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Morgan CE, Ngimbi P, Boisson-Walsh AJN, Ntambua S, Matondo J, Tabala M, Kashamuka MM, Emch M, Edwards JK, Powers KA, James L, Mbonze N, Mampunza S, Yotebieng M, Thompson P, Parr JB. Hepatitis B Virus Prevalence and Transmission in the Households of Pregnant Women in Kinshasa, Democratic Republic of Congo. Open Forum Infect Dis 2024; 11:ofae150. [PMID: 38623568 PMCID: PMC11017325 DOI: 10.1093/ofid/ofae150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Indexed: 04/17/2024] Open
Abstract
Background The World Health Organization Africa region has high regional hepatitis B virus (HBV) prevalence, and evidence suggests more frequent horizontal HBV transmission than other regions. Context-specific epidemiological studies are needed to inform additional HBV prevention measures. Methods In the cross-sectional Horizontal and Vertical Transmission of Hepatitis B (HOVER-HBV) study, we introduced HBV surface antigen (HBsAg) screening alongside existing HIV screening as part of routine antenatal care in high-volume maternity clinics in Kinshasa, Democratic Republic of Congo. We recruited households of pregnant women ("index mothers") who were HBsAg-positive and HBsAg-negative, defining households as index-positive and index-negative, respectively. Household members underwent HBsAg testing and an epidemiological survey. We evaluated HBsAg prevalence and potential transmission correlates. Results We enrolled 1006 participants from 200 households (100 index-positive, 100 index-negative) across Kinshasa. HBsAg-positivity prevalence was more than twice as high in index-positive households (5.0% [95% confidence interval {CI}, 2.8%-7.1%]) as in index-negative households (1.9% [95% CI, .6%-3.2%]). HBsAg-positivity prevalence was 3.3 (95% CI, .9-11.8) times as high among direct offspring in index-positive versus index-negative households. Factors associated with HBsAg positivity included older age, marriage, and having multiple recent partners or any new sexual partners among index mothers; and older age, lower household wealth, sharing nail clippers, and using street salons among offspring in index-positive households. Conclusions Vertical and horizontal HBV transmission within households is ongoing in Kinshasa. Factors associated with infection reveal opportunities for HBV prevention efforts, including perinatal prevention, protection during sexual contact, and sanitation of shared personal items.
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Affiliation(s)
- Camille E Morgan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Patrick Ngimbi
- Faculté de Médecine, Université Protestante du Congo, Kinshasa, Democratic Republic of the Congo
| | - Alix J N Boisson-Walsh
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sarah Ntambua
- Faculté de Médecine, Université Protestante du Congo, Kinshasa, Democratic Republic of the Congo
| | - Jolie Matondo
- Faculté de Médecine, Université Protestante du Congo, Kinshasa, Democratic Republic of the Congo
| | - Martine Tabala
- L‘École de Santé Publique, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Michael Emch
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jessie K Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kimberly A Powers
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Linda James
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nana Mbonze
- L‘École de Santé Publique, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Samuel Mampunza
- Faculté de Médecine, Université Protestante du Congo, Kinshasa, Democratic Republic of the Congo
| | - Marcel Yotebieng
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Peyton Thompson
- Division of Infectious Diseases, Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jonathan B Parr
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Khair D, El-Khoury J, Thompson P, Racine L, Harissi-Dagher M. Glaucoma after penetrating keratoplasty and keratoprosthesis. J Fr Ophtalmol 2024; 47:104023. [PMID: 37973521 DOI: 10.1016/j.jfo.2023.07.023] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/19/2023] [Accepted: 07/28/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE To compare visual and glaucoma outcomes in patients with known glaucoma after a penetrating keratoplasty (PKP) or a Boston Keratoprosthesis Type 1 (KPro) as a second corneal replacement procedure. DESIGN Retrospective interventional case series. PARTICIPANTS Charts of 141 eyes that underwent either a PKP or KPro at the Centre hospitalier de l'Université de Montréal after one failed PKP from 2008 to 2020 were reviewed. Forty-six eyes with preoperative glaucoma were included. METHODS Data collected included demographics, indication for the initial surgery, best corrected visual acuity (BCVA), concurrent ocular disorders, number of glaucoma medications, need for glaucoma surgery, cup-to-disc ratios (CDRs), mean RNFL thickness, and visual field (VF) characteristics. Primary outcomes were glaucoma progression trends. Secondary outcomes were visual outcomes and need for additional procedures. RESULTS Mean follow-up was 4.7 years for the PKP and 7.3 for the KPro group (P<0.007). 30.6% of PKP compared to 70.5% of KPro patients were diagnosed with glaucoma preoperatively. Glaucoma worsened similarly in both groups; this is based on an analysis of the number of glaucoma medications, CDR, need for glaucoma surgery, and characteristic VF changes. Patients in the PKP group required significantly more regrafts than patients in the KPro group (31.8 vs. 8.3%; P=0.045). CONCLUSIONS A preoperative diagnosis of glaucoma does not preclude KPro implantation. In glaucomatous eyes, the disease progressed similarly in both groups. Since both procedures increase the risk of worsening glaucoma, close follow-up is recommended. KPro may decrease the need for further corneal transplantation surgery.
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Affiliation(s)
- D Khair
- Department of Ophthalmology, centre hospitalier de l'université de Montréal, Montréal, Québec, H2X 3E4, Canada; Department of Ophthalmology and Visual Sciences, University of Kentucky College of Medicine, Lexington, USA
| | - J El-Khoury
- Faculty of Medicine and Health Sciences, université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - P Thompson
- Department of Ophthalmology, centre hospitalier de l'université de Montréal, Montréal, Québec, H2X 3E4, Canada
| | - L Racine
- Department of Ophthalmology, centre hospitalier de l'université de Montréal, Montréal, Québec, H2X 3E4, Canada
| | - M Harissi-Dagher
- Department of Ophthalmology, centre hospitalier de l'université de Montréal, Montréal, Québec, H2X 3E4, Canada.
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Boisson-Walsh A, Fried B, Shea CM, Ngimbi P, Mbonze N, Tabala M, Kashamuka MM, Babakazo P, Yotebieng M, Thompson P. Using intervention mapping to develop an implementation strategy to improve timely uptake of streamlined birth-dose vaccines in the Democratic Republic of the Congo. PLOS Glob Public Health 2024; 4:e0002641. [PMID: 38271398 PMCID: PMC10810515 DOI: 10.1371/journal.pgph.0002641] [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: 07/11/2023] [Accepted: 01/04/2024] [Indexed: 01/27/2024]
Abstract
Despite the policy recommendation and effectiveness of administering the hepatitis B birth-dose vaccine (HepB-BD) to newborns to prevent mother-to-child hepatitis B transmission, timely uptake remains an issue. Countries adopting the HepB-BD to their national immunization schedule report programmatic challenges to administering the vaccine within the recommended 24-hour window after delivery. Further, while the World Health Organization recommends streamlining three birth-dose vaccines (HepB-BD, BCG, and OPV0), scarce Sub-Saharan(SSA)-based literature reports on a streamlined and timely approach to birth-dose vaccines. As more SSA countries adopt the new birth-dose vaccine to their immunization schedules, a systematically developed implementation strategy-Vaccination of Newborns-Innovative Strategies to Hasten Birth-Dose vaccines' delivery (VANISH-BD)-will facilitate the adoption and implementation of timely birth-dose vaccine uptake. In this paper, we describe the development of the implementation strategy using intervention mapping, an evidence-based and theory-driven approach. We report on the development of our intervention, beginning with the needs assessment based in Kinshasa Province, Democratic Republic of the Congo (DRC), informing step 1 of intervention mapping. The intervention is contextually relevant, locally produced, sustainable, and designed to improve timely birth-dose vaccine uptake in the DRC. We intend to inform future implementers about improving timely and streamlined birth-dose vaccine uptake and for VANISH-BD to be adapted for similar contexts.
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Affiliation(s)
- Alix Boisson-Walsh
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Bruce Fried
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Christopher M. Shea
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Patrick Ngimbi
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Nana Mbonze
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Martine Tabala
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Pélagie Babakazo
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Marcel Yotebieng
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Peyton Thompson
- Division of Infectious Diseases, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, United States of America
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Boisson-Walsh A, Thompson P, Fried B, Shea CM, Ngimbi P, Lumande F, Tabala M, Kashamuka MM, Babakazo P, Domino ME, Yotebieng M. Childhood immunization uptake determinants in Kinshasa, Democratic Republic of the Congo: ordered regressions to assess timely infant vaccines administered at birth and 6-weeks. Glob Health Res Policy 2023; 8:50. [PMID: 38057919 PMCID: PMC10698958 DOI: 10.1186/s41256-023-00338-7] [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: 11/14/2022] [Accepted: 11/22/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Despite global efforts to reduce preventable childhood illness by distributing infant vaccines, immunization coverage in sub-Saharan African settings remains low. Further, timely administration of vaccines at birth-tuberculosis (Bacille Calmette-Guérin [BCG]) and polio (OPV0)-remains inconsistent. As countries such as Democratic Republic of the Congo (DRC) prepare to add yet another birth-dose vaccine to their immunization schedule, this study aims to improve current and future birth-dose immunization coverage by understanding the determinants of infants receiving vaccinations within the national timeframe. METHODS The study used two ordered regression models to assess barriers to timely BCG and first round of the hepatitis B (HepB3) immunization series across multiple time points using the Andersen Behavioral Model to conceptualize determinants at various levels. The assessment leveraged survey data collected during a continuous quality improvement study (NCT03048669) conducted in 105 maternity centers throughout Kinshasa Province, DRC. The final sample included 2398 (BCG analysis) and 2268 (HepB3 analysis) women-infant dyads living with HIV. RESULTS Between 2016 and 2020, 1981 infants (82.6%) received the BCG vaccine, and 1551 (68.4%) received the first dose of HepB3 vaccine. Of those who received the BCG vaccine, 26.3%, 43.5%, and 12.8% received BCG within 24 h, between one and seven days, and between one and 14 weeks, respectively. Of infants who received the HepB3 vaccine, 22.4% received it within six weeks, and 46% between six and 14 weeks of life. Many factors were positively associated with BCG uptake, including higher maternal education, household wealth, higher facility general readiness score, and religious-affiliated facility ownership. The factors influencing HepB3 uptake included older maternal age, higher education level, household wealth, transport by taxi to a facility, higher facility general and immunization readiness scores, and religious-affiliated facility ownership. CONCLUSIONS This study demonstrated that the study participants' uptake of vaccines was consistent with the country average, but not in a timely manner. Various factors were associated with timely uptake of BCG and HepB3 vaccines. These findings suggest that investment to strengthen the vaccine delivery system might improve timely vaccine uptake and equity in vaccine coverage.
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Affiliation(s)
- Alix Boisson-Walsh
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, 27599, USA.
| | - Peyton Thompson
- Division of Infectious Diseases, Department of Pediatrics, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Bruce Fried
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Christopher Michael Shea
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Patrick Ngimbi
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Fidéle Lumande
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Martine Tabala
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Pélagie Babakazo
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Marisa Elaine Domino
- Center for Health Information and Research, College of Health Solutions, Arizona State University, Phoenix, AZ, 85004, USA
| | - Marcel Yotebieng
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
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Chen J, Aluisio AR, Tang OY, Nwakibu UA, Hunold KM, Wangara AA, Kiruja J, Maingi A, Mutiso V, Thompson P, Wachira B, Dunlop SJ, Martin IBK, Myers JG. Diagnostic Accuracy of the World Health Organization Pediatric Emergency Triage, Assessment and Treatment Tool Plus Among Patients Seeking Care in Nairobi, Kenya: A Cross-sectional Study. Pediatr Emerg Care 2023:00006565-990000000-00360. [PMID: 38048556 DOI: 10.1097/pec.0000000000003093] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
INTRODUCTION The World Health Organization developed Emergency Triage Assessment and Treatment Plus (ETAT+) guidelines to facilitate pediatric care in resource-limited settings. ETAT+ triages patients as nonurgent, priority, or emergency cases, but there is limited research on the performance of ETAT+ regarding patient-oriented outcomes. This study assessed the diagnostic accuracy of ETAT+ in predicting the need for hospital admission in a pediatric emergency unit at Kenyatta National Hospital in Nairobi, Kenya. METHODS This was a secondary analysis of a cross-sectional study of pediatric emergency unit patients enrolled over a 4-week period using fixed random sampling. Diagnostic accuracy of ETAT+ was evaluated using receiver operating curves (ROCs) and respective 95% confidence intervals (CIs) with associated sensitivity and specificity (reference category: nonurgent). The ROC analysis was performed for the overall population and stratified by age group. RESULTS A total of 323 patients were studied. The most common reasons for presentation were upper respiratory tract disease (32.8%), gastrointestinal disease (15.5%), and lower respiratory tract disease (12.4%). Two hundred twelve participants were triaged as nonurgent (65.6%), 60 as priority (18.6%), and 51 as emergency (15.8%). In the overall study population, the area under the ROC curve was 0.97 (95% CI, 0.95-0.99). The ETAT+ sensitivity was 93.8% (95% CI, 87.0%-99.0%), and the specificity was 82.0% (95% CI, 77.0%-87.0%) for admission of priority group patients. The sensitivity and specificity for the emergency patients were 66.0% (95% CI, 55.0%-77.0%) and 98.0% (95% CI, 97.0%-100.0%), respectively. CONCLUSIONS ETAT+ demonstrated diagnostic accuracy for predicting patient need for hospital admission. This finding supports the utility of ETAT+ to inform emergency care practice. Further research on ETAT+ performance in larger populations and additional patient-oriented outcomes would enhance its generalizability and application in resource-limited settings.
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Affiliation(s)
- Josephine Chen
- From the Division of Biology and Medicine, Brown University
| | - Adam R Aluisio
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI
| | - Oliver Y Tang
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI
| | - Uzoma A Nwakibu
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Jason Kiruja
- Accident and Emergency Department, Kenyatta National Hospital
| | - Alice Maingi
- Department of Emergency Medicine, Ohio State University, Columbus, OH
| | - Vincent Mutiso
- University of Nairobi School of Medicine, Nairobi, Kenya
| | - Peyton Thompson
- Division of Infectious Disease, Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | | | - Stephen J Dunlop
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - Ian B K Martin
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Justin G Myers
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Morgan CE, Ngimbi P, Boisson-Walsh AJ, Ntambua S, Matondo J, Tabala M, Kashamuka MM, Emch M, Edwards JK, Powers KA, James L, Mbonze N, Mampunza S, Yotebieng M, Thompson P, Parr JB. Hepatitis B virus prevalence and transmission in the households of pregnant women in Kinshasa, Democratic Republic of Congo. medRxiv 2023:2023.11.27.23298863. [PMID: 38076826 PMCID: PMC10705650 DOI: 10.1101/2023.11.27.23298863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Background Despite routine infant vaccination and blood donor screening, the Democratic Republic of Congo (DRC) has high hepatitis B virus (HBV) prevalence compared to the United States and Europe. Through the cross-sectional Horizontal and Vertical Transmission of Hepatitis B (HOVER-HBV) study, we characterized household prevalence in DRC's capital, Kinshasa, to inform additional prevention efforts. Methods We introduced HBV surface antigen (HBsAg) screening alongside existing HIV screening as part of routine antenatal care (ANC) in high-volume maternity clinics in Kinshasa. We recruited households of pregnant women who were HBsAg-positive and HBsAg-negative, defining households as "exposed" and "unexposed," respectively. Household members underwent HBsAg testing and an epidemiological survey. We evaluated HBsAg prevalence and potential transmission correlates. Results We enrolled 1,006 participants from 200 households (100 exposed, 100 unexposed) across Kinshasa. HBsAg prevalence was more than twice as high in exposed households (5.0%; 95% CI: 2.8%-7.1%) as in unexposed households (1.9%; 0.6%-3.2%). Exposed direct offspring had 3.3 (0.9, 11.8) times the prevalence of unexposed direct offspring. Factors associated with HBsAg-positivity included older age, marriage, and having multiple recent partners or any new sexual partners among index mothers; and older age, lower household wealth, sharing nail clippers, and using street salons among exposed offspring. Conclusions Vertical and horizontal HBV transmission within households is ongoing in Kinshasa. Factors associated with infection reveal opportunities for HBV prevention efforts, including perinatal prevention, protection during sexual contact, and sanitation of shared personal items.
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Affiliation(s)
- Camille E Morgan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Patrick Ngimbi
- Université Protestante du Congo, Kinshasa, Democratic Republic of the Congo
| | - Alix Jn Boisson-Walsh
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Sarah Ntambua
- Université Protestante du Congo, Kinshasa, Democratic Republic of the Congo
| | - Jolie Matondo
- Université Protestante du Congo, Kinshasa, Democratic Republic of the Congo
| | - Martine Tabala
- Université Protestante du Congo, Kinshasa, Democratic Republic of the Congo
| | | | - Michael Emch
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Jessie K Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Kimberly A Powers
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Linda James
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Nana Mbonze
- Université Protestante du Congo, Kinshasa, Democratic Republic of the Congo
| | - Samuel Mampunza
- Université Protestante du Congo, Kinshasa, Democratic Republic of the Congo
| | - Marcel Yotebieng
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Peyton Thompson
- Division of Infectious Diseases, Department of Pediatrics, UNC School of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Jonathan B Parr
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Division of Infectious Diseases, Department of Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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Razavi-Shearer D, Gamkrelidze I, Pan C, Jia J, Berg T, Gray R, Lim YS, Chen CJ, Ocama P, Desalegn H, Abbas Z, Abdallah A, Aghemo A, Ahmadbekova S, Ahn SH, Aho I, Akarca U, Al Masri N, Alalwan A, Alavian S, Al-Busafi S, Aleman S, Alfaleh F, Alghamdi A, Al-Hamoudi W, Aljumah A, Al-Naamani K, Al-Rifai A, Alserkal Y, Altraif I, Amarsanaa J, Anderson M, Andersson M, Armstrong P, Asselah T, Athanasakis K, Baatarkhuu O, Ben-Ari Z, Bensalem A, Bessone F, Biondi M, Bizri AR, Blach S, Braga W, Brandão-Mello C, Brosgart C, Brown K, Brown, Jr R, Bruggmann P, Brunetto M, Buti M, Cabezas J, Casanovas T, Chae C, Chan HLY, Cheinquer H, Chen PJ, Cheng KJ, Cheon ME, Chien CH, Choudhuri G, Christensen PB, Chuang WL, Chulanov V, Cisneros L, Coffin C, Contreras F, Coppola N, Cornberg M, Cowie B, Cramp M, Craxi A, Crespo J, Cui F, Cunningham C, Dalgard O, De Knegt R, De Ledinghen V, Dore G, Drazilova S, Duberg AS, Egeonu S, Elbadri M, El-Kassas M, El-Sayed M, Estes C, Etzion O, Farag E, Ferradini L, Ferreira P, Flisiak R, Forns X, Frankova S, Fung J, Gane E, Garcia V, García-Samaniego J, Gemilyan M, Genov J, Gheorghe L, Gholam P, Gish R, Goleij P, Gottfredsson M, Grebely J, Gschwantler M, Guingane NA, Hajarizadeh B, Hamid S, Hamoudi W, Harris A, Hasan I, Hatzakis A, Hellard M, Hercun J, Hernandez J, Hockicková I, Hsu YC, Hu CC, Husa P, Janicko M, Janjua N, Jarcuska P, Jaroszewicz J, Jelev D, Jeruma A, Johannessen A, Kåberg M, Kaita K, Kaliaskarova K, Kao JH, Kelly-Hanku A, Khamis F, Khan A, Kheir O, Khoudri I, Kondili L, Konysbekova A, Kristian P, Kwon J, Lagging M, Laleman W, Lampertico P, Lavanchy D, Lázaro P, Lazarus JV, Lee A, Lee MH, Liakina V, Lukšić B, Malekzadeh R, Malu A, Marinho R, Mendes-Correa MC, Merat S, Meshesha BR, Midgard H, Mohamed R, Mokhbat J, Mooneyhan E, Moreno C, Mortgat L, Müllhaupt B, Musabaev E, Muyldermans G, Naveira M, Negro F, Nersesov A, Nguyen VTT, Ning Q, Njouom R, Ntagirabiri R, Nurmatov Z, Oguche S, Omuemu C, Ong J, Opare-Sem O, Örmeci N, Orrego M, Osiowy C, Papatheodoridis G, Peck-Radosavljevic M, Pessoa M, Pham T, Phillips R, Pimenov N, Pincay-Rodríguez L, Plaseska-Karanfilska D, Pop C, Poustchi H, Prabdial-Sing N, Qureshi H, Ramji A, Rautiainen H, Razavi-Shearer K, Remak W, Ribeiro S, Ridruejo E, Ríos-Hincapié C, Robalino M, Roberts L, Roberts S, Rodríguez M, Roulot D, Rwegasha J, Ryder S, Sadirova S, Saeed U, Safadi R, Sagalova O, Said S, Salupere R, Sanai F, Sanchez-Avila JF, Saraswat V, Sargsyants N, Sarrazin C, Sarybayeva G, Schréter I, Seguin-Devaux C, Seto WK, Shah S, Sharara A, Sheikh M, Shouval D, Sievert W, Simojoki K, Simonova M, Sinn DH, Sonderup M, Sonneveld M, Spearman CW, Sperl J, Stauber R, Stedman C, Sypsa V, Tacke F, Tan SS, Tanaka J, Tergast T, Terrault N, Thompson A, Thompson P, Tolmane I, Tomasiewicz K, Tsang TY, Uzochukwu B, Van Welzen B, Vanwolleghem T, Vince A, Voeller A, Waheed Y, Waked I, Wallace J, Wang C, Weis N, Wong G, Wong V, Wu JC, Yaghi C, Yesmembetov K, Yip T, Yosry A, Yu ML, Yuen MF, Yurdaydin C, Zeuzem S, Zuckerman E, Razavi H. Global prevalence, cascade of care, and prophylaxis coverage of hepatitis B in 2022: a modelling study. Lancet Gastroenterol Hepatol 2023; 8:879-907. [PMID: 37517414 DOI: 10.1016/s2468-1253(23)00197-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND The 2016 World Health Assembly endorsed the elimination of hepatitis B virus (HBV) infection as a public health threat by 2030; existing therapies and prophylaxis measures make such elimination feasible, even in the absence of a virological cure. We aimed to estimate the national, regional, and global prevalence of HBV in the general population and among children aged 5 years and younger, as well as the rates of diagnosis, treatment, prophylaxis, and the future burden globally. METHODS In this modelling study, we used a Delphi process with data from literature reviews and interviews with country experts to quantify the prevalence, diagnosis, treatment, and prevention measures for HBV infection. The PRoGReSs Model, a dynamic Markov model, was used to estimate the country, regional, and global prevalence of HBV infection in 2022, and the effects of treatment and prevention on disease burden. The future incidence of morbidity and mortality in the absence of additional interventions was also estimated at the global level. FINDINGS We developed models for 170 countries which resulted in an estimated global prevalence of HBV infection in 2022 of 3·2% (95% uncertainty interval 2·7-4·0), corresponding to 257·5 million (216·6-316·4) individuals positive for HBsAg. Of these individuals, 36·0 million were diagnosed, and only 6·8 million of the estimated 83·3 million eligible for treatment were on treatment. The prevalence among children aged 5 years or younger was estimated to be 0·7% (0·6-1·0), corresponding to 5·6 million (4·5-7·8) children with HBV infection. Based on the most recent data, 85% of infants received three-dose HBV vaccination before 1 year of age, 46% had received a timely birth dose of vaccine, and 14% received hepatitis B immunoglobulin along with the full vaccination regimen. 3% of mothers with a high HBV viral load received antiviral treatment to reduce mother-to-child transmission. INTERPRETATION As 2030 approaches, the elimination targets remain out of reach for many countries under the current frameworks. Although prevention measures have had the most success, there is a need to increase these efforts and to increase diagnosis and treatment to work towards the elimination goals. FUNDING John C Martin Foundation, Gilead Sciences, and EndHep2030.
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Thahir S, Muhindo E, Turigye B, Kabagambe K, Thompson P, Mulogo EM, Boyce RM. Implementation of Hepatitis B Screening Into Routine Antenatal Care to Prevent Mother-to-Child Transmission in Rural Western Uganda. Open Forum Infect Dis 2023; 10:ofad452. [PMID: 37705692 PMCID: PMC10496864 DOI: 10.1093/ofid/ofad452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/23/2023] [Indexed: 09/15/2023] Open
Abstract
In rural Uganda where birth dose vaccination for hepatitis B is not routine, we implemented a pilot program for preventing mother-to-child transmission that effectively identified women with high-risk hepatitis B virus (HBV) infection and started antiviral treatment during pregnancy. Further work is required to enhance antiviral adherence through delivery to ensure effective prevention of vertical HBV transmission.
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Affiliation(s)
- Sahal Thahir
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Enid Muhindo
- Peoples Health and Economic Development Organization, Kasese, Uganda
| | - Brian Turigye
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Kenneth Kabagambe
- The National Organisation for People Living with Hepatitis B, Kampala, Uganda
| | - Peyton Thompson
- Department of Pediatrics, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Edgar M Mulogo
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ross M Boyce
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Thompson P, Parr JB, Boisson A, Razavi-Shearer D, Ezechi OC, Wang SH, Tucker JD. Now is the Time to Scale Up Birth-Dose Hepatitis B Vaccine in Low- and Middle-Income Countries. J Infect Dis 2023; 228:368-370. [PMID: 36722048 PMCID: PMC10686687 DOI: 10.1093/infdis/jiad026] [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: 11/16/2022] [Revised: 01/17/2023] [Accepted: 01/26/2023] [Indexed: 02/02/2023] Open
Abstract
Fewer than half of the world's infants have access to the birth dose of hepatitis B vaccine (HBV), which prevents mother-to-child transmission of HBV and subsequent liver cancer. Now is the time to expand access for infants born in low-resource settings.
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Affiliation(s)
- Peyton Thompson
- Department of Pediatrics, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jonathan B Parr
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alix Boisson
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Oliver C Ezechi
- Centre for Reproductive and Population Health Studies, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Su H Wang
- World Hepatitis Alliance, London, United Kingdom
- Department of Internal Medicine, Cooperman Barnabas Medical Center, Florham Park, New Jersey, USA
| | - Joseph D Tucker
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Kahn BZ, Huang Q, Thompson P, Gilkey MB, Alton Dailey S, Brewer NT. Getting Human Papillomavirus Vaccination Back on Track: A National Survey. J Adolesc Health 2023; 72:950-957. [PMID: 36922312 PMCID: PMC10010471 DOI: 10.1016/j.jadohealth.2023.01.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 12/01/2022] [Accepted: 01/04/2023] [Indexed: 03/15/2023]
Abstract
PURPOSE Adolescent human papillomavirus (HPV) vaccine uptake in the United States dropped during the COVID-19 pandemic due to a decrease in well visits. This study sought to identify opportunities for primary care professionals (PCPs) to get adolescent vaccination back on track. METHODS In early 2021, we recruited 1,047 PCPs (71% physicians) who provided adolescent vaccines in the United States from an existing panel. Participants completed an online survey about changes in adolescent HPV vaccine uptake and actions taken to promote vaccination during the pandemic, as well as intentions to engage in activities to increase adolescent vaccination in the next 3 months. RESULTS A substantial proportion of PCPs (43%) reported that HPV vaccine uptake decreased in the first year of the pandemic; few (7%) PCPs reported an increase in uptake. PCPs reporting increased uptake were more likely to have used nurse-only vaccination visits, held drop-in and drive-through vaccination clinics, and used telehealth visits to recommend vaccination (all p < .05). Nearly two-thirds (62%) of all PCPs planned to promote adolescent vaccine uptake in the next 3 months. Planning was more common among PCPs who believed HPV vaccine uptake at their clinics increased during the pandemic, who saw more than 10 adolescent patients per week, who had ever reviewed their clinic's vaccination rates, and were nurses (all p < .05). DISCUSSION Many PCPs saw HPV vaccination drop during the pandemic. Several interventions could help clinics get HPV vaccination back on track, including increasing the availability of nurse-only vaccination visits and vaccination-only clinics.
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Affiliation(s)
- Benjamin Z Kahn
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.
| | - Qian Huang
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Peyton Thompson
- Division of Infectious Diseases, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Susan Alton Dailey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.
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Browne J, Chipps KA, Schmidt K, Schatz H, Ahn S, Pain SD, Montes F, Ong WJ, Greife U, Allen J, Bardayan DW, Blackmon JC, Blankstein D, Cha S, Chae KY, Febbraro M, Hall MR, Jones KL, Kontos A, Meisel Z, O'Malley PD, Schmitt KT, Smith K, Smith MS, Thompson P, Toomey R, Vostinar M, Walter D. First Direct Measurement Constraining the ^{34}Ar(α,p)^{37}K Reaction Cross Section for Mixed Hydrogen and Helium Burning in Accreting Neutron Stars. Phys Rev Lett 2023; 130:212701. [PMID: 37295108 DOI: 10.1103/physrevlett.130.212701] [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: 07/21/2022] [Revised: 09/19/2022] [Accepted: 05/02/2023] [Indexed: 06/12/2023]
Abstract
The rate of the final step in the astrophysical αp process, the ^{34}Ar(α,p)^{37}K reaction, suffers from large uncertainties due to a lack of experimental data, despite having a considerable impact on the observable light curves of x-ray bursts and the composition of the ashes of hydrogen and helium burning on accreting neutron stars. We present the first direct measurement constraining the ^{34}Ar(α,p)^{37}K reaction cross section, using the Jet Experiments in Nuclear Structure and Astrophysics gas jet target. The combined cross section for the ^{34}Ar,Cl(α,p)^{37}K,Ar reaction is found to agree well with Hauser-Feshbach predictions. The ^{34}Ar(α,2p)^{36}Ar cross section, which can be exclusively attributed to the ^{34}Ar beam component, also agrees to within the typical uncertainties quoted for statistical models. This indicates the applicability of the statistical model for predicting astrophysical (α,p) reaction rates in this part of the αp process, in contrast to earlier findings from indirect reaction studies indicating orders-of-magnitude discrepancies. This removes a significant uncertainty in models of hydrogen and helium burning on accreting neutron stars.
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Affiliation(s)
- J Browne
- Department of Physics and Astronomy and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824
- Joint Institute for Nuclear Astrophysics (JINA-CEE), Michigan State University, East Lansing, Michigan 48824
| | - K A Chipps
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996
| | - Konrad Schmidt
- Department of Physics and Astronomy and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824
- Joint Institute for Nuclear Astrophysics (JINA-CEE), Michigan State University, East Lansing, Michigan 48824
- Institute of Radiation Physics, Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstrasse 400, 01328 Dresden, Germany
| | - H Schatz
- Department of Physics and Astronomy and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824
- Joint Institute for Nuclear Astrophysics (JINA-CEE), Michigan State University, East Lansing, Michigan 48824
| | - S Ahn
- Department of Physics and Astronomy and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824
- Joint Institute for Nuclear Astrophysics (JINA-CEE), Michigan State University, East Lansing, Michigan 48824
| | - S D Pain
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996
| | - F Montes
- Department of Physics and Astronomy and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824
- Joint Institute for Nuclear Astrophysics (JINA-CEE), Michigan State University, East Lansing, Michigan 48824
| | - W J Ong
- Department of Physics and Astronomy and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824
- Joint Institute for Nuclear Astrophysics (JINA-CEE), Michigan State University, East Lansing, Michigan 48824
| | - U Greife
- Physics Department, Colorado School of Mines, Golden, Colorado 80401
| | - J Allen
- Department of Physics and Astronomy, University of Notre Dame, Notre Dame, Indiana 46556
| | - D W Bardayan
- Joint Institute for Nuclear Astrophysics (JINA-CEE), Michigan State University, East Lansing, Michigan 48824
- Department of Physics and Astronomy, University of Notre Dame, Notre Dame, Indiana 46556
| | - J C Blackmon
- Department of Physics and Astronomy, Louisiana State University, Baton Rouge, Louisiana 70803
| | - D Blankstein
- Department of Physics and Astronomy, University of Notre Dame, Notre Dame, Indiana 46556
| | - S Cha
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - K Y Chae
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - M Febbraro
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831
| | - M R Hall
- Department of Physics and Astronomy, University of Notre Dame, Notre Dame, Indiana 46556
| | - K L Jones
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996
| | - A Kontos
- Department of Physics and Astronomy and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824
- Joint Institute for Nuclear Astrophysics (JINA-CEE), Michigan State University, East Lansing, Michigan 48824
| | - Z Meisel
- Department of Physics and Astronomy and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824
- Joint Institute for Nuclear Astrophysics (JINA-CEE), Michigan State University, East Lansing, Michigan 48824
| | - P D O'Malley
- Department of Physics and Astronomy, University of Notre Dame, Notre Dame, Indiana 46556
| | - K T Schmitt
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831
| | - K Smith
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996
| | - M S Smith
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831
| | - P Thompson
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996
| | - R Toomey
- Department of Physics and Astronomy, Rutgers University, Piscataway, New Jersey 08854
| | - M Vostinar
- Department of Physics and Astronomy, Rutgers University, Piscataway, New Jersey 08854
| | - D Walter
- Department of Physics and Astronomy, Rutgers University, Piscataway, New Jersey 08854
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Morgan CE, Thahir S, Ngimbi P, Mwandagalirwa MK, Ntambua S, Matondo J, Tabala M, Mbendi C, Kaba D, Yotebieng M, Parr JB, Banek K, Thompson P. Participant perspectives to improve tenofovir adherence in the prevention of mother-to-child transmission of hepatitis B virus in Kinshasa, DRC. medRxiv 2023:2023.03.30.23287808. [PMID: 37034729 PMCID: PMC10081418 DOI: 10.1101/2023.03.30.23287808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Prevention of mother-to-child transmission (PMTCT) programs for hepatitis B virus (HBV) are critical to reach the World Health Organization's 2030 HBV elimination goals. Despite demonstrated feasibility utilizing HIV infrastructure, HBV PMTCT programs are not implemented in many African settings, including in the Democratic Republic of Congo (DRC). In a previous pilot of HBV PMTCT implementation in DRC's capital, Kinshasa, we observed low TDF metabolite levels at delivery among women with high-risk HBV who were given tenofovir disoproxil fumarate (TDF) antiviral therapy. As such, we conducted qualitative interviews with women who received TDF to understand facilitators and barriers of medication adherence. We used a modified Information-Motivation-Behavioral Skills model (IMB+) as a framework for thematic content analysis. We found that trust in healthcare workers, familial support, and improved awareness of the disease and treatment options were important facilitators of TDF adherence; pill size, social stigma, and low HBV knowledge were barriers to adherence. While overall acceptance of TDF was high in this pilot, improved TDF adherence is needed in order to reach efficacious levels for preventing transmission from mothers to newborns. We suggest ongoing HBV sensitization within existing maternity and HIV care infrastructure would address gaps in knowledge and stigma identified here. Additionally, given the trust women have towards maternity center staff and volunteers, scaled HBV PMTCT interventions should include specific sensitization and education for healthcare affiliates, who currently receive no HBV prevention or information in DRC. This study is timely as TDF, particularly future long-acting formulations, could be considered as an alternate rather than adjuvant to birth-dose vaccination for HBV PMTCT in sub-Saharan Africa.
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Affiliation(s)
| | - Sahal Thahir
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Patrick Ngimbi
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | | | - Sarah Ntambua
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Jolie Matondo
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Martine Tabala
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Charles Mbendi
- University Hospital, Kinshasa, Democratic Republic of Congo
| | - Didine Kaba
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | | | - Jonathan B Parr
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Kristin Banek
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Peyton Thompson
- University of North Carolina at Chapel Hill, Chapel Hill, USA
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St Jean DT, Edwards JK, Rogawski McQuade ET, Thompson P, Thomas JC, Becker-Dreps S. Transporting monovalent rotavirus vaccine efficacy estimates to an external target population: a secondary analysis of data from a randomised controlled trial in Malawi. Epidemiol Infect 2023; 151:e49. [PMID: 36843494 PMCID: PMC10052556 DOI: 10.1017/s0950268823000286] [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: 08/22/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 02/28/2023] Open
Abstract
Oral rotavirus vaccine efficacy estimates from randomised controlled trials are highly variable across settings. Although the randomised study design increases the likelihood of internal validity of findings, results from trials may not always apply outside the context of the study due to differences between trial participants and the target population. Here, we used a weight-based method to transport results from a monovalent rotavirus vaccine clinical trial conducted in Malawi between 2005 and 2008 to a target population of all trial-eligible children in Malawi, represented by data from the 2015-2016 Malawi Demographic and Health Survey (DHS). We reweighted trial participants to reflect the population characteristics described by the Malawi DHS. Vaccine efficacy was estimated for 1008 trial participants after applying these weights such that they represented trial-eligible children in Malawi. We also conducted subgroup analyses to examine the heterogeneous treatment effects by stunting and tuberculosis vaccination status at enrolment. In the original trial, the estimates of one-year vaccine efficacy against severe rotavirus gastroenteritis and any-severity rotavirus gastroenteritis in Malawi were 49.2% (95% CI 15.6%-70.3%) and 32.1% (95% CI 2.5%-53.1%), respectively. After weighting trial participants to represent all trial-eligible children in Malawi, vaccine efficacy increased to 62.2% (95% CI 35.5%-79.0%) against severe rotavirus gastroenteritis and 38.9% (95% CI 11.4%-58.5%) against any-severity rotavirus gastroenteritis. Rotavirus vaccine efficacy may differ between trial participants and target populations when these two populations differ. Differences in tuberculosis vaccination status between the trial sample and DHS population contributed to varying trial and target population vaccine efficacy estimates.
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Affiliation(s)
- Denise T. St Jean
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jessie K. Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Peyton Thompson
- Division of Infectious Diseases, Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - James C. Thomas
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sylvia Becker-Dreps
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Abstract
BACKGROUND COVID-19 vaccines are available for adolescents in the United States, but many parents are hesitant to have their children vaccinated. The advice of primary care professionals strongly influences vaccine uptake. OBJECTIVE We examined the willingness of primary care professionals (PCPs) to recommend COVID-19 vaccination for adolescents. METHODS Participants were a national sample of 1,047 US adolescent primary care professionals. They participated in an online survey in early 2021, after a COVID-19 vaccine had been approved for adults but before approval for adolescents. Respondents included physicians (71%), advanced practice providers (17%), and nurses (12%). We identified correlates of willingness to recommend COVID-19 vaccination for adolescents using logistic regression. RESULTS The majority (89%) of respondents were willing to recommend COVID-19 vaccination for adolescents, with advanced practice providers and nurses being less likely than paediatricians to recommend vaccination (84% vs. 94%, aOR 0.47, 95% CI 0.23-0.92). Respondents who had received at least one dose of a COVID-19 vaccine were more likely to recommend adolescent vaccination (92% vs. 69%, aOR 4.20, 95% CI 2.56-6.87) as were those with more years in practice (94% vs. 88%, aOR 2.93, 95% CI 1.79-4.99). Most respondents (96%) said they would need some measure of support in order to provide COVID-19 vaccination to adolescents, with vaccine safety and efficacy information being the most commonly cited need (80%). CONCLUSION Adolescent primary care professionals were generally willing to recommend COVID-19 vaccination. However, most indicated a need for additional resources to be able to administer COVID-19 vaccines at their clinic.
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Affiliation(s)
- Peyton Thompson
- Department of Pediatrics, Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Lauren McCormick
- Department of Biology, University of North Carolina, Chapel Hill, NC, United States
| | - Qian Huang
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
| | - Susan Alton Dailey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
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Boisson A, Morgan CE, Stover A, Ngimbi P, Mbonze N, Ntambua S, Matondo J, Parr JB, Yotebieng M, Mwandagalirwa K, James L, Mampunza S, Thompson P. Changes in hepatitis B vaccine perception in response to the COVID-19 pandemic: Development of the Shift in vaccine confidence (SVC) survey tool. Vaccine 2023; 41:623-629. [PMID: 36549941 PMCID: PMC9755009 DOI: 10.1016/j.vaccine.2022.12.028] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 11/18/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
The COVID-19 pandemic has disrupted access to, adherence to, and perceptions of routine vaccinations. We developed the Shift in Vaccine Confidence (SVC) survey tool to assess the impact of the pandemic on routine vaccinations, with a focus on the HBV vaccine, in Kinshasa, Democratic Republic of Congo (DRC). This study describes the content validation steps we conducted to ensure the survey tool is meaningful to measure changes in vaccine confidence to regular immunization (HBV vaccine) due to the pandemic. Three rounds of stakeholder feedback from a DRC-based study team, content and measurement experts, and study participants allowed us to produce a measure with improved readability and clarity.
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Affiliation(s)
- Alix Boisson
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, 27599, USA.
| | - Camille E. Morgan
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Angela Stover
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, 27599, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599.
| | - Patrick Ngimbi
- Université Protestante du Congo, Kinshasa, Democratic Republic of the Congo.
| | - Nana Mbonze
- Université Protestante du Congo, Kinshasa, Democratic Republic of the Congo.
| | - Sarah Ntambua
- Université Protestante du Congo, Kinshasa, Democratic Republic of the Congo.
| | - Jolie Matondo
- Université Protestante du Congo, Kinshasa, Democratic Republic of the Congo.
| | - Jonathan B. Parr
- Division of Infectious Diseases, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Marcel Yotebieng
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, 10461, USA.
| | | | - Linda James
- Université Protestante du Congo, Kinshasa, Democratic Republic of the Congo.
| | - Samuel Mampunza
- Université Protestante du Congo, Kinshasa, Democratic Republic of the Congo.
| | - Peyton Thompson
- Division of Infectious Diseases, Department of Pediatrics, University of North Carolina, Chapel Hill, NC 27599, USA.
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16
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Burger P, Dorresteijn J, Fiolet A, Koudstaal S, Eikelboom J, Nidorf S, Thompson P, Cornel J, Budgeon C, Steg P, Cramer M, Teraa M, Bhatt D, Visseren F, Mosterd A. Individual lifetime benefit from low-dose colchicine in chronic coronary artery disease patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1222] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Low-dose colchicine reduces the risk of cardiovascular events in patients with chronic coronary artery disease (CAD), but the absolute benefit may vary between patients. Individual benefit from preventive therapies can be estimated using the guideline-recommended SMART-REACH model.
Purpose
This study aimed to assess the range of individual absolute 10-year and lifetime benefit from low-dose colchicine according to patient risk profile.
Methods
The SMART-REACH model was combined with the relative treatment effect of low-dose colchicine, and applied to all participants from the LoDoCo2 trial (n=5,522), and patients with chronic CAD from the UCC-SMART cohort (n=5,308). Individual treatment benefit was expressed as (i) 10-year absolute risk reductions (ARRs) for myocardial infarction, ischemic stroke, or cardiovascular death (MACE), and (ii) life-years gained free of MACE. Predictions were also performed for MACE plus ischemia-driven coronary revascularization (MACE+), through development of a new competing risk-adjusted lifetime prediction model in data from the REACH registry (n=14,522). Low-dose colchicine was compared to alternative intensive prevention goals, i.e. low density lipoprotein-cholesterol (LDL-c) reduction to <1.4 mmol/L, and systolic blood pressure (SBP) reduction to <130 mmHg.
Results
Median individual 10-year ARR for MACE from low-dose colchicine therapy was 4.6% (interquartile range [IQR] 3.6–6.0%), and median gain in life expectancy free of MACE was 2.0 (IQR 1.6–2.5) years. Median 10-year ARR for MACE+ was 8.6% (IQR 7.6–9.8%), and median gain in MACE+-free life expectancy was 3.4 (IQR 2.6–4.2) years. For intensified LDL-c and SBP reduction respectively, median 10-year ARRs were 3.0% (IQR 1.5–5.1%) and 1.7% (IQR 0.0–5.7%) for MACE, and 5.2% (IQR 2.5–8.7%) and 2.9% (IQR 0.0–9.5%) for MACE+. Median life-years gained from LDL-c and SBP reduction were 1.2 (IQR 0.6–2.1) and 0.7 (IQR 0.0–2.3) years free of MACE, and 1.8 (IQR 0.8–3.3) and 0.9 (IQR 0.0–3.4) years free of MACE+.
Conclusion
The individual absolute benefit from low-dose colchicine varies between patients. In an era where lipid- and blood pressure-lowering therapies are already routinely used, the benefits of low-dose colchicine are expected to be of at least similar magnitude to those of intensified LDL-c and SBP reduction in patients with chronic CAD.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Burger
- University Medical Center Utrecht , Utrecht , The Netherlands
| | - J Dorresteijn
- University Medical Center Utrecht , Utrecht , The Netherlands
| | - A Fiolet
- University Medical Center Utrecht , Utrecht , The Netherlands
| | - S Koudstaal
- Green Heart Hospital , Gouda , The Netherlands
| | | | - S Nidorf
- Sir Charles Gairdner Hospital , Perth , Australia
| | - P Thompson
- Sir Charles Gairdner Hospital , Perth , Australia
| | - J Cornel
- Radboud University Medical Centre , Nijmegen , The Netherlands
| | - C Budgeon
- University of Western Australia , Perth , Australia
| | - P Steg
- University Paris Diderot , Paris , France
| | - M Cramer
- University Medical Center Utrecht , Utrecht , The Netherlands
| | - M Teraa
- University Medical Center Utrecht , Utrecht , The Netherlands
| | - D Bhatt
- Brigham and Women's Hospital , Boston , United States of America
| | - F Visseren
- University Medical Center Utrecht , Utrecht , The Netherlands
| | - A Mosterd
- Meander Medical Center , Amersfoort , The Netherlands
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17
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Grabert BK, Gilkey MB, Huang Q, Yi Kong W, Thompson P, Brewer NT. Primary care professionals' support for Covid-19 vaccination mandates: Findings from a US national survey. Prev Med Rep 2022; 28:101849. [PMID: 35662856 PMCID: PMC9153174 DOI: 10.1016/j.pmedr.2022.101849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 05/26/2022] [Accepted: 05/28/2022] [Indexed: 11/05/2022] Open
Abstract
Healthcare organizations have been early adopters of Covid-19 vaccine mandates as a strategy to end the pandemic. We sought to evaluate support for such mandates among pediatric primary care professionals (PCPs) in the United States. In February-March 2021, we conducted a national online survey of 1,047 PCPs (71% physicians). We used multivariable logistic regression to assess correlates of PCPs' support for Covid-19 vaccine mandates for health care workers. Most PCPs supported Covid-19 vaccine mandates for health care workers (83%). PCPs were more likely to support mandates if they perceived health care workers to be at highest risk of getting Covid-19 compared to other worker types (8 percentage points, p < 0.01). PCPs were also more likely to support mandates if their clinic recommended or required vaccination (11 percentage points and 20 percentage points respectively, both p < 0.01). However, PCPs were less likely to support mandates if their clinic offered incentives to vaccinate (10 percentage points, p < 0.05). Clinic recommendations and requirements for Covid-19 vaccination may increase support for mandates. Incentives may decrease support, perhaps by creating the perception that viable alternatives to mandates exist.
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Affiliation(s)
- Brigid K. Grabert
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, USA
- Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina at Chapel Hill, NC, USA
| | - Melissa B. Gilkey
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, USA
- Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina at Chapel Hill, NC, USA
| | - Qian Huang
- Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina at Chapel Hill, NC, USA
| | - Wei Yi Kong
- Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina at Chapel Hill, NC, USA
| | - Peyton Thompson
- Department of Pediatrics, Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
| | - Noel T. Brewer
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, USA
- Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina at Chapel Hill, NC, USA
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18
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Powers KA, Sullivan KM, Zadrozny SL, Shook-Sa BE, Byrnes R, Bogojevich DA, Lauen DL, Thompson P, Robinson WR, Gordon-Larsen P, Aiello AE. North Carolina public school teachers' contact patterns and mask use within and outside of school during the prevaccine phase of the COVID-19 pandemic. Am J Infect Control 2022; 50:608-617. [PMID: 34971715 PMCID: PMC8714247 DOI: 10.1016/j.ajic.2021.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/17/2021] [Accepted: 12/17/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Teachers are central to school-associated transmission networks, but little is known about their behavioral patterns during the COVID-19 pandemic. METHODS We conducted a cross-sectional survey of 700 North Carolina public school teachers in 4 districts open to in-person learning in November-December 2020 (pre-COVID-19 vaccines). We assessed indoor and outdoor time spent, numbers of people encountered at <6 feet ("close contacts"), and mask use by teachers and those around them at specific locations on the most recent weekday and weekend day. RESULTS Nearly all respondents reported indoor time at home (98%) and school (94%) on the most recent weekday, while 62% reported indoor time at stores, 18% at someone else's home, and 17% at bars/restaurants. Responses were similar for the most recent weekend day, excepting school (where 5% reported indoor time). Most teachers (>94%) reported wearing masks inside school, stores, and salons; intermediate percentages (∼50%-85%) inside places of worship, bars/restaurants, and recreational settings; and few (<25%) in their or others' homes. Approximately half reported daily close contact with students. CONCLUSIONS As schools reopened in the COVID-19 pandemic, potential transmission opportunities arose through close contacts within and outside of school, along with suboptimal mask use by teachers and/or those around them. Our granular estimates underscore the importance of multilayered mitigation strategies and can inform interventions and mathematical models addressing school-associated transmission.
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Affiliation(s)
- Kimberly A Powers
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Kristin M Sullivan
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Sabrina L Zadrozny
- Frank Porter Graham Child Development Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Bonnie E Shook-Sa
- Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Rosemary Byrnes
- Frank Porter Graham Child Development Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - David A Bogojevich
- Frank Porter Graham Child Development Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Douglas L Lauen
- Department of Public Policy, The University of North Carolina at Chapel Hill, Chapel Hill, NC; Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Peyton Thompson
- Department of Pediatrics, Division of Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Whitney R Robinson
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC; Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Penny Gordon-Larsen
- Department of Nutrition, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Allison E Aiello
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC; Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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19
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Jain N, Thompson P, Burger J, Ferrajoli A, Takahashi K, Estrov Z, Borthakur G, Bose P, Kadia T, Pemmaraju N, Sasaki K, Konopleva M, Jabbour E, Garg N, Wang X, Kanagal-Shamanna R, Patel K, Wang W, Wang S, Jorgensen J, Lopez W, Ayala A, Plunkett W, Gandhi V, Kantarjian H, O’Brien S, Keating M, Wierda W. S149: LONG TERM OUTCOMES OF IFCG REGIMEN FOR FIRSTLINE TREATMENT OF PATIENTS WITH CLL WITH MUTATED IGHV AND WITHOUT DEL(17P)/TP53 MUTATION. Hemasphere 2022. [DOI: 10.1097/01.hs9.0000843488.43813.af] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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20
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Weeland C, Vriend C, Van Der Werf Y, Huyser C, Hillegers M, Tiemeier H, White T, De Joode N, Thompson P, Stein D, Van Den Heuvel O, Kasprzak S. The thalamus and its subregions – a gateway to obsessive-compulsive disorder. Eur Psychiatry 2022. [PMCID: PMC9567138 DOI: 10.1192/j.eurpsy.2022.239] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Higher thalamic volume has been found in children with obsessive-compulsive disorder (OCD) and children with clinical-level symptoms within the general population (Boedhoe et al. 2017, Weeland et al. 2021a). Functionally distinct thalamic nuclei are an integral part of OCD-relevant brain circuitry. Objectives We aimed to study the thalamic nuclei volume in relation to subclinical and clinical OCD across different age ranges. Understanding the role of thalamic nuclei and their associated circuits in pediatric OCD could lead towards treatment strategies specifically targeting these circuits. Methods We studied the relationship between thalamic nuclei and obsessive-compulsive symptoms (OCS) in a large sample of school-aged children from the Generation R Study (N = 2500) (Weeland et al. 2021b). Using the data from the ENIGMA-OCD working group we conducted mega-analyses to study thalamic subregional volume in OCD across the lifespan in 2,649 OCD patients and 2,774 healthy controls across 29 sites (Weeland et al. 2021c). Thalamic nuclei were grouped into five subregions: anterior, ventral, intralaminar/medial, lateral and pulvinar (Figure 1). ![]()
Results Both children with subclinical and clinical OCD compared with controls show increased volume across multiple thalamic subregions. Adult OCD patients have decreased volume across all subregions (Figure 2), which was mostly driven by medicated and adult-onset patients. ![]()
Conclusions
Our results suggests that OCD-related thalamic volume differences are global and not driven by particular subregions and that the direction of effects are driven by both age and medication status. Disclosure No significant relationships.
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21
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Boisson A, Morgan CE, Fried B, Shea CM, Yotebieng M, Ngimbi P, Mbonze N, Mwandagalirwa K, Babakazo P, Thompson P. Barriers and facilitators to timely birth-dose vaccines in Kinshasa Province, the DRC: a qualitative study. Journal of Global Health Reports 2022. [DOI: 10.29392/001c.35449] [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] [Indexed: 11/08/2022] Open
Abstract
Background National vaccine policies across the world have successfully improved infant vaccine coverage, but birth-dose (BD) vaccine coverage remains low. Countries such as the Democratic Republic of the Congo (DRC) aim to include the hepatitis B birth-dose (HepB-BD) vaccine in their national immunization schedule. HepB-BD’s short window for administration – within 24 hours of delivery to prevent mother-to-child transmission – adds to the complexity of streamlined and timely BD vaccines. This study aims to identify and understand barriers and facilitators to timely delivery of BD vaccine in Kinshasa Province, DRC, through individuals’ accounts with different perspectives on the uptake of the BD vaccine in preparation for its future roll-out. Methods We conducted semi-structured interviews in seven health facilities across Kinshasa Province from June to July 2021. We purposefully sampled health facilities from the provinces’ five most prominent facility types—private, public, Catholic, Protestant, and not-for-profit. We interviewed decision-makers and/or providers from various levels of the health care continuum, including midwives, immunization staff, heads of maternity and immunizations, and vaccine officials at the health zone and the Programme Elargi de Vaccination (PEV) to understand administrative barriers to BD vaccines. We also conducted interviews with expectant mothers to elicit knowledge and perceptions about infant vaccines. Results We interviewed 30 participants (16 informants and 14 expectant mothers). Interviewees were recruited from 7 health facilities, 2 health zones, and PEV. Data analysis was guided by the Consolidated Framework for Implementation Research (CFIR). Our analysis identified 13 constructs (2-3 per domain) related to the success of timely and streamlined BD vaccines. We found significant barriers within and across each domain; most notably, the multi-dose vials of existing BD vaccines determining when facility staff could vaccinate newborns, often resulting in untimely vaccinations; logistical concerns with regular national vaccine stockouts and ability to store vaccines; complex and unsynchronized vaccine fees across facilities; inadequate communication across delivery and vaccination wards; and limited and at times incorrect understanding of vaccines among mothers and other community members. Conclusions Using the CFIR framework, this study integrated perspectives from facility informants and expectant mothers to inform national policy and implementation of the HepB-BD in DRC. These stakeholder-driven findings should guide the streamlining of timely BD vaccinations upon HepB-BD implementation.
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Affiliation(s)
- Alix Boisson
- Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Camille E. Morgan
- Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Bruce Fried
- Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Christopher M. Shea
- Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Patrick Ngimbi
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Nana Mbonze
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Pélagie Babakazo
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Peyton Thompson
- University of North Carolina, Chapel Hill, North Carolina, USA
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22
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Huang Q, Gilkey MB, Thompson P, Grabert BK, Dailey SA, Brewer NT. Explaining higher Covid-19 vaccination among some US primary care professionals. Soc Sci Med 2022; 301:114935. [PMID: 35334260 PMCID: PMC8933282 DOI: 10.1016/j.socscimed.2022.114935] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 02/24/2022] [Accepted: 03/17/2022] [Indexed: 11/16/2022]
Abstract
Background and objective Research in several countries shows higher Covid-19 vaccination willingness and uptake among physicians than nurses. Our paper aims to characterize and explain this difference. Methods In early 2021, we surveyed 1047 U.S. primary care professionals who served adolescents, ages 11–17. The national sample included physicians (71%) as well as nurses and advanced practice providers. The survey assessed the three domains of the Increasing Vaccination Model: thinking and feeling, social processes, and direct behavior change. Results Covid-19 vaccine uptake was higher among physicians than among nurses and advanced practice providers (91% vs. 76%, p < .05). Overall, in the thinking and feeling domain, higher confidence in Covid-19 vaccination, higher perceived susceptibility to the disease, and stronger anticipated regret were associated with higher vaccine uptake (all p < .05). In the social processes domain, perceiving more positive social norms for Covid-19 vaccination, receiving recommendations to get the vaccine, and wanting to help others were associated with higher vaccine uptake (all p < .05). In the direct behavior change domain, receiving an invitation to get the vaccine and better access to vaccination were associated with higher uptake (both p < .05). Of these variables, most of the thinking and feeling and social processes variables mediated the association of training with vaccine uptake. Conclusions Physicians had higher Covid-19 vaccine uptake than nurses and advanced practice providers, corresponding with their more supportive vaccine beliefs and social experiences. Efforts to reach the remaining unvaccinated cohort can build on these findings.
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Affiliation(s)
- Qian Huang
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, USA
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, USA
| | - Peyton Thompson
- Department of Pediatrics, Division of Infectious Diseases, School of Medicine, University of North Carolina, USA
| | - Brigid K Grabert
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, USA
| | - Susan Alton Dailey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, USA.
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23
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St Jean DT, Rogawski McQuade ET, Edwards JK, Thompson P, Thomas J, Becker-Dreps S. Effect of early life antibiotic use on serologic responses to oral rotavirus vaccine in the MAL-ED birth cohort study. Vaccine 2022; 40:2580-2587. [PMID: 35341645 PMCID: PMC9045361 DOI: 10.1016/j.vaccine.2022.03.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/06/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Oral rotavirus vaccine efficacy is lower in low- and middle-income countries (LMICs) than in high-income countries. The degree to which antibiotic use impacts rotavirus vaccine immunogenicity in LMICs is unknown. Using data from a multisite prospective birth cohort study of malnutrition and enteric disease, MAL-ED, we examined the effect of early life antibiotic use on the immune response to rotavirus vaccine. METHODS We assessed whether antibiotic use from birth up to 7 days following rotavirus vaccine series completion was associated with rotavirus seropositivity at 7 months of age in Brazil, Peru, and South Africa using a modified Poisson regression. We then used parametric g-computation to estimate the impact of hypothetical interventions that treated all children and alternatively prevented inappropriate antibiotic treatments on seropositivity. RESULTS Of 537 children, 178 (33%) received at least one antibiotic course during the exposure window. Probability of seropositivity was 40% higher among children who had at least one course of antibiotics compared with those with no antibiotic exposure (PR: 1.40, 95% CI: 1.04, 1.89). There was no significant difference by the number of antibiotic courses received or total duration of antibiotics. Treating all children with antibiotics would be associated with a 19% (95% CI: 18%, 21%) absolute increase in seropositivity at 7 months. In contrast, removing inappropriate antibiotics would result in a 4% absolute reduction (95% CI: -5%, -2%) in seropositivity. CONCLUSIONS Early life antibiotic use was associated with increased seropositivity. However, a hypothetical intervention to remove inappropriate antibiotics would have little effect on overall seropositivity. Further investigation into the underlying mechanisms of antibiotic use on the infant gut microbiome and immune response are needed.
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Affiliation(s)
- Denise T St Jean
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | | | - Jessie K Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Peyton Thompson
- Division of Infectious Diseases, Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James Thomas
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sylvia Becker-Dreps
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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24
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Boisson A, Goel V, Yotebieng M, Parr JB, Fried B, Thompson P. Implementation Approaches for Introducing and Overcoming Barriers to Hepatitis B Birth-Dose Vaccine in sub-Saharan Africa. Glob Health Sci Pract 2022; 10:GHSP-D-21-00277. [PMID: 35294378 PMCID: PMC8885356 DOI: 10.9745/ghsp-d-21-00277] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 10/27/2021] [Indexed: 12/14/2022]
Abstract
We discuss determinants of hepatitis B birth-dose vaccine uptake in sub-Saharan Africa countries at the policy, facility, and community levels and propose solutions to known barriers of hepatitis B vaccine introduction in low- and middle-income countries. In sub-Saharan Africa (SSA), chronic viral hepatitis B (HBV) affects more than 60 million people. Mother-to-child transmission is a major contributor to the ongoing HBV epidemic and yet only 11 of 54 (20.3%) SSA countries have introduced the birth dose of HBV vaccine (HepB-BD) into their regular immunization schedule. As more African countries adopt HepB-BD, implementation approaches must be targeted to ensure effective and timely HepB-BD delivery, especially in rural and under-resourced settings. We conducted a systematic literature review of published literature using PubMed. We included 39 articles published from January 2010 to August 2020, as well as gray literature, case studies, and research performed in SSA. We describe barriers to the uptake of HepB-BD in SSA at the policy, facility, and community levels and propose solutions that are relevant to stakeholders wishing to introduce HepB-BD. We highlight the importance and challenge of reaching infants who are born outside of health care facilities (i.e., home deliveries) with HepB-BD in partnership with community health workers. We also discuss the critical role of maternal education and community engagement in future HepB-BD scale-up efforts in SSA.
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Affiliation(s)
- Alix Boisson
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Varun Goel
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Carolina Population Center, Chapel Hill, NC, USA
| | - Marcel Yotebieng
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jonathan B Parr
- Division of Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Bruce Fried
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Peyton Thompson
- Division of Infectious Diseases, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Thompson P, Mpody C, Sayre W, Rigney C, Tabala M, Ravelomanana NLR, Malongo F, Kawende B, Behets F, Okitolonda E, Yotebieng M. Hepatitis C prevalence and quality of health services among HIV-positive mothers in the Democratic Republic of the Congo. Sci Rep 2022; 12:1384. [PMID: 35082320 PMCID: PMC8791992 DOI: 10.1038/s41598-022-05014-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 01/05/2022] [Indexed: 11/09/2022] Open
Abstract
Hepatitis C virus (HCV) contributes to liver-related morbidity and mortality throughout Africa despite effective antivirals. HCV is endemic in the Democratic Republic of the Congo (DRC) but data on HCV/HIV co-infection in pregnancy is limited. We estimated the prevalence of and risk factors for HCV/HIV co-infection among pregnant women in the Kinshasa province of the DRC. This cross-sectional study was conducted as a sub-study of an ongoing randomized trial to assess continuous quality improvement interventions (CQI) for prevention of mother-to-child transmission (PMTCT) of HIV (CQI-PMTCT study, NCT03048669). HIV-infected women in the CQI-PMTCT cohort were tested for HCV, and risk factors were evaluated using logistic regression. The prevalence of HCV/HIV co-infection among Congolese women was 0.83% (95% CI 0.43-1.23). Women who tested positive for HCV were younger, more likely to live in urban areas, and more likely to test positive during pregnancy versus postpartum. HCV-positive women had significantly higher odds of infection with hepatitis B virus (HBV) (aOR 13.87 [3.29,58.6]). An inverse relationship was noted between HCV infection and the overall capacity of the health facility as measured by the service readiness index (SRI) (aOR:0.92 [0.86,0.98] per unit increase). Women who presented to rural, for-profit and PEPFAR-funded health facilities were more likely to test positive for HCV. In summary, this study identified that the prevalence of HCV/HIV co-infection was < 1% among Congolese women. We also identified HBV infection as a major risk factor for HCV/HIV co-infection. Individuals with triple infection should be linked to care and the facility-related differences in HCV prevalence should be addressed in future studies.
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Affiliation(s)
- Peyton Thompson
- Division of Infectious Diseases, Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA.
| | - Christian Mpody
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Wesley Sayre
- School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Clare Rigney
- College of Health Sciences, Cleveland State University, Cleveland, OH, USA
| | - Martine Tabala
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | | | - Fathy Malongo
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Bienvenu Kawende
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Frieda Behets
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Emile Okitolonda
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Marcel Yotebieng
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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Thahir S, Tulenko SE, Ngimbi P, Ntambua S, Matondo J, Mwandagalirwa K, Tabala M, Kaba D, Yotebieng M, Parr JB, Thompson P. Low knowledge about hepatitis B prevention among pregnant women in Kinshasa, Democratic Republic of Congo. PLOS Glob Public Health 2022; 2:e0000450. [PMID: 36962537 PMCID: PMC10021814 DOI: 10.1371/journal.pgph.0000450] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/18/2022] [Indexed: 11/18/2022]
Abstract
Infants infected perinatally with hepatitis B (HBV) are at the highest risk of developing chronic hepatitis and associated sequelae. Prevention of mother-to-child transmission (PMTCT) of HBV requires improved screening and awareness of the disease. This study evaluated existing HBV knowledge among pregnant mothers (n = 280) enrolled in two HBV studies in urban maternity centers in Kinshasa, Democratic Republic of the Congo. All mothers responded to three knowledge questions upon study enrollment. Baseline levels of knowledge related to HBV transmission, treatment, prevention, and symptoms were low across all participants: 68.8% did not know how HBV was transmitted, 70.7% did not know how to prevent or treat HBV MTCT, and 79.6% did not know signs and symptoms of HBV. Over half of participants responded "I don't know" to all questions. HBV-positive women who participated in both studies (n = 46) were asked the same questions during both studies and showed improved knowledge after screening and treatment, despite no formal educational component in either study (p < 0.001). These findings highlight the need for intensified education initiatives in highly endemic areas to improve PMTCT efforts.
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Affiliation(s)
- Sahal Thahir
- Division of Infectious Diseases, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Samantha E Tulenko
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Patrick Ngimbi
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Sarah Ntambua
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Jolie Matondo
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | - Martine Tabala
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Didine Kaba
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Marcel Yotebieng
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, New York, New York, United States of America
| | - Jonathan B Parr
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Peyton Thompson
- Division of Infectious Diseases, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Myers JG, Nwakibu UA, Hunold KM, Wangara AA, Kiruja J, Mutiso V, Thompson P, Aluisio AR, Maingi A, Dunlop SJ, Martin IBK. Pediatric Medical Emergencies and Injury Prevention Practices in the Pediatric Emergency Unit of Kenyatta National Hospital, Nairobi, Kenya. Pediatr Emerg Care 2022; 38:e378-e384. [PMID: 34986590 DOI: 10.1097/pec.0000000000002294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The epidemiology and presence of pediatric medical emergencies and injury prevention practices in Kenya and resource-limited settings are not well understood. This is a barrier to planning and providing quality emergency care within the local health systems. We performed a prospective, cross-sectional study to describe the epidemiology of case encounters to the pediatric emergency unit (PEU) at Kenyatta National Hospital in Nairobi, Kenya; and to explore injury prevention measures used in the population. METHODS Patients were enrolled prospectively using systematic sampling over four weeks in the Kenyatta National Hospital PEU. Demographic data, PEU visit data and lifestyle practices associated with pediatric injury prevention were collected directly from patients or guardians and through chart review. Data were analyzed with descriptive statistics with stratification based on pediatric age groups. RESULTS Of the 332 patients included, the majority were female (56%) and 76% were under 5 years of age. The most common presenting complaints were cough (40%) fever (34%), and nausea/vomiting (19%). The most common PEU diagnoses were upper respiratory tract infections (27%), gastroenteritis (11%), and pneumonia (8%). The majority of patients (77%) were discharged from the PEU, while 22% were admitted. Regarding injury prevention practices, the majority (68%) of guardians reported their child never used seatbelts or car seats. Of 68 patients that rode bicycles/motorbikes, one reported helmet use. More than half of caregivers cook at potentially dangerous heights; 59% use ground/low level stoves. CONCLUSIONS Chief complaints and diagnoses in the PEU population were congruent with communicable disease burdens seen globally. Measures for primary injury prevention were reported as rarely used in the sample studied. The epidemiology described by this study provides a framework for improving public health education and provider training in resource-limited settings.
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Affiliation(s)
- Justin G Myers
- From the Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Uzoma A Nwakibu
- From the Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Katherine M Hunold
- Department of Emergency Medicine, The Ohio State University, Columbus, OH
| | - Ali Akida Wangara
- Accident and Emergency Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Jason Kiruja
- Accident and Emergency Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Vincent Mutiso
- University of Nairobi School of Medicine, Nairobi, Kenya
| | - Peyton Thompson
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | | | - Alice Maingi
- Accident and Emergency Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Stephen J Dunlop
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - Ian B K Martin
- Department of Emergency Medicine at the Medical College of Wisconsin, Milwaukee, WI
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Spencer BF, Church SA, Thompson P, Cant DJH, Maniyarasu S, Theodosiou A, Jones AN, Kappers MJ, Binks DJ, Oliver RA, Higgins J, Thomas AG, Thomson T, Shard AG, Flavell WR. Characterization of buried interfaces using Ga Kα hard X-ray photoelectron spectroscopy (HAXPES). Faraday Discuss 2022; 236:311-337. [DOI: 10.1039/d2fd00021k] [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] [Indexed: 11/21/2022]
Abstract
HAXPES enables the detection of buried interfaces with an increased photo electron sampling depth.
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Affiliation(s)
- B. F. Spencer
- Henry Royce Institute, Photon Science Institute, Department of Materials, School of Natural Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - S. A. Church
- Henry Royce Institute, Photon Science Institute, Department of Physics and Astronomy, School of Natural Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - P. Thompson
- Department of Computer Science, School of Engineering, The University of Manchester, Manchester, M13 9PL, UK
| | - D. J. H. Cant
- Surface Technologies, Chemical and Biological Sciences Department, National Physical Laboratory, Hampton Road, Teddington, TW11 0LW, UK
| | - S. Maniyarasu
- Henry Royce Institute, Photon Science Institute, Department of Physics and Astronomy, School of Natural Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - A. Theodosiou
- The Nuclear Graphite Research Group, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - A. N. Jones
- The Nuclear Graphite Research Group, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - M. J. Kappers
- Department of Materials Science & Metallurgy, University of Cambridge, 27 Charles Babbage Road, Cambridge, CB3 0FS, UK
| | - D. J. Binks
- Henry Royce Institute, Photon Science Institute, Department of Physics and Astronomy, School of Natural Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - R. A. Oliver
- Department of Materials Science & Metallurgy, University of Cambridge, 27 Charles Babbage Road, Cambridge, CB3 0FS, UK
| | | | - A. G. Thomas
- Henry Royce Institute, Photon Science Institute, Department of Materials, School of Natural Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - T. Thomson
- Department of Computer Science, School of Engineering, The University of Manchester, Manchester, M13 9PL, UK
| | - A. G. Shard
- Surface Technologies, Chemical and Biological Sciences Department, National Physical Laboratory, Hampton Road, Teddington, TW11 0LW, UK
| | - W. R. Flavell
- Henry Royce Institute, Photon Science Institute, Department of Physics and Astronomy, School of Natural Sciences, The University of Manchester, Manchester, M13 9PL, UK
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Njuki M, Thekkut S, Das R, Shahane N, Thompson P, Mirpuri K, Borgesen P, Dimitrov N. Understanding and preventing Cu–Sn micro joint defects through design and process control. J APPL ELECTROCHEM 2021. [DOI: 10.1007/s10800-021-01630-5] [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: 11/30/2022]
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Sayre W, Thompson P. Prevention of Vertical Transmission of Hepatitis B Within a North Carolina Hospital System. Clin Ther 2021; 43:1786-1791. [PMID: 34593255 PMCID: PMC8691857 DOI: 10.1016/j.clinthera.2021.08.012] [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: 06/23/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Hepatitis B virus (HBV) is a major contributor to liver-related disease globally. Vertical transmission of hepatitis B can lead to devastating outcomes in neonates, making prevention of transmission essential. Fortunately, prevention is possible with evidence-based interventions via guidelines from the American Association for the Study of Liver Diseases (AASLD). The purpose of this study was to assess compliance with AASLD guidelines at a tertiary referral hospital in North Carolina, and to suggest future quality improvement initiatives to improve care for this population. METHODS We performed a retrospective chart review, including data from all HBV-positive birthing persons at the tertiary referral hospital from April 1, 2014 through December 31, 2019. Data was then compared to AASLD guidelines. FINDINGS We identified 99 birthing persons who were hepatitis B positive at time of birth. Of the 99 birthing person/neonate dyads, nearly all infants received appropriate and timely HBV birth dose vaccination and HBIG administration. Risk status of HBV-infected birthing persons was completed in only 58% of this population. Of the individuals who were found to be high risk for vertical transmission of HBV, 75% received antiviral prophylaxis. IMPLICATIONS This study provides a current assessment of prevention practices in vertical transmission of HBV compared to published guidelines. The tertiary hospital studied generally implemented AASLD recommendations for prevention of vertical transmission. However, our data revealed that appropriate risk status testing could be improved. With improvement in risk status testing, antiviral prophylaxis can be provided, decreasing the likelihood of breakthrough HBV vertical transmission. Follow-up for HBV-infected birthing persons and HBV-exposed neonates is also a priority. Achieving full compliance with AASLD guidelines to prevent vertical transmission of HBV is possible, and we provide structure for quality improvement initiatives that aim to accomplish this.
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Affiliation(s)
- Wesley Sayre
- School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
| | - Peyton Thompson
- Department of Pediatrics, Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
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Gilkey MB, Kong WY, Huang Q, Grabert BK, Thompson P, Brewer NT. Using Telehealth to Deliver Primary Care to Adolescents During and After the COVID-19 Pandemic: National Survey Study of US Primary Care Professionals. J Med Internet Res 2021; 23:e31240. [PMID: 34406974 PMCID: PMC8437399 DOI: 10.2196/31240] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/10/2021] [Accepted: 07/14/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has led to unprecedented use of telehealth, including by primary care professionals (PCPs) who serve adolescents. OBJECTIVE To inform future practice and policies, we sought to characterize PCPs' recent experience using adolescent telehealth as well as their support for it after the COVID-19 pandemic is over. METHODS From February to March 2021, we conducted a web-based survey of 1047 PCPs in the United States. Our national sample included physicians (747/1047, 71%), advanced practice providers (177/1047, 17%), and nurses (123/1047, 12%) who provided primary care to adolescents aged 11-17 years. RESULTS Most PCPs reported using telehealth for a low, moderate, or high proportion of their adolescent patients in the three months prior to the survey (424/1047, 40%, 286/1047, 27%, and 219/1047, 21%, respectively); only 11% (118/1047) reported no use. A majority of respondents agreed that adolescent telehealth increases access to care (720/1047, 69%) and enables them to provide high-quality care (560/1047, 53%). Few believed that adolescent telehealth takes too much time (142/1047, 14%) or encourages health care overuse (157/1047, 15%). Most supported giving families the option of adolescent telehealth for primary care after the pandemic is over (683/1047, 65%) and believed that health insurance plans should continue to reimburse for telehealth visits (863/1047, 82%). Approximately two-thirds (702/1047, 67%) wanted to offer adolescent telehealth visits after the pandemic, with intentions being higher among those with recent telehealth experience (P<.001). CONCLUSIONS PCPs in our national sample reported widespread use of and predominantly positive attitudes toward adolescent telehealth. Our findings also suggest broad support among PCPs for continuing to offer adolescent telehealth after the COVID-19 pandemic ends.
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Affiliation(s)
- Melissa B Gilkey
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Wei Yi Kong
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Qian Huang
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Brigid K Grabert
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Peyton Thompson
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Noel T Brewer
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Thompson P, Morgan CE, Ngimbi P, Mwandagalirwa K, Ravelomanana NLR, Tabala M, Fathy M, Kawende B, Muwonga J, Misingi P, Mbendi C, Luhata C, Jhaveri R, Cloherty G, Kaba D, Yotebieng M, Parr JB. Arresting vertical transmission of hepatitis B virus (AVERT-HBV) in pregnant women and their neonates in the Democratic Republic of the Congo: a feasibility study. Lancet Glob Health 2021; 9:e1600-e1609. [PMID: 34416175 PMCID: PMC8607275 DOI: 10.1016/s2214-109x(21)00304-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/08/2021] [Accepted: 06/18/2021] [Indexed: 12/12/2022]
Abstract
Background Hepatitis B virus (HBV) remains endemic throughout sub-Saharan Africa despite the widespread availability of effective childhood vaccines. In the Democratic Republic of the Congo, HBV treatment and birth-dose vaccination programmes are not established. We, therefore, aimed to evaluate the feasibility and acceptability of adding HBV testing and treatment of pregnant women as well as the birth-dose vaccination of HBV-exposed infants to the HIV prevention of mother-to-child transmission programme infrastructure in the Democratic Republic of the Congo. Methods We did a feasibility study in two maternity centres in Kinshasa: Binza and Kingasani. Using the already established HIV prevention of mother-to-child transmission programme at these two maternity centres, we screened pregnant women for HBV infection at routine prenatal care registration. Those who tested positive and had a gestational age of 24 weeks or less were included in this study. Eligible pregnant women with a high viral load (≥200 000 IU/mL or HBeAg positivity, or both) were considered as having HBV of high risk of mother-to-child transmission and initiated on oral tenofovir disoproxil fumarate (300 mg/day) between 28 weeks and 32 weeks of gestation and continued through 12 weeks post partum. All HBV-exposed infants received a birth-dose of monovalent HBV vaccine (Euvax-B Pediatric: Sanofi Pasteur, Seoul, South Korea; 0·5 mL) within 24 h of life. All women were followed up for 24 weeks post partum, when they completed an exit questionnaire that assessed the acceptability of study procedures. The primary outcomes were the feasibility of screening pregnant women to identify those at high risk for HBV mother-to-child transmission and to provide them with antiviral prophylaxis, the feasibility of administrating the birth-dose vaccine to exposed infants, and the acceptability of this prevention programme. This study is registered with ClinicalTrials.gov, NCT03567382. Findings Between Sept 24, 2018, and Feb 22, 2019, 4016 women were approached and screened. Of these pregnant women, 109 (2∙7%) were positive for HBsAg. Of the 109 women, 91 (83%) met the eligibility criteria for participation. However, only data from 90 women—excluding one woman who had a false pregnancy—were included in the study analysis. The median overall age of the enrolled women was 31 years (IQR 25–34) and the median overall gestational age was 19 weeks (15–22). Ten (11%) of 91 women evaluated had high-risk HBV infection. Nine (90%) of the ten pregnant women with high-risk HBV infection received tenofovir disoproxil fumarate and one (10%) refused therapy and withdrew from the study; five (56%) of the nine women achieved viral suppression (ie, <200 000 IU/mL) on tenofovir disoproxil fumarate therapy by the time of delivery and the remaining four (44%) had decreased viral loads from enrolment to delivery. A total of 88 infants were born to the 90 enrolled women. Of the 88 infants, 60 (68%) received a birth-dose vaccine; of these, 46 (77%) received a timely birth-dose vaccine. No cases of HBV mother-to-child transmission were observed. No serious adverse events associated with tenofovir disoproxil fumarate nor with the birth-dose vaccine were reported. Only one (11%) of nine women reported dizziness during the course of tenofovir disoproxil fumarate therapy. The study procedures were considered highly acceptable (>80%) among mothers. Interpretation Adding HBV screening and treatment of pregnant women and infant birth-dose vaccination to existing HIV prevention of mother-to-child transmission platforms is feasible in countries such as the Democratic Republic of the Congo. Birth-dose vaccination against HBV infection integrated within the current Expanded Programme on Immunisation and HIV prevention of mother-to-child transmission programme could accelerate progress toward HBV elimination in Africa.
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Affiliation(s)
- Peyton Thompson
- Division of Infectious Diseases, Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA.
| | - Camille E Morgan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Patrick Ngimbi
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | | | - Martine Tabala
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Malongo Fathy
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Bienvenu Kawende
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Jérémie Muwonga
- National AIDS Control Program, Kinshasa, Democratic Republic of the Congo
| | - Pacifique Misingi
- National Blood Transfusion Program, Kinshasa, Democratic Republic of the Congo
| | - Charles Mbendi
- Department of Gastroenterology, University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Christophe Luhata
- Expanded Programme on Immunisation, Kinshasa, Democratic Republic of the Congo
| | - Ravi Jhaveri
- Department of Pediatrics, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Didine Kaba
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Marcel Yotebieng
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, New York City, NY, USA
| | - Jonathan B Parr
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
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Thompson P. Incomplete Vaccinations: Considering What Comes Before the Model. J Pediatric Infect Dis Soc 2021:piab070. [PMID: 34343325 DOI: 10.1093/jpids/piab070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/22/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Peyton Thompson
- Department of Pediatrics, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Walekhwa AW, Ntaro M, Kawungezi PC, Achangwa C, Muhindo R, Baguma E, Matte M, Migisha R, Reyes R, Thompson P, Boyce RM, Mulogo EM. Measles outbreak in Western Uganda: a case-control study. BMC Infect Dis 2021; 21:596. [PMID: 34157990 PMCID: PMC8220759 DOI: 10.1186/s12879-021-06213-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 05/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Measles outbreaks are prevalent throughout sub-Saharan Africa despite the preventive measures like vaccination that target under five-year-old children and health systems strengthening efforts like prioritizing the supply chain for supplies. Measles immunization coverage for Kasese district and Bugoye HC III in 2018 was 72 and 69%, respectively. This coverage has been very low and always marked red in the Red categorization (below the national target/poor performing) on the national league table indicators. The aim of this study was to assess the scope of the 2018-2019 measles outbreak and the associated risk factors among children aged 0-60 months in Bugoye sub-county, Kasese district, western Uganda. METHODS We conducted a retrospective unmatched case-control study among children aged 0-60 months with measles (cases) who had either a clinical presentation or a laboratory confirmation (IgM positivity) presenting at Bugoye Health Centre III (BHC) or in the surrounding communities between December 2018 and October 2019.. Caregivers of the controls (whose children did not have measles) were selected at the time of data collection in July 2020. A modified CDC case investigation form was used in data collection. Quantitative data was collected and analyzed using Microsoft excel and STATA version 13. The children's immunization cards and health registers at BHC were reviewed to ascertain the immunization status of the children before the outbreak. RESULTS An extended measles outbreak occurred in Bugoye, Uganda occured between December 2018 and October 2019. All 34 facility-based measles cases were documented to have had maculopapular rash, conjunctivitis, and cough. Also, the majority had fever (97%), coryza (94.1%), lymphadenopathy (76.5%), arthralgias (73.5%) and Koplik Spots (91.2%) as documented in the clinical registers. Similar symptoms were reported among 36 community-based cases. Getting infected even after immunized, low measles vaccination coverage were identified as the principal risk factors for this outbreak. CONCLUSION Measles is still a significant problem. This study showed that this outbreak was associated with under-vaccination. Implementing a second routine dose of measles-rubella vaccine would not only increase the number of children with at least one dose but also boost the immunity of those who had the first dose.
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Affiliation(s)
- Abel Wilson Walekhwa
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda.
| | - Moses Ntaro
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda
| | - Peter Chris Kawungezi
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda
| | - Chiara Achangwa
- Department of Public Health and Hygiene, University of Buea, P.O. Box 63, Buea, Cameroon
| | - Rabbison Muhindo
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda
| | - Emmanuel Baguma
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda
| | - Michael Matte
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda
| | - Richard Migisha
- Department of Physiology, Faculty of Medicine, Mbarara University of Science & Technology, Mbarara, Uganda
| | - Raquel Reyes
- Department of Medicine, Division of Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Peyton Thompson
- Department of Pediatrics, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Ross M Boyce
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Edgar M Mulogo
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda
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Affiliation(s)
- Noel T Brewer
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Melissa B Gilkey
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Peyton Thompson
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina
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Ninan S, Thompson P, Gershon T, Ford N, Mills W, Jewells V, Thorne L, Saunders K, Bouldin T, Smedberg JR, Miller MB, Wu E, Tilly A, Sites J, Lercher D, Clement K, Walker T, Shea P, Joyner B, Smith R. Fatal Pediatric COVID-19 Case With Seizures and Fulminant Cerebral Edema. Child Neurol Open 2021; 8:2329048X211022532. [PMID: 34179214 PMCID: PMC8207268 DOI: 10.1177/2329048x211022532] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/12/2021] [Accepted: 05/16/2021] [Indexed: 12/22/2022] Open
Abstract
The novel coronavirus, SARS-CoV-2, can present with a wide range of neurological manifestations, in both adult and pediatric populations. We describe here the case of a previously healthy 8-year-old girl who presented with seizures, encephalopathy, and rapidly progressive, diffuse, and ultimately fatal cerebral edema in the setting of acute COVID-19 infection. CSF analysis, microbiological testing, and neuropathology yielded no evidence of infection or acute inflammation within the central nervous system. Acute fulminant cerebral edema (AFCE) is an often fatal pediatric clinical entity consisting of fever, encephalopathy, and new-onset seizures followed by rapid, diffuse, and medically-refractory cerebral edema. AFCE occurs as a rare complication of a variety of common pediatric infections and a CNS pathogen is identified in only a minority of cases, suggesting a para-infectious mechanism of edema. This report suggests that COVID-19 infection can precipitate AFCE, and highlights the need for high suspicion and early recognition thereof.
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Affiliation(s)
- Siddharth Ninan
- Department of Neurology, University of North Carolina at Chapel Hill, NC, USA
| | - Peyton Thompson
- Department of Pediatrics, Division of Infectious Diseases, University of North Carolina at Chapel Hill, NC, USA
| | - Timothy Gershon
- Department of Pediatrics, Division of Infectious Diseases, University of North Carolina at Chapel Hill, NC, USA
| | - Natalie Ford
- Department of Pediatrics, University of North Carolina at Chapel Hill, NC, USA
| | - William Mills
- Department of Pediatrics, Division of Emergency Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Valerie Jewells
- Department of Radiology, University of North Carolina at Chapel Hill, NC, USA
| | - Leigh Thorne
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Katherine Saunders
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Thomas Bouldin
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Jason R. Smedberg
- Clinical Microbiology Laboratory, McLendon Clinical Laboratories, UNC Medical Center, Chapel Hill, NC
| | - Melissa B. Miller
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, NC, USA
- Clinical Microbiology Laboratory, McLendon Clinical Laboratories, UNC Medical Center, Chapel Hill, NC
| | - Eveline Wu
- Department of Pediatrics, Division of Allergy, Immunology and Rheumatology, University of North Carolina at Chapel Hill, NC, USA
| | - Alyssa Tilly
- Departments of Medicine and Pediatrics, Palliative Care Program, University of North Carolina at Chapel Hill, NC, USA
| | - Jeremy Sites
- Department of Pediatrics, Division of Critical Care, University of North Carolina at Chapel Hill, NC, USA
| | - Daniel Lercher
- Department of Pediatrics, Division of Critical Care, University of North Carolina at Chapel Hill, NC, USA
| | - Katherine Clement
- Department of Pediatrics, Division of Critical Care, University of North Carolina at Chapel Hill, NC, USA
| | - Tracie Walker
- Department of Pediatrics, Division of Critical Care, University of North Carolina at Chapel Hill, NC, USA
| | - Paul Shea
- Department of Pediatrics, Division of Critical Care, University of North Carolina at Chapel Hill, NC, USA
| | - Benny Joyner
- Department of Pediatrics, Division of Critical Care, University of North Carolina at Chapel Hill, NC, USA
| | - Rebecca Smith
- Department of Pediatrics, Division of Critical Care, University of North Carolina at Chapel Hill, NC, USA
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Thompson P, van Den Bergh C, Venter E, Schade M, Swanepoel R. Co-circulation of Rift Valley fever virus and other zoonotic arboviruses at the human-livestock-wildlife interface in KwaZulu-Natal, South Africa. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.1387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Schwartz SP, Thompson P, Smith M, Lercher DM, Rimland CA, Bartelt L, Park YA, Weiss S, Markmann AJ, Raut R, Premkumar L, Kuruc J, Willis Z. Convalescent Plasma Therapy in Four Critically Ill Pediatric Patients With Coronavirus Disease 2019: A Case Series. Crit Care Explor 2020; 2:e0237. [PMID: 33063037 PMCID: PMC7531759 DOI: 10.1097/cce.0000000000000237] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Coronavirus disease 2019 is a pandemic with no specific therapeutic agents or vaccination. Small published case series on critically ill adults suggest improvements in clinical status with minimal adverse events when patients receive coronavirus disease 2019 convalescent plasma, but data on critically ill pediatric patients are lacking. We report a series of four critically ill pediatric patients with acute respiratory failure who received coronavirus disease 2019 convalescent plasma as a treatment strategy for severe disease. CASE SUMMARY Patients ranged in age from 5 to 16 years old. All patients received coronavirus disease 2019 convalescent plasma within the first 26 hours of hospitalization. Additional disease modifying agents were also used. All patients made a full recovery and were discharged home off of oxygen support. No adverse events occurred from the coronavirus disease 2019 convalescent plasma transfusions. CONCLUSION Coronavirus disease 2019 convalescent plasma is a feasible therapy for critically ill pediatric patients infected with severe acute respiratory syndrome coronavirus 2. Well-designed clinical trials are necessary to determine overall safety and efficacy of coronavirus disease 2019 convalescent plasma and additional treatment modalities in pediatric patients.
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Affiliation(s)
- Stephanie P Schwartz
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Peyton Thompson
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Melissa Smith
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Daniel M Lercher
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Casey A Rimland
- Univeristy of North Carolina at Chapel Hill Medical Scientist Training Program, Chapel Hill, NC
| | - Luther Bartelt
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Yara A Park
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Susan Weiss
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Alena Janda Markmann
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Rajendra Raut
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Lakshmanane Premkumar
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - JoAnn Kuruc
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Zachary Willis
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Rahman U, Gemperle-Mannion E, Qureshi A, Edwin C, Smith TO, Parsons H, Mason J, Underwood M, Eldridge J, Thompson P, Metcalfe A. The feasibility of a randomised control trial to assess physiotherapy against surgery for recurrent patellar instability. Pilot Feasibility Stud 2020; 6:94. [PMID: 32642070 PMCID: PMC7336411 DOI: 10.1186/s40814-020-00635-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/26/2020] [Indexed: 11/24/2022] Open
Abstract
Background Patellar instability is a relatively common condition that leads to disability and restriction of activities. People with recurrent instability may be given the option of physiotherapy or surgery though this is largely driven by clinician preference rather than by a strong evidence base. We sought to determine the feasibility of conducting a definitive trial comparing physiotherapy with surgical treatment for people with recurrent patellar instability. Methods This was a pragmatic, open-label, two-arm feasibility randomised control trial (RCT) with an embedded interview component recruiting across three NHS sites comparing surgical treatment to a package of best conservative care; ‘Personalised Knee Therapy’ (PKT). The primary feasibility outcome was the recruitment rate per centre (expected rate 1 to 1.5 participants recruited each month). Secondary outcomes included the rate of follow-up (over 80% expected at 12 months) and a series of participant-reported outcomes taken at 3, 6 and 12 months following randomisation, including the Norwich Patellar Instability Score (NPIS), the Kujala Patellofemoral Disorder Score (KPDS), EuroQol-5D-5L, self-reported global assessment of change, satisfaction at each time point and resources use. Results We recruited 19 participants. Of these, 18 participants (95%) were followed-up at 12 months and 1 (5%) withdrew. One centre recruited at just over one case per month, one centre was unable to recruit, and one centre recruited at over one case per month after a change in participant screening approach. Ten participants were allocated into the PKT arm, with nine to the surgical arm. Mean Norwich Patellar Instability Score improved from 40.6 (standard deviation 22.1) to 28.2 (SD 25.4) from baseline to 12 months. Conclusion This feasibility trial identified a number of challenges and required a series of changes to ensure adequate recruitment and follow-up. These changes helped achieve a sufficient recruitment and follow-up rate. The revised trial design is feasible to be conducted as a definitive trial to answer this important clinical question for people with chronic patellar instability. Trial registration The trial was prospectively registered on the International Standard Randomised Controlled Trial Number registry on the 22/12/2016 (reference number: ISRCTN14950321). http://www.isrctn.com/ISRCTN14950321
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Affiliation(s)
- U Rahman
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.,University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - A Qureshi
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.,University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - C Edwin
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.,University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - T O Smith
- Nuffield Department of Orthopaedics and Rheumatology, University of Oxford, Oxford, UK
| | - H Parsons
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - J Mason
- Health Economics Department, Warwick Medical School, University of Warwick, Warwick, UK
| | - M Underwood
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - J Eldridge
- Bristol Royal Infirmary, University Hospitals Bristol NHS Trust, Bristol, UK
| | - P Thompson
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - A Metcalfe
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.,University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Thompson P, Goldhaber J, Amaral P, Ringering L. Psychological Strategies for Assisting Older Adults who are Partially Sighted. Journal of Visual Impairment & Blindness 2020. [DOI: 10.1177/0145482x9208600129] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Psychological barriers may interfere with the rehabilitation of older adults who are partially sighted. This article explores four common barriers. It examines possible contributory psychological factors and successful therapeutic approaches that a variety of rehabilitation workers can use with their clients.
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Affiliation(s)
- P. Thompson
- Center for the Partially Sighted, 720 Wilshire Boulevard, Suite 200, Santa Monica, CA 90401-1713
| | - J. Goldhaber
- Center for the Partially Sighted, 720 Wilshire Boulevard, Suite 200, Santa Monica, CA 90401-1713
| | - P. Amaral
- Center for the Partially Sighted, 720 Wilshire Boulevard, Suite 200, Santa Monica, CA 90401-1713
| | - L. Ringering
- Center for the Partially Sighted, 720 Wilshire Boulevard, Suite 200, Santa Monica, CA 90401-1713
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41
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Thompson P, Parr JB, Holzmayer V, Carrel M, Tshefu A, Mwandagalirwa K, Muwonga J, Welo PO, Fwamba F, Kuhns M, Jhaveri R, Meshnick SR, Cloherty G. Seroepidemiology of Hepatitis B in the Democratic Republic of the Congo. Am J Trop Med Hyg 2020; 101:226-229. [PMID: 31074406 DOI: 10.4269/ajtmh.18-0883] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Hepatitis B virus (HBV) is endemic throughout Africa, but its prevalence in the Democratic Republic of the Congo (DRC) is incompletely understood. We used dried blood spot (DBS) samples from the 2013 to 2014 Demographic and Health Survey in the DRC to measure the prevalence of HBV using the Abbott ARCHITECT HBV surface antigen (HBsAg) qualitative assay. We then attempted to sequence and genotype HBsAg-positive samples. The weighted national prevalence of HBV was 3.3% (95% CI: 1.8-4.7%), with a prevalence of 2.2% (95% CI: 0.3-4.1%) among children. Hepatitis B virus cases occurred countrywide and across age strata. Genotype E predominated (60%), and we found a unique cluster of genotype A isolates (30%). In conclusion, DBS-based HBsAg testing from a nationally representative survey found that HBV is common and widely distributed among Congolese adults and children. The distribution of cases across ages suggests ongoing transmission and underscores the need for additional interventions to prevent HBV infection.
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Affiliation(s)
- Peyton Thompson
- Division of Infectious Diseases, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina
| | - Jonathan B Parr
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | | | - Margaret Carrel
- Department of Geographical and Sustainability Sciences, University of Iowa, Iowa City, Iowa
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | - Jérémie Muwonga
- National AIDS Control Program, Kinshasa, Democratic Republic of the Congo
| | - Placide O Welo
- National AIDS Control Program, Kinshasa, Democratic Republic of the Congo
| | - Franck Fwamba
- National AIDS Control Program, Kinshasa, Democratic Republic of the Congo
| | - Mary Kuhns
- Abbott Laboratories, Abbott Park, Illinois
| | - Ravi Jhaveri
- Division of Infectious Diseases, Department of Pediatrics, Northwestern University, Evanston, Illinois
| | - Steven R Meshnick
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
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De Gramont A, Henriques J, Baruch B, Kim T, Martinez-Villacampa M, Gallego-Plazas J, Cervantes A, Shim K, Jonker D, Guerin-Meyer V, Mineur L, Banzi M, Dewdney A, Dejthevaporn TS, Bloemendal H, Roth A, Thompson P, Moehler M, Aguilar EA, André T. Bevacizumab plus oxaliplatin-based chemotherapy as adjuvant treatment for colon cancer (CC): Updated analysis of stage II disease from the AVANT phase III randomized trial by the GERCOR group. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kizub D, Miao J, Stopeck A, Thompson P, Paterson AH, Clemons M, Dees EC, Ingle JN, Falkson CI, Barlow W, Hortobagyi GN, Gralow JR. Abstract P1-17-03: Statin use, site of recurrence, and survival among post-menopausal women taking bisphosphonates as adjuvant therapy for breast cancer (SWOG S0307). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-17-03] [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] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: Statins may mediate suppression of molecular pathways conferring benefit in cancer. Statins have shown anti-tumor effects in preclinical studies and have been associated with decreased recurrence and improved disease-specific survival. While designed to target cholesterol biosynthesis, statins can also have liver, bone and brain effects. We collected data on statin use in the S0307 adjuvant bisphosphonate trial to test the hypothesis that statin use may decrease risk of recurrence to liver, bone and brain as well as second primary (contralateral) breast cancers, and may act synergistically with bisphosphonates to decrease the risk of recurrence to bone.
Patients and Methods: In S0307, 6097 patients diagnosed with Stage I-III breast cancer who had undergone surgery and were receiving adjuvant systemic therapy were randomized to receive zoledronic acid, clodronate, or ibandronate for 3 years. No significant difference was found in disease-free survival (DFS) among the 3 groups, including a sub-analysis of patients > age 55. Statin use was infrequent in younger women in S0307, consequently we analyzed statin use in those > age 55. Cox proportional hazard models were used to determine which variables were independently associated with DFS and to estimate hazard ratios (HR) and 95% confidence intervals (CI).
Results: Among women aged ≥ 55 years, 684 (27%) reported taking a statin at baseline and 1,848 did not. Both groups were similar in terms of hormone receptor and HER2 status (p = 0.82). Median age in the statin group was 64.3 versus 61.0 years in the no statin group, mean BMI 31.2 v. 29.5, mean tumor size 2.1cm v. 2.3cm, negative lymph nodes 60% v. 54%, Stage I disease 47% v. 36%, and receipt of chemotherapy 62% v. 71% (all p < 0.01). In the statin group, 122 (17.8%) experienced a DFS event compared to 313 (16.9%) in the no statin group (HR 1.18, CI 0.95-1.46). No difference was observed by statin use in overall recurrence (p=0.28), distant recurrence (p=0.64), or recurrences to the bone (p=0.64), liver (p=0.38) or brain (p=0.65) at initial recurrence. There was no synergy between statin use and specific bisphosphonates.
Recurrence and statin useOutcomeGroup 1: On stan at baseline n=684Group 2: No statin at baseline n=1848DFS events122 (17.8%)313 (16.9%)Died without recurrence51 7.5%)97 (5.2%)Recurrence71 (10.4%)216 (11.7%)Contralateral breast cancer9 (1.3%)17 (0.9%)Distant recurrence48 (7%)157 (8.5%)Bone as 1st site of distant recurrence (% distant recurrence)31 (65%)76 (48%)Liver as 1st site of distant recurrence (% distant recurrence)6 (13%)24 (16%)Brain/CNS as 1st site of distant recurrence (% distant recurrence)5 (10%)17 (11%)
Conclusions: We found no evidence that statins reduce risk of second primary breast cancers or distant metastases among post-menopausal women with early-stage breast cancer. Despite promising preclinical data, they did not appear to act in synergy with a specific bisphosphonate. Though women in the statin group had less advanced disease at study entry, statin use was not associated with improved DFS. Results are limited by lack of information about type of statin used, adherence, or initiation of statin in control group.
Citation Format: Kizub D, Miao J, Stopeck A, Thompson P, Paterson AH, Clemons M, Dees EC, Ingle JN, Falkson CI, Barlow W, Hortobagyi GN, Gralow JR. Statin use, site of recurrence, and survival among post-menopausal women taking bisphosphonates as adjuvant therapy for breast cancer (SWOG S0307) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-17-03.
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Affiliation(s)
- D Kizub
- The Everett Clinic, Everett, WA; SWOG Statistical Center, Seattle, WA; Stony Brook Cancer Center, Stony Brook, NY; Tom Baker Cancer Center, Calgary, AB, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Alabama, Birmingham, AL; University of Texas MD Anderson Cancer Center, Houston, TX; University of Washington, Seattle, WA
| | - J Miao
- The Everett Clinic, Everett, WA; SWOG Statistical Center, Seattle, WA; Stony Brook Cancer Center, Stony Brook, NY; Tom Baker Cancer Center, Calgary, AB, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Alabama, Birmingham, AL; University of Texas MD Anderson Cancer Center, Houston, TX; University of Washington, Seattle, WA
| | - A Stopeck
- The Everett Clinic, Everett, WA; SWOG Statistical Center, Seattle, WA; Stony Brook Cancer Center, Stony Brook, NY; Tom Baker Cancer Center, Calgary, AB, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Alabama, Birmingham, AL; University of Texas MD Anderson Cancer Center, Houston, TX; University of Washington, Seattle, WA
| | - P Thompson
- The Everett Clinic, Everett, WA; SWOG Statistical Center, Seattle, WA; Stony Brook Cancer Center, Stony Brook, NY; Tom Baker Cancer Center, Calgary, AB, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Alabama, Birmingham, AL; University of Texas MD Anderson Cancer Center, Houston, TX; University of Washington, Seattle, WA
| | - AH Paterson
- The Everett Clinic, Everett, WA; SWOG Statistical Center, Seattle, WA; Stony Brook Cancer Center, Stony Brook, NY; Tom Baker Cancer Center, Calgary, AB, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Alabama, Birmingham, AL; University of Texas MD Anderson Cancer Center, Houston, TX; University of Washington, Seattle, WA
| | - M Clemons
- The Everett Clinic, Everett, WA; SWOG Statistical Center, Seattle, WA; Stony Brook Cancer Center, Stony Brook, NY; Tom Baker Cancer Center, Calgary, AB, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Alabama, Birmingham, AL; University of Texas MD Anderson Cancer Center, Houston, TX; University of Washington, Seattle, WA
| | - EC Dees
- The Everett Clinic, Everett, WA; SWOG Statistical Center, Seattle, WA; Stony Brook Cancer Center, Stony Brook, NY; Tom Baker Cancer Center, Calgary, AB, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Alabama, Birmingham, AL; University of Texas MD Anderson Cancer Center, Houston, TX; University of Washington, Seattle, WA
| | - JN Ingle
- The Everett Clinic, Everett, WA; SWOG Statistical Center, Seattle, WA; Stony Brook Cancer Center, Stony Brook, NY; Tom Baker Cancer Center, Calgary, AB, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Alabama, Birmingham, AL; University of Texas MD Anderson Cancer Center, Houston, TX; University of Washington, Seattle, WA
| | - CI Falkson
- The Everett Clinic, Everett, WA; SWOG Statistical Center, Seattle, WA; Stony Brook Cancer Center, Stony Brook, NY; Tom Baker Cancer Center, Calgary, AB, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Alabama, Birmingham, AL; University of Texas MD Anderson Cancer Center, Houston, TX; University of Washington, Seattle, WA
| | - W Barlow
- The Everett Clinic, Everett, WA; SWOG Statistical Center, Seattle, WA; Stony Brook Cancer Center, Stony Brook, NY; Tom Baker Cancer Center, Calgary, AB, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Alabama, Birmingham, AL; University of Texas MD Anderson Cancer Center, Houston, TX; University of Washington, Seattle, WA
| | - GN Hortobagyi
- The Everett Clinic, Everett, WA; SWOG Statistical Center, Seattle, WA; Stony Brook Cancer Center, Stony Brook, NY; Tom Baker Cancer Center, Calgary, AB, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Alabama, Birmingham, AL; University of Texas MD Anderson Cancer Center, Houston, TX; University of Washington, Seattle, WA
| | - JR Gralow
- The Everett Clinic, Everett, WA; SWOG Statistical Center, Seattle, WA; Stony Brook Cancer Center, Stony Brook, NY; Tom Baker Cancer Center, Calgary, AB, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Alabama, Birmingham, AL; University of Texas MD Anderson Cancer Center, Houston, TX; University of Washington, Seattle, WA
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Hall MR, Bardayan DW, Baugher T, Lepailleur A, Pain SD, Ratkiewicz A, Ahn S, Allen JM, Anderson JT, Ayangeakaa AD, Blackmon JC, Burcher S, Carpenter MP, Cha SM, Chae KY, Chipps KA, Cizewski JA, Febbraro M, Hall O, Hu J, Jiang CL, Jones KL, Lee EJ, O'Malley PD, Ota S, Rasco BC, Santiago-Gonzalez D, Seweryniak D, Sims H, Smith K, Tan WP, Thompson P, Thornsberry C, Varner RL, Walter D, Wilson GL, Zhu S. Key ^{19}Ne States Identified Affecting γ-Ray Emission from ^{18}F in Novae. Phys Rev Lett 2019; 122:052701. [PMID: 30822026 DOI: 10.1103/physrevlett.122.052701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/15/2018] [Indexed: 06/09/2023]
Abstract
Detection of nuclear-decay γ rays provides a sensitive thermometer of nova nucleosynthesis. The most intense γ-ray flux is thought to be annihilation radiation from the β^{+} decay of ^{18}F, which is destroyed prior to decay by the ^{18}F(p,α)^{15}O reaction. Estimates of ^{18}F production had been uncertain, however, because key near-threshold levels in the compound nucleus, ^{19}Ne, had yet to be identified. We report the first measurement of the ^{19}F(^{3}He,tγ)^{19}Ne reaction, in which the placement of two long-sought 3/2^{+} levels is suggested via triton-γ-γ coincidences. The precise determination of their resonance energies reduces the upper limit of the rate by a factor of 1.5-17 at nova temperatures and reduces the average uncertainty on the nova detection probability by a factor of 2.1.
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Affiliation(s)
- M R Hall
- Department of Physics, University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - D W Bardayan
- Department of Physics, University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - T Baugher
- Department of Physics and Astronomy, Rutgers University, New Brunswick, New Jersey 08903, USA
| | - A Lepailleur
- Department of Physics and Astronomy, Rutgers University, New Brunswick, New Jersey 08903, USA
| | - S D Pain
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - A Ratkiewicz
- Department of Physics and Astronomy, Rutgers University, New Brunswick, New Jersey 08903, USA
| | - S Ahn
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - J M Allen
- Department of Physics, University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - J T Anderson
- Physics Division, Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - A D Ayangeakaa
- Physics Division, Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - J C Blackmon
- Department of Physics and Astronomy, Louisiana State University, Baton Rouge, Louisiana 70803, USA
| | - S Burcher
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - M P Carpenter
- Physics Division, Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - S M Cha
- Department of Physics, Sungkyunkwan University, Suwon 16419, South Korea
| | - K Y Chae
- Department of Physics, Sungkyunkwan University, Suwon 16419, South Korea
| | - K A Chipps
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - J A Cizewski
- Department of Physics and Astronomy, Rutgers University, New Brunswick, New Jersey 08903, USA
| | - M Febbraro
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - O Hall
- Department of Physics, University of Notre Dame, Notre Dame, Indiana 46556, USA
- Department of Physics, University of Surrey, Guildford, Surrey GU2 7XH, United Kingdom
| | - J Hu
- Department of Physics, University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - C L Jiang
- Physics Division, Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - K L Jones
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - E J Lee
- Department of Physics, Sungkyunkwan University, Suwon 16419, South Korea
| | - P D O'Malley
- Department of Physics, University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - S Ota
- Physics Division, Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - B C Rasco
- Department of Physics and Astronomy, Louisiana State University, Baton Rouge, Louisiana 70803, USA
| | - D Santiago-Gonzalez
- Department of Physics and Astronomy, Louisiana State University, Baton Rouge, Louisiana 70803, USA
| | - D Seweryniak
- Physics Division, Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - H Sims
- Department of Physics and Astronomy, Rutgers University, New Brunswick, New Jersey 08903, USA
- Department of Physics, University of Surrey, Guildford, Surrey GU2 7XH, United Kingdom
| | - K Smith
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - W P Tan
- Department of Physics, University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - P Thompson
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - C Thornsberry
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - R L Varner
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - D Walter
- Department of Physics and Astronomy, Rutgers University, New Brunswick, New Jersey 08903, USA
| | - G L Wilson
- Department of Physics and Astronomy, Louisiana State University, Baton Rouge, Louisiana 70803, USA
- Department of Physics and Applied Physics, University of Massachusetts Lowell, Lowell, Massachusetts 01854, USA
| | - S Zhu
- Physics Division, Argonne National Laboratory, Argonne, Illinois 60439, USA
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45
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Stevens J, Trimboli A, Samios P, Steele N, Welch S, Thompson P, Halvorsen C, Kerr S. A sustainable method to reduce postoperative oxycodone discharge prescribing in a metropolitan tertiary referral hospital. Anaesthesia 2019; 74:292-299. [DOI: 10.1111/anae.14570] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2018] [Indexed: 11/28/2022]
Affiliation(s)
- J. Stevens
- Brian Dwyer Department of Anaesthetics; St Vincent's Public Hospital; Darlinghurst NSW Australia
| | - A. Trimboli
- Prince of Wales Hospital; Sydney NSW Australia
| | - P. Samios
- Justice Health and Forensic Mental Health Network; Sydney NSW Australia
| | - N. Steele
- Brian Dwyer Department of Anaesthetics; St Vincent's Public Hospital; Darlinghurst NSW Australia
| | - S. Welch
- Brian Dwyer Department of Anaesthetics; St Vincent's Public Hospital; Darlinghurst NSW Australia
| | - P. Thompson
- Brian Dwyer Department of Anaesthetics; St Vincent's Public Hospital; Darlinghurst NSW Australia
| | - C. Halvorsen
- Royal Australian Air Force Base; Townsville Health Centre; Currajong QLD Australia
| | - S. Kerr
- Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
- Biostatistics Centre, Research Affairs, Faculty of Medicine, The Kirby Institute; University of New South Wales; Sydney NSW Australia
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46
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Leow K, Szulc P, Schousboe J, Kiel D, Teixeira-Pinto A, Shaikh H, Sawang M, Bondonno N, Hodgson J, Sharma A, Thompson P, Prince R, Craig J, Lim W, Wong G, Lewis J. Prognostic Value of Abdominal Aortic Calcification: A Systematic Review and Meta-analysis of Observational Studies. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.555] [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: 10/26/2022]
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47
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Cao S, Parelkar S, Ko H, Thompson P, Hayward L. CMT AND NEUROGENIC DISEASE. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.394] [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: 10/28/2022]
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48
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Cooper AL, Kelly KJ, Machado E, Pogrebnyak I, Surbrook J, Tysor C, Thompson P, Emamian M, Walsh B, Carlin B, Dermigny JR, Champagne AE, Clegg TB. Development of a variable-energy, high-intensity, pulsed-mode ion source for low-energy nuclear astrophysics studies. Rev Sci Instrum 2018; 89:083301. [PMID: 30184718 DOI: 10.1063/1.5024938] [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: 02/05/2018] [Accepted: 07/09/2018] [Indexed: 06/08/2023]
Abstract
The primary challenge in directly measuring nuclear reaction rates near stellar energies is their small cross sections. The signal-to-background ratio in these complex experiments can be significantly improved by employing high-current (mA-range) beams and novel detection techniques. Therefore, the electron cyclotron resonance ion source at the Laboratory for Experimental Nuclear Astrophysics underwent a complete upgrade of its acceleration column and microwave system to obtain high-intensity, pulsed proton beams. The new column uses a compression design with O-ring seals for vacuum integrity. Its voltage gradient between electrode sections is produced by the parallel resistance of channels of chilled, deionized water. It also incorporates alternating, transverse magnetic fields for electron suppression and an axially adjustable beam extraction system. Following this upgrade, the operational bremsstrahlung radiation levels and high-voltage stability of the source were vastly improved, over 3.5 mA of target beam current was achieved, and an order-of-magnitude increase in normalized brightness was measured. Beam optics calculations, structural design, and further performance results for this source are presented.
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Affiliation(s)
- Andrew L Cooper
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-3255, USA
| | - K J Kelly
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-3255, USA
| | - E Machado
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-3255, USA
| | - I Pogrebnyak
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-3255, USA
| | - J Surbrook
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-3255, USA
| | - C Tysor
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-3255, USA
| | - P Thompson
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-3255, USA
| | - M Emamian
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708-0308, USA
| | - B Walsh
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708-0308, USA
| | - B Carlin
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708-0308, USA
| | - J R Dermigny
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-3255, USA
| | - A E Champagne
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-3255, USA
| | - T B Clegg
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-3255, USA
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49
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Meikle P, Jayawardana KS, Mundra PA, Nestel PJ, Barnes EH, Kirby A, Thompson P, Sullivan DR, Alshehry ZH, Huynh K, Giles C, Marschner IC, Kingwell BA, Simes J, Tonkin AM. P1875Changes in plasma lipid species following pravastatin treatment predict cardiovascular outcomes and represent a measure of the relative risk reduction in secondary prevention. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P Meikle
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - K S Jayawardana
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - P A Mundra
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - P J Nestel
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | - A Kirby
- University of Sydney, Sydney, Australia
| | - P Thompson
- Sir Charles Gairdner Hospital, Perth, Australia
| | | | | | - K Huynh
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - C Giles
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | - B A Kingwell
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - J Simes
- University of Sydney, Sydney, Australia
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50
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Gu D, Dhar M, Cavale N, Khan A, Thompson P. Scrotal reconstruction - A standard procedure for giant hydrocele repair. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.595] [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: 10/28/2022]
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