1
|
Kalaria R, Maestre G, Mahinrad S, Acosta DM, Akinyemi RO, Alladi S, Allegri RF, Arshad F, Babalola DO, Baiyewu O, Bak TH, Bellaj T, Brodie-Mends DK, Carrillo MC, Celestin KKM, Damasceno A, de Silva RK, de Silva R, Djibuti M, Dreyer AJ, Ellajosyula R, Farombi TH, Friedland RP, Garza N, Gbessemehlan A, Georgiou EEZ, Govia I, Grinberg LT, Guerchet M, Gugssa SA, Gumikiriza-Onoria JL, Hogervorst E, Hornberger M, Ibanez A, Ihara M, Issac TG, Jönsson L, Karanja WM, Lee JH, Leroi I, Livingston G, Manes FF, Mbakile-Mahlanza L, Miller BL, Musyimi CW, Mutiso VN, Nakasujja N, Ndetei DM, Nightingale S, Novotni G, Nyamayaro P, Nyame S, Ogeng'o JA, Ogunniyi A, de Oliveira MO, Okubadejo NU, Orrell M, Paddick SM, Pericak-Vance MA, Pirtosek Z, Potocnik FCV, Raman R, Rizig M, Rosselli M, Salokhiddinov M, Satizabal CL, Sepulveda-Falla D, Seshadri S, Sexton CE, Skoog I, George-Hyslop PHS, Suemoto CK, Thapa P, Udeh-Momoh CT, Valcour V, Vance JM, Varghese M, Vera JH, Walker RW, Zetterberg H, Zewde YZ, Ismail O. The 2022 symposium on dementia and brain aging in low- and middle-income countries: Highlights on research, diagnosis, care, and impact. Alzheimers Dement 2024. [PMID: 38696263 DOI: 10.1002/alz.13836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 05/04/2024]
Abstract
Two of every three persons living with dementia reside in low- and middle-income countries (LMICs). The projected increase in global dementia rates is expected to affect LMICs disproportionately. However, the majority of global dementia care costs occur in high-income countries (HICs), with dementia research predominantly focusing on HICs. This imbalance necessitates LMIC-focused research to ensure that characterization of dementia accurately reflects the involvement and specificities of diverse populations. Development of effective preventive, diagnostic, and therapeutic approaches for dementia in LMICs requires targeted, personalized, and harmonized efforts. Our article represents timely discussions at the 2022 Symposium on Dementia and Brain Aging in LMICs that identified the foremost opportunities to advance dementia research, differential diagnosis, use of neuropsychometric tools, awareness, and treatment options. We highlight key topics discussed at the meeting and provide future recommendations to foster a more equitable landscape for dementia prevention, diagnosis, care, policy, and management in LMICs. HIGHLIGHTS: Two-thirds of persons with dementia live in LMICs, yet research and costs are skewed toward HICs. LMICs expect dementia prevalence to more than double, accompanied by socioeconomic disparities. The 2022 Symposium on Dementia in LMICs addressed advances in research, diagnosis, prevention, and policy. The Nairobi Declaration urges global action to enhance dementia outcomes in LMICs.
Collapse
Affiliation(s)
- Raj Kalaria
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Gladys Maestre
- Departments of Neuroscience and Human Genetics, University of Texas Rio Grande Valley, One W. University Blvd, Brownsville, Texas, USA
| | - Simin Mahinrad
- Division of Medical and Scientific Relations, Alzheimer's Association, Chicago, Illinois, USA
| | - Daisy M Acosta
- Universidad Nacional Pedro Henriquez Urena (UNPHU), Santo Domingo, Dominican Republic
| | - Rufus Olusola Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ricardo F Allegri
- Fleni Neurological Institute, Buenos Aires, Argentina
- Department of Neurosciences, Universidad de la Costa (CUC), Barranquilla, Colombia
| | - Faheem Arshad
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Olusegun Baiyewu
- Department of Psychiatry, University of Ibadan, Ibadan, Oyo, Nigeria
| | | | | | | | - Maria C Carrillo
- Division of Medical and Scientific Relations, Alzheimer's Association, Chicago, Illinois, USA
| | - Kaputu-Kalala-Malu Celestin
- Department of Neurology, Centre Neuropsychopathologique (CNPP), Kinshasa University Teaching Hospital, University of Kinshasa, Kinshasa, Republic Democratic of the Congo
| | | | - Ranil Karunamuni de Silva
- Interdisciplinary Centre for Innovation in Biotechnology and Neuroscience, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
- Institute for Combinatorial Advanced Research and Education (KDU-CARE), General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Rohan de Silva
- Reta Lila Weston Institute and Department of Clinical, Movement Neuroscience, UCL Queen Square Institute of Neurology, London, UK
| | - Mamuka Djibuti
- Partnership for Research and Action for Health (PRAH), Tbilisi, Georgia
| | | | - Ratnavalli Ellajosyula
- Cognitive Neurology Clinic, Manipal Hospital, and Annasawmy Mudaliar Hospital, Bengaluru, Karnataka, India
- Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Temitope H Farombi
- Tony Anenih Geriatric Center, University College Hospital, Ibadan, Oyo, Nigeria
| | | | - Noe Garza
- Department of Neuroscience and Human Genetics, University of Texas Rio Grande Valley, Harlingen, Texas, USA
| | - Antoine Gbessemehlan
- Inserm U1094, IRD U270, University of Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
- Inserm, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
| | - Eliza Eleni-Zacharoula Georgiou
- Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Ishtar Govia
- Caribbean Institute for Health Research, The University of the West Indies, Jamaica, West Indies, Jamaica
- Institute for Global Health, University College London, London, UK
| | - Lea T Grinberg
- Department of Neurology and Pathology, University of California San Francisco, San Francisco, California, USA
- Department of Pathology, University of Sao Paulo, R. da Reitoria, R. Cidade Universitária, São Paulo, Sao Paulo, Brazil
| | - Maëlenn Guerchet
- Inserm U1094, IRD U270, University of Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Seid Ali Gugssa
- Department of Neurology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Eef Hogervorst
- Loughborough University, Loughborough, UK
- Respati University, Yogyakarta, Indonesia
| | | | - Agustin Ibanez
- Latin American Institute for Brain Health (BrainLat), Universidad Adolfo Ibanez, Peñalolén, Santiago, Chile
- Global Brain Health Institute (GBHI), University California San Francisco (UCSF), San Francisco, California, USA
- Global Brain Health Institute (GBHI), Trinity College Dublin, Lloyd Building Trinity College Dublin, Dublin, Ireland
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, and National Scientific and Technical Research Council (CONICET), Victoria, Provincia de Buenos Aires, Argentina
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Thomas Gregor Issac
- Centre for Brain Research, Indian Institute of Science (IISc), Bengaluru, Karnataka, India
| | - Linus Jönsson
- Department of Neurobiology, Care Science and Society, section for Neurogeriatrics, Karolinska Institute, Solnavägen, Solna, Sweden
| | - Wambui M Karanja
- Global Brain Health Institute (GBHI), Trinity College Dublin, Lloyd Building Trinity College Dublin, Dublin, Ireland
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Joseph H Lee
- Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Departments of Neurology and Epidemiology, Columbia University, New York, New York, USA
| | - Iracema Leroi
- Global Brain Health Institute (GBHI), Trinity College Dublin, Lloyd Building Trinity College Dublin, Dublin, Ireland
| | | | - Facundo Francisco Manes
- Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Lingani Mbakile-Mahlanza
- Global Brain Health Institute (GBHI), University California San Francisco (UCSF), San Francisco, California, USA
- University of Botswana, Gaborone, Botswana
| | - Bruce L Miller
- Department of Neurology, Memory and Aging Center, University of California San Francisco Weill Institute for Neurosciences, San Francisco, California, USA
| | | | - Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | | | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Sam Nightingale
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Gabriela Novotni
- University Clinic of Neurology, Medical Faculty University Ss Cyril and Methodius Institute for Alzheimer's Disease and Neuroscience, Skopje, North Macedonia
| | - Primrose Nyamayaro
- Global Brain Health Institute (GBHI), Trinity College Dublin, Lloyd Building Trinity College Dublin, Dublin, Ireland
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Solomon Nyame
- Kintampo Health Research Centre, Ghana Health Service, Hospital Road, Near Kintampo-north Municipal Hospital, Kintampo, Ghana
| | | | | | - Maira Okada de Oliveira
- Global Brain Health Institute (GBHI), University California San Francisco (UCSF), San Francisco, California, USA
- Global Brain Health Institute (GBHI), Trinity College Dublin, Lloyd Building Trinity College Dublin, Dublin, Ireland
- Department of Psychiatry at Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Cognitive Neurology and Behavioral Unit (GNCC), University of Sao Paulo, R. da Reitoria, R. Cidade Universitária, São Paulo, Sao Paulo, Brazil
| | - Njideka U Okubadejo
- Neurology Unit, Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Yaba, Lagos, Nigeria
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Stella-Maria Paddick
- Newcastle University, Newcastle upon Tyne, UK
- Gateshead Health NHS Foundation Trust, Sheriff Hill, Tyne and Wear, UK
| | - Margaret A Pericak-Vance
- John P Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Coral Gables, Florida, USA
- Dr. John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Coral Gables, Florida, USA
| | - Zvezdan Pirtosek
- Faculty of Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Felix Claude Victor Potocnik
- Old Age Psychiatry Unit, Depth Psychiatry, Stellenbosch University, Western Cape, Stellenbosch Central, Stellenbosch, South Africa
| | - Rema Raman
- Alzheimer's Therapeutic Research Institute, University of Southern California, Los Angeles, California, USA
| | - Mie Rizig
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Mónica Rosselli
- Department of Psychology, Charles E. Schmidt College of Science, Florida Atlantic University, Boca Raton, Florida, USA
- Florida Alzheimer's Disease Research Center, Gainesville, Florida, USA
| | | | - Claudia L Satizabal
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, Texas, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
- The Framingham Heart Study, Framingham, Massachusetts, USA
| | - Diego Sepulveda-Falla
- Molecular Neuropathology of Alzheimer's Disease, Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases and South Texas ADRC, UT Health San Antonio, San Antonio, Texas, USA
- University of Texas Health Sciences Center, San Antonio, Texas, USA
| | - Claire E Sexton
- Division of Medical and Scientific Relations, Alzheimer's Association, Chicago, Illinois, USA
| | - Ingmar Skoog
- Institute of Neuroscience and Fysiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter H St George-Hyslop
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
- Cambridge Institute for Medical Research and Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Addenbrookes Biomedical Campus, Trumpington, Cambridge, UK
- Department of Medicine (Neurology), Temerty Faculty of Medicine, University of Toronto, and University Health Network, 27 King's College Cir, Toronto, Ontario, Canada
| | - Claudia Kimie Suemoto
- Division of Geriatrics, University of Sao Paulo Medical School, R. da Reitoria, R. Cidade Universitária, São Paulo, Sao Paulo, Brazil
| | - Prekshy Thapa
- Global Brain Health Institute (GBHI), Trinity College Dublin, Lloyd Building Trinity College Dublin, Dublin, Ireland
| | - Chinedu Theresa Udeh-Momoh
- Global Brain Health Institute (GBHI), University California San Francisco (UCSF), San Francisco, California, USA
- FINGERS Brain Health Institute, c/o Stockholms Sjukhem, Stockholm, Sweden
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institute, Solnavägen, Solna, Sweden
- Imarisha Centre for Brain health and Aging, Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Victor Valcour
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California, USA
| | - Jeffery M Vance
- John P Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Coral Gables, Florida, USA
| | - Mathew Varghese
- St. John's Medical College, Sarjapur - Marathahalli Rd, beside Bank Of Baroda, John Nagar, Koramangala, Bengaluru, Karnataka, India
| | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Richard W Walker
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, Queen Square, London, UK
- UK Dementia Research Institute at UCL, University College London, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Yared Z Zewde
- Department of Neurology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ozama Ismail
- Division of Medical and Scientific Relations, Alzheimer's Association, Chicago, Illinois, USA
| |
Collapse
|
2
|
Wang X, Liu X, O'Donnell MJ, McQueen M, Sniderman A, Pare G, Hankey GJ, Rangarajan S, Chin SL, Rao-Melacini P, Ferguson J, Xavier D, Zhang H, Liu L, Pais P, Lopez-Jaramillo P, Damasceno A, Langhorne P, Rosengren A, Dans AL, Elsayed A, Avezum A, Mondo C, Judge C, Diener HC, Ryglewicz D, Czlonkowska A, Pogosova N, Weimar C, Iqbal R, Diaz R, Yusoff K, Yusufali A, Oguz A, Penaherrera E, Lanas F, Ogah OS, Ogunniyi A, Iversen HK, Malaga G, Rumboldt Z, Oveisgharan S, Al Hussain F, Nilanont Y, Yusuf S. Tobacco use and risk of acute stroke in 32 countries in the INTERSTROKE study: a case-control study. EClinicalMedicine 2024; 70:102515. [PMID: 38516107 PMCID: PMC10955659 DOI: 10.1016/j.eclinm.2024.102515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 02/16/2024] [Accepted: 02/16/2024] [Indexed: 03/23/2024] Open
Abstract
Background Smoking is a major risk factor for the global burden of stroke. We have previously reported a global population attributable risk (PAR) of stroke of 12.4% associated with current smoking. In this study we aimed to explore the association of current tobacco use with different types of tobacco exposure and environmental tobacco smoke (ETS) exposure on the risk of stroke and stroke subtypes, and by regions and country income levels. Methods The INTERSTROKE study is a case-control study of acute first stroke and was undertaken with 13,462 stroke cases and 13,488 controls recruited between January 11, 2007 and August 8, 2015 in 32 countries worldwide. Association of risk of tobacco use and ETS exposure were analysed with overall stroke, ischemic and intracerebral hemorrhage (ICH), and with TOAST etiological stroke subtypes (large vessel, small vessel, cardioembolism, and undetermined). Findings Current smoking was associated with an increased risk of all stroke (odds ratio [OR] 1.64, 95% CI 1.46-1.84), and had a stronger association with ischemic stroke (OR 1.85, 95% CI 1.61-2.11) than ICH (OR 1.19 95% CI 1.00-1.41). The OR and PAR of stroke among current smokers varied significantly between regions and income levels with high income countries (HIC) having the highest odds (OR 3.02 95% CI 2.24-4.10) and PAR (18.6%, 15.1-22.8%). Among etiological subtypes of ischemic stroke, the strongest association of current smoking was seen for large vessel stroke (OR 2.16, 95% CI 1.63-2.87) and undetermined cause (OR 1.97, 95% CI 1.55-2.50). Both filtered (OR 1.73, 95% CI 1.50-1.99) and non-filtered (OR 2.59, 95% CI 1.79-3.77) cigarettes were associated with stroke risk. ETS exposure increased the risk of stroke in a dose-dependent manner, exposure for more than 10 h per week increased risk for all stroke (OR 1.95, 95% CI 1.69-2.27), ischemic stroke (OR 1.89, 95% CI 1.59-2.24) and ICH (OR 2.00, 95% CI 1.60-2.50). Interpretation There are significant variations in the magnitude of risk and PAR of stroke according to the types of tobacco used, active and ETS exposure, and countries with different income levels. Specific strategies to discourage tobacco use by any form and to build a smoke free environment should be implemented to ease the global burden of stroke. Funding The Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Swedish Research Council, Swedish Heart and Lung Foundation, The Health & Medical Care Committee of the Regional Executive Board, Region Västra Götaland, and through unrestricted grants from several pharmaceutical companies with major contributions from Astra Zeneca, Boehringer Ingelheim (Canada), Pfizer (Canada), MERCK, Sharp and Dohme, Swedish Heart and Lung Foundation, UK Chest, and UK Heart and Stroke.
Collapse
Affiliation(s)
- Xingyu Wang
- Beijing Hypertension League Institute, Beijing, China
- National Genetic Resources Research Center, National Research Institute for Family Planning, Beijing, China
| | - Xin Liu
- Beijing Hypertension League Institute, Beijing, China
- National Genetic Resources Research Center, National Research Institute for Family Planning, Beijing, China
| | - Martin J. O'Donnell
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
- NUI Galway, Galway, Ireland
| | - Matthew McQueen
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | | | - Guillaume Pare
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Graeme J. Hankey
- St John's Medical College and Research Institute, Bangalore, India
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Siu Lim Chin
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Purnima Rao-Melacini
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | | | - Denis Xavier
- Fundacion Oftalmologica de Santander-Clinica Carlos Ardila Lulle (FOSCAL), Bucaramanga, Colombia
| | - Hongye Zhang
- Beijing Hypertension League Institute, Beijing, China
| | - Lisheng Liu
- Beijing Hypertension League Institute, Beijing, China
| | - Prem Pais
- St John's Medical College and Research Institute, Bangalore, India
| | - Patricio Lopez-Jaramillo
- Fundacion Oftalmologica de Santander-Clinica Carlos Ardila Lulle (FOSCAL), Bucaramanga, Colombia
| | | | - Peter Langhorne
- Glasgow Royal Infirmary, University of Glasgow, Glasgow, Scotland, UK
| | - Annika Rosengren
- Sahlgrenska Academy and University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Antonio L. Dans
- College of Medicine, University of Philippines, Manila, Philippines
| | | | - Alvaro Avezum
- Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Charles Mondo
- Uganda Heart Institute, Mulago Hospital, Kampala, Uganda
| | | | | | | | | | - Nana Pogosova
- National Research Center for Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | | | - Romana Iqbal
- Department of Medicine, Aga Khan University Hospitals in Karachi, Pakistan
| | - Rafael Diaz
- Estudios Clinicos Latinoamerica, Rosario, Argentina
| | - Khalid Yusoff
- UCSI University, Cheras, Kuala Lumpur 56000, Malaysia
| | - Afzalhussein Yusufali
- Hatta Hospital, Dubai Health Authority/Dubai Medical College, Dubai, United Arab Emirates
| | - Aytekin Oguz
- Istanbul Medeniyet Üniversitesi, Istanbul, Turkey
| | | | - Fernando Lanas
- Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
| | - Okechukwu S. Ogah
- Division of Cardiovascular Medicine, Department of Medicine, University College Hospital, Ibadan PMB 5116, Nigeria
| | - A. Ogunniyi
- Department of Medicine, University College Hospital, Ibadan PMB 5116, Nigeria
| | | | | | | | | | | | - Yongchai Nilanont
- Neurology Division, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - INTERSTROKE Investigators
- Beijing Hypertension League Institute, Beijing, China
- National Genetic Resources Research Center, National Research Institute for Family Planning, Beijing, China
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
- NUI Galway, Galway, Ireland
- McGill University Health Centre, Montreal, QC, Canada
- St John's Medical College and Research Institute, Bangalore, India
- Fundacion Oftalmologica de Santander-Clinica Carlos Ardila Lulle (FOSCAL), Bucaramanga, Colombia
- Eduardo Mondlane University, Maputo, Mozambique
- Glasgow Royal Infirmary, University of Glasgow, Glasgow, Scotland, UK
- Sahlgrenska Academy and University Hospital, University of Gothenburg, Gothenburg, Sweden
- College of Medicine, University of Philippines, Manila, Philippines
- Al Shaab Teaching Hospital, Khartoum, Sudan
- Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
- Uganda Heart Institute, Mulago Hospital, Kampala, Uganda
- Department of Neurology, University Hospital, Essen, Germany
- Institute of Psychiatry and Neurology, Warsaw, Poland
- National Research Center for Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
- Department of Medicine, Aga Khan University Hospitals in Karachi, Pakistan
- Estudios Clinicos Latinoamerica, Rosario, Argentina
- UCSI University, Cheras, Kuala Lumpur 56000, Malaysia
- Hatta Hospital, Dubai Health Authority/Dubai Medical College, Dubai, United Arab Emirates
- Istanbul Medeniyet Üniversitesi, Istanbul, Turkey
- Department of Cardiology, Hospital Luis Vernaza, Guayaquil, Ecuador
- Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
- Division of Cardiovascular Medicine, Department of Medicine, University College Hospital, Ibadan PMB 5116, Nigeria
- Department of Medicine, University College Hospital, Ibadan PMB 5116, Nigeria
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Universidad Peruana Cayetano Heredia, Lima, Peru
- University of Split, Croatia
- Rush Alzheimer Disease Research Center in Chicago, Chicago, IL, USA
- University of Limpopo, Pretoria, South Africa
- Neurology Division, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
3
|
Balogun WO, Naylor R, Adedokun BO, Ogunniyi A, Olopade OI, Dagogo-Jack SE, Bell GI, Philipson LH. Implementing genetic testing in diabetes: Knowledge, perceptions of healthcare professionals, and barriers in a developing country. Popul Med 2024; 6:9. [PMID: 38681897 PMCID: PMC11052599 DOI: 10.18332/popmed/184210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/17/2024] [Indexed: 05/01/2024] Open
Abstract
INTRODUCTION Maturity-Onset Diabetes of the Young (MODY) is an unusual type of diabetes often missed in clinical practice, especially in Africa. Treatment decisions for MODY depend on a precise diagnosis, only made by genetic testing. We aimed to determine MODY knowledge among Nigerian healthcare professionals (HCPs), their perceptions, and barriers to the implementation of genetic testing in diabetes patients. METHODS A cross-sectional survey was conducted among doctors and nurses in three levels of public and private healthcare institutions in Ibadan, Nigeria, from December 2018 to June 2019. In all, 70% and 30% of a total 415 participants were recruited from public and private centers, respectively. HCPs were recruited in a 60:40% ratio, respectively. A 51-item instrument was used to assess MODY knowledge, perceptions of HCPs, and barriers to the implementation of genetic testing in diabetes patients. RESULTS In the survey, 43.4% self-rated their current MODY knowledge to be at least moderate. About 68%, 73% and 86%, respectively, correctly answered 3 of 5 questions on basic genetics' knowledge. However, only 1 of 7 MODY-specific questions was answered correctly by 72.7% of the respondents. The mean basic genetics and MODY-specific knowledge scores were 2.6/5 (SD=1.0) and 1.8/9 (SD=1.3), respectively. Multiple linear regression showed higher mean scores among those aged 30-49 years, those with degrees and fellowships (except PhD), and general practitioners; 360 (80.0%) perceived that genetic testing plays a central role in diabetes care. Barriers to genetic testing were lack of access to testing facilities, guidance on the use of and updates/educational materials on genetic testing (82.7%, 62.1% and 50.3%, respectively). CONCLUSIONS The level of MODY awareness and knowledge among Nigerian HCPs is unacceptably low with a lack of access to genetic testing facilities. These can hinder the implementation of precision diabetes medicine. Increased awareness, provision of decision support aids, and genetic testing facilities are urgently needed.
Collapse
Affiliation(s)
- Williams O. Balogun
- Department of Medicine, College of Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria
| | - Rochelle Naylor
- Departments of Medicine and Pediatrics, Kovler Diabetes Center, University of Chicago, Chicago, Illinois, United States of America
| | - Babatunde O. Adedokun
- Department of Epidemiology and Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adesola Ogunniyi
- Department of Medicine, College of Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria
| | - Olufunmilayo I. Olopade
- Center for Clinical Cancer Genetics and Global Health and Section of Haematology Oncology, University of Chicago, Chicago, Illinois, United States of America
| | - Samuel E. Dagogo-Jack
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- Division of Endocrinology and Metabolism, University of Tennessee Health Science Center, Tennessee, United States of America
| | - Graeme I. Bell
- Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
- Department of Human Genetics, University of Chicago, Chicago, Illinois, United States of America
| | - Loui H. Philipson
- Departments of Medicine and Pediatrics, Kovler Diabetes Center, University of Chicago, Chicago, Illinois, United States of America
| |
Collapse
|
4
|
Akinyemi RO, Tiwari HK, Srinivasasainagendra V, Akpa O, Sarfo FS, Akpalu A, Wahab K, Obiako R, Komolafe M, Owolabi L, Osaigbovo GO, Mamaeva OA, Halloran BA, Akinyemi J, Lackland D, Obiabo OY, Sunmonu T, Chukwuonye II, Arulogun O, Jenkins C, Adeoye A, Agunloye A, Ogah OS, Ogbole G, Fakunle A, Uvere E, Coker MM, Okekunle A, Asowata O, Diala S, Ogunronbi M, Adeleye O, Laryea R, Tagge R, Adeniyi S, Adusei N, Oguike W, Olowoyo P, Adebajo O, Olalere A, Oladele O, Yaria J, Fawale B, Ibinaye P, Oyinloye O, Mensah Y, Oladimeji O, Akpalu J, Calys-Tagoe B, Dambatta HA, Ogunniyi A, Kalaria R, Arnett D, Rotimi C, Ovbiagele B, Owolabi MO. Novel functional insights into ischemic stroke biology provided by the first genome-wide association study of stroke in indigenous Africans. Genome Med 2024; 16:25. [PMID: 38317187 PMCID: PMC10840175 DOI: 10.1186/s13073-023-01273-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/12/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND African ancestry populations have the highest burden of stroke worldwide, yet the genetic basis of stroke in these populations is obscure. The Stroke Investigative Research and Educational Network (SIREN) is a multicenter study involving 16 sites in West Africa. We conducted the first-ever genome-wide association study (GWAS) of stroke in indigenous Africans. METHODS Cases were consecutively recruited consenting adults (aged > 18 years) with neuroimaging-confirmed ischemic stroke. Stroke-free controls were ascertained using a locally validated Questionnaire for Verifying Stroke-Free Status. DNA genotyping with the H3Africa array was performed, and following initial quality control, GWAS datasets were imputed into the NIH Trans-Omics for Precision Medicine (TOPMed) release2 from BioData Catalyst. Furthermore, we performed fine-mapping, trans-ethnic meta-analysis, and in silico functional characterization to identify likely causal variants with a functional interpretation. RESULTS We observed genome-wide significant (P-value < 5.0E-8) SNPs associations near AADACL2 and miRNA (MIR5186) genes in chromosome 3 after adjusting for hypertension, diabetes, dyslipidemia, and cardiac status in the base model as covariates. SNPs near the miRNA (MIR4458) gene in chromosome 5 were also associated with stroke (P-value < 1.0E-6). The putative genes near AADACL2, MIR5186, and MIR4458 genes were protective and novel. SNPs associations with stroke in chromosome 2 were more than 77 kb from the closest gene LINC01854 and SNPs in chromosome 7 were more than 116 kb to the closest gene LINC01446 (P-value < 1.0E-6). In addition, we observed SNPs in genes STXBP5-AS1 (chromosome 6), GALTN9 (chromosome 12), FANCA (chromosome 16), and DLGAP1 (chromosome 18) (P-value < 1.0E-6). Both genomic regions near genes AADACL2 and MIR4458 remained significant following fine mapping. CONCLUSIONS Our findings identify potential roles of regulatory miRNA, intergenic non-coding DNA, and intronic non-coding RNA in the biology of ischemic stroke. These findings reveal new molecular targets that promise to help close the current gaps in accurate African ancestry-based genetic stroke's risk prediction and development of new targeted interventions to prevent or treat stroke.
Collapse
Affiliation(s)
- Rufus O Akinyemi
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Hemant K Tiwari
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Onoja Akpa
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Fred S Sarfo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Albert Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | - Kolawole Wahab
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Reginald Obiako
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Morenikeji Komolafe
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Lukman Owolabi
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Olga A Mamaeva
- Department of Epidemiology, School of Public Health University of Alabama at Birmingham, Birmingham, USA
| | - Brian A Halloran
- Department of Pediatrics, Volker Hall University of Alabama at Birmingham, Birmingham, USA
| | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Olugbo Y Obiabo
- Delta State University/Delta State University Teaching Hospital, Oghara, Nigeria
| | - Taofik Sunmonu
- Department of Medicine, Federal Medical Centre, Ondo State, Owo, Nigeria
| | - Innocent I Chukwuonye
- Department of Medicine, Federal Medical Centre Umuahia, Abia State, Umuahia, Nigeria
| | - Oyedunni Arulogun
- Department of Health Education, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | | | - Abiodun Adeoye
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Atinuke Agunloye
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Okechukwu S Ogah
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Godwin Ogbole
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adekunle Fakunle
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Public Health, College of Health Sciences, Osun State University, Osogbo, Nigeria
| | - Ezinne Uvere
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Motunrayo M Coker
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Genetics and Cell Biology Unit, Department of Zoology, Faculty of Science, University of Ibadan, Ibadan, Nigeria
| | - Akinkunmi Okekunle
- Department of Food and Nutrition, Seoul National University, Seoul, South Korea
| | - Osahon Asowata
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Samuel Diala
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mayowa Ogunronbi
- Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Osi Adeleye
- Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Ruth Laryea
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | - Raelle Tagge
- Weill Institute for Neurosciences, School of Medicine, University of California San-Francisco, San Francisco, USA
| | - Sunday Adeniyi
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Nathaniel Adusei
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Wisdom Oguike
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Paul Olowoyo
- Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
| | - Olayinka Adebajo
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Abimbola Olalere
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olayinka Oladele
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Joseph Yaria
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bimbo Fawale
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Philip Ibinaye
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Olalekan Oyinloye
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Yaw Mensah
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Omotola Oladimeji
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Josephine Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | - Benedict Calys-Tagoe
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Adesola Ogunniyi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rajesh Kalaria
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Donna Arnett
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Charles Rotimi
- Center for Genomics and Global Health, National Human Genome Research Institute, NIH, Bethesda, USA
| | - Bruce Ovbiagele
- Genetics and Cell Biology Unit, Department of Zoology, Faculty of Science, University of Ibadan, Ibadan, Nigeria
| | - Mayowa O Owolabi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.
- University College Hospital, Ibadan, Nigeria.
- Lebanese American University of Beirut, Beirut, Lebanon.
- Blossom Specialist Medical Center, Ibadan, Nigeria.
| |
Collapse
|
5
|
Lawal SA, Adedeji IA, Ogunniyi A, Henderson D. Social domains of poor mental health: A qualitative pilot study of community stakeholders' understanding and demarcation of mental illness and its interpretations in rural Nigeria. Health Sci Rep 2024; 7:e1922. [PMID: 38420202 PMCID: PMC10899201 DOI: 10.1002/hsr2.1922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/17/2024] [Accepted: 02/01/2024] [Indexed: 03/02/2024] Open
Abstract
Background and Aims Although previous studies on mental health/illness in Nigeria have explored knowledge and attitude of community members using quantitative approaches, few studies have engaged stakeholders within rural communities on the issue of mental illness using qualitative approaches. Community stakeholders play a critical role in influencing health behaviors. The objective of this pilot study was to explore community stakeholders' understanding and demarcation of mental illness, and its interpretations in a rural Nigerian town. This is with the aim of shaping stakeholders understanding of people when they experience mental distress within the community. Methods The study was conducted in Ijebu-Igbo town of Ogun State in south-west Nigeria. In-depth interviews were conducted among two religious' leaders: a Pastor and an Imam, a traditional healer, a medical doctor, and a registered nurse, and a focus group discussion was held in a church with members of its advisory committee. Results The findings showed that community stakeholders gave multiple interpretations of mental illness and many attribute mental illness to spiritual attack, ancestral curse, anger of the gods, and personal affliction (Ogun-Afowofa). This has been categorized as familial and individual attributes in this study which is part of the main themes derived. The study findings also show that the understanding of community members regarding the root causes of mental illness is somewhat vague based on their poor knowledge of mental illness. This is because of the various interpretations they gave to explain mental health is based on their cultural orientation, socialization, and belief system, and not based on any medical knowledge. Conclusion This pilot study was conducted to justify the main study. There is therefore a need for health education interventions to enlighten and educate community stakeholders with requisite knowledge for better understanding and interpretation of mental illness. Also, through mental health education interventions, community members will gain clarity on what mental health is and what it is not.
Collapse
Affiliation(s)
- Saheed A. Lawal
- Department of Public Health, School of Public and Allied HealthBabcock UniversityIlishan‐RemoOgun StateNigeria
| | - Isaac A. Adedeji
- Department of GerontologySimon Fraser UniversityBritish ColumbiaCanada
| | - Adesola Ogunniyi
- Department of Medicine, College of MedicineUniversity of IbadanIbadanNigeria
| | - David Henderson
- Department of Psychiatry, Boston University Medical CenterBoston UniversityBostonMassachusettsUSA
| |
Collapse
|
6
|
Murphy R, Damasceno A, Reddin C, Hankey GJ, Iversen HK, Oveisgharan S, Lanas F, Czlonkowska A, Langhorne P, Ogunniyi A, Wasay M, Rumboldt Z, Judge C, Oguz A, Mondo C, Winter Y, Rosengren A, Pogosova N, Avezum A, Nilanont Y, Penaherrera E, Xavier D, Lopez-Jaramillo P, Wang X, Yusuf S, O'Donnell M. Variations in the prevalence of atrial fibrillation, and in the strength of its association with ischemic stroke, in countries with different income levels: INTERSTROKE case-control study. Int J Stroke 2024:17474930241227783. [PMID: 38204182 DOI: 10.1177/17474930241227783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
BACKGROUND The contribution of atrial fibrillation (AF) to the etiology and burden of stroke may vary by country income level. AIMS We examined differences in the prevalence of AF and described variations in the magnitude of the association between AF and ischemic stroke by country income level. METHODS In the INTERSTROKE case-control study, participants with acute first ischemic stroke were recruited across 32 countries. We included 10,363 ischemic stroke cases and 10,333 community or hospital controls who were matched for age, sex, and center. Participants were grouped into high-income (HIC), upper-middle-income (subdivided into two groups-UMIC-1 and UMIC-2), and lower-middle-income (LMIC) countries, based on gross national income. We evaluated the risk factors for AF overall and by country income level, and evaluated the association of AF with ischemic stroke. RESULTS AF was documented in 11.9% (n = 1235) of cases and 3.2% (n = 328) of controls. Compared to HIC, the prevalence of AF was significantly lower in UMIC-2 (aOR 0.35, 95% CI 0.29-0.41) and LMIC (aOR 0.50, 95% CI 0.41-0.60) on multivariable analysis. Hypertension, female sex, valvular heart disease, and alcohol intake were stronger risk factors for AF in lower-income countries, and obesity a stronger risk factor in higher-income countries. The magnitude of association between AF and ischemic stroke was significantly higher in lower-income countries compared to higher-income countries. The population attributable fraction for AF and stroke varied by region and was 15.7% (95% CI 13.7-17.8) in HIC, 14.6% (95% CI 12.3-17.1) in UMIC-1, 5.7% (95% CI 4.9-6.7) in UMIC-2, and 6.3% (95% CI 5.3-7.3) in LMIC. CONCLUSION Risk factors for AF vary by country income level. AF contributes to stroke burden to a greater extent in higher-income countries than in lower-income countries, due to a higher prevalence and despite a lower magnitude of odds ratio.
Collapse
Affiliation(s)
- Robert Murphy
- HRB Clinical Research Facility Galway, School of Medicine, University of Galway, Galway, Ireland
| | | | - Catriona Reddin
- HRB Clinical Research Facility Galway, School of Medicine, University of Galway, Galway, Ireland
| | - Graeme J Hankey
- School of Medicine and Pharmacology, The University of Western Australia, Perth, WA, Australia
| | - Helle K Iversen
- Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Shahram Oveisgharan
- Rush Alzheimer's Disease Research Center, Rush University Medical Center, Chicago, IL, USA
| | - Fernando Lanas
- Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
| | | | - Peter Langhorne
- Academic Section of Geriatric Medicine, Glasgow Royal Infirmary, University of Glasgow, Glasgow, UK
| | - Adesola Ogunniyi
- Division of Cardiovascular Medicine, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | | | - Conor Judge
- HRB Clinical Research Facility Galway, School of Medicine, University of Galway, Galway, Ireland
| | - Aytekin Oguz
- Metabolic Syndrome Association, Istanbul, Turkey
| | - Charles Mondo
- Department of Cardiology, Kiruddu National Referral Hospital, Kampala, Uganda
| | - Yaroslav Winter
- Department of Neurology, Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Annika Rosengren
- Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nana Pogosova
- National Medical Research Center of Cardiology Named After Academician E.I. Chazov, Moscow, Russia
| | - Alvaro Avezum
- Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Yongchai Nilanont
- Neurology Division, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Denis Xavier
- St. John's Research Institute, St. John's Medical College, Bangalore, India
| | - Patricio Lopez-Jaramillo
- Fundacion Oftalmologica de Santander-Clinica Carlos Ardila Lulle (FOSCAL), Bucaramanga, Colombia
| | - Xingyu Wang
- Laboratory of Human Genetics, Beijing Hypertension League Institute, Beijing, China
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Martin O'Donnell
- HRB Clinical Research Facility Galway, School of Medicine, University of Galway, Galway, Ireland
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
7
|
Adebayo E, Olaniyan HO, Olumide AO, Ogunniyi A, Fawzi W. Use of mobile technology to enhance the capacity of teachers to teach family life and HIV education in Nigeria: Overview of methods for a randomized controlled trial. Dialogues Health 2023; 2:100110. [PMID: 37719990 PMCID: PMC10500967 DOI: 10.1016/j.dialog.2023.100110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Background Family Life and HIV Education (FLHE) program is a national school-based sexual education intervention program to prevent the spread of HIV among young people in Nigeria. The FLHE curriculum was first implemented nationwide in 2003. However, there have been challenges mitigating the implementation of this intervention. An important challenge is the low capacity of teachers to adequately deliver the contents of the developed curriculum. Considering the significant roles teachers play in the implementation of this important prevention program, it is important that they have the capacity to deliver it. Literature review has shown that there are no documented studies in Nigeria that have considered the use of mobile technology to improve the capacity of teachers to teach FLHE. Therefore, in this paper we have documented the methodology of a study that tested the feasibility of enhancing the self-reported capacity of teachers to deliver the FLHE curriculum through mobile technology. Methods This study was a multiphase study. In this paper, we present an overview of the methods employed in the mobile-FLHE (m-FLHE) program for teachers. We describe study design, participant eligibility and recruitment, assessments, intervention procedures, and measures in the assessments. We also present treatment fidelity assessment, procedures utilized to enhance retention of study participants, and data analysis plans. Discussion Although, the role of teachers and instructors in ensuring the fidelity of CSE has been shown to be critical to its success, very few programs have sought to improve the capacity of teachers to teach FLHE. This study presents the methods of an innovative and sustainable way to improve the capacity of teachers to increase the comprehensive knowledge of HIV among adolescents.
Collapse
Affiliation(s)
- Emmanuel Adebayo
- Adolescent Health Unit, Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Halimat O. Olaniyan
- Adolescent Health Unit, Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adesola O. Olumide
- Adolescent Health Unit, Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
- University College Hospital, Ibadan, Nigeria
| | - Adesola Ogunniyi
- University College Hospital, Ibadan, Nigeria
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Wafaie Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| |
Collapse
|
8
|
Ogbole G, Efidi R, Odo J, Okorie C, Makanjuola T, Adeyinka A, Sammet C, Berzins B, Onoja A, Ogunniyi A, Ragin A, Taiwo B. Brain computed tomography perfusion analysis in HIV-seropositive adults with and without neurocognitive impairment in Nigeria: outcomes and challenges of a pilot study. Pan Afr Med J 2023; 46:15. [PMID: 38035155 PMCID: PMC10683175 DOI: 10.11604/pamj.2023.46.15.36320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/03/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction the significance of cerebrovascular disease in HIV-associated neurocognitive disorder (HAND) in a homogeneous black population has not yet been determined. This incident case-control study used CT perfusion imaging to quantify and compare regional cerebral blood flow parameters in neuro-cognitively impaired and unimpaired HIV+ participants of the Ibadan Cohort on Neuro AIDS (ICON) in Nigeria. Methods this was an incident case-control study consisting of twenty-seven HIV+ adults, classified based on Frascati criteria into neurocognitive impaired (n=18) and unimpaired (n=9) groups, who had brain computed tomographic perfusion (CTP) with a 64-slice Toshiba T scanner. The standard deviation (SD) of regional mean transit time (MTT), cerebral blood flow (CBF), and cerebral blood volume (CBV) values were calculated for bilateral basal ganglia (BG), frontal, parietal, temporal, and occipital regions from CT perfusion maps. The regional mean values and variability (SD) in the CTP measures were compared in the groups using an independent student t-test. Results differentially higher variability in the bilateral CBF measures in the parietal (right; OR = 1.14, x̄ =5.61, p=0.041, CI=0.27-11.35/left; OR = 1.16, x̄=7.01, p=0.03, CI=5.6-13.47) and time to peak (TTP) measures in the basal ganglia (right; OR = 3.78, x̄=0.88, p=0.032, CI=0.081-1.67/left; OR = 2.44, x̄=1.48, p=0.020, CI=0.26-2.71) and occipital (right; OR = 2.18, x̄=1.32, p=0.018, CI=0.25-2.38/left; OR = 1.93, x̄=1.08, p=0.034, CI=0.086-2.06) regions were observed in the cognitively impaired group compared to the unimpaired group. Conclusion the study evidence suggests that alterations in cerebral perfusion implicated in HIV-associated neurocognitive disorder may be possibly demonstrated using CTP, a readily available resource in most African countries saddled with the highest burden of HIV.
Collapse
Affiliation(s)
- Godwin Ogbole
- Department of Radiology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Richard Efidi
- Department of Radiology, University College Hospital (UCH), University of Ibadan, Ibadan, Nigeria
| | - Joseph Odo
- Department of Radiology, University College Hospital (UCH), University of Ibadan, Ibadan, Nigeria
| | - Chinonye Okorie
- Department of Radiology, University College Hospital (UCH), University of Ibadan, Ibadan, Nigeria
| | - Tomiwa Makanjuola
- Department of Neurology, University College Hospital (UCH), Ibadan, Nigeria
| | - Abiodun Adeyinka
- Department of Radiology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Christina Sammet
- Ann & Robert H. Lurie Children's Hospital Chicago, Chicago, Illinois 60611, the United States
| | - Baiba Berzins
- Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, United States
| | - Akpa Onoja
- Department of Biostatistics, University of Ibadan, Ibadan, Nigeria
| | - Adesola Ogunniyi
- Department of Neurology, University College Hospital (UCH), Ibadan, Nigeria
| | - Ann Ragin
- Department of Radiology, Northwestern University, Evanston, Illinois, United States
| | - Babafemi Taiwo
- Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, United States
| |
Collapse
|
9
|
Ray NR, Kunkle BW, Hamilton-Nelson K, Kurup JT, Rajabli F, Cosacak MI, Kizil C, Jean-Francois M, Cuccaro M, Reyes-Dumeyer D, Cantwell L, Kuzma A, Vance JM, Gao S, Hendrie HC, Baiyewu O, Ogunniyi A, Akinyemi RO, Lee WP, Martin ER, Wang LS, Beecham GW, Bush WS, Farrer LA, Haines JL, Byrd GS, Schellenberg GD, Mayeux R, Pericak-Vance MA, Reitz C. Extended genome-wide association study employing the African Genome Resources Panel identifies novel susceptibility loci for Alzheimer's Disease in individuals of African ancestry. medRxiv 2023:2023.08.29.23294774. [PMID: 37693582 PMCID: PMC10491365 DOI: 10.1101/2023.08.29.23294774] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Despite a two-fold increased risk, individuals of African ancestry have been significantly underrepresented in Alzheimer's Disease (AD) genomics efforts. METHODS GWAS of 2,903 AD cases and 6,265 cognitive controls of African ancestry. Within-dataset results were meta-analyzed, followed by gene-based and pathway analyses, and analysis of RNAseq and whole-genome sequencing data. RESULTS A novel AD risk locus was identified in MPDZ on chromosome 9p23 (rs141610415, MAF=.002, P =3.68×10 -9 ). Two additional novel common and nine novel rare loci approached genome-wide significance at P <9×10 -7 . Comparison of association and LD patterns between datasets with higher and lower degrees of African ancestry showed differential association patterns at chr12q23.2 ( ASCL1 ), suggesting that the association is modulated by regional origin of local African ancestry. DISCUSSION Increased sample sizes and sample sets from Africa covering as much African genetic diversity as possible will be critical to identify additional disease-associated loci and improve deconvolution of local genetic ancestry effects.
Collapse
|
10
|
Schiess N, Kulo V, Anand P, Bearden DR, Berkowitz AL, Birbeck GL, Cervantes-Arslanian A, Chan P, Chishimba LC, Chow FC, Elicer I, Fleury A, Kinikar A, Kvalsund M, Mateen FJ, Mbonde AA, Meyer ACL, O'Carroll CB, Ogunniyi A, Patel AA, Rubenstein M, Siddiqi OK, Spudich S, Tackett SA, Thakur KT, Vora N, Zunt J, Saylor DR. Consensus Competencies for Postgraduate Fellowship Training in Global Neurology. Neurology 2023; 101:357-368. [PMID: 36997322 PMCID: PMC10449442 DOI: 10.1212/wnl.0000000000207184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 01/27/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Use a modified Delphi approach to develop competencies for neurologists completing ≥1 year of advanced global neurology training. METHODS An expert panel of 19 United States-based neurologists involved in global health was recruited from the American Academy of Neurology Global Health Section and the American Neurological Association International Outreach Committee. An extensive list of global health competencies was generated from review of global health curricula and adapted for global neurology training. Using a modified Delphi method, United States-based neurologists participated in 3 rounds of voting on a survey with potential competencies rated on a 4-point Likert scale. A final group discussion was held to reach consensus. Proposed competencies were then subjected to a formal review from a group of 7 neurologists from low- and middle-income countries (LMICs) with experience working with neurology trainees from high-income countries (HICs) who commented on potential gaps, feasibility, and local implementation challenges of the proposed competencies. This feedback was used to modify and finalize competencies. RESULTS Three rounds of surveys, a conference call with United States-based experts, and a semistructured questionnaire and focus group discussion with LMIC experts were used to discuss and reach consensus on the final competencies. This resulted in a competency framework consisting of 47 competencies across 8 domains: (1) cultural context, social determinants of health and access to care; (2) clinical and teaching skills and neurologic medical knowledge; (3) team-based practice; (4) developing global neurology partnerships; (5) ethics; (6) approach to clinical care; (7) community neurologic health; (8) health care systems and multinational health care organizations. DISCUSSION These proposed competencies can serve as a foundation on which future global neurology training programs can be built and trainees evaluated. It may also serve as a model for global health training programs in other medical specialties as well as a framework to expand the number of neurologists from HICs trained in global neurology.
Collapse
Affiliation(s)
- Nicoline Schiess
- From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle
| | - Violet Kulo
- From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle
| | - Pria Anand
- From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle
| | - David R Bearden
- From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle
| | - Aaron L Berkowitz
- From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle
| | - Gretchen L Birbeck
- From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle
| | - Anna Cervantes-Arslanian
- From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle
| | - Phillip Chan
- From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle
| | - Lorraine Chishimba Chishimba
- From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle
| | - Felicia C Chow
- From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle
| | - Isabel Elicer
- From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle
| | - Agnes Fleury
- From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle
| | - Aarti Kinikar
- From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle
| | - Michelle Kvalsund
- From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle
| | - Farrah J Mateen
- From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle
| | - Amir A Mbonde
- From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle
| | - Ana-Claire L Meyer
- From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle
| | - Cumara B O'Carroll
- From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle
| | - Adesola Ogunniyi
- From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle
| | - Archana A Patel
- From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle
| | - Michael Rubenstein
- From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle
| | - Omar K Siddiqi
- From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle
| | - Serena Spudich
- From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle
| | - Sean A Tackett
- From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle
| | - Kiran T Thakur
- From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle
| | - Nirali Vora
- From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle
| | - Joseph Zunt
- From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle
| | - Deanna R Saylor
- From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle.
| |
Collapse
|
11
|
Adebayo ES, Wang D, Olaniyan HO, Olumide AO, Ogunniyi A, Fawzi W. Scalability of mobile technology interventions in the prevention and management of HIV among adolescents in low-income and middle-income countries: protocol for a systematic review. BMJ Open 2023; 13:e069362. [PMID: 37451733 PMCID: PMC10351258 DOI: 10.1136/bmjopen-2022-069362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 06/19/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION The rate of new infections with HIV remains high among adolescents globally. Adolescents in low-income and middle-income countries (LMICs), who are least likely to have access to quality healthcare, have the highest proportion of those living with HIV. Mobile technology has played an important role in providing access to information and services among adolescents in recent years. This review aims to synthesise and summarise information that will be useful in the planning, designing and implementing of future mHealth strategies. METHODS AND ANALYSIS Interventional studies, reported in English, on the prevention and management of HIV among adolescents that used mobile technology in LMICs will be included. MEDLINE (via PubMed), Embase, Web of Science, CINAHL, Clinicaltrials.gov, WHO International Clinical Trials Registry Platform (ICTRP), and the Cochrane Library are the information sources that have been identified as relevant to the area of study. These sources will be searched from inception to March 2023. The risk of bias will be assessed using the Cochrane Risk of Bias tool. The scalability of each study will be assessed using the Intervention Scalability Assessment Tool. Two independent reviewers will conduct the selection of studies, data extraction, and assessment of the risk of bias and scalability. A narrative synthesis of all the included studies will be done. ETHICS AND DISSEMINATION Ethical approval was not necessary for this study. This is a systematic review of publicly available information and therefore ethical approval was not deemed necessary. The results of this review will be published in a peer reviewed journal. TRIAL REGISTRATION This protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42022362130.
Collapse
Affiliation(s)
- Emmanuel S Adebayo
- Institute of Child Health, University of Ibadan College of Medicine, Ibadan, Nigeria
| | - Dongqing Wang
- Global and Community Health, George Mason University College of Health and Human Services, Fairfax, Virginia, USA
| | | | | | - Adesola Ogunniyi
- Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria
| | - Wafaie Fawzi
- Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
12
|
Murphy RP, Reddin C, Rosengren A, Judge C, Hankey GJ, Ferguson J, Alvarez-Iglesias A, Oveisgharan S, Wasay M, McDermott C, Iversen HK, Lanas F, Al-Hussain F, Czlonkowska A, Oguz A, Ogunniyi A, Damasceno A, Xavier D, Avezum A, Wang X, Langhorne P, Yusuf S, O'Donnell M. Depressive Symptoms and Risk of Acute Stroke: INTERSTROKE Case-Control Study. Neurology 2023; 100:e1787-e1798. [PMID: 36889922 PMCID: PMC10136021 DOI: 10.1212/wnl.0000000000207093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 01/10/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Depression has been reported to be a risk factor of acute stroke, based largely on studies in high-income countries. In the INTERSTROKE study, we explored the contribution of depressive symptoms to acute stroke risk and 1-month outcome across regions of the world, within subpopulations and by stroke type. METHODS The INTERSTROKE is an international case-control study of risk factors of first acute stroke, conducted in 32 countries. Cases were patients with CT- or MRI-confirmed incident acute hospitalized stroke, and controls were matched for age, sex, and within sites. Standardized questions asked about self-reported depressive symptoms during the previous 12 months and the use of prescribed antidepressant medications were recorded. Multivariable conditional logistic regression was used to determine the association of prestroke depressive symptoms with acute stroke risk. Adjusted ordinal logistic regression was used to explore the association of prestroke depressive symptoms with poststroke functional outcome, measured with the modified Rankin scale at 1 month after stroke. RESULTS Of 26,877 participants, 40.4% were women, and the mean age was 61.7 ± 13.4 years. The prevalence of depressive symptoms within the last 12 months was higher in cases compared with that in controls (18.3% vs 14.1%, p < 0.001) and differed by region (p interaction <0.001), with lowest prevalence in China (6.9% in controls) and highest in South America (32.2% of controls). In multivariable analyses, prestroke depressive symptoms were associated with greater odds of acute stroke (odds ratio [OR] 1.46, 95% CI 1.34-1.58), which was significant for both intracerebral hemorrhage (OR 1.56, 95% CI 1.28-1.91) and ischemic stroke (OR 1.44, 95% CI 1.31-1.58). A larger magnitude of association with stroke was seen in patients with a greater burden of depressive symptoms. While preadmission depressive symptoms were not associated with a greater odds of worse baseline stroke severity (OR 1.02, 95% CI 0.94-1.10), they were associated with a greater odds of poor functional outcome at 1 month after acute stroke (OR 1.09, 95% CI 1.01-1.19). DISCUSSION In this global study, we recorded that depressive symptoms are an important risk factor of acute stroke, including both ischemic and hemorrhagic stroke. Preadmission depressive symptoms were associated with poorer functional outcome, but not baseline stroke severity, suggesting an adverse role of depressive symptoms in poststroke recovery.
Collapse
Affiliation(s)
- Robert P Murphy
- From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom.
| | - Catriona Reddin
- From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Annika Rosengren
- From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Conor Judge
- From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Graeme J Hankey
- From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - John Ferguson
- From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Alberto Alvarez-Iglesias
- From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Shahram Oveisgharan
- From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Mohammad Wasay
- From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Clodagh McDermott
- From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Helle Klingenberg Iversen
- From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Fernando Lanas
- From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Fawaz Al-Hussain
- From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Anna Czlonkowska
- From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Aytekin Oguz
- From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Adesola Ogunniyi
- From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Albertino Damasceno
- From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Denis Xavier
- From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Alvaro Avezum
- From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Xingyu Wang
- From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Peter Langhorne
- From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Salim Yusuf
- From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Martin O'Donnell
- From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| |
Collapse
|
13
|
Adebayo E, Wang D, Olumide AO, Ogunniyi A, Fawzi W. Scalability of mobile technology interventions in the prevention and management of HIV among adolescents in low- and middle-income countries: protocol for a systematic review. medRxiv 2023:2023.03.21.23287533. [PMID: 36993161 PMCID: PMC10055572 DOI: 10.1101/2023.03.21.23287533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Introduction The rate of new infection of HIV is still high among adolescents globally. Adolescents in low and middle-income countries (LMICs) who are least likely to have access to quality healthcare have the highest proportion of those living with HIV. Mobile technology has played an important role in providing access to information and services among adolescents within the region in recent years. This review aims to synthesise and summarise information that will be useful in planning, designing, and implementing future mHealth strategies within the region. Methods and Analysis Interventional studies on the prevention and management of HIV among adolescents that used mobile technology in LMICs will be included. MEDLINE (via PubMed), EMBASE, Web of Science, CINAHL, and the Cochrane Library are the information sources that have been identified as relevant to the area of study. These sources will be searched from inception to March 2023. The risk of bias will be assessed using the Cochrane Risk of Bias tool. The scalability of each study will be assessed using the Intervention Scalability Assessment Tool (ISAT). Two independent reviewers will conduct the selection of studies, data extraction, assessment of the risk of bias, and scalability. A narrative synthesis of all the included studies will be provided through a table. Ethics and dissemination An ethical approval was not necessary for this study. This is a systematic review of publicly available information and therefore ethical approval was not deemed necessary. The results of this review will be published in a peer reviewed journal and dataset will be presented in the main manuscript. Strengths and limitations We believe that the likelihood of missing any published article will be low because of the information sources we are considering.The scalability tool (ISAT) has not been used in any systematic review before.The evidence provided in this review will be limited to low-middle-income countries.The exclusion of studies not published in English is a limitation for this review.
Collapse
Affiliation(s)
- Emmanuel Adebayo
- Adolescent Health Unit, Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Dongqing Wang
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Virginia, USA
| | - Adesola O. Olumide
- Adolescent Health Unit, Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
- University College Hospital, Ibadan, Nigeria
| | - Adesola Ogunniyi
- University College Hospital, Ibadan, Nigeria
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Wafaie Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| |
Collapse
|
14
|
Maestre G, Carrillo M, Kalaria R, Acosta D, Adams L, Adoukonou T, Akinwande K, Akinyemi J, Akinyemi R, Akpa O, Alladi S, Allegri R, Arizaga R, Arshad F, Arulogun O, Babalola D, Baiyewu O, Bak T, Bellaj T, Boshe J, Brayne C, Brodie-Mends D, Brown R, Cahn J, Cyrille N, Damasceno A, de Silva R, de Silva R, Djibuti M, Dreyer AJ, Ellajosyula R, Farombi T, Fongang B, Forner S, Friedland R, Garza N, Gbessemehlan A, Georgiou EEZ, Gouider R, Govia I, Grinberg L, Guerchet M, Gugssa S, Gumikiriza-Onoria JL, Gustafson D, Hogervorst E, Hornberger M, Ibanez A, Ihara M, Ismail O, Issac T, Jönsson L, Kaputu C, Karanja W, Karungi J, Tshala-Katumbay D, Kunkle B, Lee JH, Leroi I, Lewis R, Livingston G, Lopera F, Lwere K, Manes F, Mbakile-Mahlanza L, Mena P, Miller B, Millogo A, Mohamed A, Musyimi C, Mutiso V, Nakasujja N, Ndetei D, Nightingale S, Njamnshi AK, Novotni G, Nyamayaro P, Nyame S, Ogeng'o J, Ogunniyi A, Okada De Oliveira M, Okubadejo N, Orrell M, Orunmuyi A, Owolabi M, Paddick S, A Pericak-Vance M, Pirtosek Z, Potocnik F, Preston B, Raman R, Ranchod K, Rizig M, Rosselli M, Deepa R, Roy U, Salokhiddinov M, Sano M, Sarfo F, Satizabal CL, Sepulveda-Falla D, Seshadri S, Sexton C, Skoog I, St George-Hyslop P, Suemoto C, Tanner J, Thapa P, Toure K, Ucheagwu V, Udeh-Momoh C, Valcour V, Vance J, Varghese M, Vera J, Walker R, Weidner W, Sebastian W, Whitehead Gay P, Zetterberg H, Zewde Y. The Nairobi Declaration-Reducing the burden of dementia in low- and middle-income countries (LMICs): Declaration of the 2022 Symposium on Dementia and Brain Aging in LMICs. Alzheimers Dement 2023; 19:1105-1108. [PMID: 36905253 DOI: 10.1002/alz.13025] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Indexed: 03/12/2023]
Affiliation(s)
- Gladys Maestre
- Departments of Neuroscience and Human Genetics, University of Texas Rio Grande Valley, Brownsville, TX, USA
| | | | - Raj Kalaria
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Daisy Acosta
- Internal Medicine Department, Universidad Nacional Pedro Henriquez Ureña, Santo Domingo, Dominican Republic
| | - Larry Adams
- Institute of Human Genomics, University of Miami, Miami, FL, USA
| | | | - Kazeem Akinwande
- Department of Chemical Pathology and Immunology, Federal Medical Centre, Abeokuta, Nigeria
| | | | - Rufus Akinyemi
- Institute for Advanced Medical Research and Training, University of Ibadan, Ibadan, Nigeria
| | - Onoja Akpa
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Ricardo Allegri
- Department of Cognitive Neurology, Instituto Neurologico Fleni, Buenos Aires, Argentina
| | - Raul Arizaga
- Neurología Cognitiva y Neuropsicología, Hospital Dr. Cesar Milstein, Buenos Aires, Argentina
| | | | - Oyedunni Arulogun
- Department of Health Promotion and Education, University of Ibadan, Ibadan, Nigeria
| | - David Babalola
- University College Hospital, University of Ibadan, Ibadan, Nigeria
| | | | - Thomas Bak
- Department of Neurology, University of Edinburgh, Edinburgh, UK
| | - Tarek Bellaj
- Department of Psychological Sciences, Qatar University, Doha, Qatar
| | - Judith Boshe
- Department of Medicine, Kilimanjaro Christian Medical College, Moshi, Tanzania
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | | | - Richard Brown
- Department of Psychology, Dalhousie University, Halifax, Canada
| | - Jennifer Cahn
- Departments of Neuroscience and Human Genetics, University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Nkouonlack Cyrille
- Faculty of Health Sciences, University of Buea, Buea & Brain Research Africa Initiative, Yaounde, Cameroon
| | | | - Ranil de Silva
- Faculty of Medical Sciences, University of Sri Jayewardenepura, Rathmalana, Sri Lanka
| | - Rohan de Silva
- Institute of Neurology, University College London, London, UK
| | - Mamuka Djibuti
- Partnership for Research and Action for Health, Tbilisi, Georgia
| | - Anna Jane Dreyer
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | | | - Bernard Fongang
- Glenn Biggs Institute, University of Texas, San Antonio, TX, USA
| | | | - Rob Friedland
- Department of Neurology, University of Louisville, Louisville, USA
| | - Noe Garza
- Departments of Neuroscience and Human Genetics, University of Texas Rio Grande Valley, Harlingen, TX, USA
| | - Antoine Gbessemehlan
- institute of Epidemiology and Tropical Neurology, University of Limoges, Bordeaux, France
| | | | - Riadh Gouider
- Neurology Department, Razi University Hospital, Tunis, Tunisia
| | - Ishtar Govia
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Lea Grinberg
- Department of Neurology, University of San Francisco, San Francisco, CA, USA
| | - Maëlenn Guerchet
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Seid Gugssa
- Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Deborah Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Eef Hogervorst
- Department of Psychology, University of Loughborough, Loughborough, UK
| | | | - Agustin Ibanez
- Global Brain Health Institute, Trinity College, Dublin, Ireland
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibañez, Chile
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | | | - Thomas Issac
- Centre for Brain Research (CBR), Indian Institute of Science (IISc), Bengaluru, India
| | - Linus Jönsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden
| | - Celestin Kaputu
- Department of Neurology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Wambui Karanja
- Global Brain Health Institute, Trinity College, Nairobi, Kenya
| | | | | | - Brian Kunkle
- Institute of Human Genomics, University of Miami, Miami, FL, USA
| | - Joseph H Lee
- Sergievsky Center & Taub Institute, Columbia University, New York, NY, USA
| | - Iracema Leroi
- TCIN, Lloyd Building, Trinity College, Dublin, Ireland
| | - Raphaella Lewis
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Gill Livingston
- Department of Psychiatry, University College London, London, UK
| | - Francisco Lopera
- Grupo de Neurociencias de Antioquia, Universidad de Antioquia, Medellin, Colombia
| | - Kamada Lwere
- Department of Medical Microbiology, Makerere University, Mulago, Uganda
| | - Facundo Manes
- Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | | | - Pedro Mena
- Institute of Human Genomics, University of Miami, Miami, FL, USA
| | - Bruce Miller
- Department of Neurology, University of San Francisco, San Francisco, CA, USA
| | - Athanase Millogo
- Department of Neurology, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Abdul Mohamed
- Department of Psychology, Linnaeus University, Vaxjo, Sweden
| | - Christine Musyimi
- African Mental Health Research & Training Foundation, Nairobi, Kenya
| | - Victoria Mutiso
- African Mental Health Research & Training Foundation, Nairobi, Kenya
| | | | - David Ndetei
- Africa Mental Health Research and Training Foundation and University of Nairobi, Nairobi, Kenya
| | - Sam Nightingale
- Department of Neurology, University of Cape Town, Cape Town, South Africa
| | - Alfred K Njamnshi
- Department of Neurology, FMBS, The University of Yaoundé I & Brain Research Africa Initiative, Yaounde, Cameroon
| | - Gabriela Novotni
- Department of Neurology, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | | | - Solomon Nyame
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | - Julius Ogeng'o
- Department of Human Anatomy & Medical Physiology, University of Nairobi, Nairobi, Kenya
| | | | | | - Njideka Okubadejo
- Neurology Unit, Department of Medicine, College of Medicine, University of Lagos, Nigeria
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Akintunde Orunmuyi
- Integrated Molecular Imaging Centre, Kenyatta University, Nairobi, Kenya
| | - Mayowa Owolabi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Stella Paddick
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Zvezdan Pirtosek
- Department of Neurology, Ljubljana University Medical Centre, Ljubljana, Slovenia
| | - Felix Potocnik
- Department of Geriatric Psychiatry, Stellenbosch University, Durbanville, South Africa
| | - Bill Preston
- Roots Worldwide LLC and Innovative California Biosciences International Inc, Fullerton, CA, USA
| | - Rema Raman
- Alzheimer's Therapeutic Research Institute, University of Southern California, San Diego, CA, USA
| | - Kirti Ranchod
- Global Brain Health Institute, Trinity College, Johannesburg, South Africa
| | - Mie Rizig
- UCL Queen Square Institute of Neurology, London, UK
| | - Monica Rosselli
- Department of Psychology, Florida Atlantic University, Miami, FL, USA
| | - Roy Deepa
- Department of Health and Biomedical Science, The University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Upal Roy
- Department of Health and Biomedical Science, The University of Texas Rio Grande Valley, Brownsville, TX, USA
| | | | - Mary Sano
- Alzheimer's Disease Center, Mount Sinai School of Medicine, Bronx, NY, USA
| | - Fred Sarfo
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Claudia L Satizabal
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases and Department of Population Health Sciences, UT Health San Antonio, San Antonio, Texas, United States
| | - Diego Sepulveda-Falla
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sudha Seshadri
- Glenn Biggs Institute, University of Texas, San Antonio, MA, USA
| | | | - Ingmar Skoog
- Center of Health and Aging (AgeCap), University of Gothenburg, Goteborg, Sweden
| | - Peter St George-Hyslop
- Tanz Centre for Research in Neurodegenerative Diseases and Division of Neurology, University of Toronto, Toronto, Canada
| | - Claudia Suemoto
- Division of Geriatrics, Universidade de São Paulo, São Paulo, Brazil
| | - Jeremy Tanner
- Glenn Biggs Institute, University of Texas, San Antonio, TX, USA
| | - Prekshya Thapa
- Department of Psychiatric Nursing, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Kamadore Toure
- Department of Neurology, Université de Thiès, Thies, Senegal
| | | | | | - Victor Valcour
- Global Brain Health Institute, University of San Francisco, San Francisco, CA, USA
| | - Jeffery Vance
- Institute of Human Genomics, University of Miami, Miami, FL, USA
| | - Mathew Varghese
- Department of Psychiatry, St John's Medical College, Bangalore, India
| | - Jaime Vera
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Richard Walker
- Department of Medicine, North Tyneside General Hospital, North Shields, UK
| | | | - Walsh Sebastian
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | | | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Moelndal Hospital, Moelndal, Sweden
| | - Yared Zewde
- Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
15
|
Adewale BA, Coker MM, Ogunniyi A, Kalaria RN, Akinyemi RO. Biomarkers and Risk Assessment of Alzheimer's Disease in Low- and Middle-Income Countries. J Alzheimers Dis 2023; 95:1339-1349. [PMID: 37694361 DOI: 10.3233/jad-221030] [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] [Indexed: 09/12/2023]
Abstract
Dementia is a chronic syndrome which is common among the elderly and is associated with significant morbidity and mortality for patients and their caregivers. Alzheimer's disease (AD), the most common form of clinical dementia, is biologically characterized by the deposition of amyloid-β plaques and neurofibrillary tangles in the brain. The onset of AD begins decades before manifestation of symptoms and clinical diagnosis, underlining the need to shift from clinical diagnosis of AD to a more objective diagnosis using biomarkers. Having performed a literature search of original articles and reviews on PubMed and Google Scholar, we present this review detailing the existing biomarkers and risk assessment tools for AD. The prevalence of dementia in low- and middle-income countries (LMICs) is predicted to increase over the next couple of years. Thus, we aimed to identify potential biomarkers that may be appropriate for use in LMICs, considering the following factors: sensitivity, specificity, invasiveness, and affordability of the biomarkers. We also explored risk assessment tools and the potential use of artificial intelligence/machine learning solutions for diagnosing, assessing risks, and monitoring the progression of AD in low-resource settings. Routine use of AD biomarkers has yet to gain sufficient ground in clinical settings. Therefore, clinical diagnosis of AD will remain the mainstay in LMICs for the foreseeable future. Efforts should be made towards the development of low-cost, easily administered risk assessment tools to identify individuals who are at risk of AD in the population. We recommend that stakeholders invest in education, research and development targeted towards effective risk assessment and management.
Collapse
Affiliation(s)
- Boluwatife Adeleye Adewale
- Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training (IAMRAT), College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Motunrayo Mojoyin Coker
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training (IAMRAT), College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adesola Ogunniyi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training (IAMRAT), College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
| | - Rajesh N Kalaria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training (IAMRAT), College of Medicine, University of Ibadan, Ibadan, Nigeria
- Translational and Clinical Research Institute, Newcastle University, United Kingdom
| | - Rufus Olusola Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training (IAMRAT), College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Translational and Clinical Research Institute, Newcastle University, United Kingdom
| |
Collapse
|
16
|
Affiliation(s)
- Rufus O Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan 200212, Nigeria; Neurovascular Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Mayowa O Owolabi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan 200212, Nigeria
| | - Njideka Okubadejo
- Neurology Unit, Department of Medicine, University of Lagos, Lagos, Nigeria
| | - Adesola Ogunniyi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan 200212, Nigeria
| | - Raj N Kalaria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan 200212, Nigeria; Neurovascular Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
| |
Collapse
|
17
|
Vasquez ML, Rajabli F, Beecham GW, Hendrie HC, Baiyewu O, Ogunniyi A, Gao S, Kushch NA, Hamilton‐Nelson KL, Young JJ, Dykxhoorn DM, Nuytemans K, Kunkle BW, Wang L, Jin F, Liu X, Feliciano‐Astacio BE, Dalgard CL, Griswold AJ, Byrd GS, Reitz C, Haines JL, Pericak‐Vance MA, Vance JM. A Novel Protective locus significantly reduces the
ApoEε4
risk for Alzheimer’s Disease in individuals of African Ancestry. Alzheimers Dement 2022. [DOI: 10.1002/alz.067279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Marina Lipkin Vasquez
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
| | - Farid Rajabli
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine Miami FL USA
| | - Gary W. Beecham
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine Miami FL USA
| | - Hugh C Hendrie
- Department of Psychiatry, Indiana University School of Medicine Indianapolis IN USA
| | | | | | - Sujuan Gao
- Department of Biostatistics, Indiana University School of Medicine Indianapolis IN USA
| | - Nicholas A. Kushch
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
| | - Kara L. Hamilton‐Nelson
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
| | - Juan J Young
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine Miami FL USA
| | - Derek M. Dykxhoorn
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine Miami FL USA
| | - Karen Nuytemans
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine Miami FL USA
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine Miami FL USA
| | - Brian W. Kunkle
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine Miami FL USA
- John P. Hussman Institute for Human Genomics, Miller School of Medicine Miami FL USA
| | - Liyong Wang
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine Miami FL USA
| | - Fulai Jin
- Department of Genetics and Genome Sciences, Case Western Reserve University Cleveland OH USA
| | - Xiaoxiao Liu
- Department of Genetics and Genome Sciences, Case Western Reserve University Cleveland OH USA
| | | | | | - Anthony J. Griswold
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine Miami FL USA
| | - Goldie S. Byrd
- Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston‐Salem NC USA
| | - Christiane Reitz
- Gertrude H. Sergievsky Center, Taub Institute for Research on the Aging Brain, Departments of Neurology, Psychiatry, and Epidemiology, College of Physicians and Surgeons, Columbia University New York NY USA
| | - Jonathan L. Haines
- Department of Population & Quantitative Health Sciences, Case Western Reserve University Cleveland OH USA
| | - Margaret A. Pericak‐Vance
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine Miami FL USA
| | - Jeffery M. Vance
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine Miami FL USA
- John P. Hussman Institute for Human Genomics, University of Miami Miami FL USA
| | | | | |
Collapse
|
18
|
Ogah OS, Ajayi SO, Okeke MF, Ogunniyi A. THE EARLY PHYSICIANS OF IBADAN MEDICAL SCHOOL: PROFESSOR ALEXANDER BROWN. Ann Ib Postgrad Med 2022; 20:179-186. [PMID: 37384348 PMCID: PMC10295093] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023] Open
Abstract
The paper chronicles the life and times of Professor Alexander Brown, the Foundation Professor and Head of the Department of Medicine at the University of Ibadan. The official opening of the University College Ibadan, Nigeria on 20 November 1957 as well as the graduation of the first set of clinical students in 1960 were glorious moments for Alexander Brown who laboured for 12years to witness these. He was also instrumental to the creation of the Department of Paediatrics (1962), Department of Radiology (1963) and the Medical Illustration unit of the hospital. Paediatrics and Radiology were initially units in the Department of Medicine. He played significant role in the development of postgraduate programmes in Cardiology, neuropsychiatry and nephrology units of the hospital and substantial role in the development of nursing education in the hospital. He was the brain behind the famous Ibarapa Community Health Project.
Collapse
Affiliation(s)
- O S Ogah
- Department of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - S O Ajayi
- Department of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - M F Okeke
- Department of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - A Ogunniyi
- Department of Medicine, University of Ibadan, Ibadan, Nigeria
| |
Collapse
|
19
|
Ojewale LY, Afolabi RF, Ogunniyi A. COVID-19 Vaccine Attitude and Its Predictors Among People Living With Chronic Health Conditions in Ibadan, Nigeria. Int J Public Health 2022; 67:1604811. [PMID: 36312316 PMCID: PMC9613940 DOI: 10.3389/ijph.2022.1604811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: To assess vaccination attitude and its associated factors among people with chronic health conditions. Methods: In this cross-sectional study, participants were 423 patients with chronic medical conditions. Data were collected on socio-demographic and COVID-19-related characteristics, via Open Data Kit software. A Vaccination Attitudes Examination (VAX) Scale was adopted. The main outcome was vaccine attitude status defined as positive if a VAX sum score was above the median value; otherwise, non-positive. Data were analysed using Chi-square and multivariate logistic regression analyses, at 5% level of significance. Results: Overall proportion of patients with a positive attitude towards COVID-19 vaccination uptake was 46.6%. The most influential factor towards positive attitude was rating the government high in handling the pandemic. Other factors were education, income, COVID-19 knowledge and living room arrangement (p < 0.05). Conclusion: Less than half of people living with a chronic medical condition had a positive attitude towards the COVID-19 vaccine. The attitudes are strongly mediated by confidence in the government. The government could promote a positive vaccine attitude by improving the clarity of health instructions that shows government transparency and effective communication. These are critical tools for maintaining public trust and confidence.
Collapse
Affiliation(s)
- Lucia Yetunde Ojewale
- Department of Nursing, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
- *Correspondence: Lucia Yetunde Ojewale,
| | - Rotimi Felix Afolabi
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adesola Ogunniyi
- Department of Medicine, Faculty of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| |
Collapse
|
20
|
Afolabi OA, Nkhoma K, Soyannwo O, Aje A, Ogunniyi A, Harding R, Maddocks M. Integrated Primary Palliative Care in Nigeria- Perspectives of Patients, Families and Providers. J Pain Symptom Manage 2022; 64:319-329. [PMID: 35835429 DOI: 10.1016/j.jpainsymman.2022.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/25/2022] [Accepted: 06/30/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Palliative care should be integrated into primary healthcare systems within low- and middle-income countries to achieve Universal Health Coverage goals. We aimed to identify preferences and expectations for primary palliative care among people living with serious illness and their families and the readiness of primary healthcare providers to deliver primary palliative care in Nigeria. METHODS Qualitative descriptive interview study with 48 participants: people living with serious illness (n=21) and their family caregivers (n=15), healthcare providers (n=12). Data were analysed using thematic analysis. RESULTS Three major themes were identified. 1.) Engaging patients and families. 2.) Managing patients and families' expectations and preferences. 3.) Addressing staffing-related issues. Patients and families have existing trust and bonds from using primary healthcare but lack individual agency necessary for person-centered care decisions. They expect an easily accessible service, opportunities for social interaction and adequate communication. Development of healthcare providers is needed to ensure an appropriate clinical response, manage interprofessional trust and ensure clear role delineation. CONCLUSIONS Our findings have identified specific approaches to implement the WHO policy on integrated primary palliative care. Palliative care integration within primary healthcare in Nigeria can be achieved through building information and communication skills of healthcare providers, engaging and empowering patients to exercise their agency in care decisions, and adequately delineating healthcare providers' roles to ensure staff work within their competencies and training.
Collapse
Affiliation(s)
- Oladayo A Afolabi
- Cicely Saunders Institute of Palliative care (O.A.A, K.N., R.H., M.M.), Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative care, King's College London, London, UK; Department of Nursing Science (O.A.A.), University of Maiduguri, Maiduguri, Nigeria.
| | - Kennedy Nkhoma
- Cicely Saunders Institute of Palliative care (O.A.A, K.N., R.H., M.M.), Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative care, King's College London, London, UK
| | - Olaitan Soyannwo
- Hospice and Palliative care department (O.S.), University College Hospital, Ibadan, Nigeria
| | - Akinyemi Aje
- Division of Cardiology, Department of Medicine (A.A.), University College Hospital, Ibadan, Nigeria
| | - Adesola Ogunniyi
- Division of Neurology (O.A.), Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Richard Harding
- Cicely Saunders Institute of Palliative care (O.A.A, K.N., R.H., M.M.), Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative care, King's College London, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative care (O.A.A, K.N., R.H., M.M.), Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative care, King's College London, London, UK
| |
Collapse
|
21
|
M. Ogunbode A, O. Owolabi M, O. Ogunbode O, A. Adebusoye L, Ogunniyi A. Predictors of weight reduction in a Nigerian family practice setting. Ghana Med J 2022. [DOI: 10.4314/gmj.v56i3.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives: This study identified the predictors of weight reduction among adult obese patients in a Family Practice Setting and developed a statistical model to predict weight reduction.Design: A prospective cohort design.Setting: The Family Practice Clinic, University College Hospital, Ibadan, NigeriaParticipants and study tools: Obese adults were recruited into a three-month weight reduction program. Patient Information Leaflets were used for counselling, while questionnaires were administered to obtain socio-demographic and lifestyle factors. Potential predictors were assessed using the Multidimensional Scale of Perceived Social Support, Zung Depression Scale, Rosenberg Self-Esteem scale, Garner’s Eating Attitude Test-26 (EAT-26), 24-hour dietary recall and International Physical Activity Questionnaire-short form. Anthropometric indices, blood pressure and Fast-ing Lipid Profile were assessed. Descriptive and inferential statistics were used for analysis with a significance set at α0.05.Results: Most 99(76.2%) of the 130 participants achieved weight reduction and had a median weight change of -2.3kg (IQR-4, -0.5), with 66 (66.7%) out of 99 attaining the weight reduction target of 10%. The regression model showed predictors of weight reduction to be Total Cholesterol [TC] (p=0.01) and Low-Density Lipoprotein Cholesterol [LDL-C] (p=0.03). The statistical model derived for Weight reduction = 0.0028 (LDL-C) -0.029 (TC)-0.053 (EAT-26) +0.041(High-Density Lipoprotein Cholesterol). The proportion of variance of the model tested was R2 = 0.3928 (ad-justed R2 = 0.2106).Conclusion: Predictors of weight reduction among patients were eating attitude score, Total Cholesterol, Low-Density Lipid and High-Density Lipoprotein Cholesterol levels. A statistical model was developed for managing obesity among patients.
Collapse
|
22
|
Nweke M, Nombeko M, Govender N, Akinpelu A, Ukwuoma M, Ogunniyi A. Aerobic exercise for HIV-associated neurocognitive disorders in individuals on antiretroviral therapy: A randomised controlled trial. Clin Rehabil 2022; 36:1601-1612. [PMID: 35850533 DOI: 10.1177/02692155221114587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The increasing burden of self-limiting forms of HIV-associated neurocognitive disorder (HAND) in the antiretroviral therapy era calls for adjunctive interventions. The study aimed to determine the effects of a 12-week aerobic exercise programme on HAND. METHODS This is a parallel-group, randomized controlled trial with concealed allocation and intention-to-treat analysis. This study was a clinic-based programme. Seventy-three patients with HAND were enrolled in the trial. The intervention comprised a moderate-intensity aerobic exercise, 20-60 min per session, three times per week, for twelve weeks. The control group received exercise education. Prevalence of HAND constituted the primary outcome. HAND was identified and classified following the Frascati criteria. We computed the odds ratio and number needed-to-treat to estimate the treatment effect. RESULTS There were 73 patients (38 in exercise and 35 in control arm). Individuals in the exercise arm recorded a significantly higher reduction in working memory deficit (OR = 5.14; CI = 2.6-10.4; NNT = 6) but not in attention-deficit (OR = 0.31, CI = 0.2-0.5; NNT = -5) compared to the control group at twelve-week. Reductions in attention deficit (OR = 1.55, 95 CI = 1.0-2.4; NNT = 5) and HAND prevalence (OR = 1.8, 95 CI = 1.2-2.8); NNT = 8) were significantly higher in the exercise group compared the control group at three-month. No significant between-group difference in functional independence was observed immediately after exercise (p > 0.05). DISCUSSION The neuroprotective effects of aerobic exercise appear selective and vary with cognitive abilities impaired and aerobic capacity, with a greater change occurring with improved aerobic capacity. CONCLUSION Individuals with working memory and attention deficits may benefit more from moderate-intensity aerobic exercise.
Collapse
Affiliation(s)
- Martins Nweke
- Department of Physiotherapy, School of Healthcare, Faculty of Health Sciences, 56410University of Pretoria, Pretoria South Africa
| | - Mshunqane Nombeko
- Department of Physiotherapy, School of Healthcare, Faculty of Health Sciences, 56410University of Pretoria, Pretoria South Africa
| | - Nalini Govender
- Department of Physiotherapy, School of Healthcare, Faculty of Health Sciences, 56410University of Pretoria, Pretoria South Africa
| | - Aderonke Akinpelu
- Department of Physiotherapy, School of Healthcare, Faculty of Health Sciences, 56410University of Pretoria, Pretoria South Africa
| | - Maryjane Ukwuoma
- Department of Physiotherapy, School of Healthcare, Faculty of Health Sciences, 56410University of Pretoria, Pretoria South Africa
| | - Adesola Ogunniyi
- Department of Physiotherapy, School of Healthcare, Faculty of Health Sciences, 56410University of Pretoria, Pretoria South Africa
| |
Collapse
|
23
|
Nweke M, Mshunqane N, Govender N, Akinpelu AO, Ogunniyi A. Normative scores for select neuropsychological battery tests for the detection of HIV-associated neurocognitive disorder amongst Nigerians. Niger Postgrad Med J 2022; 29:262-267. [PMID: 35900464 DOI: 10.4103/npmj.npmj_31_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The study aimed to derive socio-demographic-corrected norms for selecting neuropsychological (NP) battery tests for people living with HIV (PLWHIV) in Nigeria. This cross-sectional study was conducted amongst patients who attended the general outpatient clinic and junior staff of the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla. AIMS AND OBJECTIVES To determine the normative scores for select neuropsychological battery test for the detection of neurocognitive disorder amongst Nigerians PLWHIV. A sample of 92 individuals received voluntary HIV testing. METHODS Eligibility criteria were being HIV negative, aged 18-64 years and formal education. We undertook a brief neuromedical examination to identify putative exclusion criteria. We sampled four NP tests covering seven cognitive domains and the motor speed component of the International HIV Dementia Scale (IHDS-MS). We presented the normative scores using statistics of mean, median, standard deviation (SD), kurtosis and skewness. RESULTS All the participants were Nigerians aged 18-64 years. Most (74.1%) of the participants were females. The mean and median ages of the participants were 42.6 ± 11.42 years and 44 years, respectively. The effect of gender on NP performance was limited to the digit span test (DST)-forwards, while education affected all expect IHDS-MS and DST-backwards. The cut-off scores for defining mild and severe impairment varied (moving from 1SD to 2SD) for all cognitive domains except for IHDS-MS and DST. CONCLUSIONS With these preliminary normative scores, it will be easier to identify and classify the severity of neurocognitive impairment amongst PLWHIV in Nigeria, thus facilitating the goal of keeping HIV-associated dementia to a minimum. The lack of variability in the IHDS-MS and DST is unfavourable.
Collapse
Affiliation(s)
- Martins Nweke
- Department of Physiotherapy, University of Pretoria, Pretoria, Enugu, Nigeria
| | - Nombeko Mshunqane
- Department of Physiotherapy, University of Pretoria, Pretoria, Enugu, Nigeria
| | - Nalini Govender
- Department of Basic Medical Sciences, Durban University of Technology, Durban, KwaZulu-Natal, Nigeria
| | | | - Adesola Ogunniyi
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| |
Collapse
|
24
|
Rajabli F, Beecham GW, Hendrie HC, Baiyewu O, Ogunniyi A, Gao S, Kushch NA, Lipkin-Vasquez M, Hamilton-Nelson KL, Young JI, Dykxhoorn DM, Nuytemans K, Kunkle BW, Wang L, Jin F, Liu X, Feliciano-Astacio BE, Schellenberg GD, Dalgard CL, Griswold AJ, Byrd GS, Reitz C, Cuccaro ML, Haines JL, Pericak-Vance MA, Vance JM. A locus at 19q13.31 significantly reduces the ApoE ε4 risk for Alzheimer's Disease in African Ancestry. PLoS Genet 2022; 18:e1009977. [PMID: 35788729 PMCID: PMC9286282 DOI: 10.1371/journal.pgen.1009977] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 12/04/2021] [Revised: 07/15/2022] [Accepted: 05/27/2022] [Indexed: 11/18/2022] Open
Abstract
African descent populations have a lower Alzheimer disease risk from ApoE ε4 compared to other populations. Ancestry analysis showed that the difference in risk between African and European populations lies in the ancestral genomic background surrounding the ApoE locus (local ancestry). Identifying the mechanism(s) of this protection could lead to greater insight into the etiology of Alzheimer disease and more personalized therapeutic intervention. Our objective is to follow up the local ancestry finding and identify the genetic variants that drive this risk difference and result in a lower risk for developing Alzheimer disease in African ancestry populations. We performed association analyses using a logistic regression model with the ApoE ε4 allele as an interaction term and adjusted for genome-wide ancestry, age, and sex. Discovery analysis included imputed SNP data of 1,850 Alzheimer disease and 4,331 cognitively intact African American individuals. We performed replication analyses on 63 whole genome sequenced Alzheimer disease and 648 cognitively intact Ibadan individuals. Additionally, we reproduced results using whole-genome sequencing of 273 Alzheimer disease and 275 cognitively intact admixed Puerto Rican individuals. A further comparison was done with SNP imputation from an additional 8,463 Alzheimer disease and 11,365 cognitively intact non-Hispanic White individuals. We identified a significant interaction between the ApoE ε4 allele and the SNP rs10423769_A allele, (β = -0.54,SE = 0.12,p-value = 7.50x10-6) in the discovery data set, and replicated this finding in Ibadan (β = -1.32,SE = 0.52,p-value = 1.15x10-2) and Puerto Rican (β = -1.27,SE = 0.64,p-value = 4.91x10-2) individuals. The non-Hispanic Whites analyses showed an interaction trending in the "protective" direction but failing to pass a 0.05 significance threshold (β = -1.51,SE = 0.84,p-value = 7.26x10-2). The presence of the rs10423769_A allele reduces the odds ratio for Alzheimer disease risk from 7.2 for ApoE ε4/ε4 carriers lacking the A allele to 2.1 for ApoE ε4/ε4 carriers with at least one A allele. This locus is located approximately 2 mB upstream of the ApoE locus, in a large cluster of pregnancy specific beta-1 glycoproteins on chromosome 19 and lies within a long noncoding RNA, ENSG00000282943. This study identified a new African-ancestry specific locus that reduces the risk effect of ApoE ε4 for developing Alzheimer disease. The mechanism of the interaction with ApoEε4 is not known but suggests a novel mechanism for reducing the risk for ε4 carriers opening the possibility for potential ancestry-specific therapeutic intervention.
Collapse
Affiliation(s)
- Farid Rajabli
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Gary W. Beecham
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami, Miller School of Medicine, Miami, Florida, United States of America
| | - Hugh C. Hendrie
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | | | | | - Sujuan Gao
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Nicholas A. Kushch
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Marina Lipkin-Vasquez
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Kara L. Hamilton-Nelson
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Juan I. Young
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami, Miller School of Medicine, Miami, Florida, United States of America
| | - Derek M. Dykxhoorn
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami, Miller School of Medicine, Miami, Florida, United States of America
| | - Karen Nuytemans
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami, Miller School of Medicine, Miami, Florida, United States of America
| | - Brian W. Kunkle
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami, Miller School of Medicine, Miami, Florida, United States of America
| | - Liyong Wang
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami, Miller School of Medicine, Miami, Florida, United States of America
| | - Fulai Jin
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Xiaoxiao Liu
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, Ohio, United States of America
| | | | | | - Gerard D. Schellenberg
- Penn Neurodegeneration Genomics Center, Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Clifton L. Dalgard
- Department of Anatomy, Physiology & Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - Anthony J. Griswold
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami, Miller School of Medicine, Miami, Florida, United States of America
| | - Goldie S. Byrd
- Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Christiane Reitz
- Gertrude H. Sergievsky Center, Taub Institute for Research on the Aging Brain, Departments of Neurology, Psychiatry, and Epidemiology, College of Physicians and Surgeons, Columbia University, New York, New York State, United States of America
| | - Michael L. Cuccaro
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami, Miller School of Medicine, Miami, Florida, United States of America
| | - Jonathan L. Haines
- Department of Population & Quantitative Health Sciences, Cleveland Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Margaret A. Pericak-Vance
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami, Miller School of Medicine, Miami, Florida, United States of America
| | - Jeffery M. Vance
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami, Miller School of Medicine, Miami, Florida, United States of America
| |
Collapse
|
25
|
Leroi I, Karanja W, Adrion ER, Alladi S, Custodio N, Goswami SP, Guerchet M, Gubner J, Ibanez A, Ilinica S, Jafri H, Lawlor B, Mohamed AA, Ogunniyi A, Robertson I, Robinson L, Spector A, Varghese M, Weidner W, Caramelli P. Equity and balance in applied dementia research: A charter of conduct and checklist for global collaborations. Int J Geriatr Psychiatry 2022; 37. [PMID: 35703570 DOI: 10.1002/gps.5762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/04/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Iracema Leroi
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Wambui Karanja
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Emily R Adrion
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,School of Social and Political Science at the University of Edinburgh, Edinburgh, Scotland
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú
| | - S P Goswami
- All India Institute of Speech & Hearing, Mysuru, India
| | - Maëlenn Guerchet
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, University of California San Francisco, San Francisco, California, USA
| | - Jennie Gubner
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, University of California San Francisco, San Francisco, California, USA
| | - Agustin Ibanez
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, University of California San Francisco, San Francisco, California, USA.,Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago de Chile, Santiago, Chile.,Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, Buenos Aires, Argentina
| | - Stefania Ilinica
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Hussain Jafri
- Fatima Jinnah Medical University Lahore, Lahore, Pakistan
| | - Brian Lawlor
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Aya Ashour Mohamed
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Department of Neurology, Ain Shams University, Cairo, Egypt
| | - Adesola Ogunniyi
- Department of Neurology, University College Hospital, Ibadan, Nigeria
| | - Ian Robertson
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Louise Robinson
- Population Heath Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Aimee Spector
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Paulo Caramelli
- Behavioral and Cognitive Neurology Research Group, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | |
Collapse
|
26
|
Nweke M, Mshunqane N, Govender N, Akinpelu A, Ogunniyi A. Correction: Aerobic Exercise in HIV-Associated Neurocognitive Disorders: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e40486. [PMID: 35763803 PMCID: PMC9277530 DOI: 10.2196/40486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- Martins Nweke
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Enugu, Nigeria
| | - Nombeko Mshunqane
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Nalini Govender
- Department of Basic Medical Sciences, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Aderonke Akinpelu
- Department of Physiotherapy, Faculty of Clinical Sciences, University of Ibadan, Ibadan, Nigeria
| | - Adesola Ogunniyi
- Department of Medicine, Faculty of Clinical Sciences, University of Ibadan, Ibadan, Nigeria
| |
Collapse
|
27
|
Nweke M, Mshunqane N, Govender N, Akinpelu AO, Ogunniyi A. Correction to: Effects of aerobic exercise on quality of life of people with HIV-associated neurocognitive disorder on antiretroviral therapy: a randomised controlled trial. BMC Infect Dis 2022; 22:545. [PMID: 35701734 PMCID: PMC9195468 DOI: 10.1186/s12879-022-07524-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Martins Nweke
- Department of Physiotherapy, School of Healthcare Sciences, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
| | - Nombeko Mshunqane
- Department of Physiotherapy, School of Healthcare Sciences, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Nalini Govender
- Department of Basic Medical Sciences, Durban University of Technology, Durban, South Africa
| | - Aderonke O Akinpelu
- Department of Physiotherapy, Faculty of Clinical Sciences, University of Ibadan, Ibadan, Nigeria
| | - Adesola Ogunniyi
- Department of Medicine, Faculty of Clinical Sciences, University of Ibadan, Ibadan, Nigeria
| |
Collapse
|
28
|
O’Donnell MJ, McQueen M, Sniderman A, Pare G, Wang X, Hankey GJ, Rangarajan S, Chin SL, Rao-Melacini P, Ferguson J, Xavier D, Lisheng L, Zhang H, Pais P, Lopez-Jaramillo P, Damasceno A, Langhorne P, Rosengren A, Dans AL, Elsayed A, Avezum A, Mondo C, Judge C, Diener HC, Ryglewicz D, Czlonkowska A, Pogosova N, Weimar C, Iqbal R, Diaz R, Yusoff K, Yusufali A, Oguz A, Penaherrera E, Lanas F, Ogah OS, Ogunniyi A, Iversen HK, Malaga G, Rumboldt Z, Oveisgharan S, Al Hussain F, Nilanont Y, Yusuf S. Association of Lipids, Lipoproteins, and Apolipoproteins with Stroke Subtypes in an International Case Control Study (INTERSTROKE). J Stroke 2022; 24:224-235. [PMID: 35677977 PMCID: PMC9194539 DOI: 10.5853/jos.2021.02152] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 04/11/2022] [Indexed: 11/11/2022] Open
Abstract
Background and Purpose The association of dyslipidemia with stroke has been inconsistent, which may be due to differing associations within etiological stroke subtypes. We sought to determine the association of lipoproteins and apolipoproteins within stroke subtypes.Methods Standardized incident case-control STROKE study in 32 countries. Cases were patients with acute hospitalized first stroke, and matched by age, sex and site to controls. Concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (apoA1), and apoB were measured. Non-HDL-C was calculated. We estimated multivariable odds ratio (OR) and population attributable risk percentage (PAR%). Outcome measures were all stroke, ischemic stroke (and subtypes), and intracerebral hemorrhage (ICH).Results Our analysis included 11,898 matched case-control pairs; 77.3% with ischemic stroke and 22.7% with ICH. Increasing apoB (OR, 1.10; 95% confidence interval [CI], 1.06 to 1.14 per standard deviation [SD]) and LDL-C (OR, 1.06; 95% CI, 1.02 to 1.10 per SD) were associated with an increase in risk of ischemic stroke, but a reduced risk of ICH. Increased apoB was significantly associated with large vessel stroke (PAR 13.4%; 95% CI, 5.6 to 28.4) and stroke of undetermined cause. Higher HDL-C (OR, 0.75; 95% CI, 0.72 to 0.78 per SD) and apoA1 (OR, 0.63; 95% CI, 0.61 to 0.66 per SD) were associated with ischemic stroke (and subtypes). While increasing HDL-C was associated with an increased risk of ICH (OR, 1.20; 95% CI, 1.14 to 1.27 per SD), apoA1 was associated with a reduced risk (OR, 0.80; 95% CI, 0.75 to 0.85 per SD). ApoB/A1 (OR, 1.38; 95% CI, 1.32 to 1.44 per SD) had a stronger magnitude of association than the ratio of LDL-C/HDL-C (OR, 1.26; 95% CI, 1.21 to 1.31 per SD) with ischemic stroke (<i>P</i><0.0001). Conclusions The pattern and magnitude of association of lipoproteins and apolipoproteins with stroke varies by etiological stroke subtype. While the directions of association for LDL, HDL, and apoB were opposing for ischemic stroke and ICH, apoA1 was associated with a reduction in both ischemic stroke and ICH. The ratio of apoB/A1 was the best lipid predictor of ischemic stroke risk.
Collapse
Affiliation(s)
- Martin J. O’Donnell
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
- Department of Medicine, HRB-Clinical Research Facility, NUI Galway, Galway, Ireland
- Correspondence: Martin J. O’Donnell Department of Medicine, HRB-Clinical Research Facility, NUI Galway, Newcastle Rd., Galway, Ireland Tel: +353-91-494-098 Fax: +353-905-297-3781 E-mail:
| | - Matthew McQueen
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Allan Sniderman
- Division of Cardiology, McGill University Health Center, Montreal, QC, Canada
| | - Guillaume Pare
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Xingyu Wang
- National Center of Cardiovascular Disease, Beijing, China
| | - Graeme J. Hankey
- School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Siu Lim Chin
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Purnima Rao-Melacini
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - John Ferguson
- Department of Medicine, HRB-Clinical Research Facility, NUI Galway, Galway, Ireland
| | - Denis Xavier
- St John’s Medical College and Research Institute, Bangalore, India
| | - Liu Lisheng
- National Center of Cardiovascular Disease, Beijing, China
| | - Hongye Zhang
- Beijing Hypertension League Institute, Beijing, China
| | - Prem Pais
- St John’s Medical College and Research Institute, Bangalore, India
| | - Patricio Lopez-Jaramillo
- Fundacion Oftalmologica de Santander-Clinica Carlos Ardila Lulle (FOSCAL), Bucaramanga, Colombia
| | | | - Peter Langhorne
- Department of Geriatric Medicine, Glasgow Royal Infirmary, University of Glasgow, Glasgow, UK
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy and University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Antonio L. Dans
- College of Medicine, University of Philippines, Manila, Philippines
| | - Ahmed Elsayed
- Department of Surgery, Al Shaab Teaching Hospital, Khartoum, Sudan
| | - Alvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
| | - Charles Mondo
- Department of Cardiology, Kiruddu National Referral Hospital, Kampala, Uganda
| | - Conor Judge
- Department of Medicine, HRB-Clinical Research Facility, NUI Galway, Galway, Ireland
| | - Hans-Christoph Diener
- Institute for Medical Informatics, Department of Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | | | - Anna Czlonkowska
- Department of Neurology, Military Institute of Aviation Medicine, Warsaw, Poland
| | - Nana Pogosova
- National Research Center for Preventive Medicine, Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Christian Weimar
- Institute for Medical Informatics, Department of Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Romana Iqbal
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Rafael Diaz
- Estudios Clínicos Latino America (ECLA), Instituto Cardiovascular de Rosario (ICR), Rosario, Argentina
| | - Khalid Yusoff
- University College Sedaya International (UCSI) University, Kuala Lumpur, Malaysia
| | - Afzalhussein Yusufali
- Department of Medicine, Hatta Hospital, Dubai Health Authority, Dubai Medical College, Dubai, United Arab Emirates
| | - Aytekin Oguz
- Department of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | | | - Fernando Lanas
- Faculty of Medicine, University of La Frontera, Temuco, Chile
| | - Okechukwu S. Ogah
- Division of Cardiovascular Medicine, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Adesola Ogunniyi
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | | | | | | | | | - Yongchai Nilanont
- Neurology Division, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | | |
Collapse
|
29
|
Nweke M, Nombeko M, Govender N, Akinpelu AO, Ogunniyi A. Effects of aerobic exercise on quality of life of people with HIV-associated neurocognitive disorder on antiretroviral therapy: a randomised controlled trial. BMC Infect Dis 2022; 22:419. [PMID: 35488222 PMCID: PMC9055763 DOI: 10.1186/s12879-022-07389-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/13/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND HIV-associated neurocognitive disorder (HAND) negatively impacts quality of life (QoL) of people living with HIV who are on antiretroviral therapy (ART). Behavioural intervention adjunct to ART may improve QoL of people with HAND. We determine the effect of a 12-week aerobic exercise programme on QoL in people with HAND who were receiving ART. TRIAL DESIGN This was a parallel-group, randomised controlled trial with concealed allocation and intention-to-treat analysis. METHODS We identified 73 participants diagnosed with HAND. Participants were sampled from an earlier study that examined the prevalence of HAND according to the Frascati criteria. Participants were randomised and allocated to an intervention of 12-weeks of aerobic exercise, comprising three 20-60 min sessions per week of moderate-intensity aerobic exercise using a cycle ergometer. The primary outcome was QoL, which was evaluated using the World Health Quality of Life Questionnaire (WHOQoL)-BREF. RESULTS Participants in the exercise (n = 39) and control (n = 35) groups had similar sociodemographic characteristics (p > 0.05). Following the 12-week aerobic exercise programme, participants in the exercise group had improved physical (p < 0.001), psychological (p = 0.008) and environmental (p = 0.001) domains of the QoL (p = 0.001) and overall QoL (p = 0.001) relative to the control group. Similarly, participants in the exercise group had lower depression scores than participants in the control group. Depression scores in the exercise group were still lower 3 months post-intervention (p = 0.007). Only the improvements in physical (p = 0.02) and psychological (p = 0.007) domains of QoL were sustained at 3 months post-intervention. CONCLUSIONS Aerobic exercise improves the QoL of people with HAND. To ensure sustained benefits, people with HAND may need to engage in long-term physical exercise. Trial registration The trial is registered with the PAN African Trial Registry (PACTR). Date: 01/09/2020, ID: PACTR202009483415745.
Collapse
Affiliation(s)
- Martins Nweke
- Department of Physiotherapy, School of Healthcare Sciences, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
| | - Mshunqane Nombeko
- Department of Physiotherapy, School of Healthcare Sciences, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Nalini Govender
- Department of Basic Medical Sciences, Durban University of Technology, Durban, South Africa
| | - Aderonke O Akinpelu
- Department of Physiotherapy, Faculty of Clinical Sciences, University of Ibadan, Ibadan, Nigeria
| | - Adesola Ogunniyi
- Department of Medicine, Faculty of Clinical Sciences, University of Ibadan, Ibadan, Nigeria
| |
Collapse
|
30
|
Akinyemi RO, Yaria J, Ojagbemi A, Guerchet M, Okubadejo N, Njamnshi AK, Sarfo FS, Akpalu A, Ogbole G, Ayantayo T, Adokonou T, Paddick SM, Ndetei D, Bosche J, Ayele B, Damas A, Coker M, Mbakile-Mahlanza L, Ranchod K, Bobrow K, Anazodo U, Damasceno A, Seshadri S, Pericak-Vance M, Lawlor B, Miller BL, Owolabi M, Baiyewu O, Walker R, Gureje O, Kalaria RN, Ogunniyi A. Dementia in Africa: Current evidence, knowledge gaps, and future directions. Alzheimers Dement 2022; 18:790-809. [PMID: 34569714 PMCID: PMC8957626 DOI: 10.1002/alz.12432] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/21/2021] [Accepted: 06/11/2021] [Indexed: 12/19/2022]
Abstract
In tandem with the ever-increasing aging population in low and middle-income countries, the burden of dementia is rising on the African continent. Dementia prevalence varies from 2.3% to 20.0% and incidence rates are 13.3 per 1000 person-years with increasing mortality in parts of rapidly transforming Africa. Differences in nutrition, cardiovascular factors, comorbidities, infections, mortality, and detection likely contribute to lower incidence. Alzheimer's disease, vascular dementia, and human immunodeficiency virus/acquired immunodeficiency syndrome-associated neurocognitive disorders are the most common dementia subtypes. Comprehensive longitudinal studies with robust methodology and regional coverage would provide more reliable information. The apolipoprotein E (APOE) ε4 allele is most studied but has shown differential effects within African ancestry compared to Caucasian. More candidate gene and genome-wide association studies are needed to relate to dementia phenotypes. Validated culture-sensitive cognitive tools not influenced by education and language differences are critically needed for implementation across multidisciplinary groupings such as the proposed African Dementia Consortium.
Collapse
Affiliation(s)
- Rufus O Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
| | - Joseph Yaria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
| | - Akin Ojagbemi
- Department of Psychiatry University College Hospital/College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Maëlenn Guerchet
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Njideka Okubadejo
- Neurology Unit, Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi Araba, Lagos, Nigeria
| | - Alfred K Njamnshi
- Department of Neurology, Yaoundé Central Hospital/Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
- Brain Research Africa Initiative (BRAIN), Geneva, Switzerland/Yaoundé, Cameroon
| | - Fred S Sarfo
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Albert Akpalu
- Department of Medicine, University of Ghana Medical School/Korle Bu Teaching Hospital, Accra, Ghana
| | - Godwin Ogbole
- Department of Radiology, University College Hospital/College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Temitayo Ayantayo
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Thierry Adokonou
- Department of Neurology, University Teaching Hospital, Parakou, Benin
| | - Stella-Maria Paddick
- Translational and Clinical Research Institute, Newcastle University, UK/Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - David Ndetei
- Department of Psychiatry, University of Nairobi and African Meatal Health and Training Foundation, Nairobi, Kenya
| | - Judith Bosche
- Kilimanjaro Christian Medical College, Moshi, Tanzania
| | - Biniyam Ayele
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Andrea Damas
- Mirembe Mental Health Hospital, Dodoma, Tanzania
| | - Motunrayo Coker
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Lingani Mbakile-Mahlanza
- Department of Psychology, Faculty of Social Sciences, University of Botswana, Gaborone, Botswana
| | - Kirti Ranchod
- Lufuno Neuropsychiatry Centre, Johannesburg, South Africa
| | - Kirsten Bobrow
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Udunna Anazodo
- Lawson Health Research Institute / Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Albertino Damasceno
- Department of Cardiology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, Texas, USA
| | - Margaret Pericak-Vance
- John T. Hussman Institute for Human Genomics and the Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Brian Lawlor
- Global Brain Health Institute, Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Bruce L Miller
- Global Brain Health Institute, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Mayowa Owolabi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
| | - Olusegun Baiyewu
- Department of Psychiatry University College Hospital/College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Richard Walker
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, North Tyneside General Hospital, North Shields, UK
| | - Oye Gureje
- Department of Psychiatry University College Hospital/College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rajesh N Kalaria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Adesola Ogunniyi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
| |
Collapse
|
31
|
Nweke M, Nombeko M, Govender N, Akinpelu A, Ogunniyi A. Aerobic Exercise in HIV-Associated Neurocognitive Disorders: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e29230. [PMID: 35099405 PMCID: PMC8844984 DOI: 10.2196/29230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/15/2021] [Accepted: 09/14/2021] [Indexed: 11/13/2022] Open
Abstract
Background Since the introduction of antiretroviral therapy (ART), the incidence of HIV-associated dementia has drastically fallen. Despite using ART, people living with HIV continue to experience less severe but limiting forms of HIV-associated neurocognitive disorder (HAND). People living with HIV who are on ART and experiencing symptoms of HAND may benefit from aerobic exercise. Objective This protocol describes a randomized controlled trial designed to determine the effects of a 12-week aerobic exercise program on HAND in Southeastern Nigeria. Methods At least 68 patients diagnosed with HAND will be randomly placed into either an aerobic exercise group or control group. Patients in the aerobic exercise group will perform a moderate intensity workout on a stationary bicycle ergometer, 3 times a week for 12 weeks. We will measure the primary outcomes including neurocognitive performance, prevalence of HAND, viral load, and CD4 count. We will evaluate postexercise neurocognitive performance using reliable neuropsychological tests relevant to people living with HIV, in line with the Frascati criteria. We will assess secondary outcomes such as quality of life, activity limitation, and social participation using the World Health Organization Quality of Life (WHOQOL)-Brief, and the Oxford Participation and Activities questionnaire. We will use exploratory statistics to test the data for normality and homogeneity. We will analyze the effect of the exercise program on HAND using relative risk (RR) and absolute risk reduction (number needed to treat). Analysis of covariance will be run to estimate the effect of exercise on quality of life and activity and participation level. Results This funded trial was approved by the Institutional Review Board in May 2020. The protocol was approved on June 15, 2020. Enrollment commenced in January 2021 and was completed in May 2021. Over 60% of the participants were recruited at the time of first submission to JMIR Mental Health. Data curation is still ongoing; hence, data analysis is yet to be executed. Study outcomes are expected to be published in March 2022. Conclusions This is a protocol for a randomized controlled trial that aims to evaluate the effect of a 12-week aerobic exercise program on HAND in Southeastern Nigeria. Trial Registration Pan African Clinical Trials Registry PACTR202009483415745; https://tinyurl.com/2p97zpu9 International Registered Report Identifier (IRRID) PRR1-10.2196/29230
Collapse
Affiliation(s)
- Martins Nweke
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Enugu, Nigeria
| | - Mshunqane Nombeko
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Nalini Govender
- Department of Basic Medical Sciences, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Aderonke Akinpelu
- Department of Physiotherapy, Faculty of Clinical Sciences, University of Ibadan, Ibadan, Nigeria
| | - Adesola Ogunniyi
- Department of Medicine, Faculty of Clinical Sciences, University of Ibadan, Ibadan, Nigeria
| |
Collapse
|
32
|
Adedeji IA, Ogunniyi A, Henderson DC, Sam-Agudu NA. Experiences and practices of caregiving for older persons living with dementia in African countries: A qualitative scoping review. Dementia (London) 2022; 21:995-1011. [PMID: 34978956 DOI: 10.1177/14713012211065398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The increasing awareness and diagnosis of dementia in Africa necessitate documentation of caregiving practices to understand local patterns and improve the quality of care. Caregiving in African communities is rooted in informal-communal social organization. This scoping review analyses caregiver characteristics and experiences, and practices of caregiving for persons living with dementia in Africa. METHODS A total of 152 references were retrieved, with 64 references obtained from PubMed, 85 from AJOL, and three from Scopus. Based on the relevance of titles, 83 references were further retained from PubMed (64), AJOL (16), and Scopus (3). A rapid review of abstracts was done in Distiller SR, and finally, six relevant articles were content-analyzed using Atlas ti 8.4 qualitative analysis software. RESULTS All six included studies were published between 2003 and 2018. Four themes were identified: article characteristics, caregiver characteristics, caregiver in context, and caregiver potentialities (challenges and opportunities). Studies reported findings from research conducted in four African countries: three from Nigeria, and one each from South Africa, Egypt, and Tanzania. Caregivers of persons living with dementia typically had eight years or less of formal education, were unpaid, and spent a daily average of 13 hours in caregiving. Cultural thresholds and individual caregiver differences underlie the interpretation of stressors across cultures. Caregivers lack the right training and information as well as support systems to improve their role performance and reduce accumulated stress. CONCLUSION In African countries, informational and educational platforms are essential for improved individual dementia caregiving, vis-à-vis strengthened roles of governments, and religious/traditional leaders and organizations.
Collapse
Affiliation(s)
- Isaac A Adedeji
- Department of Sociology, 107991Olabisi Onabanjo University, Ago-Iwoye, Nigeria
| | - Adesola Ogunniyi
- Department of Medicine, 58987University College Hospital, Ibadan, Nigeria
| | - David C Henderson
- Department of Psychiatry, 1846Boston University School of Medicine, USA
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, 12264Institute of Human Virology Nigeria, Abuja, Nigeria.,Department of Paediatrics and Child Health, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana.,Division of Epidemiology and Prevention, Institute of Human Virology, 12264University of Maryland School of Medicine, Baltimore, USA
| |
Collapse
|
33
|
Kerwin D, Abdelnour C, Caramelli P, Ogunniyi A, Shi J, Zetterberg H, Traber M. Alzheimer's disease diagnosis and management: Perspectives from around the world. Alzheimers Dement (Amst) 2022; 14:e12334. [PMID: 35898519 PMCID: PMC9309007 DOI: 10.1002/dad2.12334] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/11/2022] [Accepted: 05/18/2022] [Indexed: 11/17/2022]
Abstract
Alzheimer's disease (AD) and other dementias are a global challenge. Early diagnosis is important to manage the disease. However, there are barriers to diagnosis that differ by region. Researchers from Brazil, China, Nigeria, Spain, and Sweden have identified key barriers to AD diagnosis in their countries. In Brazil, socioeconomic inequalities and poor recognition of dementia by physicians can prevent diagnosis. In China, a very large population and lack of physician training in dementia make diagnosis problematic. In Nigeria, socioeconomic inequalities and cultural stigma can stand in the way of diagnosis. In Spain, patient hesitancy and an overloaded health-care system are barriers to diagnosis. In Sweden, inconsistent use of biomarkers is a prominent barrier to diagnosis of AD. To support diagnosis, more focus is needed on education of patients and physicians, increased use of support services, and improved access to biomarkers to accurately diagnose AD.
Collapse
Affiliation(s)
| | - Carla Abdelnour
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya Barcelona Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED) Instituto de Salud Carlos III Madrid Spain
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Research Group, Faculdade de Medicina Universidade Federal de Minas Gerais Belo Horizonte Brazil
| | | | - Jiong Shi
- Lou Ruvo Center for Brain Health Cleveland Clinic Las Vegas Nevada USA
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry Institute of Neuroscience and Physiology the Sahlgrenska Academy at the University of Gothenburg Mölndal Sweden.,Clinical Neurochemistry Laboratory Sahlgrenska University Hospital Mölndal Sweden.,Department of Neurodegenerative Disease UCL Institute of Neurology London UK.,UK Dementia Research Institute at UCL London UK.,Hong Kong Center for Neurodegenerative Diseases Hong Kong China
| | | |
Collapse
|
34
|
Gray WK, Paddick SM, Ogunniyi A, Olakehinde O, Dotchin C, Kissima J, Urasa S, Kisoli A, Rogathi J, Mushi D, Adebiyi A, Haule I, Robinson L, Walker R. Population normative data for three cognitive screening tools for older adults in sub-Saharan Africa. Dement Neuropsychol 2021; 15:339-349. [PMID: 34630921 PMCID: PMC8485647 DOI: 10.1590/1980-57642021dn15-030005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/28/2021] [Indexed: 01/11/2023] Open
Abstract
In sub-Saharan Africa (SSA),cognitive screening is complicated by both cultural and educational factors, and the existing normative values may not be applicable. The Identification of Dementia in Elderly Africans (IDEA) cognitive screen is a low-literacy measure with good diagnostic accuracy for dementia.
Collapse
Affiliation(s)
- William Keith Gray
- Northumbria Healthcare NHS Foundation Trust, Department of Medicine, North Tyneside General Hospital, North Shields, United Kingdom
| | - Stella-Maria Paddick
- Newcastle University Institute of Population Health Sciences and Clinical and Translational Medicine, Framlington Place, Newcastle upon Tyne, United Kingdom
| | - Adesola Ogunniyi
- University of Ibadan, Department of Medicine, Ibadan, Oyo State, Nigeria
| | - Olaide Olakehinde
- University of Ibadan, Department of Medicine, Ibadan, Oyo State, Nigeria
| | - Catherine Dotchin
- Northumbria Healthcare NHS Foundation Trust, Department of Medicine, North Tyneside General Hospital, North Shields, United Kingdom.,Newcastle University Institute of Population Health Sciences and Clinical and Translational Medicine, Framlington Place, Newcastle upon Tyne, United Kingdom
| | - John Kissima
- Hai District Hospital, District Medical Office, Boman'gombe, Kilimanjaro, Tanzania
| | - Sarah Urasa
- Kilimanjaro Christian Medical University College, Department of Medicine, Moshi, Tanzania
| | - Aloyce Kisoli
- Kilimanjaro Christian Medical University College, Department of Medicine, Moshi, Tanzania
| | - Jane Rogathi
- Kilimanjaro Christian Medical University College, Department of Medicine, Moshi, Tanzania
| | - Declare Mushi
- Kilimanjaro Christian Medical University College, Department of Medicine, Moshi, Tanzania
| | - Akindele Adebiyi
- University of Ibadan, Department of Medicine, Ibadan, Oyo State, Nigeria
| | - Irene Haule
- Hai District Hospital, District Medical Office, Boman'gombe, Kilimanjaro, Tanzania
| | - Louise Robinson
- Newcastle University Institute of Population Health Sciences and Clinical and Translational Medicine, Framlington Place, Newcastle upon Tyne, United Kingdom
| | - Richard Walker
- Northumbria Healthcare NHS Foundation Trust, Department of Medicine, North Tyneside General Hospital, North Shields, United Kingdom.,Newcastle University Institute of Population Health Sciences and Clinical and Translational Medicine, Framlington Place, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
35
|
de Las Fuentes L, Sung YJ, Noordam R, Winkler T, Feitosa MF, Schwander K, Bentley AR, Brown MR, Guo X, Manning A, Chasman DI, Aschard H, Bartz TM, Bielak LF, Campbell A, Cheng CY, Dorajoo R, Hartwig FP, Horimoto ARVR, Li C, Li-Gao R, Liu Y, Marten J, Musani SK, Ntalla I, Rankinen T, Richard M, Sim X, Smith AV, Tajuddin SM, Tayo BO, Vojinovic D, Warren HR, Xuan D, Alver M, Boissel M, Chai JF, Chen X, Christensen K, Divers J, Evangelou E, Gao C, Girotto G, Harris SE, He M, Hsu FC, Kühnel B, Laguzzi F, Li X, Lyytikäinen LP, Nolte IM, Poveda A, Rauramaa R, Riaz M, Rueedi R, Shu XO, Snieder H, Sofer T, Takeuchi F, Verweij N, Ware EB, Weiss S, Yanek LR, Amin N, Arking DE, Arnett DK, Bergmann S, Boerwinkle E, Brody JA, Broeckel U, Brumat M, Burke G, Cabrera CP, Canouil M, Chee ML, Chen YDI, Cocca M, Connell J, de Silva HJ, de Vries PS, Eiriksdottir G, Faul JD, Fisher V, Forrester T, Fox EF, Friedlander Y, Gao H, Gigante B, Giulianini F, Gu CC, Gu D, Harris TB, He J, Heikkinen S, Heng CK, Hunt S, Ikram MA, Irvin MR, Kähönen M, Kavousi M, Khor CC, Kilpeläinen TO, Koh WP, Komulainen P, Kraja AT, Krieger JE, Langefeld CD, Li Y, Liang J, Liewald DCM, Liu CT, Liu J, Lohman KK, Mägi R, McKenzie CA, Meitinger T, Metspalu A, Milaneschi Y, Milani L, Mook-Kanamori DO, Nalls MA, Nelson CP, Norris JM, O'Connell J, Ogunniyi A, Padmanabhan S, Palmer ND, Pedersen NL, Perls T, Peters A, Petersmann A, Peyser PA, Polasek O, Porteous DJ, Raffel LJ, Rice TK, Rotter JI, Rudan I, Rueda-Ochoa OL, Sabanayagam C, Salako BL, Schreiner PJ, Shikany JM, Sidney SS, Sims M, Sitlani CM, Smith JA, Starr JM, Strauch K, Swertz MA, Teumer A, Tham YC, Uitterlinden AG, Vaidya D, van der Ende MY, Waldenberger M, Wang L, Wang YX, Wei WB, Weir DR, Wen W, Yao J, Yu B, Yu C, Yuan JM, Zhao W, Zonderman AB, Becker DM, Bowden DW, Deary IJ, Dörr M, Esko T, Freedman BI, Froguel P, Gasparini P, Gieger C, Jonas JB, Kammerer CM, Kato N, Lakka TA, Leander K, Lehtimäki T, Magnusson PKE, Marques-Vidal P, Penninx BWJH, Samani NJ, van der Harst P, Wagenknecht LE, Wu T, Zheng W, Zhu X, Bouchard C, Cooper RS, Correa A, Evans MK, Gudnason V, Hayward C, Horta BL, Kelly TN, Kritchevsky SB, Levy D, Palmas WR, Pereira AC, Province MM, Psaty BM, Ridker PM, Rotimi CN, Tai ES, van Dam RM, van Duijn CM, Wong TY, Rice K, Gauderman WJ, Morrison AC, North KE, Kardia SLR, Caulfield MJ, Elliott P, Munroe PB, Franks PW, Rao DC, Fornage M. Gene-educational attainment interactions in a multi-ancestry genome-wide meta-analysis identify novel blood pressure loci. Mol Psychiatry 2021; 26:2111-2125. [PMID: 32372009 PMCID: PMC7641978 DOI: 10.1038/s41380-020-0719-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 02/07/2023]
Abstract
Educational attainment is widely used as a surrogate for socioeconomic status (SES). Low SES is a risk factor for hypertension and high blood pressure (BP). To identify novel BP loci, we performed multi-ancestry meta-analyses accounting for gene-educational attainment interactions using two variables, "Some College" (yes/no) and "Graduated College" (yes/no). Interactions were evaluated using both a 1 degree of freedom (DF) interaction term and a 2DF joint test of genetic and interaction effects. Analyses were performed for systolic BP, diastolic BP, mean arterial pressure, and pulse pressure. We pursued genome-wide interrogation in Stage 1 studies (N = 117 438) and follow-up on promising variants in Stage 2 studies (N = 293 787) in five ancestry groups. Through combined meta-analyses of Stages 1 and 2, we identified 84 known and 18 novel BP loci at genome-wide significance level (P < 5 × 10-8). Two novel loci were identified based on the 1DF test of interaction with educational attainment, while the remaining 16 loci were identified through the 2DF joint test of genetic and interaction effects. Ten novel loci were identified in individuals of African ancestry. Several novel loci show strong biological plausibility since they involve physiologic systems implicated in BP regulation. They include genes involved in the central nervous system-adrenal signaling axis (ZDHHC17, CADPS, PIK3C2G), vascular structure and function (GNB3, CDON), and renal function (HAS2 and HAS2-AS1, SLIT3). Collectively, these findings suggest a role of educational attainment or SES in further dissection of the genetic architecture of BP.
Collapse
Affiliation(s)
- Lisa de Las Fuentes
- Cardiovascular Division, Department of Medicine, Washington University, St. Louis, MO, 63110, USA.
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, 63110, USA.
| | - Yun Ju Sung
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, 63110, USA.
| | - Raymond Noordam
- Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, 2333ZA, The Netherlands
| | - Thomas Winkler
- Department of Genetic Epidemiology, University of Regensburg, 93051, Regensburg, Germany
| | - Mary F Feitosa
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St. Louis, MO, 63108, USA
| | - Karen Schwander
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Amy R Bentley
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Michael R Brown
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Xiuqing Guo
- The Institute for Translational Genomics and Population Sciences, Division of Genomic Outcomes, Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | - Alisa Manning
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Daniel I Chasman
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Hugues Aschard
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, 02115, USA
- Centre de Bioinformatique, Biostatistique et Biologie Intégrative (C3BI), Institut Pasteur, Paris, 75724, France
| | - Traci M Bartz
- Cardiovascular Health Research Unit, Biostatistics and Medicine, University of Washington, Seattle, WA, 98101, USA
| | - Lawrence F Bielak
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Archie Campbell
- Centre for Genomic & Experimental Medicine, Institute of Genetics & Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Ching-Yu Cheng
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Ecy Centre, Singapore, 169856, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, 169857, Singapore
| | - Rajkumar Dorajoo
- Genome Institute of Singapore, Agency for Science Technology and Research, Singapore, 138672, Singapore
| | - Fernando P Hartwig
- Postgraduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, RS, 96020-220, Brazil
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK
| | - A R V R Horimoto
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, SP, 5403000, Brazil
| | - Changwei Li
- Epidemiology and Biostatistics, University of Georgia at Athens College of Public Health, Athens, GA, 30602, USA
| | - Ruifang Li-Gao
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, 2333ZA, Netherlands
| | - Yongmei Liu
- Public Health Sciences, Epidemiology and Prevention, Wake Forest University Health Sciences, Winston-Salem, NC, 27157, USA
| | - Jonathan Marten
- Medical Research Council Human Genetics Unit, Institute of Genetics and Molecular Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Solomon K Musani
- Jackson Heart Study, Department of Medicine, University of Mississippi Medical Center, Jackson, MS, 39213, USA
| | - Ioanna Ntalla
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Tuomo Rankinen
- Human Genomics Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Melissa Richard
- Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, 70808, USA
| | - Xueling Sim
- Saw Swee Hock School of Public Health, National University Health System and National University of Singapore, Singapore, 117549, Singapore
| | - Albert V Smith
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, 48109, USA
- Icelandic Heart Association, Kopavogur, 201, Iceland
| | - Salman M Tajuddin
- Health Disparities Research Section, Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, MD, 21224, USA
| | - Bamidele O Tayo
- Department of Public Health Sciences, Loyola University Chicago, Maywood, IL, 60153, USA
| | - Dina Vojinovic
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Helen R Warren
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
- NIHR Barts Cardiovascular Biomedical Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, London, EC1M 6BQ, UK
| | - Deng Xuan
- Biostatistics, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Maris Alver
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, 51010, Estonia
- Department of Biotechnology, Institute of Molecular and Cell Biology, University of Tartu, Tartu, 51010, Estonia
| | - Mathilde Boissel
- CNRS UMR 8199, European Genomic Institute for Diabetes (EGID), Institut Pasteur de Lille, University of Lille, Lille, 59000, France
| | - Jin-Fang Chai
- Saw Swee Hock School of Public Health, National University Health System and National University of Singapore, Singapore, 117549, Singapore
| | - Xu Chen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Stockholm, 17177, Sweden
| | - Kaare Christensen
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, Southern Denmark University, Odense, 5000, Denmark
| | - Jasmin Divers
- Biostatistical Sciences, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Evangelos Evangelou
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, W2 1PG, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, 45110, Greece
| | - Chuan Gao
- Molecular Genetics and Genomics Program, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Giorgia Girotto
- Medical Genetics, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, 34100, Italy
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, 34100, Italy
| | - Sarah E Harris
- Department of Psychology, Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, Edinburgh, EH8 9JZ, UK
| | - Meian He
- Department of Occupational and Environmental Health and State Key Laboratory of Environmental Health for Incubating, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Fang-Chi Hsu
- Biostatistical Sciences, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Brigitte Kühnel
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764, Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764, Neuherberg, Germany
| | - Federica Laguzzi
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, 17177, Sweden
| | - Xiaoyin Li
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, 44106, USA
- Department of Mathematics and Statistics, University of Minnesota, Duluth, MN, 55812, USA
| | - Leo-Pekka Lyytikäinen
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, 33520, Finland
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Technology, University of Tampere, Tampere, 33014, Finland
| | - Ilja M Nolte
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, 9700RB, The Netherlands
| | - Alaitz Poveda
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University Diabetes Centre, Skåne University Hospital, Malmö, Skåne, 205 02, Sweden
| | - Rainer Rauramaa
- Foundation for Research in Health Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine, Kuopio, 70100, Finland
| | - Muhammad Riaz
- College of Medicine, Biological Sciences and Psychology, Health Sciences, The Infant Mortality and Morbidity Studies (TIMMS), Leicester, LE1 7RH, UK
| | - Rico Rueedi
- Department of Computational Biology, University of Lausanne, Lausanne, 1011, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, 1015, Switzerland
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, 37203, USA
| | - Harold Snieder
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, 9700RB, The Netherlands
| | - Tamar Sofer
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Fumihiko Takeuchi
- Department of Gene Diagnostics and Therapeutics, Research Institute, National Center for Global Health and Medicine, Tokyo, 1628655, Japan
| | - Niek Verweij
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, 9700, The Netherlands
| | - Erin B Ware
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, 48104, USA
| | - Stefan Weiss
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, 9713GZ, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Health), Partner Site Greifswald, 17475, Greifswald, Germany
| | - Lisa R Yanek
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Najaf Amin
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dan E Arking
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Donna K Arnett
- Dean's Office, University of Kentucky College of Public Health, Lexington, KY, 40536, USA
| | - Sven Bergmann
- Department of Computational Biology, University of Lausanne, Lausanne, 1011, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, 1015, Switzerland
| | - Eric Boerwinkle
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Jennifer A Brody
- Cardiovascular Health Research Unit, Medicine, University of Washington, Seattle, WA, 98101, USA
| | - Ulrich Broeckel
- Section of Genomic Pediatrics, Department of Pediatrics, Medicine and Physiology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Marco Brumat
- Medical Genetics, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, 34100, Italy
| | - Gregory Burke
- Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, 27109, USA
| | - Claudia P Cabrera
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
- NIHR Barts Cardiovascular Biomedical Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, London, EC1M 6BQ, UK
| | - Mickaël Canouil
- CNRS UMR 8199, European Genomic Institute for Diabetes (EGID), Institut Pasteur de Lille, University of Lille, Lille, 59000, France
| | - Miao Li Chee
- Statistics Unit, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, 169856, Singapore
| | - Yii-Der Ida Chen
- The Institute for Translational Genomics and Population Sciences, Division of Genomic Outcomes, Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | - Massimiliano Cocca
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, 34100, Italy
| | - John Connell
- Ninewells Hospital & Medical School, University of Dundee, Dundee, Scotland, DD1 9SY, UK
| | - H Janaka de Silva
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Paul S de Vries
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | | | - Jessica D Faul
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, 48104, USA
| | - Virginia Fisher
- Biostatistics, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Terrence Forrester
- Tropical Metabolism Research Unit, Tropical Medicine Research Institute, University of the West Indies, Mona, JMAAW15, Jamaica
| | - Ervin F Fox
- Cardiology, Medicine, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Yechiel Friedlander
- Braun School of Public Health, Hebrew University-Hadassah Medical Center, Jerusalem, 91120, Israel
| | - He Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, W2 1PG, UK
- MRC-PHE Centre for Environment and Health, Imperial College London, London, W2 1PG, UK
| | - Bruna Gigante
- Cardiovascular Unit, Bioclinicum, Department of Medicine, Karolinska Hospital, Stockholm, 17164, Sweden
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, 18288, Sweden
| | | | - Chi Charles Gu
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Dongfeng Gu
- Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tamara B Harris
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Jiang He
- Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
- Medicine, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Sami Heikkinen
- Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio Campus, Kuopio, 70211, Finland
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland, Kuopio, 70211, Finland
| | - Chew-Kiat Heng
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
- Khoo Teck Puat - National University Children's Medical Institute, National University Health System, Singapore, 119228, Singapore
| | - Steven Hunt
- Cardiovascular Genetics, Department of Internal Medicine, University of Utah, Salt Lake City, UT, 84108, USA
- Weill Cornell Medicine in Qatar, Doha, Qatar
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marguerite R Irvin
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital, Tampere, 33521, Finland
- Department of Clinical Physiology, Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Health Technology, University of Tampere, Tampere, 33014, Finland
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Chiea Chuen Khor
- Genome Institute of Singapore, Agency for Science Technology and Research, Singapore, 138672, Singapore
- Department of Biochemistry, National University of Singapore, Singapore, 117596, Singapore
| | - Tuomas O Kilpeläinen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, DK-2200, Denmark
- Department of Environmental Medicine and Public Health, The Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Woon-Puay Koh
- Saw Swee Hock School of Public Health, National University Health System and National University of Singapore, Singapore, 117549, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, 169857, Singapore
| | - Pirjo Komulainen
- Foundation for Research in Health Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine, Kuopio, 70100, Finland
| | - Aldi T Kraja
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St. Louis, MO, 63108, USA
| | - J E Krieger
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, SP, 5403000, Brazil
| | - Carl D Langefeld
- Biostatistical Sciences, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Yize Li
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Jingjing Liang
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - David C M Liewald
- Department of Psychology, Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, Edinburgh, EH8 9JZ, UK
| | - Ching-Ti Liu
- Biostatistics, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Jianjun Liu
- Genome Institute of Singapore, Agency for Science Technology and Research, Singapore, 138672, Singapore
- Saw Swee Hock School of Public Health, National University Health System and National University of Singapore, Singapore, 117549, Singapore
| | - Kurt K Lohman
- Public Health Sciences, Biostatistics and Data Science, Wake Forest University Health Sciences, Winston-Salem, NC, 27157, USA
| | - Reedik Mägi
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, 51010, Estonia
| | - Colin A McKenzie
- Tropical Metabolism Research Unit, Tropical Medicine Research Institute, University of the West Indies, Mona, JMAAW15, Jamaica
| | - Thomas Meitinger
- Institute of Human Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764, Neuherberg, Germany
- Institute of Human Genetics, Technische Universität München, 80333, Munich, Germany
| | - Andres Metspalu
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, 51010, Estonia
- Department of Biotechnology, Institute of Molecular and Cell Biology, University of Tartu, Tartu, 51010, Estonia
| | - Yuri Milaneschi
- Department of Psychiatry, Amsterdam Neuroscience and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, 1081 BT, The Netherlands
| | - Lili Milani
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, 51010, Estonia
| | - Dennis O Mook-Kanamori
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, 2333ZA, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, 2333ZA, Netherlands
| | - Mike A Nalls
- Molecular Genetics Section, Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, 20895, USA
- Data Tecnica International, Glen Echo, MD, 20812, USA
| | - Christopher P Nelson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, LE3 9QP, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Jill M Norris
- Department of Epidemiology, University of Colorado Denver, Aurora, CO, 80045, USA
| | - Jeff O'Connell
- Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, MD, USA
- Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Adesola Ogunniyi
- Department of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Sandosh Padmanabhan
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, UK
| | | | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Stockholm, 17177, Sweden
| | - Thomas Perls
- Department of Medicine, Geriatrics Section, Boston Medical Center, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764, Neuherberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 85764, Neuherberg, Germany
| | - Astrid Petersmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, 17475, Greifswald, Germany
| | - Patricia A Peyser
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Ozren Polasek
- University of Split School of Medicine, Split, Croatia
- University Hospital Split, Split, Croatia
- Psychiatric Hospital "Sveti Ivan", Zagreb, Croatia
| | - David J Porteous
- Centre for Genomic & Experimental Medicine, Institute of Genetics & Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
- Department of Psychology, Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, Edinburgh, EH8 9JZ, UK
| | - Leslie J Raffel
- Division of Genetic and Genomic Medicine, Department of Pediatrics, University of California, Irvine, CA, 92868, USA
| | - Treva K Rice
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Division of Genomic Outcomes, Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | - Igor Rudan
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, EH8 9AG, UK
| | | | - Charumathi Sabanayagam
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Ecy Centre, Singapore, 169856, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, 169857, Singapore
| | | | - Pamela J Schreiner
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, 55454, USA
| | - James M Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 25249, USA
| | - Stephen S Sidney
- Division of Research, Kaiser Permanente of Northern California, Oakland, CA, USA
| | - Mario Sims
- Jackson Heart Study, Department of Medicine, University of Mississippi Medical Center, Jackson, MS, 39213, USA
| | - Colleen M Sitlani
- Cardiovascular Health Research Unit, Medicine, University of Washington, Seattle, WA, 98101, USA
| | - Jennifer A Smith
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, 48104, USA
| | - John M Starr
- Alzheimer Scotland Dementia Research Centre, The University of Edinburgh, Edinburgh, EH8 9AZ, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, Edinburgh, UK
| | - Konstantin Strauch
- Institute of Genetic Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764, Neuherberg, Germany
- Institute of Medical Informatics Biometry and Epidemiology, Ludwig-Maximilians-Universitat Munchen, 80539, Munich, Germany
| | - Morris A Swertz
- University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, 9700RB, The Netherlands
| | - Alexander Teumer
- DZHK (German Centre for Cardiovascular Health), Partner Site Greifswald, 17475, Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, 17475, Greifswald, Germany
| | - Yih Chung Tham
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Ecy Centre, Singapore, 169856, Singapore
| | - André G Uitterlinden
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dhananjay Vaidya
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - M Yldau van der Ende
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, 9700, The Netherlands
| | - Melanie Waldenberger
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764, Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764, Neuherberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 85764, Neuherberg, Germany
| | - Lihua Wang
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St. Louis, MO, 63108, USA
| | - Ya-Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Hospital, Capital Medical University, 100730, Beijing, China
| | - Wen-Bin Wei
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, 100730, Beijing, China
| | - David R Weir
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, 48104, USA
| | - Wanqing Wen
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, 37203, USA
| | - Jie Yao
- The Institute for Translational Genomics and Population Sciences, Division of Genomic Outcomes, Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | - Bing Yu
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Caizheng Yu
- Department of Occupational and Environmental Health and State Key Laboratory of Environmental Health for Incubating, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jian-Min Yuan
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer, , University of Pittsburgh, Pittsburgh, PA, 15232, USA
| | - Wei Zhao
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Alan B Zonderman
- Behavioral Epidemiology Section, Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, MD, 21224, USA
| | - Diane M Becker
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Donald W Bowden
- Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Ian J Deary
- Department of Psychology, Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, Edinburgh, EH8 9JZ, UK
| | - Marcus Dörr
- DZHK (German Centre for Cardiovascular Health), Partner Site Greifswald, 17475, Greifswald, Germany
- Department of Internal Medicine B, University Medicine Greifswald, 17475, Greifswald, Germany
| | - Tõnu Esko
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, 51010, Estonia
- Broad Institute of the Massachusetts Institute of Technology and Harvard University, Boston, MA, 02142, USA
| | - Barry I Freedman
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-, Salem, NC, 27157, USA
| | - Philippe Froguel
- CNRS UMR 8199, European Genomic Institute for Diabetes (EGID), Institut Pasteur de Lille, University of Lille, Lille, 59000, France
- Department of Genomics of Common Disease, Imperial College London, London, W12 0NN, UK
| | - Paolo Gasparini
- Medical Genetics, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, 34100, Italy
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, 34100, Italy
| | - Christian Gieger
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764, Neuherberg, Germany
- German Center for Diabetes Research (DZD e.V.), 85764, Neuherberg, Germany
| | - Jost Bruno Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, University Heidelberg, 68167, Mannheim, Germany
- Beijing Institute of Ophthalmology, Beijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Eye Center, Capital Medical University, 100730, Beijing, China
| | - Candace M Kammerer
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Norihiro Kato
- Department of Gene Diagnostics and Therapeutics, Research Institute, National Center for Global Health and Medicine, Tokyo, 1628655, Japan
| | - Timo A Lakka
- Foundation for Research in Health Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine, Kuopio, 70100, Finland
- Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio Campus, Kuopio, 70211, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, 70211, Finland
| | - Karin Leander
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, 17177, Sweden
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, 33520, Finland
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Technology, University of Tampere, Tampere, 33014, Finland
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Stockholm, 17177, Sweden
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, 1011, Switzerland
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam Neuroscience and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, 1081 BT, The Netherlands
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, Leicester, LE3 9QP, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Pim van der Harst
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, 9700, The Netherlands
- Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Ultrecht, The Netherlands
| | - Lynne E Wagenknecht
- Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, 27109, USA
| | - Tangchun Wu
- Department of Occupational and Environmental Health and State Key Laboratory of Environmental Health for Incubating, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, 37203, USA
| | - Xiaofeng Zhu
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Claude Bouchard
- Human Genomics Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Richard S Cooper
- Department of Public Health Sciences, Loyola University Chicago, Maywood, IL, 60153, USA
| | - Adolfo Correa
- Jackson Heart Study, Department of Medicine, University of Mississippi Medical Center, Jackson, MS, 39213, USA
| | - Michele K Evans
- Health Disparities Research Section, Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, MD, 21224, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, 201, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland
| | - Caroline Hayward
- Medical Research Council Human Genetics Unit, Institute of Genetics and Molecular Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Bernardo L Horta
- Postgraduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, RS, 96020-220, Brazil
| | - Tanika N Kelly
- Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
| | - Stephen B Kritchevsky
- Sticht Center for Health Aging and Alzheimer's Prevention, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Daniel Levy
- NHLBI Framingham Heart Study, Framingham, MA, 01702, USA
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD, 20892, USA
| | - Walter R Palmas
- Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY, 10032, USA
| | - A C Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, SP, 5403000, Brazil
| | - Michael M Province
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St. Louis, MO, 63108, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Epidemiology, Medicine and Health Services, University of Washington, Seattle, WA, 98101, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, 98101, USA
| | - Paul M Ridker
- Harvard Medical School, Boston, MA, 02115, USA
- Brigham and Women's Hospital, Boston, MA, 02215, USA
| | - Charles N Rotimi
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - E Shyong Tai
- Saw Swee Hock School of Public Health, National University Health System and National University of Singapore, Singapore, 117549, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, 169857, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University Health System and National University of Singapore, Singapore, 117549, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - Cornelia M van Duijn
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Tien Yin Wong
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Ecy Centre, Singapore, 169856, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, 169857, Singapore
| | - Kenneth Rice
- Department of Biostatistics, University of Washington, Seattle, WA, 98195, USA
| | - W James Gauderman
- Biostatistics, Preventive Medicine, University of Southern California, Los Angeles, CA, 90032, USA
| | - Alanna C Morrison
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Kari E North
- Epidemiology, University of North Carolina Gilling School of Global Public Health, Chapel Hill, NC, 27514, USA
| | - Sharon L R Kardia
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Mark J Caulfield
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
- NIHR Barts Cardiovascular Biomedical Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, London, EC1M 6BQ, UK
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, W2 1PG, UK
- MRC-PHE Centre for Environment and Health, Imperial College London, London, W2 1PG, UK
| | - Patricia B Munroe
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
- NIHR Barts Cardiovascular Biomedical Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, London, EC1M 6BQ, UK
| | - Paul W Franks
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University Diabetes Centre, Skåne University Hospital, Malmö, Skåne, 205 02, Sweden
- Department of Public Health & Clinical Medicine, Umeå University, Umeå, Västerbotten, 901 85, Sweden
| | - Dabeeru C Rao
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Myriam Fornage
- Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, 70808, USA
| |
Collapse
|
36
|
Judge C, O’Donnell MJ, Hankey GJ, Rangarajan S, Chin SL, Rao-Melacini P, Ferguson J, Smyth A, Xavier D, Lisheng L, Zhang H, Lopez-Jaramillo P, Damasceno A, Langhorne P, Rosengren A, Dans AL, Elsayed A, Avezum A, Mondo C, Ryglewicz D, Czlonkowska A, Pogosova N, Weimar C, Diaz R, Yusoff K, Yusufali A, Oguz A, Wang X, Lanas F, Ogah OS, Ogunniyi A, Iversen HK, Malaga G, Rumboldt Z, Oveisgharan S, Al Hussain F, Yusuf S. Urinary Sodium and Potassium, and Risk of Ischemic and Hemorrhagic Stroke (INTERSTROKE): A Case-Control Study. Am J Hypertens 2021; 34:414-425. [PMID: 33197265 PMCID: PMC8057138 DOI: 10.1093/ajh/hpaa176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/27/2020] [Accepted: 11/10/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Although low sodium intake (<2 g/day) and high potassium intake (>3.5 g/day) are proposed as public health interventions to reduce stroke risk, there is uncertainty about the benefit and feasibility of this combined recommendation on prevention of stroke. METHODS We obtained random urine samples from 9,275 cases of acute first stroke and 9,726 matched controls from 27 countries and estimated the 24-hour sodium and potassium excretion, a surrogate for intake, using the Tanaka formula. Using multivariable conditional logistic regression, we determined the associations of estimated 24-hour urinary sodium and potassium excretion with stroke and its subtypes. RESULTS Compared with an estimated urinary sodium excretion of 2.8-3.5 g/day (reference), higher (>4.26 g/day) (odds ratio [OR] 1.81; 95% confidence interval [CI], 1.65-2.00) and lower (<2.8 g/day) sodium excretion (OR 1.39; 95% CI, 1.26-1.53) were significantly associated with increased risk of stroke. The stroke risk associated with the highest quartile of sodium intake (sodium excretion >4.26 g/day) was significantly greater (P < 0.001) for intracerebral hemorrhage (ICH) (OR 2.38; 95% CI, 1.93-2.92) than for ischemic stroke (OR 1.67; 95% CI, 1.50-1.87). Urinary potassium was inversely and linearly associated with risk of stroke, and stronger for ischemic stroke than ICH (P = 0.026). In an analysis of combined sodium and potassium excretion, the combination of high potassium intake (>1.58 g/day) and moderate sodium intake (2.8-3.5 g/day) was associated with the lowest risk of stroke. CONCLUSIONS The association of sodium intake and stroke is J-shaped, with high sodium intake a stronger risk factor for ICH than ischemic stroke. Our data suggest that moderate sodium intake-rather than low sodium intake-combined with high potassium intake may be associated with the lowest risk of stroke and expected to be a more feasible combined dietary target.
Collapse
Affiliation(s)
- Conor Judge
- Department of Medicine, NUI Galway, Galway, Ireland
- Department of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
- Wellcome Trust Health Research Board Irish Clinical Academic Training (ICAT), Dublin, Ireland
| | - Martin J O’Donnell
- Department of Medicine, NUI Galway, Galway, Ireland
- Department of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Graeme J Hankey
- School of Medicine and Pharmacology, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Sumathy Rangarajan
- Department of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Siu Lim Chin
- Department of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Purnima Rao-Melacini
- Department of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | - Andrew Smyth
- Department of Medicine, NUI Galway, Galway, Ireland
| | - Denis Xavier
- Department of Medicine, St John’s Medical College and Research Institute, Bangalore, India
| | - Liu Lisheng
- Department of Medicine, National Center of Cardiovascular Disease, Beijing, China
| | - Hongye Zhang
- Department of Medicine, Beijing Hypertension League Institute, Beijing, China
| | - Patricio Lopez-Jaramillo
- Department of Medicine, Instituto de Investigaciones MASIRA, Universidad de Santander, Bucaramanga, Colombia
| | | | - Peter Langhorne
- Department of Medicine, Glasgow Royal Infirmary, University of Glasgow, Glasgow, Scotland, UK
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Antonio L Dans
- College of Medicine, University of Philippines, Manila, Philippines
| | - Ahmed Elsayed
- Department of Surgery, Al Shaab Teaching Hospital, Khartoum, Sudan
| | - Alvaro Avezum
- Department of Medicine, International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Charles Mondo
- Department of Medicine, Kiruddu National Referral Hospital, Kampala, Uganda
| | | | - Anna Czlonkowska
- Department of Medicine, Military Institute of Aviation Medicine, Warsaw, Poland
| | - Nana Pogosova
- Department of Medicine, National Medical Research Center of Cardiology, Moscow, Russia
| | | | - Rafael Diaz
- Department of Medicine, Estudios Clínicos Latino America (ECLA), Instituto Cardiovascular de Rosario (ICR), Rosario, Argentina
| | - Khalid Yusoff
- Department of Medicine, Universiti Teknologi MARA, Selayang, Selangor and UCSI University, Kuala Lumpur, Malaysia
| | - Afzalhussein Yusufali
- Department of Medicine, Hatta Hospital, Dubai Health Authority/Dubai Medical College, Dubai, UAE
| | - Aytekin Oguz
- Department of Internal Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Xingyu Wang
- Department of Medicine, Beijing Hypertension League Institute, Beijing, China
| | - Fernando Lanas
- Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
| | - Okechukwu S Ogah
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Adesola Ogunniyi
- Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
| | - Helle K Iversen
- Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - German Malaga
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Shahram Oveisgharan
- Department of Medicine, Rush Alzheimer Disease Research Center in Chicago, Chicago, Illinois, USA
| | - Fawaz Al Hussain
- Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Salim Yusuf
- Department of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| |
Collapse
|
37
|
Graff M, Justice AE, Young KL, Marouli E, Zhang X, Fine RS, Lim E, Buchanan V, Rand K, Feitosa MF, Wojczynski MK, Yanek LR, Shao Y, Rohde R, Adeyemo AA, Aldrich MC, Allison MA, Ambrosone CB, Ambs S, Amos C, Arnett DK, Atwood L, Bandera EV, Bartz T, Becker DM, Berndt SI, Bernstein L, Bielak LF, Blot WJ, Bottinger EP, Bowden DW, Bradfield JP, Brody JA, Broeckel U, Burke G, Cade BE, Cai Q, Caporaso N, Carlson C, Carpten J, Casey G, Chanock SJ, Chen G, Chen M, Chen YDI, Chen WM, Chesi A, Chiang CWK, Chu L, Coetzee GA, Conti DV, Cooper RS, Cushman M, Demerath E, Deming SL, Dimitrov L, Ding J, Diver WR, Duan Q, Evans MK, Falusi AG, Faul JD, Fornage M, Fox C, Freedman BI, Garcia M, Gillanders EM, Goodman P, Gottesman O, Grant SFA, Guo X, Hakonarson H, Haritunians T, Harris TB, Harris CC, Henderson BE, Hennis A, Hernandez DG, Hirschhorn JN, McNeill LH, Howard TD, Howard B, Hsing AW, Hsu YHH, Hu JJ, Huff CD, Huo D, Ingles SA, Irvin MR, John EM, Johnson KC, Jordan JM, Kabagambe EK, Kang SJ, Kardia SL, Keating BJ, Kittles RA, Klein EA, Kolb S, Kolonel LN, Kooperberg C, Kuller L, Kutlar A, Lange L, Langefeld CD, Le Marchand L, Leonard H, Lettre G, Levin AM, Li Y, Li J, Liu Y, Liu Y, Liu S, Lohman K, Lotay V, Lu Y, Maixner W, Manson JE, McKnight B, Meng Y, Monda KL, Monroe K, Moore JH, Mosley TH, Mudgal P, Murphy AB, Nadukuru R, Nalls MA, Nathanson KL, Nayak U, N'Diaye A, Nemesure B, Neslund-Dudas C, Neuhouser ML, Nyante S, Ochs-Balcom H, Ogundiran TO, Ogunniyi A, Ojengbede O, Okut H, Olopade OI, Olshan A, Padhukasahasram B, Palmer J, Palmer CD, Palmer ND, Papanicolaou G, Patel SR, Pettaway CA, Peyser PA, Press MF, Rao DC, Rasmussen-Torvik LJ, Redline S, Reiner AP, Rhie SK, Rodriguez-Gil JL, Rotimi CN, Rotter JI, Ruiz-Narvaez EA, Rybicki BA, Salako B, Sale MM, Sanderson M, Schadt E, Schreiner PJ, Schurmann C, Schwartz AG, Shriner DA, Signorello LB, Singleton AB, Siscovick DS, Smith JA, Smith S, Speliotes E, Spitz M, Stanford JL, Stevens VL, Stram A, Strom SS, Sucheston L, Sun YV, Tajuddin SM, Taylor H, Taylor K, Tayo BO, Thun MJ, Tucker MA, Vaidya D, Van Den Berg DJ, Vedantam S, Vitolins M, Wang Z, Ware EB, Wassertheil-Smoller S, Weir DR, Wiencke JK, Williams SM, Williams LK, Wilson JG, Witte JS, Wrensch M, Wu X, Yao J, Zakai N, Zanetti K, Zemel BS, Zhao W, Zhao JH, Zheng W, Zhi D, Zhou J, Zhu X, Ziegler RG, Zmuda J, Zonderman AB, Psaty BM, Borecki IB, Cupples LA, Liu CT, Haiman CA, Loos R, Ng MCY, North KE. Discovery and fine-mapping of height loci via high-density imputation of GWASs in individuals of African ancestry. Am J Hum Genet 2021; 108:564-582. [PMID: 33713608 PMCID: PMC8059339 DOI: 10.1016/j.ajhg.2021.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 02/09/2021] [Indexed: 01/21/2023] Open
Abstract
Although many loci have been associated with height in European ancestry populations, very few have been identified in African ancestry individuals. Furthermore, many of the known loci have yet to be generalized to and fine-mapped within a large-scale African ancestry sample. We performed sex-combined and sex-stratified meta-analyses in up to 52,764 individuals with height and genome-wide genotyping data from the African Ancestry Anthropometry Genetics Consortium (AAAGC). We additionally combined our African ancestry meta-analysis results with published European genome-wide association study (GWAS) data. In the African ancestry analyses, we identified three novel loci (SLC4A3, NCOA2, ECD/FAM149B1) in sex-combined results and two loci (CRB1, KLF6) in women only. In the African plus European sex-combined GWAS, we identified an additional three novel loci (RCCD1, G6PC3, CEP95) which were equally driven by AAAGC and European results. Among 39 genome-wide significant signals at known loci, conditioning index SNPs from European studies identified 20 secondary signals. Two of the 20 new secondary signals and none of the 8 novel loci had minor allele frequencies (MAF) < 5%. Of 802 known European height signals, 643 displayed directionally consistent associations with height, of which 205 were nominally significant (p < 0.05) in the African ancestry sex-combined sample. Furthermore, 148 of 241 loci contained ≤20 variants in the credible sets that jointly account for 99% of the posterior probability of driving the associations. In summary, trans-ethnic meta-analyses revealed novel signals and further improved fine-mapping of putative causal variants in loci shared between African and European ancestry populations.
Collapse
Affiliation(s)
- Mariaelisa Graff
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Anne E Justice
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Population Health Services, Geisinger Health, Danville, PA 17822, USA
| | - Kristin L Young
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Eirini Marouli
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK; Centre for Genomic Health, Life Sciences, Queen Mary University of London, London EC1M 6BQ, UK
| | - Xinruo Zhang
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | | | - Elise Lim
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Victoria Buchanan
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kristin Rand
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Mary F Feitosa
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St. Louis, MO 63108, USA
| | - Mary K Wojczynski
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St. Louis, MO 63108, USA
| | - Lisa R Yanek
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Yaming Shao
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Rebecca Rohde
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Adebowale A Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Melinda C Aldrich
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA; Department of Thoracic Surgery, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA 92093, USA
| | - Christine B Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Stefan Ambs
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Christopher Amos
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Donna K Arnett
- School of Public Health, University of Kentucky, Lexington, KY 40563, USA
| | - Larry Atwood
- Framingham Heart Study, Boston University School of Medicine, Boston, MA 02118, USA
| | - Elisa V Bandera
- Department of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08903, USA
| | - Traci Bartz
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA 98101, USA; Department of Biostatistics, University of Washington, Seattle, WA 98195, USA
| | - Diane M Becker
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Sonja I Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA
| | - Leslie Bernstein
- Division of Biomarkers of Early Detection and Prevention, Department of Population Sciences, Beckman Research Institute of the City of Hope, Duarte, CA 91010, USA
| | - Lawrence F Bielak
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - William J Blot
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA; International Epidemiology Institute, Rockville, MD 20850, USA
| | - Erwin P Bottinger
- The Charles R. Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Donald W Bowden
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Center for Diabetes Research, Wake Forest school of Medicine, Winston-Salem, NC 27157, USA
| | - Jonathan P Bradfield
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Jennifer A Brody
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA 98101, USA
| | - Ulrich Broeckel
- Department of Pediatrics, Section of Genomic Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Gregory Burke
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Brian E Cade
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Qiuyin Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Neil Caporaso
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA
| | - Chris Carlson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - John Carpten
- Department of Translational Genomics, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Graham Casey
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA
| | - Guanjie Chen
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Minhui Chen
- Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Yii-Der I Chen
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| | - Wei-Min Chen
- Department of Public Health Sciences and Center for Public Health Genomics, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Alessandra Chesi
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Charleston W K Chiang
- Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Lisa Chu
- Cancer Prevention Institute of California, Fremont, CA 94538, USA
| | - Gerry A Coetzee
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA; Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, LA 90033, USA
| | - David V Conti
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Richard S Cooper
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, IL 60153, USA
| | - Mary Cushman
- Department of Medicine, University of Vermont College of Medicine, Burlington, VT 05405, USA
| | - Ellen Demerath
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA
| | - Sandra L Deming
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Latchezar Dimitrov
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Jingzhong Ding
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - W Ryan Diver
- Epidemiology Research Program, American Cancer Society, Atlanta, GA 30303, USA
| | - Qing Duan
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Michele K Evans
- Health Disparities Research Section, Clinical Research Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Adeyinka G Falusi
- Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria
| | - Jessica D Faul
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI 48104, USA
| | - Myriam Fornage
- Center for Human Genetics, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Caroline Fox
- Population Sciences Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; Framingham Heart Study, Framingham, MA 01702, USA; Division of Endocrinology and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Barry I Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Melissa Garcia
- National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Elizabeth M Gillanders
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892, USA
| | - Phyllis Goodman
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Omri Gottesman
- The Charles R. Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Struan F A Grant
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Center for Spatial and Functional Genomics, The Children's Hospital of Philadelphia Research Institute, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
| | - Xiuqing Guo
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| | - Hakon Hakonarson
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
| | - Talin Haritunians
- Medical Genetics Institute, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Tamara B Harris
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892, USA
| | - Curtis C Harris
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Brian E Henderson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
| | - Anselm Hennis
- Department of Preventive Medicine, Stony Brook University, Stony Brook, NY 11794, USA; Chronic Disease Research Centre and Faculty of Medical Sciences, University of West Indies, Bridgetown, Barbados; Ministry of Health, Bridgetown, Barbados
| | - Dena G Hernandez
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20814, USA
| | - Joel N Hirschhorn
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA; Division of Endocrinology and Center for Basic and Translational Obesity Research, Boston Children's Hospital, Boston, MA 02115, USA; Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Lorna Haughton McNeill
- Department of Health Disparities Research, Division of OVP, Cancer Prevention and Population Sciences, and Center for Community Implementation and Dissemination Research, Duncan Family Institute, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Timothy D Howard
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | | | - Ann W Hsing
- Cancer Prevention Institute of California, Fremont, CA 94538, USA; Department of Medicine, Stanford Prevention Research Center and Cancer Institute, Stanford, CA 94305, USA
| | - Yu-Han H Hsu
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA; Division of Endocrinology and Center for Basic and Translational Obesity Research, Boston Children's Hospital, Boston, MA 02115, USA; Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Jennifer J Hu
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Chad D Huff
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Dezheng Huo
- Department of Public Health Sciences, University of Chicago, Chicago, IL 60637, USA
| | - Sue A Ingles
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
| | - Marguerite R Irvin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Esther M John
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Joanne M Jordan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Edmond K Kabagambe
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Sun J Kang
- Genetic Epidemiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sharon L Kardia
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Brendan J Keating
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Rick A Kittles
- Division of Health Equities, Department of Population Sciences, City of Hope Medical Center, Duarte, CA 91010, USA
| | - Eric A Klein
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Suzanne Kolb
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Laurence N Kolonel
- Epidemiology Program, Cancer Research Center, University of Hawaii Cancer Center, Honolulu, HI 96813, USA
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Lewis Kuller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Abdullah Kutlar
- Sickle Cell Center, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Leslie Lange
- Division of Biomedical Informatics and Personalized Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Carl D Langefeld
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Loic Le Marchand
- Epidemiology Program, Cancer Research Center, University of Hawaii Cancer Center, Honolulu, HI 96813, USA
| | - Hampton Leonard
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20814, USA; Data Tecnica Int'l, LLC, Glen Echo, MD 20812, USA
| | - Guillaume Lettre
- Montreal Heart Institute, Montréal, QC H1T 1C8, Canada; Department of Medicine, Université de Montréal, Montréal, QC H1T 1C8, Canada
| | - Albert M Levin
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI 48202, USA
| | - Yun Li
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Jin Li
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Yongmei Liu
- Department of Medicine, Division of Cardiology, Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC 27701, USA
| | - Youfang Liu
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Simin Liu
- Department of Epidemiology, Brown University, Providence, RI 02912, USA
| | - Kurt Lohman
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Vaneet Lotay
- The Charles R. Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Yingchang Lu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA; The Charles R. Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - William Maixner
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Barbara McKnight
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA 98101, USA; Department of Biostatistics, University of Washington, Seattle, WA 98195, USA
| | - Yan Meng
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Keri L Monda
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; The Center for Observational Research, Amgen, Inc., Thousand Oaks, CA 91320, USA
| | - Kris Monroe
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Jason H Moore
- Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Thomas H Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Poorva Mudgal
- Center for Diabetes Research, Wake Forest school of Medicine, Winston-Salem, NC 27157, USA
| | - Adam B Murphy
- Department of Urology, Northwestern University, Chicago, IL 60611, USA
| | - Rajiv Nadukuru
- The Charles R. Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Mike A Nalls
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20814, USA; Data Tecnica Int'l, LLC, Glen Echo, MD 20812, USA
| | | | - Uma Nayak
- Department of Public Health Sciences and Center for Public Health Genomics, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | | | - Barbara Nemesure
- Department of Preventive Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | | | - Marian L Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Sarah Nyante
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Heather Ochs-Balcom
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY 14214, USA
| | - Temidayo O Ogundiran
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adesola Ogunniyi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oladosu Ojengbede
- Centre for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Hayrettin Okut
- Center for Diabetes Research, Wake Forest school of Medicine, Winston-Salem, NC 27157, USA
| | - Olufunmilayo I Olopade
- Center for Clinical Cancer Genetics and Global Health, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Andrew Olshan
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Badri Padhukasahasram
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI 48202, USA
| | - Julie Palmer
- Slone Epidemiology Center, Boston University School of Medicine, Boston, MA 02118, USA
| | - Cameron D Palmer
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA; Division of Endocrinology and Center for Basic and Translational Obesity Research, Boston Children's Hospital, Boston, MA 02115, USA
| | - Nicholette D Palmer
- Department of Biochemistry, School of Medicine, Wake Forest University, Winston-Salem, NC 27157, USA
| | - George Papanicolaou
- Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sanjay R Patel
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Curtis A Pettaway
- Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Patricia A Peyser
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Michael F Press
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
| | - D C Rao
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Laura J Rasmussen-Torvik
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Susan Redline
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Alex P Reiner
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Suhn K Rhie
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
| | - Jorge L Rodriguez-Gil
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Charles N Rotimi
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jerome I Rotter
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| | - Edward A Ruiz-Narvaez
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Benjamin A Rybicki
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI 48202, USA
| | - Babatunde Salako
- Centre for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Michele M Sale
- Department of Public Health Sciences and Center for Public Health Genomics, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Maureen Sanderson
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN 37208, USA
| | - Eric Schadt
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA
| | - Claudia Schurmann
- The Charles R. Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ann G Schwartz
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI 48201, USA; Karmanos Cancer Institute, Detroit, MI 48201, USA
| | - Daniel A Shriner
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Lisa B Signorello
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA; International Epidemiology Institute, Rockville, MD 20850, USA
| | - Andrew B Singleton
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20814, USA
| | | | - Jennifer A Smith
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI 48104, USA
| | - Shad Smith
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA
| | - Elizabeth Speliotes
- Division of Gastroenterology and Hepatology, University of Michigan Health System, Ann Arbor, MI 48109, USA; Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Margaret Spitz
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Janet L Stanford
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; Department of Epidemiology, University of Washington School of Public Health, Seattle, WA 98195, USA
| | - Victoria L Stevens
- Epidemiology Research Program, American Cancer Society, Atlanta, GA 30303, USA
| | - Alex Stram
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Sara S Strom
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Lara Sucheston
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Yan V Sun
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Salman M Tajuddin
- National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Herman Taylor
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Kira Taylor
- Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville, Louisville, KY 40202, USA
| | - Bamidele O Tayo
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, IL 60153, USA
| | - Michael J Thun
- Epidemiology Research Program, American Cancer Society, Atlanta, GA 30303, USA
| | - Margaret A Tucker
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA
| | - Dhananjay Vaidya
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - David J Van Den Berg
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
| | - Sailaja Vedantam
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA; Division of Endocrinology and Center for Basic and Translational Obesity Research, Boston Children's Hospital, Boston, MA 02115, USA
| | - Mara Vitolins
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Zhaoming Wang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Erin B Ware
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI 48104, USA
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - David R Weir
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI 48104, USA
| | - John K Wiencke
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Scott M Williams
- Departments of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH 44106, USA
| | - L Keoki Williams
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI 48202, USA; Department of Internal Medicine, Henry Ford Health System, Detroit, MI 48202, USA
| | - James G Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - John S Witte
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94158, USA; Department of Urology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Margaret Wrensch
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94158, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Xifeng Wu
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jie Yao
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| | - Neil Zakai
- Department of Medicine, University of Vermont College of Medicine, Burlington, VT 05405, USA
| | - Krista Zanetti
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892, USA
| | - Babette S Zemel
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA; Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA 19146, USA
| | - Wei Zhao
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Jing Hua Zhao
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge CB2 0QQ, UK
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Degui Zhi
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Jie Zhou
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Xiaofeng Zhu
- Departments of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Regina G Ziegler
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA
| | - Joe Zmuda
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA 98101, USA
| | - Ingrid B Borecki
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St. Louis, MO 63108, USA; BioData Catalyst Program, National Heart, Lung, and Blood Institute, Bethesda, MD 20892, USA
| | - L Adrienne Cupples
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA; Framingham Heart Study, Boston University School of Medicine, Boston, MA 02118, USA
| | - Ching-Ti Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Christopher A Haiman
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
| | - Ruth Loos
- The Charles R. Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; The Mindich Child Health Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Maggie C Y Ng
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Center for Diabetes Research, Wake Forest school of Medicine, Winston-Salem, NC 27157, USA
| | - Kari E North
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| |
Collapse
|
38
|
Ogunjimi L, Yaria J, Makanjuola A, Alabi A, Osalusi B, Oboh D, Olusola-Bello M, Aderinola A, Ogunniyi A. Cognitive dysfunction in Nigerian women with epilepsy on carbamazepine and levetiracetam monotherapy. Brain Behav 2021; 11:e02038. [PMID: 33666367 PMCID: PMC8035450 DOI: 10.1002/brb3.2038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/15/2020] [Accepted: 01/04/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This study aims to identify the determinants of cognitive dysfunction and compare the effect of CPZ and LTC on cognition in WWE. METHODS An observational study involving 87 consenting adult WWE aged between 16 and 40 years on LTC or CZP monotherapy. At enrollment, an interviewer-based questionnaire was used to obtain demographic and clinical information from participants. The diagnosis of epilepsy was mainly clinical and supported by electroencephalographic (EEG) features and classified based on recommendation by the 2017 International League Against Epilepsy (ILAE). Zung Self-Reporting Depression Scale (ZSRDS) was used to assess the mood of participants. The Community Screening Interview for Dementia (CSID) was used to assess various cognition domains. The National Hospital Seizure Severity Scale (NHS-3) was used to assess disease severity. RESULTS There were statistical differences between the CZP and LTC groups in all domains of cognition assessed except for orientation. The total CSID scores of the LTC group were 59.2 (4.9) as opposed to CZP group, 57.2 (5.0); p: .005. Those with focal onset seizures had lower median total CSID score (58; IQR: 54-62) when compared to those with generalized onset seizures (62; IQR: 58-62), p: .012. There was a significant correlation between ZSRD score and NHS-3 score; rho: 0.30, p: .007. Bivariate analysis shows statistically significant correlation between total CSID score and ZSRDS (rho: -0.65), BMI (rho: 0.22), and NHSS-3 score (rho: -0.36), respectively. However, the effect of AED on CSID scores was lost after multivariate quantile regression with only ZSRDS retaining significance. CONCLUSION Depression, seizure severity, type and structural etiology were associated with cognitive impairment among WWE. However, on regression model, only depression was statistically significant. The presence of more risks for cognitive impairment in the CZP group limits possible conclusion of LTC superiority.
Collapse
Affiliation(s)
- Luqman Ogunjimi
- Department of Pharmacology and Therapeutics, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu, Nigeria
| | - Joseph Yaria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | - Akinyinka Alabi
- Department of Pharmacology and Therapeutics, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu, Nigeria
| | - Bamidele Osalusi
- Department of Medicine, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu, Nigeria
| | - David Oboh
- Department of Radiology, University College Hospital, Ibadan, Nigeria
| | - Mojisola Olusola-Bello
- Radiology Department, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu, Nigeria
| | - Adeyinka Aderinola
- Department of Pharmacology and Therapeutics, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu, Nigeria
| | - Adesola Ogunniyi
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| |
Collapse
|
39
|
Ogunjimi L, Yaria J, Makanjuola A, Alabi A, Osalusi B, Oboh D, Olusola‐Bello M, Olawale O, Ogunniyi A. Polycystic ovarian syndrome in Nigerian women with epilepsy on carbamazepine/levetiracetam monotherapy. Acta Neurol Scand 2021; 143:146-153. [PMID: 32885414 DOI: 10.1111/ane.13342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/14/2020] [Accepted: 08/27/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study is aimed at comparing effects of older drugs like carbamazepine (CBZ) and newer agent like levetiracetam (LEV) on polycystic ovarian syndrome (PCOS) in women with epilepsy (WWE). METHODS An interviewer-based questionnaire was used to obtain relevant clinical information from 50 WWE on CBZ and LEV monotherapy, respectively, and 50 age-matched controls. The diagnosis of epilepsy was clinical with electroencephalographic features taken into consideration and the seizures classified using the 2017 International League Against Epilepsy classification. The diagnosis of PCOS was based on the European Society for Human Reproduction and Embryology/American Society for Reproductive Medicine. RESULTS The frequency of PCOS and its subcomponent were higher among WWE compare to controls. PCOS was present in 22 (44%) of LEV group compare to 8 (16%) CBZ group. The frequency of its subcomponent was higher among those on LEV except for comparable effect with regard to oligomenorrhea. The levels of the sex steroid hormone were comparable in both groups of WWE except luteal phase luteinizing hormone, which was lower among the LEV group (P .001). The follicular phase estradiol level was lower (P .021), and follicle-stimulating hormone level was about 2-fold higher (P .03) among WWE compare to controls. The mean value testosterone was significantly lower among controls compared to WWE. CONCLUSIONS The increased frequency of PCOS and its subcomponent and the unsatisfactory effect of LEV compared to CBZ on reproductive endocrine function underscore the need for routine reproductive endocrine evaluation to improve overall quality of life.
Collapse
Affiliation(s)
- Luqman Ogunjimi
- Department of Pharmacology and Therapeutics Obafemi Awolowo College of Health Sciences Olabisi Onabanjo University Sagamu Nigeria
| | - Joseph Yaria
- Department of Medicine University College Hospital Ibadan Nigeria
| | | | - Akinyinka Alabi
- Department of Pharmacology and Therapeutics Obafemi Awolowo College of Health Sciences Olabisi Onabanjo University Sagamu Nigeria
| | - Bamidele Osalusi
- Department of Medicine Obafemi Awolowo College of Health Sciences Olabisi Onabanjo University Sagamu Nigeria
| | - David Oboh
- Department of Radiology University College Hospital Ibadan Nigeria
| | - Mojisola Olusola‐Bello
- Radiology Unit Department of Surgery Obafemi Awolowo College of Health Sciences Olabisi Onabanjo University Sagamu Nigeria
| | - Olatunbosun Olawale
- Department of Chemical Pathology and Immunology Obafemi Awolowo College of Health Sciences Olabisi Onabanjo University Sagamu Nigeria
| | - Adesola Ogunniyi
- Department of Medicine University College Hospital Ibadan Nigeria
| |
Collapse
|
40
|
Gao S, Lai D, Lane KA, Foroud TM, Baiyewu O, Ogunniyi A, Hendrie HC. Associations of targeted genetic variants with Alzheimer’s disease in African Americans and Nigerians. Alzheimers Dement 2020. [DOI: 10.1002/alz.042323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Sujuan Gao
- Indiana Alzheimer Disease Center Indianapolis IN USA
- Indiana University School of Medicine Indianapolis IN USA
| | - Dongbing Lai
- Indiana University School of Medicine Indianapolis IN USA
| | | | | | | | | | - Hugh C Hendrie
- Indiana University School of Medicine Indianapolis IN USA
| |
Collapse
|
41
|
Adebiyi AM, Komolafe MA, Idowu AO, Omon HE, Ogunniyi A. Cardiac autonomic neuropathy in adult epilepsy patients in a tertiary hospital in South-Western Nigeria. Niger J Clin Pract 2020; 23:1437-1442. [PMID: 33047703 DOI: 10.4103/njcp.njcp_73_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Cardiac autonomic neuropathy (CAN) resulting from seizures has been implicated in sudden unexpected death in epilepsy in persons with epilepsy (PWE), however, there are no previous studies of CAN in PWE from Nigeria. OBJECTIVES This study sought to determine the frequency and pattern of CAN in adult PWE in a tertiary hospital in South-western Nigeria and to determine the relationship between seizure variables and CAN. METHODS A cross-sectional study of 80 adult PWE and 80 matched controls aged between 18 and 60 years was carried out between March 2012 and June 2013 at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. Demographic and clinical data were obtained from all the study participants. Anxiety was excluded using the Hamilton Anxiety Scale. Those with conditions that could affect autonomic function, such as chronic renal failure, heart failure, Parkinson's disease, diabetes mellitus, anxiety, and psychiatric disorders and pregnant women were excluded. Five bedside cardiovascular reflex tests were performed on each subject after baseline heart rate and blood pressure (BP) had been recorded. RESULTS The mean age of onset of epilepsy was 19 ± 10 years, whereas the mean duration of epilepsy was 10 ± 8 years. The mean seizure frequency was 14 ± 30 per month (median three seizures per month). Of the 80 patients evaluated, 42 (52.5%) had CAN, whereas none of the controls had CAN. Majority (69%) of the PWE with CAN had purely parasympathetic dysfunction, whereas 3% had purely sympathetic dysfunction and 10% had combined autonomic dysfunction. The PWE in this study had significantly lower tilt ratios and diastolic BP change with Isometric Hand grip as well as significantly higher systolic BP change on standing than the controls. Patients who had more than four seizures per month had higher odds of CAN than those with less frequent seizures (odds ratio 0.275, P value 0.023). Also, patients who had received treatment for less than 10 years were found to have greater odds of CAN than those who had received treatment for a longer period (odds ratio 11.676, P value 0.046). CONCLUSION CAN is common in adult PWE in South-Western Nigeria and the major predictors are short duration of treatment and frequent seizure episodes. Routine screening of these patients may help with early detection of autonomic dysfunction and provide an opportunity for intervention.
Collapse
Affiliation(s)
- A M Adebiyi
- Chesterfield Royal Hospital NHS Foundation Trust, Calow, Chesterfield, United Kingdom
| | - M A Komolafe
- Department of Medicine, Obafemi Awolowo University/Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - A O Idowu
- Department of Medicine, Obafemi Awolowo University/Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - H E Omon
- Department of Surgery, Neurosurgery Unit, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - A Ogunniyi
- Department of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| |
Collapse
|
42
|
Iwuozo EU, Obiako OR, Onyemocho A, Ogunniyi A. Determinants of Health-related Quality of Life in Persons with Epilepsy Seen at a Tertiary Hospital in North Western Nigeria. West Afr J Med 2020; 37:475-480. [PMID: 33058122] [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: 06/11/2023]
Abstract
INTRODUCTION There is a growing global concern about the effect of epilepsy on the Health-Related Quality of Life (HRQoL) of the sufferers. AIM This study assessed the determinants of HRQoL in persons with epilepsy (PWE) in a tertiary hospital in North Western Nigeria. METHODOLOGY A cross-sectional study was carried out on 103 patients with epilepsy aged ≥ 18 years attending Neurology clinic. Ethical clearance was obtained from the Health Research Ethics Committee of the institution. The short version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF) was administered to the participants. Statistical significance was set with p value at 0.05. The determinants of HRQoL was obtained by using univariate and subsequent multivariate logistic regression analysis. RESULT The mean age of patients was 33.4±15.8 years. There were 54(52.4%) males and 49 (47.6%) females. The significant determinants of HRQoLfound were time of last seizure episode (OR = 7.50, 95% CI = 1.36 -41.20, p = 0.021) and social support (OR = 21.5, 95% CI = 3.67 - 125.68, p = 0.001). Following multivariate logistic regression analysis, social support (OR = 29.51, 95% CI = 2.87 - 302.66, p = 0.004) appeared as the independent determinant of HRQoLin PWE. CONCLUSION Social support was the main determining factor of HRQoL in epilepsy patients in this study. Therefore there is the need to ensure a comprehensive care which should include health education, adequate seizure control and social support for epilepsy patients to improve their HRQoL.
Collapse
Affiliation(s)
- E U Iwuozo
- Neurology Unit, Medicine Department, Benue State University Teaching Hospital, Makurdi, Benue State
| | - O R Obiako
- Neurology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Kaduna State
| | - A Onyemocho
- Department of Community Medicine and Epidemiology Benue State University, Makurdi, Benue State
| | - A Ogunniyi
- Neurology Unit, Department of Medicine, University College Hospital, Ibadan, Oyo State
| |
Collapse
|
43
|
Zocher U, Okwor TJ, Dan-Nwafor C, Yahya D, Ita Ita O, Saleh M, Ogunniyi A, Ihekweazu C, Poggensee G. A participatory and systemic training approach for IPC improvement in Nigerian health facilities. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Health care-associated infections (HAI) are one of the most common adverse events in care delivery and a major public health problem. A large percentage of HAI in hospitals are preventable through effective infection prevention and control (IPC) measures. IPC trainings for health care personnel based only on technical content do not lead to sustainable improvement of IPC standard precautions. To address this problem, the Nigeria Centre for Disease Control (NCDC) in collaboration with the Robert Koch Institute (RKI) developed a multimodal training approach to facilitate the transfer of IPC competences into working routine in Nigerian health facilities.
Objectives
The training should foster the ability of health care workers to act and communicate participatory, analyze IPC problems systemically and to develop and perform tailored IPC activities in their health facilities. It should empower health care workers to initiate and promote sustainable IPC improvement locally.
Results
We developed a participatory training approach which focusses on the relational and organizational dimension of IPC. It addresses the human and infrastructural factors for IPC compliance in daily working routine. A variety of training methods offers practice tools in communication, systemic thinking and team work, and allows experiencing a participatory attitude. The training program consists of two face to face workshops and an interjacent field project. 28 Health care workers of 14 health facilities in Lagos State participated the first implementation of the training program in 2018. The training evaluation showed the high relevance of the training to the HCW. The field projects showed that the participants could apply the participatory approach for IPC improvement.
Conclusions
A participatory and systemic approach for IPC trainings enables health care workers to take action for IPC improvement locally.
Key messages
We developed and implemented a participatory training approach that addresses the relational and organizational dimension of IPC. Health care workers took tailored actions for IPC improvement locally.
Collapse
Affiliation(s)
- U Zocher
- Independent Consultant, Heidelberg, Germany
| | - T J Okwor
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - C Dan-Nwafor
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - D Yahya
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - O Ita Ita
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - M Saleh
- Country Office Nigeria, Centres for Disease Control and Prevention, Abuja, Nigeria
| | - A Ogunniyi
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - C Ihekweazu
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - G Poggensee
- Centre for International Health, Robert Koch-Institute, Berlin, Germany
| |
Collapse
|
44
|
Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, Brayne C, Burns A, Cohen-Mansfield J, Cooper C, Costafreda SG, Dias A, Fox N, Gitlin LN, Howard R, Kales HC, Kivimäki M, Larson EB, Ogunniyi A, Orgeta V, Ritchie K, Rockwood K, Sampson EL, Samus Q, Schneider LS, Selbæk G, Teri L, Mukadam N. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet 2020; 396:413-446. [PMID: 32738937 PMCID: PMC7392084 DOI: 10.1016/s0140-6736(20)30367-6] [Citation(s) in RCA: 4024] [Impact Index Per Article: 1006.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 01/31/2020] [Accepted: 02/07/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Gill Livingston
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK.
| | - Jonathan Huntley
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Andrew Sommerlad
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - David Ames
- National Ageing Research Institute and Academic Unit for Psychiatry of Old Age, University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia
| | | | - Sube Banerjee
- Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Alistair Burns
- Department of Old Age Psychiatry, University of Manchester, Manchester, UK
| | - Jiska Cohen-Mansfield
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Heczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel; Minerva Center for Interdisciplinary Study of End of Life, Tel Aviv University, Tel Aviv, Israel
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Sergi G Costafreda
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Amit Dias
- Department of Preventive and Social Medicine, Goa Medical College, Goa, India
| | - Nick Fox
- Dementia Research Centre, UK Dementia Research Institute, University College London, London, UK; Institute of Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Laura N Gitlin
- Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MA, USA
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Helen C Kales
- Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, University of California, Sacramento, CA, USA
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Vasiliki Orgeta
- Division of Psychiatry, University College London, London, UK
| | - Karen Ritchie
- Inserm, Unit 1061, Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, University of Montpellier, Montpellier, France; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kenneth Rockwood
- Centre for the Health Care of Elderly People, Geriatric Medicine Dalhousie University, Halifax, NS, Canada
| | - Elizabeth L Sampson
- Division of Psychiatry, University College London, London, UK; Barnet, Enfield, and Haringey Mental Health Trust, London, UK
| | - Quincy Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MA, USA
| | - Lon S Schneider
- Department of Psychiatry and the Behavioural Sciences and Department of Neurology, Keck School of Medicine, Leonard Davis School of Gerontology of the University of Southern California, Los Angeles, CA, USA
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Geriatric Department, Oslo University Hospital, Oslo, Norway
| | - Linda Teri
- Department Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, WA, USA
| | - Naaheed Mukadam
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| |
Collapse
|
45
|
Ogunniyi A. 'Publish and flourish or perish': Ensuring integrity in research conduct and reporting. Niger Postgrad Med J 2020; 27:259-260. [PMID: 32687129 DOI: 10.4103/npmj.npmj_180_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Adesola Ogunniyi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| |
Collapse
|
46
|
Egu CB, Ogunniyi A. Analysis of the Cerebrospinal Fluid at Point of Care in Resource-Limited Setting: A Pilot Study. West Afr J Med 2020; 37:290-294. [PMID: 32476125] [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: 06/11/2023]
Abstract
BACKGROUND In the face of an emergency, a decision on the need for a timely intervention must be made urgently especially when it has to do with the brain. This study was conducted to determine the usefulness of Urine combistix and glucometer as a "point of care" testing tool in the emergency analysis of cerebrospinal fluid (CSF) in resource-limited settings. METHODOLOGY In this pilot cross-sectional study, CSF and blood glucose were simultaneously measured using a point of care glucometer and central laboratory. The CSF protein, glucose, blood and leucocytes were also assessed using the urine combistix strips. The CSF/blood glucose ratios obtained at the bedside with a glucometer versus those obtained by the central laboratory were also compared. RESULTS Turn-around time for glucometer and Combistix analysis was 3.5minutes (3-4mins) versus 360minutes (300- 600minutes) for the laboratory. A strong correlation was observed amongst urine Combistix values for CSF protein, blood, leucocyte and glucose with those obtained from the laboratory (ROC of 0.875, sensitivity:75% and specificity: 100%). In addition, there was significant correlation of the CSF-blood glucose ratios from both the laboratory versus glucometer. CONCLUSION This pilot study showed that a combination of Combistix analysis for CSF protein, glucose, blood and leucocyte values plus a glucometer analysis of CSF and blood glucose can serve as a reliable and accurate synergistic means for early diagnosis of CSF abnormalities particularly in patients suspected to have meningitis. Finally, it provides a template on which an accurate CSF diagnostic kit can be developed.
Collapse
Affiliation(s)
- C B Egu
- Gloryland Hospitals, Opposite new Commissioners' Quarters Opolo, Yenogoa, Bayelsa State Nigeria
| | - A Ogunniyi
- Department of Medicine,University College Hospital,Ibadan, Nigeria
| |
Collapse
|
47
|
Adewumi OM, Dukhovlinova E, Shehu NY, Zhou S, Council OD, Akanbi MO, Taiwo B, Ogunniyi A, Robertson K, Kanyama C, Hosseinipour MC, Swanstrom R. HIV-1 Central Nervous System Compartmentalization and Cytokine Interplay in Non-Subtype B HIV-1 Infections in Nigeria and Malawi. AIDS Res Hum Retroviruses 2020; 36:490-500. [PMID: 31914800 DOI: 10.1089/aid.2019.0245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
HIV-1 compartmentalization in the central nervous system (CNS) and its contribution to neurological disease have been well documented. Previous studies were conducted among people infected with subtypes B or C where CNS compartmentalization has been observed when comparing viral sequences in the blood to virus in cerebrospinal fluid (CSF). However, little is known about CNS compartmentalization in other HIV-1 subtypes. Using a deep sequencing approach with Primer ID, we conducted a cross-sectional study among Nigerian and Malawian HIV-1 cohorts with or without fungal Cryptococcus infection diagnosed as cryptococcal meningitis (CM) to determine the extent of CSF/CNS compartmentalization with CM. Paired plasma and CSF samples from 45 participants were also analyzed for cytokine/chemokine levels. Viral populations comparing virus in the blood and the CSF ranged from compartmentalized to equilibrated, including minor or partial compartmentalization or clonal amplification of a single viral sequence. The frequency of compartmentalized viral populations in the blood and CSF was similar between the CM- and CM+ participants. We confirmed the potential to see compartmentalization with subtype C infection and have also documented CNS compartmentalization of an HIV-1 subtype G infection. Cytokine profiles indicated a proinflammatory environment, especially within the CSF/CNS. However, sCD163 was suppressed in the CSF in the presence of CM, perhaps due to elevated levels of IL-4, which were also a feature of the cytokine profile, showing a distinct cytokine profile with CM.
Collapse
Affiliation(s)
- Olubusuyi Moses Adewumi
- Department of Virology, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Infectious Disease Institute, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Elena Dukhovlinova
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nathan Y. Shehu
- Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Shuntai Zhou
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Olivia D. Council
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Maxwell O. Akanbi
- Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
- Health Sciences Integrated PhD Program, Center for Education in Health Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Babafemi Taiwo
- Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Adesola Ogunniyi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Kevin Robertson
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cecilia Kanyama
- UNC Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Mina C. Hosseinipour
- UNC Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ronald Swanstrom
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Biochemistry and Biophysics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
48
|
Sarfo FS, Akinyemi R, Howard G, Howard VJ, Wahab K, Cushman M, Levine DA, Ogunniyi A, Unverzagt F, Owolabi M, Ovbiagele B. Vascular-brain Injury Progression after Stroke (VIPS) study: concept for understanding racial and geographic determinants of cognitive decline after stroke. J Neurol Sci 2020; 412:116754. [PMID: 32120131 PMCID: PMC9132491 DOI: 10.1016/j.jns.2020.116754] [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: 07/29/2019] [Revised: 01/31/2020] [Accepted: 02/18/2020] [Indexed: 10/25/2022]
Abstract
Cognitive impairment and dementia (CID) are major public health problems with substantial personal, social, and financial burdens. African Americans are at a heightened risk for Vascular Cognitive Impairment (VCI) compared to European Americans. Recent lines of evidence also suggest a high burden of Post-stroke VCI among indigenous Africans. A better understanding of the cause(s) of the racial disparity in CID, specifically VCI, is needed in order to develop strategies to reduce it. We propose and discuss the conceptual framework for a unique tri-population, trans-continental study titled The Vascular brain Injury Progression after Stroke (VIPS) study. The overarching objective of the VIPS Study will be to explore the interplay of multiple factors (racial, geographical, vascular, lifestyle, nutritional, psychosocial and inflammatory) influencing the level and trajectory of post-stroke cognitive outcomes and examine whether differences between indigenous Africans, African Americans and European Americans exist. We hypothesize that differences which might be due to racial factors will be observed in African Americans versus European Americans as well as Indigenous Africans versus European Americans but not in African Americans versus Indigenous Americans; differences due to geographical factors will be observed in Indigenous Americans versus African Americans and Indigenous Africans versus European Americans but not in African Americans versus European Americans. This overarching objective could be accomplished by building upon existing National Institutes of Health investments in the REasons for Geographical And Racial Differences in Stroke (REGARDS) study (based in the United States of America) and the Stroke Investigative Research and educational Network (SIREN) study (based in Sub-Saharan Africa).
Collapse
Affiliation(s)
- Fred Stephen Sarfo
- Department of Medicine, Neurology Division, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kolawole Wahab
- Department of Medicine, University of Ilorin, Ilorin, Nigeria
| | - Mary Cushman
- Division of Hematology and Oncology, Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Deborah A Levine
- Department of Internal Medicine, University of Michigan (U-M) Medical School (UMMS), Ann Arbor, MI, USA
| | | | - Fred Unverzagt
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco, USA
| |
Collapse
|
49
|
Abstract
Background This study determined the frailty status and its association with mortality among older patients. Design A prospective cohort design. Setting Study was conducted at the medical wards of University College Hospital, Ibadan, Nigeria. Participants and study tools Four hundred and fifty older patients (>60 years) were followed up from the day of admission to death or discharge. Information obtained includes socio-demographic characteristics and clinical frailty was assessed using the Canadian Study of Health and Aging (CSHA) scale. Bivariate and multivariate analyses were carried out using SPSS version 21 at a p <0.05. Results Overall, frailty was identified in 285 (63.3%) respondents. Mortality was significantly higher among frail respondents (25.3%) than non-frail respondents (15.4%) p=0.028. Logistic regression analysis showed factors associated with frailty were: male sex (OR=1.946 [1.005–3.774], p=0.048), non-engagement in occupational activities (OR=2.642 [1.394–5.008], p=0.003), multiple morbidities (OR=4.411 [1.944–10.006], p<0.0001), functional disability (OR=2.114 [1.029–4.343), p=0.042], malnutrition (OR=9.258 [1.029–83.301], p=0.047) and being underweight (OR=7.462 [1.499–37.037], p=0.014). Conclusion The prevalence of frailty among medical in-hospital older patients is very high and calls for its prompt identification and management to improve their survival. Funding The study was self-funded by the authors
Collapse
Affiliation(s)
- Lawrence A Adebusoye
- Chief Tony Anenih Geriatric Centre (CTAGC), University College Hospital, Ibadan, Nigeria
| | - Eniola O Cadmus
- Department of Community Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Mayowa O Owolabi
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Adesola Ogunniyi
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| |
Collapse
|
50
|
Adetunji AA, Adewumi MO, Michael OS, Fayemiwo SA, Ogunniyi A, Taiwo BO. Rapid HIV Antigen-Antibody Assays and Detection of Acute HIV Infection in Sub-Saharan Africa. Am J Trop Med Hyg 2020; 101:285-286. [PMID: 31162006 DOI: 10.4269/ajtmh.19-0144] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Detection of acute HIV infection is a unique problem that fourth-generation HIV assays were expected to alleviate. In this commentary, we draw attention to the limitations and challenges with use of currently available rapid antigen-antibody (Ag/Ab) combination tests for detection of acute HIV infection in sub-Saharan Africa. Laboratory-based HIV-1 Ag/Ab immunoassays are complex, requiring specialized equipment and handling that are currently not affordable in many settings in Africa. The point-of-care Ag/Ab platform on the other hand is easier to deploy and potentially more accessible in resource-limited settings. However, available fourth-generation HIV-1 rapid diagnostic tests have demonstrated poor performance characteristics in field studies where non-B subtypes of HIV-1 dominate. The potential for point-of-care HIV-1 Ag/Ab diagnostics to significantly improve detection of acute HIV infection remains yet to be realized in sub-Saharan Africa. Assay platforms need to be optimized to identify local circulating subtypes, and optimal algorithms need to be determined.
Collapse
Affiliation(s)
| | - Moses O Adewumi
- Department of Virology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Obaro S Michael
- Department of Clinical Pharmacology and Therapeutics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Samuel A Fayemiwo
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adesola Ogunniyi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Babafemi O Taiwo
- Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| |
Collapse
|