Circolo e Macchi Foundation, Varese, Italy
| | - D Luglietto
- Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - M Luzi
- Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy
| | | | - R Mura
- Meyer Children's Hospital IRCCS, Florence, Italy
| | - P Ragazzi
- Department of Pediatric Neurosurgery, Ospedale Infantile Regina Margherita, Città della Salute e della Scienza, Turin, Italy
| | - L Riffaud
- Rennes University Hospital, Rennes, France
| | - J Roth
- Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - A Sagarribay
- Hospital Dona Estefânia-Centro Hospitalar Universitário, Lisboa, Portugal
- Hospital CUF Descobertas, Lisboa, Portugal
| | - M Santos Pinheiro
- Centro Hospitalar Lisboa Norte-Hospital Santa Maria, Lisboa, Portugal
| | - P Spazzapan
- University Medical Center-Ljubljana, Ljubljana, Slovenia
| | - P Spennato
- Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy
| | - N Syrmos
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - L Valentini
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - M L Van Veelen
- Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands
| | - M Zucchelli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto Scienze Neurologiche Di Bologna, Boulogne, Italy
| | - G Tamburrini
- Pediatric Neurosurgery, Neuroscience-Sense Organs-Chest Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Catholic University Medical School, Rome, Italy
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Rauch P, Stefanits H, Aichholzer M, Serra C, Vorhauer D, Wagner H, Böhm P, Hartl S, Manakov I, Sonnberger M, Buckwar E, Ruiz-Navarro F, Heil K, Glöckel M, Oberndorfer J, Spiegl-Kreinecker S, Aufschnaiter-Hiessböck K, Weis S, Leibetseder A, Thomae W, Hauser T, Auer C, Katletz S, Gruber A, Gmeiner M. Deep learning-assisted radiomics facilitates multimodal prognostication for personalized treatment strategies in low-grade glioma. Sci Rep 2023; 13:9494. [PMID: 37302994 DOI: 10.1038/s41598-023-36298-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/31/2023] [Indexed: 06/13/2023] Open
Abstract
Determining the optimal course of treatment for low grade glioma (LGG) patients is challenging and frequently reliant on subjective judgment and limited scientific evidence. Our objective was to develop a comprehensive deep learning assisted radiomics model for assessing not only overall survival in LGG, but also the likelihood of future malignancy and glioma growth velocity. Thus, we retrospectively included 349 LGG patients to develop a prediction model using clinical, anatomical, and preoperative MRI data. Before performing radiomics analysis, a U2-model for glioma segmentation was utilized to prevent bias, yielding a mean whole tumor Dice score of 0.837. Overall survival and time to malignancy were estimated using Cox proportional hazard models. In a postoperative model, we derived a C-index of 0.82 (CI 0.79-0.86) for the training cohort over 10 years and 0.74 (Cl 0.64-0.84) for the test cohort. Preoperative models showed a C-index of 0.77 (Cl 0.73-0.82) for training and 0.67 (Cl 0.57-0.80) test sets. Our findings suggest that we can reliably predict the survival of a heterogeneous population of glioma patients in both preoperative and postoperative scenarios. Further, we demonstrate the utility of radiomics in predicting biological tumor activity, such as the time to malignancy and the LGG growth rate.
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Affiliation(s)
- P Rauch
- Department of Neurosurgery, Kepler University Hospital, Wagner-Jauregg Weg 15, 4020, Linz, Austria
- Johannes Kepler University, Altenberger Strasse 69, 4040, Linz, Austria
| | - H Stefanits
- Department of Neurosurgery, Kepler University Hospital, Wagner-Jauregg Weg 15, 4020, Linz, Austria.
- Johannes Kepler University, Altenberger Strasse 69, 4040, Linz, Austria.
| | - M Aichholzer
- Department of Neurosurgery, Kepler University Hospital, Wagner-Jauregg Weg 15, 4020, Linz, Austria
- Johannes Kepler University, Altenberger Strasse 69, 4040, Linz, Austria
| | - C Serra
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital, University of Zurich, Zurich, Switzerland
- Machine Intelligence in Clinical Neuroscience (MICN) Lab, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - D Vorhauer
- Institute of Statistics, Johannes Kepler University, Linz, Austria
| | - H Wagner
- Institute of Statistics, Johannes Kepler University, Linz, Austria
| | - P Böhm
- Department of Neurosurgery, Kepler University Hospital, Wagner-Jauregg Weg 15, 4020, Linz, Austria
- Johannes Kepler University, Altenberger Strasse 69, 4040, Linz, Austria
| | - S Hartl
- Department of Neurosurgery, Kepler University Hospital, Wagner-Jauregg Weg 15, 4020, Linz, Austria
- Johannes Kepler University, Altenberger Strasse 69, 4040, Linz, Austria
| | | | - M Sonnberger
- Institute of Neuroradiology, Kepler University Hospital and Johannes Kepler University, Linz, Austria
| | - E Buckwar
- Institute of Stochastics, Johannes Kepler University, Linz, Austria
| | - F Ruiz-Navarro
- Department of Neurosurgery, Kepler University Hospital, Wagner-Jauregg Weg 15, 4020, Linz, Austria
- Johannes Kepler University, Altenberger Strasse 69, 4040, Linz, Austria
| | - K Heil
- Department of Neurosurgery, Kepler University Hospital, Wagner-Jauregg Weg 15, 4020, Linz, Austria
- Johannes Kepler University, Altenberger Strasse 69, 4040, Linz, Austria
| | - M Glöckel
- Department of Neurosurgery, Kepler University Hospital, Wagner-Jauregg Weg 15, 4020, Linz, Austria
- Johannes Kepler University, Altenberger Strasse 69, 4040, Linz, Austria
| | - J Oberndorfer
- Department of Neurosurgery, Kepler University Hospital, Wagner-Jauregg Weg 15, 4020, Linz, Austria
- Johannes Kepler University, Altenberger Strasse 69, 4040, Linz, Austria
| | - S Spiegl-Kreinecker
- Department of Neurosurgery, Kepler University Hospital, Wagner-Jauregg Weg 15, 4020, Linz, Austria
- Johannes Kepler University, Altenberger Strasse 69, 4040, Linz, Austria
| | - K Aufschnaiter-Hiessböck
- Department of Neurosurgery, Kepler University Hospital, Wagner-Jauregg Weg 15, 4020, Linz, Austria
- Johannes Kepler University, Altenberger Strasse 69, 4040, Linz, Austria
| | - S Weis
- Institute of Pathology and Neuropathology, Kepler University Hospital and Johannes Kepler University, Linz, Austria
| | - A Leibetseder
- Department of Neurology, Kepler University Hospital and Johannes Kepler University, Linz, Austria
| | - W Thomae
- Department of Neurosurgery, Kepler University Hospital, Wagner-Jauregg Weg 15, 4020, Linz, Austria
- Johannes Kepler University, Altenberger Strasse 69, 4040, Linz, Austria
| | - T Hauser
- Department of Neurosurgery, Kepler University Hospital, Wagner-Jauregg Weg 15, 4020, Linz, Austria
- Johannes Kepler University, Altenberger Strasse 69, 4040, Linz, Austria
| | - C Auer
- Department of Neurosurgery, Kepler University Hospital, Wagner-Jauregg Weg 15, 4020, Linz, Austria
- Johannes Kepler University, Altenberger Strasse 69, 4040, Linz, Austria
| | - S Katletz
- Department of Neurology, Kepler University Hospital and Johannes Kepler University, Linz, Austria
| | - A Gruber
- Department of Neurosurgery, Kepler University Hospital, Wagner-Jauregg Weg 15, 4020, Linz, Austria
- Johannes Kepler University, Altenberger Strasse 69, 4040, Linz, Austria
| | - M Gmeiner
- Department of Neurosurgery, Kepler University Hospital, Wagner-Jauregg Weg 15, 4020, Linz, Austria
- Johannes Kepler University, Altenberger Strasse 69, 4040, Linz, Austria
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5
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Altmann R, Scharnreitner I, Auer C, Hirtler L, Springer C, Falschlehner S, Arzt W. Visualization of the Third Ventricle, the Future Cavum Septi Pellucidi, and the Cavum Veli Interpositi at 11+3 to 13+6 Gestational Weeks on 3D Transvaginal Ultrasound Including Normative Data. Ultraschall Med 2023; 44:e72-e82. [PMID: 35213924 DOI: 10.1055/a-1683-6141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To show the development of the third ventricle, commissural plate, future cavum septi pellucidi, and cavum veli interpositi in weeks 12-14 by transvaginal 3D ultrasound. METHODS This is a prospective transvaginal 3D study carried out to define the third ventricle and the diencephalic midline structures surrounding it. 93 of 387 fetuses in which the commissural plate with the future cavum septi pellucidi, cavum veli interpositi, and the roof of the third ventricle could be well visualized, were selected with the choroid plexus of the third ventricle and the pituitary gland serving as leading structures. In a small number of fetuses, the optic chiasm could also be displayed. In addition, the following measurements were performed: third ventricle craniocaudal and anteroposterior, roof of the third ventricle/cavum veli interpositi, and fcsp. RESULTS The sonomorphologic characteristics of the commissural plate, the future cavum septi pellucidi, and the cavum veli interpositi are described IN 9% OF THE FETUSES examined. Measurements of the third ventricle, cavum veli interpositi, and the roof of the third ventricle show the following results: 3rd V cc = 3.895 + 0.091*CRL mm; 3rd V ap = 4.175 + 0.036*CRL mm; CVI ap = 2.223 + 0.029*CRL mm; CVI cc = 0.139 + 0.02*CRL mm. CONCLUSION Transvaginal neurosonography enables visualization and measurement of the normal fetal third ventricle at 12-14 weeks of gestation including visualization of the future cavum septi pellucidi and the cavum veli interpositi. BEFORE USE IN PATIENTS CAN BE CONSIDERED, FURTHER SCIENTIFIC WORK IS REQUIRED.
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Affiliation(s)
- Reinhard Altmann
- Prenatal Medicine, Kepler University Hospital Med Campus IV, Linz, Austria
| | - Iris Scharnreitner
- Prenatal Medicine, Kepler University Hospital Med Campus IV, Linz, Austria
| | - Christian Auer
- Department of Neurosurgery, Kepler University Hospital, Linz, Austria
| | - Lena Hirtler
- Center for Anatomy and Cell Biology, Medical University of Vienna, Wien, Austria
| | - Claudia Springer
- Prenatal Medicine, Kepler University Hospital Med Campus IV, Linz, Austria
| | - Stephanie Falschlehner
- Department of Gynecology and Obstetrics, Kepler University Hospital Med Campus IV, Linz, Austria
| | - Wolfgang Arzt
- Prenatal Medicine, Kepler University Hospital Med Campus IV, Linz, Austria
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Ekpenyong N, Heitz Tokpa K, Nwankwo O, O'Donnell D, Rodriguez Franco D, Berté S, Amani Kouassi S, Eteng G, Undelikwo V, Auer C, Guessan Bi GB, Oyo-Ita A, Bosch-Capblanch X. Using and improving the PHISICC paper-based tools in the health facility laboratories: Examples of Human Centered Design taking systems thinking into practice, in Côte d'Ivoire and Nigeria. Front Public Health 2022; 10:916397. [PMID: 36187697 PMCID: PMC9521270 DOI: 10.3389/fpubh.2022.916397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/28/2022] [Indexed: 01/22/2023] Open
Abstract
Background Health workers in low- and middle-income countries are increasingly demanded to collect more and more data to report them to higher levels of the health information system (HIS), in detriment of useful data for clinical and public health decision-making, potentially compromising the quality of their health care provison. In order to support health workers' decision-making, we engaged with partners in Côte d'Ivoire, Mozambique and Nigeria in a research project to conceive, design, produce, implement and test paper-based health information tools: the PHISICC tools. Our aim was to understand the use of PHISICC tools by health workers and to improve them based on their feedback. Methods The design Health Facility Laboratories (HF Labs) in Côte d'Ivoire and in Nigeria were set up after months of use of PHISICC tools. Activities were structured in three phases or 'sprints' of co-creative research. We used a transdisciplinary approach, including anthropology and Human Centered Design (HCD), observations, shadowing, structured interviews and co-creation. Results Health workers appreciated the standardization of the tools across different health care areas, with a common visual language that optimized use. Several design issues were raised, in terms of formats and contents. They strongly appreciated how the PHISICC registers guided their clinical decision-making and how it facilitated tallying and counting for monthly reporting. However, adherence to new procedures was not universal. The co-creation sessions resulted in modifications to the PHISICC tools of out-patient care and postnatal care. Discussion Although health systems and systemic thinking allowed the teams to embrace complexity, it was the HCD approach that actually produced a shift in researchers' mind-set: from HIS as data management tools to HIS as quality of care instruments. HCD allowed navigating the complexity of health systems interventions due to its capacity to operate change: it not only allowed us to understand how the PHISICC tools were used but also how to further improve them. In the absence of (or even with) an analytical health systems framework, HCD approaches can work in real-life situations for the ideation, testing and implementation of interventions to improve health systems and health status outcomes.
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Affiliation(s)
- Nnette Ekpenyong
- Department of Community Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Kathrin Heitz Tokpa
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire,University of Basel, Basel, Switzerland
| | - Ogonna Nwankwo
- Department of Community Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria,University of Basel, Basel, Switzerland,Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | | | | | - Salimata Berté
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire,Ecological Research Center, University of Nangui Abrogoua, Abidjan, Côte d'Ivoire
| | - Simplice Amani Kouassi
- Ministry of Health and Public Hygiene, Directorate General of Health, Abidjan, Côte d'Ivoire
| | - Glory Eteng
- Department of Social Work, University of Calabar, Calabar, Nigeria
| | | | - Christian Auer
- University of Basel, Basel, Switzerland,Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | | | - Angela Oyo-Ita
- Department of Community Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Xavier Bosch-Capblanch
- University of Basel, Basel, Switzerland,Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland,*Correspondence: Xavier Bosch-Capblanch
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Zuske M, Auer C, Oliver S, Eyers J, Bosch‐Capblanch X. Framework synthesis to inform the ideation and design of a paper-based health information system (PHISICC). Int J Health Plann Manage 2022; 37:1953-1972. [PMID: 35460301 PMCID: PMC9544999 DOI: 10.1002/hpm.3487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background Health information systems (HIS) are meant to support decision‐making at all levels of the system, including frontline health workers. In field studies in Côte d’Ivoire, Mozambique and Nigeria, we observed health workers' interactions with the HIS and identified twelve decision‐making components of HIS. The objective of this framework synthesis is to portray these components in HIS research, in order to inform the ideation of a paper‐based HIS intervention (PHISICC). Methods We searched studies in the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Epistemonikos, Medline, in‐Process on the Ovid platform, OpenGrey, PDQ Evidence (“pretty darnd quick” Evidence), the World Health Organization (WHO) Global Health Library and included studies focussing on HIS interventions, data quality, information support tools and data use for decision‐making in the context of the governmental health care sector. We assessed the methodological quality of studies using the Critical Appraisal Skills Programme tool. We synthesised the findings based on the decision‐making components of HIS and thematic areas. Results The search identified 6784 studies; 50 were included. Most of the 50 studies had quality concerns. All studies included at least one of the decision‐making components: the most prominent were the technical aspects of ‘recording’ and ‘reporting’. Data use for decision‐making was much less represented. Conclusion HIS research focuses on the more technical aspects of HIS. Further research on HIS, given the strong push towards HIS digitalisation, should consider putting at the centre the human experience of decision‐making and data use, in order to make HIS relevant for quality of care. Across the health system, Health Information Systems (HIS) are meant to support data management and use, which are key activities of health care delivery. Informed by existing frameworks and by fieldwork in three African countries, we identified twelve decision‐making components of HIS. In this framework synthesis, we found that the most common decision‐making components in the HIS literature were those related to the technical aspects of data ‘recording’ and ‘reporting’; data use for decision‐making was much less represented. For HIS instruments to facilitate improved health care delivery, clinical and public health decision‐making components of HIS should be put at the centre for HIS research, ideation and implementation.
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Affiliation(s)
- Meike‐Kathrin Zuske
- Swiss Tropical and Public Health InstituteAllschwilSwitzerland
- University of BaselBaselSwitzerland
| | - Christian Auer
- Swiss Tropical and Public Health InstituteAllschwilSwitzerland
- University of BaselBaselSwitzerland
| | - Sandy Oliver
- University College LondonEPPI‐CentreSocial Research InstituteLondonUK
- University of JohannesburgAfrica Centre for EvidenceFaculty of HumanitiesJohannesburgSouth Africa
| | - John Eyers
- Independent Consultant & Senior Research Fellow, 3ie, c/o LIDCLondonUK
| | - Xavier Bosch‐Capblanch
- Swiss Tropical and Public Health InstituteAllschwilSwitzerland
- University of BaselBaselSwitzerland
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Oyo-Ita AE, Hanlon P, Nwankwo O, Bosch-Capblanch X, Arikpo D, Esu E, Auer C, Meremikwu M. Cost-effectiveness analysis of an intervention project engaging Traditional and Religious Leaders to improve uptake of childhood immunization in southern Nigeria. PLoS One 2021; 16:e0257277. [PMID: 34529714 PMCID: PMC8445457 DOI: 10.1371/journal.pone.0257277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 08/27/2021] [Indexed: 11/18/2022] Open
Abstract
Vaccination is a cost-effective public health intervention, yet evidence abounds that vaccination uptake is still poor in many low- and middle-income countries. Traditional and Religious Leaders play a substantial role in improving the uptake of health services such as immunization. However, there is paucity of evidence on the cost-effectiveness of using such strategies. This study aimed to assess the cost-effectiveness of using a multi-faceted intervention that included traditional and religious leaders for community engagement to improve uptake of routine immunisation services in communities in Cross River State, Southern Nigeria. The target population for the intervention was traditional and religious leaders in randomly selected communities in Cross River State. The impact of the intervention on the uptake of routine vaccination among children 0 to 23 months was assessed using a cluster randomized trials. Outcome assessments were performed at the end of the project (36 months).The cost of the intervention was obtained from the accounting records for expenditures incurred in the course of implementing the intervention. Costs were assessed from the health provider perspective. The cost-effectiveness analysis showed that the incremental cost of the initial implementation of the intervention was US$19,357and that the incremental effect was 323 measles cases averted, resulting in an incremental cost-effectiveness ratio (ICER) of US$60/measles case averted. However, for subsequent scale-up of the interventions to new areas not requiring a repeat expenditure of some of the initial capital expenditure the ICER was estimated to be US$34 per measles case averted. Involving the traditional and religious leaders in vaccination is a cost-effective strategy for improving the uptake of childhood routine vaccinations.
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Affiliation(s)
- Angela E. Oyo-Ita
- Department of Community Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
- * E-mail:
| | - Patrick Hanlon
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Ogonna Nwankwo
- Department of Community Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Dachi Arikpo
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Ekperonne Esu
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Christian Auer
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Martin Meremikwu
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
- Department of Paediatrics, College of Medical Sciences, University of Calabar, Calabar, Nigeria
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Bosch-Capblanch X, O'Donnell D, Krause LK, Auer C, Oyo-Ita A, Samba M, Matsinhe G, Garba AB, Rodríguez D, Zuske M, Njepuome AN, Lee SMM, Ross A, Gajewski S, Muloliwa AM, Yapi RB, Brown DW. Researching, co-creating and testing innovations in paper-based health information systems (PHISICC) to support health workers' decision-making: protocol of a multi-country, transdisciplinary, mixed-methods research programme in three sub-Saharan countries. Health Res Policy Syst 2021; 19:112. [PMID: 34380518 PMCID: PMC8355573 DOI: 10.1186/s12961-021-00768-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/30/2021] [Indexed: 12/19/2022] Open
Abstract
Background Health information systems are crucial to provide data for decision-making and demand for data is constantly growing. However, the link between data and decisions is not always rational or linear and the management of data ends up overloading frontline health workers, which may compromise quality of healthcare delivery. Despite limited evidence, there is an increasing push for the digitalization of health information systems, which poses enormous challenges, particularly in remote, rural settings in low- and middle-income countries. Paper-based tools will continue to be used in combination with digital solutions and this calls for efforts to make them more responsive to local needs. Paper-based Health Information Systems in Comprehensive Care (PHISICC) is a transdisciplinary, multi-country research initiative to create and test innovative paper-based health information systems in three sub-Saharan African countries. Methods/Design The PHISICC initiative is being carried out in remote, rural settings in Côte d’Ivoire, Mozambique and Nigeria through partnership with ministries of health and research institutions. We began with research syntheses to acquire the most up-to-date knowledge on health information systems. These were coupled with fieldwork in the three countries to understand the current design, patterns and contexts of use, and healthcare worker perspectives. Frontline health workers, with designers and researchers, used co-creation methods to produce the new PHISICC tools. This suite of tools is being tested in the three countries in three cluster-randomized controlled trials. Throughout the project, we have engaged with a wide range of stakeholders and have maintained the highest scientific standards to ensure that results are relevant to the realities in the three countries. Discussion We have deployed a comprehensive research approach to ensure the robustness and future policy uptake of findings. Besides the innovative PHISICC paper-based tools, our process is in itself innovative. Rather than emphasizing the technical dimensions of data management, we focused instead on frontline health workers’ data use and decision-making. By tackling the whole scope of primary healthcare areas rather than a subset of them, we have developed an entirely new design and visual language for a suite of tools across healthcare areas. The initiative is being tested in remote, rural areas where the most vulnerable live.
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Affiliation(s)
- Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | | | - L Kendall Krause
- Bill & Melinda Gates Foundation, Seattle, WA, United States of America
| | - Christian Auer
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Angela Oyo-Ita
- Department of Community Medicine, University of Calabar, Calabar, Nigeria
| | - Mamadou Samba
- Ministère de La Santé et de l'Hygiène Publique, Abidjan, Côte d'Ivoire.,Université Félix Houphouet Boigny, Abidjan, Côte d'Ivoire
| | - Graça Matsinhe
- Expanded Program on Immunization, Ministry of Health, Maputo, Mozambique
| | - Abdullahi Bulama Garba
- Director Planning, Research and Statistics, National Primary Health Care Development Agency, Abuja, Nigeria
| | | | - Meike Zuske
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | | | - Amanda Ross
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Suzanne Gajewski
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Richard B Yapi
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire.,Centre d'Entomologie Médicale et Vétérinaire, Université Alassane Ouattara, Bouaké, Côte d'Ivoire
| | - David W Brown
- BCGI LLC / pivot-23.5°, Cornelius, NC, United States of America
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10
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Bosch-Capblanch X, Oyo-Ita A, Muloliwa AM, Yapi RB, Auer C, Samba M, Gajewski S, Ross A, Krause LK, Ekpenyong N, Nwankwo O, Njepuome AN, Lee SM, Sacarlal J, Madede T, Berté S, Matsinhe G, Garba AB, Brown DW. Does an innovative paper-based health information system (PHISICC) improve data quality and use in primary healthcare? Protocol of a multicountry, cluster randomised controlled trial in sub-Saharan African rural settings. BMJ Open 2021; 11:e051823. [PMID: 34326056 PMCID: PMC8323359 DOI: 10.1136/bmjopen-2021-051823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/07/2021] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Front-line health workers in remote health facilities are the first contact of the formal health sector and are confronted with life-saving decisions. Health information systems (HIS) support the collection and use of health related data. However, HIS focus on reporting and are unfit to support decisions. Since data tools are paper-based in most primary healthcare settings, we have produced an innovative Paper-based Health Information System in Comprehensive Care (PHISICC) using a human-centred design approach. We are carrying out a cluster randomised controlled trial in three African countries to assess the effects of PHISICC compared with the current systems. METHODS AND ANALYSIS Study areas are in rural zones of Côte d'Ivoire, Mozambique and Nigeria. Seventy health facilities in each country have been randomly allocated to using PHISICC tools or to continuing to use the regular HIS tools. We have randomly selected households in the catchment areas of each health facility to collect outcomes' data (household surveys have been carried out in two of the three countries and the end-line data collection is planned for mid-2021). Primary outcomes include data quality and use, coverage of health services and health workers satisfaction; secondary outcomes are additional data quality and use parameters, childhood mortality and additional health workers and clients experience with the system. Just prior to the implementation of the trial, we had to relocate the study site in Mozambique due to unforeseen logistical issues. The effects of the intervention will be estimated using regression models and accounting for clustering using random effects. ETHICS AND DISSEMINATION Ethics committees in Côte d'Ivoire, Mozambique and Nigeria approved the trials. We plan to disseminate our findings, data and research materials among researchers and policy-makers. We aim at having our findings included in systematic reviews on health systems interventions and future guidance development on HIS. TRIAL REGISTRATION NUMBER PACTR201904664660639; Pre-results.
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Affiliation(s)
- Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Basel, Basel-Stadt, Switzerland
- University of Basel, Basel, Basel-Stadt, Switzerland
| | - Angela Oyo-Ita
- Department of Community Medicine, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
| | | | - Richard B Yapi
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Lagunes, Côte d'Ivoire
| | - Christian Auer
- Swiss Tropical and Public Health Institute, Basel, Basel-Stadt, Switzerland
- University of Basel, Basel, Basel-Stadt, Switzerland
| | - Mamadou Samba
- Ministère de la Santé et de l'Hygiène Publique, Abidjan, Lagunes, Côte d'Ivoire
| | - Suzanne Gajewski
- Swiss Tropical and Public Health Institute, Basel, Basel-Stadt, Switzerland
- University of Basel, Basel, Basel-Stadt, Switzerland
| | - Amanda Ross
- Swiss Tropical and Public Health Institute, Basel, Basel-Stadt, Switzerland
- University of Basel, Basel, Basel-Stadt, Switzerland
| | | | - Nnette Ekpenyong
- Department of Community Medicine, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
| | - Ogonna Nwankwo
- Department of Community Medicine, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
| | | | | | - Jahit Sacarlal
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Tavares Madede
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Salimata Berté
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Lagunes, Côte d'Ivoire
| | - Graça Matsinhe
- Expanded Program on Immunization, Ministério da Saúde, Maputo, Mozambique
| | - Abdullahi Bulama Garba
- Planning, Research and Statistics, National Primary Healthcare Development Agency, Abuja, Nigeria
| | - David W Brown
- BCGI LLC / pivot-23.5°, Chapel Hill, North Carolina, USA
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11
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Hauser T, Auer C, Ludwiczek J, Senker W, Rauch PR, Kargl S, Gruber A. Treatment Options for Scrotal Migration of Ventriculoperitoneal Shunts: Case Illustration and Systematic Review of 48 Cases. Oper Neurosurg (Hagerstown) 2021; 21:87-93. [PMID: 33989403 DOI: 10.1093/ons/opab152] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Scrotal migration of intact or disconnected tubing is a rare complication of ventriculoperitoneal shunts. While some illustrative case reports can be found in the literature, a systematic review on treatment options is lacking. OBJECTIVE To propose the first literature-based treatment algorithm on scrotal shunt migration. METHODS We conducted a literature search using the keywords: "VP," "ventriculoperitoneal," "shunt," and "scrotum." We identified 36 publications with 48 cases reported including our index case. RESULTS Median age at presentation was 13.5 mo (3 d to 65 yr) which was 4 mo (3 d to 72 mo) after last shunt-related surgery. All patients had scrotal swelling, 39 (81%) patients presented without other symptoms, 4 (8%) had additionally local pain, and 4 (8%) patients presented with symptoms of shunt dysfunction. Treatment was surgically in all but one case where spontaneous resolution without repeat migration occurred. In 3 of 4 patients who had either subcutaneous shortening or abdominal repositioning of the shunt without hernia repair, scrotal shunt migration recurred within the following month. Whereas the surgical treatment with reposition of the migrated catheter back into the peritoneal cavity via a groin incision plus hernia repair yielded a definite treatment in all 26 performed cases, the revision rate was significantly higher in the shunt revision without hernia repair cohort (P = .0009). CONCLUSION Scrotal shunt migration is a rare shunt complication with good recovery when treated surgically. We recommend hernia repair in addition to either manual or surgical repositioning of migrated tubing.
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Affiliation(s)
- Thomas Hauser
- Department of Neurosurgery, Kepler University Hospital, Neuromedcampus, Linz, Austria.,Johannes Kepler University (JKU), Linz, Austria
| | - Christian Auer
- Department of Neurosurgery, Kepler University Hospital, Neuromedcampus, Linz, Austria.,Johannes Kepler University (JKU), Linz, Austria
| | - Johanna Ludwiczek
- Department of Pediatric Surgery, Kepler University Hospital, MedCampus 4, Linz, Austria
| | - Wolfgang Senker
- Department of Neurosurgery, Kepler University Hospital, Neuromedcampus, Linz, Austria.,Johannes Kepler University (JKU), Linz, Austria
| | - Philip-Rudolf Rauch
- Department of Neurosurgery, Kepler University Hospital, Neuromedcampus, Linz, Austria
| | - Simon Kargl
- Johannes Kepler University (JKU), Linz, Austria.,Department of Pediatric Surgery, Kepler University Hospital, MedCampus 4, Linz, Austria
| | - Andreas Gruber
- Department of Neurosurgery, Kepler University Hospital, Neuromedcampus, Linz, Austria.,Johannes Kepler University (JKU), Linz, Austria
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12
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Thomale UW, Auer C, Spennato P, Schaumann A, Behrens P, Gorelyshev S, Bogoslovskaia E, Shulaev A, Kabanian A, Seliverstov A, Alexeev A, Ozgural O, Kahilogullari G, Schuhmann M, Jimenez-Guerra R, Wittayanakorn N, Sukharev A, Marquez-Rivas J, Linsler S, Damaty AE, Vacek P, Lovha M, Guzman R, Stricker S, Beez T, Wiegand C, Azab M, Buis D, Sáez M, Fleck S, Dziugan C, Ferreira A, Radovnicky T, Bührer C, Lam S, Sgouros S, Roth J, Constantini S, Cavalheiro S, Cinalli G, Kulkarni AV, Bock HC. TROPHY registry - status report. Childs Nerv Syst 2021; 37:3549-3554. [PMID: 34184098 PMCID: PMC8578079 DOI: 10.1007/s00381-021-05258-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 06/08/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The TROPHY registry has been established to conduct an international multicenter prospective data collection on the surgical management of neonatal intraventricular hemorrhage (IVH)-related hydrocephalus to possibly contribute to future guidelines. The registry allows comparing the techniques established to treat hydrocephalus, such as external ventricular drainage (EVD), ventricular access device (VAD), ventricular subgaleal shunt (VSGS), and neuroendoscopic lavage (NEL). This first status report of the registry presents the results of the standard of care survey of participating centers assessed upon online registration. METHODS On the standard of treatment forms, each center indicated the institutional protocol of interventions performed for neonatal post-hemorrhagic hydrocephalus (nPHH) for a time period of 2 years (Y1 and Y2) before starting the active participation in the registry. In addition, the amount of patients enrolled so far and allocated to a treatment approach are reported. RESULTS According to the standard of treatment forms completed by 56 registered centers, fewer EVDs (Y1 55% Y2 46%) were used while more centers have implemented NEL (Y1 39%; Y2 52%) to treat nPHH. VAD (Y1 66%; Y2 66%) and VSGS (Y1 42%; Y2 41%) were used at a consistent rate during the 2 years. The majority of the centers used at least two different techniques to treat nPHH (43%), while 27% used only one technique, 21% used three, and 7% used even four different techniques. Patient data of 110 infants treated surgically between 9/2018 and 2/2021 (13% EVD, 15% VAD, 30% VSGS, and 43% NEL) were contributed by 29 centers. CONCLUSIONS Our results emphasize the varying strategies used for the treatment of nPHH. The international TROPHY registry has entered into a phase of growing patient recruitment. Further evaluation will be performed and published according to the registry protocol.
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Affiliation(s)
- U. W. Thomale
- Pediatric Neurosurgery, Campus Virchow Klinikum, Charité Universitätsmedizin, Berlin Augustenburger Platz 1, 13353 Berlin, Germany
| | - C. Auer
- Division of Pediatric Neurosurgery, Kepler Universitätsklinikum, Linz, Austria
| | - P. Spennato
- Pediatric Neurosurgery, AORN Santobono Pausilipon, Naples, Italy
| | - A. Schaumann
- Pediatric Neurosurgery, Campus Virchow Klinikum, Charité Universitätsmedizin, Berlin Augustenburger Platz 1, 13353 Berlin, Germany
| | - P. Behrens
- Pediatric Neurosurgery, Campus Virchow Klinikum, Charité Universitätsmedizin, Berlin Augustenburger Platz 1, 13353 Berlin, Germany
| | - S. Gorelyshev
- Pediatric Neurosurgery, Moscow Bashlyaeva Pediatric Hospital, Moscow, Russia
| | - E. Bogoslovskaia
- Pediatric Neurosurgery, Surgut Clinical Perinatal Center, Surgut, Russia
| | - A. Shulaev
- Pediatric Neurosurgery, Children’s Republic Clinical Hospital, Kazan, Russia
| | - A. Kabanian
- Pediatric Neurosurgery, Children’s Regional Hospital, Krasnodar, Russia
| | - A. Seliverstov
- Pediatric Neurosurgery, Kemerovo Regional Pediatric Hospital, Kemerovo, Russia
| | - A. Alexeev
- Pediatric Neurosurgery, Chelyabinsk Regional Children’s Clinical Hospital, Chelyabinsk, Russia
| | - O. Ozgural
- Neurosurgery, Ankara University, Ankara, Turkey
| | | | - M. Schuhmann
- Pediatric Neurosurgery, University Hospital of Tübingen, Tubingen, Germany
| | - R. Jimenez-Guerra
- Neonatal Neurosurgery, National Institute of Perinatology, Mexico City, Mexico
| | - N. Wittayanakorn
- Surgery, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - A. Sukharev
- Pediatric Neurosurgery, Regional Children Hospital, Yekaterinburg, Russia
| | | | - S. Linsler
- Neurosurgery, Saarland University Hospital, Homburg, Saarland Germany
| | - A. El Damaty
- Pediatric Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - P. Vacek
- Neurosurgery, University Hospital and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - M. Lovha
- Neurosurgery, Volyn Regional Pediatric Hospital, Lutsk, Ukraine
| | - R. Guzman
- Neurosurgery, Universitätskinderspital Beider Basel, Basel, Switzerland
| | - S. Stricker
- Neurosurgery, Universitätskinderspital Beider Basel, Basel, Switzerland
| | - T. Beez
- Neurosurgery, Heinrich-Heine-University, Duesseldorf, Germany
| | - C. Wiegand
- Neurosurgery, Marienhospital, Osnabrück, Germany
| | - M. Azab
- Neurosurgery, Damietta Specialized Hospital, Damietta, Egypt
| | - D. Buis
- Neurosurgery, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - M. Sáez
- Neurosurgery, Hospital La Paz, Madrid, Spain
| | - S. Fleck
- Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - C. Dziugan
- Pediatric Neurosurgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, USA
| | - A. Ferreira
- Neurosurgery, Centro Hospitalar Universitário São João, Porto, Portugal
| | - T. Radovnicky
- Neurosurgery, Masaryk Hospital, Usti Nad Labem, Czech Republic
| | - C. Bührer
- Pediatric Neurosurgery, Campus Virchow Klinikum, Charité Universitätsmedizin, Berlin Augustenburger Platz 1, 13353 Berlin, Germany
| | - S. Lam
- Pediatric Neurosurgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, USA
| | - S. Sgouros
- Pediatric Neurosurgery, Iaso Childrens Hospital, Athens, Greece
| | - J. Roth
- Pediatric Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - S. Constantini
- Pediatric Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - S. Cavalheiro
- Pediatric Neurosurgery, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - G. Cinalli
- Pediatric Neurosurgery, AORN Santobono Pausilipon, Naples, Italy
| | - A. V. Kulkarni
- Pediatric Neurosurgery, Sick Children Hospital, University of Toronto, Toronto, Canada
| | - H. C. Bock
- Pediatric Neurosurgery, University Medical Center Göttingen, Gottingen, Germany
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Auer C, Mazitov R, Makhmudov A, Pirmahmadzoda B, Skrahina A, Dobre A, Sécula F, Bosch-Capblanch X, Van den Boom M, Migliori GB, Mdivani N, Yassin MA. Factors contributing to drug-resistant tuberculosis treatment outcome in five countries in the Eastern Europe and Central Asia region. Monaldi Arch Chest Dis 2020; 90. [PMID: 32231347 DOI: 10.4081/monaldi.2020.1235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/11/2020] [Indexed: 11/22/2022] Open
Abstract
Drug-resistant tuberculosis (DR-TB) is a global challenge and a major contributor of death from anti-microbial resistance. With the main aim to determine factors contributing to treatment outcomes observed among DR-TB patients in the countries in Eastern Europe and Central Asia (EECA), a multi-method study was conducted in: Azerbaijan, Belarus, Romania, Tajikistan and Ukraine. Both quantitative and qualitative methodologies were used for data collection and analysis. The quantitative approaches included a desk review of documents related to the DR-TB responses and an analysis of clinical records of DR-TB patients in selected health facilities of the five countries. Qualitative methods included in-depth interviews with national TB programme (NTP) managers, other healthcare providers and non-governmental organizations (NGOs) workers, as well as interviews and Focus Group Discussions (FGDs) with DR-TB patients. The desk review of 38 reports identified as the main challenges to address DR-TB financial and/or management issues and adverse events of the medicines. The most common recommendations related to treatment outcome focussed on general programme management, treatment regimen composition, clinical management and social support for the patients. In all the five countries the NTPs still have a vertical structure. Some integration into the primary health care system (PHC) already exists but further involvement of PHC facilities is feasible and recommended. Interviews with stakeholders indicated that alcoholism and homelessness and a lack of appropriate response to these issues remain as major challenges for a sub-set of patients. Civil society groups, NGOs and communities are substantially engaged in providing different services to DR-TB patients, especially in Ukraine, Romania and Tajikistan. Data from clinical records of 212 patients revealed that independent risk factors for unfavourable treatment outcome (death, loss to follow-up, failure) were culture-positivity at two months of treatment, history of treatment with second-line drugs and homelessness. More powerful, less toxic and shorter oral treatment regimens as well as comprehensive patient support are needed to improve treatment outcome of patients with DR-TB.
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Affiliation(s)
- Christian Auer
- Swiss Tropical and Public Health Institute, Basel; University of Basel.
| | | | | | | | - Alena Skrahina
- Republican Scientific and Practical Centre for Pulmonology and TB, Minsk.
| | | | - Florence Sécula
- Swiss Tropical and Public Health Institute, Basel; University of Basel.
| | | | | | - Giovanni Battista Migliori
- World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Maugeri Care and Research Institute IRCCS, Tradate.
| | - Nino Mdivani
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva.
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Oechtering TH, Sieren M, Schubert K, Schaller T, Scharfschwerdt M, Panagiotopoulos A, Fujita B, Auer C, Barkhausen J, Ensminger S, Sievers HH, Frydrychowicz A. In vitro 4D Flow MRI evaluation of aortic valve replacements reveals disturbed flow distal to biological but not to mechanical valves. J Card Surg 2019; 34:1452-1457. [PMID: 31638731 DOI: 10.1111/jocs.14253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Aortic hemodynamics influence the integrity of the vessel wall and cardiac afterload. The aim of this study was to compare hemodynamics distal to biological (BV) and mechanical aortic valve (MV) replacements by in vitro 4D Flow MRI excluding confounding factors of in-vivo testing potentially influencing hemodynamics. METHODS Two BV (Perimount MagnaEase [Carpentier-Edwards], Trifecta [Abbott]) and two MV (On-X [CryoLife], prototype trileaflet valve) were scanned in a flexible aortic phantom at 3T using a recommended 4D Flow MR sequence. A triphasic aortic flow profile with blood-mimicking fluid was established. Using GTFlow (Gyrotools), area and velocity of the ejection jet were measured. Presence and extent of sinus vortices and secondary flow patterns were graded on a 0 to 3 scale. RESULTS A narrow, accelerated central ejection jet (Area = 27 ± 7% of vessel area, Velocity = 166 ± 13 cm/s; measured at sinotubular junction) was observed in BV as compared to MV (Area = 53 ± 13%, Velocity = 109 ± 21 cm/s). As opposed to MV, the jet distal to BV impacted the outer curvature of the ascending aorta and resulted in large secondary flow patterns (BV: n = 4, grades 3, 3, 2, 1; MV: n = 1, grade 1). Sinus vortices only formed distal to MV. Although physiologically configured, they were larger than normal (grade 3). CONCLUSIONS In contrast to mechanical valves, biological valve replacements induced accelerated and increased flow patterns deviating from physiological ones. While it remains speculative whether this increases the risk of aneurysm formation through wall shear stress changes, findings are contrasted by almost no secondary flow patterns and typical, near-physiological sinus vortex formation distal to mechanical valves.
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Affiliation(s)
- Thekla H Oechtering
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Malte Sieren
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Kathrin Schubert
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Tim Schaller
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Michael Scharfschwerdt
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Apostolos Panagiotopoulos
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Buntaro Fujita
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Christian Auer
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Jörg Barkhausen
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Stephan Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Hans-Hinrich Sievers
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Alex Frydrychowicz
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany
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Auer C, Bosch-Capblanch X. Taking tuberculosis seriously requires that we take poverty seriously: reinstating the ethics of public health. Int J Tuberc Lung Dis 2018; 22:1390-1391. [DOI: 10.5588/ijtld.18.0604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Christian Auer
- Swiss Tropical and Public Health Institute, Basel, University of Basel, Basel, Switzerland
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Basel, University of Basel, Basel, Switzerland
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Auer C, Kiefer S, Zuske M, Schindler C, Wyss K, Blum J, Bosch-Capblanch X, Widmer U, Sauthier S, Janssens JP, Bossard K, Chatonnet C, Mazza-Stalder J, Začek B, Zellweger JP, Altpeter E, Mäusezahl M. Health-seeking behaviour and treatment delay in patients with pulmonary tuberculosis in Switzerland: some slip through the net. Swiss Med Wkly 2018; 148:w14659. [PMID: 30232794 DOI: 10.4414/smw.2018.14659] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AIMS OF THE STUDY To assess the health-seeking behaviour, the patient delay (onset of symptoms to first consultation) and the health system delay (first consultation to start of tuberculosis treatment) among patients with pulmonary tuberculosis (TB) diagnosed in Switzerland, and to assess the predictors of the various types of delay. METHODS A survey among pulmonary TB patients was carried out in six cantons, covering 42% of all pulmonary adult TB cases notified in Switzerland. Data were collected by collaborators of the cantonal lung associations in charge of the follow-up of TB patients to investigate treatment seeking behaviour and to establish various delays and its predictors. Predictors of percentiles of delay (median and 75th percentile) were assessed using quantile regression. RESULTS Among 252 eligible patients, 162 patients could be interviewed. Of these, 20.4% were born in Switzerland. Cough as a symptom was mentioned by 76% of the interviewed patients. Almost half of the 162 patients (46%) consulted first a general practitioner in an ambulatory care setting and 26% approached a hospital first. The median delay between symptom onset and first healthcare contact (patient delay) was 5.2 weeks, which is slightly longer than findings in other low prevalence countries. The interquartile range was 1.6 to 14.2 weeks. The median delay between first consultation in Switzerland and the start of TB treatment (health system delay) was 2 weeks. The interquartile range was 0.6 to 7.1 weeks. There were no clear predictors of patient delay. The main predictors of a longer median health system delay were the presence of fever (1.6 weeks, 95% confidence interval [CI] 0.5 to 2.6 weeks), having visited first a general practitioner or a paediatrician (1 week, 95% CI 0.1 to 1.9 weeks) and having seen three or four doctors before beginning TB treatment (2.9 weeks, 95% CI 0.7 to 5.1 weeks). A clear predictor of a shorter median health system delay was having undergone an X-ray at the first consultation (-2.9 weeks, 95% CI -4.8 to -0.9 weeks). Marginally significant for shorter delay was male sex (-2.6 weeks, 95% CI -5.4 to 0.1 weeks). CONCLUSIONS No predictor of patient delay was found among the variables collected. For one fourth of the patients, the health system delay was longer than 7 weeks. General practitioners are commonly approached first, and they have to consider TB, also for patients not considered at high-risk for TB.
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Affiliation(s)
- Christian Auer
- Swiss Tropical and Public Health Institute, Basel, Switzerland / University of Basel, Switzerland
| | - Sabine Kiefer
- Swiss Tropical and Public Health Institute, Basel, Switzerland / University of Basel, Switzerland
| | - Meike Zuske
- Swiss Tropical and Public Health Institute, Basel, Switzerland / University of Basel, Switzerland
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, Basel, Switzerland / University of Basel, Switzerland
| | - Kaspar Wyss
- Swiss Tropical and Public Health Institute, Basel, Switzerland / University of Basel, Switzerland
| | - Johannes Blum
- Swiss Tropical and Public Health Institute, Basel, Switzerland / University of Basel, Switzerland
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Basel, Switzerland / University of Basel, Switzerland
| | - Ursula Widmer
- Lung Association of Canton Aargau, Aarau, Switzerland
| | - Sonia Sauthier
- Division of Pneumology, Department of Medical Specialities, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Paul Janssens
- Division of Pneumology, Department of Medical Specialities, Geneva University Hospitals, Geneva, Switzerland
| | | | - Christophe Chatonnet
- Lung Association of Canton Vaud (Ligue Pulmonaire Vaudoise), Lausanne, Switzerland
| | - Jesica Mazza-Stalder
- Division of Respiratory Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Bea Začek
- TB Centre of the Lung Association of Canton Zurich (Verein Lunge Zürich), Zurich, Switzerland
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Bosch-Capblanch X, Zuske MK, Auer C. Research on subgroups is not research on equity attributes: Evidence from an overview of systematic reviews on vaccination. Int J Equity Health 2017; 16:95. [PMID: 28592273 PMCID: PMC5463415 DOI: 10.1186/s12939-017-0587-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 05/22/2017] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Equity remains a priority in the international health development agenda. However, major inequities in vaccination coverage jeopardise the achievement of the Sustainable Development Goals. We aim at comprehensively describing how research has addressed equity issues related to vaccination. METHODS We carried out an overview of systematic reviews (SRs) that explicitly explored the effects of interventions to improve vaccination in any context; for any vaccine and, in any language. We followed standard research synthesis methods to systematically search for SR, assess them for inclusion and extracting relevant data, particularly on vaccination related outcomes. To gather evidence on equity issues addressed in the SR, we used the PROGRESS-plus framework. FINDINGS Our search obtained 2,003 hits which resulted in 54 included SRs, published between 1994 and 2014. The quality of SRs was generally poor, with less than half complying with most of the quality criteria. Reported vaccines included, by order of frequency, influenza and Expanded Programme on Immunisation vaccines. The types of interventions more frequently reported were related to vaccination delivery strategies, financial support and information, education and communication. Most of the SRs suggested effects favouring intervention groups as opposed to comparison groups. The most frequently reported equity attribute was 'place of residence' and the least reported equity attributes were sexual orientation and religion. Very few estimates of effects actually measured differences or changes between groups having those attributes and all of them referred to the place of residence. No data was found about reducing equity gaps for vulnerable groups or minorities, or attributes such as sexual orientation, education or specific religious groups. CONCLUSIONS Although research on vulnerable populations as a subgroup is abundant, it fails to report on the interventions that will actually reduce inequities and consider how redistribution of health care resources could shrink the gap between the privileged and most vulnerable groups including minorities. Research, if aiming at being responsive to global health policy trends, needs to report not only on specific attributes but also on how a better redistribution of health care resources could contribute to alleviating the unjust situation of the most vulnerable populations.
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Affiliation(s)
- Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002 Basel, Switzerland
- Universität Basel, Petersplatz 1, 4003 Basel, Switzerland
| | - Meike-Kathrin Zuske
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002 Basel, Switzerland
- Universität Basel, Petersplatz 1, 4003 Basel, Switzerland
| | - Christian Auer
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002 Basel, Switzerland
- Universität Basel, Petersplatz 1, 4003 Basel, Switzerland
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Gmeiner M, Wagner H, Zacherl C, Polanski P, Auer C, van Ouwerkerk WJR, Holl K. Long-term mortality rates in pediatric hydrocephalus-a retrospective single-center study. Childs Nerv Syst 2017; 33:101-109. [PMID: 27766469 DOI: 10.1007/s00381-016-3268-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 10/05/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Very long-term follow-up and outcome are rare for pediatric patients with hydrocephalus and shunt operations. The aim of this study was to determine the long-term mortality rates in these patients. METHODS Pediatric patients with first shunt operation between 1982 and 1992 were included. For each patient, time and cause of death were determined. Further, patients with first operation from 1982 to 1987 were compared to those first operated from 1988 to 1992. RESULTS One-hundred thirty-seven patients were included. Etiologies of hydrocephalus were intraventricular hemorrhage (31.4 %), meningomyelocele (25.5 %), postinfectious (11.7 %), congenital (10.2 %), posterior fossa cyst (8.8 %), aqueductal stenosis (8 %), and others (4.4 %). Overall, 53 patients (38.7 %) died. The percentage of patients surviving 1, 2, 10, and 20 years after first operation were 82.6, 73.6, 69.4, and 65.3 %, respectively. In 23 patients, the cause of death was related to shunt treatment: shunt infection was diagnosed in 18 and acute shunt dysfunction in 5 patients. Mortality was considerably higher for patients with their first operation in time period 1982-1987 compared to time period 1988-1992 (51 versus 25 %). The reduction of mortality was mainly due to an increased survival after shunt infection. Eighty-seven patients survived more than 20 years after initial shunt operation. Of those long-term survivors, three (3.4 %) patients died 22-24 years after first operation. CONCLUSION Mortality in hydrocephalic pediatric patients is high especially in the first postoperative years but is even significant in adult patients with pediatric hydrocephalus. As deaths occur even after 20 years, routine follow-up of long-term survivors remains necessary.
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Affiliation(s)
- Matthias Gmeiner
- Division of Neurosurgery, Kepler-Universitätsklinikum Linz, Wagner-Jauregg-Weg 15A, 4020, Linz, Austria.
| | - Helga Wagner
- Department of Applied Statistics, Johannes Kepler University, Linz, Austria
| | - Christoph Zacherl
- Division of Neurosurgery, Kepler-Universitätsklinikum Linz, Wagner-Jauregg-Weg 15A, 4020, Linz, Austria
| | - Petra Polanski
- Department of Pediatric Surgery, Children's Hospital, Linz, Austria
| | - Christian Auer
- Division of Neurosurgery, Kepler-Universitätsklinikum Linz, Wagner-Jauregg-Weg 15A, 4020, Linz, Austria
| | - Willem J R van Ouwerkerk
- Department of Neurosurgery, Vrije Universitet University Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Kurt Holl
- Division of Neurosurgery, Kepler-Universitätsklinikum Linz, Wagner-Jauregg-Weg 15A, 4020, Linz, Austria
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Auer C, Scharfschwerdt M, Yan J, Sievers HH, Hanke T. Hemodynamic Behavior of Two 4th Generation Aortic Valve Bioprosthesis during Exercise. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Considering the controversially discussed issue of whiplash injury a pragmatic approach based on our own experience in the area of forensic expert opinion is presented. Findings of accident analysis and biomechanics are correlated with the individual situation after the accident (initial clinical appearance), the course of the ailment and the indispensable physical examination. The latter leads to determination of the individual vulnerability (not increased/increased) which is important for the evaluation of the physical condition and estimation of the physical stress limit. These limits vary widely between individuals and must be considered carefully when relating dose and effect of accident severity to a possible physical injury. Determination of the accident severity is especially important when there are no objective signs of injury and the existence of a minor whiplash injury (Quebec Task Force degree 1 or 2) is in question.
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Affiliation(s)
- M N Magin
- Spezialpraxis für Orthopädie und Unfallchirurgie, Bahnhofsweg 10, 82008, Unterhaching/München, Deutschland,
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Hanke T, Charitos EI, Stierle U, Auer C, Sievers HH. Hemodynamic performance of a new aortic valve bioprostheses (Trifecta; St. Jude Medical) at rest and exercise. A comparative study. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Eisenmann U, Wirths M, Metzner R, Auer C, Dickhaus H. GPU-Based Interactive Segmentation For Planning And Performing Neurosurgical Interventions. BIOMED ENG-BIOMED TE 2013; 58 Suppl 1:/j/bmte.2013.58.issue-s1-L/bmt-2013-4256/bmt-2013-4256.xml. [DOI: 10.1515/bmt-2013-4256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Auer C, Kallus S, Eisenmann U, Korber J, Wolf SI, Dickhaus H. An Experimental Setup for Instrumental Analysis of Femoral Derotation Osteotomy. BIOMED ENG-BIOMED TE 2013; 58 Suppl 1:/j/bmte.2013.58.issue-s1-M/bmt-2013-4302/bmt-2013-4302.xml. [DOI: 10.1515/bmt-2013-4302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Preusser M, Woehrer A, Zielonke N, Heinzl H, Auer C, Waldhoer T, Roessler K, Marosi C, Hainfellner JA. Real-life survival in unselected adult glioblastoma patients: A population-based study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.2014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Auer C, Roques A, Goussard F, Charles PJ. Effets de l'accroissement provoqué du niveau de population de la tordeuse du mélèze Zeiraphera diniana Guénée (Lep., Tortricidae) au cours de la phase de régression dans un massif forestier du Briançonnais1. ACTA ACUST UNITED AC 2009. [DOI: 10.1111/j.1439-0418.1981.tb01676.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Auer C. Erste Ergebnisse einfacher stochastischer Modelluntersuchungen über die Ursachen der Populationsbewegung des grauen Lärchenwicklers Zeiraphera diniana, Gn. (=Z. griseana Hb.) im Oberengadin, 1949/66. ACTA ACUST UNITED AC 2009. [DOI: 10.1111/j.1439-0418.1968.tb04121.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gosoniu GD, Ganapathy S, Kemp J, Auer C, Somma D, Karim F, Weiss MG. Gender and socio-cultural determinants of delay to diagnosis of TB in Bangladesh, India and Malawi. Int J Tuberc Lung Dis 2008; 12:848-855. [PMID: 18544215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
SETTING Tuberculosis (TB) control programmes in Bangladesh, India and Malawi. OBJECTIVE To compare the interval from symptom onset to diagnosis of TB for men and women, and to assess socio-cultural and gender-related features of illness explaining diagnostic delay. DESIGN Semi-structured Explanatory Model Interview Catalogue (EMIC) interviews were administered to 100 or more patients at each site, assessing categories of distress, perceived causes and help seeking. Based on time from initial symptoms to diagnosis of TB, patients were classified with problem delay (>90 days), timely diagnosis (< or =30 days) or moderate delay. EMIC interview data were analysed to explain problem delay. RESULTS The median interval from symptom onset to diagnosis was longest in India and shortest in Malawi. With adjustment for confounding, female sex (Bangladesh), and status of married woman (India) and housewife (Malawi) were associated with problem delay. Prominent non-specific symptoms--chest pain (Bangladesh) and breathlessness (Malawi)--were also significant. Cough in India, widely associated with TB, was associated with timely diagnosis. Sanitation as a perceived cause linked to poor urban conditions was associated with delayed diagnosis in India. Specific prior help seeking with circuitous referral patterns was identified. CONCLUSION The study identified gender- and illness-related features of diagnostic delay. Further research distinguishing patient and provider delay is needed.
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Affiliation(s)
- G D Gosoniu
- Department of Public Health and Epidemiology, Swiss Tropical Institute, Basel, Switzerland
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Weiss MG, Somma D, Karim F, Abouihia A, Auer C, Kemp J, Jawahar MS. Cultural epidemiology of TB with reference to gender in Bangladesh, India and Malawi. Int J Tuberc Lung Dis 2008; 12:837-847. [PMID: 18544214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
SETTING TB control programmes in Bangladesh, India and Malawi. OBJECTIVE To identify and compare socio-cultural features of tuberculosis (TB) and the distribution of TB-related experiences, meanings and behaviours with reference to gender across cultures in three high-endemic low-income countries. DESIGN Approximately 100 patients at three sites were interviewed with in-depth semi-structured Explanatory Model Interview Catalogue (EMIC) interviews inquiring about patterns of distress, perceived causes and help-seeking behaviours in the context of illness narratives. RESULTS Female patients reported more diverse symptoms and men more frequently focused on financial concerns. Most patients reported psychological and emotional distress. Men emphasised smoking and drinking alcohol as causes of TB, and women in Malawi reported sexual causes associated with HIV/AIDS. In Bangladesh, exaggerated concerns about the risk of spread despite treatment contributed to social isolation of women. Public health services were preferred in Malawi, and private doctors in India and Bangladesh. CONCLUSION Cross-site analysis of these studies has identified features of TB that influence the burden of disease and are likely to affect timely help seeking and adherence to treatment. Health systems benefit from sex-disaggregated epidemiological data complemented by cultural epidemiological study, which together clarify the role of gender and contribute to the knowledge base for TB control at various levels.
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Affiliation(s)
- M G Weiss
- Department of Public Health and Epidemiology, Swiss Tropical Institute, Basel, Switzerland.
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Somma D, Thomas BE, Karim F, Kemp J, Arias N, Auer C, Gosoniu GD, Abouihia A, Weiss MG. Gender and socio-cultural determinants of TB-related stigma in Bangladesh, India, Malawi and Colombia. Int J Tuberc Lung Dis 2008; 12:856-866. [PMID: 18544216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
SETTING Tuberculosis (TB) control programmes in Bangladesh, India, Malawi and Colombia. OBJECTIVE Assess indicators of TB-related stigma and socio-cultural and gender-related features of illness associated with stigma. DESIGN Semi-structured Explanatory Model Interview Catalogue (EMIC) interviews were administered to 100 or more patients at each site, assessing categories of distress, perceived causes and help seeking. Indicators of self-perceived stigma were analysed individually and in a validated index, which was compared across sites and between men and women at each site. Cultural epidemiological explanatory variables for stigma and interactions with female sex were analysed at each site. Qualitative illness narratives were examined to explain the role and context of explanatory variables. RESULTS The overall stigma index was highest in India, lowest in Malawi and greater for women in Bangladesh. In India and Malawi, women were more likely to be concerned about impact on marital prospects. Associations with HIV/AIDS were linked to TB stigma in Malawi, where sexual contact as a perceived cause was more associated with stigma for men and less for women. CONCLUSION Stigma both influences and indicates the effectiveness of TB control. Cultural epidemiological methods clarify cross-cutting and local features of stigma and gender for TB control.
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Affiliation(s)
- D Somma
- Department of Public Health and Epidemiology, Swiss Tropical Institute, Basel, Switzerland
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Lichtenberger P, Auer C, Schürrer F. A SemiContinuous Solution of the Boltzmann Equation for Carrier‐Carrier and Carrier‐Phonon Interaction. ACTA ACUST UNITED AC 2007. [DOI: 10.1080/00411450701465700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Auer C, Lagahid JY, Tanner M, Weiss MG. Diagnosis and management of tuberculosis by private practitioners in Manila, Philippines. Health Policy 2005; 77:172-81. [PMID: 16099529 DOI: 10.1016/j.healthpol.2005.07.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2004] [Accepted: 07/10/2005] [Indexed: 11/16/2022]
Abstract
SETTING Private for-profit health care providers are prominent in the health system of the Philippines. OBJECTIVES To examine the practices of the private practitioners in Malabon, Metropolitan Manila, Philippines, concerning diagnosis and treatment of tuberculosis (TB). DESIGN Forty-five private practitioners of Malabon who treat adult TB patients were interviewed. RESULTS For diagnosis, most private practitioners relied on the clinical presentation and result of an X-ray. Only 13% of the respondents routinely also asked for sputum examination. Ninety-six percent used X-ray as a tool to monitor treatment. Sixty percent of the respondents prescribed a regimen consisting of isoniazid, rifampicin, pyrazinamide, and ethambutol. Except for rifampicin, over-dosage was common. For re-treatment cases, none prescribed the WHO-recommended re-treatment regimen. The private practitioners perceived the main reasons for patient non-adherence to be the patients' lack of finances to buy drugs and patients' perceived well being after a certain period of treatment. Patients' lack of money was seen as the main obstacle to compliance. The only case holding mechanism mentioned was occasional clinic appointments of the TB patients. CONCLUSION Private practices for diagnosis and treatment of TB typically deviate from guidelines. The quality of care among private practitioners needs improvement. Innovative strategies are required.
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Affiliation(s)
- Christian Auer
- Department of Public Health and Epidemiology, Swiss Tropical Institute, Socinstr. 57, CH-4002 Basel, Switzerland.
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Auer C, Mair R, Geiselseder G, Sames E, Buhl P, Gross C. A novel technique of antegrade cerebral perfusion in the newborn with critical aortic stenosis. J Extra Corpor Technol 2004; 36:129-32. [PMID: 15334751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Various methods of cerebral protection have been used during such aortic arch operations as the Norwood Procedure and operations on the interrupted aortic arch in neonates and infants. Deep hypothermia with circulatory arrest is the most common technique, but has a limited safe period for circulatory arrest. Antegrade cerebral perfusion has been introduced to prolong this safe period. We reviewed our experience with antegrade cerebral perfusion during surgical repair, in a patient with hypoplastic left heart syndrom in stage 1 palliation.
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Affiliation(s)
- Christian Auer
- Department of Medical Technology/Perfusion Unit, AKH-Linz, Austria.
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Abstract
BACKGROUND If medical treatment fails in uveitic glaucoma a surgical approach should be considered. Classical trabeculectomy is known to have a less favourable outcome in uveitis. Our intention is to report the first series of uveitis patients with glaucoma resistant to medical therapy who were treated with deep sclerectomy (DS). PATIENTS AND METHODS Fourteen eyes of 13 patients (mean age 39.0 +/- 18.5 years; range 8 to 76 years) with chronic uveitis underwent non-penetrating filtering surgery from 1995 to 2003. All patients had their uveitis controlled before and after surgery by immunomodulatory therapy. Non-penetrating filtering surgery consisted of DS with collagen implant (Staar(R)) in 4 eyes, DS with draining device (T-Flux Ioltech(R)) in 2 patients, DS without implant in 7 patients and with viscocanalostomy in 1 patient. Nine eyes (65 %) received mitomycin C peri-operatively. RESULTS Intra-ocular pressure (IOP) was reduced from a mean pre-operative value of 42.8 +/- 13.6 mmHg to a 1-year mean post-operative value of 12.1 +/- 4.0 (71.7 % reduction). Eleven of the 14 eyes completed 12 months of follow-up, resulting in complete success in 5 (45.4 %) and in qualified success in 5 (45 %) and in failure in one patient (9.2 %), later controlled by a second operation. Anti-glaucomatous medication was reduced from a mean of 3.7 +/- 0.5 medications preoperatively to 1.2 +/- 0.8 medications (71.4 % reduction) at the 12 month follow-up. Nine of the 14 patients achieved a 24 month follow-up with a mean IOP of 14.1 +/- 3.8 mmHg and mean of anti-glaucomatous medications of 1.6. Four patients have been examined 4 years after the DS: mean IOP was 13.2 +/- 2.2 mmHg and mean medication 1.7 +/- 1.0. Post-operative complications included one case of lens opacity and 2 cases of hypotony lasting for five months and four weeks after the intervention respectively. CONCLUSION Non-penetrating filtering surgery controlled the intra-ocular pressure in 90 % of eyes with uveitic glaucoma resistant to medical therapy at 12 months. Surgical complications were low which may explain the high success rate of the procedure, compared to classical penetrating surgery.
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Affiliation(s)
- C Auer
- Inflammatory Eye Diseases, Centre Ophtalmologique de la Source, Lausanne, Switzerland
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Jaworska JS, Comber M, Auer C, Van Leeuwen CJ. Summary of a workshop on regulatory acceptance of (Q)SARs for human health and environmental endpoints. Environ Health Perspect 2003; 111:1358-60. [PMID: 12896859 PMCID: PMC1241619 DOI: 10.1289/ehp.5757] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
The "Workshop on Regulatory Use of (Q)SARs for Human Health and Environmental Endpoints," organized by the European Chemical Industry Council and the International Council of Chemical Associations, gathered more than 60 human health and environmental experts from industry, academia, and regulatory agencies from around the world. They agreed, especially industry and regulatory authorities, that the workshop initiated great potential for the further development and use of predictive models, that is, quantitative structure-activity relationships [(Q)SARs], for chemicals management in a much broader scope than is currently the case. To increase confidence in (Q)SAR predictions and minimization of their misuse, the workshop aimed to develop proposals for guidance and acceptability criteria. The workshop also described the broad outline of a system that would apply that guidance and acceptability criteria to a (Q)SAR when used for chemical management purposes, including priority setting, risk assessment, and classification and labeling.
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Abstract
The present study investigates whether physiological activity may play a part in maintaining the amplified perception of bodily processes typical for somatization. Eighty-one persons were classified into three groups by means of a structured clinical interview: 24 patients with somatization syndrome, 34 patients with somatization syndrome and comorbid major depression, and 23 healthy controls. Subjects completed four blocks of an attentional task, each of the blocks separated by resting periods. Physiological patterns demonstrated higher activity during mental tasks than during rest. The heart rate deceleration after changing from mental challenge to rest was less pronounced in the groups of patients with somatization syndrome than in controls. Moreover, patients with somatization syndrome reported feeling more and more tense during the investigation, while controls showed the tendency to habituate. The effects of heart rate and of feelings of tension partly replicated earlier findings, and demonstrated that physiological activity may interact with psychological processes in somatization.
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Affiliation(s)
- W Rief
- Clinic Roseneck, Center for Behavioral Medicine, Am Roseneck 6, D-83209, Prien am Chiemsee, Germany.
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Abstract
BACKGROUND Inflammatory choriocapillaropathies (choriocapillaritis) correspond to the clinical spectrum of lesions of the fundus, including acute posterior multifocal placoid pigment epitheliopathy (APMPPE), multiple evanescent white dot syndrome (MEWDS), multifocal choroiditis (MC), and other rarer entities caused by inflammatory disturbances of choriocapillaris perfusion. The aim here was to study the sensitivity of indocyanine green (ICG) angiography in investigating and following inflammatory choriocapillaropathies. PATIENTS AND METHODS Patients with inflammatory choriocapillaropthies were included who had had a dual fluorescein and ICG angiography as well as visual field testing (Goldman or computerized perimetry) at presentation and on follow-up visits. ICG angiography was performed according to a routine angiographic protocol used for inflammatory diseases and was correlated with fundus examination, fluorescein angiography, and visual field testing. RESULTS Three patients with MEWDS, two with APMPPE, and two with MC were included. The visual field alterations in all seven patients were well correlated with the extent of the hypofluorescent areas seen on ICG angiography, whereas they were badly correlated with fluorescein angiographic signs and their evolution. The visual field in MEWDS was particularly well correlated with the importance of peripapillary hypofluorescence seen on ICG angiography. In MC, the evolution of new lesions was well demonstrated by ICG angiography and well correlated with visual symptoms and visual fields, but was barely detected on fundus examination and by fluorescein angiography. CONCLUSIONS ICG angiographic signs were shown to be closely correlated with visual function (visual field testing). This was not the case for either fundus examination or fluorescein angiography. ICG angiography appears as a very sensitive follow-up parameter in inflammatory choriocapillaropathies, giving morphological information on the evolution of the disease and on the response to treatment when therapy is indicated.
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Affiliation(s)
- L Cimino
- Department of Ophthalmology, University of Parma, Parma, Italy
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Abstract
Inefficient case finding is an important stumbling block to successful control of tuberculosis (TB). Multiple health seeking may account for delayed case finding. Health-seeking behaviour, health seeking delay, perceived causes, and perceived quality of care related to TB were studied in interviews with 319 sputum smear-positive TB patients. The patients were treated in 22 governmental health centres of Malabon, a municipality of Metro Manila, Philippines. Only 29% of the respondents had gone first to a health centre after onset of TB-related symptoms, and more than half (53%) had initially consulted a private doctor. A chest X-ray was obtained for nearly everyone (97%). Two thirds of the patients (66%) had received a prescription for drugs, and 29% had purchased and taken anti-TB drugs for at least three weeks before they came to a governmental health centre. Concerning community interactions, 36% said they knew at least one person who had been treated for TB without success. The health seeking delay after symptom onset was relatively short - 64% of the respondents said they went to a health facility within 1 month. Case studies illustrate the rationale for health seeking and explain delayed initiation of appropriate treatment for many patients. Findings underscore the need for and indicate approaches to health communication for improved control of TB. Our findings from interview narratives also suggest that improved interpersonal skills of health centre staff and co-ordination between the private doctors and the health centres may substantially improve services for TB patients.
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Affiliation(s)
- C Auer
- Swiss Tropical Institute, Basel, Switzerland.
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Affiliation(s)
- HR Siebner
- Department of Neurology, Technische Universitat Munchen, Moehistrasse 28, 81675 Munich, Germany
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Abstract
Somatization symptoms are frequently associated with depression, anxiety, and feelings of distress. These features interact with the activity of the HPA-axis. Therefore we investigated relationships between somatization symptoms and cortisol. Seventy-seven participants were classified into three groups: somatization syndrome (at least eight physical symptoms from the DSM-IV somatization disorder list), somatization syndrome combined with major depression, and healthy controls. The following data were collected: salivary cortisol at three time points (morning, afternoon, evening), nighttime urinary cortisol, serum cortisol after the dexamethasone suppression test (DST), and psychological variables such as depression, anxiety, somatization, and hypochondriasis. Salivary cortisol showed typical diurnal variations. However, the groups did not differ on any of the cortisol variables. A possible explanation may be counteracting effects of somatization and depression. Exploratory correlational analyses revealed that associations between cortisol and psychopathological variables were time-dependent. DST results correlated with psychological aspects of somatization, but not with the number of somatoform symptoms per se.
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Affiliation(s)
- W Rief
- Klinik Roseneck-Center for Behavioral Medicine, Prien am Chiemsee, Germany.
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Auer C, Tipka M, Handsteiner CK, Gustafsson C, Krammer S, Feik V. [Experiences with inservice training--a report]. Osterr Krankenpflegez 2000; 53:38-9. [PMID: 10909345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Siebner HR, Mentschel C, Auer C, Lehner C, Conrad B. Repetitive transcranial magnetic stimulation causes a short-term increase in the duration of the cortical silent period in patients with Parkinson's disease. Neurosci Lett 2000; 284:147-50. [PMID: 10773420 DOI: 10.1016/s0304-3940(00)00990-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In ten patients with Parkinson's disease (PD) and ten age-matched healthy controls, we applied 15 30-s trains of subthreshold 5-Hz repetitive transcranial magnetic stimulation (rTMS) over the primary motor hand area. Ten minutes after rTMS, PD patients showed a significant prolongation of the transcranially evoked silent period (SP) in the contralateral first dorsal interosseus muscle, whereas the SP remained unchanged in healthy subjects. Since the duration of the transcranially evoked SP is a well-established measure of intracortical inhibition, this finding demonstrates that rTMS is capable of inducing a short-term increase in intracortical inhibition in PD. The lack of a prolongation of the SP in healthy controls suggests that PD patients may be particularly susceptible to modulatory effects of rTMS on motocortical inhibition.
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Affiliation(s)
- H R Siebner
- Department of Neurology, Technische Universität München, Möhlstrasse 28, 81675, Munich, Germany.
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Rief W, Trenkamp S, Auer C, Fichter MM. Cognitive behavior therapy in panic disorder and comorbid major depression. A naturalistic study. Psychother Psychosom 2000; 69:70-8. [PMID: 10671827 DOI: 10.1159/000012369] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is a lack of evidence about the effectiveness of cognitive behavior therapies (CBT) in settings of routine clinical care as well as in the treatment of panic and comorbid disorders. METHODS We investigated a group-oriented CBT approach for 80 patients with panic disorder including 35 patients with current comorbid major depression. Assessments took place 6 months before treatment, at the beginning and end of treatment, and 1 year later. Structured interviews and multiple clinical self-rating scales were used. RESULTS Panic patients with comorbid major depression showed higher anxiety-specific and nonspecific pathology. The most striking benefits were in reducing avoidance behavior, while improvements concerning catastrophic beliefs were smaller, but still significant. For most self-rating scale results, patients with and without comorbid depression improved to a comparable degree. However, the end-state functioning of patients with panic disorder and current comorbid depression at admission is significantly lower than for patients with panic disorder alone. CONCLUSIONS The results point to the necessity to develop and improve treatment approaches for patients with comorbidity of panic disorder and current major depression.
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Affiliation(s)
- W Rief
- Center for Behavioral Medicine Roseneck, Prien a. Ch., University of Munich, Germany.
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Siebner HR, Peller M, Willoch F, Minoshima S, Boecker H, Auer C, Drzezga A, Conrad B, Bartenstein P. Lasting cortical activation after repetitive TMS of the motor cortex: a glucose metabolic study. Neurology 2000; 54:956-63. [PMID: 10690992 DOI: 10.1212/wnl.54.4.956] [Citation(s) in RCA: 186] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Cerebral [18F]fluorodeoxy-D-glucose PET ([18F]FDG-PET) was used to visualize the lasting neuronal activation after repetitive transcranial magnetic stimulation (rTMS) over the left hand area of the primary motor cortex (M1HAND). BACKGROUND Applied over M1HAND, rTMS has been shown to produce a modulation of corticomotor excitability beyond the time of stimulation itself. METHODS Eight right-handed subjects underwent nonquantitative [18F]FDG-PET measurements during two experimental conditions: at rest and after focal subthreshold 5-Hz rTMS over the left M1HAND. In the post-rTMS condition, [18F]FDG was injected immediately after the administration of 1,800 magnetic pulses over the left M1HAND. Relative differences in normalized regional cerebral metabolic rate of glucose (normalized rCMRglc) between conditions were determined using a voxel-by-voxel Student's t-test and volume-of-interest (VOI) analysis. Analysis was a priori restricted to the M1HAND, the supplementary motor area (SMA), and the primary auditory cortex of both hemispheres. RESULTS A 5-Hz rTMS of the left M1HAND caused a lasting relative increase in normalized rCMRglc within the M1HAND bilaterally and the SMA. The magnitude and the topographic pattern of persisting relative rCMRglc increases within these motor cortical areas demonstrated considerable interindividual variations. CONCLUSIONS Subthreshold 5-Hz repetitive transcranial magnetic stimulation (rTMS) over the hand area of the primary motor cortex is associated with a persisting neuronal activation in a distinct set of motor cortical areas beyond the time of stimulation. The current findings demonstrate that [18F]FDG-PET can localize and quantify regional net changes in synaptic cortical activity after rTMS and thus might elucidate the mechanisms underlying rTMS-associated therapeutic effects.
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Affiliation(s)
- H R Siebner
- Department of Neurology, Technische Universität München, Munich, Germany.
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Siebner HR, Auer C, Ceballos-Baumann A, Conrad B. Has repetitive transcranial magnetic stimulation of the primary motor hand area a therapeutic application in writer's cramp? Electroencephalogr Clin Neurophysiol Suppl 1999; 51:265-75. [PMID: 10590959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- H R Siebner
- Department of Neurology, Technische Universität München, Germany
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Siebner HR, Ceballos-Baumann A, Standhardt H, Auer C, Conrad B, Alesch F. Changes in handwriting resulting from bilateral high-frequency stimulation of the subthalamic nucleus in Parkinson's disease. Mov Disord 1999; 14:964-71. [PMID: 10584671 DOI: 10.1002/1531-8257(199911)14:6<964::aid-mds1009>3.0.co;2-c] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
High-frequency stimulation of the subthalamic nucleus (STN) is a promising therapeutic approach in patients with severely disabling Parkinson's disease (PD). Whereas STN stimulation improves the cardinal signs of PD, little is known about the effects of STN stimulation on fine manual skills like handwriting. Therefore, the present study investigated the changes in handwriting during bilateral STN stimulation in 12 patients with advanced PD. Dopaminergic medication was discontinued at least 12 hours before the study. The patients were asked to write a standardized sentence repetitively. Five samples of the patient's script were recorded during effective bilateral STN stimulation and 1 hour after both stimulators had been switched off. The movements of the tip of the pencil were recorded using a digitizing tablet. Handwriting movements were segmented into subsequent up- and down-strokes, and a stroke-based kinematic analysis of handwriting was performed. During high-frequency STN stimulation, handwriting movements became faster and smoother indicating a partial restoration of an "open-loop" automatic performance. In addition, STN stimulation gave rise to a significant increase in the mean vertical stroke length demonstrating a stimulation-related reduction in micrographia. The present data underscores the importance of the STN in "open-loop" performance of highly skilled sequential hand movements.
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Affiliation(s)
- H R Siebner
- Department of Neurology, Technische Universität München, Munich, Germany
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Siebner HR, Gräflin von Einsiedel H, Wilhelm T, Auer C, Conrad B. [The "heme"-sequence (T2*-weighted gradient echo magnetic resonance tomography). Value in differential spontaneous intracerebral hemorrhage diagnosis]. Nervenarzt 1999; 70:714-22. [PMID: 10483571 DOI: 10.1007/s001150050500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In four patients presenting with acute non-traumatic intracerebral or intraspinal hemorrhage, T2*-weighted gradient-echo MRI showed numerous residual hemosiderin deposits due to old intracerebral hemorrhages that were missed on initial CT and spin-echo MRI. The demonstration of additional chronic bleedings and their anatomical distribution provided important diagnostic information. In a hypertensive patient, the hemosiderin deposits were most pronounced within deep brain structures suggesting hypertensive cerebral microangiopathy. In a second patient, the cortico-subcortical distribution of the hemorrhages was typical of cerebral amyloid angiopathy. In a third patient, the diffuse distribution including spinal bleeding, the marked calcification, and the characteristic appearance on spin-echo MRI were consistent with multiple cavernomas. In another patient with cerebral and spinal hemorrhage, T2*-weighted gradient-echo MRI revealed new subclinical hemorrhages during follow-up. Based on these findings, we recommend that T2*-weighted gradient-echo MRI of the brain should be performed in all patients with acute intracranial and spinal bleedings.
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Affiliation(s)
- H R Siebner
- Neurologische Klinik und Poliklinik der Technischen Universität München
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Siebner HR, Peller M, Willoch F, Auer C, Bartenstein P, Drzezga A, Schwaiger M, Conrad B. Imaging functional activation of the auditory cortex during focal repetitive transcranial magnetic stimulation of the primary motor cortex in normal subjects. Neurosci Lett 1999; 270:37-40. [PMID: 10454140 DOI: 10.1016/s0304-3940(99)00454-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Positron emission tomography (PET) during focal repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising approach to study cortical connectivity in awake humans. However, the noise caused by the discharging magnetic coil might have confounding effects on the rTMS-related cortical activation pattern. In twelve healthy volunteers, 18-fluoro-2-deoxy-D-glucose (18FDG) PET was employed to visualize the functional activation of the primary auditory cortex (PAC) during 2 Hz rTMS of the left primary sensorimotor hand area. Magnetic stimuli (1800) were applied at an intensity of 140% of motor resting threshold during the uptake period of 18FDG. Though all subjects wore earplugs, rTMS-related noise induced a consistent bilateral increase of regional glucose utilization in the PAC (P < 0.05, corrected). Thus, rTMS-related acoustic input needs to be taken into account in combined rTMS/PET studies.
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Affiliation(s)
- H R Siebner
- Department of Neurology, Technische Universität München, Munich, Germany.
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