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Parkhurst J, Ghilardi L, Webster J, Snow RW, Lynch CA. Competing interests, clashing ideas and institutionalizing influence: insights into the political economy of malaria control from seven African countries. Health Policy Plan 2021; 36:35-44. [PMID: 33319225 PMCID: PMC7938496 DOI: 10.1093/heapol/czaa166] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 11/13/2022] Open
Abstract
This article explores how malaria control in sub-Saharan Africa is shaped in important ways by political and economic considerations within the contexts of aid-recipient nations and the global health community. Malaria control is often assumed to be a technically driven exercise: the remit of public health experts and epidemiologists who utilize available data to select the most effective package of activities given available resources. Yet research conducted with national and international stakeholders shows how the realities of malaria control decision-making are often more nuanced. Hegemonic ideas and interests of global actors, as well as the national and global institutional arrangements through which malaria control is funded and implemented, can all influence how national actors respond to malaria. Results from qualitative interviews in seven malaria-endemic countries indicate that malaria decision-making is constrained or directed by multiple competing objectives, including a need to balance overarching global goals with local realities, as well as a need for National Malaria Control Programmes to manage and coordinate a range of non-state stakeholders who may divide up regions and tasks within countries. Finally, beyond the influence that political and economic concerns have over programmatic decisions and action, our analysis further finds that malaria control efforts have institutionalized systems, structures and processes that may have implications for local capacity development.
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Affiliation(s)
- Justin Parkhurst
- Department of Health Policy, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
| | - Ludovica Ghilardi
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Jayne Webster
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Robert W Snow
- Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
| | - Caroline A Lynch
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Webster J, Hoyt J, Diarra S, Manda-Taylor L, Okoth G, Achan J, Ghilardi L, D’Alessandro U, Madanista M, Kariuki S, Kayentao K, Hill J. Adoption of evidence-based global policies at the national level: intermittent preventive treatment for malaria in pregnancy and first trimester treatment in Kenya, Malawi, Mali and The Gambia. Health Policy Plan 2021; 35:1364-1375. [PMID: 33179027 PMCID: PMC7886437 DOI: 10.1093/heapol/czaa132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2020] [Indexed: 11/14/2022] Open
Abstract
In 2012, the World Health Organization (WHO) updated its policy on intermittent preventive treatment in pregnancy with sulphadoxine-pyrimethamine (IPTp-SP). A global recommendation to revise the WHO policy on the treatment of malaria in the first trimester is under review. We conducted a retrospective study of the national policy adoption process for revised IPTp-SP dosing in four sub-Saharan African countries. Alongside this retrospective study, we conducted a prospective policy adoption study of treatment of first trimester malaria with artemisinin combination therapies (ACTs). A document review informed development and interpretation of stakeholder interviews. An analytical framework was used to analyse data exploring stakeholder perceptions of the policies from 47 in-depth interviews with a purposively selected range of national level stakeholders. National policy adoption processes were categorized into four stages: (1) identify policy need; (2) review the evidence; (3) consult stakeholders and (4) endorse and draft policy. Actors at each stage were identified with the roles of evidence generation; technical advice; consultative and statutory endorsement. Adoption of the revised IPTp-SP policy was perceived to be based on strong evidence, support from WHO, consensus from stakeholders; and followed these stages. Poor tolerability of quinine was highlighted as a strong reason for a potential change in treatment policy. However, the evidence on safety of ACTs in the first trimester was considered weak. For some, trust in WHO was such that the anticipated announcement on the change in policy would allay these fears. For others, local evidence would first need to be generated to support a change in treatment policy. A national policy change from quinine to ACTs for the treatment of first trimester malaria will be less straightforward than experienced with increasing the IPTp dosing regimen despite following the same policy processes. Strong leadership will be needed for consultation and consensus building at national level.
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Affiliation(s)
- Jayne Webster
- Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St., London WC1E 7HT, UK
| | - Jenna Hoyt
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Samba Diarra
- Malaria Research and Training Centre, University of Sciences, Techniques, and Technologies of Bamako, Bamako BP: 1805, Mali
| | - Lucinda Manda-Taylor
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - George Okoth
- Kenya Medical Research Institute/Centre for Global Health Research, Off Kisumu-Busia Road, PO Box 1578-4100 Kisumu, Kenya
| | - Jane Achan
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, The Gambia
| | - Ludovica Ghilardi
- Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St., London WC1E 7HT, UK
| | - Umberto D’Alessandro
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, The Gambia
| | - Mwayi Madanista
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Simon Kariuki
- Kenya Medical Research Institute/Centre for Global Health Research, Off Kisumu-Busia Road, PO Box 1578-4100 Kisumu, Kenya
| | - Kassoum Kayentao
- Malaria Research and Training Centre, University of Sciences, Techniques, and Technologies of Bamako, Bamako BP: 1805, Mali
| | - Jenny Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
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Ghilardi L, Okello G, Nyondo-Mipando L, Chirambo CM, Malongo F, Hoyt J, Lee J, Sedekia Y, Parkhurst J, Lines J, Snow RW, Lynch CA, Webster J. How useful are malaria risk maps at the country level? Perceptions of decision-makers in Kenya, Malawi and the Democratic Republic of Congo. Malar J 2020; 19:353. [PMID: 33008465 PMCID: PMC7530951 DOI: 10.1186/s12936-020-03425-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/23/2020] [Indexed: 11/24/2022] Open
Abstract
Background Declining malaria prevalence and pressure on external funding have increased the need for efficiency in malaria control in sub-Saharan Africa (SSA). Modelled Plasmodium falciparum parasite rate (PfPR) maps are increasingly becoming available and provide information on the epidemiological situation of countries. However, how these maps are understood or used for national malaria planning is rarely explored. In this study, the practices and perceptions of national decision-makers on the utility of malaria risk maps, showing prevalence of parasitaemia or incidence of illness, was investigated. Methods A document review of recent National Malaria Strategic Plans was combined with 64 in-depth interviews with stakeholders in Kenya, Malawi and the Democratic Republic of Congo (DRC). The document review focused on the type of epidemiological maps included and their use in prioritising and targeting interventions. Interviews (14 Kenya, 17 Malawi, 27 DRC, 6 global level) explored drivers of stakeholder perceptions of the utility, value and limitations of malaria risk maps. Results Three different types of maps were used to show malaria epidemiological strata: malaria prevalence using a PfPR modelled map (Kenya); malaria incidence using routine health system data (Malawi); and malaria prevalence using data from the most recent Demographic and Health Survey (DRC). In Kenya the map was used to target preventative interventions, including long-lasting insecticide-treated nets (LLINs) and intermittent preventive treatment in pregnancy (IPTp), whilst in Malawi and DRC the maps were used to target in-door residual spraying (IRS) and LLINs distributions in schools. Maps were also used for operational planning, supply quantification, financial justification and advocacy. Findings from the interviews suggested that decision-makers lacked trust in the modelled PfPR maps when based on only a few empirical data points (Malawi and DRC). Conclusions Maps were generally used to identify areas with high prevalence in order to implement specific interventions. Despite the availability of national level modelled PfPR maps in all three countries, they were only used in one country. Perceived utility of malaria risk maps was associated with the epidemiological structure of the country and use was driven by perceived need, understanding (quality and relevance), ownership and trust in the data used to develop the maps.
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Affiliation(s)
- Ludovica Ghilardi
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
| | - George Okello
- Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
| | - Linda Nyondo-Mipando
- Department of Health Systems and Policy, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Fathy Malongo
- Kinshasa School of Public Health, University of Kinshasa, Mont Amba/Lemba, BP 11850 Kin I, Kinshasa, Democratic Republic of Congo
| | - Jenna Hoyt
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Jieun Lee
- World Vision UK, 1rb, 11 Belgrave Rd, Pimlico, London, SW1V 1RB, UK
| | - Yovitha Sedekia
- Mwanza Intervention Trials Unit (MITU)/ National Institute for Medical Research (NIMR)- Mwanza Research Centre, P.O BOX 11936, Isamilo road, Mwanza, Tanzania
| | - Justin Parkhurst
- London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - Jo Lines
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Robert W Snow
- Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, OX3 7LJ, Oxford, UK
| | - Caroline A Lynch
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Jayne Webster
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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Negrini G, Ghilardi L, Bonomi L, Arnoldi E, Tondini C, Sansi C, Bettini A. Evaluation of the correlation between diverticulosis and the onset of diarrhea in patients with lung cancer treated with immune checkpoint inhibitors. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz449.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gobbini E, Chiari R, Pizzutillo P, Bordi P, Ghilardi L, Pilotto S, Osman G, Cappuzzo F, Cecere F, Riccardi F, Scotti V, Martelli O, Borra G, Maiello E, Rossi A, Graziano P, Gregorc V, Casartelli C, Sergi C, Del Conte A, Delmonte A, Bareggi C, Cortinovis D, Rizzo P, Tabbò F, Rossi G, Bria E, Galetta D, Tiseo M, Di Maio M, Novello S. Real-world outcomes according to treatment strategies in ALK-rearranged non-small-cell lung cancer (NSCLC) patients: an Italian retrospective study. Clin Transl Oncol 2019; 22:294-301. [PMID: 31630357 DOI: 10.1007/s12094-019-02222-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 09/27/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Anaplastic lymphoma kinase (ALK) rearrangement confers sensitivity to ALK inhibitors (ALKis) in non-small-cell lung cancer (NSCLC). Although several drugs provided an impressive outcome benefit, the most effective sequential strategy is still unknown. We describe outcomes of real-life patients according to the treatment strategy received. PATIENTS We retrospectively collected 290 ALK rearranged advanced NSCLC diagnosed between 2011 and 2017 in 23 Italian institutions. RESULTS After a median follow-up of 26 months, PFS for crizotinib and a new generation ALKis were 9.4 [CI 95% 7.9-11.2] and 11.1 months [CI 95% 9.2-13.8], respectively, while TTF were 10.2 [CI 95% 8.5-12.6] and 11.9 months [CI 95% 9.7-17.4], respectively, being consistent across the different settings. The composed outcomes (the sum of PFS or TTF) in patients treated with crizotinib followed by a new generation ALKis were 27.8 months [CI 95% 24.3-33.7] in PFS and 30.4 months [CI 95% 24.7-34.9] in TTF. The median OS from the diagnosis of advanced disease was 39 months [CI 95% 31.8-54.5]. Patients receiving crizotinib followed by a new generation ALKis showed a higher median OS [57 months (CI 95% 42.0-73.8)] compared to those that did not receive crizotinib [38 months (CI 95% 18.6-NR)] and those who performed only crizotinib as target agent [15 months (CI 95% 11.3-34.0)] (P < 0.0001). CONCLUSION The sequential administration of crizotinib and a new generation ALKis provided a remarkable clinical benefit in this real-life population, being an interesting option to consider in selected patients.
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Affiliation(s)
- E Gobbini
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Italy. .,Cancer Research Center Lyon, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon Cedex 08, France.
| | - R Chiari
- Oncology Unit, Santa Maria della Misericordia Hospital, Sant'Andrea delle Fratte, 6156, Perugia, Italy
| | - P Pizzutillo
- Medical Thoracic Unit, IRCCS Istituto Oncologico "Giovanni Paolo II", Viale Orazio Flacco 65, 70124, Bari, Italy
| | - P Bordi
- Medical Oncology Unit, University Hospital, Via Gramsci 14, 43123, Parma, Italy
| | - L Ghilardi
- Oncology Department, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - S Pilotto
- Oncology Unit, Department of Medicine, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - G Osman
- UOSD Pneumologia Oncologica, San Camillo Forlanini Hospital, Circonvallazione Gianicolense 87, 00152, Roma, Italy
| | - F Cappuzzo
- Oncology and Hematology Department, AUSL Romagna-Ravenna, Viale Randi 5, 48100, Ravenna, Italy
| | - F Cecere
- Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Roma, Italy
| | - F Riccardi
- Oncology Unit, Antonio Cardarelli Hospital, Via Antonio Cardarelli 9, 80131, Napoli, Italy
| | - V Scotti
- Radiotherapy Unit, University Hospital Careggi, Largo Brambilla 3, 50134, Firenze, Italy
| | - O Martelli
- Medical Oncology Unit, San Giovanni Addolorata Hospital, Via dell'Amba Aradam 9, 00184, Rome, Italy
| | - G Borra
- Oncology Unit, East Piedmont University, Maggiore della Carità Hospital, Corso Mazzini 18, 28100, Novara, Italy
| | - E Maiello
- Department of Oncology and Hematology, Foundation IRCCS 'Casa Sollievo della Sofferenza', Viale Cappuccini 1, 71013, San Giovanni Rotondo, Italy
| | - A Rossi
- Department of Oncology and Hematology, Foundation IRCCS 'Casa Sollievo della Sofferenza', Viale Cappuccini 1, 71013, San Giovanni Rotondo, Italy
| | - P Graziano
- Department of Oncology and Hematology, Foundation IRCCS 'Casa Sollievo della Sofferenza', Viale Cappuccini 1, 71013, San Giovanni Rotondo, Italy
| | - V Gregorc
- Department of Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Hospital, Via Olgettina Milano 60, 20132, Milano, Italy
| | - C Casartelli
- Oncology Unit, Valduce Hospital, Via Dante Alighieri 11, 22100, Como, Italy
| | - C Sergi
- Oncology Unit, A.O.R.N.A.S Garibaldi Nesima, Via Palermo 636, 95100, Catania, Italy
| | - A Del Conte
- S.O.C. Oncologia Medica e dei Tumori Immunocorrelati, Centro di Riferimento Oncologico (CRO), IRCCS, Via Gallini 2, Aviano, Italy
| | - A Delmonte
- Thoracic Oncology Group, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Via Maroncelli 40, 47014, Meldola, Italy
| | - C Bareggi
- Oncology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122, Milan, Italy
| | - D Cortinovis
- Oncology Unit, ASST San Gerardo Hospital, Via G. B. Pergolesi 33, 20052, Monza, Italy
| | - P Rizzo
- Medical Oncology Division and Breast Unit, Antonio Perrino Hospital, Strada Statale 7 per Mesagne, 72100, Brindisi, Italy
| | - F Tabbò
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Italy
| | - G Rossi
- Operative Unit of Pathologic Anatomy, Azienda Unità Sanitaria Locale della Romagna, Hospital St. Maria delle Croci, Viale Vincenzo Randi 5, 48121, Ravenna, Italy
| | - E Bria
- U.O.C. Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Roma, Italy
| | - D Galetta
- Medical Thoracic Unit, IRCCS Istituto Oncologico "Giovanni Paolo II", Viale Orazio Flacco 65, 70124, Bari, Italy
| | - M Tiseo
- Medical Oncology Unit, University Hospital, Via Gramsci 14, 43123, Parma, Italy
| | - M Di Maio
- Department of Oncology, University of Turin, Mauriziano Umberto I, Via Magellano 1, 10128, Turin, Italy
| | - S Novello
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Italy
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Gobbini E, Pizzutilo P, Chiari R, Pilotto S, Dazzi C, Osman G, Bordi P, Ghilardi L, Cecere F, Graziano P, Maiello E, Borra G, Martelli O, Gregorc V, Scotti V, Casartelli C, Riccardi F, Rizzo P, Del Conte A, Delmonte A, Bareggi C, Cortinovis D, Sergi C, Rossi A, Rossi G, Bria E, Di Maio M, Novello S. MA26.02 Upfront or Sequential Strategy for New Generation Anaplastic Lymphoma Kinase (ALK) Inhibitors: An Italian Retrospective Study. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kondé MK, Diop MK, Curtis MY, Barry A, Kouyaté S, Ghilardi L, Kouyaté S, Diallo AM, Magassouba N, Quick I, Keïta M, Carroll MW, Jansa J, Subissi L. Sex practices and awareness of Ebola virus disease among male survivors and their partners in Guinea. BMJ Glob Health 2017; 2:e000412. [PMID: 29018586 PMCID: PMC5623339 DOI: 10.1136/bmjgh-2017-000412] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/16/2017] [Accepted: 08/17/2017] [Indexed: 02/01/2023] Open
Abstract
Introduction Towards the end of the 2013–2016 West African outbreak, sexually-transmitted Ebola virus re-emerged from Ebola virus disease (EVD) survivors in all three hardest hit countries. We explore sex practices and awareness of the risk of Ebola virus transmission among EVD survivors and their partners. Methods In this cross-sectional study, we recruited a convenience sample of study participants aged >15 years who were male EVD survivors, their sexual partners and a comparison group. We administered a questionnaire to all respondents, estimated self-reported sexual practices and risk awareness and conducted in-depth interviews. Results We recruited 234 EVD survivors, 256 sexual partners of survivors and 65 individuals in the comparison group from five prefectures in Guinea. The prevalence of safe sexual behaviour (regular condom use or sexual abstinence >12 months) and regular condom use in EVD survivors was 38% (95% CI 31% to 44%) and 21% (95% CI 16% to 27%), respectively. Among partners, these prevalences were lower (11%, 95% CI 7% to 15% and 9%, 95% CI 5% to 12%, respectively). EVD survivors were more than five times as likely to engage in safe sexual behaviour compared with the comparison group (aOR 5.59, 95% CI 2.36 to 13.2). One-hundred and thirty one EVD survivors (57%) and 94 partners (37%) were aware of the risk of Ebola virus re-emergence associated with having unsafe sex. Partners who reported not being informed by their husband/boyfriend (EVD survivor) were more likely to be unaware of this risk (aOR 20.5, 95% CI 8.92 to 47.4). Conclusions We disclose here a need to improve knowledge of the disease and close the gap between knowledge and practice found in EVD survivors and their partners. Current and future survivors’ follow-up programmes should include partners and be more effective at communicating sex-related risks. Community-level fears and attitudes that enable stigmatisation should be addressed. Safe sex interventions targeting EVD survivors and their partners should be prioritised.
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Affiliation(s)
- Mandy Kader Kondé
- Department of Public Health, Universite Gamal Abdel Nasser de Conakry, Conakry, Guinea.,Fondation Santé et Développement durable, FOSAD-CEFORPAG, Conakry, Guinea
| | - Moustapha Keita Diop
- Laboratoire d'analyse socio-anthropologique de Guinée (LASAG), Université Général Lansana Conté de Sonfonia-Conakry, Conakry, Guinea
| | - Marie Yvonne Curtis
- Laboratoire d'analyse socio-anthropologique de Guinée (LASAG), Université Général Lansana Conté de Sonfonia-Conakry, Conakry, Guinea
| | - Abdoulaye Barry
- Fondation Santé et Développement durable, FOSAD-CEFORPAG, Conakry, Guinea
| | - Saidou Kouyaté
- Fondation Santé et Développement durable, FOSAD-CEFORPAG, Conakry, Guinea
| | - Ludovica Ghilardi
- Department of Disease Control, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Sékou Kouyaté
- Laboratoire d'analyse socio-anthropologique de Guinée (LASAG), Université Général Lansana Conté de Sonfonia-Conakry, Conakry, Guinea
| | - Aissatou Malal Diallo
- Laboratoire d'analyse socio-anthropologique de Guinée (LASAG), Université Général Lansana Conté de Sonfonia-Conakry, Conakry, Guinea
| | - N'faly Magassouba
- Laboratoire des Fièvres Hémorragiques en Guinée, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea
| | - Isadora Quick
- Institut thématique multi-organismes I3M (Immunologie, Inflammation,Infectiologie et microbiologie), Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Mory Keïta
- WHO Country office, World Health Organization, Conakry, Guinea
| | - Miles W Carroll
- Microbiology services, Public Health England, London, London, UK.,University of Southampton, South General Hospital, Southampton, UK
| | - Josep Jansa
- Section of Epidemic Intelligence and Response, European Centre for Disease Prevention and Control, Stockholm, Stockholms Län, Sweden
| | - Lorenzo Subissi
- Section of Epidemic Intelligence and Response, European Centre for Disease Prevention and Control, Stockholm, Stockholms Län, Sweden.,Global Outbreak Alert and Response Network, World Health Organization, Geneva, Switzerland
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Ghilardi L, Massazza G, Bonomi L, Ciaravino G, Michetti G, Oprandi B, Lucianetti A, Candiago E, Bertuletti C, Gianatti A, Tondini C, Labianca R, Bettini A. Effectiveness of direct egfr mutations research at time of diagnostic biopsy for lung cancer: a single institution outcome research. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv343.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mira E, Guidetti G, Ghilardi L, Fattori B, Malannino N, Maiolino L, Mora R, Ottoboni S, Pagnini P, Leprini M, Pallestrini E, Passali D, Nuti D, Russolo M, Tirelli G, Simoncelli C, Brizi S, Vicini C, Frasconi P. Betahistine dihydrochloride in the treatment of peripheral vestibular vertigo. Eur Arch Otorhinolaryngol 2003; 260:73-7. [PMID: 12582782 DOI: 10.1007/s00405-002-0524-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2001] [Accepted: 06/17/2002] [Indexed: 11/29/2022]
Abstract
The present study compares the efficacy and safety of betahistine dihydrochloride to that of a placebo in recurrent vertigo resulting from Meniere's disease (MD) or in paroxysmal positional vertigo (PPV) of probable vascular origin. The design was double-blind, multicentre and parallel-group randomised. Eleven Italian centres enrolled 144 patients: 75 of the patients were treated with betahistine (41 MD/34 PPV) and 69 with placebos (40 MD/29 PPV). The betahistine dosage was 16 mg twice per day for 3 months. Compared to the placebo, betahistine had a significant effect on the frequency, intensity and duration of vertigo attacks. Associated symptoms and the quality of life also were significantly improved by betahistine. Both the physician's judgement and the patient's opinion on the efficacy and acceptability of the treatment were in agreement as to the superiority of betahistine. The effective and safe profile of betahistine in the treatment of vertigo due to peripheral vestibular disorders was confirmed.
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Affiliation(s)
- Eugenio Mira
- Department of Otorhinolaryngology, University of Pavia, I.R.C.C.S. Policlinico S. Matteo, Pavia, Italy.
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Abstract
In this article, the authors examine the compliance of periodontal patients from a behavioral psychology perspective. The causes of non-compliance are analyzed along with the main methods of intervention. An experiment was carried out in which various behaviour modification techniques were compared. This study, in particular, examined the effect of periodontist's use of behaviour modification techniques on patient compliance in four treatment maintenance conditions. A functional analysis of compliance and non-compliance behaviour revealed various treatment opportunities. Hence, 4 treatment conditions (which included basic oral hygiene instructions, performance feedback, behavioural self-management, and positive reinforcement) were compared in 3 phases. Data collected over a period of 3 months indicated that behavioural self-management plus positive reinforcement increase patient compliance significantly. Implications for further research are discussed in terms of analyzing the cost of each component procedure for both the patient and the doctor in terms of time, money and effort required. Hence, the present study demonstrates that behavioural strategies can make a significant contribution to the area of patient management.
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Affiliation(s)
- R Weinstein
- Department of Periodontology, School of Dentistry, Milan State University, Italy
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Lazzari E, Casella G, Cortesi R, Ghilardi L. [Occluso-postural diagnostic-therapeutic coordination]. Attual Dent 1991; 7:14-6. [PMID: 2049163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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12
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Casella G, Cortesi R, Ghilardi L. [Gnathologic-postural tracing]. Attual Dent 1991; 7:8-12. [PMID: 2049166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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13
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Casella G, Ghilardi L. [Treatment plan for the reconstruction of esthetically important teeth]. Dent Cadmos 1984; 52:15-8, 21-2, 24-5 passim. [PMID: 6598768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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