1
|
Lewis A, Young MJ, Rohaut B, Jox RJ, Claassen J, Creutzfeldt CJ, Illes J, Kirschen M, Trevick S, Fins JJ. Ethics Along the Continuum of Research Involving Persons with Disorders of Consciousness. Neurocrit Care 2023; 39:565-577. [PMID: 36977963 PMCID: PMC11023737 DOI: 10.1007/s12028-023-01708-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/23/2023] [Indexed: 03/30/2023]
Abstract
Interest in disorders of consciousness (DoC) has grown substantially over the past decade and has illuminated the importance of improving understanding of DoC biology; care needs (use of monitoring, performance of interventions, and provision of emotional support); treatment options to promote recovery; and outcome prediction. Exploration of these topics requires awareness of numerous ethics considerations related to rights and resources. The Curing Coma Campaign Ethics Working Group used its expertise in neurocritical care, neuropalliative care, neuroethics, neuroscience, philosophy, and research to formulate an informal review of ethics considerations along the continuum of research involving persons with DoC related to the following: (1) study design; (2) comparison of risks versus benefits; (3) selection of inclusion and exclusion criteria; (4) screening, recruitment, and enrollment; (5) consent; (6) data protection; (7) disclosure of results to surrogates and/or legally authorized representatives; (8) translation of research into practice; (9) identification and management of conflicts of interest; (10) equity and resource availability; and (11) inclusion of minors with DoC in research. Awareness of these ethics considerations when planning and performing research involving persons with DoC will ensure that the participant rights are respected while maximizing the impact and meaningfulness of the research, interpretation of outcomes, and communication of results.
Collapse
Affiliation(s)
- Ariane Lewis
- NYU Langone Medical Center, 530 First Avenue, Skirball-7R, New York, NY, 10016, USA.
| | - Michael J Young
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Benjamin Rohaut
- Inserm, CNRS, APHP - Hôpital de la Pitié Salpêtrière, Paris Brain Institute - ICM, DMU Neuroscience, Sorbonne University, Paris, France
| | - Ralf J Jox
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jan Claassen
- New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Claire J Creutzfeldt
- Harborview Medical Center, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
- Cambia Palliative Care Center of Excellence, Seattle, WA, USA
| | - Judy Illes
- University of British Columbia, Vancouver, BC, Canada
| | | | | | - Joseph J Fins
- Weill Cornell Medical College, New York, NY, USA
- Yale Law School, New Haven, CT, USA
- Rockefeller University, New York, NY, USA
| |
Collapse
|
2
|
Busisiwe N, Seeley J, Strode A, Parker M. Beyond translations, perspectives for researchers to consider to enhance comprehension during consent processes for health research in sub-saharan Africa: a scoping review. BMC Med Ethics 2023; 24:43. [PMID: 37344810 DOI: 10.1186/s12910-023-00920-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/09/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Literature on issues relating to comprehension during the process of obtaining informed consent (IC) has largely focused on the challenges potential participants can face in understanding the IC documents, and the strategies used to enhance comprehension of those documents. In this review, we set out to describe the factors that have an impact on comprehension and the strategies used to enhance the IC process in sub-Saharan African countries. METHODS From November 2021 to January 2022, we conducted a literature search using a PRISMA tool. We searched electronic databases (PubMed, EMBASE, EBSCOHOST) to identify relevant peer reviewed studies. We then reviewed the references of these articles to find additional literature that might have been missed through the initial search. We were particularly interested in full text articles in English that focused on the IC process in SSA published between 2006 and 2020. We included systematic reviews, and studies from Western and Asian countries that included data about SSA. We excluded articles that focused on medical interventions and studies that did not require IC. RESULTS Out of the 50 studies included most were multi-country (n = 13) followed by single country studies in South Africa (n = 12); Kenya, Tanzania, Uganda (n = 5) each; Gambia, Ghana and Nigeria (n = 2)each ; and one each for Botswana, Malawi, Mali, Mozambique. We identified three areas of focus: (1) socio-cultural factors affecting IC; (2) gaps in the ethical and legal frameworks guiding the IC process; and (3) strategies used to improve participants' understanding of IC. CONCLUSION Our review showed wide recognition that the process of achieving IC in SSA is inherently challenging, and there are limitations in the strategies aimed at improving comprehension in IC. We suggest that there is a need for greater flexibility and negotiation with communities to ensure that the approach to IC is suited to the diverse socio-cultural contexts. We propose moving beyond the literal translations and technical language to understanding IC comprehension from the participants' perspectives and the researchers' views, while examining contextual factors that impact the IC process.
Collapse
Affiliation(s)
- Nkosi Busisiwe
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa.
- Institute for Global Health, University College London, London, UK.
- School of Law, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
- London School of Hygiene and Tropical Medicine, London, UK
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Ann Strode
- School of Law, University of KwaZulu-Natal, Pietermaritzburg, South Africa
- South African Research Ethics Training Initiative, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | | |
Collapse
|
3
|
Sayed BA, Posey DL, Maskery B, Wingate LT, Cetron MS. Cost effectiveness analysis of implementing tuberculosis screening among applicants for non-immigrant U.S. work visas. Pneumonia (Nathan) 2020; 12:15. [PMID: 33357237 PMCID: PMC7761151 DOI: 10.1186/s41479-020-00078-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/23/2020] [Indexed: 11/27/2022] Open
Abstract
Background While persons who receive immigrant and refugee visas are screened for active tuberculosis before admission into the United States, nonimmigrant visa applicants (NIVs) are not routinely screened and may enter the United States with infectious tuberculosis. Objectives We evaluated the costs and benefits of expanding pre-departure tuberculosis screening requirements to a subset of NIVs who arrive from a moderate (Mexico) or high (India) incidence tuberculosis country with temporary work visas. Methods We developed a decision tree model to evaluate the program costs and estimate the numbers of active tuberculosis cases that may be diagnosed in the United States in two scenarios: 1) “Screening”: screening and treatment for tuberculosis among NIVs in their home country with recommended U.S. follow-up for NIVs at elevated risk of active tuberculosis; and, 2) “No Screening” in their home country so that cases would be diagnosed passively and treatment occurs after entry into the United States. Costs were assessed from multiple perspectives, including multinational and U.S.-only perspectives. Results Under “Screening” versus “No Screening”, an estimated 179 active tuberculosis cases and 119 hospitalizations would be averted in the United States annually via predeparture treatment. From the U.S.-only perspective, this program would result in annual net cost savings of about $3.75 million. However, rom the multinational perspective, the screening program would cost $151,388 per U.S. case averted for Indian NIVs and $221,088 per U.S. case averted for Mexican NIVs. Conclusion From the U.S.-only perspective, the screening program would result in substantial cost savings in the form of reduced treatment and hospitalization costs. NIVs would incur increased pre-departure screening and treatment costs. Supplementary Information The online version contains supplementary material available at 10.1186/s41479-020-00078-z.
Collapse
Affiliation(s)
- Bisma Ali Sayed
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, Building 16, MS 16-4, Atlanta, GA, 30329, USA
| | - Drew L Posey
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, Building 16, MS 16-4, Atlanta, GA, 30329, USA
| | - Brian Maskery
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, Building 16, MS 16-4, Atlanta, GA, 30329, USA.
| | | | - Martin S Cetron
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, Building 16, MS 16-4, Atlanta, GA, 30329, USA
| |
Collapse
|
4
|
Kerani R, Narita M, Lipira L, Endeshaw M, Holmes KK, Golden MR. Challenges in Recruiting African-Born, US-Based Participants for HIV and Tuberculosis Research. J Immigr Minor Health 2019; 21:533-539. [PMID: 29946866 DOI: 10.1007/s10903-018-0776-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Research is critical for developing HIV and tuberculosis (TB) programming for U.S. African-born communities, and depends on successful recruitment of African-born people. From January 2014 to June 2016, we recruited African-born people for HIV and TB research in King County, Washington. We compared the characteristics of study participants and the underlying populations of interest, and assessed recruitment strategies. Target enrollment for the HIV study was 167 participants; 51 participants (31%) were enrolled. Target enrollment for the TB study was 218 participants; 38 (17%) were successfully recruited. Of 249 prior TB patients we attempted to contact by phone, we reached 72 (33%). Multiple recruitment strategies were employed with variable impact. Study participants differed from the underlying populations in terms of gender, country of origin and language. Inequities in research participation and in meaningful opportunities for such participation may exacerbate existing health disparities.
Collapse
Affiliation(s)
- Roxanne Kerani
- Department of Medicine, University of Washington, Seattle, WA, USA.
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, USA.
- Department of Epidemiology, University of Washington, Seattle, WA, USA.
- Center for AIDS and STD, NJB #359932, 325 9th Ave, Seattle, WA, 98104, USA.
| | - Masahiro Narita
- Department of Medicine, University of Washington, Seattle, WA, USA
- TB Control Program, Public Health - Seattle and King County, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Lauren Lipira
- Department of Health Services, University of Washington, Seattle, WA, USA
| | | | - King K Holmes
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Matthew R Golden
- Department of Medicine, University of Washington, Seattle, WA, USA
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| |
Collapse
|
5
|
Zhang B, Wu H, Hao J, Wu Y, Yang B. Inhibition of DNA-PKcs activity re-sensitizes uveal melanoma cells to radio- and chemotherapy. Biochem Biophys Res Commun 2019; 522:639-646. [PMID: 31785810 DOI: 10.1016/j.bbrc.2019.11.133] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/20/2019] [Indexed: 02/06/2023]
Abstract
Uveal melanoma (UM) is the most common primary intraocular tumor in adults. Despite of important progress in the local therapy, high radioresistance in primary tumor and chemoresistance in metastatic disease are the major obstacles for UM therapy. Therefore, strategies to overcome resistance to radiation or chemotherapy in UM are urgently needed. In this study, we found that phosphorylation of DNA-PKcs, which is the key factor of non-homologous end joining (NHEJ) pathway, was remarkably overexpressed in ionizing radiation (IR)- and Selumetinib resistant UM cells. Increased amount of NHEJ events were also observed in resistant UM cells. Inhibition of DNA-PKcs by NU7441 significantly impaired DNA repair and re-sensitized resistant UM cells to radiation and Selumetinib both in vitro and in vivo. The results demonstrate increased DNA double strand break repair as a mechanism of resistance to ionizing radiation and Selumetinib, and identify DNA-PKcs as a promising target for radio-and chemotherapy in UM patients.
Collapse
Affiliation(s)
- Bingjie Zhang
- Department of Ophthalmology, First Hospital of Jilin University, Changchun, China.
| | - Haiyan Wu
- Department of Ophthalmology, Songyuan Central Hospital, Songyuan, China.
| | - Jilong Hao
- Department of Ophthalmology, First Hospital of Jilin University, Changchun, China.
| | - Yunlong Wu
- Department of Ophthalmology, First Hospital of Jilin University, Changchun, China.
| | - Ben Yang
- China-Japan Union Hospital of Jilin University, Changchun, China.
| |
Collapse
|
6
|
High Rates of Tuberculosis and Opportunities for Prevention among International Students in the United States. Ann Am Thorac Soc 2017; 13:522-8. [PMID: 26730745 DOI: 10.1513/annalsats.201508-547oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Foreign-born persons traveling on a student visa are not currently screened for tuberculosis on entry into the United States, despite residing in the United States for up to several years. OBJECTIVES To characterize the risk of tuberculosis in international students entering the United States and to identify strategies for early diagnosis and prevention in this population. METHODS Data were collected in 18 tuberculosis control jurisdictions in the United States. A cohort of 1,268 foreign-born patients of known visa status, diagnosed with active tuberculosis between 2004 and 2007, was used for analysis. Incidence rates were estimated on the basis of immigration data from study jurisdictions. MEASUREMENTS AND MAIN RESULTS Tuberculosis was diagnosed in 46 student residents, providing an annual estimate of 308 cases nationally. The estimated tuberculosis case rate in student residents was 48.1 cases per 100,000 person-years (95% confidence interval, 35.6-64.8), more than twice that of the general foreign-born population. Students identified by tuberculosis screening programs were more likely to be diagnosed within 6 months of U.S. arrival (75 vs. 6%; P < 0.001), and those with pulmonary disease were less likely to have a positive sputum smear for acid-fast bacilli compared with those not screened (18 vs. 63%; P = 0.05). In unscreened students, 71% were diagnosed more than 1 year after U.S. arrival and only 6% were previously treated for latent tuberculosis infection. CONCLUSIONS The tuberculosis case rate in foreign-born students is significantly higher than in other foreign-born individuals. Screening this group after arrival to the United States is an effective strategy for earlier diagnosis of active tuberculosis.
Collapse
|
7
|
Kambali S, Nantsupawat N, Lee M, Nugent K. A workplace tuberculosis case investigation in the presence of immigrant contacts from high prevalence countries. J Community Health 2016; 40:576-80. [PMID: 25236657 DOI: 10.1007/s10900-014-9946-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The highest prevalence of tuberculosis (TB) occurs in foreign born immigrants in the United States. Contact investigations at work sites with mostly immigrant workers present multiple practical problems. Recently 402 contacts were investigated at a meat packing plant in rural Texas by the Texas Department of State Health Services (DSHS). Our objective was to study the approach and effectiveness of this intensive investigation. We reviewed information, including symptoms, BCG status, TB history, X-rays, and treatment, on the sentinel case and 47 contacts managed by the Texas DSHS TB Division in Lubbock, TX. We used a gamma interferon release assay (T-SPOT.TB) to identify contacts with TB infection. The sentinel case was foreign born and had cavitary TB with acid-fast positive smears. Forty-two work site contacts were foreign born, and five were US born. The foreign born contacts were from Sudan, Somalia, Mexico, Burma, and Haiti; 18 contacts had a history of BCG vaccination. T-SPOT.TB tests were positive in 20 contacts, borderline in four, and negative in 23. Contacts with borderline results had negative repeat tests. Twenty-three contacts with negative T-SPOT.TB tests were scheduled for repeat tests in 4 weeks, but only four returned for this testing. Chest X-rays were abnormal in two contacts who were started on treatment. Sputum was collected in three individuals; one was culture positive for pan-sensitive Mycobacterium tuberculosis. Twelve contacts were treated for latent TB. Our investigation established an infection rate of 42.5% in this work site contact cohort, which is similar to the 39% prevalence reported by the Center for Disease Control. The use of T-SPOT.TB assays simplified testing in immigrants with high rates of BCG vaccination. Our investigation was complicated by language barriers, varying and uncertain levels of exposure, and a high rate of drop outs in the negative T-SPOT.TB contacts. This concerted effort provides a model for investigating work site contacts, especially with numerous immigrants, and illustrates the problems associated with these investigations.
Collapse
Affiliation(s)
- Shrinivas Kambali
- Department of Internal Medicine, Texas Tech University Health Sciences Center, 3601 4th Street, Lubbock, TX, 79430, USA,
| | | | | | | |
Collapse
|
8
|
Aiona K, Lowenthal P, Painter JA, Reves R, Flood J, Parker M, Fu Y, Wall K, Walter ND. Transnational Record Linkage for Tuberculosis Surveillance and Program Evaluation. Public Health Rep 2015; 130:475-84. [PMID: 26327726 DOI: 10.1177/003335491513000511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Pre-immigration tuberculosis (TB) screening, followed by post-arrival rescreening during the first year, is critical to reducing TB among foreign-born people in the United States. However, existing U.S. public health surveillance is inadequate to monitor TB among immigrants during subsequent years. We developed and tested a novel method for ascertaining post-U.S.-arrival TB outcomes among high-TB-risk immigrant cohorts to improve surveillance. METHODS We used a probabilistic record linkage program to link pre-immigration screening records from U.S.-bound immigrants from the Philippines (n=422,593) and Vietnam (n=214,401) with the California TB registry during 2000-2010. We estimated sensitivity using Monte Carlo simulations to account for uncertainty in key inputs. Specificity was evaluated by using a time-stratified approach, which defined false-positives as TB records linked to pre-immigration screening records dated after the person had arrived in the United States. RESULTS TB was reported in 4,382 and 2,830 people born in the Philippines and Vietnam, respectively, in California during the study period. Of these TB cases, records for 973 and 452 cases of people born in the Philippines and Vietnam, respectively, were linked to pre-immigration screening records. Sensitivity and specificity of linkage were 89% (90% credible interval [CrI] 83, 97) and 100%, respectively, for the Philippines, and 90% (90% CrI 83, 98) and 99.9%, respectively, for Vietnam. CONCLUSION Electronic linkage of pre-immigration screening records to a domestic TB registry was feasible, sensitive, and highly specific in two high-priority immigrant cohorts. Transnational record linkage can be used for program evaluation and routine monitoring of post-U.S.-arrival TB risk among immigrants, but requires interagency data sharing and collaboration.
Collapse
Affiliation(s)
- Kaylynn Aiona
- Denver Public Health Department, Denver Metro Tuberculosis Control Program, Denver, CO
| | - Phillip Lowenthal
- California Department of Public Health, Center for Infectious Diseases, Division of Communicable Disease Control, Tuberculosis Control Branch, Richmond, CA
| | - John A Painter
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, Immigrant, Refugee, and Migrant Health Branch, Atlanta, GA
| | - Randall Reves
- Denver Public Health Department, Denver Metro Tuberculosis Control Program, Denver, CO
| | - Jennifer Flood
- California Department of Public Health, Center for Infectious Diseases, Division of Communicable Disease Control, Tuberculosis Control Branch, Richmond, CA
| | - Matthew Parker
- Denver Public Health Department, Denver Metro Tuberculosis Control Program, Denver, CO
| | - Yunxin Fu
- University of Texas Health Science Center, School of Public Health, Human Genetics Center and Division of Biostatistics, Houston, TX
| | - Kirsten Wall
- Denver Public Health Department, Denver Metro Tuberculosis Control Program, Denver, CO
| | - Nicholas D Walter
- Denver Public Health Department, Denver Metro Tuberculosis Control Program, Denver, CO ; University of Colorado Denver, Division of Pulmonary Sciences and Critical Care Medicine, Aurora, CO
| |
Collapse
|
9
|
Davidow AL, Katz D, Ghosh S, Blumberg H, Tamhane A, Sevilla A, Reves R. Preventing Infectious Pulmonary Tuberculosis Among Foreign-Born Residents of the United States. Am J Public Health 2015; 105:e81-8. [PMID: 26180947 PMCID: PMC4539796 DOI: 10.2105/ajph.2015.302662] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We described risk factors associated with infectious tuberculosis (TB) and missed TB-prevention opportunities in foreign-born US residents, who account for almost two thirds of the nation's TB patients. METHODS In a cross-sectional study at 20 US sites of foreign-born persons diagnosed with TB in 2005 through 2006, we collected results of sputum smear microscopy for acid-fast bacilli (a marker for infectiousness) and data on visa status, sociodemographics, TB-related care seeking, and latent TB infection (LTBI) diagnosis opportunities. RESULTS Among 980 persons with pulmonary TB who reported their visa status, 601 (61%) were legal permanent residents, 131 (13.4%) had temporary visas, and 248 (25.3%) were undocumented. Undocumented persons were more likely than permanent residents to have acid-fast bacilli-positive smears at diagnosis (risk ratio = 1.3; 95% confidence interval = 1.2, 1.4). Of those diagnosed 1 year or more after arrival, 57.3% reported LTBI screening opportunities; fewer than 25% actually were. Undocumented persons reported fewer LTBI screening opportunities and were less likely to be tested. CONCLUSIONS Progress toward TB elimination in the United States depends upon expanding opportunities for regular medical care and promotion of LTBI screening and treatment among foreign-born persons.
Collapse
Affiliation(s)
- Amy L Davidow
- Amy L. Davidow is with Rutgers Biological and Health Sciences, New Jersey Medical School, Department of Preventive Medicine and Community Health, Newark. Dolly Katz and Smita Ghosh are with Centers for Disease Control and Prevention, Division of TB Elimination, Atlanta, GA. Henry Blumberg is with Emory University School of Medicine, Department of Medicine, Atlanta. Ashutosh Tamhane is with University of Alabama at Birmingham, Department of Medicine. Anna Sevilla is with Global TB Institute, Rutgers Biological and Health Sciences. Randall Reves is with Denver Health and Hospitals Authority, Denver, CO
| | - Dolly Katz
- Amy L. Davidow is with Rutgers Biological and Health Sciences, New Jersey Medical School, Department of Preventive Medicine and Community Health, Newark. Dolly Katz and Smita Ghosh are with Centers for Disease Control and Prevention, Division of TB Elimination, Atlanta, GA. Henry Blumberg is with Emory University School of Medicine, Department of Medicine, Atlanta. Ashutosh Tamhane is with University of Alabama at Birmingham, Department of Medicine. Anna Sevilla is with Global TB Institute, Rutgers Biological and Health Sciences. Randall Reves is with Denver Health and Hospitals Authority, Denver, CO
| | - Smita Ghosh
- Amy L. Davidow is with Rutgers Biological and Health Sciences, New Jersey Medical School, Department of Preventive Medicine and Community Health, Newark. Dolly Katz and Smita Ghosh are with Centers for Disease Control and Prevention, Division of TB Elimination, Atlanta, GA. Henry Blumberg is with Emory University School of Medicine, Department of Medicine, Atlanta. Ashutosh Tamhane is with University of Alabama at Birmingham, Department of Medicine. Anna Sevilla is with Global TB Institute, Rutgers Biological and Health Sciences. Randall Reves is with Denver Health and Hospitals Authority, Denver, CO
| | - Henry Blumberg
- Amy L. Davidow is with Rutgers Biological and Health Sciences, New Jersey Medical School, Department of Preventive Medicine and Community Health, Newark. Dolly Katz and Smita Ghosh are with Centers for Disease Control and Prevention, Division of TB Elimination, Atlanta, GA. Henry Blumberg is with Emory University School of Medicine, Department of Medicine, Atlanta. Ashutosh Tamhane is with University of Alabama at Birmingham, Department of Medicine. Anna Sevilla is with Global TB Institute, Rutgers Biological and Health Sciences. Randall Reves is with Denver Health and Hospitals Authority, Denver, CO
| | - Ashutosh Tamhane
- Amy L. Davidow is with Rutgers Biological and Health Sciences, New Jersey Medical School, Department of Preventive Medicine and Community Health, Newark. Dolly Katz and Smita Ghosh are with Centers for Disease Control and Prevention, Division of TB Elimination, Atlanta, GA. Henry Blumberg is with Emory University School of Medicine, Department of Medicine, Atlanta. Ashutosh Tamhane is with University of Alabama at Birmingham, Department of Medicine. Anna Sevilla is with Global TB Institute, Rutgers Biological and Health Sciences. Randall Reves is with Denver Health and Hospitals Authority, Denver, CO
| | - Anna Sevilla
- Amy L. Davidow is with Rutgers Biological and Health Sciences, New Jersey Medical School, Department of Preventive Medicine and Community Health, Newark. Dolly Katz and Smita Ghosh are with Centers for Disease Control and Prevention, Division of TB Elimination, Atlanta, GA. Henry Blumberg is with Emory University School of Medicine, Department of Medicine, Atlanta. Ashutosh Tamhane is with University of Alabama at Birmingham, Department of Medicine. Anna Sevilla is with Global TB Institute, Rutgers Biological and Health Sciences. Randall Reves is with Denver Health and Hospitals Authority, Denver, CO
| | - Randall Reves
- Amy L. Davidow is with Rutgers Biological and Health Sciences, New Jersey Medical School, Department of Preventive Medicine and Community Health, Newark. Dolly Katz and Smita Ghosh are with Centers for Disease Control and Prevention, Division of TB Elimination, Atlanta, GA. Henry Blumberg is with Emory University School of Medicine, Department of Medicine, Atlanta. Ashutosh Tamhane is with University of Alabama at Birmingham, Department of Medicine. Anna Sevilla is with Global TB Institute, Rutgers Biological and Health Sciences. Randall Reves is with Denver Health and Hospitals Authority, Denver, CO
| |
Collapse
|
10
|
Colson PW, Couzens GL, Royce RA, Kline T, Chavez-Lindell T, Welbel S, Pang J, Davidow A, Hirsch-Moverman Y. Examining the impact of patient characteristics and symptomatology on knowledge, attitudes, and beliefs among foreign-born tuberculosis cases in the US and Canada. J Immigr Minor Health 2015; 16:125-35. [PMID: 23440450 DOI: 10.1007/s10903-013-9787-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Foreign-born individuals represent the majority of TB cases in the US/Canada. Little is known about their TB knowledge, attitudes, and beliefs (KAB). Cross-sectional survey was conducted in 22 sites in the US/Canada among foreign-born adults with active TB. Multiple regression was used to examine KAB factors against covariates. Of 1,475 participants interviewed, most answered the six knowledge items correctly. Significant predictors of correct knowledge included region of origin, education, income, age, visa status, place of diagnosis, BCG vaccination, and TB symptoms. Significant predictors of higher perceived risk/stigma scores included region of origin, age, place of diagnosis, English fluency, time in the US/Canada, TB symptoms, and household rooms. This study examines associations between TB KAB and patient and disease characteristics in foreign-born individuals in the US/Canada. The findings call for improved health education, along with efforts to reduce stigma and enhance realistic risk assessments.
Collapse
Affiliation(s)
- Paul W Colson
- Charles P. Felton National Tuberculosis Center, ICAP, Mailman School of Public Health, Columbia University, 215 W. 125th St., 1st fl., Suite A, New York, NY, 10027, USA,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Ehman M, Flood J, Barry PM. Tuberculosis treatment managed by providers outside the Public Health Department: lessons for the Affordable Care Act. PLoS One 2014; 9:e110645. [PMID: 25340876 PMCID: PMC4207732 DOI: 10.1371/journal.pone.0110645] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 09/24/2014] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Tuberculosis (TB) requires at least six months of multidrug treatment and necessitates monitoring for response to treatment. Historically, public health departments (HDs) have cared for most TB patients in the United States. The Affordable Care Act (ACA) provides coverage for uninsured persons and may increase the proportion of TB patients cared for by private medical providers and other providers outside HDs (PMPs). We sought to determine whether there were differences in care provided by HDs and PMPs to inform public health planning under the ACA. METHODS We conducted a retrospective, cross-sectional analysis of California TB registry data. We included adult TB patients with culture-positive, pulmonary TB reported in California during 2007-2011. We examined trends, described case characteristics, and created multivariate models measuring two standards of TB care in PMP- and HD-managed patients: documented culture conversion within 60 days, and use of directly observed therapy (DOT). RESULTS The proportion of PMP-managed TB patients increased during 2007-2011 (p = 0.002). On univariable analysis (N = 4,606), older age, white, black or Asian/Pacific Islander race, and birth in the United States were significantly associated with PMP care (p<0.05). Younger age, Hispanic ethnicity, homelessness, drug or alcohol use, and cavitary and/or smear-positive TB disease, were associated with HD care. Multivariable analysis showed PMP care was associated with lack of documented culture conversion (adjusted relative risk [aRR] = 1.37, confidence interval [CI] 1.25-1.51) and lack of DOT (aRR = 8.56, CI 6.59-11.1). CONCLUSION While HDs cared for TB cases with more social and clinical complexities, patients under PMP care were less likely to receive DOT and have documented culture conversion. This indicates a need for close collaboration between PMPs and HDs to ensure that optimal care is provided to all TB patients and TB transmission is halted. Strategies to enhance collaboration between HDs and PMPs should be included in ACA implementation.
Collapse
Affiliation(s)
- Melissa Ehman
- Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California, United States of America
- Institute of Global Health, Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Jennifer Flood
- Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California, United States of America
| | - Pennan M. Barry
- Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California, United States of America
| |
Collapse
|
12
|
Pang J, Teeter LD, Katz DJ, Davidow AL, Miranda W, Wall K, Ghosh S, Stein-Hart T, Restrepo BI, Reves R, Graviss EA. Epidemiology of tuberculosis in young children in the United States. Pediatrics 2014; 133:e494-504. [PMID: 24515517 PMCID: PMC5135007 DOI: 10.1542/peds.2013-2570] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To estimate tuberculosis (TB) rates among young children in the United States by children's and parents' birth origins and describe the epidemiology of TB among young children who are foreign-born or have at least 1 foreign-born parent. METHODS Study subjects were children <5 years old diagnosed with TB in 20 US jurisdictions during 2005-2006. TB rates were calculated from jurisdictions' TB case counts and American Community Survey population estimates. An observational study collected demographics, immigration and travel histories, and clinical and source case details from parental interviews and health department and TB surveillance records. RESULTS Compared with TB rates among US-born children with US-born parents, rates were 32 times higher in foreign-born children and 6 times higher in US-born children with foreign-born parents. Most TB cases (53%) were among the 29% of children who were US born with foreign-born parents. In the observational study, US-born children with foreign-born parents were more likely than foreign-born children to be infants (30% vs. 7%), Hispanic (73% vs. 37%), diagnosed through contact tracing (40% vs. 7%), and have an identified source case (61% vs. 19%); two-thirds of children were exposed in the United States. CONCLUSIONS Young children who are US born of foreign-born parents have relatively high rates of TB and account for most cases in this age group. Prompt diagnosis and treatment of adult source cases, effective contact investigations prioritizing young contacts, and targeted testing and treatment of latent TB infection are necessary to reduce TB morbidity in this population.
Collapse
Affiliation(s)
- Jenny Pang
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Larry D. Teeter
- Department of Pathology and Genomic Medicine, Center for Molecular and Translational Human Infectious Diseases Research, Houston Methodist Research Institute, Houston, Texas
| | - Dolly J. Katz
- Division of TB Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy L. Davidow
- Global TB Institute and Department of Preventive Medicine and Community Health, New Jersey Medical School at Rutgers, The State University of New Jersey, Newark, New Jersey
| | | | - Kirsten Wall
- Denver Metro Tuberculosis Control Program, Denver Public Health Department, Denver, Colorado
| | - Smita Ghosh
- Division of TB Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Trudy Stein-Hart
- Tennessee Department of Health TB Elimination Program, Nashville, Tennessee
| | - Blanca I. Restrepo
- School of Public Health in Brownsville, University of Texas Health Science Center at Houston, Brownsville, Texas
| | - Randall Reves
- Denver Metro Tuberculosis Control Program, Denver Public Health Department, Denver, Colorado
| | - Edward A. Graviss
- Department of Pathology and Genomic Medicine, Center for Molecular and Translational Human Infectious Diseases Research, Houston Methodist Research Institute, Houston, Texas
| | | |
Collapse
|
13
|
Optimizing the protection of research participants and personnel in HIV-related research where TB is prevalent: practical solutions for improving infection control. J Acquir Immune Defic Syndr 2014; 65 Suppl 1:S19-23. [PMID: 24321979 DOI: 10.1097/qai.0000000000000035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Tuberculosis (TB) is a leading cause of death among persons with HIV globally. HIV-related research in TB endemic areas raises some unique and important ethical issues in infection control related to protecting both research participants and personnel. To address such concerns, this article provides practical guidance to help research teams develop strategies to prevent TB transmission in studies involving persons with HIV in TB endemic settings.
Collapse
|
14
|
Lahey T. The ethics of clinical research in low- and middle-income countries. HANDBOOK OF CLINICAL NEUROLOGY 2013; 118:301-13. [PMID: 24182387 DOI: 10.1016/b978-0-444-53501-6.00025-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The increasing conduct of clinical research in low- and middle-income countries (LMIC) is motivated by the desire to promote host country access to biomedical research, to enhance LMIC access to modern clinical care, and opportunities to conduct research with simpler regulatory requirements and at lower cost. Yet clinical research in LMIC is associated with ethical risks beyond those of clinical research conducted in high-income countries (HIC). Ethical challenges particular to clinical research in LMIC include the conduct of placebo-controlled clinical trials in LMIC despite HIC availability of effective comparator interventions, obtaining informed consent despite power inequities, and the obligation of HIC researchers to redress health disparities in LMIC. This chapter covers these and additional ethical challenges of clinical research in LMIC, and proposes ways to navigate these challenges through awareness, regulatory oversight, consultation, and collaboration with LMIC investigators and community representatives. With its ethical challenges properly managed, clinical research in LMIC provides historic opportunities to bring biomedical research and better healthcare infrastructure to countries previously left behind in the modern rush to biomedical innovation.
Collapse
Affiliation(s)
- Timothy Lahey
- Department of Microbiology & Immunology, Geisel School of Medicine at Dartmouth, Hanover; Section of Infectious Diseases and International Health, Department of Medicine, Lebanon and Bioethics Committee, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| |
Collapse
|
15
|
Socioeconomic determinants associated with willingness to participate in medical research among a diverse population. Contemp Clin Trials 2012; 33:1197-205. [PMID: 22885788 DOI: 10.1016/j.cct.2012.07.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 07/21/2012] [Accepted: 07/23/2012] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Although it is federally-mandated that racial/ethnic minorities be included in research studies, recruiting diverse populations remains a challenge. This is particularly difficult when research involves children. The purpose of this study was to assess attitudes and beliefs toward medical research among a racially and socioeconomically diverse population of parents of school children. METHODS A cross-sectional parent-report survey was conducted in New York City public elementary schools using stratified random selection to obtain a diverse population. Fear of medical research and likelihood to participate in medical research were assessed using a validated questionnaire. Differences in fear/likelihood to participate in research across race/ethnicity and socioeconomic characteristics were evaluated. RESULTS In general, parents were afraid of their child "being treated as a guinea pig", but were willing to allow their child to participate in research if asked by their own doctor. Factors associated with a lower score on fear toward research were; primary language other than English (OR=0.59), access to an interpreter (OR=0.73) and access to medical service within a day (OR=0.51). Latinos had the highest fear score (OR=1.87) compared to Whites. Asians were the ethnic group most likely to participate in research (OR=1.71). Low education level (OR=2.18) and public health insurance (OR=1.37) were associated with a higher score for likelihood of allowing one's child to participate in medical research. CONCLUSION Minority parents reported more fear of allowing their children to participate in medical research, but were as likely to consent their children's participation, especially if asked by their own physician.
Collapse
|