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Miles S, Renedo A, Kühlbrandt C, McGowan C, Stuart R, Grenfell P, Marston C. Health risks at work mean risks at home: Spatial aspects of COVID-19 among migrant workers in precarious jobs in England. Sociol Health Illn 2024; 46:381-398. [PMID: 37728181 DOI: 10.1111/1467-9566.13711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 08/11/2023] [Indexed: 09/21/2023]
Abstract
During COVID-19 lockdowns in England, 'key workers' including factory workers, carers and cleaners had to continue to travel to workplaces. Those in key worker jobs were often from more marginalised communities, including migrant workers in precarious employment. Recognising space as materially and socially produced, this qualitative study explores migrant workers' experiences of navigating COVID-19 risks at work and its impacts on their home spaces. Migrant workers in precarious employment often described workplace COVID-19 protection measures as inadequate. They experienced work space COVID-19 risks as extending far beyond physical work boundaries. They developed their own protection measures to try to avoid infection and to keep the virus away from family members. Their protection measures included disinfecting uniforms, restricting leisure activities and physically separating themselves from their families. Inadequate workplace COVID-19 protection measures limited workers' ability to reduce risks. In future outbreaks, support for workers in precarious jobs should include free testing, paid sick leave and accommodation to allow for self-isolation to help reduce risks to workers' families. Work environments should not be viewed as discrete risk spaces when planning response measures; responses and risk reduction approaches must also take into account impacts on workers' lives beyond the workplace.
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Affiliation(s)
- Sam Miles
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Alicia Renedo
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Charlotte Kühlbrandt
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Catherine McGowan
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rachel Stuart
- College of Business, Arts and Social Sciences, Brunel University London, London, UK
| | - Pippa Grenfell
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Cicely Marston
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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2
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Ireland J, McGowan C. Deciphering reference intervals and clinical decision limits in equine endocrine diagnostic testing. Vet J 2023; 300-302:106037. [PMID: 37832629 DOI: 10.1016/j.tvjl.2023.106037] [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: 06/16/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 10/15/2023]
Abstract
Reference intervals (RIs) and clinical decision limits (CDLs) are frequently established to facilitate interpretation of values of endocrine biomarkers in the diagnosis of disease. Despite their commonplace use in clinical decision-making, these concepts can be confused. Comparing a test result with a RI provides an estimation as to whether or not the individual is healthy, whereas comparison with a CDL facilitates identification of individuals with a particular disease state or at greater risk of adverse clinical outcomes. In practice, there will also be a range of results for which the discriminative ability of the test is insufficient to inform a specific diagnostic decision. Including a range of uncertain test results, or 'grey zone', between positive and negative avoids the constraint of a binary decision in classifying an individual with a test value above (or below) a single cut-off value as diseased. This review will detail the application of both RIs and CDLs, including defining the range of uncertain test results, in the context of equine endocrinology.
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Affiliation(s)
- Joanne Ireland
- Department of Equine Clinical Science, Faculty of Health and Life Sciences, The University of Liverpool, Leahurst, CH64 7TE Cheshire, UK.
| | - Catherine McGowan
- Department of Equine Clinical Science, Faculty of Health and Life Sciences, The University of Liverpool, Leahurst, CH64 7TE Cheshire, UK
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3
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Abstract
Background: The effects of breastfeeding on neurodevelopmental outcomes are unclear. Inconsistent findings have been reported and confounding factors make interpretation of studies difficult. The World Health Organization published a systematic review on breastfeeding and intelligence in 2013, demonstrating a positive association with improved performance on intelligence tests. The objective of this review is to explore published literature since 2013 to examine the association between breastfeeding, cognition, executive function, and behavior. Methods: Duplicate searches were carried out using Web of Science and OVID for publications between January 2012 and March 2022. Non-English articles and those not correcting for maternal IQ or home environment were excluded. Results: Twenty-three studies were included, examining the effects of breastfeeding on cognition (21), executive function (3), and behavior (6). Most studies showed a modest dose-dependent increase in cognitive scores in children who were breastfed, test score differences ranging from 0.19 to 0.96 points per month of breastfeeding comparing any breastfeeding, predominant and exclusive breastfeeding. Four out of six studies showed a positive correlation between breastfeeding and behavior. One out of three studies assessing breastfeeding and executive function showed a positive dose-dependent correlation. Discussion: Recent evidence demonstrates that breastfeeding has a small positive effect on IQ in later childhood. Evidence suggesting that breastfeeding is a protective factor in developing conduct disorders and achieving higher executive function is limited. Further research is required. Limitations include potential confounders and recall bias of breastfeeding.
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Affiliation(s)
- Catherine McGowan
- Department of General Paediatrics, Royal Hospital for Children, Glasgow, United Kingdom
| | - Ruth Bland
- Department of General Paediatrics, Royal Hospital for Children, Glasgow, United Kingdom.,Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.,School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Johannesburg, South Africa
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4
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Furtado T, Perkins E, Pinchbeck G, McGowan C, Watkins F, Christley R. Exploring human behavior change in equine welfare: Insights from a COM-B analysis of the UK's equine obesity epidemic. Front Vet Sci 2022; 9:961537. [DOI: 10.3389/fvets.2022.961537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022] Open
Abstract
While equine obesity is understood by equine professionals to be a serious and widespread welfare problem, thus far approaches to reducing the prevalence of obesity in the UK's leisure horses have mainly been limited to educating owners about the dangers of obesity in their horses. In human health, approaches to behavior change encourage holistic thinking around human behavior, recognizing the importance of the connection between the individuals' knowledge, attitudes, habits, and the social and physical environments. This study used qualitative data from interviews with horse owners and professionals, open-access discussion fora and focus groups in order to collate extensive information about the factors shaping the UK's equine obesity crisis. The data were initially analyzed using a grounded theory method to determine the common themes, and were then analyzed using the COM-B model of behavior change, in order to identify areas where human behavior change might be better supported. The analysis highlighted the importance of a holistic approach to behavior change, since all areas of the COM-B were important in limiting owners' recognition of, and response to, equine obesity. For example, environments and social norms limited the likelihood of owners proactively managing horse weight, and owners also found it difficult to identify overweight horses, and evaluate the risks of long-term health issues as a result of weight, with short-term negative impacts of weight management. While interventions often aim to educate owners into changing their behavior, this analysis highlights the importance of creative and holistic approaches which work alongside the owners' motivations, while shaping the social and physical environments.
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Wilson A, Mair T, Williams N, McGowan C, Pinchbeck G. Antimicrobial prescribing and antimicrobial resistance surveillance in equine practice. Equine Vet J 2022; 55:494-505. [PMID: 35575046 DOI: 10.1111/evj.13587] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Antimicrobial resistance (AMR) is an increasingly serious threat to human and animal health, therefore responsible use of antimicrobials in equine practice is vital. There is a need to have accurate, up to date data on antimicrobial prescribing in equine practice in the UK. OBJECTIVES To characterise current antimicrobial prescribing practices by equine veterinarians and to describe surveillance, audit processes and identification of AMR. STUDY DESIGN Online cross-sectional, questionnaire-based survey. METHODS An online questionnaire targeting veterinarians who treat horses in the UK and Europe was distributed. The questionnaire collected data on participants' country of origin, practice policies, prescribing practices including use of high priority critical antimicrobials. Four common clinical case-based scenarios were included to further explore prescribing practice. Responses were compared using both descriptive statistics and multivariable logistic regression models. RESULTS Questionnaires were completed by 264 veterinarians from Europe (n=33/264) and the UK (n=231/264); 87% respondents worked only with horses and 67% worked at premises with hospitalisation facilities. Approximately half of respondents (54.4%) had a written antimicrobial use or stewardship policy within their practice. Over half of respondents did not perform any environmental surveillance (54.2%), audit of clinical infections (53.1%) or audit of infection control (57.1%). Potentiated sulphonamides were cited as the most used antimicrobial, although 44% reported using enrofloxacin in the last year and 66% used 3rd or 4th generation cephalosporins. Prophylactic antimicrobials before clean surgery were frequently/always prescribed by 48% respondents and 24% respondents frequently/always prescribed antimicrobials post-operatively in clean surgery. MAIN LIMITATIONS Potential selection bias of respondents, given individuals volunteered to take part in the survey. CONCLUSIONS Compared to a previous similar study conducted in 2009, overall antimicrobial usage appeared to be declining in clinical scenarios and a greater proportion of practices now have stewardship policies. However, the use of high priority critical antimicrobials is still relatively common in equine practice in the UK and Europe.
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Affiliation(s)
- A Wilson
- Department of Equine Clinical Science, Institute of Veterinary and Ecological Sciences, University of Liverpool, Neston, UK
| | - T Mair
- Bell Equine Veterinary Clinic, Mereworth, Kent, UK
| | - N Williams
- Department of Equine Clinical Science, Institute of Veterinary and Ecological Sciences, University of Liverpool, Neston, UK
| | - C McGowan
- Department of Equine Clinical Science, Institute of Veterinary and Ecological Sciences, University of Liverpool, Neston, UK
| | - G Pinchbeck
- Department of Equine Clinical Science, Institute of Veterinary and Ecological Sciences, University of Liverpool, Neston, UK
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6
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Reynolds R, Aromi J, McGowan C, Paris B. Digital divide, critical‐, and
crisis‐informatics
perspectives on K‐12 emergency remote teaching during the pandemic. J Assoc Inf Sci Technol 2022. [DOI: 10.1002/asi.24654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Rebecca Reynolds
- Department of Library and Information Science Rutgers University School of Communication & Information New Brunswick New Jersey USA
| | - Julie Aromi
- Department of Library and Information Science Rutgers University School of Communication & Information New Brunswick New Jersey USA
| | - Catherine McGowan
- Department of Library and Information Science Rutgers University School of Communication & Information New Brunswick New Jersey USA
| | - Britt Paris
- Department of Library and Information Science Rutgers University School of Communication & Information New Brunswick New Jersey USA
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Crabtree-Ramirez B, Jenkins CA, Shepherd BE, Jayathilake K, Veloso VG, Carriquiry G, Gotuzzo E, Cortes CP, Padgett D, McGowan C, Sierra-Madero J, Koenig S, Pape JW, Sterling TR. Tuberculosis treatment intermittency in the continuation phase and mortality in HIV-positive persons receiving antiretroviral therapy. BMC Infect Dis 2022; 22:341. [PMID: 35382770 PMCID: PMC8985331 DOI: 10.1186/s12879-022-07330-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 03/28/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Some tuberculosis (TB) treatment guidelines recommend daily TB treatment in both the intensive and continuation phases of treatment in HIV-positive persons to decrease the risk of relapse and acquired drug resistance. However, guidelines vary across countries, and treatment is given 7, 5, 3, or 2 days/week. The effect of TB treatment intermittency in the continuation phase on mortality in HIV-positive persons on antiretroviral therapy (ART), is not well-described. METHODS We conducted an observational cohort study among HIV-positive adults treated for TB between 2000 and 2018 and after enrollment into the Caribbean, Central, and South America network for HIV epidemiology (CCASAnet; Brazil, Chile, Haiti, Honduras, Mexico and Peru). All received standard TB therapy (2-month initiation phase of daily isoniazid, rifampin or rifabutin, pyrazinamide ± ethambutol) and continuation phase of isoniazid and rifampin or rifabutin, administered concomitantly with ART. Known timing of ART and TB treatment were also inclusion criteria. Kaplan-Meier and Cox proportional hazards methods compared time to death between groups. Missing model covariates were imputed via multiple imputation. RESULTS 2303 patients met inclusion criteria: 2003(87%) received TB treatment 5-7 days/week and 300(13%) 2-3 days/week in the continuation phase. Intermittency varied by site: 100% of patients from Brazil and Haiti received continuation phase treatment 5-7 days/week, followed by Honduras (91%), Peru (42%), Mexico (7%), and Chile (0%). The crude risk of death was lower among those receiving treatment 5-7 vs. 2-3 days/week (HR = 0.68; 95% CI = 0.51-0.91; P = 0.008). After adjusting for age, sex, CD4, ART use at TB diagnosis, site of TB disease (pulmonary vs. extrapulmonary), and year of TB diagnosis, mortality risk was lower, but not significantly, among those treated 5-7 days/week vs. 2-3 days/week (HR 0.75, 95%CI 0.55-1.01; P = 0.06). After also stratifying by study site, there was no longer a protective effect (HR 1.42, 95%CI 0.83-2.45; P = 0.20). CONCLUSIONS TB treatment 5-7 days/week was associated with a marginally decreased risk of death compared to TB treatment 2-3 days/week in the continuation phase in multivariable, unstratified analyses. However, little variation in TB treatment intermittency within country meant the results could have been driven by other differences between study sites. Therefore, randomized trials are needed, especially in heterogenous regions such as Latin America.
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Affiliation(s)
- Brenda Crabtree-Ramirez
- Departamento de Infectología. Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Cathy A Jenkins
- Vanderbilt University Medical Center, A2209 Medical Center North, 1161 21st Avenue South, Nashville, TN, 37232, USA
| | - Bryan E Shepherd
- Vanderbilt University Medical Center, A2209 Medical Center North, 1161 21st Avenue South, Nashville, TN, 37232, USA
| | - Karu Jayathilake
- Vanderbilt University Medical Center, A2209 Medical Center North, 1161 21st Avenue South, Nashville, TN, 37232, USA
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Gabriela Carriquiry
- Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Eduardo Gotuzzo
- Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Dennis Padgett
- Hospital Escuela and Instituto Hondureño de Seguridad Social, Tegucigalpa, Honduras
| | - Catherine McGowan
- Vanderbilt University Medical Center, A2209 Medical Center North, 1161 21st Avenue South, Nashville, TN, 37232, USA
| | - Juan Sierra-Madero
- Departamento de Infectología. Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Serena Koenig
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
- Le Groupe Haïtien d'Etude du Sarcome de Kaposi Et Des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - Jean W Pape
- Le Groupe Haïtien d'Etude du Sarcome de Kaposi Et Des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - Timothy R Sterling
- Vanderbilt University Medical Center, A2209 Medical Center North, 1161 21st Avenue South, Nashville, TN, 37232, USA.
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8
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Coelho LE, Jenkins CA, Shepherd BE, Pape JW, Cordero FM, Padgett D, Ramirez BC, Grinsztejn B, Althoff KN, Koethe JR, Marconi VC, Tien PC, Willig AL, Moore RD, Castilho JL, Colasanti J, Crane HM, Gill MJ, Horberg MA, Mayor A, Silverberg MJ, McGowan C, Rebeiro PF. Weight gain post-ART in HIV+ Latinos/as differs in the USA, Haiti, and Latin America. Lancet Reg Health Am 2022; 8:100173. [PMID: 35528706 PMCID: PMC9070999 DOI: 10.1016/j.lana.2021.100173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background An obesity epidemic has been documented among adult Latinos/as in Latin America and the United States (US); however, little is known about obesity among Latinos/as with HIV (PWH). Moreover, Latinos/as PWH in the US may have different weight trajectories than those in Latin America due to the cultural and environmental contexts. We assessed weight and body mass index (BMI) trajectories among PWH initiating antiretroviral therapy (ART) across 5 countries in Latin America and the Caribbean and the US. Methods ART-naÿve PWH ≥18 years old, enrolled in Brazil, Honduras, Mexico, Peru, and Haiti (sites within CCA-SAnet) and the US (NA-ACCORD) starting ART between 2000 and 2017, with at least one weight measured after ART initiation were included. Participants were classified according to site/ethnicity as: Latinos/as in US, non-Latinos/as in US, Haitians, and Latinos/as in Latin America. Generalized least squares models were used to assess trends in weight and BMI. Models estimating probabilities of becoming overweight/obese (BMI ≥25 kg/m2) and of becoming obese (BMI ≥30 kg/m2) post ART initiation for males and females were fit using generalized estimating equations with a logit link and an independence working correlation structure. Findings Among 59,207 PWH, 9% were Latinos/as from Latin America, 9% Latinos/as from the US, 68% non-Latinos/as from the US and 14% were Haitian. At ART initiation, 29% were overweight and 14% were obese. Post-ART weight and BMI increases were steeper for Latinos/as in Latin America compared with other sites/ethnicities; however, BMI at 3-years post ART remained lower compared to Latinos/as and non-Latinos/as in the US. Among females, at 3-years post ART initiation the greatest adjusted probability of obesity was found among non-Latinas in the US (15·2%) and lowest among Latinas in Latin America (8.6%). Among males, while starting with a lower BMI, Latinos in Latin America had the greatest adjusted probability of becoming overweight or obese 3-years post-ART initiation. Interpretation In the Americas, PWH gain substantial weight after ART initiation. Despite environmental and cultural differences, PWH in Latin America, Haiti and Latinos and non-Latinos in the US share similar BMI trajectories on ART and high probabilities of becoming overweight and obese over time. Multicohort studies are needed to better understand the burden of other metabolic syndrome components in PWH across different countries.
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Affiliation(s)
- Lara E. Coelho
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Cathy A. Jenkins
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bryan E. Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jean W. Pape
- Groupe Haitien d'Etudes du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti
| | - Fernando Mejia Cordero
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Denis Padgett
- Instituto Hondureño de Seguridad Social & Hospital Escuela Universitario, Tegucigalpa, Honduras
| | - Brenda Crabtree Ramirez
- Deparatmento de Infectologia, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán. Mexico City, Mexico
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - John R. Koethe
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Vincent C. Marconi
- Emory University School of Medicine and Rollins School of Public Health, Atlanta, GA, USA
| | - Phyllis C. Tien
- Department of Medicine, University of California, San Francisco (UCSF), and the Department of Veterans Affairs Medical Center. San Francisco, CA, USA
| | - Amanda L. Willig
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Jessica L. Castilho
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonathan Colasanti
- Emory University School of Medicine and Rollins School of Public Health, Atlanta, GA, USA
| | | | | | - Michael A. Horberg
- Kaiser Permanente, Mid-Atlantic Permanente Research Institute, Rockville, MD, US
| | - Angel Mayor
- Universidad Central del Caribe, Retrovirus Research Center, Bayamón, PR, US
| | | | - Catherine McGowan
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Peter F. Rebeiro
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - North American AIDS Collaboration on Research and Design (NA-ACCORD) and the Caribbean, Central and South America network for HIV epidemiology (CCASAnet) of the International epidemiology Databases to Evaluate AIDS (IeDEA)
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
- Groupe Haitien d'Etudes du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Instituto Hondureño de Seguridad Social & Hospital Escuela Universitario, Tegucigalpa, Honduras
- Deparatmento de Infectologia, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán. Mexico City, Mexico
- Johns Hopkins University, Baltimore, MD, USA
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
- Emory University School of Medicine and Rollins School of Public Health, Atlanta, GA, USA
- Department of Medicine, University of California, San Francisco (UCSF), and the Department of Veterans Affairs Medical Center. San Francisco, CA, USA
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- University of Washington, Seattle, WA, US
- The University of Calgary, Calgary, AB, Canada
- Kaiser Permanente, Mid-Atlantic Permanente Research Institute, Rockville, MD, US
- Universidad Central del Caribe, Retrovirus Research Center, Bayamón, PR, US
- Kaiser Permanente Northern California, Oakland, CA, US
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9
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Furtado T, King M, Perkins E, McGowan C, Chubbock S, Hannelly E, Rogers J, Pinchbeck G. An Exploration of Environmentally Sustainable Practices Associated with Alternative Grazing Management System Use for Horses, Ponies, Donkeys and Mules in the UK. Animals (Basel) 2022; 12:ani12020151. [PMID: 35049774 PMCID: PMC8772570 DOI: 10.3390/ani12020151] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/07/2021] [Accepted: 01/04/2022] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Equestrian land could be a potentially important environmental resource, given that pastureland can help to sequester carbon from the atmosphere, prevent soil erosion and provide diverse ecosystems for native plant and wildlife species. However, equestrian land has been overlooked in environmental research and policy. This study reports on the ways which horse, pony, donkey and mule keepers in the UK described environmental practices as part of their equid care. Through an analysis of survey responses (N = 758) from equid keepers using alternative grazing systems, we report on three very different management approaches which resulted in keepers aiming to promote healthy pastures and healthy animals. This study provides the basis for future research exploring attitudes to sustainability in equid keepers, as well as evaluating the impact of their efforts. Abstract Equestrian grazing management is a poorly researched area, despite potentially significant environmental impacts. This study explored keepers’ use of alternative grazing systems in the care of UK horses, donkeys and mules through an internet survey. The survey was available during the summer of 2020 and comprised closed and open questions, which were analysed with descriptive statistics and iterative thematic analysis, respectively. A total of 758 responses was incorporated into the analysis; the most popular system used were tracks (56.5%), Equicentral (19%), “other” (e.g., non-grass turnout) (12.5%), rewilding (7.5%) and turnout on either moorland (0.7%) or woodland (2.5%). The thematic analysis highlighted that equid keepers across the systems were highly engaged in exploring sustainable practices. Their approaches varied according to each system, yet all aimed to fulfil practices in three major categories, i.e., supporting diverse plant life (usually through restricting equid access to certain areas), supporting wildlife (through the creation of biodiverse environments) and sustainably managing droppings and helminths. Additionally, proponents of the Equicentral systems declared to be aiming to support soil health. These data provide a promising insight into equid keepers’ behaviour and attitudes to sustainability.
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Affiliation(s)
- Tamzin Furtado
- Department of Livestock and One Health, Institute for Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool CH64 7TE, UK;
- Correspondence:
| | - Mollie King
- School of Veterinary Science, Institute for Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool CH64 7TE, UK; (M.K.); (C.M.)
| | - Elizabeth Perkins
- Institute of Population Health, University of Liverpool, Liverpool L69 3GL, UK;
| | - Catherine McGowan
- School of Veterinary Science, Institute for Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool CH64 7TE, UK; (M.K.); (C.M.)
| | - Samantha Chubbock
- World Horse Welfare, Anne Colvin House, Snetterton, Norwich NR16 2LR, UK;
| | - Emmeline Hannelly
- The British Horse Society (Welfare Dept) Abbey Park, Stareton, Warwickshire CV8 2XZ, UK;
| | - Jan Rogers
- The Horse Trust, Slad Ln, Princes Risborough HP27 0PP, UK;
| | - Gina Pinchbeck
- Department of Livestock and One Health, Institute for Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool CH64 7TE, UK;
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10
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Han WM, Law MG, Egger M, Wools-Kaloustian K, Moore R, McGowan C, Kumarasamy N, Desmonde S, Edmonds A, Davies MA, Yiannoutsos C, Althoff KN, Cortes CP, Mohamed TJ, Jaquet A, Anastos K, Euvrard J, Castelnuovo B, Salters K, Coelho LE, Ekouevi DK, Eley B, Diero L, Zaniewski E, Ford N, Sohn AH, Kariminia A. Global estimates of viral suppression in children and adolescents and adults on antiretroviral therapy adjusted for missing viral load measurements: a multiregional, retrospective cohort study in 31 countries. Lancet HIV 2021; 8:e766-e775. [PMID: 34856180 PMCID: PMC8782625 DOI: 10.1016/s2352-3018(21)00265-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/12/2021] [Accepted: 09/16/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND As countries move towards the UNAIDS's 95-95-95 targets and with strong evidence that undetectable equals untransmittable, it is increasingly important to assess whether those with HIV who are receiving antiretroviral therapy (ART) achieve viral suppression. We estimated the proportions of children and adolescents and adults with viral suppression at 1, 2, and 3 years after initiating ART. METHODS In this retrospective cohort study, seven regional cohorts from the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium contributed data from individuals initiating ART between Jan 1, 2010, and Dec 31, 2019, at 148 sites in 31 countries with annual viral load monitoring. Only people with HIV who started ART after the time a site started routine viral load monitoring were included. Data up to March 31, 2020, were analysed. We estimated the proportions of children and adolescents (aged <18 years at ART initiation) and adults (aged ≥18 years at ART initiation) with viral suppression (viral load <1000 copies per mL) at 1, 2, and 3 years after ART initiation using an intention-to-treat approach and an adjusted approach that accounted for missing viral load measurements. FINDINGS 21 594 children and adolescents (11 812 [55%] female, 9782 [45%] male) from 106 sites in 22 countries and 255 662 adults (163 831 [64%] female, 91 831 [36%] male) from 143 sites in 30 countries were included. Using the intention-to-treat approach, the proportion of children and adolescents with viral suppression was 7303 (36%) of 20 478 at 1 year, 5709 (30%) of 19 135 at 2 years, and 4287 (24%) of 17 589 at 3 years after ART initiation; the proportion of adults with viral suppression was 106 541 (44%) of 240 600 at 1 year, 79 141 (36%) of 220 925 at 2 years, and 57 970 (29%) of 201 124 at 3 years after ART initiation. After adjusting for missing viral load measurements among those who transferred, were lost to follow-up, or who were in follow-up without viral load testing, the proportion of children and adolescents with viral suppression was 12 048 (64% [plausible range 43-81]) of 18 835 at 1 year, 10 796 (62% [41-77]) of 17 553 at 2 years, and 9177 (59% [38-91]) of 15 667 at 3 years after ART initiation; the proportion of adults with viral suppression was 176 964 (79% [53-80]) of 225 418 at 1 year, 145 552 (72% [48-79]) of 201 238 at 2 years, and 115 260 (65% [43-69]) of 178 458 at 3 years after ART initiation. INTERPRETATION Although adults with HIV are approaching the global target of 95% viral suppression, progress among children and adolescents is much slower. Substantial efforts are still needed to reach the viral suppression target for children and adolescents. FUNDING US National Institutes of Health.
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Affiliation(s)
- Win Min Han
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
| | - Matthew G Law
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Richard Moore
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Catherine McGowan
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nagalingesawaran Kumarasamy
- Chennai Antiviral Research and Treatment Clinical Research Site, The Voluntary Health Services, Chennai, India
| | | | - Andrew Edmonds
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mary-Ann Davies
- Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Keri N Althoff
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Claudia P Cortes
- Fundación Arriaran-Facultad de Medicina Universidad de Chile, Santiago, Chile
| | | | - Antoine Jaquet
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development, UMR 1219, Bordeaux, France
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jonathan Euvrard
- Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Kate Salters
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada
| | - Lara Esteves Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Didier K Ekouevi
- Program PAC-CI, Abidjan, Côte d'Ivoire; Bordeaux Population Health (UMR1219), Bordeaux, France
| | - Brian Eley
- Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Lameck Diero
- Department of Medicine, Moi University School of Medicine and Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Elizabeth Zaniewski
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Nathan Ford
- Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; HIV/AIDS Department and Global Hepatitis Program, WHO, Geneva, Switzerland
| | - Annette H Sohn
- TREAT Asia/amfAR, The Foundation for AIDS Research, Bangkok, Thailand
| | - Azar Kariminia
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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de Clifford LT, Lowe JN, McKellar CD, McGowan C, David F. A Double-Blinded Positive Control Study Comparing the Relative Efficacy of 2.5% Polyacrylamide Hydrogel (PAAG) Against Triamcinolone Acetonide (TA) And Sodium Hyaluronate (HA) in the Management of Middle Carpal Joint Lameness in Racing Thoroughbreds. J Equine Vet Sci 2021; 107:103780. [PMID: 34802625 DOI: 10.1016/j.jevs.2021.103780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 12/01/2022]
Abstract
The purpose of this prospective double-blinded positive control study was to compare the efficacy of 2.5% polyacrylamide hydrogel (2.5% PAAG) in the management of middle carpal joint lameness in Thoroughbreds against treatments of triamcinolone acetonide (TA) or sodium hyaluronate (HA). A total of 31 flat-racing Thoroughbreds with lameness (grade 1-3/5) localized to the carpus by intra-articular analgesia were selected. Following a radiological assessment of the carpi confirming the absence of fragment/fracture, the horses were randomly assigned for intra-articular treatment with either 2 ml of 2.5% PAAG, 12 mg TA or 20 mg HA (followed by two further intravenous treatments of 40 mg, at weekly intervals in the HA group only), by a treating veterinarian. All horses were rested for 48 hours post-treatment and then re-entered an unaltered training regimen. Subsequent examinations at 2, 4, and 6 weeks were performed by a blinded examining veterinarian for all groups, while horses treated with 2.5% PAAG were monitored for 12 weeks for recurrence of lameness. Significantly more joints treated with 2.5% PAAG were lame free (83%) at 6 weeks compared to TA (27%; P = .007) and to HA (40%; P = .04). There was no significant difference between TA and HA groups at any time. All the joints treated within 2.5% PAAG that were lame free at 6 weeks (10/12) were still lame-free at 12 weeks. In conclusion, treatment with 2.5% PAAG led to statistically superior results compared to TA and HA in the management of selected middle carpal joint lameness in flat-racing Thoroughbreds, with therapeutic effects persisting up to 12 weeks.
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Affiliation(s)
| | | | | | - Catherine McGowan
- Equine Clinical Science, University of Liverpool, Leahurst, United Kingdom
| | - Florent David
- Equine Veterinary Medical Center, Member of Qatar Foundation, Al Rayyan, Doha, Qatar; College of Health & Life Science, Hamad Bin Khalifa University, Member of Qatar Foundation, Education city, Doha, Qatar.
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12
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Purchase S, Batist E, Mmile N, Nkosi S, Workman J, Martinson N, Fairlie L, Schaaf HS, Choo L, McGowan C, Crook AM, Seddon JA, Hesseling AC. Challenges in recruiting children to a multidrug-resistant TB prevention trial. Int J Tuberc Lung Dis 2021; 25:814-822. [PMID: 34615578 DOI: 10.5588/ijtld.21.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Recruitment to randomised clinical trials can be challenging and slow recruitment has serious consequences. This study aimed to summarise and reflect on the challenges in enrolling young children to a multidrug-resistant TB (MDR-TB) prevention trial in South Africa.METHODS: Recruitment to the Tuberculosis Child Multidrug-resistant Preventive Therapy Trial (TB-CHAMP) was tracked using an electronic recruiting platform, which was used to generate a recruiting flow diagram. Structured personnel questionnaires, meeting minutes and workshop notes were thematically analysed to elucidate barriers and solutions.RESULT: Of 3,682 (85.3%) adult rifampicin (RIF) resistant index cases with pre-screening outcomes, 1597 (43.4%) reported having no children under 5 years in the household and 562 (15.3%) were RIF-monoresistant. More than nine index cases were pre-screened for each child enrolled. Numerous barriers to recruitment were identified. Thorough recruitment planning, customised tracking data systems, a dedicated recruiting team with strong leadership, adequate resources to recruit across large geographic areas, and excellent relationships with routine TB services emerged as key factors to ensure successful recruitment.CONCLUSION: Recruitment of children into MDR-TB prevention trials can be difficult. Several MDR-TB prevention trials are underway, and lessons learnt from TB-CHAMP will be relevant to these and other TB prevention studies.
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Affiliation(s)
- S Purchase
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - E Batist
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - N Mmile
- Perinatal HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa
| | - S Nkosi
- Wits Reproductive Health & HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - J Workman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - N Martinson
- Perinatal HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa
| | - L Fairlie
- Wits Reproductive Health & HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - L Choo
- Institute of Clinical Trials and Methodology, MRC Clinical Trials Unit at University College London, London, UK
| | - C McGowan
- Institute of Clinical Trials and Methodology, MRC Clinical Trials Unit at University College London, London, UK
| | - A M Crook
- Institute of Clinical Trials and Methodology, MRC Clinical Trials Unit at University College London, London, UK
| | - J A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa, Department of Infectious Diseases, Imperial College London, Norfolk Place, London, UK
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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Paris B, Reynolds R, McGowan C. Sins of omission: Critical informatics perspectives on privacy in e‐learning systems in higher education. J Assoc Inf Sci Technol 2021. [DOI: 10.1002/asi.24575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Britt Paris
- Department of Library and Information Science Rutgers, The State University of New Jersey New Brunswick New Jersey USA
| | - Rebecca Reynolds
- Department of Library and Information Science Rutgers, The State University of New Jersey New Brunswick New Jersey USA
| | - Catherine McGowan
- Department of Library and Information Science Rutgers, The State University of New Jersey New Brunswick New Jersey USA
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Hederstedt S, McGowan C, Essner A. The Immediate Effect of Parachute-Resisted Gallop on Heart Rate, Running Speed and Stride Frequency in Dogs. Animals (Basel) 2021; 11:ani11071983. [PMID: 34359110 PMCID: PMC8300255 DOI: 10.3390/ani11071983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/20/2021] [Accepted: 06/30/2021] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Physical fitness is needed for canine athletes and working dogs to optimize their performance in various disciplines. Application of resistance on movements causes biomechanical and cardiorespiratory responses to physical exercise. However, there is still a lack of research on the effects of high-intensity resistance exercise on cardiorespiratory fitness components such as heart rate in canine athletes. In this article, we investigate the short-term effects of parachute-resisted galloping on heart rate, running speed and stride frequency. Healthy dogs of various breeds were extensively studied in five experimental single cases. The dogs ran on a straight 200 m course with and without resistive drag force applied by a parachute attached to their harness while heart rate, running speed and stride frequency were measured. Subsequently, the measurements were compared to baseline phases at rest. In the present trials we found that heart rate increases similarly with and without parachute-resistance while dogs galloped at lower speeds and with increased stride frequency with applied drag force. Our findings lead us to suggest that parachute-resisted galloping is a clinically applicable exercise in healthy dogs to achieve instant cardiorespiratory response. Abstract Physical fitness is required for canine athletes and working dogs to optimize performance in various disciplines. There is a lack of research on the effects of resistance exercise on cardiorespiratory variables in dogs. The aim of this study was to investigate the immediate effects of parachute-resisted (PR) gallop on heart rate, running speed and stride frequency compared to unresisted (UR) gallop in dogs. Five N-of-1 trials RCTs with alternating interventions were implemented. Dogs ran on a 200 m course with and without resistive force applied by a parachute attached to their harness while cardiac inter-beat intervals (IBI), running speed and stride frequency were measured. The results were visually displayed and interpreted in graphs and percentage of non-overlapping data estimated effect size. Both interventions showed large effects on heart rate compared to resting values. Mean IBI increased (10–17%) during PR gallop compared to UR gallop although this change was small relative to decreased running speed (19–40%) and increased stride frequency (18–63%). Minimum IBI showed no difference between interventions indicating similar maximum heartbeat per minute. In conclusion, parachute-resistance resulted in dogs galloping at lower speeds at the same cardiorespiratory level of intensity, which may be useful in canine physical rehabilitation and fitness training.
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Affiliation(s)
- Sandra Hederstedt
- AniCura Falu Djursjukhus, Samueldalsvägen 2B, SE-791 61 Falun, Sweden;
- School of Veterinary Science, The University of Liverpool, Leahurst Campus, Chester High Road, Neston, Wirral CH64 7TE, UK;
| | - Catherine McGowan
- School of Veterinary Science, The University of Liverpool, Leahurst Campus, Chester High Road, Neston, Wirral CH64 7TE, UK;
| | - Ann Essner
- IVC Evidensia Djurkliniken Gefle, Norra Gatan 1, SE-803 21 Gävle, Sweden
- Department of Neuroscience, Uppsala University, Box 593, SE-751 24 Uppsala, Sweden
- Correspondence: or
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15
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Sellers E, Baillie S, Dean R, Warman S, Janicke H, Arlt SP, Boulton C, Brennan M, Brodbelt D, Brown F, Buckley L, Du M, Gallop E, Goran G, Grindlay DJC, Haddock L, Ireland J, McGowan C, Moberly HK, Place E, Rahman MM, Rees G, Reyher K, Sanchez J, Schoeman JP, Urdes L, VanLeeuwen J, Verheyen K. Promoting Evidence-based Veterinary Medicine through the online resource ‘EBVM Learning’: User feedback. VE 2021. [DOI: 10.18849/ve.v6i1.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
‘EBVM Learning’ is a freely available resource created in 2015 by an international team with the support of RCVS Knowledge. The resource comprises a series of online modules teaching the fundamental concepts of evidence-based veterinary medicine (EBVM) (Ask, Acquire, Appraise, Apply & Assess) supported by case studies, exercises, worked examples and quizzes. The aim of the current study (undertaken in 2019) was to review ‘EBVM Learning’ to ensure its ongoing relevance and usefulness to the range of learners engaged in EBVM. Feedback was gathered from stakeholder groups using website statistics and feedback forms, a survey and semi-structured interviews to provide a combination of quantitative and qualitative data.
Website statistics revealed an international audience and a steady increase in visitors exceeding 1,000 per month in August 2020. Feedback via the online form (n=35) and survey (n=71) indicated that the resource was well structured, with an appropriate level and amount of content, useful examples and quizzes and the majority of respondents would use it again. Semi-structured interviews of educators (n=5) and veterinarians (n=8) identified three themes: features of the ‘EBVM Learning’ resource (strengths, suggestions for improvement), embedding the resource in education (undergraduate, postgraduate) and promoting EBVM (challenges, motivation for engagement). At a project team workshop the results were used to plan updates to the existing content and to identify new ways to promote learning and engagement. An updated version of ‘EBVM Learning’ was developed.
‘EBVM Learning’ is helping to produce the next generation of evidence-based practitioners and enabling to engage in the concepts of EBVM as part of their clinical practice.
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Person AK, Maruri F, Brazier E, Madero JGS, Rouzier V, Carriquiry G, Avelino-Silva VI, de Alencastro PR, Ikeda MLR, Souza RA, Rocha SQ, Cesar C, Wolff M, Machado D, Padgett D, Pinto JA, Grinsztejn B, McGowan C, Rebeiro PF. 475. Describing the impact of the COVID-19 pandemic on HIV care in Latin America. Open Forum Infect Dis 2020. [PMCID: PMC7776433 DOI: 10.1093/ofid/ofaa439.668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background The effects of the COVID-19 pandemic on people living with HIV (PWH) are unknown. Beyond SARS-CoV-2 co-infection, the pandemic may have devastating consequences for HIV care delivery. Understanding these is crucial as reduced antiretroviral therapy (ART) availability alone could lead to ≥500,000 AIDS-related deaths in 2020–2021. With Latin America now a focal point in the pandemic, we sought to describe the impact of COVID-19 on HIV care at Latin American clinical sites. Methods Caribbean, Central and South America network for HIV epidemiology (CCASAnet) and additional Brazilian HIV care sites in Argentina, Brazil, Chile, Haiti, Honduras, Mexico, and Peru were included. An electronic survey of COVID-19 effects on HIV clinic operations was administered in Spanish or English via phone and email, April 28-June 2, 2020. We also compared national COVID-19 case, mortality, and policy data from public sources. Results Brazil’s and Mexico’s epidemics appear most pronounced, with >10,000 confirmed COVID-19-related deaths (Figure 1); countries implemented “social distancing” policies at different times after initial cases, with Haiti earliest and Mexico latest (Figure 2). Nearly all 13 sites reported decreased hours and providers for HIV care. Twelve of 13 reported increased use of telehealth, suspension/postponements of routine HIV appointments, and/or suspension of HIV research. Eleven of 13 reported initiation of new COVID-19 research but suspension of community HIV testing, and nearly half provided additional ART supplies. Nearly 70% reported impacts on HIV viral load testing and nearly 40% reported personal protective equipment stock-outs (Table). All 13 sites experienced changes in resources/services in tandem with national policies; there was wide variation, however, in the number of economic and health supports implemented thus far (e.g., quarantines, tax deferrals, interest rate reductions, etc.), from 172 COVID-19-related policies in Brazil to only 30 in Mexico. Table Site Assessment of Impacts of the COVID-19 Pandemic on HIV services in Latin America at CCASAnet and Coorte Sites, N=13 ![]()
Figure 1. Cumulative mortality due to COVID-19 in countries within which CCASAnet and Coorte sites are located Figure 1 footnote: Source for mortality counts: the WHO COVID-19 Dashboard, available at: https://covid19.who.int/ All data were up-to-date as of, and were accessed on, June 17th, 2020 ![]()
Figure 2. Cumulative cases of COVID-19 in countries within which CCASAnet and Coorte sites are located and dates (relative to the day on which the first positive case of COVID-19 was detected) of general social distancing, public health emergency, or mass quarantine policy introduction (vertical dashed lines), 2020 Figure 2 footnote: Source for case counts: the WHO COVID-19 Dashboard, available at: https://covid19.who.int/ Source for health policy implementation: the United Nations Economic Council for Latin America & the Caribbean, available at: https://cepalstat-prod.cepal.org/forms/covid-countrysheet/index.html All data were up-to-date as of, and were accessed on, June 17th, 2020 ![]()
Conclusion The COVID-19 pandemic has already had a substantial effect on daily operations of HIV clinics in Latin America. The downstream effects of these impacts on HIV outcomes in Latin America will need to be further studied. Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Anna K Person
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Fernanda Maruri
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Ellen Brazier
- School of Public Health & Health Policy, City University of New York, New York, New York
| | - Juan G Sierra Madero
- Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Distrito Federal, Mexico
| | - Vanessa Rouzier
- Groupe Haitien d’Etudes du Sarcome de Kaposi et des Infections Opportunistes, Port-Au-Prince, Centre, Haiti
| | - Gabriela Carriquiry
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, San Martin, Peru
| | | | | | - Maria Leticia R Ikeda
- University of Vale do Rio dos Sinos, São Leopoldo, Sao Leopoldo, Rio Grande do Sul, Brazil
| | | | - Simone Queiroz Rocha
- STD/AIDS Referral and Training Center-Sao Paulo State Department of Health, Sao Paulo, Sao Paulo, Brazil
| | - Carina Cesar
- Fundación Huésped, Buenos Aires, Buenos Aires, Argentina
| | - Marcello Wolff
- Fundación Arriarán, Universidad de Chile, Facultad de Medicina, Santiago, Region Metropolitana, Chile
| | - Daisy Machado
- Departamento de Pediatria, Universidade Federal de São Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Denis Padgett
- Instituto Hondureño de Seguridad Social and Hospital Escuela Universitario, Tegucigalpa, Francisco Morazan, Honduras
| | - Jorge A Pinto
- Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janiero, Rio de Janeiro, Brazil
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Wilson A, Pinchbeck G, Dean R, McGowan C. Equine influenza vaccination in the UK: Current practices may leave horses with suboptimal immunity. Equine Vet J 2020; 53:1004-1014. [PMID: 33124070 PMCID: PMC8451788 DOI: 10.1111/evj.13377] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/26/2020] [Accepted: 10/22/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vaccination is integral to preventive healthcare. Despite numerous guidelines on equine vaccination, evidence of current vaccination practices is lacking. OBJECTIVES To describe current vaccination practices advised by vets treating horses in the United Kingdom (UK) and compare practices with manufacturer datasheets and current guidelines. STUDY DESIGN Cross-sectional survey. METHODS An online questionnaire was distributed using email addresses acquired through professional registration listings and social media, targeting vets who treat horses in the UK. The questionnaire collected demographic data and information regarding vaccination practices and vaccine hesitancy. Descriptive statistical analysis was performed. RESULTS Questionnaires were completed by 304 UK vets working with horses used for leisure (97.4%, n = 296/304), competition (86.2%, n = 262/304), stud-work (47.7%, n = 145/304) and racing (40.5%, n = 123/304). Variation was identified in vaccine protocols for competition and noncompetition horses. Fifty-seven per cent (n = 170/298) of respondents reported variation in advised 'booster' frequency; most commonly (n = 118) advising a 6-monthly vaccination in competition horses and annual vaccination in noncompetition horses. Most common vaccination guidelines volunteered were British Horseracing Authority (68.8%, n = 172/250) and Federation Equestre Internationale (66.4%, n = 166/250). Most vaccination practices were not consistent with datasheet guidance. Only 7.7% (n = 23/300) of respondents complied with datasheet timeframes between the second and third vaccination. Adverse events following vaccination in the previous year were encountered by 66% (n = 199/304) of respondents, representing 2760 adverse events; but only 526 (19.1%) cases were reported to the Veterinary Medicines Directorate. Most common reactions were transient, including stiffness (931), localised swelling (835), lethargy (559) and pyrexia (355). 86.4% respondents reported vaccine hesitancy from horse owners, most commonly due to perception of over-vaccination, cost and concern regarding adverse events. MAIN LIMITATIONS Potential selection, respondent and recall bias. The recent Equine Influenza (EI) and Equine Herpes Virus (EHV) outbreaks in the UK may have altered responses. CONCLUSIONS Current equine vaccination practices, although complying with competition rules, are mostly noncompliant with datasheet guidelines, potentially risking suboptimal immunity.
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Affiliation(s)
- Amie Wilson
- Department of Equine Clinical Science, Institute of Veterinary and Ecological Sciences, University of Liverpool, Neston, Cheshire, UK
| | - Gina Pinchbeck
- Department of Equine Clinical Science, Institute of Veterinary and Ecological Sciences, University of Liverpool, Neston, Cheshire, UK
| | | | - Catherine McGowan
- Department of Equine Clinical Science, Institute of Veterinary and Ecological Sciences, University of Liverpool, Neston, Cheshire, UK
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Furtado T, Perkins E, Pinchbeck G, McGowan C, Watkins F, Christley R. Exploring horse owners' understanding of obese body condition and weight management in UK leisure horses. Equine Vet J 2020; 53:752-762. [PMID: 33002214 DOI: 10.1111/evj.13360] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 08/26/2020] [Accepted: 09/20/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Equine obesity is considered one of the most serious welfare concerns in UK leisure horses, yet little is known about how horse owners conceptualise their horse's weight as part of its health, or how they plan and carry out weight management. OBJECTIVES This study aimed to further our understanding of leisure horse owners' perceptions of equine health and awareness of excess fat in order to clarify our understanding of successful strategies for managing equine weight. STUDY DESIGN This study used a qualitative research methodology. METHODS Data comprised 16 threads from online UK equine discussion fora, 28 individual interviews with leisure horse owners, 19 interviews with equine professionals such as vets and nutritionists, and two focus groups with a further 21 horse owners. Data were anonymised and analysed using a grounded theory approach. RESULTS Awareness of excess fat was a complex issue, with owners finding it difficult to differentiate equine obesity from the shape they thought the horse was "meant to be", particularly if the horse was a heavier breed such as a native pony or cob. Owners were not necessarily "aware" or "unaware" of fat, but instead equine body fat was constructed as an integral part of the equine body. For example, owners might say that they thought their horse was an ideal weight yet describe their horse's overall body shape as "like a Thelwell". When owners became aware of fat as a changeable part of the horse's body, and/or a threat to health, the presence of fat was articulated as a strong-willed adversary, and weight management was considered a "battle" or "war". Owners found weight management difficult because they perceived that it had immediate negative welfare implications for the horse, and this therefore interfered with their preferred ownership practices and the horse-human relationship. MAIN LIMITATIONS Interview data are self-reported, and people may not always do what they say they do. CONCLUSIONS This study has provided valuable insight into how owners conceptualise weight and weight management, yielding important information about communicating with owners about weight, tailoring weight management strategies, and promoting positive welfare.
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Affiliation(s)
- Tamzin Furtado
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, UK
| | - Elizabeth Perkins
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Gina Pinchbeck
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, UK
| | - Catherine McGowan
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, UK
| | - Francine Watkins
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Robert Christley
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, UK
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Harris M, Scott J, Hope V, Wright T, McGowan C, Ciccarone D. Correction to: Navigating environmental constraints to injection preparation: the use of saliva and other alternatives to sterile water among unstably housed PWID in London. Harm Reduct J 2020; 17:38. [PMID: 32517703 PMCID: PMC7282092 DOI: 10.1186/s12954-020-00388-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Affiliation(s)
- Magdalena Harris
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Jenny Scott
- Department of Pharmacy & Pharmacology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Vivian Hope
- Public Health Institute, Liverpool John Moores University, Tithebarn Street, Liverpool, L2 2QP, UK
| | - Talen Wright
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Catherine McGowan
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Daniel Ciccarone
- School of Medicine, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA, 94143-0410, USA
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Harris M, Scott J, Hope V, Wright T, McGowan C, Ciccarone D. Navigating environmental constraints to injection preparation: the use of saliva and other alternatives to sterile water among unstably housed PWID in London. Harm Reduct J 2020; 17:24. [PMID: 32276626 PMCID: PMC7145770 DOI: 10.1186/s12954-020-00369-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/26/2020] [Indexed: 11/16/2022] Open
Abstract
Background The United Kingdom is experiencing an increase in drug-related deaths and serious bacterial infections among its most vulnerable citizens. Cuts to essential services, coupled with a growing homeless population, create a challenging environment to tackle this public health crisis. In this paper, we highlight an underexplored environmental constraint faced by people living and injecting drugs on the streets. Access to water for injection is restricted in the UK, due to legislative and financial barriers. Austerity measures, such as public toilet closures, further restrict the ability of people made homeless to access clean water and protect themselves from health harms. Methods We generated questionnaire (n = 455) and in-depth qualitative interview (n = 32) data with people who inject drugs in London for the Care and Prevent study. Participants provided detail on their life history; drug use, injecting and living environments; health conditions and care seeking practices. Findings A high proportion of the survey sample reported lifetime history of street homelessness (78%), bacterial infections (65%) and related hospitalisation (30%). Qualitative accounts highlight unsafe, potentially dangerous, injection practices in semi-public spaces. Multiple constraints to sourcing sterile water for injection preparation were reported. Alternatives to sterile water included puddle water, toilet cistern water, whisky, cola soda and saliva. Participants who injected heroin and crack cocaine together unanimously reported adding water at two stages during injection preparation: first, adding water as a vehicle for heroin (which was then heated); second, adding cold water to the heroin mixture prior to adding the crack cocaine. This new finding of a stage addition of solvent may represent an additional risk of infection. Conclusion Currently, harm reduction equipment and resources for safe injecting are not meeting the needs of people who inject drugs who are street homeless or unstably housed. Preparation of injections with non-sterile water sources could precipitate bacterial and fungal infections, particularly when used without the application of heat. It is crucial that water for injection, also skin cleaning, is made available for the unstably housed and that harm reduction messaging is tailored to speak to the everyday realities of people who prepare and inject drugs in public spaces.
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Affiliation(s)
- Magdalena Harris
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Jenny Scott
- Department of Pharmacy & Pharmacology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Vivian Hope
- Public Health Institute, Liverpool John Moores University, Tithebarn Street, Liverpool, L2 2QP, UK
| | - Talen Wright
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Catherine McGowan
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Daniel Ciccarone
- School of Medicine, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA, 94143-0410, USA
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Murphy A, McGowan C, McKee M, Suhrcke M, Hanson K. Coping with healthcare costs for chronic illness in low-income and middle-income countries: a systematic literature review. BMJ Glob Health 2019; 4:e001475. [PMID: 31543984 PMCID: PMC6730576 DOI: 10.1136/bmjgh-2019-001475] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/25/2019] [Accepted: 06/29/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Experiencing illness in low-income and middle-income countries (LMICs) can incur very high out-of-pocket (OOP) payments for healthcare and, while the existing literature typically focuses on levels of expenditure, it rarely examines what happens when households do not have the necessary money. Some will adopt one or more 'coping strategies', such as borrowing money, perhaps at exorbitant interest rates, or selling assets, some necessary for their future income, with detrimental long-term effects. This is particularly relevant for chronic illnesses that require consistent, long-term OOP payments. We systematically review the literature on strategies for financing OOP costs of chronic illnesses in LMICs, their correlates and their impacts on households. METHODS We searched MEDLINE, EconLit, EMBASE, Global Health and Scopus on 22 October 2018 for literature published on or after 1 January 2000. We included qualitative or quantitative studies describing at least one coping strategy for chronic illness OOP payments in a LMIC context. Our narrative review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. RESULTS Forty-seven papers were included. Studies identified coping strategies for chronic illness costs that are not traditionally addressed in financial risk protection research (eg, taking children out of school, sending them to work, reducing expenditure on food or education, quitting work to give care). Twenty studies reported socioeconomic or other correlates of coping strategies, with poorer households and those with more advanced disease more vulnerable to detrimental strategies. Only six studies (three cross-sectional and three qualitative) included evidence of impacts of coping strategies on households, including increased labour to repay debts and discontinuing treatment. CONCLUSIONS Monitoring of financial risk protection provides an incomplete picture if it fails to capture the effect of coping strategies. This will require qualitative and longitudinal research to understand the long-term effects, especially those associated with chronic illness in LMICs.
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Affiliation(s)
- Adrianna Murphy
- Centre for Global Chronic Conditions, Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Catherine McGowan
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Humanitarian Public Health Technical Unit, Save the Children UK, London, United Kingdom
| | - Martin McKee
- Centre for Global Chronic Conditions, Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Marc Suhrcke
- Centre for Health Economics, University of York, York, UK
- Luxembourg Institute of Socio-economic Research (LISER), Belval, Luxembourg
| | - Kara Hanson
- Department of Global Health Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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White N, Reid F, Harries P, Harris AJL, Minton O, McGowan C, Lodge P, Tookman A, Stone P. The (un)availability of prognostic information in the last days of life: a prospective observational study. BMJ Open 2019; 9:e030736. [PMID: 31292186 PMCID: PMC6624101 DOI: 10.1136/bmjopen-2019-030736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES The aims of this study were (1) to document the clinical condition of patients considered to be in the last 2 weeks of life and (2) to compare patients who did or did not survive for 72 hours. DESIGN A prospective observational study. SETTING Two sites in London, UK (a hospice and a hospital palliative care team). PARTICIPANTS Any inpatient, over 18 years old, English speaking, who was identified by the palliative care team as at risk of dying within the next 2 weeks was eligible. OUTCOME MEASURES Prognostic signs and symptoms were documented at a one off assessment and patients were followed up 7 days later to determine whether or not they had died. RESULTS Fifty participants were recruited and 24/50 (48%) died within 72 hours of assessment. The most prevalent prognostic features observed were a decrease in oral food intake (60%) and a rapid decline of the participant's global health status (56%). Participants who died within 72 hours had a lower level of consciousness and had more care needs than those who lived longer. A large portion of data was unavailable, particularly that relating to the psychological and spiritual well-being of the patient, due to the decreased consciousness of the patient. CONCLUSIONS The prevalence of prognostic signs and symptoms in the final days of life has been documented between those predicted to die and those who did not. How doctors make decisions with missing information is an area for future research, in addition to understanding the best way to use the available information to make more accurate predictions.
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Affiliation(s)
- Nicola White
- Marie Curie Palliative Care Research Department, University College London, London, London, UK
| | - Fiona Reid
- Department of Primary Care & Public Health Sciences, King’s College London, London, London, UK
| | - Priscilla Harries
- Centre for Applied Health and Social Care Research (CAHSCR), Kingston University & St George’s, University of London, London, UK
- Department of Clinical Sciences, Brunel University London, London, UK
| | - Adam J L Harris
- Experimental Psychology, University College London, London, London, UK
| | - Ollie Minton
- Palliative Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, Brighton and Hove, UK
| | - Catherine McGowan
- Palliative Medicine, St. Georges University Hospitals NHS Foundation Trust, London, UK
| | - Philip Lodge
- Palliative Medicine, Royal Free London NHS Foundation Trust, London, London, UK
- Marie Curie Hospice Hampstead, London, UK
| | - Adrian Tookman
- Palliative Medicine, Royal Free London NHS Foundation Trust, London, London, UK
- Marie Curie Hospice Hampstead, London, UK
| | - Patrick Stone
- Marie Curie Palliative Care Research Department, University College London, London, London, UK
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McLean K, Glasbey J, Borakati A, Brooks T, Chang H, Choi S, Goodson R, Nielsen M, Pronin S, Salloum N, Sewart E, Vanniasegaram D, Drake T, Gillies M, Harrison E, Chapman S, Khatri C, Kong C, Claireaux H, Bath M, Mohan M, McNamee L, Kelly M, Mitchell H, Fitzgerald J, Bhangu A, Nepogodiev D, Antoniou I, Dean R, Davies N, Trecarten S, Henderson I, Holmes C, Wylie J, Shuttleworth R, Jindal A, Hughes F, Gouda P, Fleck R, Hanrahan M, Karunakaran P, Chen J, Sykes M, Sethi R, Suresh S, Patel P, Patel M, Varma R, Mushtaq J, Gundogan B, Bolton W, Khan T, Burke J, Morley R, Favero N, Adams R, Thirumal V, Kennedy E, Ong K, Tan Y, Gabriel J, Bakhsh A, Low J, Yener A, Paraoan V, Preece R, Tilston T, Cumber E, Dean S, Ross T, McCance E, Amin H, Satterthwaite L, Clement K, Gratton R, Mills E, Chiu S, Hung G, Rafiq N, Hayes J, Robertson K, Dynes K, Huang H, Assadullah S, Duncumb J, Moon R, Poo S, Mehta J, Joshi K, Callan R, Norris J, Chilvers N, Keevil H, Jull P, Mallick S, Elf D, Carr L, Player C, Barton E, Martin A, Ratu S, Roberts E, Phan P, Dyal A, Rogers J, Henson A, Reid N, Burke D, Culleton G, Lynne S, Mansoor S, Brennan C, Blessed R, Holloway C, Hill A, Goldsmith T, Mackin S, Kim S, Woin E, Brent G, Coffin J, Ziff O, Momoh Z, Debenham R, Ahmed M, Yong C, Wan J, Copley H, Raut P, Chaudhry F, Nixon G, Dorman C, Tan R, Kanabar S, Canning N, Dolaghan M, Bell N, McMenamin M, Chhabra A, Duke K, Turner L, Patel T, Chew L, Mirza M, Lunawat S, Oremule B, Ward N, Khan M, Tan E, Maclennan D, McGregor R, Chisholm E, Griffin E, Bell L, Hughes B, Davies J, Haq H, Ahmed H, Ungcharoen N, Whacha C, Thethi R, Markham R, Lee A, Batt E, Bullock N, Francescon C, Davies J, Shafiq N, Zhao J, Vivekanantham S, Barai I, Allen J, Marshall D, McIntyre C, Wilson H, Ashton A, Lek C, Behar N, Davis-Hall M, Seneviratne N, Esteve L, Sirakaya M, Ali S, Pope S, Ahn J, Craig-McQuaide A, Gatfield W, Leong S, Demetri A, Kerr A, Rees C, Loveday J, Liu S, Wijesekera M, Maru D, Attalla M, Smith N, Brown D, Sritharan P, Shah A, Charavanamuttu V, Heppenstall-Harris G, Ng K, Raghvani T, Rajan N, Hulley K, Moody N, Williams M, Cotton A, Sharifpour M, Lwin K, Bright M, Chitnis A, Abdelhadi M, Semana A, Morgan F, Reid R, Dickson J, Anderson L, McMullan R, Ahern N, Asmadi A, Anderson L, Boon Xuan JL, Crozier L, McAleer S, Lees D, Adebayo A, Das M, Amphlett A, Al-Robeye A, Valli A, Khangura J, Winarski A, Ali A, Woodward H, Gouldthrope C, Turner M, Sasapu K, Tonkins M, Wild J, Robinson M, Hardie J, Heminway R, Narramore R, Ramjeeawon N, Hibberd A, Winslow F, Ho W, Chong B, Lim K, Ho S, Crewdson J, Singagireson S, Kalra N, Koumpa F, Jhala H, Soon W, Karia M, Rasiah M, Xylas D, Gilbert H, Sundar-Singh M, Wills J, Akhtar S, Patel S, Hu L, Brathwaite-Shirley C, Nayee H, Amin O, Rangan T, Turner E, McCrann C, Shepherd R, Patel N, Prest-Smith J, Auyoung E, Murtaza A, Coates A, Prys-Jones O, King M, Gaffney S, Dewdney C, Nehikhare I, Lavery J, Bassett J, Davies K, Ahmad K, Collins A, Acres M, Egerton C, Cheng K, Chen X, Chan N, Sheldon A, Khan S, Empey J, Ingram E, Malik A, Johnstone M, Goodier R, Shah J, Giles J, Sanders J, McLure S, Pal S, Rangedara A, Baker A, Asbjoernsen C, Girling C, Gray L, Gauntlett L, Joyner C, Qureshi S, Mogan Y, Ng J, Kumar A, Park J, Tan D, Choo K, Raman K, Buakuma P, Xiao C, Govinden S, Thompson O, Charalambos M, Brown E, Karsan R, Dogra T, Bullman L, Dawson P, Frank A, Abid H, Tung L, Qureshi U, Tahmina A, Matthews B, Harris R, O'Connor A, Mazan K, Iqbal S, Stanger S, Thompson J, Sullivan J, Uppal E, MacAskill A, Bamgbose F, Neophytou C, Carroll A, Rookes C, Datta U, Dhutia A, Rashid S, Ahmed N, Lo T, Bhanderi S, Blore C, Ahmed S, Shaheen H, Abburu S, Majid S, Abbas Z, Talukdar S, Burney L, Patel J, Al-Obaedi O, Roberts A, Mahboob S, Singh B, Sheth S, Karia P, Prabhudesai A, Kow K, Koysombat K, Wang S, Morrison P, Maheswaran Y, Keane P, Copley P, Brewster O, Xu G, Harries P, Wall C, Al-Mousawi A, Bonsu S, Cunha P, Ward T, Paul J, Nadanakumaran K, Tayeh S, Holyoak H, Remedios J, Theodoropoulou K, Luhishi A, Jacob L, Long F, Atayi A, Sarwar S, Parker O, Harvey J, Ross H, Rampal R, Thomas G, Vanmali P, McGowan C, Stein J, Robertson V, Carthew L, Teng V, Fong J, Street A, Thakker C, O'Reilly D, Bravo M, Pizzolato A, Khokhar H, Ryan M, Cheskes L, Carr R, Salih A, Bassiony S, Yuen R, Chrastek D, Rosen O'Sullivan H, Amajuoyi A, Wang A, Sitta O, Wye J, Qamar M, Major C, Kaushal A, Morgan C, Petrarca M, Allot R, Verma K, Dutt S, Chilima C, Peroos S, Kosasih S, Chin H, Ashken L, Pearse R, O'Loughlin R, Menon A, Singh K, Norton J, Sagar R, Jathanna N, Rothwell L, Watson N, Harding F, Dube P, Khalid H, Punjabi N, Sagmeister M, Gill P, Shahid S, Hudson-Phillips S, George D, Ashwood J, Lewis T, Dhar M, Sangal P, Rhema I, Kotecha D, Afzal Z, Syeed J, Prakash E, Jalota P, Herron J, Kimani L, Delport A, Shukla A, Agarwal V, Parthiban S, Thakur H, Cymes W, Rinkoff S, Turnbull J, Hayat M, Darr S, Khan U, Lim J, Higgins A, Lakshmipathy G, Forte B, Canning E, Jaitley A, Lamont J, Toner E, Ghaffar A, McDowell M, Salmon D, O'Carroll O, Khan A, Kelly M, Clesham K, Palmer C, Lyons R, Bell A, Chin R, Waldron R, Trimble A, Cox S, Ashfaq U, Campbell J, Holliday R, McCabe G, Morris F, Priestland R, Vernon O, Ledsam A, Vaughan R, Lim D, Bakewell Z, Hughes R, Koshy R, Jackson H, Narayan P, Cardwell A, Jubainville C, Arif T, Elliott L, Gupta V, Bhaskaran G, Odeleye A, Ahmed F, Shah R, Pickard J, Suleman Y, North A, McClymont L, Hussain N, Ibrahim I, Ng G, Wong V, Lim A, Harris L, Tharmachandirar T, Mittapalli D, Patel V, Lakhani M, Bazeer H, Narwani V, Sandhu K, Wingfield L, Gentry S, Adjei H, Bhatti M, Braganza L, Barnes J, Mistry S, Chillarge G, Stokes S, Cleere J, Wadanamby S, Bucko A, Meek J, Boxall N, Heywood E, Wiltshire J, Toh C, Ward A, Shurovi B, Horth D, Patel B, Ali B, Spencer T, Axelson T, Kretzmer L, Chhina C, Anandarajah C, Fautz T, Horst C, Thevathasan A, Ng J, Hirst F, Brewer C, Logan A, Lockey J, Forrest P, Keelty N, Wood A, Springford L, Avery P, Schulz T, Bemand T, Howells L, Collier H, Khajuria A, Tharakan R, Parsons S, Buchan A, McGalliard R, Mason J, Cundy O, Li N, Redgrave N, Watson R, Pezas T, Dennis Y, Segall E, Hameed M, Lynch A, Chamberlain M, Peck F, Neo Y, Russell G, Elseedawy M, Lee S, Foster N, Soo Y, Puan L, Dennis R, Goradia H, Qureshi A, Osman S, Reeves T, Dinsmore L, Marsden M, Lu Q, Pitts-Tucker T, Dunn C, Walford R, Heathcote E, Martin R, Pericleous A, Brzyska K, Reid K, Williams M, Wetherall N, McAleer E, Thomas D, Kiff R, Milne S, Holmes M, Bartlett J, Lucas de Carvalho J, Bloomfield T, Tongo F, Bremner R, Yong N, Atraszkiewicz B, Mehdi A, Tahir M, Sherliker G, Tear A, Pandey A, Broyd A, Omer H, Raphael M, Chaudhry W, Shahidi S, Jawad A, Gill C, Fisher IH, Adeleja I, Clark I, Aidoo-Micah G, Stather P, Salam G, Glover T, Deas G, Sim N, Obute R, Wynell-Mayow W, Sait M, Mitha N, de Bernier G, Siddiqui M, Shaunak R, Wali A, Cuthbert G, Bhudia R, Webb E, Shah S, Ansari N, Perera M, Kelly N, McAllister R, Stanley G, Keane C, Shatkar V, Maxwell-Armstrong C, Henderson L, Maple N, Manson R, Adams R, Semple E, Mills M, Daoub A, Marsh A, Ramnarine A, Hartley J, Malaj M, Jewell P, Whatling E, Hitchen N, Chen M, Goh B, Fern J, Rogers S, Derbyshire L, Robertson D, Abuhussein N, Deekonda P, Abid A, Harrison P, Aildasani L, Turley H, Sherif M, Pandey G, Filby J, Johnston A, Burke E, Mohamud M, Gohil K, Tsui A, Singh R, Lim S, O'Sullivan K, McKelvey L, O'Neill S, Roberts H, Brown F, Cao Y, Buckle R, Liew Y, Sii S, Ventre C, Graham C, Filipescu T, Yousif A, Dawar R, Wright A, Peters M, Varley R, Owczarek S, Hartley S, Khattak M, Iqbal A, Ali M, Durrani B, Narang Y, Bethell G, Horne L, Pinto R, Nicholls K, Kisyov I, Torrance H, English W, Lakhani S, Ashraf S, Venn M, Elangovan V, Kazmi Z, Brecher J, Sukumar S, Mastan A, Mortimer A, Parker J, Boyle J, Elkawafi M, Beckett J, Mohite A, Narain A, Mazumdar E, Sreh A, Hague A, Weinberg D, Fletcher L, Steel M, Shufflebotham H, Masood M, Sinha Y, Jenvey C, Kitt H, Slade R, Craig A, Deall C, Reakes T, Chervenkoff J, Strange E, O'Bryan M, Murkin C, Joshi D, Bergara T, Naqib S, Wylam D, Scotcher S, Hewitt C, Stoddart M, Kerai A, Trist A, Cole S, Knight C, Stevens S, Cooper G, Ingham R, Dobson J, O'Kane A, Moradzadeh J, Duffy A, Henderson C, Ashraf S, McLaughin C, Hoskins T, Reehal R, Bookless L, McLean R, Stone E, Wright E, Abdikadir H, Roberts C, Spence O, Srikantharajah M, Ruiz E, Matthews J, Gardner E, Hester E, Naran P, Simpson R, Minhas M, Cornish E, Semnani S, Rojoa D, Radotra A, Eraifej J, Eparh K, Smith D, Mistry B, Hickling S, Din W, Liu C, Mithrakumar P, Mirdavoudi V, Rashid M, Mcgenity C, Hussain O, Kadicheeni M, Gardner H, Anim-Addo N, Pearce J, Aslanyan A, Ntala C, Sorah T, Parkin J, Alizadeh M, White A, Edozie F, Johnston J, Kahar A, Navayogaarajah V, Patel B, Carter D, Khonsari P, Burgess A, Kong C, Ponweera A, Cody A, Tan Y, Ng A, Croall A, Allan C, Ng S, Raghuvir V, Telfer R, Greenhalgh A, McKerr C, Edison M, Patel B, Dear K, Hardy M, Williams P, Hassan S, Sajjad U, O'Neill E, Lopes S, Healy L, Jamal N, Tan S, Lazenby D, Husnoo S, Beecroft S, Sarvanandan T, Weston C, Bassam N, Rabinthiran S, Hayat U, Ng L, Varma D, Sukkari M, Mian A, Omar A, Kim J, Sellathurai J, Mahmood J, O'Connell C, Bose R, Heneghan H, Lalor P, Matheson J, Doherty C, Cullen C, Cooper D, Angelov S, Drislane C, Smith A, Kreibich A, Palkhi E, Durr A, Lotfallah A, Gold D, Mckean E, Dhanji A, Anilkumar A, Thacoor A, Siddiqui Z, Lim S, Piquet A, Anderson S, McCormack D, Gulati J, Ibrahim A, Murray S, Walsh S, McGrath A, Ziprin P, Chua E, Lou C, Bloomer J, Paine H, Osei-Kuffour D, White C, Szczap A, Gokani S, Patel K, Malys M, Reed A, Torlot G, Cumber E, Charania A, Ahmad S, Varma N, Cheema H, Austreng L, Petra H, Chaudhary M, Zegeye M, Cheung F, Coffey D, Heer R, Singh S, Seager E, Cumming S, Suresh R, Verma S, Ptacek I, Gwozdz A, Yang T, Khetarpal A, Shumon S, Fung T, Leung W, Kwang P, Chew L, Loke W, Curran A, Chan C, McGarrigle C, Mohan K, Cullen S, Wong E, Toale C, Collins D, Keane N, Traynor B, Shanahan D, Yan A, Jafree D, Topham C, Mitrasinovic S, Omara S, Bingham G, Lykoudis P, Miranda B, Whitehurst K, Kumaran G, Devabalan Y, Aziz H, Shoa M, Dindyal S, Yates J, Bernstein I, Rattan G, Coulson R, Stezaker S, Isaac A, Salem M, McBride A, McFarlane H, Yow L, MacDonald J, Bartlett R, Turaga S, White U, Liew W, Yim N, Ang A, Simpson A, McAuley D, Craig E, Murphy L, Shepherd P, Kee J, Abdulmajid A, Chung A, Warwick H, Livesey A, Holton P, Theodoreson M, Jenkin S, Turner J, Entwisle J, Marchal S, O'Connor S, Blege H, Aithie J, Sabine L, Stewart G, Jackson S, Kishore A, Lankage C, Acquaah F, Joyce H, McKevitt K, Coffey C, Fawaz A, Dolbec K, O'Sullivan D, Geraghty J, Lim E, Bolton L, FitzPatrick D, Robinson C, Ramtoola T, Collinson S, Grundy L, McEnhill P, Harbhajan Singh G, Loughran D, Golding D, Keeling R, Williams R, Whitham R, Yoganathan S, Nachiappan R, Egan R, Owasil R, Kwan M, He A, Goh R, Bhome R, Wilson H, Teoh P, Raji K, Jayakody N, Matthams J, Chong J, Luk C, Greig R, Trail M, Charalambous G, Rocke A, Gardiner N, Bulley F, Warren N, Brennan E, Fergurson P, Wilson R, Whittingham H, Brown E, Khanijau R, Gandhi K, Morris S, Boulton A, Chandan N, Barthorpe A, Maamari R, Sandhu S, McCann M, Higgs L, Balian V, Reeder C, Diaper C, Sale T, Ali H, Archer C, Clarke A, Heskin J, Hurst P, Farmer J, O'Flynn L, Doan L, Shuker B, Stott G, Vithanage N, Hoban K, Nesargikar P, Kennedy H, Grossart C, Tan E, Roy C, Sim P, Leslie K, Sim D, Abul M, Cody N, Tay A, Woon E, Sng S, Mah J, Robson J, Shakweh E, Wing V, Mills H, Li M, Barrow T, Balaji S, Jordan H, Phillips C, Naveed H, Hirani S, Tai A, Ratnakumaran R, Sahathevan A, Shafi A, Seedat M, Weaver R, Batho A, Punj R, Selvachandran H, Bhatt N, Botchey S, Khonat Z, Brennan K, Morrison C, Devlin E, Linton A, Galloway E, McGarvie S, Ramsay N, McRobbie H, Whewell H, Dean W, Nelaj S, Eragat M, Mishra A, Kane T, Zuhair M, Wells M, Wilkinson D, Woodcock N, Sun E, Aziz N, Ghaffar MKA. Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study. Br J Anaesth 2019; 122:42-50. [PMID: 30579405 DOI: 10.1016/j.bja.2018.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. METHODS This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy. RESULTS Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI. CONCLUSIONS After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.
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Kariminia A, Law M, Davies M, Vinikoor M, Wools‐Kaloustian K, Leroy V, Edmonds A, McGowan C, Vreeman R, Fairlie L, Ayaya S, Yotebieng M, Takassi E, Pinto J, Adedimeji A, Malateste K, Machado DM, Penazzato M, Hazra R, Sohn AH. Mortality and losses to follow-up among adolescents living with HIV in the IeDEA global cohort collaboration. J Int AIDS Soc 2018; 21:e25215. [PMID: 30548817 PMCID: PMC6291755 DOI: 10.1002/jia2.25215] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [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: 07/11/2018] [Accepted: 11/15/2018] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION We assessed mortality and losses to follow-up (LTFU) during adolescence in routine care settings in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. METHODS Cohorts in the Asia-Pacific, the Caribbean, Central, and South America, and sub-Saharan Africa (Central, East, Southern, West) contributed data, and included adolescents living with HIV (ALHIV) enrolled from January 2003 and aged 10 to 19 years (period of adolescence) while under care up to database closure (June 2016). Follow-up started at age 10 years or the first clinic visit, whichever was later. Entering care at <15 years was a proxy for perinatal infection, while entering care ≥15 years represented infection acquired during adolescence. Competing risk regression was used to assess associations with death and LTFU among those ever receiving triple-drug antiretroviral therapy (triple-ART). RESULTS Of the 61,242 ALHIV from 270 clinics in 34 countries included in the analysis, 69% (n = 42,138) entered care <15 years of age (53% female), and 31% (n = 19,104) entered care ≥15 years (81% female). During adolescence, 3.9% died, 30% were LTFU and 8.1% were transferred. For those with infection acquired perinatally versus during adolescence, the four-year cumulative incidences of mortality were 3.9% versus 5.4% and of LTFU were 26% versus 69% respectively (both p < 0.001). Overall, there were higher hazards of death for females (adjusted sub-hazard ratio (asHR) 1.19, 95% confidence interval (CI) 1.07 to 1.33), and those starting treatment at ≥5 years of age (highest asHR for age ≥15: 8.72, 95% CI 5.85 to 13.02), and in care in mostly urban (asHR 1.40, 95% CI 1.13 to 1.75) and mostly rural settings (asHR 1.39, 95% CI 1.03 to 1.87) compared to urban settings. Overall, higher hazards of LTFU were observed among females (asHR 1.12, 95% CI 1.07 to 1.17), and those starting treatment at age ≥5 years (highest asHR for age ≥15: 11.11, 95% CI 9.86 to 12.53), in care at district hospitals (asHR 1.27, 95% CI 1.18 to 1.37) or in rural settings (asHR 1.21, 95% CI 1.13 to 1.29), and starting triple-ART after 2006 (highest asHR for 2011 to 2016 1.84, 95% CI 1.71 to 1.99). CONCLUSIONS Both mortality and LTFU were worse among those entering care at ≥15 years. ALHIV should be evaluated apart from younger children and adults to identify population-specific reasons for death and LTFU.
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Affiliation(s)
| | - Matthew Law
- The Kirby InstituteUNSW SydneySydneyAustralia
| | - Mary‐Ann Davies
- Centre for Infectious Disease Epidemiology and ResearchUniversity of Cape TownCape TownSouth Africa
| | | | | | | | - Andrew Edmonds
- The University of North Carolina at Chapel HillChapel HillNCUSA
| | | | | | - Lee Fairlie
- Wits Reproductive Health and HIV InstituteJohannesburgSouth Africa
| | - Samuel Ayaya
- Moi University College of Health SciencesEldoretKenya
| | | | | | - Jorge Pinto
- Federal University of Minas GeraisBelo HorizoneBrazil
| | | | | | | | | | - Rohan Hazra
- Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentBethesdaMDUSA
| | - Annette H Sohn
- TREAT Asia/amfARThe Foundation for AIDS ResearchBangkokThailand
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White N, Harries P, Harris AJ, Vickerstaff V, Lodge P, McGowan C, Minton O, Tomlinson C, Tookman A, Reid F, Stone P. How do palliative care doctors recognise imminently dying patients? A judgement analysis. BMJ Open 2018; 8:e024996. [PMID: 30473542 PMCID: PMC6254495 DOI: 10.1136/bmjopen-2018-024996] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To identify a group of palliative care doctors who perform well on a prognostic test and to understand how they make their survival predictions. DESIGN Prospective observational study and two cross-sectional online studies. SETTING Phase I: an online prognostic test, developed from a prospective observational study of patients referred to palliative care. Phase II: an online judgement task consisting of 50 hypothetical vignettes. PARTICIPANTS All members of the Association of Palliative Medicine (APM) were eligible (n=~1100). 99 doctors completed the prognostic test and were included in the phase I analysis. The top 20% were invited to participate in phase II; 14/19 doctors completed the judgement task and were included in the phase II analysis. MEASURES Phase I: participants were asked to give a probability of death within 72 hours (0%-100%) for all 20 cases. Accuracy on the prognostic test was measured with the Brier score which was used to identify the 'expert' group (scale range: 0 (expert)-1 (non-expert)). Phase II: participants gave a probability of death within 72 hours (0%-100%). A mixed model regression analysis was completed using the percentage estimate as the outcome and the patient information included in the vignettes as the predictors. RESULTS The mean Brier score of all participants was 0.237 (95% CI 0.235 to 0.239). The mean Brier score of the 'experts' was 0.184 (95% CI 0.176 to 0.192). Six of the seven prognostic variables included in the hypothetical vignettes were significantly associated with clinician predictions of death. The Palliative Performance Score was identified as being the most influential in the doctors' prognostic decision making (β=0.48, p<0.001). CONCLUSIONS This study identified six clinical signs and symptoms which influenced the judgement policies of palliative care doctors. These results may be used to teach novice doctors how to improve their prognostic skills.
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Affiliation(s)
- Nicola White
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Priscilla Harries
- Kingston University & St George's, University of London, London, UK
- Departmentof Clinical Sciences, Brunel University London, London, United Kingdom
| | - Adam Jl Harris
- Department of Experimental Psychology, University College London, London, UK
| | - Victoria Vickerstaff
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | | | | | - Ollie Minton
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | | | - Fiona Reid
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Patrick Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
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White N, Harries P, Harris AJL, Vickerstaff V, Lodge P, McGowan C, Minton O, Tomlinson C, Tookman A, Reid F, Stone P. 44 An evidenced-based heuristics model (or rule of thumb) to improve doctors’ intuition about when patients are imminently dying. BMJ Support Palliat Care 2018. [DOI: 10.1136/bmjspcare-2018-mariecurie.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
IntroductionEvidence suggests that the majority of doctors are not very good at identifying when a patient is dying1 however there is little training available to improve this skill. Even experts are unable to articulate how they recognise when a patient is dying other than by saying that ‘I just knew’.2AimTo understand how expert palliative care doctors recognise a dying person.MethodsRather than relying on ‘years of experience’ as a surrogate measure of expertise we developed a test to identify which doctors really are the prognostic ‘experts’. The prognostic test consisted of 20 real patient case summaries. Participants (palliative care doctors) were asked to predict whether or not they expected the patient to die within the next 3 days. Those who were the most accurate at this task were deemed to be the ‘prognostic experts’ and were invited to complete an additional online judgement task. In this task it was possible to identify which factors were most influential in their prognostic decision-making.Results19/99 doctors who completed the prognostic test were deemed to be ‘experts’. Of those 14 also completed the additional judgement task. The following factors influenced the experts’ decisions: Cheyne Stokes breathing palliative performance score (PPS) a decline in condition in the previous 24 hours respiratory secretions cyanosis and level of agitation or sedation.ConclusionThis novel study presents a simple evidenced-based heuristic (or rule of thumb) to help novices recognise when a patient is imminently dying.References. Neuberger J, Guthrie C, Aaronovitch D. More care less pathway: A review of the Liverpool Care Pathway. Department of Health2013.. Taylor P, Dowding D, Johnson M. Clinical decision making in the recognition of dying: A qualitative interview study. BMC Palliative Care2017;16(1):11.
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McGowan C. Recommendations from the Australian and New Zealand Equine Endocrine Group and the interpretation of plasma endogenous ACTH concentrations for the diagnosis of pituitary pars intermedia dysfunction (PPID). Aust Vet J 2018; 96:317-318. [DOI: 10.1111/avj.12743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Giles ML, Achhra AC, Abraham AG, Haas AD, Gill MJ, Lee MP, Luque M, McGowan C, Cornell M, Braitstein P, de Rekeneire N, Becquet R, Wools‐Kaloustian K, Law M. Sex-based differences in antiretroviral therapy initiation, switching and treatment interruptions: global overview from the International Epidemiologic Databases to Evaluate AIDS (IeDEA). J Int AIDS Soc 2018; 21:e25149. [PMID: 29956882 PMCID: PMC6024257 DOI: 10.1002/jia2.25149] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 01/07/2018] [Accepted: 05/22/2018] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION In 2015, the World Health Organization recommended that all HIV-infected individuals consider ART initiation as soon as possible after diagnosis. Sex differences in choice of initial ART regimen, indications for switching, time to switching and choice of second-line regimens have not been well described. The aims of this study were to describe first-line ART and CD4 count at ART initiation by sex, calendar year and region, and to analyse time to change or interruption in first-line ART, according to sex in each region. METHODS Participating cohorts included: Southern, East and West Africa (IeDEA-Africa), North America (NA-ACCORD), Caribbean, Central/South America (CCASAnet) and Asia-Pacific including Australia (IeDEA Asia-Pacific). The primary outcomes analysed for each region and according to sex were choice of initial ART, time to switching and time to discontinuation of the first-line regimen. RESULTS AND DISCUSSION The combined cohort data set comprised of 715,252 participants across seven regions from low- to high-income settings. The median CD4 count at treatment initiation was lower in men compared with women in nearly all regions and time periods. Women from North America and Southern Africa were more likely to switch ART compared to men (p < 0.001) with approximately 90% of women reporting a major change after 10 years in North America. Overall, after 8 years on ART, >50% of HIV- positive men and women from Southern Africa, East Africa, South and Central America remained on their original regimen. Men were more likely to have a treatment interruption compared with women in low- and middle-income countries from the Asia/Pacific region (p < 0.001) as were men from Southern Africa (p < 0.001). Greater than 75% of men and women did not report a treatment interruption after 10 years on ART from all regions except North America and Southern Africa. CONCLUSIONS There are regional variations in the ART regimen commenced at baseline and rates of major change and treatment interruption according to sex. Some of this is likely to reflect changes in local and international antiretroviral guideline recommendations but other sex-specific factors such as pregnancy may contribute to these differences.
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Affiliation(s)
- Michelle L Giles
- Department of Infectious DiseasesMonash University and Alfred HealthMelbourneVICAustralia
| | | | | | | | | | | | - Marco Luque
- Hospital Escuela UniversitarioTegucigalpaHonduras
| | | | - Morna Cornell
- Centre for Infectious Disease Epidemiologyand Division of Epidemiology and BiostatisticsSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | | | - Nathalie de Rekeneire
- University of BordeauxInsermBordeaux Population Health Research CenterUMR 1219Team IDLICBordeauxFrance
| | - Renaud Becquet
- University of BordeauxInsermBordeaux Population Health Research CenterUMR 1219Team IDLICBordeauxFrance
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Fink VI, Jenkins CA, Castilho JL, Person AK, Shepherd BE, Grinsztejn B, Netto J, Crabtree-Ramirez B, Cortés CP, Padgett D, Jayathilake K, McGowan C, Cahn P. Survival after cancer diagnosis in a cohort of HIV-positive individuals in Latin America. Infect Agent Cancer 2018; 13:16. [PMID: 29760767 PMCID: PMC5941620 DOI: 10.1186/s13027-018-0188-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/25/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND This study aimed to evaluate trends and predictors of survival after cancer diagnosis in persons living with HIV in the Caribbean, Central, and South America network for HIV epidemiology cohort. METHODS Demographic, cancer, and HIV-related data from HIV-positive adults diagnosed with cancer ≤ 1 year before or any time after HIV diagnosis from January 1, 2000-June 30, 2015 were retrospectively collected. Cancer cases were classified as AIDS-defining cancers (ADC) and non-AIDS-defining cancers (NADC). The association of mortality with cancer- and HIV-related factors was assessed using Kaplan-Meier curves and Cox proportional hazards models stratified by clinic site and cancer type. RESULTS Among 15,869 patients, 783 had an eligible cancer diagnosis; 82% were male and median age at cancer diagnosis was 39 years (interquartile range [IQR]: 32-47). Patients were from Brazil (36.5%), Argentina (19.9%), Chile (19.7%), Mexico (19.3%), and Honduras (4.6%). A total of 564 ADC and 219 NADC were diagnosed. Patients with NADC had similar survival probabilities as those with ADC at one year (81% vs. 79%) but lower survival at five years (60% vs. 69%). In the adjusted analysis, risk of mortality increased with detectable viral load (adjusted hazard ratio [aHR] = 1.63, p = 0.02), age (aHR = 1.02 per year, p = 0.002) and time between HIV and cancer diagnoses (aHR = 1.03 per year, p = 0.01). CONCLUSION ADC remain the most frequent cancers in the region. Overall mortality was related to detectable viral load and age. Longer-term survival was lower after diagnosis of NADC than for ADC, which may be due to factors unrelated to HIV.
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Affiliation(s)
- Valeria I. Fink
- Fundación Huésped, Pasaje Gianantonio 3932, C1202ABB Buenos Aires, Argentina
| | - Cathy A. Jenkins
- Vanderbilt University School of Medicine, 1161 21st Ave. S A2200 Medical Center North, Nashville, TN 37232 USA
| | - Jessica L. Castilho
- Vanderbilt University School of Medicine, 1161 21st Ave. S A2200 Medical Center North, Nashville, TN 37232 USA
| | - Anna K. Person
- Vanderbilt University School of Medicine, 1161 21st Ave. S A2200 Medical Center North, Nashville, TN 37232 USA
| | - Bryan E. Shepherd
- Vanderbilt University School of Medicine, 1161 21st Ave. S A2200 Medical Center North, Nashville, TN 37232 USA
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, 4365 - Manguinhos, Rio de Janeiro, RJ 21040-900 Brasil
| | - Juliana Netto
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, 4365 - Manguinhos, Rio de Janeiro, RJ 21040-900 Brasil
| | - Brenda Crabtree-Ramirez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán: Unidad del Paciente Ambulatorio (UPA), 5to piso Vasco de Quiroga # 15 Col. Sección XVI Delegación Tlalpan; C.P, 14000 Mexico City, Mexico
| | | | - Denis Padgett
- Instituto Hondureño de Seguridad Social, Barrio la Granja, Tegucigalpa Honduras, Hospital Escuela Universitario: Av La Salud, Tegucigalpa, Honduras
| | - Karu Jayathilake
- Vanderbilt University School of Medicine, 1161 21st Ave. S A2200 Medical Center North, Nashville, TN 37232 USA
| | - Catherine McGowan
- Vanderbilt University School of Medicine, 1161 21st Ave. S A2200 Medical Center North, Nashville, TN 37232 USA
| | - Pedro Cahn
- Fundación Huésped, Pasaje Gianantonio 3932, C1202ABB Buenos Aires, Argentina
| | - on behalf of CCASAnet
- Fundación Huésped, Pasaje Gianantonio 3932, C1202ABB Buenos Aires, Argentina
- Vanderbilt University School of Medicine, 1161 21st Ave. S A2200 Medical Center North, Nashville, TN 37232 USA
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, 4365 - Manguinhos, Rio de Janeiro, RJ 21040-900 Brasil
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán: Unidad del Paciente Ambulatorio (UPA), 5to piso Vasco de Quiroga # 15 Col. Sección XVI Delegación Tlalpan; C.P, 14000 Mexico City, Mexico
- Fundación Arriarán, Santa Elvira 629, Santiago, Chile
- Instituto Hondureño de Seguridad Social, Barrio la Granja, Tegucigalpa Honduras, Hospital Escuela Universitario: Av La Salud, Tegucigalpa, Honduras
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Desmonde S, Tanser F, Vreeman R, Takassi E, Edmonds A, Lumbiganon P, Pinto J, Malateste K, McGowan C, Kariminia A, Yotebieng M, Dicko F, Yiannoutsos C, Mubiana-Mbewe M, Wools-Kaloustian K, Davies MA, Leroy V. Access to antiretroviral therapy in HIV-infected children aged 0-19 years in the International Epidemiology Databases to Evaluate AIDS (IeDEA) Global Cohort Consortium, 2004-2015: A prospective cohort study. PLoS Med 2018; 15:e1002565. [PMID: 29727458 PMCID: PMC5935422 DOI: 10.1371/journal.pmed.1002565] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 04/04/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Access to antiretroviral therapy (ART) is a global priority. However, the attrition across the continuum of care for HIV-infected children between their HIV diagnosis and ART initiation is not well known. We analyzed the time from enrollment into HIV care to ART initiation in HIV-infected children within the International Epidemiology Databases to Evaluate AIDS (IeDEA) Global Cohort Consortium. METHODS AND FINDINGS We included 135,479 HIV-1-infected children, aged 0-19 years and ART-naïve at enrollment, between 1 January 2004 and 31 December 2015, in IeDEA cohorts from Central Africa (3 countries; n = 4,948), East Africa (3 countries; n = 22,827), West Africa (7 countries; n = 7,372), Southern Africa (6 countries; n = 93,799), Asia-Pacific (6 countries; n = 4,045), and Latin America (7 countries; n = 2,488). Follow-up in these cohorts is typically every 3-6 months. We described time to ART initiation and missed opportunities (death or loss to follow-up [LTFU]: last clinical visit >6 months) since baseline (the date of HIV diagnosis or, if unavailable, date of enrollment). Cumulative incidence functions (CIFs) for and determinants of ART initiation were computed, with death and LTFU as competing risks. Among the 135,479 children included, 99,404 (73.4%) initiated ART, 1.9% died, 1.4% were transferred out, and 20.4% were lost to follow-up before ART initiation. The 24-month CIF for ART initiation was 68.2% (95% CI: 67.9%-68.4%); it was lower in sub-Saharan Africa-ranging from 49.8% (95% CI: 48.4%-51.2%) in Central Africa to 72.5% (95% CI: 71.5%-73.5%) in West Africa-compared to Latin America (71.0%, 95% CI: 69.1%-72.7%) and the Asia-Pacific (78.3%, 95% CI: 76.9%-79.6%). Adolescents aged 15-19 years and infants <1 year had the lowest cumulative incidence of ART initiation compared to other ages: 62.2% (95% CI: 61.6%-62.8%) and 66.4% (95% CI: 65.7%-67.0%), respectively. Overall, 49.1% were ART-eligible per local guidelines at baseline, of whom 80.6% initiated ART. The following children had lower cumulative incidence of ART initiation: female children (p < 0.01); those aged <1 year, 2-4 years, 5-9 years, and 15-19 years (versus those aged 10-14 years, p < 0.01); those who became eligible during follow-up (versus eligible at enrollment, p < 0.01); and those receiving care in low-income or lower-middle-income countries (p < 0.01). The main limitations of our study include left truncation and survivor bias, caused by deaths of children prior to enrollment, and use of enrollment date as a proxy for missing data on date of HIV diagnosis, which could have led to underestimation of the time between HIV diagnosis and ART initiation. CONCLUSIONS In this study, 68% of HIV-infected children initiated ART by 24 months. However, there was a substantial risk of LTFU before ART initiation, which may also represent undocumented mortality. In 2015, many obstacles to ART initiation remained, with substantial inequities. More effective and targeted interventions to improve access are needed to reach the target of treating 90% of HIV-infected children with ART.
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Affiliation(s)
| | - Franck Tanser
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa
| | - Rachel Vreeman
- School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
| | | | - Andrew Edmonds
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | | | - Jorge Pinto
- School of Medicine, Universide Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Karen Malateste
- Inserm U1219, University of Bordeaux, Bordeaux, France
- Bordeaux School of Public Health, University of Bordeaux, Bordeaux, France
| | - Catherine McGowan
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Azar Kariminia
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Marcel Yotebieng
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio, United States of America
| | | | - Constantin Yiannoutsos
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, United States of America
| | | | - Kara Wools-Kaloustian
- School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Valériane Leroy
- Inserm U1027, Toulouse III University, Toulouse, France
- * E-mail:
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Anderegg N, Panayidou K, Abo Y, Alejos B, Althoff KN, Anastos K, Antinori A, Balestre E, Becquet R, Castagna A, Castelnuovo B, Chêne G, Coelho L, Collins IJ, Costagliola D, Crabtree-Ramírez B, Dabis F, d’Arminio Monforte A, Davies MA, De Wit S, Delpech V, De La Mata NL, Duda S, Freeman A, Gange SJ, Grabmeier-Pfistershammer K, Gunsenheimer-Bartmeyer B, Jiamsakul A, Kitahata MM, Law M, Manzardo C, McGowan C, Meyer L, Moore R, Mussini C, Nakigoz G, Nash D, Tek Ng O, Obel N, Pantazis N, Poda A, Raben D, Reiss P, Riggen L, Sabin C, d’Amour Sinayobye J, Sönnerborg A, Stoeckle M, Thorne C, Torti C, Twizere C, Wasmuth JC, Wittkop L, Wools-Kaloustian K, Yotebieng M, Kirk O, Egger M. Global Trends in CD4 Cell Count at the Start of Antiretroviral Therapy: Collaborative Study of Treatment Programs. Clin Infect Dis 2018; 66:893-903. [PMID: 29373672 PMCID: PMC5848308 DOI: 10.1093/cid/cix915] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 11/21/2017] [Indexed: 11/14/2022] Open
Abstract
Background Early initiation of combination antiretroviral therapy (cART), at higher CD4 cell counts, prevents disease progression and reduces sexual transmission of human immunodeficiency virus (HIV). We describe the temporal trends in CD4 cell counts at the start of cART in adults from low-income, lower-middle-income, upper-middle-income, and high-income countries (LICs, LMICs, UMICs, and HICs, respectively). Methods We included HIV-infected individuals aged ≥16 years who started cART between 2002 and 2015 in a clinic participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) or the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE). Missing CD4 cell counts at the start of cART were estimated through multiple imputation. Weighted mixed-effect models were used to smooth trends in median CD4 cell counts. Results A total of 951855 adults from 16 LICs, 11 LMICs, 9 UMICs, and 19 HICs were included. Overall, the modeled median CD4 cell count at the start of cART increased from 2002 to 2015, from 78/µL (95% confidence interval, 58-104/µL) to 287/µL (250-328/µL) in LICs, from 99/µL (71-140/µL) to 234/µL (192-285/µL) in LMICs, from 71/µL (49-104/µL) to 311/µL (255-379/µL) in UMICs, and from 161/µL (143-181/µL) to 327/µL (286-372/µL) in HICs. In LICs, LMICs, and UMICs, the increase was more pronounced in women; in HICs, the opposite was observed. Conclusions Median CD4 cell counts at the start of cART increased in all income groups, but generally remained below 350/μL in 2015. Substantial additional efforts and resources are required to achieve earlier diagnosis, linkage to care, and initiation of cART.
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Nemery E, Gabriel A, Cassart D, Bayrou C, Piret J, Antoine N, Nilsson M, Steinwall L, Jacobson I, Martins Â, Carvalho C, Viegas I, Marcellin-Little DJ, Harrysson OLA, Crimi CS, Levine D, Calatayud M, Resano M, Mucha M, Virac I, Lang C, Wittek K, Tichy A, Bockstahler B, Randy Walker J, Swogger Ā, Gibson T, Ryan J, Gilligan C, Haulcomb K, Norris LA, Powers M, Pugh T, Purkey S, Pulkkinen H, Lappalainen A, Laitinen-Vapaavuori O, Hyytiäinen H, Essner A, Sjöström R, Zetterberg L, Hellström K, Gustås P, Högberg H, Hielm-Björkman A, Orrfors C, Sundelin G, Gonçalves L, Niza-Ribeiro J, Millis DL, de Matos AJ, Teeling M, Ross K, Geddes V, Carstens A, Kriel T, du Toit K, Pauw J, Martindale G, Mylo K, van den Berg SS, Ogasawara M, Noguchi H, Minami T, Zdeb K, Baumgart U, Ribeiro AM, Palas R, Capelão M, Speciani M, De Luca A, Anzolin E, Pirinen N, Pastell M, Mykkänen A, Jokisalo J, Niinistö K, Hänninen L, McGowan C, Holt A, Subirats M, Perez M, Hernández T, Gutierrez-Cepeda L, Cediel R, Román JLS, Boström AF, Savolainen L, Lappalainen AK, Stadig S, Lundström L, Bergh A, Ley C, Olsén L, Ingvast-Larsson C, Diniz R, Nicolau C, Gamundi A, Akaarir M, Roberts E, McLennan L, Cartildge HC, Evans LKM, Baugh S, Stenfeldt P, Ericson C, Söderberg L, Sjöström L, Colborne R, Byström A, Drum M, de Swarte M, Morandi F, Guevara J, Hickey D, Camp E, Dickson R. Proceedings of the 9th international symposium on veterinary rehabilitation and physical therapy. Acta Vet Scand 2016. [PMCID: PMC5259818 DOI: 10.1186/s13028-016-0259-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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White N, Harris A, Reid F, Harries P, Minton O, McGowan C, Lodge P, Tookman A, Stone P. How accurate are palliative care doctors at recognising dying? BMJ Support Palliat Care 2016. [DOI: 10.1136/bmjspcare-2016-001204.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Platt L, Easterbrook P, Gower E, McDonald B, Sabin K, McGowan C, Yanny I, Razavi H, Vickerman P. Prevalence and burden of HCV co-infection in people living with HIV: a global systematic review and meta-analysis. The Lancet Infectious Diseases 2016; 16:797-808. [PMID: 26922272 DOI: 10.1016/s1473-3099(15)00485-5] [Citation(s) in RCA: 455] [Impact Index Per Article: 56.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 11/06/2015] [Accepted: 11/18/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND At global level, there are 37 million people infected with HIV and 115 million people with antibodies to hepatitis C virus (HCV). Little is known about the extent of HIV-HCV co-infection. We sought to characterise the epidemiology and burden of HCV co-infection in people living with HIV. METHODS In this systematic review and meta-analysis we searched MEDLINE, Embase, CINAHL+, POPLINE, Africa-wide Information, Global Health, Web of Science, and the Cochrane Library and WHO databases for studies measuring prevalence of HCV and HIV, published between Jan 1, 2002, and Jan 28, 2015. We included studies in HIV population samples of more than 50 individuals and recruited patients based on HIV infection status or other behavioural characteristics. We excluded editorials or reviews containing no primary data, samples of HCV or HIV-HCV co-infected individuals, or samples relying on self-reported infection status. We also excluded samples drawn from populations with other comorbidities or undergoing interventions that put them at increased risk of co-infection. Populations were categorised according to HIV exposure, with the regional burden of co-infection being derived by applying co-infection prevalence estimates to published numbers of HIV-infected individuals. We did a meta-analysis to estimate the odds of HCV in HIV-infected individuals compared with their HIV-negative counterparts. FINDINGS From 31 767 citations identified, 783 studies met the inclusion criteria, resulting in 902 estimates of the prevalence of HIV-HCV co-infection. In HIV-infected individuals, HIV-HCV co-infection was 2·4% (IQR 0·8-5·8) within general population samples, 4·0% (1·2-8·4) within pregnant or heterosexually exposed samples, 6·4% (3·2-10·0) in men who have sex with men (MSM), and 82·4% (55·2-88·5) in people who inject drugs (PWID). Odds of HCV infection were six times higher in people living with HIV (5·8, 95% CI 4·5-7·4) than their HIV-negative counterparts. Worldwide, there are approximately 2 278 400 HIV-HCV co-infections (IQR 1 271 300-4 417 000) of which 1 362 700 (847 700-1 381 800) are in PWID, equalling an overall co-infection prevalence in HIV-infected individuals of 6·2% (3·4-11·9). INTERPRETATION We noted a consistently higher HCV prevalence in HIV-infected individuals than HIV-negative individuals across all risk groups and regions, but especially in PWID. This study highlights the importance of routine HCV testing in all HIV-infected individuals, but especially in PWID. There is also a need to improve country-level surveillance of HCV prevalence across different population groups in all regions. FUNDING WHO.
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Affiliation(s)
- Lucy Platt
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | - Philippa Easterbrook
- Global Hepatitis Programme, HIV Department, World Health Organization, Geneva, Switzerland
| | - Erin Gower
- Centre for Disease Analysis, Boulder, CO, USA
| | - Bethan McDonald
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Keith Sabin
- Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | - Catherine McGowan
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Irini Yanny
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Crabtree-Ramírez B, Caro-Vega Y, Shepherd BE, Grinsztejn B, Wolff M, Cortes CP, Padgett D, Carriquiry G, Fink V, Jayathilake K, Person AK, McGowan C, Sierra-Madero J. Time to HAART Initiation after Diagnosis and Treatment of Opportunistic Infections in Patients with AIDS in Latin America. PLoS One 2016; 11:e0153921. [PMID: 27271083 PMCID: PMC4896474 DOI: 10.1371/journal.pone.0153921] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 04/06/2016] [Indexed: 12/02/2022] Open
Abstract
Background Since 2009, earlier initiation of highly active antiretroviral therapy (HAART) after an opportunistic infection (OI) has been recommended based on lower risks of death and AIDS-related progression found in clinical trials. Delay in HAART initiation after OIs may be an important barrier for successful outcomes in patients with advanced disease. Timing of HAART initiation after an OI in “real life” settings in Latin America has not been evaluated. Methods Patients in the Caribbean, Central and South America network for HIV Epidemiology (CCASAnet) ≥18 years of age at enrolment, from 2001–2012 who had an OI before HAART initiation were included. Patients were divided in an early HAART (EH) group (those initiating within 4 weeks of an OI) and a delayed HAART (DH) group (those initiating more than 4 weeks after an OI). All patients with an AIDS-defining OI were included. In patients with more than one OI the first event reported was considered. Calendar trends in the proportion of patients in the EH group (before and after 2009) were estimated by site and for the whole cohort. Factors associated with EH were estimated using multivariable logistic regression models. Results A total of 1457 patients had an OI before HAART initiation and were included in the analysis: 213 from Argentina, 686 from Brazil, 283 from Chile, 119 from Honduras and 156 from Mexico. Most prevalent OI were Tuberculosis (31%), followed by Pneumocystis pneumonia (24%), Invasive Candidiasis (16%) and Toxoplasmosis (9%). Median time from OI to HAART initiation decreased significantly from 5.7 (interquartile range [IQR] 2.8–12.1) weeks before 2009 to 4.3 (IQR 2.0–7.1) after 2009 (p<0.01). Factors associated with starting HAART within 4 weeks of OI diagnosis were lower CD4 count at enrolment (p-<0.001), having a non-tuberculosis OI (p<0.001), study site (p<0.001), and more recent years of OI diagnosis (p<0.001). Discussion The time from diagnosis of an OI to HAART initiation has decreased in Latin America coinciding with the publication of evidence of its benefit. We found important heterogeneity between sites which may reflect differences in clinical practices, local guidelines, and access to HAART. The impact of the timing of HAART initiation after OI on patient survival in this “real life” context needs further evaluation.
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Affiliation(s)
- Brenda Crabtree-Ramírez
- Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Infectious Diseases Department. Mexico City, Mexico
- * E-mail:
| | - Yanink Caro-Vega
- Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Infectious Diseases Department. Mexico City, Mexico
| | - Bryan E. Shepherd
- Vanderbilt University, Department of Biostatistics, Nashville, TN, United States of America
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas-Fiocruz, Rio de Janeiro, Brazil
| | - Marcelo Wolff
- Universidad de Chile- Fundación Arriarán, Santiago, Chile
| | | | - Denis Padgett
- Instituto Hondureño de Seguro Social and Hospital Escuela Universitario, Tegucigalpa, Honduras
| | | | - Valeria Fink
- Fundación Huésped, Investigaciones Clínicas, Buenos Aires, Argentina
| | - Karu Jayathilake
- Vanderbilt University, Department of Medicine, Nashville, TN, United States of America
| | - Anna K. Person
- Vanderbilt University, Department of Medicine, Nashville, TN, United States of America
| | - Catherine McGowan
- Vanderbilt University, Department of Medicine, Nashville, TN, United States of America
| | - Juan Sierra-Madero
- Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Infectious Diseases Department. Mexico City, Mexico
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Carslake H, Karikoski N, Pinchbeck G, McGowan C. Serum insulin concentration in horses: Effect of storage and handling. Vet J 2016; 211:94-6. [PMID: 27033594 DOI: 10.1016/j.tvjl.2016.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 01/10/2016] [Accepted: 02/27/2016] [Indexed: 10/22/2022]
Abstract
Serum insulin concentration is commonly measured during investigation of suspected endocrinopathic disease in horses, but immediate analysis is frequently unavailable. The aim of this study was to examine the effect of storing samples at room temperature for 72 h as serum and as whole blood, compared to immediate separation and freezing. Samples from 14 horses were evaluated. Correlation was excellent for all comparisons (≥0.992). Bland-Altman plots revealed a negative bias (mean difference 2.16 µIU/mL) in samples stored as whole blood compared to serum, but this difference was not considered clinically significant. At two commonly used diagnostic cut-offs, there was no effect of storage on result. This study indicates that storage at room temperature for 72 h, either as serum or whole blood, has minimal effect on measured serum insulin concentration in horses.
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Affiliation(s)
- Harry Carslake
- Institute of Ageing and Chronic Disease and Infection and Global Health, Faculty of Health and Life Sciences, University of Liverpool, Neston, Wirral CH64 7TE, UK.
| | - Ninja Karikoski
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Gina Pinchbeck
- Institute of Ageing and Chronic Disease and Infection and Global Health, Faculty of Health and Life Sciences, University of Liverpool, Neston, Wirral CH64 7TE, UK
| | - Catherine McGowan
- Institute of Ageing and Chronic Disease and Infection and Global Health, Faculty of Health and Life Sciences, University of Liverpool, Neston, Wirral CH64 7TE, UK
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Abstract
Laminitis is one of the most common and frustrating clinical presentations in equine practice. While the principles of treatment for laminitis have not changed for several decades, there have been some important paradigm shifts in our understanding of laminitis. Most importantly, it is essential to consider laminitis as a clinical sign of disease and not as a disease in its own right. Once this shift in thinking has occurred, it is logical to then question what disease caused the laminitis. More than 90 per cent of horses presented with laminitis as their primary clinical sign will have developed it as a consequence of endocrine disease; most commonly equine metabolic syndrome (EMS). Given the fact that many horses will have painful protracted and/or chronic recurrent disease, a good understanding of the predisposing factors and how to diagnose and manage them is crucial. Current evidence suggests that early diagnosis and effective management of EMS should be a key aim for practising veterinary surgeons to prevent the devastating consequences of laminitis. This review will focus on EMS, its diagnosis and management.
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Affiliation(s)
- R Morgan
- BHF Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - J Keen
- European Specialist in Equine Internal Medicine, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Campus, Midlothian EH25 9RG, UK
| | - C McGowan
- European Specialist in Equine Internal Medicine, Institute of Aging and Chronic Disease, University of Liverpool, Leahurst Campus, Neston, Cheshire CH64 7TE, UK
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Cesar C, Jenkins CA, Shepherd BE, Padgett D, Mejía F, Ribeiro SR, Cortes CP, Pape JW, Madero JS, Fink V, Sued O, McGowan C, Cahn P. Incidence of virological failure and major regimen change of initial combination antiretroviral therapy in the Latin America and the Caribbean: an observational cohort study. Lancet HIV 2015; 2:e492-500. [PMID: 26520929 DOI: 10.1016/s2352-3018(15)00183-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 09/03/2015] [Accepted: 09/04/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Access to combination antiretroviral therapy (ART) is expanding in Latin America (Mexico, Central America, and South America) and the Caribbean. We assessed the incidence of and factors associated with regimen failure and regimen change of initial ART in this region. METHODS This observational cohort study included antiretroviral-naive adults starting ART from 2000 to 2014 at sites in seven countries throughout Latin America and the Caribbean. Primary outcomes were time from ART initiation until virological failure, major regimen modification, and a composite endpoint of the first of virological failure or major regimen modification. Cumulative incidence of the primary outcomes was estimated with death considered a competing event. FINDINGS 14,027 patients starting ART were followed up for a median of 3.9 years (2.0-6.5): 8374 (60%) men, median age 37 years (IQR 30-44), median CD4 count 156 cells per μL (61-253), median plasma HIV RNA 5.0 log10 copies per mL (4.4-5.4), and 3567 (28%) had clinical AIDS. 1719 (12%) patients had virological failure and 1955 (14%) had a major regimen change. Excluding the site in Haiti, which did not regularly measure HIV RNA, cumulative incidence of virological failure was 7.8% (95% CI 7.2-8.5) 1 year after ART initiation, 19.2% (18.2-20.2) at 3 years, and 25.8% (24.6-27.0) at 5 years; cumulative incidence of major regimen change was 5.9% (5.3-6.4) at 1 year, 12.7% (11.9-13.5) at 3 years, and 18.2% (17.2-19.2) at 5 years. Incidence of major regimen change at the site in Haiti was 10.7% (95% CI 9.7-11.6) at 5 years. Virological failure was associated with younger age (adjusted hazard ratio [HR] 2.03, 95% CI 1.68-2.44, for 20 years vs 40 years), infection through injection drug use (vs infection through heterosexual sex; 1.60, 1.02-2.52), and initiation in earlier calendar years (1.28, 1.13-1.46, for 2002 vs 2006), but was not significantly associated with boosted protease inhibitor-based regimens (vs non-nucleoside reverse transcriptase inhibitor; 1.17, 1.00-1.36). INTERPRETATION Incidence of virological failure in Latin America and the Caribbean was generally lower than that reported in North America or Europe. Our results suggest the need to design strategies to reduce failure and major regimen change in young patients and those with a history of injection drug use. FUNDING US National Institutes of Health.
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Affiliation(s)
| | | | | | - Denis Padgett
- Instituto Hondureño de Seguridad Social and Hospital Escuela, Tegucigalpa, Honduras
| | - Fernando Mejía
- Instituto de Medicina Tropical Alexander von Humboldt, Lima, Peru
| | - Sayonara Rocha Ribeiro
- Instituto de Pesquisa Clinica Evandro Chagas-Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | | | | | | | - Omar Sued
- Fundación Huésped, Buenos Aires, Argentina
| | | | - Pedro Cahn
- Fundación Huésped, Buenos Aires, Argentina
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Malalana F, Stylianides A, McGowan C. Equine recurrent uveitis: Human and equine perspectives. Vet J 2015; 206:22-9. [PMID: 26188862 DOI: 10.1016/j.tvjl.2015.06.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 06/22/2015] [Accepted: 06/30/2015] [Indexed: 12/31/2022]
Abstract
Equine recurrent uveitis (ERU) is a spontaneous disease characterised by repeated episodes of intraocular inflammation. The epidemiology of ERU has not been fully elucidated, but the condition appears to be much more common in horses than is recurrent uveitis in humans, especially in certain breeds and geographical regions. Both humans and horses show a similarly altered immune response and a marked autoimmune response as the primary disease pathophysiology. However, an inciting cause is not always clear. Potential inciting factors in horses include microbial agents such as Leptospira spp. Microbial factors and genetic predisposition to the disease may provide clues as to why the horse appears so susceptible to this disease. The aim of this review is to discuss the immunology and genetics of ERU, compare the disease in horses with autoimmune anterior uveitis in humans, and discuss potential reasons for the increased prevalence in the horse.
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Affiliation(s)
- Fernando Malalana
- The Philip Leverhulme Equine Hospital, The University of Liverpool, Leahurst Campus, Neston, Wirral, CH64 7TE, UK.
| | - Amira Stylianides
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
| | - Catherine McGowan
- Department of Musculoskeletal Biology, Institute of Ageing and Chronic disease, The University of Liverpool, Leahurst Campus, Neston, Wirral, CH64 7TE, UK
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McGowan C, Tee R. Masters in veterinary professional studies. Vet Rec 2015; 176:i-ii. [PMID: 26025722 DOI: 10.1136/vr.h2869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Kate Thompson and Dan Shaw will soon become the first graduates of the University of Liverpool's Postgraduate Masters in Veterinary Professional Studies. Catherine McGowan, director of veterinary postgraduate education, and Rebekah Tee, lecturer in small animal practice, believe that the programme marks a new phase in postgraduate education.
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Belaunzarán-Zamudio PF, Caro-Vega YN, Shepherd BE, Crabtree-Ramírez BE, Luz PM, Grinsztejn B, Cesar C, Cahn P, Cortés C, Wolff M, Pape JW, Padgett D, Gotuzzo E, McGowan C, Sierra-Madero JG. Monitoring of HIV treatment in seven countries in the WHO Region of the Americas. Bull World Health Organ 2015; 93:529-39. [PMID: 26478610 PMCID: PMC4581655 DOI: 10.2471/blt.14.147447] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 03/18/2015] [Accepted: 03/19/2015] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To determine the prevalence of adequate monitoring and the costs of measuring CD4+ T-lymphocytes (CD4+ cell) and human immunodeficiency virus (HIV) viral load in people receiving antiretroviral therapy (ART) in seven countries in the WHO Region of the Americas. METHODS We obtained retrospective, longitudinal data for 14 476 adults who started a first ART regimen at seven HIV clinics in Argentina, Brazil, Chile, Haiti, Honduras, Mexico and Peru between 2000 and 2011. We estimated the proportion of 180-day periods with adequate monitoring, which we defined as at least one CD4+ cell count and one viral load measurement. Factors associated with adequate monitoring were analysed using regression methods. The costs of the tests were estimated. FINDINGS The median follow-up time was 50.4 months; the proportion of 180-day periods with adequate CD4+ cell counts was 69% while the proportion with adequate monitoring was 62%. Adequate monitoring was more likely in participants who were older, who started ART more recently, whose first regimen included a non-nucleoside reverse transcriptase inhibitor or who had a CD4+ cell count less than 200 cells/µl at ART initiation. The cost of one CD4+ cell count ranged from 7.37 United States dollars (US$) in Argentina to US$ 64.09 in Chile; the cost of one viral load measurement ranged from US$ 20.34 in Brazil to US$ 186.28 in Haiti. CONCLUSION In HIV-infected participants receiving ART in the WHO Region of the Americas, CD4+ cell count and viral load monitoring was often carried out less frequently than regional guidelines recommend. The laboratory costs of monitoring varied greatly.
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Affiliation(s)
- Pablo F Belaunzarán-Zamudio
- Clínica de Inmuno-Infectología, Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Calle Vasco de Quiroga 15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, México Distrito Federal, CP 14080, Mexico
| | - Yanink N Caro-Vega
- Clínica de Inmuno-Infectología, Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Calle Vasco de Quiroga 15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, México Distrito Federal, CP 14080, Mexico
| | - Bryan E Shepherd
- Department of Biostatistics, Vanderbilt University, Nashville, United States of America (USA)
| | - Brenda E Crabtree-Ramírez
- Clínica de Inmuno-Infectología, Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Calle Vasco de Quiroga 15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, México Distrito Federal, CP 14080, Mexico
| | - Paula M Luz
- Instituto de Pesquisa Clínica Evandro Chagas, Fundacão Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto de Pesquisa Clínica Evandro Chagas, Fundacão Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Pedro Cahn
- Fundación Huésped, Buenos Aires, Argentina
| | - Claudia Cortés
- Fundación Arriarán, Universidad de Chile, Santiago, Chile
| | - Marcelo Wolff
- Fundación Arriarán, Universidad de Chile, Santiago, Chile
| | - Jean W Pape
- Le Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti
| | - Denis Padgett
- Instituto Hondureño de Seguridad Social and Hospital Escuela, Tegucigalpa, Honduras
| | - Eduardo Gotuzzo
- Instituto de Medicina Tropical Alexander von Humboldt, Lima, Peru
| | | | - Juan G Sierra-Madero
- Clínica de Inmuno-Infectología, Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Calle Vasco de Quiroga 15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, México Distrito Federal, CP 14080, Mexico
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Robin M, Archer D, McGowan C, Garros C, Gardès L, Baylis M. Repellent effect of topical deltamethrin on blood feeding by Culicoides on horses. Vet Rec 2015; 176:574. [PMID: 25948630 DOI: 10.1136/vr.102800] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2015] [Indexed: 11/04/2022]
Abstract
African horse sickness (AHS) is a vectorborne disease spread by Culicoides biting midges. The UK's Department for Environment, Food and Rural Affairs currently suggests using topical deltamethrin for AHS control; however, no data are available regarding its efficacy in the horse. The aims of this study were to investigate the effect of topical deltamethrin on blood feeding by Culicoides on horses and to investigate which Culicoides species blood fed on horses. Three pairs of horses were placed in partially enclosed cages that allowed samples representing the Culicoides interacting with individual horses to be sampled. Four data collection sessions were completed before one horse from each pair was topically treated with 10 ml of 1 per cent deltamethrin solution and another four sessions were then carried out. Collected Culicoides were identified and each biting midge examined to see if it had blood fed. The most abundant species collected were C. chiopterus, C. dewulfi, C. obsoletus and C. scoticus (44.3 per cent) and either C. pulicaris or C. punctatus (34.7 per cent). These species were also more likely to have blood fed than other species, supporting their potential role as AHS vectors if the virus were to reach the UK. There was no significant effect of treatment on blood feeding by Culicoides. The results do not support the use of topical deltamethrin to prevent blood feeding by Culicoides on individual horses; however, the study does not investigate the effect that the widespread use of topical deltamethrin might have on vector numbers or disease transmission from viraemic individuals during an outbreak of AHS.
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Affiliation(s)
- M Robin
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Leahurst, Chester High Road, Neston, Cheshire CH64 7TE, UK
| | - D Archer
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Leahurst, Chester High Road, Neston, Cheshire CH64 7TE, UK
| | - C McGowan
- Faculty of Health and Life Sciences, Institute of Ageing and Chronic Disease, University of Liverpool, Leahurst, Chester High Road, Neston, Cheshire CH64 7TE, UK
| | - C Garros
- Cirad, UMR15 CMAEE, INRA UMR1309 CMAEE, Montpellier, France
| | - L Gardès
- Cirad, UMR15 CMAEE, INRA UMR1309 CMAEE, Montpellier, France
| | - M Baylis
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Leahurst, Chester High Road, Neston, Cheshire CH64 7TE, UK NIHR Health Protection Research Unit, Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
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Fong J, Gyaneshwar R, Lin S, Morrell S, Taylor R, Brassil A, Stuart A, McGowan C. Cervical Screening Using Visual Inspection with Acetic Acid (VIA) and Treatment with Cryotherapy in Fiji. Asian Pac J Cancer Prev 2015; 15:10757-62. [DOI: 10.7314/apjcp.2014.15.24.10757] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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McGowan C, Rattray B, Thompson K, Pyne D, Raglin J. Current warm-up practices and the contemporary issues faced by elite swimming coaches. J Sci Med Sport 2014. [DOI: 10.1016/j.jsams.2014.11.333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Murphy A, Roberts B, McGowan C, Kizilova K, Kizilov A, Rhodes T, McKee M. One for all: workplace social context and drinking among railway workers in Ukraine. Glob Public Health 2014; 10:391-409. [PMID: 25428193 DOI: 10.1080/17441692.2014.979856] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Alcohol consumption is a leading cause of mortality and morbidity in countries of the former Soviet Union, but little is known about its social determinants. Recent research has suggested that workplace contexts may play a role. Using qualitative methods, we investigate the relationship between workplace social contexts and drinking in Ukraine. We conducted 24 individual semi-structured interviews and two focus group discussions in Lviv and Kharkiv, Ukraine, with male railway employees aged 18+ years. Data were analysed using a thematic analysis approach. Men in our sample expressed strong feelings of interdependence and trust towards their co-workers which we defined as 'social solidarity'. Drinking with co-workers was often seen as obligatory and an integral part of co-worker social occasions. Engagement in sport or family obligations seemed to act as a deterrent to drinking among some workers. A strong sense of solidarity exists between railway co-workers in Ukraine, perhaps a remnant of the Soviet era when individuals relied on informal networks for support. Alcohol may be used as a means of expressing this solidarity. Our findings point to factors, namely engagement in sports and family, which may offer opportunities for interventions to reduce alcohol consumption among workers in Ukraine.
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Affiliation(s)
- Adrianna Murphy
- a Faculty of Public Health and Policy , London School of Hygiene & Tropical Medicine , London , UK
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Scantlebury C, Perkins E, McGowan C, Pinchbeck G, Christley R, Archer D. ‘Riding the Rollercoaster’: Veterinary Experiences of Managing Laminitis in Practice. Equine Vet J 2014. [DOI: 10.1111/evj.12323_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C.E. Scantlebury
- Department of Epidemiology and Population Health, School of Veterinary Science; University of Liverpool; Leahurst Campus CH64 7TE UK
| | - E. Perkins
- Health Services Research Department, Institute of Psychology Health and Society; University of Liverpool; UK
| | - C. McGowan
- Department of Epidemiology and Population Health, School of Veterinary Science; University of Liverpool; Leahurst Campus CH64 7TE UK
| | - G.L. Pinchbeck
- Department of Epidemiology and Population Health, School of Veterinary Science; University of Liverpool; Leahurst Campus CH64 7TE UK
| | - R.M. Christley
- Department of Epidemiology and Population Health, School of Veterinary Science; University of Liverpool; Leahurst Campus CH64 7TE UK
| | - D.C. Archer
- Department of Epidemiology and Population Health, School of Veterinary Science; University of Liverpool; Leahurst Campus CH64 7TE UK
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Affiliation(s)
- L Goff
- University of Queensland; Gatton Queensland Australia
| | - L Jeffcott
- University of Sydney; Sydney NSW Australia
| | - C Riggs
- Hong Kong Jockey Club; Hong Kong China
| | - C McGowan
- University of Liverpool; Leahurst United Kingdom
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Goff L, Van Weeren P, Jeffcott L, McGowan C. Measurement of Motion During Manipulation of the Equine Pelvis. Equine Vet J 2014. [DOI: 10.1111/evj.12267_160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- L Goff
- University of Queensland; Gatton Australia
| | | | | | - C McGowan
- University of Liverpool; Leahurst United Kingdom
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Hyytiäinen H, Mykkänen A, Hielm-Björkman A, Stubbs N, McGowan C. Muscle Fibre Type Distribution of the Thoracolumbar and Hindlimb Regions of Horses: Relating Fibre Type and Functional Role. Equine Vet J 2014. [DOI: 10.1111/evj.12267_162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - A Mykkänen
- University of Helsinki; Helsinki Finland
| | | | - N Stubbs
- Michigan State University; East Lansing United States
| | - C McGowan
- University of Liverpool; Liverpool United Kingdom
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Avila D, Althoff KN, Mugglin C, Wools-Kaloustian K, Koller M, Dabis F, Nash D, Gsponer T, Sungkanuparph S, McGowan C, May M, Cooper D, Chimbetete C, Wolff M, Collier A, McManus H, Davies MA, Costagliola D, Crabtree-Ramirez B, Chaiwarith R, Cescon A, Cornell M, Diero L, Phanuphak P, Sawadogo A, Ehmer J, Eholie SP, Li PCK, Fox MP, Gandhi NR, González E, Lee CKC, Hoffmann CJ, Kambugu A, Keiser O, Ditangco R, Prozesky H, Lampe F, Kumarasamy N, Kitahata M, Lugina E, Lyamuya R, Vonthanak S, Fink V, d'Arminio Monforte A, Luz PM, Chen YMA, Minga A, Casabona J, Mwango A, Choi JY, Newell ML, Bukusi EA, Ngonyani K, Merati TP, Otieno J, Bosco MB, Phiri S, Ng OT, Anastos K, Rockstroh J, Santos I, Oka S, Somi G, Stephan C, Teira R, Wabwire D, Wandeler G, Boulle A, Reiss P, Wood R, Chi BH, Williams C, Sterne JA, Egger M. Immunodeficiency at the start of combination antiretroviral therapy in low-, middle-, and high-income countries. J Acquir Immune Defic Syndr 2014; 65:e8-16. [PMID: 24419071 PMCID: PMC3894575 DOI: 10.1097/qai.0b013e3182a39979] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To describe the CD4 cell count at the start of combination antiretroviral therapy (cART) in low-income (LIC), lower middle-income (LMIC), upper middle-income (UMIC), and high-income (HIC) countries. METHODS Patients aged 16 years or older starting cART in a clinic participating in a multicohort collaboration spanning 6 continents (International epidemiological Databases to Evaluate AIDS and ART Cohort Collaboration) were eligible. Multilevel linear regression models were adjusted for age, gender, and calendar year; missing CD4 counts were imputed. RESULTS In total, 379,865 patients from 9 LIC, 4 LMIC, 4 UMIC, and 6 HIC were included. In LIC, the median CD4 cell count at cART initiation increased by 83% from 80 to 145 cells/μL between 2002 and 2009. Corresponding increases in LMIC, UMIC, and HIC were from 87 to 155 cells/μL (76% increase), 88 to 135 cells/μL (53%), and 209 to 274 cells/μL (31%). In 2009, compared with LIC, median counts were 13 cells/μL [95% confidence interval (CI): -56 to +30] lower in LMIC, 22 cells/μL (-62 to +18) lower in UMIC, and 112 cells/μL (+75 to +149) higher in HIC. They were 23 cells/μL (95% CI: +18 to +28 cells/μL) higher in women than men. Median counts were 88 cells/μL (95% CI: +35 to +141 cells/μL) higher in countries with an estimated national cART coverage >80%, compared with countries with <40% coverage. CONCLUSIONS Median CD4 cell counts at the start of cART increased 2000-2009 but remained below 200 cells/μL in LIC and MIC and below 300 cells/μL in HIC. Earlier start of cART will require substantial efforts and resources globally.
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