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Morris SE, Zipfel CM, Peer K, Madewell ZJ, Brenner S, Garg S, Paul P, Slayton RB, Biggerstaff M. Modeling the Impacts of Antiviral Prophylaxis Strategies in Mitigating Seasonal Influenza Outbreaks in Nursing Homes. Clin Infect Dis 2024; 78:1336-1344. [PMID: 38072652 DOI: 10.1093/cid/ciad764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Antiviral chemoprophylaxis is recommended for use during influenza outbreaks in nursing homes to prevent transmission and severe disease among non-ill residents. Centers for Disease Control and Prevention (CDC) guidance recommends prophylaxis be initiated for all non-ill residents once an influenza outbreak is detected and be continued for at least 14 days and until 7 days after the last laboratory-confirmed influenza case is identified. However, not all facilities strictly adhere to this guidance and the impact of such partial adherence is not fully understood. METHODS We developed a stochastic compartmental framework to model influenza transmission within an average-sized US nursing home. We compared the number of symptomatic illnesses and hospitalizations under varying prophylaxis implementation strategies, in addition to different levels of prophylaxis uptake and adherence by residents and healthcare personnel (HCP). RESULTS Prophylaxis implemented according to current guidance reduced total symptomatic illnesses and hospitalizations among residents by a median of 12% and 36%, respectively, compared with no prophylaxis. We did not find evidence that alternative implementations of prophylaxis were more effective: compared to full adoption of current guidance, partial adoption resulted in increased symptomatic illnesses and/or hospitalizations, and longer or earlier adoption offered no additional improvements. In addition, increasing uptake and adherence among nursing home residents was effective in reducing resident illnesses and hospitalizations, but increasing HCP uptake had minimal indirect impacts for residents. CONCLUSIONS The greatest benefits of influenza prophylaxis during nursing home outbreaks will likely be achieved through increasing uptake and adherence among residents and following current CDC guidance.
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Affiliation(s)
- Sinead E Morris
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Casey M Zipfel
- Divison of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Komal Peer
- Division of Environmental Health Science and Practice, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Zachary J Madewell
- Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephan Brenner
- Agency for Toxic Substances and Disease Registry, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shikha Garg
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Prabasaj Paul
- Divison of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rachel B Slayton
- Divison of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Matthew Biggerstaff
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Huang S, Baker K, Ibinaiye T, Oresanya O, Nnaji C, Richardson S. Predictors of accessing seasonal malaria chemoprevention medicines through non-door-to-door distribution in Nigeria. Malar J 2024; 23:131. [PMID: 38702672 PMCID: PMC11067122 DOI: 10.1186/s12936-024-04964-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/25/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND In Nigeria, seasonal malaria chemoprevention (SMC) is typically administered door-to-door to children under five by community medicine distributors during high transmission seasons. While door-to-door distribution (DDD) is exclusively employed in Nigeria as part of standard operating procedures of SMC programmes, some households access SMC through non-DDD channels, such as fixed-point distributions, health facilities, and private purchase. However, analysis of access to SMC medicines through non-DDD has been limited, with little evidence of its outcomes on adherence to the three-day complete course of SMC medicines and caregiver actions in the event of adverse reactions to SMC medicines. METHODS Data were obtained from SMC end-of-round coverage surveys conducted in Nigeria in 2021 and 2022, including 25,278 households for the analysis. The proportion of households accessing SMC medicine through non-DDD and the distribution of various non-DDD sources of SMC medicines were described. Multivariate random-effects logistic regression models were performed to identify predictors of accessing SMC medicines through non-DDD. The associations between non-DDD, and caregiver-reporting of adherence to complete administration of SMC medicines and caregiver actions in the event of adverse reactions to SMC medicines were also assessed. RESULTS Less than 2% (314/24003) of households accessed SMC medicines through non-DDD in the states surveyed. Over 60% of non-DDD access was via health facility personnel and community medicine distributors from different locations. Variables associated with non-DDD access included heads of household being born in the local state (OR = 0.68, 95% CI 0.47 to 0.90), households residing in the study state since the first cycle of the SMC round (OR = 0.39, 95% CI 0.17 to 0.88), households with high wealth index (OR = 1.36, 95% CI 1.01 to 1.82), and caregivers hearing about date of SMC delivery in the previous cycle (OR = 0.18, 95%CI 0.14 to 0.24). Furthermore, non-DDD was associated with reduced SMC adherence and higher caregiver non-reporting of adverse reactions to SMC medicines in children compared with DDD. CONCLUSION This study provides evidence on the characteristics of households accessing SMC medicines through non-DDD and its potential negative outcomes on adherence to SMC medicine and adverse reaction reporting, underscoring potential implementation issues that may arise if non-DDD delivery models are adopted in SMC, particularly in places where DDD had been firstly used.
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Affiliation(s)
- Sikai Huang
- Vanke School of Public Health, Tsinghua University, Beijing, 100083, China
| | - Kevin Baker
- Malaria Consortium UK, The Green House, 244-254 Cambridge Heath Road, London, E2 9DA, UK
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Taiwo Ibinaiye
- Malaria Consortium Nigeria, 33 Pope John Paul Street, Maitama, Abuja-FCT, Nigeria
| | - Olusola Oresanya
- Malaria Consortium Nigeria, 33 Pope John Paul Street, Maitama, Abuja-FCT, Nigeria
| | - Chuks Nnaji
- Malaria Consortium UK, The Green House, 244-254 Cambridge Heath Road, London, E2 9DA, UK
| | - Sol Richardson
- Vanke School of Public Health, Tsinghua University, Beijing, 100083, China.
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Oldenburg CE, Ouattara M, Bountogo M, Boudo V, Ouedraogo T, Compaoré G, Dah C, Zakane A, Coulibaly B, Bagagnan C, Hu H, O’Brien KS, Nyatigo F, Keenan JD, Doan T, Porco TC, Arnold BF, Lebas E, Sié A, Lietman TM. Mass Azithromycin Distribution to Prevent Child Mortality in Burkina Faso: The CHAT Randomized Clinical Trial. JAMA 2024; 331:482-490. [PMID: 38349371 PMCID: PMC10865159 DOI: 10.1001/jama.2023.27393] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/14/2023] [Indexed: 02/15/2024]
Abstract
Importance Repeated mass distribution of azithromycin has been shown to reduce childhood mortality by 14% in sub-Saharan Africa. However, the estimated effect varied by location, suggesting that the intervention may not be effective in different geographical areas, time periods, or conditions. Objective To evaluate the efficacy of twice-yearly azithromycin to reduce mortality in children in the presence of seasonal malaria chemoprevention. Design, Setting, and Participants This cluster randomized placebo-controlled trial evaluating the efficacy of single-dose azithromycin for prevention of all-cause childhood mortality included 341 communities in the Nouna district in rural northwestern Burkina Faso. Participants were children aged 1 to 59 months living in the study communities. Interventions Communities were randomized in a 1:1 ratio to receive oral azithromycin or placebo distribution. Children aged 1 to 59 months were offered single-dose treatment twice yearly for 3 years (6 distributions) from August 2019 to February 2023. Main Outcomes and Measures The primary outcome was all-cause childhood mortality, measured during a twice-yearly enumerative census. Results A total of 34 399 children (mean [SD] age, 25.2 [18] months) in the azithromycin group and 33 847 children (mean [SD] age, 25.6 [18] months) in the placebo group were included. A mean (SD) of 90.1% (16.0%) of the censused children received the scheduled study drug in the azithromycin group and 89.8% (17.1%) received the scheduled study drug in the placebo group. In the azithromycin group, 498 deaths were recorded over 60 592 person-years (8.2 deaths/1000 person-years). In the placebo group, 588 deaths were recorded over 58 547 person-years (10.0 deaths/1000 person-years). The incidence rate ratio for mortality was 0.82 (95% CI, 0.67-1.02; P = .07) in the azithromycin group compared with the placebo group. The incidence rate ratio was 0.99 (95% CI, 0.72-1.36) in those aged 1 to 11 months, 0.92 (95% CI, 0.67-1.27) in those aged 12 to 23 months, and 0.73 (95% CI, 0.57-0.94) in those aged 24 to 59 months. Conclusions and Relevance Mortality in children (aged 1-59 months) was lower with biannual mass azithromycin distribution in a setting in which seasonal malaria chemoprevention was also being distributed, but the difference was not statistically significant. The study may have been underpowered to detect a clinically relevant difference. Trial Registration ClinicalTrials.gov Identifier: NCT03676764.
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Affiliation(s)
- Catherine E. Oldenburg
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Epidemiology & Biostatistics, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
- Institute for Global Health Sciences, University of California, San Francisco
| | | | | | | | | | | | - Clarisse Dah
- Centre de Recherche en Santé de Nouna, Burkina Faso
| | | | | | | | - Huiyu Hu
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Kieran S. O’Brien
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Epidemiology & Biostatistics, University of California, San Francisco
| | - Fanice Nyatigo
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Jeremy D. Keenan
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
| | - Thuy Doan
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
| | - Travis C. Porco
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Epidemiology & Biostatistics, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
| | - Benjamin F. Arnold
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
| | - Elodie Lebas
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Burkina Faso
| | - Thomas M. Lietman
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Epidemiology & Biostatistics, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
- Institute for Global Health Sciences, University of California, San Francisco
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Bell S, Orellana T, Garrett A, Smith K, Kim H, Rosiello A, Rush S, Berger J, Lesnock J. Prophylactic anticoagulation after minimally invasive hysterectomy for endometrial cancer: a cost-effectiveness analysis. Int J Gynecol Cancer 2023; 33:1875-1881. [PMID: 37903564 DOI: 10.1136/ijgc-2023-004922] [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: 11/01/2023] Open
Abstract
OBJECTIVE To determine our institutional rate of venous thromboembolism (VTE) following minimally invasive surgery for endometrial cancer and to perform a cost-effectiveness analysis of extended prophylactic anticoagulation after minimally invasive staging surgery for endometrial cancer. METHODS All patients with newly diagnosed endometrial cancer who underwent minimally invasive staging surgery from January 1, 2017 to December 31, 2020 were identified retrospectively, and clinicopathologic and outcome data were obtained through chart review. Event probabilities and utility decrements were obtained through published clinical data and literature review. A decision model was created to compare 28 days of no post-operative pharmacologic prophylaxis, prophylactic enoxaparin, and prophylactic apixaban. Outcomes included no complications, deep vein thrombosis (DVT), pulmonary embolism, clinically relevant non-major bleeding, and major bleeding. We assumed a willingness-to-pay threshold of $100 000 per quality-adjusted life year (QALY) gained. RESULTS Three of 844 patients (0.36%) had a VTE following minimally invasive staging surgery for endometrial cancer. In this model, no pharmacologic prophylaxis was less costly and more effective than prophylactic apixaban and prophylactic enoxaparin over all parameters examined. When all patients were assigned prophylaxis, prophylactic apixaban was both less costly and more effective than prophylactic enoxaparin. If the risk of DVT was ≥4.8%, prophylactic apixaban was favored over no pharmacologic prophylaxis. On Monte Carlo probabilistic sensitivity analysis for the base case scenario, no pharmacologic prophylaxis was favored in 41.1% of iterations at a willingness-to-pay threshold of $100 000 per QALY. CONCLUSIONS In this cost-effectiveness model, no extended pharmacologic anticoagulation was superior to extended prophylactic enoxaparin and apixaban in clinically early-stage endometrial cancer patients undergoing minimally invasive surgery. This model supports use of prophylactic apixaban for 7 days post-operatively in select patients when the risk of DVT is 4.8% or higher.
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Affiliation(s)
- Sarah Bell
- Obstetrics and Gynecology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Taylor Orellana
- Obstetrics and Gynecology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Alison Garrett
- Obstetrics and Gynecology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kenneth Smith
- Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Haeyon Kim
- Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Abigail Rosiello
- Howard Hughes Medical Institute - West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Shannon Rush
- Obstetrics and Gynecology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jessica Berger
- Obstetrics and Gynecology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jamie Lesnock
- Obstetrics and Gynecology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Greenwood B, Cairns M, Chaponda M, Chico RM, Dicko A, Ouedraogo JB, Phiri KS, Ter Kuile FO, Chandramohan D. Combining malaria vaccination with chemoprevention: a promising new approach to malaria control. Malar J 2021; 20:361. [PMID: 34488784 PMCID: PMC8419817 DOI: 10.1186/s12936-021-03888-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/20/2021] [Indexed: 11/13/2022] Open
Abstract
Malaria control has stalled in a number of African countries and novel approaches to malaria control are needed for these areas. The encouraging results of a recent trial conducted in young children in Burkina Faso and Mali in which a combination of the RTS,S/AS01E malaria vaccine and seasonal malaria chemoprevention led to a substantial reduction in clinical cases of malaria, severe malaria, and malaria deaths compared with the administration of either intervention given alone suggests that there may be other epidemiological/clinical situations in which a combination of malaria vaccination and chemoprevention could be beneficial. Some of these potential opportunities are considered in this paper. These include combining vaccination with intermittent preventive treatment of malaria in infants, with intermittent preventive treatment of malaria in pregnancy (through vaccination of women of child-bearing age before or during pregnancy), or with post-discharge malaria chemoprevention in the management of children recently admitted to hospital with severe anaemia. Other potential uses of the combination are prevention of malaria in children at particular risk from the adverse effects of clinical malaria, such as those with sickle cell disease, and during the final stages of a malaria elimination programme when vaccination could be combined with repeated rounds of mass drug administration. The combination of a pre-erythrocytic stage malaria vaccine with an effective chemopreventive regimen could make a valuable contribution to malaria control and elimination in a variety of clinical or epidemiological situations, and the potential of this approach to malaria control needs to be explored.
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Affiliation(s)
| | - Matthew Cairns
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Alassane Dicko
- Malaria Research and Training Centre, University of Science, Techniques and Technology of Bamako, Bamako, Mali
| | | | - Kamija S Phiri
- School of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
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Zhang Y, Xu S, Zhong C, Li Q, Wu M, Zhang G, Chen R, Liu C, Wu J, Huang L, Chen X, Gao Q, Sun G, Xiong G, Yang X, Hao L, Jin Z, Yang H, Yang N. Periconceptional iron supplementation and risk of gestational diabetes mellitus: A prospective cohort study. Diabetes Res Clin Pract 2021; 176:108853. [PMID: 33961900 DOI: 10.1016/j.diabres.2021.108853] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 11/25/2022]
Abstract
AIMS Iron supplementation has been recommended for healthy pregnancy, but concerns have been raised regarding the potential adverse effects. We sought to examine the impact of periconceptional iron supplement use on subsequent gestational diabetes mellitus (GDM) risk. METHODS Participants (N = 5101) with information on periconceptional micronutrient supplementation and diagnosis of GDM were involved. Information on iron supplementation and general characteristics were collected at enrollment and follow-up visits. GDM was diagnosed by oral glucose tolerance tests (OGTT) conducted at 24-28 weeks of gestation. Robust Poisson regression model was used to estimate the relative risks (RRs) and 95% confidence intervals (CI) for the effect of iron supplement use on GDM. RESULTS 10.5% of the participants were diagnosed with GDM and the incidence was significantly higher in users with iron >30 mg/d for more than 3 months (Iron >30-L) than in nonusers. Adjusted RRs (95% CI) were 1.53 (1.21, 1.93) in Iron >30-L group, 1.14 (0.80, 1.61) in users with iron >30 mg/d for<3 months (Iron > 30-S) and 1.15 (0.86, 1.54) in users with iron ≤30 mg/d for any duration (Iron ≤30) respectively, compared to nonusers. This link in Iron >30-L group was even stronger (adjusted RR: 1.70, 95% CI: 1.25, 2.31) when restricting the analysis among primiparous and iron-replete participants without family history of diabetes. There were no significant differences in birth outcomes among groups. CONCLUSIONS Periconceptional iron supplementation >30 mg/d for long-term was associated with increased GDM risk. The need and safety of prophylactic iron supplement in iron-replete pregnant women should be reconsidered.
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Affiliation(s)
- Yu Zhang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shangzhi Xu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chunrong Zhong
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qian Li
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Meng Wu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Guofu Zhang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Renjuan Chen
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chaoqun Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiangyue Wu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Li Huang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xi Chen
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qin Gao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Guoqiang Sun
- Department of Obstetrics and Gynaecology, Hubei Maternal and Child Health Hospital, Wuhan, Hubei, China
| | - Guoping Xiong
- Department of Obstetrics and Gynaecology, The Central Hospital of Wuhan, Wuhan, Hubei, China
| | - Xuefeng Yang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Liping Hao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhichun Jin
- Department of Integrated Traditional & Western Medicine, Hubei Maternal and Child Health Hospital, Wuhan, Hubei, China
| | - Hongying Yang
- Institute of Health Education, Hubei Provincial Center for Disease Control and Prevention, Wuhan, Hubei, China
| | - Nianhong Yang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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7
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Bartoszko JJ, Siemieniuk RAC, Kum E, Qasim A, Zeraatkar D, Martinez JPD, Azab M, Ibrahim S, Izcovich A, Soto GB, Roldan Y, Agarwal A, Agoritsas T, Chu DK, Couban R, Devji T, Foroutan F, Ghadimi M, Honarmand K, Khamis A, Lamontagne F, Loeb M, McLeod SL, Motaghi S, Murthy S, Mustafa RA, Rochwerg B, Switzer C, Thabane L, Vandvik PO, Vernooij RWM, Wang Y, Yao L, Guyatt GH, Brignardello-Petersen R. Prophylaxis against covid-19: living systematic review and network meta-analysis. BMJ 2021; 373:n949. [PMID: 33903131 PMCID: PMC8073806 DOI: 10.1136/bmj.n949] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UPDATES This is the second version (first update) of the living systematic review, replacing the previous version (available as a data supplement). When citing this paper please consider adding the version number and date of access for clarity. OBJECTIVE To determine and compare the effects of drug prophylaxis on severe acute respiratory syndrome coronavirus virus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (covid-19). DESIGN Living systematic review and network meta-analysis (NMA). DATA SOURCES World Health Organization covid-19 database, a comprehensive multilingual source of global covid-19 literature to 4 March 2022. STUDY SELECTION Randomised trials in which people at risk of covid-19 were allocated to prophylaxis or no prophylaxis (standard care or placebo). Pairs of reviewers independently screened potentially eligible articles. METHODS After duplicate data abstraction, we conducted random-effects bayesian network meta-analysis. We assessed risk of bias of the included studies using a modification of the Cochrane risk of bias 2.0 tool and assessed the certainty of the evidence using the grading of recommendations assessment, development and evaluation (GRADE) approach. RESULTS The second iteration of this living NMA includes 32 randomised trials which enrolled 25 147 participants and addressed 21 different prophylactic drugs; adding 21 trials (66%), 18 162 participants (75%) and 16 (76%) prophylactic drugs. Of the 16 prophylactic drugs analysed, none provided convincing evidence of a reduction in the risk of laboratory confirmed SARS-CoV-2 infection. For admission to hospital and mortality outcomes, no prophylactic drug proved different than standard care or placebo. Hydroxychloroquine and vitamin C combined with zinc probably increase the risk of adverse effects leading to drug discontinuation—risk difference for hydroxychloroquine (RD) 6 more per 1000 (95% credible interval (CrI) 2 more to 10 more); for vitamin C combined with zinc, RD 69 more per 1000 (47 more to 90 more), moderate certainty evidence. CONCLUSIONS Much of the evidence remains very low certainty and we therefore anticipate future studies evaluating drugs for prophylaxis may change the results for SARS-CoV-2 infection, admission to hospital and mortality outcomes. Both hydroxychloroquine and vitamin C combined with zinc probably increase adverse effects. SYSTEMATIC REVIEW REGISTRATION This review was not registered. The protocol established a priori is included as a supplement. FUNDING This study was supported by the Canadian Institutes of Health Research (grant CIHR-IRSC:0579001321).
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Affiliation(s)
- Jessica J Bartoszko
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Joint first authors
| | - Reed AC Siemieniuk
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Joint first authors
| | - Elena Kum
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Joint first authors
| | - Anila Qasim
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Joint first authors
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Joint first authors
| | - Juan Pablo Diaz Martinez
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Maria Azab
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Sara Ibrahim
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Ariel Izcovich
- Servicio de Clinica Médica del Hospital Alemán, Buenos Aires, Argentina
| | - Gonzalo Bravo Soto
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Yetiani Roldan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Arnav Agarwal
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Derek K Chu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Rachel Couban
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Tahira Devji
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Farid Foroutan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Maryam Ghadimi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Kimia Honarmand
- Department of Medicine, Western University, London, ON, Canada
| | - Assem Khamis
- Wolfson Palliative Care Research Centre, Hull York Medical School, Hull, UK
| | - Francois Lamontagne
- Department of Medicine and Centre de recherche du CHU de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mark Loeb
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Shelley L McLeod
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Sharhzad Motaghi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Srinivas Murthy
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Reem A Mustafa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, University of Kansas Medical Center, Kansas City, MO, USA
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Charlotte Switzer
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Per O Vandvik
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Robin WM Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Ying Wang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Liang Yao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Romina Brignardello-Petersen
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
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8
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Ahmad A, Prom A, Bradley J, Ndiath M, Etoketim B, Bah M, Van Geertruyden JP, Drakeley C, Bousema T, Achan J, D'Alessandro U. Gametocyte carriage after seasonal malaria chemoprevention in Plasmodium falciparum infected asymptomatic children. Malar J 2021; 20:169. [PMID: 33771166 PMCID: PMC7995796 DOI: 10.1186/s12936-021-03706-1] [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: 11/16/2020] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment of clinical Plasmodium falciparum malaria with sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ) is associated with increased post-treatment gametocyte carriage. The effect of seasonal malaria chemoprevention (SMC) with SP and AQ on gametocyte carriage was assessed in asymptomatic P. falciparum infected children. METHODS The study was carried out in eastern Gambia. Asymptomatic P. falciparum malaria infected children aged 24-59 months old who were eligible to receive SMC (SMC group) and children 5-8 years that were not eligible to receive SMC (comparison group) were recruited. Gametocytaemia was determined by molecular methods before and after SMC administration. Gametocyte carriage between the groups was compared using the chi-squared test and within-person using conditional logistic regression. RESULTS During the 2017 and 2018 malaria transmission seasons, 65 and 75 children were recruited in the SMC and comparison groups, respectively. Before SMC administration, gametocyte prevalence was 10.7% (7/65) in the SMC group and 13.3% (10/75) in the comparison group (p = 0.64). At day 13 (IQR 12, 13) after SMC administration, this was 9.4% (5/53) in children who received at least the first dose of SMC treatment and 12.7% (9/71) for those in the comparison group (p = 0.57). Similarly, there was no difference in prevalence of gametocytes between children that adhered to all 3-day doses of SMC treatment 15.6% (5/32) and those in the comparison group (p = 0.68). In the SMC group, within-group gametocyte carriage was similar before and after SMC administration in children that received at least the first dose of SMC treatment (OR 0.6, 95% CI 0.14-2.51; p = 0.48) and in those that adhered to all 3-day doses of SMC treatment (OR 1.0, 95% CI 0.20-4.95; p = 1.0). CONCLUSION In this study with relative low gametocyte prevalence prior to SMC treatment, no evidence was observed that SMC treatment increased gametocyte carriage in asymptomatic P. falciparum malaria infected children.
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Affiliation(s)
- Abdullahi Ahmad
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia At London, School of Hygiene and Tropical Medicine, P.O Box 273, Banjul, The Gambia.
- Global Health Institute, University of Antwerp, Gouverneur Kinsbergencentrum, Campus Drie Eiken, Doornstraat 331, 2610, Wilrijk, Belgium.
| | - Aurelia Prom
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia At London, School of Hygiene and Tropical Medicine, P.O Box 273, Banjul, The Gambia
| | - John Bradley
- MRC Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Mamadou Ndiath
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia At London, School of Hygiene and Tropical Medicine, P.O Box 273, Banjul, The Gambia
| | - Blessed Etoketim
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia At London, School of Hygiene and Tropical Medicine, P.O Box 273, Banjul, The Gambia
| | - Mamadou Bah
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia At London, School of Hygiene and Tropical Medicine, P.O Box 273, Banjul, The Gambia
| | - Jean-Pierre Van Geertruyden
- Global Health Institute, University of Antwerp, Gouverneur Kinsbergencentrum, Campus Drie Eiken, Doornstraat 331, 2610, Wilrijk, Belgium
| | - Chris Drakeley
- Department of Immunology and Infection, School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Teun Bousema
- Department of Medical Microbiology, Radboud University Medical Center, Geert Grooteplein 28, Microbiology 268, 6500 HB, Nijmegen, The Netherlands
| | - Jane Achan
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia At London, School of Hygiene and Tropical Medicine, P.O Box 273, Banjul, The Gambia
| | - Umberto D'Alessandro
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia At London, School of Hygiene and Tropical Medicine, P.O Box 273, Banjul, The Gambia
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9
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Varasteh Kia M, Lau BD, Owodunni OP, Kraus PS, Holzmueller CG, Hobson DB, Shaffer DL, Streiff MB, Haut ER. Nonadministration of pharmacologic venous thromboembolism prophylaxis is less common in hospitalized patients with COVID-19. J Thromb Thrombolysis 2021; 52:471-475. [PMID: 33507453 PMCID: PMC7840619 DOI: 10.1007/s11239-021-02384-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2021] [Indexed: 12/28/2022]
Abstract
Introduction The incidence of venous thromboembolism (VTE) in patients hospitalized with COVID-19 is higher than most other hospitalized patients. Nonadministration of pharmacologic VTE prophylaxis is common and is associated with VTE events. Our objective was to determine whether nonadministration of pharmacologic VTE prophylaxis is more common in patients with COVID-19 versus other hospitalized patients. Materials and methods In this retrospective cohort analysis of all adult patients discharged from the Johns hopkins hospital between Mar 1 and May 12, 2020, we compared demographic, clinical characteristics, VTE outcomes, prescription and administration of VTE prophylaxis between COVID-19 positive, negative, and not tested groups. Results Patients tested positive for COVID-19 were significantly older, and more likely to be Hispanic, have a higher median body mass index, have longer hospital length of stay, require mechanical ventilation, develop pulmonary embolism and die (all p < 0.001). COVID-19 patients were more likely to be prescribed (aOR 1.51, 95% CI 1.38–1.66) and receive all doses of prescribed pharmacologic VTE prophylaxis (aOR 1.48, 95% CI 1.36–1.62). The number of patients who missed at least one dose of VTE prophylaxis and developed VTE was similar between the three groups (p = 0.31). Conclusions It is unlikely that high rates of VTE in COVID-19 are due to nonadministration of doses of pharmacologic prophylaxis. Hence, we should prioritize research into alternative approaches to optimizing VTE prevention in patients with COVID-19.
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Affiliation(s)
- Mujan Varasteh Kia
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Brandyn D. Lau
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD USA
- Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, MD USA
- The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Oluwafemi P. Owodunni
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Peggy S. Kraus
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD USA
| | - Christine G. Holzmueller
- The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD USA
| | - Deborah B. Hobson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
- The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD USA
- Department of Nursing, The Johns Hopkins Hospital, Baltimore, MD USA
| | - Dauryne L. Shaffer
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
- Department of Nursing, The Johns Hopkins Hospital, Baltimore, MD USA
| | - Michael B. Streiff
- The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD USA
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Elliott R. Haut
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
- The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD USA
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
- The Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, MD USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Sheikh Zayed 6107C, 1800 Orleans St., Baltimore, MD 21287 USA
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10
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Juszkiewicz K, Jarosz MJ, Włoszczak-Szubzda A, Głowacka M. Effectiveness of tuberculosis prophylaxis in patients with HIV/AIDS - retrospective analysis of data from Almaty, Kazakhstan, 2010-2015. Ann Agric Environ Med 2020; 27:695-701. [PMID: 33356080 DOI: 10.26444/aaem/118611] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION According to data from the National Centre for Prevention and Control of AIDS, in the Republic of Kazakhstan, 45.8% of patients in the symptomatic stages of HIV infection are diagnosed with tuberculosis (TB) which is the cause of death in 36% of patients infected with HIV. OBJECTIVE The aim of the study was to conduct a retrospective analysis of the effectiveness of tuberculosis (TB) chemoprophylaxis among people living with HIV in the Republic of Kazakhstan (RK) in Central Asia. MATERIAL AND METHODS Materials and method. A retrospective analysis of patient health status was performed for each of the 648 patients (323 in the study group and 325 in the control group) during 2010-2015. Data from outpatient treatment charts were used concerning each patient infected with HIV observed at AIDS Treatment Centres. From among the 648 patients infected with HIV, 136 were receiving isoniazid in 2010, and 187 in 2011. The control group consisted of 325 people living with HIV (PLW HIV), who did not received isoniazid during observation. RESULTS Results. The incidence of TB in patients who underwent chemoprophylaxis did not exceed 0.555/ 100,000 population in the first year of observation. Within 5 years, the TB incidence dropped to 0. In the control group, the TB incidence rate during the first year of observation was 3.262/100,000, with a decrease to 0.364 observed in 2015. Cumulated incidence rate in 2011-2015 in the study group accounted for 1.276/100,000. In the control group, the cumulative incidence was 4.3 times higher and accounted for 5.527. A significant difference in the mortality rate due to TB in the study and control groups was observed, the share of deaths due to TB in study group was 21.6% - nearly 3 times lower than in the control group (57.0%). CONCLUSIONS Conclusions. The effectiveness of chemoprophylaxis for TB depends on biomedical, organizational and cultural factors. The presence of HIV co-infections is a special situation. Opposite to the majority of reports, in own study, no drug-resistant forms of tuberculosis were observed in relation with chemoprophylaxis with isoniazid. In the examined population, TB chemoprophylaxis reduced the incidence and cumulative incidence of TB among PLW HIV by 3.4-4.8 times. Isoniazid chemoprophylaxis decreased 4-fold the annual and cumulative mortality due to TB.
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Visalli G, Facciolà A, Laganà P, Di Pietro A. Food chemoprevention and air pollution: the health comes with eating. Rev Environ Health 2020; 35:471-479. [PMID: 32573482 DOI: 10.1515/reveh-2019-0072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 05/13/2020] [Indexed: 06/11/2023]
Abstract
Ambient air pollution is known to be an important causative agent of many non-communicable diseases, mainly due to fine particulate matter (PM2.5). According to Global Burden Disease study in 2015, the estimated premature deaths caused by PM2.5 were 4.2 million. Besides deaths, airborne pollution's effect on human health also has dramatic economic and social costs, contributing greatly to disability-adjusted life-year (DALY). To reduce the health impact is necessary a double approach, which includes the improvement of air quality and food chemoprevention, aimed at enhancing the homeostatic abilities of exposed subjects. The scavenging, antioxidant, and anti-inflammatory properties of nutraceuticals effectively counteract the pathogenic mechanisms common in almost all non-communicable diseases associated with air pollutants. Moreover, several bioactive compounds of food modulate, by epigenetic mechanisms, the metabolism of xenobiotics, favouring conjugation reactions and promoting excretion. This narrative review summarize the numerous pieces of evidence collected in the last decades by observational and experimental studies which underline the chemopreventive role of flavonoids, contained in several fruits and consumer beverages (wine, tea, etc.), and isothiocyanate sulforaphane, contained in the cruciferous vegetables belonging to the genus Brassica. These bioactive compounds, enhancing the individual homeostatic abilities, reduce the harmful effects of airborne pollution.
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Affiliation(s)
- Giuseppa Visalli
- Department of Biomedical and Dental Sciences and Morpho Functional Imaging, University of Messina, Messina, Italy
| | - Alessio Facciolà
- Epidemiology Operative Unit, Department of Prevention, Health Provincial Agency, Messina, Italy
| | - Pasqualina Laganà
- Department of Biomedical and Dental Sciences and Morpho Functional Imaging, University of Messina, Messina, Italy
| | - Angela Di Pietro
- Department of Biomedical and Dental Sciences and Morpho Functional Imaging, University of Messina, Messina, Italy
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12
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Liang F, Chao M, Li JB, Ye XM. Characteristics and risk factors of deep vein thrombosis in hemiplegic, healthy and bilateral limbs of hemiplegic patients: a 10-year retrospective study. J Thromb Thrombolysis 2020; 51:798-804. [PMID: 32852670 DOI: 10.1007/s11239-020-02254-w] [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] [Accepted: 08/11/2020] [Indexed: 11/25/2022]
Abstract
Deep vein thrombosis (DVT) in hemiplegic patients mainly affects hemiplegic limbs, DVT can also occur only in healthy limbs, and some hemiplegic patients have DVT in both limbs. Characteristics and risk factors of DVT in hemiplegic, healthy, and bilateral limbs are unknown. To describe the proportion, risk factors, extent, and timing of DVT in hemiplegic, healthy and bilateral limbs. A 10-year retrospective review of consecutive patients was performed. DVT affected hemiplegic limbs in 34 (62%), healthy limbs in 11 (20%), and was bilateral in 10 (18%). DVT was more likely to develop in healthy limbs of hemiplegic patients without surgery (odds ratio (OR) 0.022; 95% confidence interval (CI) 0.001-0.922), and without diabetes (OR 0.023, 95% CI 0.001-0.853). Among the veins at the level of which DVT occurred, intermuscular veins represented 20 (45%) in hemiplegic, 5 (37%) in healthy, and 6 (74%) in bilateral limbs. The median time that DVT occurred after hemiplegia onset was 18 days (interquartile range [IQR] 9-79) in hemiplegic, 17 days (IQR 10-56) in healthy, and 21 days (IQR 8-27) in bilateral limbs. Early and effective prevention of DVT after surgery and optimal management of diabetes may reduce the risk of DVT in bilateral limbs. It's important to prevent proximal extension of calf vein DVT. DVT prophylaxis should be started early and continued for at least 3 weeks after hemiplegia onset.
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Affiliation(s)
- Feng Liang
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, No.158, Shangtang Road, Xiacheng District, Hangzhou, 310014, Zhejiang, China
| | - Min Chao
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jue-Bao Li
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, No.158, Shangtang Road, Xiacheng District, Hangzhou, 310014, Zhejiang, China
| | - Xiang-Ming Ye
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, No.158, Shangtang Road, Xiacheng District, Hangzhou, 310014, Zhejiang, China.
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13
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Asfaw MA, Zerdo Z, Churko C, Seife F, Yihune M, Chisha Y, Teshome A, Getachew B, Negussu N. Preventive chemotherapy coverage against soil-transmitted helminth infection among school age children: Implications from coverage validation survey in Ethiopia, 2019. PLoS One 2020; 15:e0235281. [PMID: 32589660 PMCID: PMC7319348 DOI: 10.1371/journal.pone.0235281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/11/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Soil-transmitted helminth (STH) infections remain the most common neglected tropical diseases among children living mainly in low-resource settings. Preventive chemotherapy (PC) has been implemented as one of the main public health interventions to control and eliminate STH infections. Although data on routine coverage of PC against STH are available at different level of the health system; these data are unreliable as they are subject to errors and manipulation and evidence is lacking on validated treatment coverage. Thus, this study aimed to determine anthelminthic coverage among school age children (SAC) to inform decision made in PC program implementation. METHODS We conducted a community-based cross-sectional coverage survey in ten districts of Ethiopia; in April 2019. Sample size was computed automatically using Coverage Survey Builder (CSB) tool in Microsoft excel. Thirty segments were randomly selected per each selected districts. Collected data were cleaned and analysed using SPSS software (IBM, version 25). PRINCIPAL FINDINGS In all, 8154 SAC participated in the study. The overall anthelminthic coverage was found to be 71% (95%confidence interval (CI) = 70-71.9%). The reported coverage was lower than the surveyed coverage only in Guagusa district. The PC coverage among males (71.9%) was slightly higher than females' coverage (70%); and the coverage in the age group between10 and 14 years (77%) was higher compared with the age group between 5 and 9 years (64.3%). In addition, the PC coverage in school attending children (81.1%) was much higher than coverage in non-enrolled children (28.3%). Moreover, the most frequently mentioned reasons for not swallowing drugs were drug not given (24.75%) and not attending school (19.75%). CONCUSSION This study showed that only five out of ten districts met the target threshold (minimum 75%) for effective coverage. Hence, implementations of preventive chemotherapy should be improved in those districts with low coverage data.
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Affiliation(s)
- Mekuria Asnakew Asfaw
- Collaborative Research and Training Centre for NTDs, Arba Minch University, Arba Minch, Ethiopia
- * E-mail:
| | - Zerihun Zerdo
- Collaborative Research and Training Centre for NTDs, Arba Minch University, Arba Minch, Ethiopia
| | - Chuchu Churko
- Collaborative Research and Training Centre for NTDs, Arba Minch University, Arba Minch, Ethiopia
| | - Fikre Seife
- Neglected Tropical Diseases, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Manaye Yihune
- College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Yilma Chisha
- College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Abinet Teshome
- College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | | | - Nebiyu Negussu
- Neglected Tropical Diseases, Federal Ministry of Health, Addis Ababa, Ethiopia
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14
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Konaté D, Diawara SI, Touré M, Diakité SAS, Guindo A, Traoré K, Diarra A, Keita B, Thiam S, Keita M, Sissoko I, Sogoba N, Traoré SF, Krogtad DJ, Doumbia S, Diakité M. Effect of routine seasonal malaria chemoprevention on malaria trends in children under 5 years in Dangassa, Mali. Malar J 2020; 19:137. [PMID: 32252774 PMCID: PMC7137428 DOI: 10.1186/s12936-020-03202-y] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Seasonal malaria chemoprevention (SMC) is a new strategy to prevent malaria in children under 5 years old. It has been recommended by the World Health Organization since 2012 in malaria-endemic areas with seasonal transmission. This study aimed to assess the changes in malaria indicators through two consecutive years of SMC routine implementation in children under 5 years old in Dangassa, where malaria is endemic with a long and high transmission season. METHODS From 2012 to 2016, a cohort study was conducted in Dangassa village. The study team based in the village followed all malaria clinical cases in children under 5 years old at the community health centre. During the study, SMC was routinely implemented in collaboration with the National Malaria Control Programme. The Cox regression model was used in order to compare malaria risk during the study. RESULTS The Cox regression model showed a significant reduction in malaria clinical incidence, both in 2015 (HR = 0.27 (0.18-0.40), 95% CI) and in 2016 (HR = 0.23 (0.15-0.35), 95% CI) of SMC implementation compared to October 2013. Gametocyte and fever prevalence was lower between September and October during SMC implementation (2015 and 2016) compared to the same period before SMC implementation (2013-2014). A slight increase of malaria incidence was observed in December at the end of SMC implementation. CONCLUSION SMC has significantly reduced both malaria incidence and gametocyte prevalence and improved haemoglobin levels in children under 5 years old after 2 years of routine implementation.
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Affiliation(s)
- Drissa Konaté
- West African International Center for Excellence in Malaria Research (ICEMR-WA), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali.
| | - Sory I Diawara
- West African International Center for Excellence in Malaria Research (ICEMR-WA), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Mahamoudou Touré
- West African International Center for Excellence in Malaria Research (ICEMR-WA), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Seidina A S Diakité
- West African International Center for Excellence in Malaria Research (ICEMR-WA), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Agnès Guindo
- West African International Center for Excellence in Malaria Research (ICEMR-WA), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Karim Traoré
- West African International Center for Excellence in Malaria Research (ICEMR-WA), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Ayouba Diarra
- West African International Center for Excellence in Malaria Research (ICEMR-WA), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Bourama Keita
- West African International Center for Excellence in Malaria Research (ICEMR-WA), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Sibe Thiam
- West African International Center for Excellence in Malaria Research (ICEMR-WA), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Moussa Keita
- West African International Center for Excellence in Malaria Research (ICEMR-WA), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Ibrahim Sissoko
- West African International Center for Excellence in Malaria Research (ICEMR-WA), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Nafomon Sogoba
- West African International Center for Excellence in Malaria Research (ICEMR-WA), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Sékou F Traoré
- West African International Center for Excellence in Malaria Research (ICEMR-WA), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Donald J Krogtad
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Seydou Doumbia
- West African International Center for Excellence in Malaria Research (ICEMR-WA), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Mahamadou Diakité
- West African International Center for Excellence in Malaria Research (ICEMR-WA), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
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Khalili M, Lepeytre F, Guertin JR, Goupil R, Troyanov S, Bouchard J, Madore F. Impact of updated recommendations on acetylsalicylic acid use for primary prevention of cardiovascular disease in Canada: a population-based survey. CMAJ Open 2020; 8:E41-E47. [PMID: 31992558 PMCID: PMC6996036 DOI: 10.9778/cmajo.20190105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The debate over acetylsalicylic acid (ASA) therapy for primary prevention of cardiovascular disease (CVD) has recently resurfaced, but scarce data are available on prophylactic ASA use in Canada for this purpose. This study aimed to evaluate the prevalence and factors associated with ASA use, and the potential impact of implementing the most recent (2016) US Preventive Services Task Force recommendations for primary CVD prevention in a Canadian setting. METHODS We performed a cross-sectional analysis using data from the CARTaGENE study, which included a representative sample (n = 20 004) of the 2018 general population of the province of Quebec. We assessed eligibility for ASA treatment using US Preventive Services Task Force criteria (age 50-69 yr, no past history of myocardial infarction or stroke, and 10-year risk of CVD of at least 10%). We extrapolated to the entire 2018 Quebec population the number of people who would need to start ASA treatment. RESULTS A total of 6231 respondents in the CARTaGENE study (54.2% of those aged 50-69 yr with no prior history of CVD) were found to be potentially eligible for ASA use for primary CVD prevention. Of the 6231, 1379 (22.1%) were receiving prophylactic ASA treatment. Factors found to be related to ASA use included age, male sex, regular medical visits, lower education level, obesity, hypertension, diabetes and dyslipidemia. Income and smoking status were not found to be significantly associated with ASA use. Our results indicate that 885 261 people would potentially have started ASA treatment if the US Preventive Services Task Force recommendations had been implemented in Quebec in 2018. INTERPRETATION Prevalent ASA use for primary CVD prevention was low. Implementation of the 2016 US Preventive Services Task Force recommendations would require initiating ASA treatment in a substantial proportion of people, with undetermined potential benefits.
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Affiliation(s)
- Myriam Khalili
- Faculty of Medicine (Khalili, Lepeytre, Goupil, Troyanov, Bouchard, Madore), Université de Montréal; Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal (Khalili, Lepeytre, Goupil, Troyanov, Bouchard, Madore), Montréal, Que.; Département de médecine sociale et preventive (Guertin), Faculty of Medicine, Université Laval; Centre de recherche du Centre hospitalier universitaire de Québec (Guertin), Québec, Que
| | - Fanny Lepeytre
- Faculty of Medicine (Khalili, Lepeytre, Goupil, Troyanov, Bouchard, Madore), Université de Montréal; Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal (Khalili, Lepeytre, Goupil, Troyanov, Bouchard, Madore), Montréal, Que.; Département de médecine sociale et preventive (Guertin), Faculty of Medicine, Université Laval; Centre de recherche du Centre hospitalier universitaire de Québec (Guertin), Québec, Que
| | - Jason Robert Guertin
- Faculty of Medicine (Khalili, Lepeytre, Goupil, Troyanov, Bouchard, Madore), Université de Montréal; Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal (Khalili, Lepeytre, Goupil, Troyanov, Bouchard, Madore), Montréal, Que.; Département de médecine sociale et preventive (Guertin), Faculty of Medicine, Université Laval; Centre de recherche du Centre hospitalier universitaire de Québec (Guertin), Québec, Que
| | - Rémi Goupil
- Faculty of Medicine (Khalili, Lepeytre, Goupil, Troyanov, Bouchard, Madore), Université de Montréal; Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal (Khalili, Lepeytre, Goupil, Troyanov, Bouchard, Madore), Montréal, Que.; Département de médecine sociale et preventive (Guertin), Faculty of Medicine, Université Laval; Centre de recherche du Centre hospitalier universitaire de Québec (Guertin), Québec, Que
| | - Stéphan Troyanov
- Faculty of Medicine (Khalili, Lepeytre, Goupil, Troyanov, Bouchard, Madore), Université de Montréal; Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal (Khalili, Lepeytre, Goupil, Troyanov, Bouchard, Madore), Montréal, Que.; Département de médecine sociale et preventive (Guertin), Faculty of Medicine, Université Laval; Centre de recherche du Centre hospitalier universitaire de Québec (Guertin), Québec, Que
| | - Josée Bouchard
- Faculty of Medicine (Khalili, Lepeytre, Goupil, Troyanov, Bouchard, Madore), Université de Montréal; Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal (Khalili, Lepeytre, Goupil, Troyanov, Bouchard, Madore), Montréal, Que.; Département de médecine sociale et preventive (Guertin), Faculty of Medicine, Université Laval; Centre de recherche du Centre hospitalier universitaire de Québec (Guertin), Québec, Que
| | - François Madore
- Faculty of Medicine (Khalili, Lepeytre, Goupil, Troyanov, Bouchard, Madore), Université de Montréal; Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal (Khalili, Lepeytre, Goupil, Troyanov, Bouchard, Madore), Montréal, Que.; Département de médecine sociale et preventive (Guertin), Faculty of Medicine, Université Laval; Centre de recherche du Centre hospitalier universitaire de Québec (Guertin), Québec, Que.
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Danziger P, Skoczylas M, Laventhal N. Parental Refusal of Standard-of-Care Prophylactic Newborn Practices: In One Center's Experience, Many Refuse One but Few Refuse All. Hosp Pediatr 2019; 9:429-433. [PMID: 31061136 DOI: 10.1542/hpeds.2019-0029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Several interventions to reduce neonatal morbidity and mortality are universally recommended: intramuscular (IM) vitamin K (VK), erythromycin ophthalmic prophylaxis, and hepatitis B vaccine for newborns, and maternal pertussis vaccine. Despite robust efficacy and safety evidence, parental refusal of these practices is increasing. We sought to define the current declination rate and characterize the association between declination of 1 intervention and declination of the others. METHODS A retrospective cohort study was performed of all inborn singletons admitted to the well newborn nursery over a 12-month period (November 15, 2015 through November 15, 2016) at a large quaternary center. RESULTS In total, 3758 infants met inclusion criteria. 25% (n = 921) did not receive at least 1 of the 4 interventions. 13.6% (n = 511) did not receive the hepatitis B vaccine, 2.3% (n = 85) did not receive IM VK, 5.9% (n = 223) did not receive erythromycin, and 7.2% (n = 271) of mothers did not receive the prenatal tetanus, diphtheria, pertussis vaccine. Odds of refusal of IM VK were 6.2 times greater for infants delivered by a certified nurse midwife versus physician (95% confidence interval 3.3-11.6). Pattern of declination was variable; of 921 mother-infant dyads who did not receive at least 1 intervention, only 2 dyads received none of the interventions. CONCLUSIONS Our study is one of the first in which patterns of refusal of standard-of-care perinatal practices are characterized. Alarmingly, one-fourth of our cohort did not receive at least 1 core infant health intervention. Our finding of only modest overlap in declination of each intervention carries implications for the development of targeted interventions.
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Affiliation(s)
| | | | - Naomi Laventhal
- Division of Neonatal-Perinatal Medicine
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan
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Frimpong A, Thiam LG, Arko-Boham B, Owusu EDA, Adjei GO. Safety and effectiveness of antimalarial therapy in sickle cell disease: a systematic review and network meta-analysis. BMC Infect Dis 2018; 18:650. [PMID: 30541465 PMCID: PMC6292161 DOI: 10.1186/s12879-018-3556-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/26/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND About 80% of all reported sickle cell disease (SCD) cases in children anually are recorded in Africa. Although malaria is considered a major cause of death in SCD children, there is limited data on the safety and effectiveness of the available antimalarial drugs used for prophylaxis. Also, previous systematic reviews have not provided quantitative measures of preventive effectiveness. The purpose of this research was to conduct a systematic review and meta-analysis of the available literature to determine the safety and effectiveness of antimalarial chemoprophylaxis used in SCD patients. METHODS We searched in PubMed, Medline, CINAHL, POPLine and Cochrane library, for the period spanning January 1990 to April 2018. We considered randomized or quasi-randomized controlled trials comparing any antimalarial chemoprophylaxis to, 1) other antimalarial chemoprophylaxis, 2) placebo or 3) no intervention, in SCD patients. Studies comparing at least two treatment arms, for a minimum duration of three months, with no restriction on the number of patients per arm were reviewed. The data were extracted and expressed as odds ratios. Direct pairwise comparisons were performed using fixed effect models and the heterogeneity assessed using the I-square. RESULTS Six qualified studies that highlighted the importance of antimalarial chemoprophylaxis in SCD children were identified. In total, seven different interventions (Chloroquine, Mefloquine, Mefloquine artesunate, Proguanil, Pyrimethamine, Sulfadoxine-pyrimethamine, Sulfadoxine-pyrimethamine amodiaquine) were evaluated in 912 children with SCD. Overall, the meta-analysis showed that antimalarial chemoprophylaxis provided protection against parasitemia and clinical malaria episodes in children with SCD. Nevertheless, the risk of hospitalization (OR = 0.72, 95% CI = 0.267-1.959; I2 = 0.0%), blood transfusion (OR = 0.83, 95% CI = 0.542-1.280; I2 = 29.733%), vaso-occlusive crisis (OR = 19, 95% CI = 1.713-2.792; I2 = 93.637%), and mortality (OR = 0.511, 95% CI = 0.189-1.384; I2 = 0.0%) did not differ between the intervention and placebo groups. CONCLUSION The data shows that antimalarial prophylaxis reduces the incidence of clinical malaria in children with SCD. However, there was no difference between the occurrence of adverse events in children who received placebo and those who received prophylaxis. This creates an urgent need to assess the efficacy of new antimalarial drug regimens as potential prophylactic agents in SCD patients. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42016052514).
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Affiliation(s)
- Augustina Frimpong
- West African Centre for Cell Biology of Infectious Pathogens, Department of Biochemistry Cell and Molecular Biology, University of Ghana, Accra, Ghana
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- African Institute for Mathematical Sciences, Cape Coast, Ghana
| | - Laty Gaye Thiam
- West African Centre for Cell Biology of Infectious Pathogens, Department of Biochemistry Cell and Molecular Biology, University of Ghana, Accra, Ghana
| | - Benjamin Arko-Boham
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ewurama Dedea Ampadu Owusu
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - George O Adjei
- Centre for Tropical Clinical Pharmacology and Therapeutics, School of Medicine and Dentistry, University of Ghana, Accra, Ghana.
- Office of Research Innovation and Development, University of Ghana, Accra, Ghana.
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Eaton LA, Matthews DD, Bukowski LA, Friedman MR, Chandler CJ, Whitfield DL, Sang JM, Stall RD. Elevated HIV Prevalence and Correlates of PrEP Use Among a Community Sample of Black Men Who Have Sex With Men. J Acquir Immune Defic Syndr 2018; 79:339-346. [PMID: 30063650 PMCID: PMC6510021 DOI: 10.1097/qai.0000000000001822] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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] [Indexed: 01/12/2023]
Abstract
BACKGROUND The HIV epidemic among black men who have sex with men (BMSM) demands urgent public health attention. Pre-exposure prophylaxis (PrEP) is a highly efficacious option for preventing HIV, but characteristics of PrEP use among community samples of BMSM are not well-understood. METHODS A serial cross-sectional survey assessment (N = 4184 BMSM reporting HIV-negative/unsure status) and HIV testing were conducted at Black Gay Pride events in 6 US cities in 2014, 2015, 2016, and 2017. RESULTS HIV prevalence was higher among BMSM self-reporting current PrEP use (1 of 3 participants) than BMSM not self-reporting current PrEP use (1 of 5 participants) [32.3%, N = 103/319 vs. 20.0%, N = 639/3,193, adjusted odds ratio (aOR) = 1.68, 95% confidence interval (CI): 1.31 to 2.15]. BMSM reporting current PrEP use (N = 380) were more likely to report having a greater number of male sex partners (aOR = 1.02, 95% CI: 1.01 to 1.03), a sexually transmitted infection diagnosis (aOR = 2.44, 95% CI: 1.88 to 3.16), and stimulant drug use (aOR = 2.05, 95% CI, 1.21 to 3.47) when compared with BMSM not reporting current PrEP use (N = 3804). PrEP use increased from 4.7% (2014) to 15.5% (2017) (aOR = 1.19, 95% CI: 1.13 to 1.25). Among PrEP users, inability to afford health care coverage was associated with testing HIV-positive (aOR = 2.10, 95% CI: 1.24 to 3.56). CONCLUSIONS The high prevalence of HIV infection among BMSM reporting PrEP use is concerning. It does not, however, challenge the efficacy of PrEP itself but rather the uptake of the surrounding preventative package including behavioral risk reduction support, sexually transmitted infection treatment, and medication adherence counseling. Further research to understand barriers to fully effective PrEP is needed to guide operational and behavioral interventions that close the gap on incident infection.
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Affiliation(s)
- Lisa A Eaton
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT
| | | | - Leigh A Bukowski
- Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | | | - Cristian J Chandler
- Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | | | - Jordan M Sang
- Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Ron D Stall
- Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
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Abstract
Randomized controlled trials have established that seasonal malaria chemoprevention (SMC) in children is a promising strategy to reduce malaria transmission in Sahelian West Africa. This strategy was recently introduced in a dozen countries, and about 12 million children received SMC in 2016. However, evidence on SMC effectiveness under routine programme conditions is sparse. We aim to measure the effects of the nationwide SMC programme in Mali on the prevalence of malaria and anemia in children 6-59 months. We used data from the 2015 nationally representative malaria indicator survey. A post-test only with non-randomized control group study was designed. We fitted a generalized structural equation model that controlled for potential bias on observed and non-observed variables (endogenous treatment effect model). Having received SMC reduced by 44% (95% CI [0.39-0.49]) the risk of having a positive rapid diagnostic test for malaria. In addition, the programme indirectly reduced by 18% the risk of moderate-to-severe anemia (95% CI [0.15-0.21]). SMC in Mali has substantial protective effects under routine nationwide programme conditions. Endogenous treatment effects analyses can contribute to rigorously measuring the effectiveness of health programmes and to bridging a widening gap in evaluation methods to measure progress towards achieving malaria elimination.
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Affiliation(s)
- Thomas Druetz
- Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane University, New Orleans, USA.
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada.
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Muñoz Martín AJ, Ortega I, Font C, Pachón V, Castellón V, Martínez-Marín V, Salgado M, Martínez E, Calzas J, Rupérez A, Souto JC, Martín M, Salas E, Soria JM. Multivariable clinical-genetic risk model for predicting venous thromboembolic events in patients with cancer. Br J Cancer 2018; 118:1056-1061. [PMID: 29588512 PMCID: PMC5931103 DOI: 10.1038/s41416-018-0027-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/17/2018] [Accepted: 01/22/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) is a leading cause of death among patients with cancer. Outpatients with cancer should be periodically assessed for VTE risk, for which the Khorana score is commonly recommended. However, it has been questioned whether this tool is sufficiently accurate at identifying patients who should receive thromboprophylaxis. The present work proposes a new index, TiC-Onco risk score to be calculated at the time of diagnosis of cancer, that examines patients' clinical and genetic risk factors for thrombosis. METHODS We included 391 outpatients with a recent diagnosis of cancer and candidates for systemic outpatient chemotherapy. All were treated according to standard guidelines. The study population was monitored for 6 months, and VTEs were recorded. The Khorana and the TiC-Onco scores were calculated for each patient and their VTE predictive accuracy VTEs was compared. RESULTS We recorded 71 VTEs. The TiC-Onco risk score was significantly better at predicting VTE than the Khorana score (AUC 0.73 vs. 0.58, sensitivity 49 vs. 22%, specificity 81 vs. 82%, PPV 37 vs. 22%, and NPV 88 vs. 82%). CONCLUSIONS TiC-Onco risk score performed significantly better than Khorana score at identifying cancer patients at high risk of VTE who would benefit from personalised thromboprophylaxis.
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Affiliation(s)
- Andrés J Muñoz Martín
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo, 46, 28007, Madrid, Spain.
- Cancer & Thrombosis Working Group, Spanish Society of Medical Oncology (SEOM), C/ de Velázquez, 7, 28001, Madrid, Spain.
| | - Israel Ortega
- Scientific Department, Gendiag, Joan XXIII, 10, 08950, Esplugues de Llobregat, Spain
| | - Carme Font
- Cancer & Thrombosis Working Group, Spanish Society of Medical Oncology (SEOM), C/ de Velázquez, 7, 28001, Madrid, Spain
- Medical Oncology, Hospital Clínic, c/ Villarroel, 170, 08036, Barcelona, Spain
| | - Vanesa Pachón
- Cancer & Thrombosis Working Group, Spanish Society of Medical Oncology (SEOM), C/ de Velázquez, 7, 28001, Madrid, Spain
- Medical Oncology, Hospital Universitario Ramón y Cajal Madrid, Ctra. Colmenar Viejo, Km. 9,100, 28034, Madrid, Spain
| | - Victoria Castellón
- Cancer & Thrombosis Working Group, Spanish Society of Medical Oncology (SEOM), C/ de Velázquez, 7, 28001, Madrid, Spain
- Medical Oncology, Complejo Hospitalario de Torrecárdenas, c/ Hermandad de Donantes de Sangre, 04009, Almería, Spain
| | - Virginia Martínez-Marín
- Cancer & Thrombosis Working Group, Spanish Society of Medical Oncology (SEOM), C/ de Velázquez, 7, 28001, Madrid, Spain
- Medical Oncology, Hospital Universitario la Paz, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Mercedes Salgado
- Cancer & Thrombosis Working Group, Spanish Society of Medical Oncology (SEOM), C/ de Velázquez, 7, 28001, Madrid, Spain
- Medical Oncology, Complejo Hospitalario Universitario de Ourense, c/ Ramon Puga Noguerol, 54, 32005, Ourense, Spain
| | - Eva Martínez
- Cancer & Thrombosis Working Group, Spanish Society of Medical Oncology (SEOM), C/ de Velázquez, 7, 28001, Madrid, Spain
- Medical Oncology, Hospital Universitario Marqués de Valdecilla, Av. Valdecilla, 25, 39008, Santander, Spain
| | - Julia Calzas
- Cancer & Thrombosis Working Group, Spanish Society of Medical Oncology (SEOM), C/ de Velázquez, 7, 28001, Madrid, Spain
- Medical Oncology, Hospital Universitario de Fuenlabrada, Camino del Molino, 2, 28942, Madrid, Spain
| | - Ana Rupérez
- Cancer & Thrombosis Working Group, Spanish Society of Medical Oncology (SEOM), C/ de Velázquez, 7, 28001, Madrid, Spain
- Medical Oncology, Fundación Jiménez Díaz, Av. Reyes Católicos, 2, 28040, Madrid, Spain
| | - Juan C Souto
- Thrombosis and Haemostasia, Hospital de la Santa Creu i Sant Pau, Carrer de Sant Quintí, 89, 08041, Barcelona, Spain
| | - Miguel Martín
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo, 46, 28007, Madrid, Spain
- Cancer & Thrombosis Working Group, Spanish Society of Medical Oncology (SEOM), C/ de Velázquez, 7, 28001, Madrid, Spain
| | - Eduardo Salas
- Scientific Department, Gendiag, Joan XXIII, 10, 08950, Esplugues de Llobregat, Spain
| | - Jose M Soria
- Genomic of complex diseases, Institut d'Investigació Sant Pau (IIB-Sant Pau), Carrer de Sant Quintí, 89, 08041, Barcelona, Spain
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Phillips AE, Gazzinelli-Guimarães PH, Aurelio HO, Dhanani N, Ferro J, Nala R, Deol A, Fenwick A. Urogenital schistosomiasis in Cabo Delgado, northern Mozambique: baseline findings from the SCORE study. Parasit Vectors 2018; 11:30. [PMID: 29316983 PMCID: PMC5761122 DOI: 10.1186/s13071-017-2592-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 12/13/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The results presented here are part of a five-year cluster-randomised intervention trial that was implemented to understand how best to gain and sustain control of schistosomiasis through different preventive chemotherapy strategies. This paper presents baseline data that were collected in ten districts of Cabo Delgado province, northern Mozambique, before treatment. METHODS A cross-sectional study of 19,039 individuals was sampled from 144 villages from May to September 2011. In each village prevalence and intensity of S. haematobium were investigated in 100 children first-year students (aged 5-8 years), 100 school children aged 9-12 years (from classes 2 to 7) and 50 adults (20-55 years). Prevalence and intensity of S. haematobium infection were evaluated microscopically by two filtrations, each of 10 ml, from a single urine specimen. Given that individual and community perceptions of schistosomiasis influence control efforts, community knowledge and environmental risk factors were collected using a face-to-face interview. Data were entered onto mobile phones using EpiCollect. Data summary was made using descriptive statistics. Chi-square and logistic regression were used to determine the association between dependent and independent variables. RESULTS The overall prevalence of urogenital schistosomiasis was 60.4% with an arithmetic mean intensity of infection of 55.8 eggs/10 ml of urine. Heavy infections were detected in 17.7%, of which 235 individuals (6.97%) had an egg count of 1000 eggs/10 ml or more. There was a significantly higher likelihood of males being infected than females across all ages (62% vs 58%; P < 0.0005). Adolescents aged 9-12 years had a higher prevalence (66.6%) and mean infection intensity (71.9 eggs/10 ml) than first-year students (63.1%; 58.2 eggs/10 ml). This is the first study in Mozambique looking at infection rates among adults. Although children had higher levels of infection, it was found here that adults had a high average prevalence and intensity of infection (44.5%; 23.9 eggs/10 ml). Awareness of schistosomiasis was relatively high (68.6%); however, correct knowledge of how schistosomiasis is acquired was low (23.2%) among those who had heard of the disease. Schistosomiasis risk behaviour such as washing (91.3%) and bathing (86.7%) in open water sources likely to be infested with host snails was high. CONCLUSIONS Urogenital schistosomiasis is widespread in Cabo Delgado. In addition, poor community knowledge about the causes of schistosomiasis and how to prevent it increases the significant public health challenge for the national control program. This was the first study in Mozambique that examined infection levels among adults, where results showed that S. haematobium infection was also extremely high. Given that this controlled trial aims to understand the impact of different combinations of schistosomiasis control through treatment of communities, schools, and treatment holidays over a five-year period, these findings highlight the importance of examining the impact of different treatment approaches also in adults. TRIAL REGISTRATION The trials have been registered with the International Standard Randomised Controlled Trial registry under ISRCT 14117624 Mozambique (14 December 2015).
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Affiliation(s)
- Anna E. Phillips
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College London, W2 1PG, London, UK
| | - Pedro H. Gazzinelli-Guimarães
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College London, W2 1PG, London, UK
| | - Herminio O. Aurelio
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College London, W2 1PG, London, UK
- Faculdade of Health Sciences, Universidade Católica de Moçambique (UCM), Beira, Mozambique
| | - Neerav Dhanani
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College London, W2 1PG, London, UK
| | - Josefo Ferro
- Faculdade of Health Sciences, Universidade Católica de Moçambique (UCM), Beira, Mozambique
| | | | - Arminder Deol
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College London, W2 1PG, London, UK
| | - Alan Fenwick
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College London, W2 1PG, London, UK
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Tan KR, Henderson SJ, Williamson J, Ferguson RW, Wilkinson TM, Jung P, Arguin PM. Long term health outcomes among Returned Peace Corps Volunteers after malaria prophylaxis, 1995-2014. Travel Med Infect Dis 2017; 17:50-55. [PMID: 28487213 PMCID: PMC10956545 DOI: 10.1016/j.tmaid.2017.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/02/2017] [Accepted: 05/03/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND A primary reason for non-adherence to malaria chemoprophylaxis is fear of latent side effects. We examined latent effects of malaria chemoprophylaxis among Returned Peace Corps Volunteers (RPCVs). METHODS During July 18-September 16, 2016, RPCVs who served during 1995-2014 with an e-mail address in Peace Corps' RPCV database were invited to take an internet-based survey on malaria prophylaxis and medical diagnoses. "Good adherence" meant taking prophylaxis "as prescribed" or "most of the time." Prevalence of diseases diagnosed after Peace Corps service was compared between users and nonusers of each antimalarial using log-binomial regression. RESULTS Of 8931 participants (11% response rate), 5055 (57%) took chemoprophylaxis. Initial chemoprophylaxis was mefloquine 59%, chloroquine 13%, doxycycline 16%, atovaquone-proguanil 4%, and "other" 8%. Sixty percent reported good adherence. Mefloquine users had the best adherence (67% good adherence). Prevalences of most diseases were similar between exposed and unexposed groups. Certain psychiatric diagnoses were slightly more likely among mefloquine users (PR 1.14, 95% CI [1.04-1.25], P = 0.0048). When excluding those with prior psychiatric illness, there were no differences in psychiatric diagnosis rates. CONCLUSION Malaria chemoprophylaxis use by Peace Corps Volunteers is safe. Avoiding mefloquine use in those with prior psychiatric illness can reduce psychiatric side effects.
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Affiliation(s)
- Kathrine R Tan
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | - John Williamson
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | - Paul M Arguin
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Koné Z, Coulibaly G, Daix ATJ, Bakayoko AS, Samaké K, Kouassi DP, Domoua KMS. [Current situation of primary prophylaxis with isoniazid (INH) in children who are contacts of patients with bacillary pulmonary tuberculosis in Abidjan (Cote d'Ivoire)]. Rev Pneumol Clin 2016; 72:340-345. [PMID: 27776945 DOI: 10.1016/j.pneumo.2016.08.003] [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] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 08/20/2016] [Accepted: 08/27/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION The National tuberculosis program (NTP) in Ivory Coast recommends that children under 5 years living in a family environment with contagious tuberculosis patients, should receive Prophylactic treatment with INH (PTI), whatever the result of the tuberculin skin test (positive or negative) and their BCG status (vaccinated or not), at a dose of 5mg/kg/day for 6 months. We conducted this study to check the implementation of this recommendation in three support services of tuberculosis in Abidjan, the economic capital. MATERIAL AND METHOD We conducted a multicenter, cross-sectional and descriptive study over 3 years (2011-2013), on consented patients, adolescents and adults aged at least 15 years, with a first episode of infectious pulmonary tuberculosis, in order to look for information on the INH prophylaxis in children under 5 years living under the same roof. We made patients interviews during their visit for bacteriological sputum controls at the second month of TB treatment. RESULTS Of a total of 412 patients (53% males and 47% females) with a mean age of 34.5 years and with a low level of instruction (66.5%), we noticed 639 children under 5 years living under the same roof with them. Information on the screening of contact children was given to 71% of interviewed patients (291/412). Of the 339 children examined among 639 contacts, 234 (69%) had received only an intradermoreaction (IDR) and PTI was finally administered to 64% of them (217/339). CONCLUSION High proportion of contact children under 5 not examined is a major concern for the NTP and a missed opportunity to prevent additional cases of tuberculosis among children.
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Affiliation(s)
- Z Koné
- Service de pneumophtisiologie, CHU Treichville, BP V 03 Abidjan, Cote d'Ivoire.
| | - G Coulibaly
- Service de pneumophtisiologie, CHU Treichville, BP V 03 Abidjan, Cote d'Ivoire
| | - A T J Daix
- Service de pneumophtisiologie, CHU Treichville, BP V 03 Abidjan, Cote d'Ivoire
| | - A S Bakayoko
- Service de pneumophtisiologie, CHU Treichville, BP V 03 Abidjan, Cote d'Ivoire
| | - K Samaké
- Service de pneumophtisiologie, CHU Treichville, BP V 03 Abidjan, Cote d'Ivoire
| | - D P Kouassi
- Service de surveillance épidémiologique, Institut national d'hygiène publique, Antenne régional de Bouaké, Bouaké, Cote d'Ivoire
| | - K M S Domoua
- Service de pneumophtisiologie, CHU Treichville, BP V 03 Abidjan, Cote d'Ivoire
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Abstract
OBJECTIVE To characterise the current usage of chemoprevention agents among hospitalised women who are at higher risk for breast cancer. STUDY DESIGN A cross-sectional study. SETTING Academic hospital at Baltimore. PARTICIPANTS A bedside survey of 250 women aged 50-75 years was conducted who were cancer-free at the time of study enrolment and hospitalised to a general medicine service. Reproductive history, family history for breast cancer, chemopreventive agents use and medical comorbidities data was collected for all patients. χ2 and t-tests were used to analyse population characteristics. PRIMARY OUTCOME MEASURES Prevalence of women at high risk for developing breast cancer (5-year Gail risk score ≥1.7) and their chemopreventive agent use. RESULTS Mean age for the study population was 61.5 years (SD 7.5), and mean 5-year Gail risk score was 1.67 (SD 0.88). A third of study population was at high risk for breast cancer. None of the high-risk women (0%) were taking chemoprevention for breast cancer risk reduction, and 23% were at very high risk with 5-year Gail score ≥3%. These women were not recognised as being high risk by their hospital providers and none were referred to the high-risk breast cancer clinics following discharge. CONCLUSIONS Many hospitalised women are at high risk for breast cancer and we could not identify even a single woman who was using chemoprevention for risk reduction. Current chemoprevention guidelines may be falling short in their dissemination and implementation. Since women at high risk for breast cancer may only interface with the healthcare system at select points, all healthcare providers must be willing and able to do risk assessment. For those identified to be at high risk, providers must then either engage in chemopreventive counselling or refer patients to providers who are more comfortable working with patients on this critical decision.
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Affiliation(s)
- Waseem Khaliq
- Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Danijela Jelovac
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Scott M Wright
- Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
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Huang WK, Hsu HC, Liu JR, Yang TS, Chen JS, Chang JWC, Lin YC, Yu KH, Kuo CF, See LC. The Association of Ursodeoxycholic Acid Use With Colorectal Cancer Risk: A Nationwide Cohort Study. Medicine (Baltimore) 2016; 95:e2980. [PMID: 26986110 PMCID: PMC4839891 DOI: 10.1097/md.0000000000002980] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Data from preclinical studies suggest that ursodeoxycholic acid (UDCA) has a chemopreventive effect on colorectal cancer (CRC) development, but no large observational study has examined this possibility. The aim of this study was to investigate the association of UDCA use with CRC risk in a nationwide population-based cohort. This nationwide population-based cohort study used data from the Taiwan National Health Insurance Research Database for the period from 2000 through 2010. This study included data from 7119 Taiwanese adults who received ≥28 cumulative defined daily doses (cDDDs) of UDCA and 14,238 patients who did not receive UDCA (<28 cDDDs). UDCA nonusers were matched 1:2 for age, sex, enrollment date, and presence of chronic liver disease, viral hepatitis, cholelithiasis, and alcoholic liver disease. The 2 cohorts were followed until December 31, 2010 or occurrence of CRC. Cox proportional hazards regression with robust Sandwich variance estimator, which can cooperate with matching design, was used to examine the association between UDCA use and CRC risk. During 109,312 person-years of follow-up (median, 5 years), 121 patients had newly diagnosed CRC: 28 UDCA users (76.7 per 100,000 person-years) and 93 nonusers (127.7 per 100,000 person-years) (log-rank test, P = 0.0169). After multivariate adjustment for age, UDCA use was associated with a reduced risk of CRC (hazard ratio, 0.60; 95% confidence interval [CI], 0.39-0.92). The adjusted hazard ratios were 0.55 (95% CI, 0.35-0.89), 0.89 (95% CI, 0.36-2.20), and 0.63 (95% CI, 0.16-2.53) for patients with 28 to 180, 181 to 365, and >365 cDDDs, respectively, relative to nonusers. UDCA use was associated with reduced risk of CRC in a cohort mainly comprising patients with chronic liver diseases. However, further studies are needed to determine the optimal dosage of UDCA.
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Affiliation(s)
- Wen-Kuan Huang
- From the Department of Internal Medicine, Division of Hematology/Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, College of Medicine (W-KH, H-CH, T-SY, J-SC, JW-CC, Y-CL); Department of Public Health, College of Medicine, Chang Gung University (J-RL, L-CS); Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University, College of Medicine (K-HY, C-FK, L-CS); and Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University (L-CS), Taoyuan, Taiwan
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Bardia A, Keenan TE, Ebbert JO, Lazovich D, Wang AH, Vierkant RA, Olson JE, Vachon CM, Limburg PJ, Anderson KE, Cerhan JR. Personalizing Aspirin Use for Targeted Breast Cancer Chemoprevention in Postmenopausal Women. Mayo Clin Proc 2016; 91:71-80. [PMID: 26678006 PMCID: PMC4807132 DOI: 10.1016/j.mayocp.2015.10.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 09/28/2015] [Accepted: 10/23/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the association of aspirin and other nonsteroidal anti-inflammatory drugs with the incidence of postmenopausal breast cancer for risk subgroups defined by selected nonmodifiable or difficult to modify breast cancer risk factors in order to better understand the potential risk-benefit ratio for targeted chemoprevention. PATIENTS AND METHODS Postmenopausal women with no history of cancer on July 1, 1992 (N=26,580), were prospectively followed up through December 31, 2005, for breast cancer incidence (N=1581). Risk subgroups were defined on the basis of family history of breast cancer, age at menarche, age at menopause, parity/age at first live birth, personal history of benign breast disease, and body mass index. Hazard ratios (HRs) and 95% CIs adjusted for other breast cancer risk factors were estimated using Cox models. RESULTS Aspirin use was associated with a lower incidence of breast cancer for women with a family history of breast cancer (HR, 0.62 for 6 or more times per week vs never use; 95% CI, 0.41-0.93) and those with a personal history of benign breast disease (HR, 0.69; 95% CI, 0.50-0.95) but not for women in higher-risk subgroups for age at menarche, age at menopause, parity/age at first live birth, or body mass index. In contrast, inverse associations with aspirin use were observed in all lower-risk subgroups. Nonsteroidal anti-inflammatory drug use had no association with breast cancer incidence. CONCLUSION On the basis of their increased risk of breast cancer, postmenopausal women with a family history of breast cancer or a personal history of benign breast disease could potentially be targeted for aspirin chemoprevention studies. Future studies are needed to confirm these findings.
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Affiliation(s)
- Aditya Bardia
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Tanya E Keenan
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Jon O Ebbert
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - DeAnn Lazovich
- School of Public Health, University of Minnesota, Minneapolis
| | - Alice H Wang
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Janet E Olson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Celine M Vachon
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Paul J Limburg
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
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Soil-transmitted helminthiases: number of children treated in 2014. Wkly Epidemiol Rec 2015; 90:705-11. [PMID: 26685391] [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: 06/05/2023]
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Cohen SE, Vittinghoff E, Doblecki-Lewis S, Coleman M, Bacon O, Elion R, Kolber MA, Buchbinder S, Liu AY. Authors' Reply: Race and the Public Health Impact Potential of Pre-Exposure Prophylaxis in the United States. J Acquir Immune Defic Syndr 2015; 70:e33-5. [PMID: 26049284 PMCID: PMC4558271 DOI: 10.1097/qai.0000000000000716] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Stephanie E. Cohen
- San Francisco Department of Public Health, San Francisco, USA
- University of California, San Francisco, San Francisco, USA
| | | | | | | | - Oliver Bacon
- San Francisco Department of Public Health, San Francisco, USA
- University of California, San Francisco, San Francisco, USA
| | | | | | - Susan Buchbinder
- San Francisco Department of Public Health, San Francisco, USA
- University of California, San Francisco, San Francisco, USA
| | - Albert Y. Liu
- San Francisco Department of Public Health, San Francisco, USA
- University of California, San Francisco, San Francisco, USA
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Cohen SE, Vittinghoff E, Bacon O, Doblecki-Lewis S, Postle BS, Feaster DJ, Matheson T, Trainor N, Blue RW, Estrada Y, Coleman ME, Elion R, Castro JG, Chege W, Philip SS, Buchbinder S, Kolber MA, Liu AY. High interest in preexposure prophylaxis among men who have sex with men at risk for HIV infection: baseline data from the US PrEP demonstration project. J Acquir Immune Defic Syndr 2015; 68:439-48. [PMID: 25501614 PMCID: PMC4334721 DOI: 10.1097/qai.0000000000000479] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [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: 01/16/2023]
Abstract
BACKGROUND Preexposure prophylaxis (PrEP) is the first biomedical intervention with proven efficacy to reduce HIV acquisition in men who have sex with men (MSM) and transgender women. Little is known about levels of interest and characteristics of individuals who elect to take PrEP in real-world clinical settings. METHODS The US PrEP Demonstration Project is a prospective open-label cohort study assessing PrEP delivery in municipal sexually transmitted disease clinics in San Francisco and Miami and a community health center in Washington, DC. HIV-uninfected MSM and transgender women seeking sexual health services at participating clinics were assessed for eligibility and offered up to 48 weeks of emtricitabine/tenofovir for PrEP. Predictors of enrollment were assessed using a multivariable Poisson regression model, and characteristics of enrolled participants are described. RESULTS Of 1069 clients assessed for participation, 921 were potentially eligible and 557 (60.5%) enrolled. In multivariable analyses, participants from Miami (adjusted Relative Risk [aRR]: 1.53; 95% confidence interval [CI]: 1.33 to 1.75) or DC (aRR: 1.33; 95% CI: 1.2 to 1.47), those who were self-referred (aRR: 1.48; 95% CI: 1.32 to 1.66), those with previous PrEP awareness (aRR: 1.56; 95% CI: 1.05 to 2.33), and those reporting >1 episode of anal sex with an HIV-infected partner in the last 12 months (aRR: 1.20; 95% CI: 1.09 to 1.33) were more likely to enroll. Almost all (98%) enrolled participants were MSM, and at baseline, 63.5% reported condomless receptive anal sex in the previous 3 months. CONCLUSIONS Interest in PrEP is high among a diverse population of MSM at risk for HIV infection when offered in sexually transmitted disease and community health clinics.
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Affiliation(s)
- Stephanie E Cohen
- *San Francisco Department of Public Health, San Francisco, CA; †Department of Medicine, University of California-San Francisco, San Francisco, CA; ‡Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL; §DF/Net Research, Inc, Seattle, WA; ‖Whitman-Walker Health Center, Washington, DC; and ¶Division of AIDS, National Institutes of Health, Bethesda, MD
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VanDeusen A, Paintsil E, Agyarko-Poku T, Long EF. Cost effectiveness of option B plus for prevention of mother-to-child transmission of HIV in resource-limited countries: evidence from Kumasi, Ghana. BMC Infect Dis 2015; 15:130. [PMID: 25887574 PMCID: PMC4374181 DOI: 10.1186/s12879-015-0859-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 10/31/2014] [Accepted: 02/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Achieving the goal of eliminating mother-to-child HIV transmission (MTCT) necessitates increased access to antiretroviral therapy (ART) for HIV-infected pregnant women. Option B provides ART through pregnancy and breastfeeding, whereas Option B+ recommends continuous ART regardless of CD4 count, thus potentially reducing MTCT during future pregnancies. Our objective was to compare maternal and pediatric health outcomes and cost-effectiveness of Option B+ versus Option B in Ghana. METHODS A decision-analytic model was developed to simulate HIV progression in mothers and transmission (in utero, during birth, or through breastfeeding) to current and all future children. Clinical parameters, including antenatal care access and fertility rates, were estimated from a retrospective review of 817 medical records at two hospitals in Ghana. Additional parameters were obtained from published literature. Modeled outcomes include HIV infections averted among newborn children, quality-adjusted life-years (QALYs), and cost-effectiveness ratios. RESULTS HIV-infected women in Ghana have a lifetime average of 2.3 children (SD 1.3). Projected maternal life expectancy under Option B+ is 16.1 years, versus 16.0 years with Option B, yielding a gain of 0.1 maternal QALYs and 3.2 additional QALYs per child. Despite higher initial ART costs, Option B+ costs $785/QALY gained, a value considered very cost-effective by World Health Organization benchmarks. Widespread implementation of Option B+ in Ghana could theoretically prevent up to 668 HIV infections among children annually. Cost-effectiveness estimates remained favorable over robust sensitivity analyses. CONCLUSIONS Although more expensive than Option B, Option B+ substantially reduces MTCT in future pregnancies, increases both maternal and pediatric QALYs, and is a cost-effective use of limited resources in Ghana.
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Affiliation(s)
- Adam VanDeusen
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.
| | - Elijah Paintsil
- Departments of Pediatrics & Pharmacology, Yale School of Medicine, Yale Child Health Research Center, 464 Congress Ave, New Haven, CT, USA.
| | - Thomas Agyarko-Poku
- Department of Pharmacy, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Elisa F Long
- University of California Los Angeles, Anderson School of Management, Los Angeles, CA, USA.
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Ramaiah KD, Ottesen EA. Progress and impact of 13 years of the global programme to eliminate lymphatic filariasis on reducing the burden of filarial disease. PLoS Negl Trop Dis 2014; 8:e3319. [PMID: 25412180 PMCID: PMC4239120 DOI: 10.1371/journal.pntd.0003319] [Citation(s) in RCA: 204] [Impact Index Per Article: 20.4] [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: 06/05/2014] [Accepted: 10/06/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A Global Programme to Eliminate Lymphatic Filariasis was launched in 2000, with mass drug administration (MDA) as the core strategy of the programme. After completing 13 years of operations through 2012 and with MDA in place in 55 of 73 endemic countries, the impact of the MDA programme on microfilaraemia, hydrocele and lymphedema is in need of being assessed. METHODOLOGY/PRINCIPAL FINDINGS During 2000-2012, the MDA programme made remarkable achievements - a total of 6.37 billion treatments were offered and an estimated 4.45 billion treatments were consumed by the population living in endemic areas. Using a model based on empirical observations of the effects of treatment on clinical manifestations, it is estimated that 96.71 million LF cases, including 79.20 million microfilaria carriers, 18.73 million hydrocele cases and a minimum of 5.49 million lymphedema cases have been prevented or cured during this period. Consequently, the global prevalence of LF is calculated to have fallen by 59%, from 3.55% to 1.47%. The fall was highest for microfilaraemia prevalence (68%), followed by 49% in hydrocele prevalence and 25% in lymphedema prevalence. It is estimated that, currently, i.e. after 13 years of the MDA programme, there are still an estimated 67.88 million LF cases that include 36.45 million microfilaria carriers, 19.43 million hydrocele cases and 16.68 million lymphedema cases. CONCLUSIONS/SIGNIFICANCE The MDA programme has resulted in significant reduction of the LF burden. Extension of MDA to all at-risk countries and to all regions within those countries where MDA has not yet reached 100% geographic coverage is imperative to further reduce the number of microfilaraemia and chronic disease cases and to reach the global target of interrupting transmission of LF by 2020.
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Affiliation(s)
- K. D. Ramaiah
- Consultant on Lymphatic Filariasis, Tagore Nagar, Pondicherry, India
| | - Eric A. Ottesen
- Neglected Tropical Disease Support Center, The Task Force for Global Health, Decatur, Georgia, United States of America
- ENVISION Project, RTI International, Washington, D.C., United States of America
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Sánchez DP, Guillén JJ, Torres AM, Sánchez FI. [Analysis of medications dispensed to control the main cardiovascular risks in the Murcia Region: are there gender differences?]. Aten Primaria 2014; 46:147-55. [PMID: 24210690 PMCID: PMC6985612 DOI: 10.1016/j.aprim.2013.09.003] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 09/05/2013] [Accepted: 09/09/2013] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To estimate the use of cardiovascular medicines and its distribution by age and sex. DESIGN Observational study. SETTING Region of Murcia. MAIN MEASUREMENTS Daily doses of cardiovascular drugs prescribed and dispensed in all the pharmacies of the Region per 1,000 inhabitants-day (DHD). A comparison was made of consumption rates (DHD) by age and sex. RESULTS The probability of receiving antiplatelet drugs increases with age, with the proportion of men being higher. The use of beta-blockers and angiotensin II increases with age up to 79 years, with an increased consumption in men up to 65 years. The probability of receiving treatment with calcium channel blockers, ACE inhibitors, or statins, linearly increases with age, and the proportion of men under treatment exceeds that of women in the early ages, tending to equalize beyond 80 years. CONCLUSIONS This study shows that the cardiovascular disease prevention focuses on people aged 40 to 74 years. Access by women to cardiovascular therapy occurs with a delay of 3-5 years, depending on the treatment subgroup. Changes should be promoted to encourage rational and equitable access and use of the drugs.
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Affiliation(s)
- Diego P Sánchez
- Departamento de Ciencias Sociosanitarias, Facultad de Medicina, Universidad de Murcia, Murcia, España.
| | - José J Guillén
- Departamento de Ciencias Sociosanitarias, Facultad de Medicina, Universidad de Murcia, Murcia, España
| | - Alberto M Torres
- Departamento de Ciencias Sociosanitarias, Facultad de Medicina, Universidad de Murcia, Murcia, España
| | - Fernando I Sánchez
- Departamento de Economía Aplicada, Facultad de Economía y Empresa, Universidad de Murcia, Murcia, España
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Naibe DT, Samadoulougou A, Kabore H, Yameogo RA, Millogo G, Yameogo NV, Kologo JK, Toguyeni BJY, Zabsonre P. Pratique de la prophylaxie de la maladie thromboembolique veineuse: enquête réalisée auprès des professionnels de santé de la ville de Ouagadougou. Pan Afr Med J 2014; 19:395. [PMID: 25995791 PMCID: PMC4430153 DOI: 10.11604/pamj.2014.19.395.5474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 09/24/2014] [Accepted: 12/13/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction L'impact clinique et l'incidence de la maladie thromboembolique veineuse ont conduit à établir des recommandations pour la thromboprophylaxie. L'objectif de notre étude était d’évaluer la pratique de cette prophylaxie par les professionnels de santé de Ouagadougou. Méthodes Il s'est agi d'une enquête d'intention réalisée dans le mois de mai 2012 au Centre Hospitalier Universitaire Yalgado Ouédraogo et Centre Médical avec Antenne chirurgicale Paul VI. Un questionnaire a été administré auprès des prescripteurs impliqués dans la prophylaxie de la maladie thromboembolique veineuse (MTEV). Résultats Une interview a été administrée à 86 professionnels de santé dont 20 attachés de santé en anesthésie-réanimation, 17 chirurgiens, 11 médecins généralistes et 07 gynécologue-obstétriciens. Leur expérience professionnelle était inférieure à cinq ans dans 65% des cas et ils exerçaient dans 70% des cas au CHU-YO. Les héparines de bas poids moléculaire étaient les plus utilisées (81,4%) avec une intention de prescription significativement plus élevée en réanimation et en chirurgie (p<0,05). Dans 65,7% des cas, la prophylaxie était maintenue jusqu'à la mobilisation des patients. Le coût élevé de l'héparinothérapie représentait une raison de la non utilisation de la prophylaxie dans 46,5% des cas. Conclusion Nous constatons que la réalisation de la prophylaxie de la MTEV reste insuffisante à Ouagadougou en dépit de l'existence de recommandations précises de bonnes pratiques. Ces résultats suggèrent la nécessité de la formation médicale continue des professionnels de santé, avec l’établissement des recommandations de pratique clinique adaptée à notre niveau de développement.
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Affiliation(s)
| | - André Samadoulougou
- Service de Cardiologie du CHU Yalgado Ouedraogo, Ouagadougou, Burkina Faso ; Unité de Formation et de Recherche en Science de la Santé/Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - Hervé Kabore
- Service de Cardiologie du CHU Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | | | - Georges Millogo
- Service de Cardiologie du CHU Yalgado Ouedraogo, Ouagadougou, Burkina Faso ; Unité de Formation et de Recherche en Science de la Santé/Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - Nobila Valentin Yameogo
- Service de Cardiologie du CHU Yalgado Ouedraogo, Ouagadougou, Burkina Faso ; Unité de Formation et de Recherche en Science de la Santé/Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - Jonas Koudougou Kologo
- Service de Cardiologie du CHU Yalgado Ouedraogo, Ouagadougou, Burkina Faso ; Unité de Formation et de Recherche en Science de la Santé/Université de Ouagadougou, Ouagadougou, Burkina Faso
| | | | - Patrice Zabsonre
- Service de Cardiologie du CHU Yalgado Ouedraogo, Ouagadougou, Burkina Faso ; Unité de Formation et de Recherche en Science de la Santé/Université de Ouagadougou, Ouagadougou, Burkina Faso
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Wieten RW, Harting J, Biemond PM, Grobusch MP, van Vugt M. Towards improved uptake of malaria chemoprophylaxis among West African travellers: identification of behavioural determinants. Malar J 2013; 12:360. [PMID: 24107150 PMCID: PMC3852732 DOI: 10.1186/1475-2875-12-360] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 09/30/2013] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Malaria is a potentially lethal illness for which preventive measures are not optimally used among all travellers. Travellers visiting friends and relatives in their country of origin (VFRs) are known to use chemoprophylaxis less consistently compared to tourist travellers. In this study, factors explaining the low use of chemoprophylaxis were pursued to contribute to improving uptake of preventive measures among VFRs. METHODS Following in-depth interviews with Ghanaians living in Amsterdam, a questionnaire was developed to assess which behavioural determinants were related to taking preventive measures. The questionnaire was administered at gates of departing flights from Schiphol International Airport, Amsterdam (the Netherlands) to Kotoka International Airport, Accra (Ghana). RESULTS In total, 154 questionnaires were eligible for analysis. Chemoprophylaxis had been started by 83 (53.9%) and bought by 93 (60.4%) travellers. Pre-travel advice had been obtained by 104 (67.5%) travellers. Those who attended the pre-travel clinic and those who incorrectly thought they had been vaccinated against malaria were more likely to use preventive measures. Young-, business- and long-term travellers, those who had experienced malaria, and those who thought curing malaria was easier than taking preventive tablets were less likely to use preventive measures. CONCLUSION Almost half of the VFRs travelling to West Africa had not started chemoprophylaxis; therefore, there is room for improvement. Risk reduction strategies could aim at improving attendance to travel clinics and focus on young-, business and long term travellers and VFRs who have experienced malaria during consultation. Risk reduction strategies should focus on improving self-efficacy and conceptions of response efficacy, including social environment to aim at creating the positive social context needed.
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Affiliation(s)
- Rosanne W Wieten
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Janneke Harting
- Department of Behavioral Sciences, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Pieter M Biemond
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Michèle van Vugt
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Baker MC, Krotki K, Sankara DP, Trofimovich L, Zoerhoff KL, Courtney L, Chowdhury D, Linehan M. Measuring treatment coverage for neglected tropical disease control programs: analysis of a survey design. Am J Epidemiol 2013; 178:268-75. [PMID: 23860563 DOI: 10.1093/aje/kws468] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [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: 11/12/2022] Open
Abstract
Monitoring of treatment coverage following mass drug administration is essential to ensure program success. Coverage results reported by drug administrators are often validated by using population surveys. This study evaluates the design of a multistage cluster sample survey conducted in 2007-2008 and implemented at the district level to assess drug coverage in the 4 African countries of Burkina Faso, Ghana, Niger, and Uganda. Estimates of precision of coverage were calculated, and factors contributing to the observed variance were analyzed. Precision of ±5 percentage points was obtained in 39% (n = 12) of cases, and precision of ±10 percentage points was obtained in 77% (n = 24) of cases. The factor having the largest impact on the actual precision obtained in these surveys was the high level of clustering, the impact of which is incorporated in the design effect. Key recommendations are made for the design and analysis of future surveys; guidelines are presented for thinking through the number of clusters that should be selected and how a cluster should be designed.
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Affiliation(s)
- Margaret C Baker
- Department of International Health, Georgetown University, 3700 Reservoir Road, NW,Washington, DC 20057-1107, USA.
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Amoran OE, Ariba AA, Iyaniwura CA. Determinants of intermittent preventive treatment of malaria during pregnancy (IPTp) utilization in a rural town in Western Nigeria. Reprod Health 2012; 9:12. [PMID: 22889320 PMCID: PMC3453493 DOI: 10.1186/1742-4755-9-12] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Accepted: 06/14/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Malaria infection in pregnancy is a major risk factor for maternal and child death, and substantially increases the risk of miscarriage, stillbirth and low birthweight. The aim of this study therefore is to assess the prevalence and determinants of Intermittent preventive treatment of Malaria [IPTp] utilization by pregnant women in a rural town in Western Nigeria. METHODS This study is an analytical cross-sectional study. All pregnant women that were due for delivery and were attending the three primary health care center in Sagamu town, Nigeria within a 2 months period were recruited into the study. A semi- structured questionnaire was used to collect relevant information. RESULTS A total of 255 pregnant women were recruited into the study. The mean age of respondents was 28.07 ± 5.12 years. The mean parity and booking age was 2.7 ± 1.67 and 4.42 ± 1.7 months respectively. The prevalence of Malaria attack in the last 3 months was 122(47.8%). Only 107/255 (40.4%) practice IPTp for malaria prevention during the current pregnancy, with only 14.6% of them taking the second dose during pregnancy as recommended. Chloroquine [27.1%] was the most frequently used medication for the treatment of Malaria in Pregnancy. Early booking age [OR = 1.11, C.I = 0.61-2.01], adverse last pregnancy outcome [OR = 1.23, C.I = 0.36-4.22], and parity [OR = 1.87, C.I = 0.25-16.09] were not statistically significantly associated with IPTp utilization. The only predictor of IPTp use was the knowledge of prophylaxis for malaria prevention [OR = 2.47, C.I = 1.06-3.52] using multivariate analysis. CONCLUSION The study concludes that most women who attend ANC in rural areas in Nigeria do not receive IPTp as expected. A major determinant of utilization of IPTp among the study population was the knowledge of prophylaxis for malaria prevention. This study highlights the importance of health education of the pregnant women in increasing IPTp uptake despite the regular drug stock out at the facility level in rural areas in low resource countries.
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Affiliation(s)
- Olorunfemi E Amoran
- Department of Community Medicine and Primary Care, College of Health Sciences Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria.
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Angral R, Islam MS, Kundan S. Incidence of deep vein thrombosis and justification of chemoprophylaxis in Indian patients: a prospective study. Bangladesh Med Res Counc Bull 2012; 38:67-71. [PMID: 23227631 DOI: 10.3329/bmrcb.v38i2.12885] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Venous thromboembolism (VTE) is considered a major health problem in western countries necessitating thromboprophylaxis. Only a few studies are available regarding incidence in Indian patients resulting in uncertainty regarding thromboprophylaxis for our patients. In our prospective study over a period of 3 years we studied 150 patients (average age 55 years) to determine the incidence of Deep Vein Thrombosis (DVT). These patients were admitted in ICU who remained bedridden for many days and were observed for atleast four weeks. No mechanical or chemical form of deep venous thrombosis prophylaxis was used. All the patients underwent duplex ultrasonography between 7th and 14th postoperative day. None of the patients developed pulmonary embolism (PE). DVT developed in only 10 patients (6.6%). In India there is much lower incidence of DVT as compared to western countries.
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Affiliation(s)
- R Angral
- Madras Medical Mission, Chennai, India.
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Abstract
The final epidemic size (R(∞)) remains one of the fundamental outcomes of an epidemic, and measures the total number of individuals infected during a "free-fall" epidemic when no additional control action is taken. As such, it provides an idealised measure for optimising control policies before an epidemic arises. Although the generality of formulae for calculating the final epidemic size have been discussed previously, we offer an alternative probabilistic argument and then use this formula to consider the optimal deployment of vaccine in spatially segregated populations that minimises the total number of cases. We show that for a limited stockpile of vaccine, the optimal policy is often to immunise one population to the exclusion of others. However, as greater realism is included, this extreme and arguably unethical policy, is replaced by an optimal strategy where vaccine supply is more evenly spatially distributed.
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Affiliation(s)
- Matt J Keeling
- Mathematics Institute & School of Life Sciences, University of Warwick, Coventry, United Kingdom.
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Mokhtari M, Salameh P, Kouchek M, Kashani BS, Taher A, Waked M. The AVAIL ME Extension: a multinational Middle Eastern survey of venous thromboembolism risk and prophylaxis. J Thromb Haemost 2011; 9:1340-9. [PMID: 21605327 DOI: 10.1111/j.1538-7836.2011.04336.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a major worldwide problem. OBJECTIVES The primary objectives of this survey were to identify patients at risk for VTE, to define the rate of patients receiving appropriate VTE prophylaxis and to examine the frequency of the presence of guidelines and their application. PATIENTS AND METHODS Ten countries, 101 hospitals and a total of 4983 patients were included in this multinational cross-sectional survey. Standardized case report forms were filled out by trained individuals on one predefined day. Risks were categorized according to the Caprini Risk Assessment Model. Logistic regressions were carried out to assess factors that determined VTE prophylaxis. RESULTS Of 4983 patients, 3368 (68%) and 1615 (32%) were surgical and medical, respectively. Seven hundred and seventy-two (15.5%) were considered to be at low risk, 1001 (20%) at moderate risk, 1289 (26%) at high risk and 1921 (38.5%) at very high risk for VTE. Of 3575 (72%) patients who were eligible to receive VTE prophylaxis, 2747 (77%) received any drug prophylaxis. Among these patients 720/1056 (68%) and 2027/2519 (80%) were medical and surgical patients, respectively. The overall compliance with ACCP guidelines was 38%, being 24% for medical patients and 44% for surgical patients. CONCLUSIONS The results of this large multinational survey, although indicating overall improvement in VTE prophylaxis, identify a considerable number of patients who either did not receive any VTE prophylaxis or received it inappropriately. Although more medical patients were at risk for VTE, they were given prophylaxis less frequently than surgical patients. Concordance with VTE prophylaxis guidelines was higher in surgical patients, but overall application of these tools was unacceptably low.
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Affiliation(s)
- M Mokhtari
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Abstract
BACKGROUND/OBJECTIVE The START study was a large general practice observational study involving 400 patients with migraine. Given the large sample size, a sub-analysis was planned to ascertain whether any patient characteristics/behaviors might help predict/explain the responses observed in this study, which demonstrated that almotriptan administered early when pain was mild significantly improved pain-related outcomes compared with non-early/non-mild treatment. METHODS This pre-planned sub-analysis assessed the impact of predictors of patient satisfaction, medication history, delayed drug intake, etc. on the primary pain endpoints of the START study. RESULTS Patients had previously tried an average of 2.5 drugs for migraine relief and were currently taking a mean of 1.4 drugs. Almotriptan had been tried by 21% of the sample and was still being used by 83% of this sub-group. Treatment satisfaction was higher in the subset of patients taking almotriptan than in almotriptan-naїve individuals (p < 0.001) and this may explain why this group had the highest continuation rate of all drugs evaluated. On completion of the study, patient satisfaction was higher in the early/mild treatment group than the non-early/non-mild group (p = 0.049). Many patients delayed taking almotriptan, despite being instructed otherwise. Patients reported that this was primarily because they believed that they should only take the medication in the case of a severe migraine attack and/or to ensure that the symptoms were definitely due to migraine headache. The limitations of the trial include its open, observational design, and the small number of individuals who managed to treat their migraine attack within 1 hour when it was still mild. CONCLUSIONS Almotriptan was associated with increased patient satisfaction, particularly when taken early. Further action is required to increase patient compliance with early treatment regimens to improve clinical outcomes.
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van Kaam AH, De Jaegere AP, Borensztajn D, Rimensberger PC. Surfactant replacement therapy in preterm infants: a European survey. Neonatology 2011; 100:71-77. [PMID: 21228602 DOI: 10.1159/000322004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 10/03/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Exogenous surfactant is an undisputed treatment for neonatal respiratory distress syndrome but its efficacy is highly dependent on the treatment strategy. International guidelines have published recommendations on the optimal surfactant replacement strategy. OBJECTIVE To determine how evidence-based guidelines on surfactant replacement therapy are implemented in daily clinical practice. METHODS Data on surfactant replacement therapy, including preparation, dosing and timing, were collected in 173 European neonatal intensive care units (NICUs) by questionnaire and in a cohort of preterm infants mechanically ventilated on two separate predefined dates in these units. RESULTS All NICUs used animal-derived surfactant in the treatment of respiratory distress syndrome, with Poractant being most widely used (86%). The most frequently used first dose was 100 mg/kg (58%) and 200 mg/kg (39%) and all NICUs allowed for repeat dosing. 39% of the NICUs claimed to use prophylactic treatment (<15 min of life). Data on surfactant treatment were collected in 338 infants, with a median gestational age of 27 weeks and a birth weight of 860 g. All infants were treated with animal-derived surfactant. The median first dose was 168 mg/kg in the Poractant group compared with 100 mg/kg in the Beractant and Bovactant groups. Prophylactic treatment was used in 23% of the infants and 28% of the infants received surfactant >2 h after birth. 43% of the infants received multiple doses. CONCLUSIONS With the exception of surfactant timing, guidelines on surfactant replacement therapy seem to be implemented in daily clinical practice in European NICUs.
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van Rijckevorsel GGC, Sonder GJB, Geskus RB, Wetsteyn JCFM, Ligthelm RJ, Visser LG, Keuter M, van Genderen PJJ, van den Hoek A. Declining incidence of imported malaria in the Netherlands, 2000-2007. Malar J 2010; 9:300. [PMID: 21029424 PMCID: PMC2988037 DOI: 10.1186/1475-2875-9-300] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [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: 06/11/2010] [Accepted: 10/28/2010] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND To describe the epidemiology and trends of imported malaria in the Netherlands from 2000 through 2007. METHODS Based on national surveillance data regarding all reported infections of imported malaria, diagnosed 2000 through 2007, incidence and trends of imported malaria in the Netherlands were estimated. Travellers statistics were used to estimate incidence, and data on malaria chemoprophylaxis prescriptions were used to estimate the number of unprotected travellers. RESULTS Importation of malaria to the Netherlands is declining even as more travellers visit malaria-endemic countries. On average, 82% were acquired in sub-Saharan Africa, and 75% were caused by Plasmodium falciparum. The overall incidence in imported falciparum malaria fell from 21.5 to 6.6/10,000 of unprotected travellers. The percentage of unprotected travellers rose from 47% to 52% of all travellers. The incidence of imported falciparum infections is greatest from Middle and West Africa, and decreased from 121.3 to 36.5/10,000 travellers. The import of malaria from this region by immigrants visiting friends and relatives (VFR) decreased from 138 infections in 2000, to 69 infections in 2007. CONCLUSION The annual number of imported malaria shows a continuing declining trend, even with an increasing number of travellers visiting malaria endemic countries. VFR import less malaria than previously, and contribute largely to the declining incidence seen. The decline is not readily explained by increased use of chemoprophylaxis and may reflect a reduced risk of infection due to decreasing local malaria transmission as observed in some malaria endemic areas. Nevertheless, the increasing number of unprotected travellers remains worrisome.
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Affiliation(s)
- Gini GC van Rijckevorsel
- Public Health Service Amsterdam, Department of Infectious Diseases, Amsterdam, The Netherlands
- Malaria Working Group of National Coordination Centre for Travellers' Health Advice (LCR), Amsterdam, The Netherlands
| | - Gerard JB Sonder
- Public Health Service Amsterdam, Department of Infectious Diseases, Amsterdam, The Netherlands
- Malaria Working Group of National Coordination Centre for Travellers' Health Advice (LCR), Amsterdam, The Netherlands
- Academic Medical Center, Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Amsterdam, The Netherlands
| | - Ronald B Geskus
- Public Health Service Amsterdam, Department of Infectious Diseases, Amsterdam, The Netherlands
- Academic Medical Center, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam, The Netherlands
| | - Jose CFM Wetsteyn
- Malaria Working Group of National Coordination Centre for Travellers' Health Advice (LCR), Amsterdam, The Netherlands
- Academic Medical Center, Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Amsterdam, The Netherlands
| | - Robert J Ligthelm
- Malaria Working Group of National Coordination Centre for Travellers' Health Advice (LCR), Amsterdam, The Netherlands
- Tropvacc BV, Rotterdam, The Netherlands
| | - Leo G Visser
- Malaria Working Group of National Coordination Centre for Travellers' Health Advice (LCR), Amsterdam, The Netherlands
- Leiden University Medical Centre, Department of Infectious Disease, Section Travel Medicine, The Netherlands
| | - Monique Keuter
- Malaria Working Group of National Coordination Centre for Travellers' Health Advice (LCR), Amsterdam, The Netherlands
- Radboud University Nijmegen Medical Center, Department of Medicine, Division of General Internal Medicine, Nijmegen
| | - Perry JJ van Genderen
- Malaria Working Group of National Coordination Centre for Travellers' Health Advice (LCR), Amsterdam, The Netherlands
- Department of Internal Medicine, Harbour Hospital and Institute for Tropical Diseases, Rotterdam, The Netherlands
| | - Anneke van den Hoek
- Public Health Service Amsterdam, Department of Infectious Diseases, Amsterdam, The Netherlands
- Malaria Working Group of National Coordination Centre for Travellers' Health Advice (LCR), Amsterdam, The Netherlands
- Academic Medical Center, Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Amsterdam, The Netherlands
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Abstract
BACKGROUND Cardiovascular disease (CVD) is a leading cause of death in the US and Western Europe, but regular use of preventive low-dose aspirin has proven effective in preventing CVD events. The purpose of this study was to explore the potential economic impact in the US if preventive aspirin usage were to be increased in line with clinical guidelines for primary and secondary prevention. METHODS The risk profile of the US population was characterized using NHANES data, and Framingham cardiovascular risk equations were applied to calculate risk for myocardial infarction, angina and ischemic stroke according to age and gender. Primary and secondary patients were considered separately. Using publicly available unit costs, a budget impact model calculated the annual impact of increased preventive aspirin usage considering gastrointestinal bleeding and hemorrhagic stroke adverse events and diminishing aspirin adherence over a 10-year time horizon. RESULTS In a base population of 1,000,000 patients, full implementation of clinical guidelines would potentially prevent an additional 1273 myocardial infarctions, 2184 angina episodes and 565 ischemic strokes in primary prevention patients and an additional 578 myocardial infarctions, and 607 ischemic strokes in secondary prevention patients. This represents a total savings of $79.6 million for primary prevention and $32.2 million for secondary and additional out-of-pocket expense to patients of $29.0 million for primary prevention and $2.6 million for secondary prevention for the cost of aspirin. CONCLUSIONS This budgetary model suggests that there is a strong economic case, both for payers and society, to encourage aspirin use for patients at appropriate risk and per clinical guidelines. It also provides an example of how minimizing costs do not necessarily have to imply a rationing of care. Limitations include the exclusion of other CVD interventions in the analysis.
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Abstract
OBJECTIVES Malaria is a serious disease hazard facing travellers to tropical countries. On average around 2000 cases of malaria are annually imported into the UK, with an over-representation of ethnic minority members. The current research examined adherence to chemoprophylaxis among UK South Asians travelling to malarial regions in South Asia and East Africa. DESIGN Four hundred South Asians were interviewed with a questionnaire investigating use of malaria prophylaxis, knowledge of malaria, risk perceptions and reasons for inadequate or zero adherence to chemoprophylaxis. Two hundred interviews were conducted in 1994, and a further 200 interviews in 2004. Participants were recruited from areas of known ethnic density in Leicester, London and Oxford. RESULTS In 1994, although 49% embarked on taking anti-malaria tablets, only 22% took tablets for 2 or more weeks upon return to the UK (and only 6% for the medically advisory period of 4 weeks). In 2004, 32% embarked on taking tablets but only 9% took tablets for 2 or more weeks upon returning to the UK (and only 2.5% for 4 weeks). Good adherence was associated with greater knowledge about the symptoms and transmission of malaria, and being more likely to define the trip as a 'holiday' rather than as a visit to 'family and friends'. Zero adherence was associated with a failure to recognise the potential severity and critical nature of malaria. Common reasons for partial and zero adherence were the perception that the personal risk of getting malaria was low and an erroneous belief in immunity. CONCLUSIONS The specific cognitions available to ethnic minority members travelling 'home' contribute to a very low use of chemoprophylaxis, thus placing them at a heightened risk of acquiring malaria. Health messages need to stress that malaria is a serious health hazard and that emigres visiting malarial regions cannot rely on personal immunity.
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Abstract
Postexposure prophylaxis after sexual exposure to human immunodeficiency virus (HIV) is recommended by state and national agencies. A cross-sectional survey of 117 Los Angeles County sites found that 17 sites (14.5%) offer postexposure prophylaxis. Ten sites (8.5%) offer postexposure prophylaxis to patients who are uninsured. General availability of postexposure prophylaxis should be a public health priority.
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Affiliation(s)
- Raphael J Landovitz
- University of California, Los Angeles, Center for Clinical AIDS Research and Education, David Geffen School of Medicine, Los Angeles, CA 90035, USA.
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John H, Buckley C, Koh L, Obrenovic K, Erb N, Rowe IF. Regional survey of tuberculosis risk assessment in rheumatology outpatients commencing anti-TNF-alpha treatment in relation to British Thoracic Society guidelines. Clin Med (Lond) 2009; 9:225-30. [PMID: 19634383 PMCID: PMC4953607 DOI: 10.7861/clinmedicine.9-3-225] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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: 11/27/2022]
Abstract
The aim of this study was to analyse tuberculosis (TB) risk assessment for rheumatology patients commencing anti-tumour necrosis factor-alpha (anti-TNF-alpha) therapy using the British Thoracic Society (BTS) guidelines. Data were obtained retrospectively on 856 outpatients regionally receiving anti-TNF-alpha. Prior to commencing treatment, patients had the following assessments documented: respiratory examination, 47.4%; chest X-ray, 84.5%; TB history, 92.9%; and advice about TB risk, 45.8%. Of the 856 patients, 94.3% were on immunosuppressives but 27% had a tuberculin test; 12.6% had > or =1 high-risk factors for TB. In total, 3.4% were referred to a TB specialist and of these, 24.1% had no risk factors for TB. Of patients with > or =1 risk factor, 76.9% were not referred. Only 4/28 patients at high risk for TB due to ethnicity or birthplace received chemoprophylaxis. Marked inter-unit variation was demonstrated and it was evident that patients require improved screening for TB. Greater awareness is necessary of patients with risk factors, particularly ethnicity, to facilitate more appropriate targeting of chemoprophylaxis. Multi-centre audit is a valuable clinical governance tool.
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Affiliation(s)
- H John
- Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Dudley
| | - C Buckley
- Department of Rheumatology, Worcestershire Royal Hospital, Worcester
| | - L Koh
- Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Dudley
| | - K Obrenovic
- Department of Clinical Audit, Dudley Group of Hospitals NHS Trust, Dudley
| | - N Erb
- Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Dudley
| | - IF Rowe
- Department of Rheumatology, Worcestershire Royal Hospital, Worcester
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