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Zadey S, Smith ER, Staton CA, Fitzgerald TN, Vissoci JRN. Population-level surgical rates and unmet need in India: a retrospective analysis of districts and states from 2011 to 2019. Int J Surg 2024; 110:1884-1887. [PMID: 38181119 PMCID: PMC10942208 DOI: 10.1097/js9.0000000000001024] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/11/2023] [Indexed: 01/07/2024]
Affiliation(s)
- Siddhesh Zadey
- Association for Socially Applicable Research (ASAR)
- Dr. D.Y. Patil Medical College, Hospital, and Research Centre, Pune, Maharashtra, India
- Department of Emergency Medicine, Duke University Medical Center
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University
- Department of Surgery, Duke University School of Medicine
| | - Emily R. Smith
- Department of Emergency Medicine, Duke University Medical Center
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University
- Department of Surgery, Duke University School of Medicine
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Catherine A. Staton
- Department of Emergency Medicine, Duke University Medical Center
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Tamara N. Fitzgerald
- Department of Surgery, Duke University School of Medicine
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Joao Ricardo Nickenig Vissoci
- Department of Emergency Medicine, Duke University Medical Center
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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Zimmerman A, Minnig MC, Meela J, Tupetz A, Bettger JP, Nickenig Vissoci JR, Staton C. A systematic review and cross-sectional survey of rehabilitation resources for injury patients in the Kilimanjaro Region of Tanzania. Disabil Rehabil 2024; 46:1045-1052. [PMID: 36803149 PMCID: PMC10468893 DOI: 10.1080/09638288.2023.2179674] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 01/24/2023] [Accepted: 02/06/2023] [Indexed: 02/22/2023]
Abstract
PURPOSE An estimated 10 million people across Tanzania have a condition that would benefit from rehabilitative care. However, access to rehabilitation remains inadequate to meet the needs of Tanzania's population. The goal of this study was to identify and characterize rehabilitation resources available to injury patients in the Kilimanjaro region of Tanzania. METHODS We used two approaches to identify and characterize rehabilitation services. First, we conducted a systematic review of peer-reviewed and gray literature. Second, we administered a questionnaire to rehabilitation clinics identified through the systematic review as well as through staff at Kilimanjaro Christian Medical Centre. RESULTS Our systematic review identified eleven organizations offering rehabilitation services. Eight of these organizations responded to our questionnaire. Seven of the surveyed organizations provide care to patients with spinal cord injuries, short term disability, or permanent movement disorders. Six offer diagnostic and treatment procedures to injured and disabled patients. Six offer homecare support. Two require no payment. Only three accept health insurance. None offer financial support. CONCLUSIONS There is a sizable portfolio of health clinics offering rehabilitation services to injury patients in the Kilimanjaro region. However, there remains an ongoing need to connect more patients in the region to long-term rehabilitative care.IMPLICATIONS FOR REHABILITATIONInjury is a leading cause of death and disability worldwide and disproportionately affects populations in low- and middle-income countries (LMICs).Rehabilitation is an essential component of injury care, yet an estimated 50% of patients in LMICs who need rehabilitation do not receive it.This study offers insight into the availability and use of rehabilitative services in an LMIC with a substantial injury burden.
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Affiliation(s)
| | | | - Joseph Meela
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Anna Tupetz
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | | | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, USA
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Polick CS, Darwish H, de Olivera LP, Watson A, Vissoci JRN, Calhoun PS, Ploutz-Snyder R, Connell CM, Braley TJ, Stoddard SA. Resilience, mental health, sleep, and smoking mediate pathways between lifetime stressors and Multiple Sclerosis severity. medRxiv 2024:2024.02.06.24302405. [PMID: 38370736 PMCID: PMC10871453 DOI: 10.1101/2024.02.06.24302405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Intro Lifetime stressors (e.g., poverty, violence, discrimination) have been linked to Multiple Sclerosis (MS) features; yet mechanistic pathways and relationships with cumulative disease severity remain nebulous. Further, protective factors like resilience, that may attenuate the effects of stressors on outcomes, are seldom evaluated. Aim To deconstruct pathways between lifetime stressors and cumulative severity on MS outcomes, accounting for resilience. Methods Adults with MS (N=924) participated in an online survey through the National MS Society listserv. Structural Equation Modeling was used to examine the direct and indirect effect of lifetime stressors (count/severity) on MS severity (self-reported disability, relapse burden, fatigue, pain intensity and interference), via resilience, mental health (anxiety and depression), sleep disturbance, and smoking. Results The final analytic model had excellent fit (GFI=0.998). Lifetime stressors had a direct relationship with MS severity (β=0.27, p<.001). Resilience, mental health, sleep disturbance, and smoking significantly mediated the relationship between lifetime stressors and MS severity. The total effect of mediation was significant (β=0.45). Conclusions This work provides foundational evidence to inform conceptualization of pathways by which stress could influence MS disease burden. Resilience may attenuate effects of stressors, while poor mental health, smoking, and sleep disturbances may exacerbate their impact. Parallel with usual care, these mediators could be targets for early multimodal therapies to improve disease course.
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Affiliation(s)
- Carri S Polick
- School of Nursing, Duke University, Durham, NC, USA
- VA Healthcare System, Durham, NC, USA
| | - Hala Darwish
- Division of Multiple Sclerosis & Neuroimmunology, Department of Neurology, Michigan Medicine, Ann Arbor, MI, USA
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | | | - Ali Watson
- School of Medicine, Duke University, Durham, NC, USA
| | | | - Patrick S Calhoun
- VA Healthcare System, Durham, NC, USA
- Department of Psychiatry, Duke University, Durham, NC, USA
| | | | | | - Tiffany J Braley
- Division of Multiple Sclerosis & Neuroimmunology, Department of Neurology, Michigan Medicine, Ann Arbor, MI, USA
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Zimmerman A, Monteiro W, Nickenig Vissoci JR, Smith ER, Rocha T, Sachett J, Wen FH, Staton C, Gerardo CJ, Ogbuoji O. Scaling up antivenom for snakebite envenoming in the Brazilian Amazon: a cost-effectiveness analysis. Lancet Reg Health Am 2024; 29:100651. [PMID: 38124996 PMCID: PMC10733094 DOI: 10.1016/j.lana.2023.100651] [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] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
Background Snakebite envenoming (SBE) affects nearly three million people yearly, causing up to 180,000 deaths and 400,000 cases of permanent disability. Brazil's state of Amazonas is a global hotspot for SBE, with one of the highest annual incidence rates per 100,000 people, worldwide. Despite this burden, snake antivenom remains inaccessible to a large proportion of SBE victims in Amazonas. This study estimates the costs, and health and economic benefits of scaling up antivenom to community health centers (CHCs) and hospitals in the state. Methods We built a decision tree model to simulate three different antivenom scale-up scenarios: (1) scale up to 95% of hospitals, (2) scale up to 95% of CHCs, and (3) scale up to 95% of hospitals and 95% of CHCs. We consider each scenario with and without a 10% increase in demand for antivenom among SBE victims. For each scenario, we model the treatment costs averted, deaths averted, and disability-adjusted life years (DALYs) averted from a societal, health system, and patient perspective relative to the status quo and over a time horizon of one year. For each scenario and perspective, we also calculate the incremental cost per DALY averted and per death averted. We use a willingness to pay threshold equal to the 2022 gross domestic product (GDP) per capita of Brazil. Findings Scaling up antivenom to 95% of hospitals averts up to 2022 DALYs, costs up to USD $460 per DALY averted from a health system perspective, but results in net economic benefits up to USD $4.42 million from a societal perspective. Scaling up antivenom to 95% of CHCs averts up to 3179 DALYs, costs up to USD $308 per DALY averted from a health system perspective, but results in net economic benefits up to USD $7.35 million from a societal perspective. Scaling up antivenom to 95% of hospitals and CHCs averts up to 3922 DALYs, costs up to USD $328 per DALY averted from a health system perspective, but results in net economic benefits up to USD $8.98 million from a societal perspective. Interpretation All three antivenom scale up scenarios - scale up to 95% of hospitals, scale up to 95% of CHCs, and scale up to 95% of hospitals and 95% of CHCs - avert a substantial proportion of the SBE burden in Amazonas and are cost-saving from a societal perspective and cost-effective from a health system perspective. Funding W.M. and J.S. were funded by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq productivity scholarships). W.M. was funded by Fundação de Amparo à Pesquisa do Estado do Amazonas (PRÓ-ESTADO, call n. 011/2021-PCGP/FAPEAM, call n. 010/2021-CT&I ÁREAS PRIORITÁRIAS, call n. 003/2022-PRODOC/FAPEAM, POSGRAD/FAPEAM) and by the Ministry of Health, Brazil (Proposal No. 733781/19-035). Research reported in this publication was supported by the Fogarty International Center of the National Institutes of Health under Award Number R21TW011944. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Affiliation(s)
- Armand Zimmerman
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Wuelton Monteiro
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Programa de Pós-Graduação em Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, NC, United States
| | - Emily R. Smith
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, NC, United States
| | - Thiago Rocha
- Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, NC, United States
| | - Jacqueline Sachett
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Programa de Pós-Graduação em Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Fan Hui Wen
- Instituto Butantan, São Paulo, São Paulo, Brazil
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, NC, United States
| | - Charles J. Gerardo
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, NC, United States
| | - Osondu Ogbuoji
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Duke University, Durham, NC, United States
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Vissoci JRN, Friedman K, Caruzzo NM, de Oliveira LP, Pauley A, Zadey S, Menegassi V, Sakita F, Boshe J, Staton CA, Mmbaga B. Clinical evaluation of the alcohol use disorders identification test (AUDIT) in Moshi, Tanzania. PLoS One 2023; 18:e0287835. [PMID: 37939063 PMCID: PMC10631671 DOI: 10.1371/journal.pone.0287835] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/14/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Alcohol use disorder is a major cause of morbidity and mortality in low- and middle-income countries. Alcohol screening using a validated tool is a useful way to capture high-risk patients and engage them in early harm reduction interventions. Our objectives were to 1) evaluate the psychometric evidence the Alcohol Use Disorders Identification Test (AUDIT) and its subscales in the general population of Moshi, Tanzania, and 2) evaluate the usefulness of the tool at predicting alcohol-related harms. METHODS Two hundred and fifty-nine adults living in Moshi, Tanzania were included in the study. We used the AUDIT and its subscales to determine the classification of harmful and hazardous drinking. To analyze the internal structure of AUDIT and the model adequacy we used Confirmatory Factor Analysis (CFA). The reliability of AUDIT was analyzed for Cronbach's alpha, Omega 6 and Composite Reliability. The optimal cut off point for the AUDIT was determined by the receiver operating characteristic (ROC) curve, using the Youden approach to maximize sensitivity and specificity. RESULTS The median score of the AUDIT was 1 (inter-quartile range: 0-7). The internal structure of the AUDIT showed factor loadings ranging from 0.420 to 0.873. Cronbach's alpha, Omega and Composite Reliability produced values above 0.70. The Average Variance Extracted was 0.530. For the AUDIT, a score of 8 was identified as the ideal cut-off value in our population. CONCLUSIONS This study validates AUDIT in the general population of Moshi and is one of the only studies in Africa to include measures of the internal structure of the AUDIT and its subscales.
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Affiliation(s)
- Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Duke Emergency Medicine, Duke University Medical Center, Durham, NC, United States of America
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University Durham, NC, United States of America
| | - Kaitlyn Friedman
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | | | | | - Alena Pauley
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University Durham, NC, United States of America
| | - Siddhesh Zadey
- Duke Emergency Medicine, Duke University Medical Center, Durham, NC, United States of America
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University Durham, NC, United States of America
| | | | | | - Judith Boshe
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Catherine A. Staton
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Duke Emergency Medicine, Duke University Medical Center, Durham, NC, United States of America
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University Durham, NC, United States of America
| | - Blandina Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Zimmerman A, Elahi C, Hernandes Rocha TA, Sakita F, Mmbaga BT, Staton CA, Vissoci JRN. Machine learning models to predict traumatic brain injury outcomes in Tanzania: Using delays to emergency care as predictors. PLOS Glob Public Health 2023; 3:e0002156. [PMID: 37856444 PMCID: PMC10586611 DOI: 10.1371/journal.pgph.0002156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/13/2023] [Indexed: 10/21/2023]
Abstract
Constraints to emergency department resources may prevent the timely provision of care following a patient's arrival to the hospital. In-hospital delays may adversely affect health outcomes, particularly among trauma patients who require prompt management. Prognostic models can help optimize resource allocation thereby reducing in-hospital delays and improving trauma outcomes. The objective of this study was to investigate the predictive value of delays to emergency care in machine learning based traumatic brain injury (TBI) prognostic models. Our data source was a TBI registry from Kilimanjaro Christian Medical Centre Emergency Department in Moshi, Tanzania. We created twelve unique variables representing delays to emergency care and included them in eight different machine learning based TBI prognostic models that predict in-hospital outcome. Model performance was compared using the area under the receiver operating characteristic curve (AUC). Inclusion of our twelve time to care variables improved predictability in each of our eight prognostic models. Our Bayesian generalized linear model produced the largest AUC, with a value of 89.5 (95% CI: 88.8, 90.3). Time to care variables were among the most important predictors of in-hospital outcome in our best three performing models. In low-resource settings where delays to care are highly prevalent and contribute to high mortality rates, incorporation of care delays into prediction models that support clinical decision making may benefit both emergency medicine physicians and trauma patients by improving prognostication performance.
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Affiliation(s)
- Armand Zimmerman
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Cyrus Elahi
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | | | | | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Catherine A. Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
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Staton CA, Friedman K, Phillips AJ, Minnig MC, Sakita FM, Ngowi KM, Suffoletto B, Hirshon JM, Swahn M, Mmbaga BT, Vissoci JRN. Feasibility of a pragmatic randomized adaptive clinical trial to evaluate a brief negotiational interview for harmful and hazardous alcohol use in Moshi, Tanzania. PLoS One 2023; 18:e0288458. [PMID: 37535693 PMCID: PMC10399826 DOI: 10.1371/journal.pone.0288458] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/26/2023] [Indexed: 08/05/2023] Open
Abstract
INTRODUCTION Low-resourced settings often lack personnel and infrastructure for alcohol use disorder treatment. We culturally adapted a Brief Negotiational Interview (BNI) for Emergency Department injury patients, the "Punguza Pombe Kwa Afya Yako (PPKAY)" ("Reduce Alcohol For Your Health") in Tanzania. This study aimed to evaluate the feasibility of a pragmatic randomized adaptive controlled trial of the PPKAY intervention. MATERIALS AND METHODS This feasibility trial piloted a single-blind, parallel, adaptive, and multi-stage, block-randomized controlled trial, which will subsequently be used to determine the most effective intervention, with or without text message booster, to reduce alcohol use among injury patients. We reported our feasibility pilot study using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, with recruitment and retention rates being our primary and secondary outcomes. We enrolled adult patients seeking care for an acute injury at the Kilimanjaro Christian Medical Center in Tanzania if they (1) exhibited an Alcohol Use Disorder Identification Test (AUDIT) ≥8, (2) disclosed alcohol use prior to injury, or (3) had a breathalyzer ≥0.0 on arrival. Intervention arms were usual care (UC), PPKAY, PPKAY with standard text booster, or a PPKAY with a personalized text booster. RESULTS Overall, 181 patients were screened and 75 enrolled with 80% 6-week, 82.7% 3-month and 84% 6-month follow-up rates showing appropriate Reach and retention. Adoption measures showed an overwhelmingly positive patient acceptance with 100% of patients perceiving a positive impact on their behavior. The Implementation and trial processes were performed with high rates of PPKAY fidelity (76%) and SMS delivery (74%). Intervention nurses believed Maintenance and sustainability of this 30-minute, low-cost intervention and adaptive clinical trial were feasible. CONCLUSIONS Our intervention and trial design are feasible and acceptable, have evidence of good fidelity, and did not show problematic deviations in protocol. Results suggest support for undertaking a full trial to evaluate the effectiveness of the PPKAY, a nurse-driven BNI in a low-income country. TRIAL REGISTRATION Trial registration number NCT02828267. https://classic.clinicaltrials.gov/ct2/show/NCT02828267.
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Affiliation(s)
- Catherine A. Staton
- Division of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Kaitlyn Friedman
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Ashley J. Phillips
- Division of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | | | | | | | - Brian Suffoletto
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittbsurgh, PA, United States of America
| | - Jon Mark Hirshon
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore MD, United States of America
| | - Monica Swahn
- Department of Epidemiology, Georgia State University School of Public Health, Atlanta, GA, United States of America
| | - Blandina T. Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Joao Ricardo Nickenig Vissoci
- Division of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
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Shetty R, Zadey S, Jindal A, Iyer H, Dubey S, Jesudian G, Smith ER, Staton CA, Fitzgerald TN, Vissoci JRN. Prioritization of surgical, obstetric, trauma, and anesthesia care in India over seven decades: A systematic analysis of policy documents. PLOS Glob Public Health 2023; 3:e0002084. [PMID: 37523346 PMCID: PMC10389714 DOI: 10.1371/journal.pgph.0002084] [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] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 07/11/2023] [Indexed: 08/02/2023]
Abstract
Improving access to surgical care in India requires policy-level prioritization of surgical, obstetric, trauma, and anesthesia (SOTA) care. We quantified SOTA care prioritization in the last seven decades by analyzing India's national policy and programmatic documents. Forty documents of national importance over seven decades (1946-2017) were screened for a set of 52 surgical and 6 non-surgical keywords. The number of mentions per keyword was used as a proxy for surgical prioritization. For thematic analysis, surgical mentions were further classified into five domains: Infrastructure, Workforce, Service Delivery, Financing, and Information Management. The total number of mentions was 4681 for the surgical keywords and 2322 for non-surgical. The number of mentions per keyword was 90.02 for surgical keywords and 387 for non-surgical. The older committee reports showed relatively higher SOTA care prioritization compared to the years after 2010. Among the domains, Service Delivery (897) had the maximum number of mentions followed by Infrastructure (545), Workforce (516), Financing (98), and Information Management (40). National Health Policy 2017, the most recent high-level policy, grossly neglected SOTA care. SOTA care is inadequately prioritized in Indian national health policies, especially in the documents after 2010. Concerted efforts are necessary to improve the focus on financing and information management. Prioritization can be improved through a stand-alone national plan for SOTA care along with integration into existing policies.
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Affiliation(s)
- Ritika Shetty
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Terna Medical College and Hospital, Navi Mumbai, Maharashtra, India
| | - Siddhesh Zadey
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Dr. D.Y. Patil Medical College, Hospital, and Research Centre, Pune, Maharashtra, India
| | - Anushka Jindal
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- King's College Hospital, Denmark Hill, London, United Kingdom
| | - Himanshu Iyer
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Department of Surgery, Khurshitji Beharamji Bhabha Municipal General Hospital, Mumbai, Maharashtra, India
| | - Sweta Dubey
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
| | - Gnanaraj Jesudian
- Department of EIE, Karunya University, Coimbatore, Tamil Nadu, India
- Association of Rural Surgeons of India/International Federation of Rural Surgeons-Rural Surgery Research and Training Center, Shanthi Bhavan Medical Center, Jharkhand, India
| | - Emily R Smith
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Catherine A Staton
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Tamara N Fitzgerald
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Joao Ricardo Nickenig Vissoci
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
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Zadey S, Iyer H, Nayan A, Shetty R, Sonal S, Smith ER, Staton CA, Fitzgerald TN, Nickenig Vissoci JR. Evaluating the status of the Lancet Commission on Global Surgery indicators for India. Lancet Reg Health Southeast Asia 2023; 13:100178. [PMID: 37383563 PMCID: PMC10306037 DOI: 10.1016/j.lansea.2023.100178] [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] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 02/03/2023] [Accepted: 03/02/2023] [Indexed: 06/30/2023]
Abstract
For universal surgical, obstetric, trauma, and anesthesia care by 2030, the Lancet Commission on Global Surgery (LCoGS) suggested tracking six indicators. We reviewed academic and policy literature to investigate the current state of LCoGS indicators in India. There was limited primary data for access to timely essential surgery, risk of impoverishing and catastrophic health expenditures due to surgery, though some modeled estimates are present. Surgical specialist workforce estimates are heterogeneous across different levels of care, urban and rural areas, and diverse health sectors. Surgical volumes differ widely across demographic, socio-economic, and geographic cohorts. Perioperative mortality rates vary across procedures, diagnoses, and follow-up time periods. Available data suggest India falls short of achieving global targets. This review highlights the evidence gap for India's surgical care planning. India needs a systematic subnational mapping of indicators and adaptation of targets as per the country's health needs for equitable and sustainable planning.
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Affiliation(s)
- Siddhesh Zadey
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, 411007, India
- Department of Surgery, Duke University School of Medicine, Durham, NC, 27707, USA
- Global Emergency Medicine Innovation and Implementation Research Center, Duke University, Durham, NC, 27710, USA
- Duke Global Health Institute, Durham, NC, 27710, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, 27707, USA
- Dr. D.Y. Patil Medical College, Hospital, and Research Centre, Pune, Maharashtra, 411018, India
| | - Himanshu Iyer
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, 411007, India
| | - Anveshi Nayan
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, 411007, India
- Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, 400012, India
| | - Ritika Shetty
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, 411007, India
- Terna Medical College and Hospital, Navi Mumbai, Maharashtra, 400706, India
| | - Swati Sonal
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, 411007, India
- Division of General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA
- Department of Surgery, Harvard Medical School, Boston, MA, 02114, USA
| | - Emily R. Smith
- Department of Surgery, Duke University School of Medicine, Durham, NC, 27707, USA
- Global Emergency Medicine Innovation and Implementation Research Center, Duke University, Durham, NC, 27710, USA
- Duke Global Health Institute, Durham, NC, 27710, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, 27707, USA
| | - Catherine A. Staton
- Department of Surgery, Duke University School of Medicine, Durham, NC, 27707, USA
- Global Emergency Medicine Innovation and Implementation Research Center, Duke University, Durham, NC, 27710, USA
- Duke Global Health Institute, Durham, NC, 27710, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, 27707, USA
| | - Tamara N. Fitzgerald
- Department of Surgery, Duke University School of Medicine, Durham, NC, 27707, USA
- Duke Global Health Institute, Durham, NC, 27710, USA
| | - Joao Ricardo Nickenig Vissoci
- Department of Surgery, Duke University School of Medicine, Durham, NC, 27707, USA
- Global Emergency Medicine Innovation and Implementation Research Center, Duke University, Durham, NC, 27710, USA
- Duke Global Health Institute, Durham, NC, 27710, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, 27707, USA
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10
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Isaacson JE, Ye JJ, Silva LL, Hernandes Rocha TA, de Andrade L, Scheidt JFHC, Wen FH, Sachett J, Monteiro WM, Staton CA, Vissoci JRN, Gerardo CJ. Antivenom access impacts severity of Brazilian snakebite envenoming: A geographic information system analysis. PLoS Negl Trop Dis 2023; 17:e0011305. [PMID: 37343007 PMCID: PMC10284398 DOI: 10.1371/journal.pntd.0011305] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 04/14/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Snakebite envenoming (SBE) is a neglected tropical disease capable of causing both significant disability and death. The burden of SBE is especially high in low- and middle-income countries. The aim of this study was to perform a geospatial analysis evaluating the association of sociodemographics and access to care indicators on moderate and severe cases of SBE in Brazil. METHODS We conducted an ecological, cross-sectional study of SBE in Brazil from 2014 to 2019 using the open access National System Identification of Notifiable Diseases (SINAN) database. We then collected a set of indicators from the Brazil Census of 2010 and performed a Principal Component Analysis to create variables related to health, economics, occupation, education, infrastructure, and access to care. Next, a descriptive and exploratory spatial analysis was conducted to evaluate the geospatial association of moderate and severe events. These variables related to events were evaluated using Geographically Weighted Poisson Regression. T-values were plotted in choropleth maps and considered statistically significant when values were <-1.96 or >+1.96. RESULTS We found that the North region had the highest number of SBE cases by population (47.83/100,000), death rates (0.18/100,000), moderate and severe rates (22.96/100,000), and proportion of cases that took more than three hours to reach healthcare assistance (44.11%). The Northeast and Midwest had the next poorest indicators. Life expectancy, young population structure, inequality, electricity, occupation, and more than three hours to reach healthcare were positively associated with greater cases of moderate and severe events, while income, illiteracy, sanitation, and access to care were negatively associated. The remaining indicators showed a positive association in some areas of the country and a negative association in other areas. CONCLUSION Regional disparities in SBE incidence and rates of poor outcomes exist in Brazil, with the North region disproportionately affected. Multiple indicators were associated with rates of moderate and severe events, such as sociodemographic and health care indicators. Any approach to improving snakebite care must work to ensure the timeliness of antivenom administration.
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Affiliation(s)
| | - Jinny Jing Ye
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Lincoln Luís Silva
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Post-Graduation Program in Biosciences and Physiopathology, State University of Maringá, Maringá, Paraná, Brazil
| | - Thiago Augusto Hernandes Rocha
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Luciano de Andrade
- Department of Medicine, State University of Maringá, Maringá, Paraná, Brazil
| | | | - Fan Hui Wen
- Antivenom Production Section, Butantan Institute, São Paulo, São Paulo, Brazil
| | - Jacqueline Sachett
- School of Health Sciences, University of Amazonas State, Manaus, Amazonas, Brazil
| | - Wuelton Marcelo Monteiro
- School of Health Sciences, University of Amazonas State, Manaus, Amazonas, Brazil
- Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Catherine Ann Staton
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Joao Ricardo Nickenig Vissoci
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Charles John Gerardo
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
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Zadey S, Leraas H, Gupta A, Biswas A, Hollier P, Vissoci JRN, Mugaga J, Ssekitoleko RT, Everitt JI, Loh AHP, Lee YT, Saterbak A, Mueller JL, Fitzgerald TN. KeyLoop retractor for global gasless laparoscopy: evaluation of safety and feasibility in a porcine model. Surg Endosc 2023:10.1007/s00464-023-10054-5. [PMID: 37074419 PMCID: PMC10338623 DOI: 10.1007/s00464-023-10054-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/26/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Many surgeons in low- and middle-income countries have described performing surgery using gasless (lift) laparoscopy due to inaccessibility of carbon dioxide and reliable electricity, but the safety and feasibility of the technique has not been well documented. We describe preclinical testing of the in vivo safety and utility of KeyLoop, a laparoscopic retractor system to enable gasless laparoscopy. METHODS Experienced laparoscopic surgeons completed a series of four laparoscopic tasks in a porcine model: laparoscopic exposure, small bowel resection, intracorporeal suturing with knot tying, and cholecystectomy. For each participating surgeon, the four tasks were completed in a practice animal using KeyLoop. Surgeons then completed these tasks using standard-of-care (SOC) gas laparoscopy and KeyLoop in block randomized order to minimize learning curve effect. Vital signs, task completion time, blood loss and surgical complications were compared between SOC and KeyLoop using paired nonparametric tests. Surgeons completed a survey on use of KeyLoop compared to gas laparoscopy. Abdominal wall tissue was evaluated for injury by a blinded pathologist. RESULTS Five surgeons performed 60 tasks in 15 pigs. There were no significant differences in times to complete the tasks between KeyLoop and SOC. For all tasks, there was a learning curve with task completion times related to learning the porcine model. There were no significant differences in blood loss, vital signs or surgical complications between KeyLoop and SOC. Eleven surgeons from the United States and Singapore felt that KeyLoop could be used to safely perform several common surgical procedures. No abdominal wall tissue injury was observed for either KeyLoop or SOC. CONCLUSIONS Procedure times, blood loss, abdominal wall tissue injury and surgical complications were similar between KeyLoop and SOC gas laparoscopy for basic surgical procedures. This data supports KeyLoop as a useful tool to increase access to laparoscopy in low- and middle-income countries.
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Affiliation(s)
- Siddhesh Zadey
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
- Association for Socially Applicable Research (ASAR), Pune, MH, India.
| | - Harold Leraas
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Aryaman Gupta
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Arushi Biswas
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | | | - Joao Ricardo Nickenig Vissoci
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | - Julius Mugaga
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Jeffrey I Everitt
- Department of Pathology, Duke University of School of Medicine, Durham, NC, USA
| | - Amos H P Loh
- Duke-NUS Medical School, SingHealth Duke-NUS Global Health Institute, Singapore, Singapore
| | - York Tien Lee
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Ann Saterbak
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Jenna L Mueller
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA
- Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tamara N Fitzgerald
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
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Rocha TAH, Silva LL, Wen FH, Sachett J, Tupetz A, Staton CA, Monteiro WM, Vissoci JRN, Gerardo CJ. River dataset as a potential fluvial transportation network for healthcare access in the Amazon region. Sci Data 2023; 10:188. [PMID: 37024499 PMCID: PMC10078007 DOI: 10.1038/s41597-023-02085-3] [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: 11/24/2021] [Accepted: 03/20/2023] [Indexed: 04/08/2023] Open
Abstract
Remote areas, such as the Amazon Forest, face unique geographical challenges of transportation-based access to health services. As transportation to healthcare in most of the Amazon Forest is only possible by rivers routes, any travel time and travel distance estimation is limited by the lack of data sources containing rivers as potential transportation routes. Therefore, we developed an approach to convert the geographical representation of roads and rivers in the Amazon into a combined, interoperable, and reusable dataset. To build the dataset, we processed and combined data from three data sources: OpenStreetMap, HydroSHEDS, and GloRiC. The resulting dataset can consider distance metrics using the combination of streets and rivers as a transportation route network for the Amazon Forest. The created dataset followed the guidelines and attributes defined by OpenStreetMap to leverage its reusability and interoperability possibilities. This new data source can be used by policymakers, health authorities, and researchers to perform time-to-care analysis in the International Amazon region.
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Affiliation(s)
- Thiago Augusto Hernandes Rocha
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, 27710, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, 27710, United States of America
| | - Lincoln Luís Silva
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, 27710, United States of America
- Post-Graduation Program in Biosciences and Physiopathology, State University of Maringá, Maringá, Paraná, 87020-900, Brazil
| | - Fan Hui Wen
- Butantan Institute, São Paulo, São Paulo, 05503-900, Brazil
| | | | - Anna Tupetz
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, 27710, United States of America
| | - Catherine Ann Staton
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, 27710, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, 27710, United States of America
| | - Wuelton Marcelo Monteiro
- State University of Amazonas, Manaus, Amazonas, 69750-000, Brazil
- Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil
| | - Joao Ricardo Nickenig Vissoci
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, 27710, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, 27710, United States of America
| | - Charles John Gerardo
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, 27710, United States of America.
- Duke Global Health Institute, Duke University, Durham, NC, 27710, United States of America.
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13
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Keating EM, Mitao M, Kozhumam A, Souza JV, Anthony CS, Costa DB, Staton CA, Mmbaga BT, Vissoci JRN. Validation of the Pediatric Resuscitation and Trauma Outcome (PRESTO) model in injury patients in Tanzania. BMJ Open 2023; 13:e070747. [PMID: 37019480 PMCID: PMC10083748 DOI: 10.1136/bmjopen-2022-070747] [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] [Indexed: 04/07/2023] Open
Abstract
INTRODUCTION Sub-Saharan Africa has the highest rate of unintentional paediatric injury deaths. The Pediatric Resuscitation and Trauma Outcome (PRESTO) model predicts mortality using patient variables available in low-resource settings: age, systolic blood pressure (SBP), heart rate (HR), oxygen saturation, need for supplemental oxygen (SO) and neurologic status (Alert Verbal Painful Unresponsive (AVPU)). We sought to validate and assess the prognostic performance of PRESTO for paediatric injury patients at a tertiary referral hospital in Northern Tanzania. METHODS This is a cross-sectional study from a prospective trauma registry from November 2020 to April 2022. We performed exploratory analysis of sociodemographic variables and developed a logistic regression model to predict mortality using R (V.4.1). The logistic regression model was evaluated using area under the receiver operating curve (AUC). RESULTS 499 patients were enrolled with a median age of 7 years (IQR 3.41-11.18). 65% were boys, and in-hospital mortality was 7.1%. Most were classified as alert on AVPU Scale (n=326, 86%) and had normal SBP (n=351, 98%). Median HR was 107 (IQR 88.5-124). The logistic regression model based on the original PRESTO model revealed that AVPU, HR and SO were statistically significant to predict in-hospital mortality. The model fit to our population revealed AUC=0.81, sensitivity=0.71 and specificity=0.79. CONCLUSION This is the first validation of a model to predict mortality for paediatric injury patients in Tanzania. Despite the low number of participants, our results show good predictive potential. Further research with a larger injury population should be done to improve the model for our population, such as through calibration.
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Affiliation(s)
- Elizabeth M Keating
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Modesta Mitao
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania, United Republic of
- Kilimanjaro Christian Medical University College, Moshi, Tanzania, United Republic of
| | - Arthi Kozhumam
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | - Cecilia S Anthony
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania, United Republic of
- Kilimanjaro Christian Medical University College, Moshi, Tanzania, United Republic of
| | - Dalton Breno Costa
- Department of Computer Science, University of North Carolina at Greensboro (UNCG), Greensboro, North Carolina, USA
| | - Catherine A Staton
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania, United Republic of
- Kilimanjaro Christian Medical University College, Moshi, Tanzania, United Republic of
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania, United Republic of
| | - Joao Ricardo Nickenig Vissoci
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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Galson SW, Pesambili M, Vissoci JRN, Manavalan P, Hertz JT, Temu G, Staton CA, Stanifer JW. Hypertension in an Emergency Department Population in Moshi, Tanzania; A Qualitative Study of Barriers to Hypertension Control. PLoS One 2023; 18:e0279377. [PMID: 36608026 PMCID: PMC9821488 DOI: 10.1371/journal.pone.0279377] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 12/06/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Sub-Saharan Africa has a high prevalence of hypertension with a low rate of awareness, treatment adherence, and control. The emergency department (ED) may represent a unique opportunity to improve hypertension screening, awareness, and linkage to care. We conducted a qualitative study among hypertensive patients presenting to the ED and their healthcare providers to determine barriers to hypertension care and control. METHODS In northern Tanzania, between November and December 2017, we conducted three focus group discussions among patients with hypertension presenting to the emergency department and three in-depth interviews among emergency department physicians. In our study, hypertension was defined as a single blood pressure of ≥160/100 mm Hg or a two-time average of ≥140/90 mm Hg. Barriers to care were identified by thematic analysis applying an inductive approach within the framework method. RESULTS We enrolled 24 total patients into three focus groups and performed three in-depth interviews with individual providers. Thematic analysis identified two major domains: 1) patient knowledge, attitudes, and practices, and 2) structural barriers to hypertension care. Four major themes emerged within the knowledge, attitudes, and practices domain, including disease chronicity, provider communication, family support, and fear-based attitudes. Within the structural domain, several themes emerged that identified barriers that impeded hypertension follow-up care and self-management, including cost, access to care, and transportation and wait time. CONCLUSION Patients and physicians identified multiple barriers and facilitators to hypertension care. These perspectives may be helpful to design emergency department-based interventions that target blood pressure control and linkage to outpatient care.
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Affiliation(s)
- Sophie W. Galson
- Duke Emergency Medicine, Duke Global Health Institute, Durham, NC, United States of America
- * E-mail:
| | | | | | - Preeti Manavalan
- Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Julian T. Hertz
- Duke Emergency Medicine, Duke Global Health Institute, Durham, NC, United States of America
| | - Gloria Temu
- Kilimanjaro Christian Medical Center, Kilimanjaro, Tanzania
| | - Catherine A. Staton
- Duke University Medical Center, Duke Global Health Institute, Durham, NC, United States of America
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Staton CA, Minnig MC, Phillips AJ, Kozhumam AS, Pesambili M, Suffoletto B, Mmbaga BT, Ngowi K, Vissoci JRN. Feasibility of SMS booster for alcohol reduction in injury patients in Tanzania. PLOS Glob Public Health 2022; 2:e0000410. [PMID: 36962731 PMCID: PMC10022354 DOI: 10.1371/journal.pgph.0000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 10/29/2022] [Indexed: 12/02/2022]
Abstract
Alcohol use is associated with 3 million annual deaths globally. Harmful alcohol use, which is associated with a high burden of disease in low- and middle-income countries (LMICs), often increases the probability of traumatic injury. Treatments for harmful alcohol use in LMICs, such as Tanzania, lack trained personnel and adequate infrastructure. The aim of this study was to assess the feasibility of using SMS boosters to augment a hospital based brief negotiational intervention (BNI) in this low resourced setting. We conducted a three stage, four arm feasibility trial of a culturally adapted BNI for injury patients with harmful and hazardous drinking admitted to Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania. Post hospital discharge, two of the four arms included patients receiving either a standard or personalized short message service (SMS) booster to enhance and or perpetuate the effect of the in-hospital BNI. Text messages were sent weekly throughout a 3-month follow-up period. SMS feasibility was assessed according to the TIDier checklist evaluating what, when, how much, tailoring processes, modifications and how well (intervention fidelity). Data was collected with SMS logs and short answer surveys to participants. A total of 41 study participants were assigned to each receive 12 SMS over a three-month period; 38 received messages correctly, 3 did not receive intended messages, and 1 received a message who was not intended to. Of the 258 attempted texts, 73% were successfully sent through the messaging system. Of the messages that failed delivery, the majority were not able to be sent due to participants traveling out of cellular service range or turning off their phones. Participants interviewed in both booster arms reported that messages were appropriate, and that they would appreciate the continuation of such reminders. At 6-month follow-up, 100% (n = 11) of participants interviewed believed that the boosters had a positive impact on their behavior, with 90% reporting a large impact. This study demonstrated feasibility and acceptability of the integration of SMS mobile health technology to supplement this type of nurse-led BNI. SMS booster is a practical tool that can potentially prolong the impact of a brief hospital based intervention to enact behavioral change in injury patients with AUD.
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Affiliation(s)
- Catherine A. Staton
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Mary Catherine Minnig
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Ashley J. Phillips
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Arthi S. Kozhumam
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | | | - Brian Suffoletto
- Department of Emergency Medicine, Stanford University, California, United States of America
| | - Blandina T. Mmbaga
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Kennedy Ngowi
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Joao Ricardo Nickenig Vissoci
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
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Zadey S, Sonal S, Iyer H, Baxy H, Smith ER, Staton CA, Fitzgerald TN, Nickenig Vissoci JR. Roadblocks and solutions to planning surgical care for a billion Indians. BMJ Glob Health 2022; 7:bmjgh-2022-010292. [DOI: 10.1136/bmjgh-2022-010292] [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] [Received: 07/30/2022] [Accepted: 08/21/2022] [Indexed: 11/17/2022] Open
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Barcenas LK, Appenteng R, Sakita F, O’Leary P, Rice H, Mmbaga BT, Vissoci JRN, Staton CA. The epidemiology of pediatric traumatic brain injury presenting at a referral center in Moshi, Tanzania. PLoS One 2022; 17:e0273991. [PMID: 36197935 PMCID: PMC9534435 DOI: 10.1371/journal.pone.0273991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 04/08/2021] [Accepted: 08/19/2022] [Indexed: 11/05/2022] Open
Abstract
Background Over 95% of childhood injury deaths occur in low- and middle-income countries (LMICs). Patients with severe traumatic brain injury (TBI) have twice the likelihood of dying in LMICs than in high-income countries (HICs). In Africa, TBI estimates are projected to increase to upwards of 14 million new cases in 2050; however, these estimates are based on sparse data, which underscores the need for robust injury surveillance systems. We aim to describe the clinical factors associated with morbidity and mortality in pediatric TBI at the Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania to guide future prevention efforts. Methods We conducted a secondary analysis of a TBI registry of all pediatric (0–18 years of age) TBI patients presenting to the KCMC emergency department (ED) between May 2013 and April 2014. The variables included demographics, acute treatment and diagnostics, Glasgow Coma Scores (GCSs, severe 3–8, moderate 9–13, and mild 14–15), morbidity at discharge as measured by the Glasgow Outcome Scale (GOS, worse functional status 1–3, better functional status 4–6), and mortality status at discharge. The analysis included descriptive statistics, bivariable analysis and multivariable logistic regression to report the predictors of mortality and morbidity. The variables used in the multivariable logistic regression were selected according to their clinical validity in predicting outcomes. Results Of the total 419 pediatric TBI patients, 286 (69.3%) were male with an average age of 10.12 years (SD = 5.7). Road traffic injury (RTI) accounted for most TBIs (269, 64.4%), followed by falls (82, 19.62%). Of the 23 patients (5.58%) who had alcohol-involved injuries, most were male (3.6:1). Severe TBI occurred in 54 (13.0%) patients. In total, 90 (24.9%) patients underwent TBI surgery. Of the 21 (5.8%) patients who died, 11 (55.0%) had severe TBI, 6 (30.0%) had moderate TBI (GCS 9–13) and 3 (15.0%) presented with mild TBI (GCS>13). The variables most strongly associated with worse functional status included having severe TBI (OR = 9.45) and waiting on the surgery floor before being moved to the intensive care unit (ICU) (OR = 14.37). Conclusions Most pediatric TBI patients were males who suffered RTIs or falls. Even among children under 18 years of age, alcohol was consumed by at least 5% of patients who suffered injuries, and more commonly among boys. Patients becoming unstable and having to be transferred from the surgery floor to the ICU could reflect poor risk identification in the ED or progression of injury severity. The next steps include designing interventions to reduce RTI, mitigate irresponsible alcohol use, and improve risk identification and stratification in the ED.
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Affiliation(s)
| | | | | | - Paige O’Leary
- Duke Global Health Institute, Durham, NC, United States of America
| | - Henry Rice
- Division of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | - Blandina T. Mmbaga
- Duke Global Health Institute, Durham, NC, United States of America
- Vanderbilt University, Nashville, TN, United States of America
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Catherine A. Staton
- Duke Global Health Institute, Durham, NC, United States of America
- Division of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States of America
- * E-mail:
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Tupetz A, Strand E, Hoque KI, Sultana M, Vissoci JRN, Staton C, Landry MD. Scarf Injury: a qualitative examination of the emergency response and acute care pathway from a unique mechanism of road traffic injury in Bangladesh. BMC Emerg Med 2022; 22:141. [PMID: 35922760 PMCID: PMC9351164 DOI: 10.1186/s12873-022-00698-2] [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: 09/03/2021] [Accepted: 07/18/2022] [Indexed: 12/04/2022] Open
Abstract
Background Road traffic injuries (RTI) are the leading cause of death worldwide in children over 5 and adults aged 18–29. Nonfatal RTIs result in 20–50 million annual injuries. In Bangladesh, a new mechanism of RTI has emerged over the past decade known as a ‘scarf injury.’ Scarf injuries occur when scarves, part of traditional female dress, are caught in the driveshaft of an autorickshaw. The mechanism of injury results in novel, strangulation-like cervical spine trauma. This study aimed to understand the immediate emergency response, acute care pathway, and subsequent functional and health outcomes for survivors of scarf injuries. Methods Key informant interviews were conducted with female scarf injury survivors (n = 12), caregivers (n = 6), and health care workers (n = 15). Themes and subthemes were identified via inductive content analysis, then applied to the three-delay model to examine specific breakdowns in pre-hospital care and provide a basis for future interventions. Findings Over half of the scarf injury patients were between the ages of 10 and 15. All but two were tetraplegic. Participants emphasized less than optimal patient outcomes were due to unawareness of scarf injuries and spinal cord injuries among the general public and health professionals; unsafe and inefficient bystander first aid and transportation; and high cost of acute health care. Conclusions Females in Bangladesh are at significant risk of sustaining serious and life-threatening trauma through scarf injuries in autorickshaws, further worsened through inadequate care along the trauma care pathway. Interventions designed to increase awareness and knowledge of basic SCI care at the community and provider level would likely improve health and functional outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00698-2.
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Affiliation(s)
- Anna Tupetz
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Emergency Medicine, Duke University Medical Center, Durham, NC, USA
| | - Eleanor Strand
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Emergency Medicine, Duke University Medical Center, Durham, NC, USA
| | | | - Mohsina Sultana
- Center for the Rehabilitation of the Paralyzed (CRP), Savar, Bangladesh.,Directorate of General Health Services (DGHS), Government of Mohakhali, Dhaka, Bangladesh
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Emergency Medicine, Duke University Medical Center, Durham, NC, USA
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Emergency Medicine, Duke University Medical Center, Durham, NC, USA
| | - Michel D Landry
- Western Norway University of Applied Sciences, Bergen, Norway. .,Virginia Commonwealth University, Richmond, VA, USA.
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Tupetz A, Barcenas LK, Phillips AJ, Vissoci JRN, Gerardo CJ. BITES study: A qualitative analysis among emergency medicine physicians on snake envenomation management practices. PLoS One 2022; 17:e0262215. [PMID: 34995326 PMCID: PMC8741014 DOI: 10.1371/journal.pone.0262215] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 02/05/2021] [Accepted: 12/19/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Antivenom is currently considered standard treatment across the full spectrum of severity for snake envenomation in the United States. Although safe and effective antivenoms exist, their use in clinical practice is not universal. OBJECTIVE This study explored physicians' perceptions of antivenom use and experience with snake envenomation treatment in order to identify factors that influence treatment decisions and willingness to administer. METHODS We conducted a qualitative study including in-depth interviews via online video conferencing with physicians practicing in emergency departments across the United States. Participants were selected based on purposive sampling methods. Data analysis followed inductive strategies, conducted by two researchers. The codebook and findings were discussed within the research team. FINDINGS Sixteen in-depth interviews with physicians from nine states across the US were conducted. The participants' specialties include emergency medicine (EM), pediatric EM, and toxicology. The experience of treating snakebites ranged from only didactic education to having treated over 100 cases. Emergent themes for this manuscript from the interview data included perceptions of antivenom, willingness to administer antivenom and influencing factors to antivenom usage. Overall, cost-related concerns were a major barrier to antivenom administration, especially in cases where the indications and effectiveness did not clearly outweigh the potential financial burden on the patient in non-life- or limb-threatening cases. The potential to decrease recovery time and long-term functional impairments was not commonly reported by participants as an indication for antivenom. In addition, level of exposure and perceived competence, based on prior education and clinical experience, further impacted the decision to treat. Resources such as Poison Center Call lines were well received and commonly used to guide the treatment plan. The need for better clinical guidelines and updated treatment algorithms with clinical and measurable indicators was stated to help the decision-making process, especially among those with low exposure to snake envenomation patients. CONCLUSIONS A major barrier to physician use of antivenom is a concern about cost, cost transparency and cost-benefit for the patients. Those concerns, in addition to the varying degrees of awareness of potential long-term benefits, further influence inconsistent clinical treatment practices.
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Affiliation(s)
- Anna Tupetz
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Loren K. Barcenas
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Ashley J. Phillips
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Joao Ricardo Nickenig Vissoci
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Charles J. Gerardo
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- * E-mail:
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Staton CA, Zadey S, O’Leary P, Phillips A, Minja L, Swahn MH, Hirshon JM, Boshe J, Sakita F, Vissoci JRN, Mmbaga BT. PRACT: a pragmatic randomized adaptive clinical trial protocol to investigate a culturally adapted brief negotiational intervention for alcohol use in the emergency department in Tanzania. Trials 2022; 23:120. [PMID: 35123566 PMCID: PMC8818146 DOI: 10.1186/s13063-022-06060-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/27/2022] [Indexed: 12/20/2022] Open
Abstract
Background Alcohol use in resource-limited settings results in significant morbidity and mortality. These settings lack the necessary specialty-trained personnel and infrastructure. Therefore, implementing evidence-based interventions from high-income settings, like a brief negotiational intervention (BNI) for alcohol, will require rapid production of evidence of effectiveness to guide implementation priorities. Thus, this study describes a clinical trial protocol to rapidly optimize and evaluate the impact of a culturally adapted BNI to reduce alcohol-related harms and alcohol consumption among injury patients. Methods Our pragmatic, adaptive, randomized controlled trial (PRACT) is designed to determine the most effective intervention approach to reduce hazardous alcohol use among adult (≥18 years old) in acute (< 24 h) injury patients. Our culturally adapted, nurse-delivered, intervention (PPKAY) has been augmented with evidence-based, culturally appropriate standards and will be evaluated as follows. Stage 1 of the trial will determine if PPKAY, either with a standard short-message-service (SMS) booster or with a personalized SMS booster is more effective than usual care (UC). While optimizing statistical efficiency, Stage 2 drops the UC arm to compare the PPKAY with a standard SMS booster to PPKAY with a personalized SMS booster. Finally, in Stage 3, the more effective arm in Stage 2 is compared to PPKAY without an SMS booster. The study population is acute injury patients who present to Kilimanjaro Christian Medical Centre, Tanzania, who (1) test alcohol positive by breathalyzer upon arrival; (2) have an Alcohol Use Disorder Identification Test of 8 or above; and/or (3) have reported drinking alcohol prior to their injury. Outcome measures will be evaluated for all arms at 3, 6, 9, 12, and 24 months. The primary outcome for the study is the reduction of the number of binge drinking days in the 4 weeks prior to follow-up. Secondary outcomes include alcohol-related consequences, measured by the Drinker Inventory of Consequences. Discussion The findings from this study will be critically important to identify alcohol harm reduction strategies where alcohol research and interventions are scarce. Our innovative and adaptive trial design can transform behavior change research and identify the most effective nurse-driven intervention to be targeted for integration into standard care. Trial registration ClinicalTrials.govNCT04535011. Registered on September 1, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06060-y.
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21
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Isaacson JE, Joiner AP, Kozhumam AS, Caruzzo NM, de Andrade L, Iora PH, Costa DB, Vissoci BM, Sartori MLL, Rocha TAH, Vissoci JRN. Emergency Care Sensitive Conditions in Brazil: A Geographic Information System Approach to Timely Hospital Access. Lancet Reg Health Am 2021; 4:100063. [PMID: 36776707 PMCID: PMC9903578 DOI: 10.1016/j.lana.2021.100063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/26/2021] [Accepted: 08/20/2021] [Indexed: 11/16/2022]
Abstract
Background The benefits of treatment for many conditions are time dependent. The burden of these emergency care sensitive conditions (ECSCs) is especially high in low- and middle-income countries. Our objective was to analyze geospatial trends in ECSCs and characterize regional disparities in access to emergency care in Brazil. Methods From publicly available datasets, we extracted data on patients assigned an ECSC-related ICD-10 code and on the country's emergency facilities from 2015-2019. Using ArcGIS, OpenStreetMap, and WorldPop, we created catchment areas corresponding to 180 minutes of driving distance from each hospital. We then used ArcGIS to characterize space-time trends in ECSC admissions and to complete an Origin-Destination analysis to determine the path from household to closest hospital. Findings There were 1362 municipalities flagged as "hot spots," areas with a high volume of ECSCs. Of those, 69.7% were more than 180 minutes (171 km) from the closest emergency facility. These municipalities were primarily located in the states of Minas Gerais, Bahia, Espiríto Santo, Tocantins, and Amapá. In the North region, only 69.1% of the population resided within 180 minutes of an emergency hospital. Interpretations Significant geographical barriers to accessing emergency care exist in certain areas of Brazil, especially in peri-urban areas and the North region. One limitation of this approach is that geolocation was not possible in some areas and thus we are likely underestimating the burden of inadequate access. Subsequent work should evaluate ECSC mortality data. Funding This study was funded by the Duke Global Health Institute Artificial Intelligence Pilot Project.
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Affiliation(s)
- Julia Elizabeth Isaacson
- Duke University School of Medicine, DUMC 3170, Durham, North Carolina, 27710, United States of America
| | - Anjni Patel Joiner
- Duke Global Health Institute, 310 Trent Drive, Durham, North Carolina, 27710, United States of America,Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, North Carolina, 27710, United States of America,Corresponding Author:
| | - Arthi Shankar Kozhumam
- Duke Global Health Institute, 310 Trent Drive, Durham, North Carolina, 27710, United States of America
| | - Nayara Malheiros Caruzzo
- Department of Physical Education, State University of Maringá, Av. Colombo, 5790 - Zona 7, Maringá - Paraná, 87020-900, Brazil
| | - Luciano de Andrade
- Department of Medicine, State University of Maringá, Av. Colombo, 5790 - Zona 7, Maringá - Paraná, 87020-900, Brazil
| | - Pedro Henrique Iora
- Department of Medicine, State University of Maringá, Av. Colombo, 5790 - Zona 7, Maringá - Paraná, 87020-900, Brazil
| | - Dalton Breno Costa
- Department of Psychology, Federal University of Health Sciences of Porto Alegre, R. Sarmento Leite, 245 - Centro Histórico, Porto Alegre - Rio Grande do Sul, 90050-170, Brazil
| | - Bianca Maria Vissoci
- Program for Health Sciences, State University of Maringá, Av. Colombo, 5790 - Zona 7, Maringá - Paraná, 87020-900, Brazil
| | - Marcos Luiggi Lemos Sartori
- Department of Computer Science, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga, 6681 - Partenon, Porto Alegre - Rio Grande do Sul, 90619-900, Brazil
| | | | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, 310 Trent Drive, Durham, North Carolina, 27710, United States of America,Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, North Carolina, 27710, United States of America
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22
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Natesan S, Todd B, Hsu RS, Ren RK, Clark R, Jara‐Almonta G, Vissoci JRN, Narajeenron K. Novel tool for assessing the quality of feedback in the emergency room (FEED-ER). AEM Educ Train 2021; 5:e10698. [PMID: 34859168 PMCID: PMC8616187 DOI: 10.1002/aet2.10698] [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] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/09/2021] [Accepted: 09/23/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education (ACGME) emphasizes constructive feedback as a critical component of residency training. Despite over a decade of using competency-based milestone evaluations, emergency medicine (EM) residency programs lack a standardized method for assessing the quality of feedback. We developed two novel EM-specific feedback surveys to assess the quality of feedback in the ER (FEED-ER) from both the resident and the faculty perspectives. This study aimed to evaluate the surveys' psychometric properties. METHODS We developed FEED-ER using a Likert scale with faculty and resident versions based on the ACGME framework and a literature review. The preliminary survey consisted of 25 questions involving the feedback domains of timeliness, respect/communication, specificity, action plan, and feedback culture. We conducted two modified Delphi rounds involving 17 content experts to ensure respondent understanding of the items, item coherence to corresponding feedback domains, thematic saturation of domain content, and time duration. A multicenter study was conducted at five university-based EDs in the United States and one in Thailand in 2019. We evaluated the descriptive statistics of the frequency of responses, validity evidence, and reliability of FEED-ER. RESULTS A total of 147 EM faculty and 126 EM residents completed the survey. Internal consistency was adequate (Cronbach's alpha > 0.70) and test-retest reliability showed adequate temporal stability (ICC > 0.80) for all dimensions. Content validity was deemed acceptable (CVC > 0.80) for all items. From the 25 items of FEED-ER, 23 loaded into the originally theorized dimensions (with factor loadings > 0.50). Additionally, the five feedback domains were found to be statistically distinct, with correlations between 0.40 and 0.60. The final survey has 23 items. CONCLUSIONS This is the first study to develop and provide validity evidence for an EM-specific feedback tool that has strong psychometric properties, is reproducible and reliable, and provides an objective measure for assessing the quality of feedback in the ED.
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Affiliation(s)
- Sreeja Natesan
- Division of Emergency MedicineDuke UniversityDurhamNorth CarolinaUSA
| | - Brett Todd
- Department of Emergency MedicineOakland University William Beaumont School of MedicineBeaumont HealthRoyal OakMichiganUSA
| | - Robert S. Hsu
- Christiana Care Emergency Medicine Residency ProgramSidney Kimmel Medical CollegeThomas Jefferson UniversityCherry HillNew JerseyUSA
| | | | - Ryan Clark
- Department of Emergency MedicineUMMS‐BaystateWilliamsburgMassachusettsUSA
| | - Geoff Jara‐Almonta
- Icahn School of Medicine at Mt Sinai Dept of Emergency MedicineNew York City Health and HospitalsElmhurst Hospital Center Department of Emergency MedicineNew YorkNew YorkUSA
| | | | - Khuansiri Narajeenron
- Department of Emergency Medicine, Faculty of MedicineChulalongkorn UniversityKing Chulalongkorn Memorial Hospital, The Thai Red Cross SocietyBangkokThailand
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23
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Carvalho ECAD, Vissoci JRN, Andrade LD, Machado WDL, Paraiso EC, Nievola JC. BNPA: An R package to learn path analysis input models from a data set semi-automatically using Bayesian networks. Knowl Based Syst 2021. [DOI: 10.1016/j.knosys.2021.107042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Joiner A, Lee A, Chowa P, Kharel R, Kumar L, Caruzzo NM, Ramirez T, Reynolds L, Sakita F, Van Vleet L, von Isenburg M, Yaffee AQ, Staton C, Vissoci JRN. Access to care solutions in healthcare for obstetric care in Africa: A systematic review. PLoS One 2021; 16:e0252583. [PMID: 34086753 PMCID: PMC8177460 DOI: 10.1371/journal.pone.0252583] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/18/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Emergency Medical Services (EMS) systems exist to reduce death and disability from life-threatening medical emergencies. Less than 9% of the African population is serviced by an emergency medical services transportation system, and nearly two-thirds of African countries do not have any known EMS system in place. One of the leading reasons for EMS utilization in Africa is for obstetric emergencies. The purpose of this systematic review is to provide a qualitative description and summation of previously described interventions to improve access to care for patients with maternal obstetric emergencies in Africa with the intent of identifying interventions that can innovatively be translated to a broader emergency context. METHODS The protocol was registered in the PROSPERO database (International Prospective Register of Systematic Reviews) under the number CRD42018105371. We searched the following electronic databases for all abstracts up to 10/19/2020 in accordance to PRISMA guidelines: PubMed/MEDLINE, Embase, CINAHL, Scopus and African Index Medicus. Articles were included if they were focused on a specific mode of transportation or an access-to-care solution for hospital or outpatient clinic care in Africa for maternal or traumatic emergency conditions. Exclusion criteria included in-hospital solutions intended to address a lack of access. Reference and citation analyses were performed, and a data quality assessment was conducted. Data analysis was performed using a qualitative metasynthesis approach. FINDINGS A total of 6,457 references were imported for screening and 1,757 duplicates were removed. Of the 4,700 studies that were screened against title and abstract, 4,485 studies were excluded. Finally, 215 studies were assessed for full-text eligibility and 152 studies were excluded. A final count of 63 studies were included in the systematic review. In the 63 studies that were included, there was representation from 20 countries in Africa. The three most common interventions included specific transportation solutions (n = 39), community engagement (n = 28) and education or training initiatives (n = 27). Over half of the studies included more than one category of intervention. INTERPRETATION Emergency care systems across Africa are understudied and interventions to improve access to care for obstetric emergencies provides important insight into existing solutions for other types of emergency conditions. Physical access to means of transportation, efforts to increase layperson knowledge and recognition of emergent conditions, and community engagement hold the most promise for future efforts at improving emergency access to care.
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Affiliation(s)
- Anjni Joiner
- Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
| | - Austin Lee
- Division of Global Emergency Medicine, Department of Emergency Medicine, Brown University, Providence, RI, United States of America
| | - Phindile Chowa
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Ramu Kharel
- Division of Global Emergency Medicine, Department of Emergency Medicine, Brown University, Providence, RI, United States of America
| | - Lekshmi Kumar
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Nayara Malheiros Caruzzo
- Physical Education Department, State University of Maringá, Maringá, PR, United States of America
| | - Thais Ramirez
- Duke Global Health Institute, Durham, NC, United States of America
| | - Lindy Reynolds
- University of Alabama School of Public Health, Birmingham, AL, United States of America
| | - Francis Sakita
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Lee Van Vleet
- Durham County Emergency Services, Durham, NC, United States of America
| | - Megan von Isenburg
- Medical Center Library, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Anna Quay Yaffee
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Catherine Staton
- Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
| | - Joao Ricardo Nickenig Vissoci
- Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
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25
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Chakraborty P, Vissoci JRN, Muhumuza C, Fuller AT, Koltai DC, Nshemerirwe S, Haglund MM, Kaddumukasa MN. Validity of the Personal Impact of Epilepsy Scale (PIES) in patients with epilepsy in Uganda. Epilepsy Behav 2021; 114:107303. [PMID: 32718815 DOI: 10.1016/j.yebeh.2020.107303] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE We sought to address the construct validity and reliability of the Personal Impact of Epilepsy Scale (PIES), an epilepsy-specific quality-of-life measure, in patients with epilepsy in Uganda. We also sought to assess the applicability of the scale across three languages: English, Luganda, and Runyankole. METHODS Patients with epilepsy (N = 626) were recruited at the time of care seeking from Mulago National Referral Hospital (MNRH), Butabika National Referral Mental Hospital (BNRMH), and Mbarara Regional Referral Hospital (MRRH), and were given the English, Runyankole, and Luganda versions of the PIES as a part of a larger interview. Reliability, internal consistency specifically, was assessed using three parameters: Cronbach's alpha, McDonald's Omega, and composite reliability. Construct validity (internal structure) was evaluated with principal component analysis (PCA) for three factors, as well as confirmatory factor analysis (CFA) for a three-factor structure of the scale. We also assessed correlations between the three PIES subscales and the seizure severity question in the Liverpool Seizure Severity Scale (LSSS) and reported seizure frequency. RESULTS The three-factor model of the PIES had adequate reliability, with Cronbach's Alpha, McDonald's Omega, and composite reliability values over 0.7, except for the Cronbach's Alpha and McDonald's Omega values for the second factor, which was slightly lower than 0.7 in the full sample as well as when stratified by study language. The PCA and CFA models for the scale demonstrated adequate fit with the Tucker-Lewis index (TLI), comparative fit index (CFI), and root mean square error of approximation (RMSEA), with TLI and CFI values above 0.9 and RMSEA values less than 0.08. However, the model demonstrated inadequate fit with the Chi-square indicator, which yielded a significant p-value. Individual factor loadings ranged from 0.50 to 0.95 in the full sample, 0.45 to 0.98 in the English sample, and 0.45 to 0.93 in the Luganda sample. Finally, the three PIES subscales aligned with reported seizure frequency and the seizure severity question from the LSSS. CONCLUSIONS This study presents the first Luganda and Runyankole versions of the PIES, and the first validation of this scale in English and Luganda with patients with epilepsy in Uganda. The PIES was found to have acceptable psychometric properties for reliability and validity parameters. Thus, the scale is recommended for use and for further investigation in patients with epilepsy in Uganda. This article is part of the Special Issue "The Intersection of Culture, Resources, and Disease: Epilepsy Care in Uganda".
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Affiliation(s)
- Payal Chakraborty
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA
| | - Joao Ricardo Nickenig Vissoci
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University School of Medicine, Department of Surgery, Emergency Medicine, Durham, NC, USA
| | - Christine Muhumuza
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Makerere University School of Public Health, Department of Epidemiology and Biostatistics, New Mulago complex, P.O.BOX 7072, Kampala, Uganda
| | - Anthony T Fuller
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University School of Medicine, Durham, NC, USA
| | - Deborah C Koltai
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA; Duke University School of Medicine, Department of Neurology, Durham, NC, USA.
| | - Sylvia Nshemerirwe
- Butabika National Referral Mental Hospital, P.O.BOX 7017, Kampala, Uganda
| | - Michael M Haglund
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University School of Medicine, Durham, NC, USA
| | - Martin N Kaddumukasa
- Department of Medicine, Mulago National Referral Hospital, Neurology Unit, Kampala, Uganda; School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
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Tupetz A, Friedman K, Zhao D, Liao H, Isenburg MV, Keating EM, Vissoci JRN, Staton CA. Prevention of childhood unintentional injuries in low- and middle-income countries: A systematic review. PLoS One 2020; 15:e0243464. [PMID: 33373371 PMCID: PMC7771986 DOI: 10.1371/journal.pone.0243464] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 06/17/2020] [Accepted: 11/21/2020] [Indexed: 11/29/2022] Open
Abstract
Injuries are a leading cause of death and disability among children. Numerous injury prevention strategies have been successful in high-income countries, but the majority of unintentional injuries happen to children living in low- and middle-income countries (LMICs). This project aims to delineate the childhood injury prevention initiatives in LMICs. For inclusion, peer-reviewed articles needed to address unintentional injury, include children <18, assess a prevention-related intervention, contain a control group, and be published after 1988. Two pairs of reviewers evaluated articles independently to determine study eligibility. 74 articles were included. 30 studies addressed road traffic injuries, 11 drowning, 8 burns, 3 falls, 8 poisonings, and 21 an unspecified injury type. The findings show positive effects on injury outcome measures following educational interventions, the need for longer follow-up periods after the intervention, the need for effectiveness trials for behavior change, and the need for an increase in injury prevention services in LMICs. This is the first systematic review to summarize the prevention initiatives for all types of childhood unintentional injuries in LMICs. Increased attention and funding are required to go beyond educational initiatives with self-reported measures and little follow-up time to robust interventions that will reduce the global burden of unintentional injuries among children.
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Affiliation(s)
- Anna Tupetz
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Kaitlyn Friedman
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Duan Zhao
- Duke Kunshan University, Kunshan, Suzhou, Jiangsu, China
| | - Huipeng Liao
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Megan Von Isenburg
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Elizabeth M. Keating
- Division of Pediatric Emergency Medicine, Division of Public Health, University of Utah, Salt Lake City, Utah, United States of America
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Catherine A. Staton
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
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Staton CA, Zhao D, Ginalis EE, Hirshon JM, Sakita F, Swahn MH, Mmbaga BT, Vissoci JRN. Alcohol Availability, Cost, Age of First Drink, and Its Association with At-Risk Alcohol Use in Moshi, Tanzania. Alcohol Clin Exp Res 2020; 44:2266-2274. [PMID: 32944986 PMCID: PMC7680393 DOI: 10.1111/acer.14457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Kilimanjaro region has one of the highest levels of reported alcohol intake per capita in Tanzania. Age at first drink has been found to be associated with alcohol problems in adulthood, but there is less information on the age of first drink in the Kilimanjaro region and its associations with alcohol-related consequences later in life. Furthermore, local alcohol cost and availability may influence the prevalence of alcohol use and alcohol use disorders. METHODS Data on the age of first drink, alcohol use disorder identification tool (AUDIT), number and type of alcohol consequences (DrInC), and perceived alcohol at low cost and high availability for children and adolescents were collected from an alcohol and health behavior survey of injury patients (N = 242) in Moshi, Tanzania. Generalized linear models were used to test age at first drink, perceived alcohol cost and availability, and their association with the AUDIT and DrInC scores, and current alcohol use, respectively. RESULTS Consuming alcohol before age 18 was significantly associated with higher AUDIT and DrInC scores, with odds ratios of 1.22 (CI: 1.004, 1.47) and 1.72 (CI: 1.11, 2.63), respectively. Female gender is strongly associated with less alcohol use and alcohol consequences, represented by an odds ratio of 3.70 (CI: 1.72, 8.33) for an AUDIT score above 8 and an odds ratio of 3.84 (CI: 2.13, 6.67) with the DrInC score. Perceived high availability of alcohol for children is significantly related to higher alcohol use quantity, with the odds ratio of 1.6 (CI: 1.17, 2.20). CONCLUSIONS The first use of alcohol before the age of 18 is associated with higher alcohol use and alcohol-related adverse consequences. In Tanzania, age at first drink is an important target for interventions aiming to prevent negative alcohol-related consequences later in life.
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Affiliation(s)
| | - Duan Zhao
- Duke Kunshan Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu China
| | | | - Jon Mark Hirshon
- University of Maryland School of Medicine, College Park, Maryland USA
| | | | | | - Blandina Theophil Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC USA
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Zimmerman A, Fox S, Griffin R, Nelp T, Thomaz EBAF, Mvungi M, Mmbaga BT, Sakita F, Gerardo CJ, Vissoci JRN, Staton CA. An analysis of emergency care delays experienced by traumatic brain injury patients presenting to a regional referral hospital in a low-income country. PLoS One 2020; 15:e0240528. [PMID: 33045030 PMCID: PMC7549769 DOI: 10.1371/journal.pone.0240528] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/29/2020] [Indexed: 11/12/2022] Open
Abstract
Background Trauma is a leading cause of death and disability worldwide. In low- and middle-income countries (LMICs), trauma patients have a higher risk of experiencing delays to care due to limited hospital resources and difficulties in reaching a health facility. Reducing delays to care is an effective method for improving trauma outcomes. However, few studies have investigated the variety of care delays experienced by trauma patients in LMICs. The objective of this study was to describe the prevalence of pre- and in-hospital delays to care, and their association with poor outcomes among trauma patients in a low-income setting. Methods We used a prospective traumatic brain injury (TBI) registry from Kilimanjaro Christian Medical Center in Moshi, Tanzania to model nine unique delays to care. Multiple regression was used to identify delays significantly associated with poor in-hospital outcomes. Results Our analysis included 3209 TBI patients. The most common delay from injury occurrence to hospital arrival was 1.1 to 4.0 hours (31.9%). Most patients were evaluated by a physician within 15.0 minutes of arrival (69.2%). Nearly all severely injured patients needed and did not receive a brain computed tomography scan (95.0%). A majority of severely injured patients needed and did not receive oxygen (80.8%). Predictors of a poor outcome included delays to lab tests, fluids, oxygen, and non-TBI surgery. Conclusions Time to care data is informative, easy to collect, and available in any setting. Our time to care data revealed significant constraints to non-personnel related hospital resources. Severely injured patients with the greatest need for care lacked access to medical imaging, oxygen, and surgery. Insights from our study and future studies will help optimize resource allocation in low-income hospitals thereby reducing delays to care and improving trauma outcomes in LMICs.
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Affiliation(s)
- Armand Zimmerman
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Samara Fox
- Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Randi Griffin
- Department of Evolutionary Anthropology, Duke University, Durham, North Carolina, United States of America
| | - Taylor Nelp
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | | | - Mark Mvungi
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Francis Sakita
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Charles J Gerardo
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.,Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Catherine A Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.,Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
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Zhao D, Nickenig Vissoci JR, Mmbaga BT, Abdullah AS, Staton CA. Alcohol-Related Risky Behavior Patterns and Their Association With Alcohol Use and Perceived Alcohol Stigma in Moshi, Tanzania. J Stud Alcohol Drugs 2020; 81:614-623. [PMID: 33028474 PMCID: PMC8076481] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 04/12/2020] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE The Kilimanjaro region has one of the highest rates of reported alcohol use per capita in Tanzania. Alcohol-related risky behaviors pose substantial threats to the health and well-being of alcohol users and the people around them. This study seeks to understand how alcohol-related risky behaviors co-occur with other risky behaviors. METHOD Latent class analysis (LCA) was applied to examine alcohol-related risky behaviors. The optimal number of latent classes was confirmed by using model fit indices. Negative binomial models were used to test latent classes and their association with harmful and hazardous drinking and perceived alcohol stigma. With the model defined, we explored each class's drinking patterns and risky behavior patterns. RESULTS A total of 622 (60% male) of 841 participants were included in these analyses because they drank alcohol at least once in their lifetime. Three classes of risky behavior patterns were identified: Class 1, "Limited risk behaviors" (59.7%); Class 2, "Primarily foolish behaviors" (25.6%); and Class 3, "Pervasive risk behaviors" (13.1%). Class 3 had the most alcohol use quantity and frequency. No association between classes and alcohol stigma was found. Compared with males, females are less likely to be classified in Class 2 and 3. CONCLUSIONS Three different classes of risky behaviors became apparent and were distinguished by gender, age, and personal alcohol use. Our findings suggest a potential role for personalized interventions based on latent classes specifically to reduce risk behaviors.
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Affiliation(s)
- Duan Zhao
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Abu S. Abdullah
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Catherine A. Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina
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30
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Zhao D, Nickenig Vissoci JR, Mmbaga BT, Abdullah AS, Staton CA. Alcohol-Related Risky Behavior Patterns and Their Association With Alcohol Use and Perceived Alcohol Stigma in Moshi, Tanzania. J Stud Alcohol Drugs 2020; 81:614-623. [PMID: 33028474 PMCID: PMC8076481 DOI: 10.15288/jsad.2020.81.614] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 04/12/2020] [Indexed: 10/26/2023] Open
Abstract
OBJECTIVE The Kilimanjaro region has one of the highest rates of reported alcohol use per capita in Tanzania. Alcohol-related risky behaviors pose substantial threats to the health and well-being of alcohol users and the people around them. This study seeks to understand how alcohol-related risky behaviors co-occur with other risky behaviors. METHOD Latent class analysis (LCA) was applied to examine alcohol-related risky behaviors. The optimal number of latent classes was confirmed by using model fit indices. Negative binomial models were used to test latent classes and their association with harmful and hazardous drinking and perceived alcohol stigma. With the model defined, we explored each class's drinking patterns and risky behavior patterns. RESULTS A total of 622 (60% male) of 841 participants were included in these analyses because they drank alcohol at least once in their lifetime. Three classes of risky behavior patterns were identified: Class 1, "Limited risk behaviors" (59.7%); Class 2, "Primarily foolish behaviors" (25.6%); and Class 3, "Pervasive risk behaviors" (13.1%). Class 3 had the most alcohol use quantity and frequency. No association between classes and alcohol stigma was found. Compared with males, females are less likely to be classified in Class 2 and 3. CONCLUSIONS Three different classes of risky behaviors became apparent and were distinguished by gender, age, and personal alcohol use. Our findings suggest a potential role for personalized interventions based on latent classes specifically to reduce risk behaviors.
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Affiliation(s)
- Duan Zhao
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Abu S. Abdullah
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Catherine A. Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina
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31
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Le E, Shrader P, Bosworth H, Hurst J, Goldstein B, Drake A, Wood J, David LR, Runyan CM, Vissoci JRN, Harker M, Allori AC. Provision and Utilization of Team- and Community-Based Operative Care for Patients With Cleft Lip/Palate in North Carolina. Cleft Palate Craniofac J 2020; 57:1298-1307. [PMID: 32844676 DOI: 10.1177/1055665620946565] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To characterize operative care for cleft lip and/or palate (CL/P) based on location (ie, from American Cleft Palate Craniofacial Association [ACPA]-approved multidisciplinary teams or from community providers). DESIGN Cross-sectional analysis of Healthcare Cost and Utilization Project State Inpatient Database and State Ambulatory Surgery & Services Database databases for North Carolina from 2012 to 2015. SETTING/PATIENTS AND MAIN OUTCOME MEASURES Clinical encounters for children with CL/P undergoing operative procedures were identified, classified by location as "Team" versus "Community," and characterized by demographic, geographic, clinical, and procedural factors. A secondary evaluation reviewed concordance of team and community practices with an ACPA guideline related to coordination of care. RESULTS Three teams and 39 community providers performed a total of 3010 cleft-related procedures across 2070 encounters. Teams performed 69.7% of total volume and performed the majority of cleft procedures, including cleft lip repair, palate repair, alveolar bone grafting, and correction of velopharyngeal insufficiency. Community locations principally offered myringotomy and rhinoplasty. Team care was associated with higher guideline concordance. CONCLUSIONS American Cleft Palate Craniofacial Association -approved team-based care accounts for the majority of cleft-related care in North Carolina; however, a substantial volume of cleft-related procedures was provided by community providers, with 3 providers accounting for the vast majority of community cases.
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Affiliation(s)
- Elliot Le
- 12277Duke University School of Medicine, Durham, NC, USA
| | - Peter Shrader
- 169142Duke Clinical Research Institute (DCRI), Durham, NC, USA
| | - Hayden Bosworth
- Departments of Population Health Sciences, Medicine, Psychiatry, School of Nursing, Duke University; Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Jillian Hurst
- Children's Health & Discovery Initiative (CHDI), 12277Duke University School of Medicine, Durham, NC, USA
| | - Benjamin Goldstein
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, USA.,Children's Health & Discovery Initiative (CHDI), Department of Pediatrics; 12277Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute (DCRI), Duke University, Durham, NC, USA.,Department of Population Health, Duke University, Durham, NC, USA
| | - Amelia Drake
- Department of Otolaryngology, University of North Carolina-Chapel Hill Medical Center, NC, USA
| | - Jeyhan Wood
- Division of Plastic Surgery, University of North Carolina-Chapel Hill Medical Center, NC, USA
| | - Lisa R David
- Department of Plastic and Reconstructive Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Christopher M Runyan
- Department of Plastic and Reconstructive Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | | | | | - Alexander C Allori
- Children's Health & Discovery Initiative (CHDI), Department of Pediatrics; 12277Duke University School of Medicine, Durham, NC, USA.,Department of Population Health, Duke University, Durham, NC, USA.,Division of Plastic, Maxillofacial & Oral Surgery, Duke University Medical Center, Durham, NC, USA
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32
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Gafaar TO, Pesambili M, Henke O, Vissoci JRN, Mmbaga BT, Staton C. Good death: An exploratory study on perceptions and attitudes of patients, relatives, and healthcare providers, in northern Tanzania. PLoS One 2020; 15:e0233494. [PMID: 32649715 PMCID: PMC7351142 DOI: 10.1371/journal.pone.0233494] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 07/25/2019] [Accepted: 05/06/2020] [Indexed: 12/03/2022] Open
Abstract
IMPORTANCE In the Kilimanjaro region of Tanzania, there are no advance care planning (ACP) protocols being used to document patient preferences for end-of-life (EoL) care. There is a general avoidance of the topic and contemplating ACP in healthcare-limited regions can be an ethically complex subject. Nonetheless, evidence from similar settings indicate that an appropriate quality of life is valued, even as one is dying. What differs amongst cultures is the definition of a 'good death'. OBJECTIVE Evaluate perceptions of quality of death and advance EoL preparation in Moshi, Tanzania. DESIGN 13 focus group discussions (FGDs) were conducted in Swahili using a semi-structured guide. These discussions were audio-recorded, transcribed, translated, and coded using an inductive approach. SETTING Kilimanjaro Christian Medical Centre (KCMC), referral hospital for northern Tanzania. PARTICIPANTS A total of 122 participants, including patients with life-threatening illnesses (34), their relatives/friends (29), healthcare professionals (29; HCPs; doctors and nurses), and allied HCPs (30; community health workers, religious leaders, and social workers) from KCMC, or nearby within Moshi, participated in this study. FINDINGS In characterizing Good Death, 7 first-order themes emerged, and, of these themes, Religious & Spiritual Wellness, Family & Interpersonal Wellness, Grief Coping & Emotional Wellness, and Optimal Timing comprised the second-order theme, EoL Preparation and Life Completion. The other first-order themes for Good Death were Minimal Suffering & Burden, Quality of Care by Formal Caregivers, and Quality of Care by Informal Caregivers. INTERPRETATION The results of this study provide a robust thematic description of Good Death in northern Tanzania and they lay the groundwork for future clinical and research endeavors to improve the quality of EoL care at KCMC.
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Affiliation(s)
- Temitope O. Gafaar
- Duke University School of Medicine, Duke University, Durham, NC, United States of America
| | - Msafiri Pesambili
- Duke University Research Collaboration, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Oliver Henke
- Cancer Care Center, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Duke Emergency Medicine, Duke University Medical Center, Durham, NC, United States of America
| | - Blandina Theophil Mmbaga
- Cancer Care Center, Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Duke Emergency Medicine, Duke University Medical Center, Durham, NC, United States of America
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Dedeken P, Nickenig Vissoci JR, Sebera F, Boon PAJM, Rutembesa E, Teuwen DE. Validity, Reliability, and Diagnostic Cut-off of the Kinyarwandan Version of the Hamilton Depression Rating Scale in Rwanda. Front Psychol 2020; 11:1343. [PMID: 32719632 PMCID: PMC7350898 DOI: 10.3389/fpsyg.2020.01343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/08/2020] [Accepted: 05/20/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction: In Rwanda, major depressive disorder affects 11.9% of the population and up to 35% of genocide survivors. Mental health services remain underutilized due to stigma and lack of awareness. Increasing the ability and capacity to diagnose and treat mental disorders is considered important to close this gap. We describe the translation, validity, and reliability assessment of the Hamilton Depression Rating Scale (HDRS) as a diagnostic tool for moderate to severe depression in Rwanda. Methods: The HDRS-21 was translated by a multi-group taskforce. We validated the translation against expert assessment in a comparative study on a sample of patients living with depression and of healthy volunteers. Psychometric properties, namely internal structure, reliability, and external validity were assessed using confirmatory factor analysis, three reliability calculations, and correlation analysis, respectively. Maximized Youden’s index was used for determining diagnostic cut-off. Results: The translated version demonstrated a kappa of 0.93. We enrolled 105 healthy volunteers and 105 patients with confirmed mild to severe depression. In the confirmatory factor analysis, HDRS had good factor loadings of 0.32–0.80. Reliability coefficients above 0.92 indicated strong internal consistency. External validity was shown by good sensitivity (0.95) and specificity (0.94) to differentiate depression from absence of depression. At a cut-off point of 17 for the diagnosis of depression, sensitivity and specificity were both 0.95 relative to gold standard. Conclusion: The validated HDRS in Kinyarwanda with diagnostic cut-off provides mental healthcare staff with an accurate tool to diagnose moderate to severe depression, enabling closure of the diagnosis and treatment gap.
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Affiliation(s)
- Peter Dedeken
- Department of Neurology, Heilig Hart Hospital, Lier, Belgium.,Corporate Societal Responsibility, UCB Pharma, Brussels, Belgium.,Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Joao Ricardo Nickenig Vissoci
- Division of Emergency Medicine, Department of Surgery, Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Fidele Sebera
- Department of Neurology, Ghent University Hospital, Ghent, Belgium.,Department of Neurology, Neuropsychiatric Hospital, CARAES Ndera, Kigali, Rwanda.,Department of Neurology and Psychiatry, University of Rwanda, Kigali, Rwanda
| | - Paul A J M Boon
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Eugene Rutembesa
- Department of Neurology and Psychiatry, University of Rwanda, Kigali, Rwanda
| | - Dirk E Teuwen
- Corporate Societal Responsibility, UCB Pharma, Brussels, Belgium
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Sebera F, Vissoci JRN, Umwiringirwa J, Teuwen DE, Boon PE, Dedeken P. Validity, reliability and cut-offs of the Patient Health Questionnaire-9 as a screening tool for depression among patients living with epilepsy in Rwanda. PLoS One 2020; 15:e0234095. [PMID: 32530968 PMCID: PMC7292570 DOI: 10.1371/journal.pone.0234095] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/18/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with epilepsy (PwE) have an increased risk of active and lifetime depression. Two in 10 patients experience depression. Lack of trained psychiatric staff in low- and middle-income countries (LMIC) creates a need for screening tools that enable detection of depression in PwE. We describe the translation, validity and reliability assessment of the Patient Health Questionnaire-9 (PHQ-9) as a screening tool for depression among PwE in Rwanda. METHOD PHQ-9 was translated to Kinyarwanda using translation-back translation and validated by a discussion group. For validation, PwE of ≥15 years of age were administered the PHQ-9 and Hamilton Depression Rating Scale (HDRS) by trained psychiatry staff at Visit 1. A random sample of 20% repeated PHQ-9 and HDRS after 14 days to assess temporal stability and intra-rater reliability. Internal structure, reliability and external validity were assessed using confirmatory factor analysis, reliability coefficients and HDRS-correlation, respectively. Maximal Youden's index was considered for cut-offs. RESULTS Four hundred and thirty-four PwE, mean age 30.5 years (SD ±13.3), were included of whom 33.6%, 37.9%, 13.4%, and 15.1% had no, mild, moderate and severe depression, respectively. PHQ-9 performed well on a one-factor model (unidimensional model), with factor loadings of 0.63-0.86. Reliability coefficients above 0.80 indicated strong internal consistency. Good temporal stability was observed (0.79 [95% CI: 0.68-0.87]). A strong correlation (R = 0.66, p = 0.01) between PHQ-9 and HDRS summed scores demonstrated robust external validity. The optimal cut-off for the PHQ-9 was similar (≥5) for mild and moderate depression and ≥7 for severe depression. CONCLUSION PHQ-9 validation in Kinyarwanda creates the capacity to screen PwE in Rwanda at scores of ≥5 for mild or moderate and ≥7 for severe depression. The availability of validated tools for screening and diagnosis for depression is a forward step for holistic care in a resource-limited environment.
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Affiliation(s)
- Fidèle Sebera
- CARAES Neuropsychiatric Hospital, Ndera, Kigali, Rwanda
- Centre Hospitalier Universitaire Kigali (CHUK), Kigali, Rwanda
| | - Joao Ricardo Nickenig Vissoci
- Department of Surgery, Duke University Medical School, Durham, NC, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | | | | | | | - Peter Dedeken
- UCB Pharma, Brussels, Belgium
- Ghent University Hospital, Ghent, Belgium
- Heilig Hart Hospitaal, Lier, Belgium
- * E-mail:
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35
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El-Gabri D, Toomey N, Gil NM, de Oliveira AC, Calvo PRS, Tchuisseu YP, Williams S, Andrade L, Vissoci JRN, Staton C. Association Between Socioeconomic and Demographic Characteristics and Non-fatal Alcohol-Related Injury in Maringá, Brazil. Front Public Health 2020; 8:66. [PMID: 32269983 PMCID: PMC7109310 DOI: 10.3389/fpubh.2020.00066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/21/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Previous research has corroborated a high burden of alcohol-related injury in Brazil and the presence of socioeconomic disparities among the injured. Yet, individual-level data is scarce. To fill this gap, we examined the association between demographic and socioeconomic characteristics with non-fatal alcohol-related injury in Maringá, Brazil. Methods: We used household survey data collected during a 2015 cross-sectional study. We conducted univariate and multivariate analyses to evaluate associations of demographic (age, gender, race) and socioeconomic characteristics (employment, education, income) with non-fatal alcohol-related injury. Results: Of the 995 participants who reported injuries, 62 (6.26%) were alcohol-related. Fifty-three (85%) alcohol-related injuries were reported by males. Multivariate analysis indicated being male (OR = 5.98 95% CI = 3.02, 13.28), 15–29 years of age (OR = 3.62 95% CI = 1.72, 7.71), and identifying as Black (OR = 2.38 95% CI = 1.09, 4.95) were all significantly associated with increased likelihood of reporting an alcohol-related injury, whereas unemployment was significantly associated with decreased likelihood of reporting an alcohol-related injury (OR = 0.41 95% CI = 0.18, 0.88). Conclusion: Our findings suggest that in Maringá, being male, between the ages of 15 and 29, employed, or identifying as Black were characteristics associated with a higher risk for non-fatal alcohol-related injury. Individual level data, such as ours, should be considered in combination with area-level and country-level data when developing evidence-based public-health policies.
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Affiliation(s)
- Deena El-Gabri
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Nicole Toomey
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Division of Emergency Medicine, Duke University Medical Center, Durham, NC, United States
| | - Nelly Moraes Gil
- Department of Nursing, State University of Maringá, Maringá, Brazil
| | | | | | | | - Sarah Williams
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Luciano Andrade
- Department of Nursing, State University of Maringá, Maringá, Brazil
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Division of Emergency Medicine, Duke University Medical Center, Durham, NC, United States
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Division of Emergency Medicine, Duke University Medical Center, Durham, NC, United States
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36
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Friedman K, Raymond J, Minnig MC, Sakita F, Vissoci JRN, Staton C. Association between alcohol use and violence-related injury in emergency department patients in Moshi, Tanzania: analysis of a prospective trauma registry. The Lancet Global Health 2020. [DOI: 10.1016/s2214-109x(20)30159-5] [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: 10/24/2022] Open
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37
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Nickenig Vissoci JR, Krebs E, Meier B, Vieira IF, de Andrade L, Byiringiro F, Rulisa S, Staton CA. Road traffic crash experience among commercial motorcyclists in Kigali, Rwanda. Int J Inj Contr Saf Promot 2020; 27:181-187. [PMID: 32138575 DOI: 10.1080/17457300.2020.1724158] [Citation(s) in RCA: 5] [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] [Indexed: 10/24/2022]
Abstract
Objective: Road traffic injuries (RTI) cause ∼1.2 million deaths and 50 million injuries annually, disproportionately occurring in low- and middle-income countries. Although policy changes and infrastructural developments have continued to contribute to the decrease in RTI-related deaths, limited studies have investigated the relationship between motorcycle taxi driver behaviors and RTIs in Rwanda. This study aims to describe the safety behaviors of commercial motorcyclists in Kigali, Rwanda.Methods: We surveyed 609 commercial motorcyclists in January 2014 then conducted a cross-sectional analysis of the results, including descriptive and bivariate logistic regression analyses.Results: We found that 38.7% of surveyed motorcycle drivers experienced a crash during their lifetime, of which, more than half (n = 134, 56.8%) suffered injuries. Of all injuries, 38.8% (n = 52) resulted in hospitalization, and 14.2% (n = 19) in disability. Among motorcyclists, 100% reported always wearing a helmet, 99% reported always wearing a chin strap, and 98.8% reported always having a passenger helmet. There was an association between sustaining a crash and believing that helmets (p = 0.08) and chin straps (p = 0.05) reduced crash risk.Conclusions: Rwandan commercial motorcyclists demonstrate generally proper safety behaviors, but remain a high-risk occupational group. Road safety policy initiatives have been effective in changing driver behavior regardless of driver safety beliefs.
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Affiliation(s)
- Joao Ricardo Nickenig Vissoci
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Elizabeth Krebs
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA.,Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brian Meier
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | | | - Luciano de Andrade
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA.,Department of Medicine, State University of Maringá, Maringá, Paraná, Brazil
| | - Fidele Byiringiro
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Stephen Rulisa
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Catherine A Staton
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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Grizzo FMF, Alarcão ACJ, Dell' Agnolo CM, Pedroso RB, Santos TS, Vissoci JRN, Pinheiro MM, Carvalho MDB, Pelloso SM. How does women's bone health recover after lactation? A systematic review and meta-analysis. Osteoporos Int 2020; 31:413-427. [PMID: 31897544 DOI: 10.1007/s00198-019-05236-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/14/2019] [Indexed: 01/11/2023]
Abstract
This is a systematic review aiming to evaluate the recovery of bone mass after lactation-related loss. Bone loss is transitory with recovery depending on the return of menstruation and weaning, and several compensatory homeostatic mechanisms are involved to minimize any significant damage to the maternal skeleton. Lactation has been associated with significant temporary bone loss, especially during the exclusive breastfeeding period. In the bone recovery phase, there is wide methodological heterogeneity among clinical trials, including follow-up timing, methods and sites of bone measurements, and body composition changes. The purpose of this study is to perform a systematic review and meta-analysis aiming to evaluate the recovery rate of bone mass after lactation-related loss, including the PubMed, Web of Science, and Scopus databases, with no publication date restrictions. The following MeSH terms were used: "bone diseases," "bone resorption," "bone density," "osteoporosis," "calcium," "postpartum period," "weaning," "breast feeding," and "lactation." The inclusion criteria were as follows: prospective human studies in women of reproductive age and bone measurements with two assessments in the postpartum period at least: the first one within the first weeks of lactation and another one 12 months after delivery, 3 months following the return of menses or 3 months postweaning. This research was recorded on the Prospero database (CRD42018096586Bone). A total of 9455 studies were found and 32 papers met the inclusion criteria. The follow-up period ranged from one to 3.6 years postpartum. Lactation was associated with transient bone loss, with a strong tendency to recover in all the sites studied, depending on the return of menstruation and weaning. Small deficits in the microarchitecture of the peripheral skeleton may be present, especially in women with prolonged breastfeeding, but with no deficit regarding the hip geometry was found. Women with a successive gestation after prolonged lactation and women who had breastfed when adolescents had no significant bone loss. Bone loss related to lactation is transitory, and several compensatory homeostatic mechanisms are involved to minimize any significant damage to the maternal skeleton.
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Affiliation(s)
- F M F Grizzo
- Post Graduate Program in Health Sciences, Maringá State University, Avenida Colombo, 5790, Maringá, Paraná, 87020-900, Brazil.
| | - A C J Alarcão
- Post Graduate Program in Health Sciences, Maringá State University, Avenida Colombo, 5790, Maringá, Paraná, 87020-900, Brazil
| | | | - R B Pedroso
- Post Graduate Program in Health Sciences, Maringá State University, Avenida Colombo, 5790, Maringá, Paraná, 87020-900, Brazil
| | - T S Santos
- Post Graduate Program in Biosciences and Physiopathology, Maringa State University, Maringá, Paraná, Brazil
| | - J R N Vissoci
- Global Neurosurgery and Neuroscience Division, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - M M Pinheiro
- Rheumatology Division, Bone and Mineral Section and Spondyloarthritis Section, Federal University of São Paulo (Unifesp/EPM), São Paulo, Brazil
| | - M D B Carvalho
- Department of Health Sciences, State University of Maringá, Maringá, Paraná, Brazil
| | - S M Pelloso
- Department of Health Sciences, State University of Maringá, Maringá, Paraná, Brazil
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Theophanous RG, Vissoci JRN, Wen FH, Griffin SM, Anderson VE, Mullins ME, Brandehoff NP, Quackenbush EB, Bush SP, Toschlog EA, Greene SC, Sharma K, Kleinschmidt K, Charlton NP, Rose SR, Schwartz R, Lewis B, Lavonas EJ, Gerardo CJ. Validity and reliability of telephone administration of the patient-specific functional scale for the assessment of recovery from snakebite envenomation. PLoS Negl Trop Dis 2019; 13:e0007935. [PMID: 31834923 PMCID: PMC6934321 DOI: 10.1371/journal.pntd.0007935] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/27/2019] [Accepted: 11/19/2019] [Indexed: 11/29/2022] Open
Abstract
Objectives Although more than 1.8 million people survive snakebite envenomation each year, their recovery is understudied. Obtaining long-term follow-up is challenging in both high- and low-resource settings. The Patient-Specific Functional Scale (PSFS) is an easily administered, well-accepted patient-reported outcome that is validated for assessing limb recovery from snakebite envenomation. We studied whether the PSFS is valid and reliable when administered by telephone. Methods This is a secondary analysis of data from a randomized clinical trial. We analyzed the results of PSFS collected in-person on days 3, 7, 14, 21, and 28 and by telephone on days 10, 17, and 24. We assessed the following scale psychometric properties: (a) content validity (ceiling and floor effects), (b) internal structure and consistency (Cronbach’s alpha), and (c) temporal and external validity using Intraclass Correlation Coefficient (ICC). Temporal stability was assessed using Spearman’s correlation coefficient and agreement between adjacent in-person and telephonic assessments with Cohen’s kappa. Bland Altman analysis was used to assess differential bias in low and high score results. Results Data from 74 patients were available for analysis. Floor effects were seen in the early post-injury time points (median: 3 (IQR: 0, 5) at 3 days post-enrollment) and ceiling effects in the late time points (median: 9 (IQR: 8, 10). Internal consistency was good to excellent with both in-person (Cronbach α: 0.91 (95%CI 0.88, 0.95)) and telephone administration (0.81 (0.73, 0.89). Temporal stability was also good (ICC: 0.83 (0.72, 0.89) in-person, 0.80 (0.68, 0.88) telephone). A strong linear correlation was found between in-person and telephone administration (Spearman’s ρ: 0.83 (CI: 0.78, 0.84), consistency was assessed as excellent (Cohen’s κ 0.81 (CI: 0.78, 0.84), and Bland Altman analysis showed no systematic bias. Conclusions Telephone administration of the PSFS provides valid, reliable, and consistent data for the assessment of recovery from snakebite envenomation. Snakebite envenomation is an important but neglected tropical disease that impacts millions of people worldwide each year. These bites lead to both death and permanent disability. As they occur in tropical and subtropical regions, they primarily impact people from low-income areas of the world. As potential new treatments are being developed, we must understand their potential benefit in humans before they can be widely disseminated. Performing these human studies requires the ability to determine how patients recovered with these treatments. Having people return for evaluation during recovery is difficult in these low-income regions. We evaluated the ability to use a telephone version of an already accepted measurement of recovery in snakebite, the Patient-Specific Functional Scale. This study demonstrates that using this telephone-administered measure is feasible, valid, and reliable. With the results of this study, we now have an important tool to easily measure recovery in areas where snakebite predominates. This tool will help snakebite envenomation researchers evaluate the potential benefit of new treatments and accelerate the process of bringing new effective treatments to those snakebite patients in the most need.
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Affiliation(s)
- Rebecca G. Theophanous
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
| | - Joao Ricardo Nickenig Vissoci
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Fan Hui Wen
- Hospital Vital, Instituto Butantan, São Paulo, Brazil
| | - S. Michelle Griffin
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
| | - Victoria E. Anderson
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, United States of America
| | - Michael E. Mullins
- Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Nicklaus P. Brandehoff
- Department of Emergency Medicine, University of California San Francisco Fresno, Fresno, CA, United States of America
| | - Eugenia B. Quackenbush
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
| | - Sean P. Bush
- Department of Emergency Medicine, Brody School of Medicine at East Carolina University, Greenville, NC, United States of America
| | - Eric A. Toschlog
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, United States of America
| | - Spencer C. Greene
- Henry J. N. Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Kapil Sharma
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Kurt Kleinschmidt
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Nathan P. Charlton
- Division of Medical Toxicology, University of Virginia, Charlottesville, VA, United States of America
| | - S. Rutherfoord Rose
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Richard Schwartz
- Department of Emergency Medicine and Hospital Services, Medical College of Georgia, Augusta, GA, United States of America
| | - Brandon Lewis
- Texas A&M Health Science Center, College Station, TX, United States of America
| | - Eric J. Lavonas
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, United States of America
- Department of Emergency Medicine, Denver Health and Hospital Authority, Denver, CO, United States of America
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Charles J. Gerardo
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- * E-mail:
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Kwaramba T, Ye JJ, Elahi C, Lunyera J, Oliveira AC, Sanches Calvo PR, de Andrade L, Vissoci JRN, Staton CA. Lifetime prevalence of intimate partner violence against women in an urban Brazilian city: A cross-sectional survey. PLoS One 2019; 14:e0224204. [PMID: 31725729 PMCID: PMC6855440 DOI: 10.1371/journal.pone.0224204] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 01/25/2019] [Accepted: 10/08/2019] [Indexed: 11/19/2022] Open
Abstract
Background Intimate partner violence is a global health burden that disproportionately affects women and their health outcomes. Women in Brazil are also affected by interpersonal violence. We aimed to estimate the lifetime prevalence of three forms of interpersonal violence against women (IPVAW) and to identify sociodemographic factors associated with IPVAW in one urban Brazilian city. Methods Using a cross-sectional design, we interviewed women aged ≥18 years in the urban Brazilian city, Maringá, who currently have or have had an intimate partner. The 13-item WHO Violence Against Women instrument was used to ask participants about their experiences with intimate partner violence, categorized into psychological, physical and sexual violence. We estimated associations between IPVAW and sociodemographic characteristics using generalized linear models. Results and conclusions Of the 419 women who were enrolled and met inclusion criteria, lifetime prevalence of IPVAW was 56%. Psychological violence was more prevalent (52%) than physical (21%) or sexual violence (13%). Twenty-eight women (6.4%) experienced all three forms of IPVAW. Women were more likely to experience violence if they were employed, did not live with their partner or had 4 or more children. Educational level, household income, age and race were not significantly associated factors. Our findings highlight a high prevalence of IPVAW in a community in southern Brazil.
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Affiliation(s)
- Tendai Kwaramba
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Jinny J. Ye
- Division of Emergency Medicine, Department of Surgery, Duke Medical Center, Durham, North Carolina, United States of America
| | - Cyrus Elahi
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Joseph Lunyera
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | | | | | | | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Division of Emergency Medicine, Department of Surgery, Duke Medical Center, Durham, North Carolina, United States of America
- Division of Global Neurosurgery and Neuroscience, Department of Neurosurgery, Duke Medical Center, Durham, North Carolina, United States of America
- * E-mail:
| | - Catherine A. Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Division of Emergency Medicine, Department of Surgery, Duke Medical Center, Durham, North Carolina, United States of America
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Maffioli EM, Hernandes Rocha TA, Vivas G, Rosales C, Staton C, Nickenig Vissoci JR. Addressing inequalities in medical workforce distribution: evidence from a quasi-experimental study in Brazil. BMJ Glob Health 2019; 4:e001827. [PMID: 31798991 PMCID: PMC6861089 DOI: 10.1136/bmjgh-2019-001827] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/04/2019] [Accepted: 10/12/2019] [Indexed: 11/23/2022] Open
Abstract
Background Brazil faces huge health inequality challenges since not all municipalities have access to primary care physicians. The More Doctors Programme (MDP), which started in 2013, was born out of this recognition, providing more than 18 000 doctors in the first few years. However, the programme faced a restructuring at the end of 2018. Methods We construct a panel municipality-level data between 2008 and 2017 for 5570 municipalities in Brazil. We employ a difference-in-differences empirical approach, combined with propensity score matching, to study the impacts of the programme on hospitalisations for ambulatory care sensitive conditions and its costs. We explore heterogeneous impacts by age of the patients, type of admissions, and municipalities that were given priority. Findings The MDP reduced ambulatory admissions by 2.9 per cent (p value <0.10) and the costs by 3.7 per cent (p value <0.01) over the mean. The reduction was driven by infectious gastroenteritis, bacterial pneumonias, asthma, kidney and urinary infections, and pelvic inflammatory disease. The results held on the subsample of municipalities targeted by the programme. By comparing the benefits of the programme from the reduction in the costs of ambulatory admissions to the total financial costs of the MDP, the impacts allowed the government to save at least BRL 27.88 (US$ 6.9 million) between 2014 and 2017. Conclusion Addressing inequalities in the distribution of the medical workforce remains a global challenge. Our results inform the discussion on the current strategy adopted in Brazil to increase access to primary healthcare in underserved areas.
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Affiliation(s)
| | | | - Gabriel Vivas
- Pan American Health Organization Brazil, Nassau, Bahamas
| | - Carlos Rosales
- Pan American Health Organization Brazil, Brasilia, Brazil
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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Abdelgadir J, Elahi C, Corley J, Wall KC, Najjuma JN, Muhindo A, Nickenig Vissoci JR, Haglund MM, Kitya D. Trends in neurosurgical care in Western Uganda: an interrupted time series analysis. Neurosurg Focus 2019; 45:E15. [PMID: 30269580 DOI: 10.3171/2018.7.focus18270] [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: 12/29/2022]
Abstract
OBJECTIVE In addition to the rising burden of surgical disease globally, infrastructure and human resources for health remain a great challenge for low- and middle-income countries, especially in Uganda. In this study, the authors aim to explore the trends of neurosurgical care at a regional referral hospital in Uganda and assess the long-term impact of the institutional collaboration between Mulago National Referral Hospital and Duke University. METHODS An interrupted time series is a quasi-experimental design used to evaluate the effects of an intervention on longitudinal data. The authors applied this design to evaluate the trends in monthly mortality rates for neurosurgery patients at Mbarara Regional Referral Hospital (MRRH) from March 2013 to October 2015. They used segmented regression and autoregressive integrated moving average models for the analysis. RESULTS Over the study timeframe, MRRH experienced significant increases in referrals received (from 117 in 2013 to 211 in 2015), neurosurgery patients treated (from 337 in 2013 to 625 in 2015), and operations performed (from 61 in 2013 to 173 in 2015). Despite increasing patient volumes, the hospital achieved a significant reduction in hospital mortality during 2015 compared to prior years (p value = 0.0039). CONCLUSIONS This interrupted time series analysis study showed improving trends of neurosurgical care in Western Uganda. There is a steady increase in volume accompanied by a sharp decrease in mortality through the years. Multiple factors are implicated in the significant increase in volume and decrease in mortality, including the addition of a part-time neurosurgeon, improvement in infrastructure, and increased experience. Further in-depth prospective studies exploring seasonality and long-term outcomes are warranted.
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Affiliation(s)
- Jihad Abdelgadir
- 1Department of Neurosurgery, Duke University Medical Center.,2Duke Division of Global Neurosurgery and Neurology
| | - Cyrus Elahi
- 2Duke Division of Global Neurosurgery and Neurology.,3Duke University Global Health Institute
| | - Jacquelyn Corley
- 1Department of Neurosurgery, Duke University Medical Center.,2Duke Division of Global Neurosurgery and Neurology
| | - Kevin C Wall
- 4Duke University School of Medicine, Durham, North Carolina
| | - Josephine N Najjuma
- 5Department of Neurosurgery, Mbarara Regional Referral Hospital, Mbarara; and
| | - Alex Muhindo
- 6Department of Neurosurgery, Mulago National Referral Hospital, Kampala, Uganda
| | | | - Michael M Haglund
- 1Department of Neurosurgery, Duke University Medical Center.,3Duke University Global Health Institute
| | - David Kitya
- 5Department of Neurosurgery, Mbarara Regional Referral Hospital, Mbarara; and
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Hernandes Rocha TA, Elahi C, Cristina da Silva N, Sakita FM, Fuller A, Mmbaga BT, Green EP, Haglund MM, Staton CA, Nickenig Vissoci JR. A traumatic brain injury prognostic model to support in-hospital triage in a low-income country: a machine learning-based approach. J Neurosurg 2019; 132:1961-1969. [PMID: 31075779 DOI: 10.3171/2019.2.jns182098] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 02/12/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Traumatic brain injury (TBI) is a leading cause of death and disability worldwide, with a disproportionate burden of this injury on low- and middle-income countries (LMICs). Limited access to diagnostic technologies and highly skilled providers combined with high patient volumes contributes to poor outcomes in LMICs. Prognostic modeling as a clinical decision support tool, in theory, could optimize the use of existing resources and support timely treatment decisions in LMICs. The objective of this study was to develop a machine learning-based prognostic model using data from Kilimanjaro Christian Medical Centre in Moshi, Tanzania. METHODS This study is a secondary analysis of a TBI data registry including 3138 patients. The authors tested nine different machine learning techniques to identify the prognostic model with the greatest area under the receiver operating characteristic curve (AUC). Input data included demographics, vital signs, injury type, and treatment received. The outcome variable was the discharge score on the Glasgow Outcome Scale-Extended. RESULTS The AUC for the prognostic models varied from 66.2% (k-nearest neighbors) to 86.5% (Bayesian generalized linear model). An increasing Glasgow Coma Scale score, increasing pulse oximetry values, and undergoing TBI surgery were predictive of a good recovery, while injuries suffered from a motor vehicle crash and increasing age were predictive of a poor recovery. CONCLUSIONS The authors developed a TBI prognostic model with a substantial level of accuracy in a low-resource setting. Further research is needed to externally validate the model and test the algorithm as a clinical decision support tool.
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Affiliation(s)
| | - Cyrus Elahi
- 1Duke Division of Global Neurosurgery and Neurology.,2Duke University Global Health Institute, Durham, North Carolina
| | | | | | - Anthony Fuller
- 1Duke Division of Global Neurosurgery and Neurology.,2Duke University Global Health Institute, Durham, North Carolina.,4Department of Neurosurgery, Duke University Medical Center
| | - Blandina T Mmbaga
- 2Duke University Global Health Institute, Durham, North Carolina.,3Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,5Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Eric P Green
- 2Duke University Global Health Institute, Durham, North Carolina
| | - Michael M Haglund
- 1Duke Division of Global Neurosurgery and Neurology.,2Duke University Global Health Institute, Durham, North Carolina.,4Department of Neurosurgery, Duke University Medical Center
| | - Catherine A Staton
- 1Duke Division of Global Neurosurgery and Neurology.,2Duke University Global Health Institute, Durham, North Carolina.,6Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina; and
| | - Joao Ricardo Nickenig Vissoci
- 1Duke Division of Global Neurosurgery and Neurology.,2Duke University Global Health Institute, Durham, North Carolina
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Vissoci JRN, de Oliveira LP, Gafaar T, Haglund MM, Mvungi M, Mmbaga BT, Staton CA. Cross-cultural adaptation and psychometric properties of the MMSE and MoCA questionnaires in Tanzanian Swahili for a traumatic brain injury population. BMC Neurol 2019; 19:57. [PMID: 30961532 PMCID: PMC6454609 DOI: 10.1186/s12883-019-1283-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 08/23/2018] [Accepted: 03/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Traumatic Brain Injury (TBI) is the most common cause of injury-related death and disability globally, and a common sequelae is cognitive impairment. Addressing post-TBI cognitive deficits is crucial because they affect rehabilitation outcomes, but doing this requires valid and reliable cognitive assessment measures. However, no such instrument has been validated in Tanzania's TBI population. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) are two commonly used instruments to measure cognitive impairment, and there have been a few studies reporting their use in post-TBI cognitive assessment. Our aim was to report the psychometric properties of the Swahili version of both scales amongst the TBI population in Tanzania. METHODS A cross-cultural adaptation committee participated in the translation and content validation process for both questionnaires. Our patient sample consisted of 192 adults with TBI who were admitted to Kilimanjaro Christian Medical Center (KCMC) in Tanzania. Confirmatory factor analysis, reliability and external validity were evaluated. RESULTS MoCA showed adequate factor loadings (values > 0.50 for all items except items 7 & 10) and adequate reliability (values > 0.70). Factor loadings for most of the MMSE items were below 0.5 and internal consistency was medium (< 0.7). Polychoric correlation between MMSE and MoCA was strong, positive and statistically significant (r = 0.68, p = 0.001); correlation with the cognitive subscale of FIM indicated moderately positive relationships - MMSE (r = 0.35, p = 0.001) and MoCA (r = 0.43, p = 0.001). CONCLUSIONS With the exception of the language and memory items, MoCA is a valid and reliable instrument for cognitive impairment screening in Tanzania's adult TBI population. On the other hand, MMSE does not appear to be an appropriate tool in this patient group, but its positive correlations with MoCA and cFIM indicate similar theoretical concepts. Both instruments require further validation studies to prove their predictive ability for screening cognitive impairment before they are considered suitable for clinical use.
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Affiliation(s)
- Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, NC, USA.
- Duke Emergency Medicine, Duke University School of Medicine, Durham, NC, 27710, USA.
- Division of Global Neurosurgery and Neuroscience, Duke University, Durham, NC, USA.
| | | | - Temitope Gafaar
- Duke University School of Medicine, Duke University, Durham, NC, USA
| | - Michael M Haglund
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Division of Global Neurosurgery and Neuroscience, Duke University, Durham, NC, USA
| | - Mark Mvungi
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Blandina Theophil Mmbaga
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Catherine A Staton
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke Emergency Medicine, Duke University School of Medicine, Durham, NC, 27710, USA
- Division of Global Neurosurgery and Neuroscience, Duke University, Durham, NC, USA
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Krebs E, Luck JF, Nightingale RW, Jayaraman S, Nickenig Vissoci JR, Rulisa S, Byringiro JC, Staton CA. Mortality predictors in traumatic brain injury due to motorcycle crashes in Rwanda. Traffic Inj Prev 2019; 19:183-184. [PMID: 31341426 PMCID: PMC6652189 DOI: 10.1080/15389588.2018.1532234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Vaca SD, Kuo BJ, Nickenig Vissoci JR, Staton CA, Xu LW, Muhumuza M, Ssenyonjo H, Mukasa J, Kiryabwire J, Rice HE, Grant GA, Haglund MM. Temporal Delays Along the Neurosurgical Care Continuum for Traumatic Brain Injury Patients at a Tertiary Care Hospital in Kampala, Uganda. Neurosurgery 2019; 84:95-103. [PMID: 29490070 PMCID: PMC6292785 DOI: 10.1093/neuros/nyy004] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [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: 04/20/2017] [Accepted: 02/16/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Significant care continuum delays between acute traumatic brain injury (TBI) and definitive surgery are associated with poor outcomes. Use of the "3 delays" model to evaluate TBI outcomes in low- and middle-income countries has not been performed. OBJECTIVE To describe the care continuum, using the 3 delays framework, and its association with TBI patient outcomes in Kampala, Uganda. METHODS Prospective data were collected for 563 TBI patients presenting to a tertiary hospital in Kampala from 1 June to 30 November 2016. Four time intervals were constructed along 5 time points: injury, hospital arrival, neurosurgical evaluation, computed tomography (CT) results, and definitive surgery. Time interval differences among mild, moderate, and severe TBI and their association with mortality were analyzed. RESULTS Significant care continuum differences were observed for interval 3 (neurosurgical evaluation to CT result) and 4 (CT result to surgery) between severe TBI patients (7 h for interval 3 and 24 h for interval 4) and mild TBI patients (19 h for interval 3 and 96 h for interval 4). These postarrival delays were associated with mortality for mild (P = .05) and moderate TBI (P = .03) patients. Significant hospital arrival delays for moderate TBI patients were associated with mortality (P = .04). CONCLUSION Delays for mild and moderate TBI patients were associated with mortality, suggesting that quality improvement interventions could target current triage practices. Future research should aim to understand the contributors to delays along the care continuum, opportunities for more effective resource allocation, and the need to improve prehospital logistical referral systems.
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Affiliation(s)
- Silvia D Vaca
- Stanford University School of Medicine, Palo Alto, California
- Stanford Center for Innovation in Global Health, Palo Alto, California
| | - Benjamin J Kuo
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina
- Duke University Global Health Institute, Durham, North Carolina
- Duke-NUS Medical School, Singapore, Singapore
| | - Joao Ricardo Nickenig Vissoci
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina
- Duke-NUS Medical School, Singapore, Singapore
- Duke Emergency Medicine, Duke University Medical Center, Durham, North Carolina
| | - Catherine A Staton
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina
- Duke-NUS Medical School, Singapore, Singapore
- Duke Emergency Medicine, Duke University Medical Center, Durham, North Carolina
| | - Linda W Xu
- Stanford Center for Innovation in Global Health, Palo Alto, California
- Department of Neurosurgery, Stanford University Medical Center, Palo Alto, California
| | | | | | - John Mukasa
- Department of Neurosurgery, Mulago Hospital, Kampala, Uganda
| | - Joel Kiryabwire
- Department of Neurosurgery, Mulago Hospital, Kampala, Uganda
| | - Henry E Rice
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Gerald A Grant
- Stanford Center for Innovation in Global Health, Palo Alto, California
- Department of Neurosurgery, Stanford University Medical Center, Palo Alto, California
| | - Michael M Haglund
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina
- Duke University Global Health Institute, Durham, North Carolina
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
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Zhao D, Staton CA, He Q, Mmbaga BT, Vissoci JRN. Cross-Culture Adaptation and Psychometric Properties of the DrInC Questionnaire in Tanzanian Swahili. Front Public Health 2018; 6:330. [PMID: 30515371 PMCID: PMC6255945 DOI: 10.3389/fpubh.2018.00330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 07/31/2018] [Accepted: 10/26/2018] [Indexed: 11/18/2022] Open
Abstract
Aims: To develop Swahili versions of the Drinker Inventory of Consequences (DrInC) and evaluate its psychometric properties among a mixed population in Tanzania. Methods: A Swahili version of the DrInC was developed by a panel of bilingual Swahili and English speakers through translation and back-translation. The translated DrInC was administered to a sample of Tanzanian injury patients and a sample of the general population. The validity and reliability of the scale were tested using standard statistical methods. Results: The translated version of the DrInC questionnaire was found to have outstanding domain coherence and language clarity. The tested scale and subscales have adequate reliability (>0.85). Confirmatory factor analysis (CFA) confirmed the five-factor solution by yielding adequate results. DrInC score is statistically significantly correlated with alcohol consumption quantity and the AUDIT score, suggesting that DrInC is able to predict alcohol use as well. Conclusions: This study presents the first validation of the DrInC questionnaire with injury patients and a general population and the first adaptations of the DrInC questionnaire in the Tanzanian and Swahili setting. DrInC instrument was found to have satisfactory psychometric properties, resulting in a new medical and social research tool in this setting.
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Affiliation(s)
- Duan Zhao
- Duke Kunshan Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Catherine A Staton
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Qing He
- Department of Linguistics, South China University of Technology, Guangzhou, China
| | - Blandina Theophil Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Research and Innovation, Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,Research and Innovation and Paediatric and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Nickenig Vissoci JR, Oliveira ACD, Gil NM, Calvo P, Stival N, Yen T, Haglund M, Staton CA. Being highly productive in the Biomedical Sciences: A qualitative study of motivation and habits of high-throughput researchers. GeS 2018. [DOI: 10.21171/ges.v13i34.2472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: Quantity, quality, and impact of scientific publications are used to assess national, institutional, and individual levels of research productivity. While the importance of quality research is stressed among the medical research community, minimal research has been conducted on analyzing which factors affect research productivity. Current literature assesses the quality of research institutions rather than that of individual researchers; there is also no research on the difference between high-impact researchers and other researchers. This study, conducted in 2015, sought to investigate the underlying reason for high-throughput authors' success by understanding their similar habits and motivations leading to high productivity.
Methods: The authors conducted a qualitative study via interviews of high-throughput researchers from around the world. Semi-structured interview scripts guided the interviews in accordance to the grounded theory method for qualitative studies. Broad themes from preliminary interviews were identified and explored in subsequent interviews.
Results: Qualitative analysis of participant interviews identified eight major themes: “Writing habits,” “Writing strategy,” “Previous training and writing experience,” “Major driver,” “Balancing volume and impact of publications,” “Ideal and non-ideal conditions,” “Timelines,” and “Role of networking on high-throughput productivity.” These themes are not exclusive nor required qualities of high-throughput researchers but highlight similarities and broadly unifying characteristics of these researchers.
Conclusion:This study identified the common qualities and attitudes of high-throughput researchers. We found common factors in most individuals that can be considered markers of high productivity.
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Smith ER, van de Water BJ, Martin A, Barton SJ, Seider J, Fitzgibbon C, Bility MM, Ekeji N, Vissoci JRN, Haglund MM, Bettger JP. Availability of post-hospital services supporting community reintegration for children with identified surgical need in Uganda. BMC Health Serv Res 2018; 18:727. [PMID: 30236098 PMCID: PMC6149201 DOI: 10.1186/s12913-018-3510-2] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/29/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Community services and supports are essential for children transitioning home to recover from the hospital after surgery. This study assessed the availability and geographic capacity of rehabilitation, assistive devices, familial support, and school reintegration programs for school-aged children in Uganda with identified surgical need. METHODS This study assessed the geographic epidemiology and spatial analysis of resource availability in communities in Uganda. Participants were children with identified surgical need using the Surgeons OverSeas Assessment of Surgical need (SOSAS). Community-based resources available to children and adolescents after surgery in Uganda were identified using publicly available data sources and searching for resources through consultation with in-country collaborators We sought resources available in all geographic regions for a variety of services. RESULTS Of 1082 individuals surveyed aged 5 to 14 yearsr, 6.2% had identified surgical needs. Pediatric surgical conditions were most prevalent in the Northern and Central regions of Uganda. Of the 151 community-based services identified, availability was greatest in the Central region and least in the Northern region, regardless of type. Assuming 30% of children with surgical needs will need services, a maximum of 50.1% of these children would have access to the needed services in the extensive capacity estimates, while only 10.0% would have access in the minimal capacity estimates. The capacity varied dramatically by region with the Northern region having much lower capacity in all scenarios as compared to the Central, Eastern, or Western regions. CONCLUSIONS Our study found that beyond the city of Kampala in the Central region, community-based services were severely lacking for school-aged children in Uganda. Increased pediatric surgical capacity to additional hospitals in Uganda will need to be met with increased availability and access to community-based services to support recovery and community re-integration.
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Affiliation(s)
- Emily R. Smith
- Duke Global Health Institute, Duke University, Durham, NC USA
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, One Bear Place #97313, Waco, TX 76798 USA
| | | | - Anna Martin
- Duke University, Sanford School of Public Policy, Durham, NC USA
| | - Sarah Jean Barton
- Physical Therapy and Occupational Therapy, Duke University Medical Center, Durham, NC USA
- Duke University Divinity School, Durham, NC USA
| | - Jasmine Seider
- Department of Orthopedic Surgery, Division of Physical Therapy, Duke University, School of Medicine, Durham, NC USA
| | - Christopher Fitzgibbon
- Mechanical Engineering and Materials Science, Duke University, Durham, NC USA
- Triangle Insights Group, Durham, NC USA
| | | | - Nelia Ekeji
- Duke University, Trinity College, Durham, NC USA
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, NC USA
- Department of Surgery, Division of Emergency Medicine, Duke University, School of Medicine, Durham, NC USA
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC USA
| | - Michael M. Haglund
- Duke Global Health Institute, Duke University, Durham, NC USA
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC USA
- Department of Neurosurgery, Duke University, Durham, NC USA
| | - Janet Prvu Bettger
- Duke Global Health Institute, Duke University, Durham, NC USA
- Duke University, Sanford School of Public Policy, Durham, NC USA
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Fagundes DM, Thomaz EBAF, Queiroz RCDS, Rocha TAH, Silva NCD, Vissoci JRN, Calvo MCM, Facchini LA. [Dialogues on the work process in oral health in Brazil: an analysis based on the PMAQ-AB survey]. CAD SAUDE PUBLICA 2018; 34:e00049817. [PMID: 30208170 DOI: 10.1590/0102-311x00049817] [Citation(s) in RCA: 5] [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: 03/26/2017] [Accepted: 04/06/2018] [Indexed: 11/21/2022] Open
Abstract
The study aimed to: (1) describe the work process in Brazil's oral health teams, based on the essential attributes of primary health care, according to geographic region, type of team, and the municipality's socioeconomic characteristics and (2) verify whether the data in the work process of the oral health teams in the Brazilian National Program to Improve Access and Quality in primary health (PMAQ-AB) were capable of measuring such attributes. This was a nationwide ecological study with data from cycle I of PMAQ-AB. The study included descriptive, exploratory factor, and confirmatory factor analyses (α = 5%). Constructs were analyzed in light of the essential attributes of primary health care (first contact, coordination of care, comprehensiveness, and continuity). The first three constructs and a fourth factor were formed, called dental prosthesis actions. However, the continuity attribute was not formed. The models' goodness-of-fit measures were satisfactory. Factor loads were greater than 0.5, except for the two variables in factor 3. The actions most frequently performed by the oral health teams (> 60%) were in first contact, and the least frequent were those in comprehensiveness, highlighting referrals to specialties (7.6%). There were differences in the work process in oral health teams between regions of the country, type of team, and certification strata (p < 0.05). In conclusion, data on the work process in oral health teams from cycle primary health care in the services' work routine. Further research is recommended on continuity of care. In addition, the oral health teams participating in cycle I of PMAQ-AB should make further progress in actions related to comprehensiveness and coordination of care.
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