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Plaisy MK, Minga AK, Wandeler G, Murenzi G, Samala N, Ross J, Lopez A, Mensah E, de Waal R, Kuniholm MH, Diero L, Salvi S, Moreira R, Attia A, Mandiriri A, Shumbusho F, Goodrich S, Rupasinghe D, Alarcon P, Maruri F, Perrazo H, Jaquet A. Metabolic causes of liver disease among adults living with HIV from low- and middle-income countries: a cross-sectional study. J Int AIDS Soc 2024; 27:e26238. [PMID: 38566493 PMCID: PMC10988113 DOI: 10.1002/jia2.26238] [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: 08/09/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Liver disease is a leading cause of morbidity and mortality among persons living with HIV (PLHIV). While chronic viral hepatitis has been extensively studied in low- and middle-income countries (LMICs), there is limited information about the burden of metabolic disorders on liver disease in PLHIV. METHODS We conducted a cross-sectional analysis of baseline data collected between October 2020 and July 2022 from the IeDEA-Sentinel Research Network, a prospective cohort enrolling PLHIV ≥40 years on antiretroviral treatment (ART) for ≥6 months from eight clinics in Asia, Americas, and central, East, southern and West Africa. Clinical assessments, laboratory testing on fasting blood samples and liver stiffness measurement (LSM)/controlled attenuation parameter (CAP) by vibration-controlled transient elastography were performed. Multivariable logistic regression models assessed factors associated with liver fibrosis (LSM ≥7.1 kPa) and steatosis (CAP ≥248 dB/m). Population attributable fraction (PAF) of each variable associated with significant liver fibrosis was estimated using Levin's formula. RESULTS Overall, 2120 PLHIV (56% female, median age 50 [interquartile range: 45-56] years) were included. The prevalence of obesity was 19%, 12% had type 2 diabetes mellitus (T2DM), 29% had hypertension and 53% had dyslipidaemia. The overall prevalence of liver fibrosis and steatosis was 7.6% (95% confidence interval [CI] 6.1-8.4) and 28.4% (95% CI 26.5-30.7), respectively, with regional variability. Male sex at birth (odds ratio [OR] 1.62, CI 1.10-2.40), overweight/obesity (OR = 2.50, 95% CI 1.69-3.75), T2DM (OR 2.26, 95% CI 1.46-3.47) and prolonged exposure to didanosine (OR 3.13, 95% CI 1.46-6.49) were associated with liver fibrosis. Overweight/obesity and T2DM accounted for 42% and 11% of the PAF for liver fibrosis, while HBsAg and anti-HCV accounted for 3% and 1%, respectively. Factors associated with steatosis included overweight/obesity (OR 4.25, 95% CI 3.29-5.51), T2DM (OR 2.06, 95% CI 1.47-2.88), prolonged exposure to stavudine (OR 1.69, 95% CI 1.27-2.26) and dyslipidaemia (OR 1.68, 95% CI 1.31-2.16). CONCLUSIONS Metabolic disorders were significant risk factors for liver disease among PLHIV in LMICs. Early recognition of metabolic disorders risk factors might be helpful to guide clinical and lifestyle interventions. Further prospective studies are needed to determine the causative natures of these findings.
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Affiliation(s)
- Marie Kerbie Plaisy
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health CentreBordeauxFrance
| | - Albert K. Minga
- Blood Bank Medical Centre, the HIV care clinic of the National Blood Transfusion CentreAbidjanCôte d'Ivoire
| | - Gilles Wandeler
- Department of Infectious DiseasesBern University HospitalUniversity of BernBernSwitzerland
| | - Gad Murenzi
- Research for Development (RD Rwanda) and Rwanda Military HospitalKigaliRwanda
| | - Niharika Samala
- Department of MedicineSchool of MedicineIndiana UniversityIndianapolisIndianaUSA
| | - Jeremy Ross
- TREAT Asia/amfAR – The Foundation for AIDS ResearchBangkokThailand
| | - Alvaro Lopez
- Departamento de InfectologíaInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
| | | | - Renée de Waal
- Centre for Infectious Disease Epidemiology and ResearchUniversity of Cape TownCape TownSouth Africa
| | - Mark H. Kuniholm
- Department of Epidemiology and BiostatisticsUniversity at AlbanyState University of New YorkRensselaerNew YorkUSA
| | - Lameck Diero
- Department of MedicineSchool of MedicineCollege of Health SciencesMoi UniversityEldoretKenya
| | - Sonali Salvi
- Byramjee Jeejeebhoy Government Medical CollegePuneIndia
| | - Rodrigo Moreira
- Evandro Chagas National Institute of Infectious Diseases‐Oswaldo Cruz Foundation (INI/FIOCRUZ)Rio de JaneiroBrazil
| | - Alain Attia
- University Hospital of YopougonAbidjanCôte d'Ivoire
| | | | - Fabienne Shumbusho
- Research for Development (RD Rwanda) and Rwanda Military HospitalKigaliRwanda
| | - Suzanne Goodrich
- Department of MedicineSchool of MedicineIndiana UniversityIndianapolisIndianaUSA
| | | | - Paola Alarcon
- Departamento de InfectologíaInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
| | - Fernanda Maruri
- Department of MedicineDivision of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Hugo Perrazo
- Evandro Chagas National Institute of Infectious Diseases‐Oswaldo Cruz Foundation (INI/FIOCRUZ)Rio de JaneiroBrazil
| | - Antoine Jaquet
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health CentreBordeauxFrance
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Kwobah EK, Goodrich S, Kulzer JL, Kanyesigye M, Obatsa S, Cheruiyot J, Kiprono L, Kibet C, Ochieng F, Bukusi EA, Ofner S, Brown SA, Yiannoutsos CT, Atwoli L, Wools-Kaloustian K. Adaptation of the Client Diagnostic Questionnaire for East Africa. PLOS Glob Public Health 2024; 4:e0001756. [PMID: 38502647 PMCID: PMC10950255 DOI: 10.1371/journal.pgph.0001756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/17/2024] [Indexed: 03/21/2024]
Abstract
Research increasingly involves cross-cultural work with non-English-speaking populations, necessitating translation and cultural validation of research tools. This paper describes the process of translating and criterion validation of the Client Diagnostic Questionnaire (CDQ) for use in a multisite study in Kenya and Uganda. The English CDQ was translated into Swahili, Dholuo (Kenya) and Runyankole/Rukiga (Uganda) by expert translators. The translated documents underwent face validation by a bilingual committee, who resolved unclear statements, agreed on final translations and reviewed back translations to English. A diagnostic interview by a mental health specialist was used for criterion validation, and Kappa statistics assessed the strength of agreement between non-specialist scores and mental health professionals' diagnoses. Achieving semantic equivalence between translations was a challenge. Validation analysis was done with 30 participants at each site (median age 32.3 years (IQR = (26.5, 36.3)); 58 (64.4%) female). The sensitivity was 86.7%, specificity 64.4%, positive predictive value 70.9% and negative predictive value 82.9%. Diagnostic accuracy by the non-specialist was 75.6%. Agreement was substantial for major depressive episode and positive alcohol (past 6 months) and alcohol abuse (past 30 days). Agreement was moderate for other depressive disorders, panic disorder and psychosis screen; fair for generalized anxiety, drug abuse (past 6 months) and Post Traumatic Stress Disorder (PTSD); and poor for drug abuse (past 30 days). Variability of agreement between sites was seen for drug use (past 6 months) and PTSD. Our study successfully adapted the CDQ for use among people living with HIV in East Africa. We established that trained non-specialists can use the CDQ to screen for common mental health and substance use disorders with reasonable accuracy. Its use has the potential to increase case identification, improve linkage to mental healthcare, and improve outcomes. We recommend further studies to establish the psychometric properties of the translated tool.
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Affiliation(s)
- Edith Kamaru Kwobah
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Suzanne Goodrich
- Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Jayne Lewis Kulzer
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | | | - Sarah Obatsa
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Lorna Kiprono
- Academic Model Providing Access to Care, Eldoret, Kenya
| | - Colma Kibet
- Academic Model Providing Access to Care, Eldoret, Kenya
| | - Felix Ochieng
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Elizabeth A. Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Susan Ofner
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Steven A. Brown
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Constantin T. Yiannoutsos
- Department of Biostatistics and Health Data Science, Indiana University Fairbanks School of Public Health, Indianapolis, Indiana, United States of America
| | - Lukoye Atwoli
- Department of Mental Health and Behavioral Sciences, Moi University School of Medicine, Eldoret, Kenya
- Brain and Mind Institute and the Department of Internal Medicine, Medical College East Africa, Aga Khan University, Nairobi, Kenya
| | - Kara Wools-Kaloustian
- Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
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DeLong SM, Xu Y, Genberg BL, Nyambura M, Goodrich S, Tarus C, Ndege S, Hogan JW, Braitstein P. Population-Based Estimates and Predictors of Child and Adolescent Linkage to HIV Care or Death in Western Kenya. J Acquir Immune Defic Syndr 2023; 94:281-289. [PMID: 37643416 PMCID: PMC10609679 DOI: 10.1097/qai.0000000000003288] [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: 03/07/2023] [Accepted: 07/17/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Population-level estimates of linkage to HIV care among children and adolescents (CAs) can facilitate progress toward 95-95-95 goals. SETTING This study was conducted in Bunyala, Chulaimbo, and Teso North subcounties, Western Kenya. METHODS Linkage to care was defined among CAs diagnosed with HIV through Academic Model Providing Access to Healthcare (AMPATH)'s home-based counseling and testing initiative (HBCT) by merging HBCT and AMPATH Medical Record System data. Using follow-up data from Bunyala, we examined factors associated with linkage or death, using weighted multinomial logistic regression to account for selection bias from double-sampled visits. Based on the estimated model, we imputed the trajectory for each person in 3 subcounties until a simulated linkage or death occurred or until the end of 8 years when an individual was simulated to be censored. RESULTS Of 720 CAs in the analytic sample, 68% were between 0 and 9 years and 59% were female. Probability of linkage among CAs in the combined 3 subcounties was 48%-49% at 2 years and 64%-78% at 8 years while probability of death was 13% at 2 years and 19% at 8 years. Single or double orphanhood predicted linkage (adjusted odds ratio [aOR]: 2.66, 95% confidence interval [CI]: 1.33 to 5.32) and death (aOR: 9.85 [95% CI: 2.21 to 44.01]). Having a mother known to be HIV-positive also predicted linkage (aOR = 1.94, 95% CI: 0.97 to 3.86) and death (aOR: 14.49, 95% CI: 3.32 to 63.19). CONCLUSION HIV testers/counselors should continue to ensure linkage among orphans and CAs with mothers known to be HIV-positive and also to support other CAs to link to HIV care.
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Affiliation(s)
- Stephanie M. DeLong
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Yizhen Xu
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Becky L. Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Monicah Nyambura
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Suzanne Goodrich
- Department of Biostatistics, Brown University School of Public Health, Providence, RI; and
| | - Carren Tarus
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Samson Ndege
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi University, School of Public Health, Eldoret, Kenya
| | - Joseph W. Hogan
- Department of Biostatistics, Brown University School of Public Health, Providence, RI; and
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi University, School of Public Health, Eldoret, Kenya
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Humphrey JM, Alera M, Enane LA, Kipchumba B, Goodrich S, Scanlon M, Songok J, Musick B, Diero L, Yiannoutsos C, Wools-Kaloustian K. Effects of the COVID-19 pandemic on late postpartum women living with HIV in Kenya. PLOS Glob Public Health 2023; 3:e0001513. [PMID: 36989321 PMCID: PMC10058168 DOI: 10.1371/journal.pgph.0001513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 03/09/2023] [Indexed: 03/30/2023]
Abstract
Although an estimated 1.4 million women living with HIV (WHIV) are pregnant each year globally, data describing the effects of the COVID-19 pandemic on postpartum women in low- and middle-income countries (LMICs) are limited. To address this gap, we conducted phone surveys among 170 WHIV ≥18 years and 18-24 months postpartum enrolled in HIV care at the Academic Model Providing Access to Healthcare in western Kenya, and assessed the effects of the pandemic across health, social and economic domains. We found that 47% of WHIV experienced income loss and 71% experienced food insecurity during the pandemic. The majority (96%) of women reported having adequate access to antiretroviral treatment and only 3% reported difficulties refilling medications, suggesting that the program's strategies to maintain HIV service delivery during the early phase of the pandemic were effective. However, 21% of WHIV screened positive for depression and 8% for anxiety disorder, indicating the need for interventions to address the mental health needs of this population. Given the scale and duration of the pandemic, HIV programs in LMICs should work with governments and non-governmental organizations to provide targeted support to WHIV at highest risk of food and income insecurity and their associated adverse health outcomes.
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Affiliation(s)
- John M. Humphrey
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Marsha Alera
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Leslie A. Enane
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Bett Kipchumba
- Department of Reproductive Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Suzanne Goodrich
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Michael Scanlon
- Indiana University Center for Global Health, Indianapolis, Indiana, United States of America
| | - Julia Songok
- Department of Paediatrics, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Beverly Musick
- Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana, United States of America
| | - Lameck Diero
- Department of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Constantin Yiannoutsos
- Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana, United States of America
| | - Kara Wools-Kaloustian
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
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Mburia-Mwalili A, Wagner KD, Kwobah EK, Atwoli L, Aluda M, Simmons B, Lewis-Kulzer J, Goodrich S, Wools-Kaloustian K, Syvertsen JL. Social support and the effects of the COVID-19 pandemic among a cohort of people living with HIV (PLWH) in Western Kenya. PLOS Glob Public Health 2023; 3:e0000778. [PMID: 36962963 PMCID: PMC10022114 DOI: 10.1371/journal.pgph.0000778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 01/22/2023] [Indexed: 03/04/2023]
Abstract
As coronavirus disease (COVID-19) was declared a pandemic in 2020, countries around the world implemented various prevention strategies, such as banning of public and social gatherings, restriction in movement, etc. These efforts may have had a deleterious effect on already vulnerable populations, including people living with HIV (PLWH). PLWH were concerned about contracting COVID-19, the impact of COVID-19 on their social networks that provide social support, and the continued availability of antiretroviral medications during the pandemic. In addition, their mental health may have been exacerbated by the pandemic. The purpose of this study was to explore pandemic-related concerns among a cohort of PLWH in Kenya and investigate social support factors associated with symptoms of depression and anxiety. This study is part of a larger cohort study that recruited from two clinics in Western Kenya. Data are drawn from 130 PLWH who participated in two phone surveys about experiences during the pandemic in 2020 and 2021. Participants reported a variety of concerns over the course of the pandemic and we documented statistically significant increases in symptoms of depression and anxiety over time, which affected some participants' ability to adhere to their antiretroviral medication. However, a small but statistically significant group of participants reached out to expand their networks and mobilize support in the context of experiencing mental health and adherence challenges, speaking to the importance of social support as a coping strategy during times of stress. Our findings call for holistic approaches to HIV care that consider the broader political, economic, and social contexts that shape its effectiveness.
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Affiliation(s)
- Adel Mburia-Mwalili
- School of Public Health, University of Nevada, Reno, Nevada, United States of America
| | - Karla D. Wagner
- School of Public Health, University of Nevada, Reno, Nevada, United States of America
| | - Edith Kamaru Kwobah
- Mental Health Department, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Lukoye Atwoli
- Department of Mental Health and Behavioural Sciences, Moi University School of Medicine, Eldoret, Kenya
- Department of Medicine, Brain and Mind Institute, Medical College East Africa, The Aga Khan University, Nairobi, Kenya
| | - Maurice Aluda
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Brianna Simmons
- Department of Anthropology, University of California, Riverside, California, United States of America
| | - Jayne Lewis-Kulzer
- Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, California, United States of America
| | - Suzanne Goodrich
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
| | - Kara Wools-Kaloustian
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
| | - Jennifer L. Syvertsen
- Department of Anthropology, University of California, Riverside, California, United States of America
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Lewis-Kulzer J, Mburu M, Obatsa S, Cheruiyot J, Kiprono L, Brown S, Apaka C, Koros H, Muyindike W, Kwobah EK, Diero L, Aluda M, Wools-Kaloustian K, Goodrich S. Patient perceptions of facilitators and barriers to reducing hazardous alcohol use among people living with HIV in East Africa. Subst Abuse Treat Prev Policy 2023; 18:8. [PMID: 36737735 PMCID: PMC9896687 DOI: 10.1186/s13011-023-00520-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hazardous alcohol use among people living with HIV is associated with poor outcomes and increased morbidity and mortality. Understanding the hazardous drinking experiences of people living with HIV is needed to reduce their alcohol use. METHODS We conducted 60 interviews among people living with HIV in East Africa with hazardous drinking histories. Interviews and Alcohol Use Disorder Identification Test (AUDIT) scores were conducted 41 - 60 months after their baseline assessment of alcohol use to identify facilitators and barriers to reduced alcohol use over time. RESULTS People living with HIV who stopped or reduced hazardous drinking were primarily motivated by their HIV condition and desire for longevity. Facilitators of reduced drinking included health care workers' recommendations to reduce drinking (despite little counseling and no referrals) and social support. In those continuing to drink at hazardous levels, barriers to reduced drinking were stress, social environment, alcohol accessibility and alcohol dependency. CONCLUSIONS Interventions that capacity-build professional and lay health care workers with the skills and resources to decrease problematic alcohol use, along with alcohol cessation in peer support structures, should be explored.
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Affiliation(s)
- Jayne Lewis-Kulzer
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 550 16TH Street, 3rd Floor, San Francisco, CA, USA.
| | - Margaret Mburu
- Centre for Microbiology Research, Kenya Medical Research Institute, P.O. Box 1578-40100, Kisumu, Kenya
| | - Sarah Obatsa
- Centre for Microbiology Research, Kenya Medical Research Institute, P.O. Box 1578-40100, Kisumu, Kenya
| | - Julius Cheruiyot
- Academic Model Providing Access to Health Care (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
| | - Lorna Kiprono
- Academic Model Providing Access to Health Care (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
| | - Steve Brown
- Department of Biostatistics and Health Data Science, School of Medicine, Indiana University, 410 W. 10th Street, HITS 3000, Indianapolis, IN, USA
| | - Cosmas Apaka
- Academic Model Providing Access to Health Care (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
| | - Hillary Koros
- Academic Model Providing Access to Health Care (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
| | - Winnie Muyindike
- The Immune Suppression Syndrome Clinic, Mbarara University of Science and Technology, P.O. Box 40, Mbarara, Uganda
| | - Edith Kamaru Kwobah
- Department of Mental Health, Moi Teaching and Referral Hospital, P.O. Box 3-30100, Eldoret, Kenya
| | - Lameck Diero
- Department of Medicine, Moi University School of Medicine, P.O. Box 4606-30100, Eldoret, Kenya
| | - Maurice Aluda
- Centre for Microbiology Research, Kenya Medical Research Institute, P.O. Box 1578-40100, Kisumu, Kenya
| | - Kara Wools-Kaloustian
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Indiana University, 545 Barnhill Drive, Indianapolis, IN, USA
| | - Suzanne Goodrich
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Indiana University, 545 Barnhill Drive, Indianapolis, IN, USA
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Ali SM, Humphrey J, Novitsky V, Sang E, DeLong A, Jawed B, Kemboi E, Goodrich S, Gardner A, Hogan JW, Kantor R. 1270. HIV Drug Resistance and Viral Outcomes after 2nd-line Antiretroviral Failure in Kenya. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1101] [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: 12/23/2022] Open
Abstract
Abstract
Background
Program data on HIV drug resistance and clinical outcomes after 2nd-line antiretroviral therapy (ART) failure in resource-limited settings are limited, yet can inform care, particularly with better ART access and options.
Methods
We examined resistance upon 2nd-line failure and subsequent viral outcomes at the Academic Model Providing Access to Healthcare (AMPATH) in Kenya. Charts of people with genotypes upon 2nd-line failure up to 6/2021 were reviewed; and associations with viral suppression (< 1000 copies/mL) closest to 12 months post-genotyping were determined using bi- and multivariate analyses, adjusting for age, sex, time on ART, switch to 3rd-line (darunavir-, dolutegravir-, and/or raltegravir-based ART), and any resistance to regimens upon viral load (VL) testing.
Results
Of 194 participants (53% female; median age 41 years; median 3.3 and 4.1 years on 1st- and 2nd-line), 60% were on lopinavir/ritonavir and 40% on atazanavir/ritonavir-based regimens. Overall, 178 (92%) had any resistance: 19% mono-, 40% dual-, 41% triple-class; 79% to NRTIs; 81% NNRTIs; and 43% PIs - 33% of those on lopinavir/ritonavir; 58% on atazanavir/ritonavir (p< 0.001); 24% with intermediate-high predicted resistance to darunavir/ritonavir (12 upon LPV/ritonavir, and 8 upon atazanavir/ritonavir failure; p=0.98). Of 140/194 people with post-genotype VLs, 55% stayed on 2nd-line, and 45% switched to 3rd-line. Of those 140, 72% virally suppressed (89% who switched to 3rd-line; 58% who didn't), and 75% had any resistance to their regimen at post-genotype VL (90% who switched to 3rd-line; 62% who didn't). In bivariate analysis, suppression was associated with switching to 3rd-line, and with resistance upon VL testing (Table). In multivariate analysis, suppression remained more likely among those who switched to 3rd-line, and association with resistance was less pronounced.
Conclusion
In a large Kenyan HIV program, high resistance upon 2nd-line failure, high failure rates, and suppression association with 3rd-line switch suggest the need for dedicated management of this vulnerable population. Potential association between resistance and better viral outcomes, similar to reports upon 1st-line failure, needs further data and suggests significance of inadequate adherence.
Disclosures
All Authors: No reported disclosures.
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Affiliation(s)
| | - John Humphrey
- Indiana University School of Medicine , Indianapolis, Indiana
| | - Vladimir Novitsky
- Alpert Medical School of Brown University , Providence, Rhode Island
| | | | | | - Bilal Jawed
- Indiana University School of Medicine , Indianapolis, Indiana
| | | | | | - Adrian Gardner
- Indiana University School of Medicine , Indianapolis, Indiana
| | - Joseph W Hogan
- Brown University School of Public Health , Providence, Rhode Island
| | - Rami Kantor
- Brown Alpert Medical School , Providence RI, USA, Providence, Rhode Island
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Chang AY, Karwa R, Odhiambo H, Were P, Fletcher SL, Tonui EC, Kohn MA, Lee J, Chang D, Lensing S, Namaemba DF, Busakhala N, Kiprono SK, Maurer T, Goodrich S, Pastakia SD. Compression Therapy for HIV-Associated Kaposi Sarcoma Leg Lymphedema: Results of the Kenyan Improvised Compression for Kaposi Sarcoma Randomized Controlled Trial. JCO Glob Oncol 2022; 8:e2100329. [PMID: 35025687 PMCID: PMC8769101 DOI: 10.1200/go.21.00329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/19/2021] [Accepted: 12/14/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Evaluate the effectiveness of compression while receiving chemotherapy compared with chemotherapy alone in the treatment of HIV-associated Kaposi sarcoma (KS) lymphedema. METHODS A randomized controlled trial was conducted in a single oncology clinic in western Kenya (NCT03404297). A computer-generated randomization schedule was used to allocate treatment arms. Randomized block design was used for stratification by lymphedema stage. Participants were HIV positive adults age ≥ 18 years on antiretroviral therapy with biopsy-proven KS associated with leg lymphedema and being initiated on chemotherapy. The intervention was 10 weeks of weekly clinic-based application of two-component paste compression bandages. The primary outcome was change in the Lower Extremity Lymphedema Index (LELI) score from week 0 to week 14. The secondary outcomes were change in the Lymphedema Quality of Life measure (LYMQOL) and change in the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 score from week 0 to week 14. Blinded outcome assessments were conducted. RESULTS Of 30 participants randomly assigned, 25 eligible patients (chemotherapy [control], n = 13; compression plus chemotherapy [intervention], n = 12) returned at week 14. Change in LELI, LYMQOL, and EORTC QLQ-C30 scores between week 14 and week 0 did not significantly differ by arm. The mean (standard deviation) change in LELI score was -25.9 (34.6) for the control arm compared with -13.3 (29.5) for the intervention arm, P = .340. The difference (95% CI) in the change in LELI score was -12.6 (-39.3 to 14.1). CONCLUSION Future studies evaluating a 14-week change in LELI for KS lymphedema should assume a standard deviation of approximately 30. Lessons learned from this pilot trial should inform the development of a larger, multicenter trial to evaluate the effectiveness of compression for KS lymphedema.
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Affiliation(s)
- Aileen Y Chang
- University of California, San Francisco School of Medicine, Department of Dermatology, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, Department of Dermatology, San Francisco, CA
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya
| | - Rakhi Karwa
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya
- Purdue University School of Pharmacy, Department of Pharmacy Practice, Center for Health Equity and Innovation, Indianapolis, IN
- Moi University School of Medicine, Department of Pharmacology, Eldoret, Kenya
| | - Haji Odhiambo
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya
| | - Phelix Were
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya
| | | | - Edith C Tonui
- Kericho County Referral Hospital, Pharmacy Department, Kericho, Kenya
| | - Michael A Kohn
- University of California, San Francisco School of Medicine, Department of Epidemiology & Biostatistics, San Francisco, CA
| | - Jeannette Lee
- University of Arkansas for Medical Sciences, Department of Biostatistics, Little Rock, AR
| | - Di Chang
- University of Arkansas for Medical Sciences, Department of Biostatistics, Little Rock, AR
| | - Shelly Lensing
- University of Arkansas for Medical Sciences, Department of Biostatistics, Little Rock, AR
| | | | - Naftali Busakhala
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya
- Moi University School of Medicine, Department of Pharmacology, Eldoret, Kenya
| | - Samson K Kiprono
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya
- Moi University School of Medicine, Department of Medicine, Eldoret, Kenya
| | - Toby Maurer
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya
- Indiana University School of Medicine, Department of Dermatology, Indianapolis, IN
| | - Suzanne Goodrich
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya
- Indiana University School of Medicine, Department of Medicine, Division of Infectious Diseases, Indianapolis, IN
| | - Sonak D Pastakia
- AMPATH (Academic Model Providing Access to Healthcare), Eldoret, Kenya
- Purdue University School of Pharmacy, Department of Pharmacy Practice, Center for Health Equity and Innovation, Indianapolis, IN
- Moi University School of Medicine, Department of Pharmacology, Eldoret, Kenya
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9
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Enane LA, Apondi E, Aluoch J, Bakoyannis G, Lewis Kulzer J, Kwena Z, Kantor R, Chory A, Gardner A, Scanlon M, Goodrich S, Wools-Kaloustian K, Elul B, Vreeman RC. Social, economic, and health effects of the COVID-19 pandemic on adolescents retained in or recently disengaged from HIV care in Kenya. PLoS One 2021; 16:e0257210. [PMID: 34506555 PMCID: PMC8432853 DOI: 10.1371/journal.pone.0257210] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/25/2021] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Adolescents living with HIV (ALHIV, ages 10-19) experience complex challenges to adhere to antiretroviral therapy (ART) and remain in care, and may be vulnerable to wide-scale disruptions during the COVID-19 pandemic. We assessed for a range of effects of the pandemic on ALHIV in western Kenya, and whether effects were greater for ALHIV with recent histories of being lost to program (LTP). METHODS ALHIV were recruited from an ongoing prospective study at 3 sites in western Kenya. The parent study enrolled participants from February 2019-September 2020, into groups of ALHIV either 1) retained in care or 2) LTP and traced in the community. Phone interviews from July 2020-January 2021 assessed effects of the pandemic on financial and food security, healthcare access and behaviors, and mental health. Responses were compared among the parent study groups. RESULTS Phone surveys were completed with 334 ALHIV or their caregivers, including 275/308 (89.3%) in the retained group and 59/70 (84.3%) among those LTP at initial enrollment. During the pandemic, a greater proportion of LTP adolescents were no longer engaged in school (45.8% vs. 36.4%, p = 0.017). Over a third (120, 35.9%) of adolescents reported lost income for someone they relied on. In total, 135 (40.4%) did not have enough food either some (121, 36.2%) or most (14, 4.2%) of the time. More LTP adolescents (4/59, 6.8% vs. 2/275, 0.7%, p = 0.010) reported increased difficulties refilling ART. Adolescent PHQ-2 and GAD-2 scores were ≥3 for 5.6% and 5.2%, respectively. CONCLUSIONS The COVID-19 pandemic has had devastating socioeconomic effects for Kenyan ALHIV and their households. ALHIV with recent care disengagement may be especially vulnerable. Meanwhile, sustained ART access and adherence potentially signal resilience and strengths of ALHIV and their care programs. Findings from this survey indicate the critical need for support to ALHIV during this crisis.
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Affiliation(s)
- Leslie A. Enane
- Department of Pediatrics, The Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- Indiana University Center for Global Health, Indianapolis, Indiana, United States of America
| | - Edith Apondi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Giorgos Bakoyannis
- Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana, United States of America
| | - Jayne Lewis Kulzer
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Zachary Kwena
- Research, Care and Treatment Programme, Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Rami Kantor
- Division of Infectious Diseases, Department of Medicine, Brown University Apert Medical School, Providence, Rhode Island, United States of America
| | - Ashley Chory
- Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Arnhold Institute for Global Health, New York, New York, United States of America
| | - Adrian Gardner
- Indiana University Center for Global Health, Indianapolis, Indiana, United States of America
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Michael Scanlon
- Indiana University Center for Global Health, Indianapolis, Indiana, United States of America
| | - Suzanne Goodrich
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Kara Wools-Kaloustian
- Indiana University Center for Global Health, Indianapolis, Indiana, United States of America
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Batya Elul
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Rachel C. Vreeman
- Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Arnhold Institute for Global Health, New York, New York, United States of America
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10
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Goodrich S, Siika A, Mwangi A, Nyambura M, Naanyu V, Yiannoutsos C, Spira T, Bateganya M, Toroitich-Ruto C, Otieno-Nyunya B, Wools-Kaloustian K. Development, Assessment, and Outcomes of a Community-Based Model of Antiretroviral Care in Western Kenya Through a Cluster-Randomized Control Trial. J Acquir Immune Defic Syndr 2021; 87:e198-e206. [PMID: 33492018 PMCID: PMC8126486 DOI: 10.1097/qai.0000000000002634] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To develop and assess an alternative care model using community-based groups for people living with HIV and facilitate by lay personnel. METHODS Geographic locations in the Academic Model Providing Access to Healthcare Kitale clinic catchment were randomized to standard of care versus a community-based care group (ART Co-op). Adults stable on antiretroviral therapy and virally suppressed were eligible. Research Assistant-led ART Co-ops met in the community every 3 months. Participants were seen in the HIV clinic only if referred. CD4 count and viral load were measured in clinic at enrollment and after 12 months. Retention, viral suppression, and clinic utilization were compared between groups using χ2, Fisher exact, and Wilcoxon rank sum tests. RESULTS At 12 months, there were no significant differences in mean CD4 count or viral load suppression. There was a significant difference in patient retention in assigned study group between the intervention and control group (81.6% vs 98.6%; P < 0.001), with a number of intervention patients withdrawing because of stigma, relocation, pregnancy, and work conflicts. All participants, however, were retained in an HIV care program for the study duration. The median number of clinic visits was lower for the intervention group than that for the control group (0 vs 3; P < 0.001). CONCLUSIONS Individuals retained in a community-based HIV care model had clinical outcomes equivalent to those receiving clinic-based care. This innovative model of HIV care addresses the problems of insufficient health care personnel and patient retention barriers, including time, distance, and cost to attend clinic, and has the potential for wider implementation.
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Affiliation(s)
- Suzanne Goodrich
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | | | - Ann Mwangi
- Behavioural Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya;
| | - Monicah Nyambura
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya;
| | - Violet Naanyu
- Behavioural Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya;
| | - Constantin Yiannoutsos
- Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, IN
| | - Thomas Spira
- Division of Global HIV and TB, Center for Global Health (DGHT), Centers for Disease Control and Prevention (CDC), Atlanta, GA; and
| | - Moses Bateganya
- Division of Global HIV and TB, Center for Global Health (DGHT), Centers for Disease Control and Prevention (CDC), Atlanta, GA; and
| | | | | | - Kara Wools-Kaloustian
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
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11
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Genberg BL, Wachira J, Steingrimsson JA, Pastakia S, Tran DNT, Said JA, Braitstein P, Hogan JW, Vedanthan R, Goodrich S, Kafu C, Wilson-Barthes M, Galárraga O. Integrated community-based HIV and non-communicable disease care within microfinance groups in Kenya: study protocol for the Harambee cluster randomised trial. BMJ Open 2021; 11:e042662. [PMID: 34006540 PMCID: PMC8137246 DOI: 10.1136/bmjopen-2020-042662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION In Kenya, distance to health facilities, inefficient vertical care delivery and limited financial means are barriers to retention in HIV care. Furthermore, the increasing burden of non-communicable diseases (NCDs) among people living with HIV complicates chronic disease treatment and strains traditional care delivery models. Potential strategies for improving HIV/NCD treatment outcomes are differentiated care, community-based care and microfinance (MF). METHODS AND ANALYSIS We will use a cluster randomised trial to evaluate integrated community-based (ICB) care incorporated into MF groups in medium and high HIV prevalence areas in western Kenya. We will conduct baseline assessments with n=900 HIV positive members of 40 existing MF groups. Group clusters will be randomised to receive either (1) ICB or (2) standard of care (SOC). The ICB intervention will include: (1) clinical care visits during MF group meetings inclusive of medical consultations, NCD management, distribution of antiretroviral therapy (ART) and NCD medications, and point-of-care laboratory testing; (2) peer support for ART adherence and (3) facility referrals as needed. MF groups randomised to SOC will receive regularly scheduled care at a health facility. Findings from the two trial arms will be compared with follow-up data from n=300 matched controls. The primary outcome will be VS at 18 months. Secondary outcomes will be retention in care, absolute mean change in systolic blood pressure and absolute mean change in HbA1c level at 18 months. We will use mediation analysis to evaluate mechanisms through which MF and ICB care impact outcomes and analyse incremental cost-effectiveness of the intervention in terms of cost per HIV suppressed person-time, cost per patient retained in care and cost per disability-adjusted life-year saved. ETHICS AND DISSEMINATION The Moi University Institutional Research and Ethics Committee approved this study (IREC#0003054). We will share data via the Brown University Digital Repository and disseminate findings via publication. TRIAL REGISTRATION NUMBER NCT04417127.
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Affiliation(s)
- Becky L Genberg
- Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Juddy Wachira
- Behavioral Sciences, Moi University College of Health Sciences, School of Medicine, Eldoret, Kenya
| | - Jon A Steingrimsson
- Biostatistics, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Sonak Pastakia
- Center for Health Equity and Innovation, Purdue University College of Pharmacy, Indianapolis, Indiana, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Dan N Tina Tran
- Center for Health Equity and Innovation, Purdue University College of Pharmacy, Indianapolis, Indiana, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Jamil AbdulKadir Said
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Internal Medicine, Moi University School of Medicine, Eldoret, Kenya
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Epidemiology, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Joseph W Hogan
- Biostatistics, Brown University School of Public Health, Providence, Rhode Island, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Rajesh Vedanthan
- Global Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Suzanne Goodrich
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Catherine Kafu
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Marta Wilson-Barthes
- Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Omar Galárraga
- Health Services, Policy and Practice, Brown University School of Public Health, 121 South Main St. Box G-S121-2 Providence, Rhode Island, USA
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12
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Patsis I, Goodrich S, Yiannoutsos CT, Brown SA, Musick BS, Diero L, Kulzer JL, Bwana MB, Oyaro P, Wools-Kaloustian KK. Lower rates of ART initiation and decreased retention among ART-naïve patients who consume alcohol enrolling in HIV care and treatment programs in Kenya and Uganda. PLoS One 2020; 15:e0240654. [PMID: 33095784 PMCID: PMC7584184 DOI: 10.1371/journal.pone.0240654] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/01/2020] [Indexed: 12/21/2022] Open
Abstract
Objectives Almost 13 million people are estimated to be on antiretroviral therapy in Eastern and Southern Africa, and their disease course and program effectiveness could be significantly affected by the concurrent use of alcohol. Screening for alcohol use may be important to assess the prevalence of alcohol consumption and its impact on patient and programmatic outcomes. Methods As part of this observational study, data on patient characteristics and alcohol consumption were collected on a cohort of 765 adult patients enrolling in HIV care in East Africa. Alcohol consumption was assessed with the AUDIT questionnaire at enrollment. Subjects were classified as consuming any alcohol (AUDIT score >0), hazardous drinkers (AUDIT score ≥8) and hyper drinkers (AUDIT score ≥16). The effects of alcohol consumption on retention in care, death and delays in antiretroviral therapy (ART) initiation were assessed through competing risk (Fine & Gray) models. Results Of all study participants, 41.6% consumed alcohol, 26.7% were classified as hazardous drinkers, and 16.0% as hyper drinkers. Depending on alcohol consumption classification, men were 3–4 times more likely to consume alcohol compared to women. Hazardous drinkers (median age 32.8 years) and hyper drinkers (32.7 years) were slightly older compared to non-hazardous drinkers (30.7 years) and non-hyper drinkers (30.8 years), (p-values = 0.014 and 0.053 respectively). Median CD4 at enrollment was 330 cells/μl and 16% were classified World Health Organization (WHO) stage 3 or 4. There was no association between alcohol consumption and CD4 count or WHO stage at enrollment. Alcohol consumption was associated with significantly lower probability of ART initiation (adjusted sub-distribution hazard ratio aSHR = 0.77 between alcohol consumers versus non-consumers; p-value = 0.008), and higher patient non-retention in care (aSHR = 1.77, p-value = 0.023). Discussion Alcohol consumption is associated with significant delays in ART initiation and reduced retention in care for patients enrolling in HIV care and treatment programs in East Africa. Consequently, interventions that target alcohol consumption may have a significant impact on the HIV care cascade.
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Affiliation(s)
- Ioannis Patsis
- Department of Hygiene and Epidemiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Suzanne Goodrich
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Constantin T. Yiannoutsos
- Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Indiana, United States of America
- * E-mail:
| | - Steven A. Brown
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Beverly S. Musick
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Lameck Diero
- School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Jayne L. Kulzer
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Mwembesa Bosco Bwana
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Patrick Oyaro
- Centre for Microbiology Research, Kenya Medical Research (KEMRI), Nairobi, Kenya
| | - Kara K. Wools-Kaloustian
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
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13
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Naanyu V, Ruff J, Goodrich S, Spira T, Bateganya M, Toroitich-Ruto C, Otieno-Nyunya B, Siika AM, Wools-Kaloustian K. Qualitative exploration of perceived benefits of care and barriers influencing HIV care in trans Nzoia, Kenya. BMC Health Serv Res 2020; 20:355. [PMID: 32334601 PMCID: PMC7183649 DOI: 10.1186/s12913-020-05236-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 04/17/2020] [Indexed: 01/13/2023] Open
Abstract
Background Substantial efforts have been made to ensure people living with HIV (PLHIV) are linked to and retained in care but many challenges deter care utilization. We report perceived benefits of seeking HIV care and barriers to HIV care that were identified through a formative assessment conducted to advise the development of an alternative care model to deliver antiretroviral treatment therapy (ART) in Trans Nzoia County, Kenya. Methods Data were collected in 2015 through key informant interviews (KIIs), in-depth interviews (IDIs), and focus group discussions (FGDs). The study involved 55 participants of whom 53% were female. Ten KIIs provided community contextual information and viewpoints on the HIV epidemic in Trans Nzoia County while 20 PLHIV (10 male and 10 female) participated in IDIs. Twenty-five individuals living with HIV participated in four FGDs - two groups for men and two for women. Key informants were purposively selected, while every third patient above 18 years at the Kitale HIV Clinic was invited to share their HIV care experience through IDIs or FGDs. Trained research assistants moderated all sessions and audio recordings were transcribed and analyzed thematically. Results Findings showed that PLHIV in Trans Nzoia County used both conventional and complementary alternative care for HIV; however, public health facilities were preferred. Popular perceived benefits of adopting care were relief from symptoms and the chance to live longer. Benefits of care uptake included weight gain, renewed energy, and positive behavior change. Individual-level barriers to HIV care included lack of money and food, use of alternative care, negative side effects of ART, denial, and disclosure difficulties. At the community level, stigma, limited social support for conventional HIV treatment, and poor means of transport were reported. The health system barriers were limited supplies and staff, long distance to conventional HIV care, and unprofessional providers. Conclusions Diverse individual, community and health system barriers continue to affect HIV care-seeking efforts in Kenya. Appreciation of context and lived experiences allows for development of realistic care models.
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Affiliation(s)
- V Naanyu
- Department of Health Policy and Management, School of Public Health, College of Health Science, Moi University, Eldoret, Kenya.
| | - J Ruff
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - S Goodrich
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - T Spira
- Division of Global HIV &TB, United States Centers for Disease Control & Prevention (CDC), Atlanta, GA, USA
| | - M Bateganya
- Division of Global HIV &TB, United States Centers for Disease Control & Prevention (CDC), Atlanta, GA, USA
| | | | | | - A M Siika
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - K Wools-Kaloustian
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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14
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Genberg BL, Hogan JW, Xu Y, Nyambura M, Tarus C, Rotich E, Kafu C, Wachira J, Goodrich S, Braitstein P. Population-based estimates of engagement in HIV care and mortality using double-sampling methods following home-based counseling and testing in western Kenya. PLoS One 2019; 14:e0223187. [PMID: 31577834 PMCID: PMC6774575 DOI: 10.1371/journal.pone.0223187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 09/16/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Data on engagement in HIV care from population-based samples in sub-Saharan Africa are limited. The objective of this study was to use double-sampling methods to estimate linkage to HIV care, ART initiation, and mortality among all adults diagnosed with HIV by a comprehensive home-based counseling and testing (HBCT) program in western Kenya. Methods HBCT was conducted door-to-door from December 2009 to April 2011 in three sub-counties of western Kenya by AMPATH (Academic Model Providing Access to Healthcare). For those identified as HIV-positive, data were merged with electronic medical records to determine engagement with HIV care. A randomly-drawn follow-up sample of 120 adults identified via HBCT who had not linked to care as of June 2015 in Bunyala sub-county were visited by trained fieldworkers to ascertain HIV care engagement and vital status. Double-sampled data were used to generate, via multinomial regression, predicted probabilities of engagement in care and mortality among those whose status could not be ascertained by matching with the electronic medical records in the three catchments. Results Incorporating information from the double-sampling yielded estimates of prospective linkage to HIV care that ranged from 40–45%. Mortality estimates of those who did not engage in care following HBCT ranged from 12–16%. Among those who linked to care following HBCT, between 72–81% initiated ART. Discussion In settings without universal national identifiers, rates of linkage to care from community-based programs may be subject to substantial underestimation. Follow-up samples of those with missing information can be used to partially correct this bias, as has been demonstrated previously for mortality among those who were lost-to-care programs. There is a need for harmonized data systems across health systems and programs.
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Affiliation(s)
- Becky L. Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Brown University, Providence, Rhode Island, United States of America
| | - Joseph W. Hogan
- Department of Biostatistics, Brown University School of Public Health, Brown University, Providence, Rhode Island, United States of America
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Yizhen Xu
- Department of Biostatistics, Brown University School of Public Health, Brown University, Providence, Rhode Island, United States of America
| | - Monicah Nyambura
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Caren Tarus
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Elyne Rotich
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Catherine Kafu
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Juddy Wachira
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Suzanne Goodrich
- Division of Infectious Diseases, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
- Epidemiology Division, Office of Global Public Health Education & Training, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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15
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Chang AY, Karwa R, Busakhala N, Fletcher SL, Tonui EC, Wasike P, Kohn MA, Asirwa FC, Kiprono SK, Maurer T, Goodrich S, Pastakia SD. Randomized controlled trial to evaluate locally sourced two-component compression bandages for HIV-associated Kaposi sarcoma leg lymphedema in western Kenya: The Kenyan Improvised Compression for Kaposi Sarcoma (KICKS) study protocol. Contemp Clin Trials Commun 2018; 12:116-122. [PMID: 30402565 PMCID: PMC6205322 DOI: 10.1016/j.conctc.2018.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/26/2018] [Accepted: 10/17/2018] [Indexed: 11/17/2022] Open
Abstract
Background HIV-associated Kaposi sarcoma (KS), among the most frequent cancers seen in sub-Saharan Africa, is associated with a high prevalence of lymphedema. Lymphedema causes progressive functional impairment marked by swelling, physical discomfort, disfiguring changes, skin hardening from fibrosis, poor wound healing, and recurrent skin infection. While compression therapy is considered a major component of lymphedema management, this intervention has never been evaluated in HIV-associated KS lymphedema. Methods/design The Kenyan Improvised Compression for Kaposi Sarcoma (KICKS) study is a randomized, controlled trial. Due to variable lymphedema stage, we will use block randomization with a 1:1 allocation to assign participants to one of two groups: “Immediate compression” or “Delayed compression.” Those randomized to “Immediate compression” intervention arm will receive weekly two-component compression bandages while receiving chemotherapy, whereas those in the “Delayed compression” control arm will be followed during chemotherapy and then receive compression after chemotherapy is completed. The primary outcome is change in Lower Extremity Lymphedema Index from enrollment at Week 0 to blinded outcome assessment at Week 14 between intervention and control arms. Secondary outcomes are change in leg lymphedema-specific quality of life (LYMQOL) and change in overall health quality of life in cancer (EORTC QLQ C30). Discussion This represents the first study in sub-Saharan Africa to assess a lymphedema-directed intervention for KS, and the intervention—locally sourced two-component compression bandages—is affordable and available. Thus, the KICKS study is an important step towards developing an evidence-based path for regionally relevant management of HIV-associated KS lymphedema. Trial registration This trial was registered at ClinicalTrials.gov on January 19, 2018: identifier NCT03404297.
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Affiliation(s)
- Aileen Y. Chang
- University of California, San Francisco School of Medicine, Department of Dermatology, United States
- AMPATH (Academic Model Providing Access to Healthcare), Kenya
- Corresponding author. University of California San Francisco, Department of Dermatology, San Francisco General Hospital, 1001 Potrero, Building 90, Ward 92, San Francisco, CA 94110, United States.
| | - Rakhi Karwa
- Purdue University School of Pharmacy, Department of Pharmacy Practice, United States
- Moi University School of Medicine, Department of Pharmacology, Kenya
| | - Naftali Busakhala
- AMPATH (Academic Model Providing Access to Healthcare), Kenya
- Moi University School of Medicine, Department of Pharmacology, Kenya
| | - Sara L. Fletcher
- AMPATH (Academic Model Providing Access to Healthcare), Kenya
- Purdue University School of Pharmacy, Department of Pharmacy Practice, United States
| | - Edith C. Tonui
- AMPATH (Academic Model Providing Access to Healthcare), Kenya
| | - Paul Wasike
- AMPATH (Academic Model Providing Access to Healthcare), Kenya
- Moi University School of Medicine, Department of Pharmacology, Kenya
| | - Michael A. Kohn
- University of California, San Francisco School of Medicine, Department of Epidemiology and Biostatistics, United States
| | - Fredrick Chite Asirwa
- AMPATH (Academic Model Providing Access to Healthcare), Kenya
- Indiana University School of Medicine, Department of Hematology/Oncology, United States
| | - Samson K. Kiprono
- AMPATH (Academic Model Providing Access to Healthcare), Kenya
- Moi University School of Medicine, Department of Medicine, Kenya
| | - Toby Maurer
- University of California, San Francisco School of Medicine, Department of Dermatology, United States
- AMPATH (Academic Model Providing Access to Healthcare), Kenya
| | - Suzanne Goodrich
- AMPATH (Academic Model Providing Access to Healthcare), Kenya
- Indiana University School of Medicine, Department of Medicine, Division of Infectious Diseases, United States
| | - Sonak D. Pastakia
- AMPATH (Academic Model Providing Access to Healthcare), Kenya
- Purdue University School of Pharmacy, Department of Pharmacy Practice, United States
- Moi University School of Medicine, Department of Pharmacology, Kenya
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Goodrich S, Bristow R, Santoso J, Desimone C, Miller R, Smith A, Vannagell J, Zhang Z, Ueland F. Evaluating an adnexal mass using a multivariate index assay and imaging. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.197] [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: 11/26/2022]
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Goodrich S, Ndege S, Kimaiyo S, Some H, Wachira J, Braitstein P, Sidle JE, Sitienei J, Owino R, Chesoli C, Gichunge C, Komen F, Ojwang C, Sang E, Siika A, Wools-Kaloustian K. Delivery of HIV care during the 2007 post-election crisis in Kenya: a case study analyzing the response of the Academic Model Providing Access to Healthcare (AMPATH) program. Confl Health 2013; 7:25. [PMID: 24289095 PMCID: PMC4176498 DOI: 10.1186/1752-1505-7-25] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [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: 12/17/2012] [Accepted: 11/20/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Widespread violence followed the 2007 presidential elections in Kenya resulting in the deaths of a reported 1,133 people and the displacement of approximately 660,000 others. At the time of the crisis the United States Agency for International Development-Academic Model Providing Access to Healthcare (USAID-AMPATH) Partnership was operating 17 primary HIV clinics in western Kenya and treating 59,437 HIV positive patients (23,437 on antiretroviral therapy (ART)). METHODS This case study examines AMPATH's provision of care and maintenance of patients on ART throughout the period of disruption. This was accomplished by implementing immediate interventions including rapid information dissemination through the media, emergency hotlines and community liaisons; organization of a Crisis Response leadership team; the prompt assembly of multidisciplinary teams to address patient care, including psychological support staff (in clinics and in camps for internally displaced persons (IDP)); and the use of the AMPATH Medical Records System to identify patients on ART who had missed clinic appointments. RESULTS These interventions resulted in the opening of all AMPATH clinics within five days of their scheduled post-holiday opening dates, 23,949 patient visits in January 2008 (23,259 previously scheduled), uninterrupted availability of antiretrovirals at all clinics, treatment of 1,420 HIV patients in IDP camps, distribution of basic provisions, mobilization of outreach services to locate missing AMPATH patients and delivery of psychosocial support to 300 staff members and 632 patients in IDP camps. CONCLUSION Key lessons learned in maintaining the delivery of HIV care in a crisis situation include the importance of advance planning to develop programs that can function during a crisis, an emphasis on a rapid programmatic response, the ability of clinics to function autonomously, patient knowledge of their disease, the use of community and patient networks, addressing staff needs and developing effective patient tracking systems.
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Affiliation(s)
- Suzanne Goodrich
- Department of Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Samson Ndege
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Epidemiology, School of Public Health, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Sylvester Kimaiyo
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Hosea Some
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Juddy Wachira
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Paula Braitstein
- Department of Medicine, Indiana University School of Medicine, Indianapolis, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
- Divison of Global Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - John E Sidle
- Department of Medicine, Indiana University School of Medicine, Indianapolis, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Regenstrief Institute, Indianapolis, USA
| | - Jackline Sitienei
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Health Policy and Management, School of Public Health, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Regina Owino
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Cleophas Chesoli
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Catherine Gichunge
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- School of Public Health, Griffith Health Institute, Griffith University, Southport, Queensland, Australia
| | - Fanice Komen
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Claris Ojwang
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Edwin Sang
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Abraham Siika
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Kara Wools-Kaloustian
- Department of Medicine, Indiana University School of Medicine, Indianapolis, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
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Abstract
This study investigated whether the complaint of night-time heartburn (NHB) as opposed to daytime heartburn (DHB) is a reliable reflection of actual sleep-related reflux events. Three groups of individuals were studied: individuals with complaints of NHB at least twice per week (n = 24), individuals with complaints of DHB (n = 23), and normal participants without any complaints of regular heartburn during the day or night (n = 25). All three groups were studied on one occasion with combined pH monitoring and polysomnography, and subjective questionnaires about sleep disturbance and sleep quality were given to all participants. The NHB group had significantly more sleep-related reflux events compared with both DHB and control groups (P < 0.01). DHB subjects had significantly (P < 0.05) more sleep-related reflux events than normal controls. Total acid contact time (ACT) was significantly (P < 0.05) elevated in the NHB group compared with both the DHB and control group. Sleep-related ACT was also significantly (P < 0.05) elevated in the NHB group compared with the other two groups, while upright (daytime) ACT was not significantly different. The NHB group was significantly (P < 0.05) worse regarding measures of both objective and subjective sleep quality. Subjects with exclusively DHB do have sleep-related reflux that is greater than normal controls. Subjects with NHB have significantly more sleep-related reflux, and both objective and subjective sleep abnormalities compared with normal controls. Complaints of NHB reflect sleep-related reflux events and may be indicative of a more clinically significant condition.
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Affiliation(s)
- W C Orr
- The Lynn Institute for Healthcare Research, Oklahoma City, OK, USA; University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Bronstein MZ, Pettis A, Fine L, Cleveland T, Goodrich S, Gorman D. Assessing Central Line-associated Bacteremias as a Proportion of All Healthcare-associated Bacteremias: Report from a Pediatric Hospital. Am J Infect Control 2013. [DOI: 10.1016/j.ajic.2013.03.256] [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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20
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Johnson S, Griffin D, Smouse B, Haskal Z, Almeida J, Javier J, Mackay E, Mustapha J, Castleberry J, Goodrich S, Parmenter M, Trommeter J, Shandas R. Long-term evaluation of the medusatm vascular plug for vascular embolization: pre-clinical evaluation. J Vasc Interv Radiol 2013. [DOI: 10.1016/j.jvir.2013.01.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Orr WC, Goodrich S, Wright S, Shepherd K, Mellow M. The effect of baclofen on nocturnal gastroesophageal reflux and measures of sleep quality: a randomized, cross-over trial. Neurogastroenterol Motil 2012; 24:553-9, e253. [PMID: 22404184 DOI: 10.1111/j.1365-2982.2012.01900.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [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: 01/12/2023]
Abstract
BACKGROUND Baclofen, a GABA(b) agonist, has been shown to reduce episodes of gastroesophageal reflux (GER). To determine if baclofen would significantly reduce reflux during sleep, and also improve objective and subjective measures of sleep. METHODS Twenty-one individuals with complaints of nighttime heartburn at least twice a week and a Carlsson GERD score of at least 5 were studied. Patients underwent polysomnography (PSG) and simultaneous esophageal pH monitoring on two occasions separated by approximately 1 week in a cross-over design. The night of each polysomnographic study, patients consumed a refluxogenic meal. Baclofen (40 mg) or placebo was given in random order 90 min prior to the start of the PSG. KEY RESULTS Baclofen significantly reduced the number of reflux events compared with placebo. Upright and recumbent acid contact times were both reduced by baclofen vs placebo, but the differences were not significant. Regarding sleep outcomes, several variables were significantly improved by baclofen. Total sleep time and sleep efficiency increased, and wake after sleep onset decreased in the baclofen condition compared with placebo. Proportion of Stage 1 sleep was also significantly decreased on baclofen. CONCLUSIONS & INFERENCES In addition to reducing the number of reflux events during sleep, baclofen significantly improved several measures of sleep in patients with documented GER and sleep disturbances. Baclofen could therefore be considered as a useful adjunct therapy to proton pump inhibitors (PPIs) in patients with nighttime heartburn and sleep disturbance who continue to have heartburn and/or sleep complaints despite PPI therapy.
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Affiliation(s)
- W C Orr
- Lynn Institute for Healthcare Research, Oklahoma City, OK, USA.
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22
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Shandas R, Castleberry J, Dyamenahalli K, Goodrich S, Parmenter M, Trommeter J. Abstract No. 262: Novel functionalized shape-memory polymer embolic coils provide rapid embolization and clinically viable radiographic visibility with minimal MR artifact: pre-clinical studies in ovine and canine models. J Vasc Interv Radiol 2012. [DOI: 10.1016/j.jvir.2011.12.315] [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: 11/28/2022] Open
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23
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Goodrich S, Moore E, Callahan M, Sutton G. The toxicity of sandwich therapy in the treatment of advanced endometrial cancer: A single-institution review of treatment in a community setting. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.357] [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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24
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Miller R, DeSimone C, Ueland F, Seamon L, Podzielinski I, Goodrich S, Elder J, Pavlik E, van Nagell J. Long-term survival of patients with epithelial ovarian cancer detected by sonographic screening. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.089] [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: 10/18/2022]
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25
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Pavlik E, DeSimone C, Miller R, Podzielinski I, Ubellacker J, Goodrich S, Ueland F, Seamon L, Kryscio R, van Nagell J. Women without ovarian cancer reporting disease-specific symptoms. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.192] [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: 11/29/2022]
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26
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Ueland F, DeSimone C, Seamon L, Miller R, Goodrich S, Podzielinski I, Sokoll L, Smith A, van Nagell J, Zhang Z. OVA1 has high sensitivity in identifying ovarian malignancy compared with preoperative assessment and CA-125. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.176] [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]
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27
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Mathews C, Goodrich S, Farrell R, DeSimone C, Seamon L, Landrum L. Adenocarcinoma as an independent risk factor for early-stage intermediate-risk cervical carcinoma. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.249] [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]
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Dyamenahalli K, Castleberry J, Trommeter J, Goodrich S, Lanning C, Shandas R. Abstract No. 59: Radio-opaque, MRI-compatible, shape-memory polymer embolic coils: In vitro and in vivo evaluation. J Vasc Interv Radiol 2011. [DOI: 10.1016/j.jvir.2011.01.065] [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: 10/18/2022] Open
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29
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Lau V, Leonard R, Goodrich S, Lau D, Stuart K, Luu Q, Farwell D, Purdy J, Chen A. Voice Quality after Organ-Preservation Therapy for Laryngeal Cancer. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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30
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Baldwin L, Ware R, Huang B, Tucker T, Goodrich S, Podzielinski I, DeSimone CP, Vannagell J, Ueland F, Seamon LG. Ten-year relative suvival for ovarian cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5113] [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: 11/20/2022] Open
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31
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Ware R, Baldwin L, Huang B, Tucker T, Goodrich S, Podzielinski I, DeSimone CP, Ueland F, Vannagell J, Seamon LG. Relative conditional survival in 41,476 patients with ovarian cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Affiliation(s)
- C. Wong
- Univ of Vermont, Burlington, VT
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33
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Abstract
BACKGROUND Several studies have demonstrated that night-time gastro-oesophageal reflux affects sleep quality, and thereby impairs daytime functioning. AIM To determine whether treatment with a proton-pump inhibitor (rabeprazole) would improve both objective and subjective measures of sleep. METHODS Individuals with complaints of significant gastro-oesophageal reflux disease were studied by polysomnography and 24-h pH monitoring on two separate nights. On one occasion, participants received 20 mg rabeprazole b.d., and on another they received placebo. Both study conditions were preceded by a week of treatment with either rabeprazole or placebo. The order of treatments was randomized. RESULTS Rabeprazole significantly reduced overall acid reflux, but it did not significantly reduce night-time acid contact. Rabeprazole treatment significantly improved subjective indices of sleep quality. There were no significant differences on objective measures of sleep between placebo and rabeprazole treatment. CONCLUSIONS Consistent with other studies of pharmacological treatments for gastro-oesophageal reflux, subjective measures of sleep improved with heartburn medication but objective measures were not affected.
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Affiliation(s)
- W C Orr
- Lynn Institute for Healthcare Research, Oklahoma City, OK, USA.
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Partida-Sánchez S, Cockayne DA, Monard S, Jacobson EL, Oppenheimer N, Garvy B, Kusser K, Goodrich S, Howard M, Harmsen A, Randall TD, Lund FE. Cyclic ADP-ribose production by CD38 regulates intracellular calcium release, extracellular calcium influx and chemotaxis in neutrophils and is required for bacterial clearance in vivo. Nat Med 2001; 7:1209-16. [PMID: 11689885 DOI: 10.1038/nm1101-1209] [Citation(s) in RCA: 349] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cyclic ADP-ribose is believed to be an important calcium-mobilizing second messenger in invertebrate, mammalian and plant cells. CD38, the best-characterized mammalian ADP-ribosyl cyclase, is postulated to be an important source of cyclic ADP-ribose in vivo. Using CD38-deficient mice, we demonstrate that the loss of CD38 renders mice susceptible to bacterial infections due to an inability of CD38-deficient neutrophils to directionally migrate to the site of infection. Furthermore, we show that cyclic ADP-ribose can directly induce intracellular Ca++ release in neutrophils and is required for sustained extracellular Ca++ influx in neutrophils that have been stimulated by the bacterial chemoattractant, formyl-methionyl-leucyl-phenylalanine (fMLP). Finally, we demonstrate that neutrophil chemotaxis to fMLP is dependent on Ca++ mobilization mediated by cyclic ADP-ribose. Thus, CD38 controls neutrophil chemotaxis to bacterial chemoattractants through its production of cyclic ADP-ribose, and acts as a critical regulator of inflammation and innate immune responses.
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Abstract
Muscarinic-cholinergic antagonism produces learning and memory deficits in a wide variety of hippocampal-dependent tasks. Hippocampal lesions produce both acquisition deficits and retrograde amnesia of contextual fear (fear of the place of conditioning), but do not impact fear conditioning to discrete cues (such as a tone). In order to examine the effects of muscarinic antagonism in this paradigm, rats were given 0.01 to 100 mg/kg of scopolamine (or methylscopolamine) either before or after a fear conditioning session in which tones were paired with aversive footshocks. Fear to the context and the tone were assessed by measuring freezing in separate tests. It was found that pretraining, but not post-training, scopolamine severely impaired fear conditioning; methylscopolamine was ineffective in disrupting conditioning. Although contextual fear conditioning was more sensitive to cholinergic disruption, high doses of scopolamine also disrupted tone conditioning. Scopolamine did not affect footshock reactivity, but did produce high levels of activity. However, hyperactivity was not directly responsible for deficits in conditioning. It was concluded that scopolamine disrupts CS-US association formation or CS processing, perhaps through an attenuation of hippocampal theta rhythm.
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Affiliation(s)
- S G Anagnostaras
- Department of Psychology, University of California, Los Angeles 90095-1563, USA
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36
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Abstract
Shiftwork causes a number of physical and psychological problems. As a result, we predicted depression to be worse for shiftworkers than for workers with more traditional schedules. In addition, we predicted that women would report more depressive symptoms than men as is the case in the general population. Questionnaire packets which included the Beck Depression Inventory were mailed to 153 workers in a small community. Analysis showed that, contrary to expectation, shiftworkers as a group suffered no more depressive symptoms than traditional workers. However, while both sexes had similar mean scores on depression among the shiftworkers, women were significantly more depressed than men among traditional workers.
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Wilson M, Marek D, Killoran M, Ward D, Goodrich S, Kirkpatrick S, Martin L, Madden J. Autologous somatic cell co-culture of human intracytoplasmic sperm injection (ICSI) derived embryos: Effect on pregnancy rate, implantation rate and blastocyst development. Theriogenology 1998. [DOI: 10.1016/s0093-691x(98)90722-1] [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: 11/28/2022]
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Bates CJ, Evans PH, Allison G, Sonko BJ, Hoare S, Goodrich S, Aspray T. Biochemical indices and neuromuscular function tests in rural Gambian schoolchildren given a riboflavin, or multivitamin plus iron, supplement. Br J Nutr 1994; 72:601-10. [PMID: 7986790 DOI: 10.1079/bjn19940062] [Citation(s) in RCA: 15] [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] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Ninety preselected children, aged between 8 and 14 years, living in two rural West African (Gambian) villages, were randomly divided into three groups, matched for age and sex. One group received a placebo (lactose) tablet, one received riboflavin (5 mg) on 5 d every week, which was sufficient to correct an endemic riboflavin deficiency, and one received a multivitamin supplement (Protovit; Hoffmann La Roche), on 5 d every week, together with FeSO4 (200 mg) once weekly, and the supplements were given for 1 year. Neuromuscular tests, including arm tremor and manipulative skills, were performed on three occasions: once just before the introduction of the supplements; again 6 weeks after commencing the supplements; and again 1 year later. Venous blood samples were collected at the same time as the first two sets of neuromuscular tests. These samples were used for haematology and nutrient status indices: plasma ferritin, ascorbic acid, cyanocobalamin and pyridoxal phosphate, and erythrocyte tests for folate status, for riboflavin status (erythrocyte glutathione reductase activation coefficient) and thiamine status (erythrocyte transketolase activation coefficient). The riboflavin in both supplements achieved a clear-cut response in biochemical status, which was dose-dependent. The pyridoxine, ascorbic acid and Fe components of the multivitamin also affected the associated biochemical indices. Although overall the arm tremor and related neuromuscular function tests did not respond significantly to the supplements, significant improvement was seen in the boys for the arm-tremor test in both the supplemented groups.
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Affiliation(s)
- C J Bates
- Medical Research Council, Dunn Nutrition Unit, Cambridge, The Gambia
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39
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Wing AM, Goodrich S, Virji-Babul N, Jenner JR, Clapp S. Balance evaluation in hemiparetic stroke patients using lateral forces applied to the hip. Arch Phys Med Rehabil 1993; 74:292-9. [PMID: 8439258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A technique for assessing balance that involves applying predictable controlled forces to the hips is described. Impairments in hemiparetic stroke patients' balance were documented by comparing their hip movements during and after a push with those of control subjects of similar age. Stroke patients swayed further and took longer to stabilize hip position than did the control subjects. The disturbance to stroke patients' balance caused by the termination of lateral force caused them more difficulty than did the onset of the force. Differences between stroke patients' involved and noninvolved sides were more pronounced on release from a push than at its onset. The implications of the findings for the assessment and treatment of balance after stroke are discussed.
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Affiliation(s)
- A M Wing
- Medical Research Council Applied Psychology Unit, Cambridge, UK
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40
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Abstract
OBJECTIVE This study analyzed psychological representations in 58 subjects in order to achieve a better understanding of the relation between adult borderline personality disorder and reported histories of childhood sexual and physical abuse. METHOD The subjects were 29 inpatients with borderline personality disorder diagnosed according to the Diagnostic Interview for Borderlines, 14 nonborderline inpatients with major depressive disorder according to the Research Diagnostic Criteria, and 15 normal comparison subjects recruited from the community and screened for the absence of psychopathology. Earliest memories were used as the source of mental representations in all subjects. The memories were reliably coded for malevolent affect tone, presence of deliberate injury, and effectiveness of helpers. Family histories of childhood sexual and physical abuse were obtained with the Familial Experiences Interview, a structured interview. Abuse histories for a subset of the subjects were corroborated by interviews with family members. RESULTS A reported history of sexual abuse, but not a reported history of physical abuse, predicted the presence of extremely malevolent representations in these earliest memories as well as representations involving deliberate injury. These two kinds of representations also discriminated borderline patients who reported histories of sexual abuse from borderline patients who did not report sexual abuse. Mean affect tone (from malevolent to benevolent) did not, however, discriminate sexually abused or physically abused subjects. CONCLUSION The results suggest that malevolent representations associated with the borderline diagnosis in previous research may be partially related to a history of childhood sexual abuse. Implications for the object relations theory of borderline personality disorder are noted.
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Affiliation(s)
- J T Nigg
- Department of Psychiatry, University of Michigan, Ann Arbor
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Henderson L, Kennard C, Crawford TJ, Day S, Everitt BS, Goodrich S, Jones F, Park DM. Scales for rating motor impairment in Parkinson's disease: studies of reliability and convergent validity. J Neurol Neurosurg Psychiatry 1991; 54:18-24. [PMID: 2010754 PMCID: PMC1014292 DOI: 10.1136/jnnp.54.1.18] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Study 1 examined the reliability of the ratings assigned to the performance of five sign-and-symptom items drawn from tests of motor impairment in Parkinson's disease. Patients with Parkinson's disease of varying severity performed gait, rising from chair, and hand function items. Video recordings of these performances were rated by a large sample of experienced and inexperienced neurologists and by psychology undergraduates, using a four point scale. Inter-rater reliability was moderately high, being higher for gait than hand function items. Clinical experience proved to have no systematic effect on ratings or their reliability. The idiosyncrasy of particular performances was a major source of unreliable ratings. Study 2 examined the intercorrelation of several standard rating scales, comprised of sign-and-symptom items as well as activities of daily living. The correlation between scales was high, ranging from 0.70 to 0.83, despite considerable differences in item composition. Inter-item correlations showed that the internal cohesion of the tests was high, especially for the self-care scale. Regression analysis showed that the relationship between the scales could be efficiently captured by a small selection of test items, allowing the construction of a much briefer test.
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Affiliation(s)
- L Henderson
- Department of Neurology, London Hospital, Whitechapel, United Kingdom
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Abstract
Two experiments are reported in which high-compatibility reaction time (RT) tasks were performed with, and without, a concurrent secondary task. In both experiments, the secondary task interfered to a greater extent with simple RT than with choice RT. In fact, the effect of adding a secondary task was to eliminate the advantage of simple RT over two-alternative-choice RT. Previous studies of this phenomenon employed a task in which subjects raised a finger when it received tactile stimulation, while engaging in continuous reading aloud. The present experiments show that the effect can be obtained using a different stimulus modality (vision) as well as other responses (vocal) and secondary tasks (shadowing, auditory step-tracking). The paradigm provides a means of isolating preparatory processes that are peculiar to the simple RT task.
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Abstract
Experiences of abuse and neglect were assessed in 24 adults diagnosed as having borderline personality disorder according to the Diagnostic Interview for Borderline Patients and in 18 depressed control subjects without borderline disorder. Significantly more of the borderline patients than depressed patients reported childhood sexual abuse, abuse by more than one person, and both sexual and physical abuse. There were no between-group differences for rates of neglect or physical abuse without sexual abuse. A stepwise logistic regression revealed that derealization, diagnostic group, and chronic dysphoria were the best predictors of childhood sexual abuse in this group of patients.
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Affiliation(s)
- S N Ogata
- Department of Psychiatry, University of Michigan, Ann Arbor
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Korn EL, Goodrich S. Use of the carbon dioxide laser to remove an eyelid hemangioma. Ophthalmic Surg 1989; 20:887-8. [PMID: 2517140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- E L Korn
- Bethesda Eye Institute, Ophthalmic Plastic and Reconstructive Surgery Services, Department of Ophthalmology, St. Louis, Mo
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Crawford T, Goodrich S, Henderson L, Kennard C. Predictive responses in Parkinson's disease: manual keypresses and saccadic eye movements to regular stimulus events. J Neurol Neurosurg Psychiatry 1989; 52:1033-42. [PMID: 2795072 PMCID: PMC1031737 DOI: 10.1136/jnnp.52.9.1033] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In a coincidence timing task, Parkinsonian patients and a control group were instructed to synchronize a keypress with the onset of a visual signal which had been preceded by a regular train of warning signals. Although the Parkinsonian group had previously exhibited slower reactions in a conventional simple reaction-time task, they were able to generate predictive responses that fell as close to the target onset as the controls' but showed greater variability. In a second experiment, Parkinsonian patients and controls made saccadic eye movements to a visual target that stepped at regular intervals between two fixed locations. After a few trials all the subjects tended to make predictive saccades that were initiated before the target excursion. However, the Parkinsonian group were slower to develop this strategy and when they did their saccades became considerably more hypometric than those of the controls. Both groups were able to maintain predictive responding even when the visual target disappeared and responses were paced by a buzzer. We concluded that Parkinsonian patients are capable of initiating predictive responses of the eye and the hand, at least in some circumstances, but such responses tend to be inaccurate in execution. This, in turn, may dispose the Parkinsonian patient against predictive movement.
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Affiliation(s)
- T Crawford
- Department of Neurology, London Hospital
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Abstract
A two-step analytic procedure to determine the rate and extent of metabolite production following administration of the parent compound is described. The procedure provides the rate and extent of metabolite production as a function of time by application of the general model independent approach of deconvolution. The metabolite unit impulse response function is obtained by implicit deconvolution of the metabolite data with a truncated constant-rate metabolite input function. Then the obtained unit impulse response function is used in an analytic deconvolution with metabolite data following administration of the parent compound to obtain the rate and extent of metabolite production. The input function is also deconvolved with metabolite data to obtain the unit impulse response function appropriate for prediction of metabolite levels given a selected input of parent compound. The expected profile following administration of the consecutive infusions of parent drug is shown for both parent and metabolite. The rationale for selection of deconvolution methods is discussed. The approach is applied to data for procainamide and N-acetylprocainamide from three human subjects. The results indicate that from 27 to 39% of the procainamide was converted to N-acetylprocainamide in these subjects.
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Affiliation(s)
- M D Karol
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Arizona, Tucson 85721
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