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Osborn B, Hatfield J, Lanier W, Wagner J, Oakeson K, Casey R, Bullough J, Kache P, Miko S, Kunz J, Pederson G, Leeper M, Strockbine N, McKeel H, Hofstetter J, Roundtree A, Kahler A, Mattioli M. Shiga Toxin-Producing Escherichia coli O157:H7 Illness Outbreak Associated with Untreated, Pressurized, Municipal Irrigation Water - Utah, 2023. MMWR Morb Mortal Wkly Rep 2024; 73:411-416. [PMID: 38722798 PMCID: PMC11095944 DOI: 10.15585/mmwr.mm7318a1] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
During July-September 2023, an outbreak of Shiga toxin-producing Escherichia coli O157:H7 illness among children in city A, Utah, caused 13 confirmed illnesses; seven patients were hospitalized, including two with hemolytic uremic syndrome. Local, state, and federal public health partners investigating the outbreak linked the illnesses to untreated, pressurized, municipal irrigation water (UPMIW) exposure in city A; 12 of 13 ill children reported playing in or drinking UPMIW. Clinical isolates were genetically highly related to one another and to environmental isolates from multiple locations within city A's UPMIW system. Microbial source tracking, a method to indicate possible contamination sources, identified birds and ruminants as potential sources of fecal contamination of UPMIW. Public health and city A officials issued multiple press releases regarding the outbreak reminding residents that UPMIW is not intended for drinking or recreation. Public education and UPMIW management and operations interventions, including assessing and mitigating potential contamination sources, covering UPMIW sources and reservoirs, indicating UPMIW lines and spigots with a designated color, and providing conspicuous signage to communicate risk and intended use might help prevent future UPMIW-associated illnesses.
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Matovelo D, Boniphace M, Singhal N, Nettel-Aguirre A, Kabakyenga J, Turyakira E, Mercader HFG, Khan S, Shaban G, Kyomuhangi T, Hobbs AJ, Manalili K, Subi L, Hatfield J, Ngallaba S, Brenner JL. Evaluation of a comprehensive maternal newborn health intervention in rural Tanzania: single-arm pre-post coverage survey results. Glob Health Action 2022; 15:2137281. [PMID: 36369729 PMCID: PMC9665093 DOI: 10.1080/16549716.2022.2137281] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background In Tanzania, maternal and newborn deaths can be prevented via quality facility-based antenatal care (ANC), delivery, and postnatal care (PNC). Scalable, integrated, and comprehensive interventions addressing demand and service-side care-seeking barriers are needed. Objective Assess coverage survey indicators before and after a comprehensive maternal newborn health (MNH) intervention in Misungwi District, Tanzania. Methods A prospective, single-arm, pre- (2016) and post-(2019) coverage survey (ClinicalTrials.gov #NCT02506413) was used to assess key maternal and newborn health (MNH) outcomes. The Mama na Mtoto intervention included district activities (planning, leadership training, supportive supervision), health facility activities (training, equipment, infrastructure upgrades), and plus community health worker mobilization. Implementation change strategies, a process model, and a motivational framework incorporated best practices from a similar Ugandan intervention. Cluster sampling randomized hamlets then used ‘wedge sampling’ protocol as an alternative to full household enumeration. Key outcomes included: four or more ANC visits (ANC4+); skilled birth attendant (SBA); PNC for mother within 48 hours (PNC-woman); health facility delivery (HFD); and PNC for newborn within 48 hours (PNC-baby). Trained interviewers administered the ‘Real Accountability: Data Analysis for Results Coverage Survey to women 15–49 years old. Descriptive statistics incorporated design effect; the Lives Saved Tool estimated deaths averted based on ANC4+/HFD. Results Between baseline (n = 2,431) and endline (n = 2,070), surveys revealed significant absolute percentage increases for ANC4+ (+11.6, 95% CI [5.4, 17.7], p < 0.001), SBA (+16.6, 95% CI [11.1, 22.0], p < 0.001), PNC-woman (+9.2, 95% CI [3.2, 15.2], p = 0.002), and HFD (+17.2%, 95% CI [11.3, 23.1], p < 0.001). A PNC-baby increase (+6.1%, 95% CI [−0.5, 12.8], p = 0.07) was not statistically significant. An estimated 121 neonatal and 20 maternal lives were saved between 2016 and 2019. Conclusions Full-district scale-up of a comprehensive MNH package embedded government health system was successfully implemented over a short time and associated with significant maternal care-seeking improvements and potential for lives saved.
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Affiliation(s)
- Dismas Matovelo
- Department of Obstetrics & Gynecology, Catholic University of Health & Allied Sciences, Mwanza, Tanzania
| | - Maendeleo Boniphace
- Department of Obstetrics & Gynecology, Catholic University of Health & Allied Sciences, Mwanza, Tanzania
| | - Nalini Singhal
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alberto Nettel-Aguirre
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Centre for Health and Social Analytics, NIASRA, University of Wollongong, Wollongong, Australia
| | - Jerome Kabakyenga
- Institute of Maternal Newborn and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Eleanor Turyakira
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Hannah Faye G. Mercader
- Indigenous, Local & Global Health Office, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sundus Khan
- Indigenous, Local & Global Health Office, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Girles Shaban
- Department of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Teddy Kyomuhangi
- Institute of Maternal Newborn and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Amy J. Hobbs
- Indigenous, Local & Global Health Office, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Maryland, United States
| | - Kimberly Manalili
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Leonard Subi
- Department of Preventive Services, Tanzania Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Jennifer Hatfield
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sospatro Ngallaba
- Department of Community Health, Catholic University of Health & Allied Sciences, Mwanza, Tanzania
| | - Jennifer L. Brenner
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Indigenous, Local & Global Health Office, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Osborn B, Pan CY, Hatada A, Hatfield J, Wagner J, Oakeson K, Montmayeur A, Morales C, Vinjé J. Cluster of Norovirus Genogroup IX Outbreaks in Long-Term Care Facilities, Utah, USA, 2021. Emerg Infect Dis 2022; 28:2312-2315. [PMID: 36286223 PMCID: PMC9622255 DOI: 10.3201/eid2811.220842] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report 5 clustered acute gastroenteritis outbreaks in long-term care facilities in Utah, USA, that were linked to healthcare employees working at multiple facilities. Four outbreaks were caused by norovirus genotype GIX. We recommend continued norovirus surveillance and genotyping to determine contributions of this genotype to norovirus outbreaks.
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Hoang T, Brown K, Leimbach R, Hatfield J, Shakir M. PMON97 Pituitary Abscess: Long-term follow up. J Endocr Soc 2022. [DOI: 10.1210/jendso/bvac150.1187] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Abstract
Introduction
In spite of recent advances in radiological evaluation, preoperative diagnosis of pituitary abscess is often difficult and the diagnosis is established at the time of surgery. Most patients present with a chronic and indolent course with few infective manifestations, thus mimicking a pituitary tumor. Although there are several case reports in literature, long term follow-up of these patients have not been reported previously. We report long-term follow-up of two patients with pituitary abscess who underwent trans-sphenoidal surgery (TSS).
Case 1
A 45-year-old female was seen in endocrine clinic for follow-up of a pituitary abscess diagnosed 22 years earlier. At the age of 23, the patient had severe headaches and bitemporal visual field defects. Workup included a pituitary MRI which revealed a 2.3 cm mass with compression of the optic chiasma. She denied any fever or chills. Detailed pituitary function confirmed secondary hypogonadism and secondary adrenal insufficiency. Because of the visual defects she underwent TSS which revealed the diagnosis of pituitary abscess. Additionally, the pituitary abscess was confirmed by histological examination and cultures from the abscess grew coagulase negative staphylococcus. Anaerobic and fungal cultures were negative. The patient was successfully treated with vancomycin, ceftazidime and metronidazole. After the TSS, she required treatment for diabetes insipidus, central hypothyroidism, adrenal insufficiency and hypogonadism. For the last 22 years she has had no further major illnesses and continues to require treatment for diabetes insipidus and hypopituitarism.
Case 2
A 37-year-old female underwent evaluation for migraines 7 years ago. During workup, a pituitary MRI showed a 6×5 mm lesion suggestive of a partially cystic microadenoma. The patient had worsening of her headaches and a follow-up MRI 6 weeks later showed an enlarging heterogeneous pituitary macroadenoma now 1.9×2.1×1.5cm, with marked effect on the optic chiasm. The patient underwent TSS and intraoperatively a diagnosis of pituitary abscess was made. Although cultures were negative for any pathogens, the patient received empiric antibiotic treatment with cefotaxime and metronidazole for 4 weeks. After the TSS, she developed central diabetes insipidus and hypopituitarism. Since surgery she has had no significant illness and has been leading an active life for the last 7 years.
Conclusion
Both of these patients underwent treatment with TSS with an intraoperative diagnosis of pituitary abscess and were able to recover with no long-term sequelae or evidence of recurrent abscesses. They did however develop the common side effects of TSS surgery including diabetes insipidus and hypopituitarism, but are able to live a normal life on medical therapy.
Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
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Konje ET, Hatfield J, Sauve R, Kuhn S, Magoma M, Dewey D. Late initiation and low utilization of postnatal care services among women in the rural setting in Northwest Tanzania: a community-based study using a mixed method approach. BMC Health Serv Res 2021; 21:635. [PMID: 34215254 PMCID: PMC8252323 DOI: 10.1186/s12913-021-06695-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 06/24/2021] [Indexed: 11/15/2022] Open
Abstract
Background Maternal and newborn mortality is high immediately after childbirth and up to 42 days postnatally despite the availability of interventions. Postnatal care is crucial in preventing mortality and improving the health of women and newborns. This prospective cohort study investigated the initiation and utilization of postnatal care at health facilities and explored users’ and providers’ perspectives on utilization of postnatal care services. Methods A sequential explanatory mixed method was used involving women who were followed from the 3rd trimester of pregnancy to 3–4 months postnatally in Northwest, Tanzania. From January to December 2018, a door-to-door survey was conducted 3–4 months postnatally among 1385 of these women. A convenience sample of women and community health workers participated in focus group discussions, and traditional birth attendants and nurses participated in key informant interviews to complement quantitative data. Data analyses were conducted using STATA version 13 and NVIVO version 12. Study findings Approximately, one half of participants attended postnatal care within 42 days after delivery. Postnatal care seeking within 48 h after delivery was reported by 14.6 % of the participants. Women who attended antenatal care at least four times, delivered at health facilities or experienced delivery-related complications were more likely to seek postnatal care. Limited knowledge on the postnatal care services and obstetric complications after childbirth, and not being scheduled for postnatal care by health providers negatively influenced services uptake. Overwhelming workload and shortages of supplies were reported to hinder the provision of postnatal care services. Conclusions Utilization of postnatal care services remains low in this setting as a result of a number of disparate and complex factors that influence women’s choices. Provision of effective postnatal care is hindered by lack of supplies, staffing, and inadequate infrastructure. To ensure accessibility and availability of quality services in this setting, both demand and supply sides factors need to be addressed. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06695-8.
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Affiliation(s)
- Eveline T Konje
- Department of Biostatistics and Epidemiology, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania. .,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Calgary, Canada.
| | - Jennifer Hatfield
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Calgary, Canada
| | - Reg Sauve
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Calgary, Canada
| | - Susan Kuhn
- Department of Paediatrics, University of Calgary, Alberta, Calgary, Canada
| | - Moke Magoma
- Engender Health Tanzania, Dar es Salaam, Tanzania
| | - Deborah Dewey
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Calgary, Canada.,Department of Paediatrics, University of Calgary, Alberta, Calgary, Canada.,Owerko Centre, Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, Alberta, Calgary, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Calgary, Canada
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Nyanza EC, Bernier FP, Martin JW, Manyama M, Hatfield J, Dewey D. Effects of prenatal exposure and co-exposure to metallic or metalloid elements on early infant neurodevelopmental outcomes in areas with small-scale gold mining activities in Northern Tanzania. Environ Int 2021; 149:106104. [PMID: 32948351 DOI: 10.1016/j.envint.2020.106104] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 04/18/2020] [Revised: 08/07/2020] [Accepted: 08/27/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Artisanal and small-scale gold mining (ASGM) is associated with release of neurotoxic metallic or metalloid chemical elements including lead (Pb), mercury (Hg), cadmium (Cd) and arsenic (As). OBJECTIVE To examine associations between prenatal exposure and co-exposure to total lead (T-Pb), total mercury (T-Hg), total cadmium (T-Cd) and total arsenic (T-As) and infant neurodevelopment at 6 to 12 months of age in areas with ASGM activities in Tanzania. METHODS Women in their second trimester of pregnancy who resided in ASGM areas were enrolled from 2015 to 2017 (n = 883). At 6 to 12 months of age, children were assessed with the Malawi Developmental Assessment Tool (MDAT) (n = 439). We measured T-Pb, T-Hg, and T-Cd in maternal dried blood spots and T-As in maternal urines. Poisson regression was used to examine associations between prenatal concentrations of these elements and neurodevelopmental outcomes. RESULTS Prenatal T-Hg concentration was associated with global neurodevelopment status (aPR 1.03, CI:1.01-1.04; p < 0.001) and language impairment (aPR 1.05, CI:1.03-1.07; p < 0.001) on the MDAT. When prenatal T-Hg and T-As values were at or above the human biomonitoring reference values (≥95%) of the German Environmental Survey for Human Biomonitoring, that is 0.80 µg/L and 15 µg/L, respectively, the prevalence ratio of global neurodevelopmental impairment was two times higher (aPR 2.1, CI:1.0-4.3; p = 0.034). There was a 40% increase in the prevalence ratio of global neurodevelopmental impairment (aPR 1.4, CI:0.90-2.10, p = 0.027), when prenatal T-Hg was at or above the reference value of 0.80 µg/L and T-Pb was at or above the reference value of 35 µg/L. When prenatal T-Hg was at or above the reference value of 0.80 µg/L and T-As was at or above the reference value of 15 µg/L, the prevalence ratio of global neurodevelopmental impairment was two times higher (aPR 2.1, CI:1.0-4.3; p < 0.034). DISCUSSION Infants born to women in areas with ASGM activities are at significant risk for neurodevelopmental impairment and this is associated with exposure to higher concentrations of Hg prenatally. Co-exposure to high concentrations of Hg and Pb, or Hg and As appeared to have negative potentiated effects on infants' neurodevelopment.
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Affiliation(s)
- Elias C Nyanza
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Department of Environmental, Occupational Health and GIS, School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Bugando, Mwanza, Tanzania
| | - Francois P Bernier
- Department of Paediatrics, University of Calgary, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB T3B 6A8, Canada; Department of Medical Genetics, Cumming School of Medicine, 3330 Hospital Drive NW University of Calgary, Canada; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Room 294, Heritage Medical Research Building, 3330 Hospital Drive, NW Calgary, AB T2N 4N1, Canada
| | - Jonathan W Martin
- Science for Life Laboratory, Department of Environmental Science, Stockholm University, 106 91 Stockholm, Sweden; Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Mange Manyama
- Division of Medical Education, Weill-Cornell Medicine-Qatar, Doha, Qatar
| | - Jennifer Hatfield
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Deborah Dewey
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Department of Paediatrics, University of Calgary, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB T3B 6A8, Canada; Department of Medical Genetics, Cumming School of Medicine, 3330 Hospital Drive NW University of Calgary, Canada; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Room 294, Heritage Medical Research Building, 3330 Hospital Drive, NW Calgary, AB T2N 4N1, Canada; Owerko Centre, #397 Child Development Centre, University of Calgary, 2500 University Dr. NW Calgary, AB T2N 1N4, Canada.
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Eltantawy M, Orsel K, Schroeder A, Morona D, Mazigo HD, Kutz S, Hatfield J, Manyama M, van der Meer F. Soil transmitted helminth infection in primary school children varies with ecozone in the Ngorongoro Conservation Area, Tanzania. Trop Med Health 2021; 49:22. [PMID: 33691800 PMCID: PMC7945338 DOI: 10.1186/s41182-021-00310-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Soil-transmitted helminthiasis is a neglected tropical disease, thriving in environments of poverty and disadvantage. Our objective was to determine the prevalence and intensity of four soil transmitted helminths (STH) among primary school children in the Ngorongoro Conservation Area (NCA), Tanzania. METHODS A cross-sectional study was performed between May 15th and June 2nd, 2014. Six of 20 primary schools were chosen, based on elevation, designated low elevation ecozone (LEE) or high elevation ecozone (HEE). A total of 340 children from standards one to four were recruited. Height and weight of each child was determined and body mass index (BMI) was calculated. Stool samples were analyzed using the Kato-Katz, Wisconsin, and Baermann techniques to detect STH eggs and larvae. An interviewer-administered questionnaire on socio-demographic variables was used to capture information from the school's headmaster and a checklist was used to assess sanitation facilities. RESULTS STHs identified included Ascaris (presumably lumbricoides), Trichuris (presumably trichiura), hookworms (presumably Ancylostoma duodenale and/or Necator americanus), and Strongyloides (presumably stercoralis). The overall prevalence of STH infection was 29.0% in LEE and 34.0% in HEE. Prevalence was 34.3% and 28.2% in males versus females, respectively. Ascaris sp. were only identified in HEE, prevalence of Trichuris sp. and hookworms were significantly higher in HEE compared to LEE, and Strongyloides spp. prevalence was lower in HEE. Intensity of Trichuris sp. was significantly higher in HEE and lower for hookworms. We did not detect a significant relationship between BMI and helminth intensity; however, BMI was lower in lower elevations and in males vs. females. Sanitation practices are taught at the schools, but challenges were identified when implementing. Latrine facilities were available and latrine-cleaning routines were practiced; however, hand washing practices were challenging due to restricted water availability. CONCLUSIONS Significant differences in prevalence in HEE and LEE exist, and STH infections are still very common among school children suggesting that anthelminthic intervention and education may be necessary in this region. Based on this outcome, the study area in the NCA would be classified as a medium risk area, where periodic treatment recommendations should be based on prevalence estimations in the different ecozones. TRIAL REGISTRATION Ethics approval was obtained from the Catholic University of Health and Allied Sciences (CUHAS; Lake Zone Institutional Review Board MR/53/100/307)); the Conjoint Health Research Ethics Board (CHREB) at the University of Calgary in Canada (Study ID REB14-0127); the National Institute of Medical Research (NIMR) of Tanzania; and the Tanzania Commission for Science and Technology (COSTEC).
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Affiliation(s)
- Manar Eltantawy
- Department. of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Karin Orsel
- Department. of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ashley Schroeder
- Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Domenica Morona
- Department of Parasitology, Catholic University of Health and Allied Science, Mwanza, Tanzania
| | - Humphrey D Mazigo
- Department of Parasitology, Catholic University of Health and Allied Science, Mwanza, Tanzania
| | - Susan Kutz
- Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Jennifer Hatfield
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mange Manyama
- Division of Medical Education, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Frank van der Meer
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada.
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Graybill S, Hatfield J, Kravchenko M, Beckman D, Tate J, Beauvais A, Clerc P, Davila D, Forbes W, Wardian J, Kemm M, Hubberd A, True M. Neutral effect of exenatide on serum testosterone in men with type 2 diabetes mellitus: A prospective cohort. Andrology 2021; 9:792-800. [PMID: 33400403 DOI: 10.1111/andr.12966] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Endogenous testosterone increases with weight loss from diet, exercise, and bariatric surgery. However, little is known about testosterone levels after weight loss from medication. OBJECTIVES Uncover the effects of Glucagon-Like Peptide-1 receptor agonist (GLP-1 RA) therapy on serum testosterone. MATERIAL AND METHODS Prospective cohort study of men starting GLP-1 RA therapy for type 2 diabetes mellitus. RESULTS 51 men lost 2.27 kg (p = 0.00162) and their HbA1c values improved by 0.7% (p = 0.000503) after 6 months of GLP-1 RA therapy. There was no significant change in testosterone for the group as a whole. However, in subgroup analyses, there was a significant difference in total testosterone change between men starting with baseline total testosterone <320 ng/dL (238.5 ± 56.5 ng/dL to 272.2 ± 82.3 ng/dL) compared to higher values (438 ± 98.2 ng/dL to 412 ± 141.2 ng/dL) (p = 0.0172);free testosterone increased if the baseline total testosterone was <320 ng/dL (55.2 ± 12.8 pg/mL to 57.2 ± 17.6 pg/mL) and decreased if >320 ng/dL (74.7 ± 16.3 pg/mL to 64.2 ± 17.7 pg/mL) (p = 0.00807). Additionally, there were significant differences in testosterone change between men with HbA1c improvements ≥1% (351.6 ± 123.9 ng/dL to 394.4 ± 136.5 ng/dL) compared to men with HbA1c changes <1% (331.8 ± 128.6 ng/dL to 316.1 ± 126.2 ng/dL) (p = 0.0413). CONCLUSION GLP-1 RA therapy improves weight and HbA1c without adverse effects on testosterone. Those starting with lower testosterone values or attaining greater improvement in HbA1c may see additional benefits.
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Affiliation(s)
- Sky Graybill
- Medicine, US Army Brooke Army Medical Center, San Antonio, TX, USA
| | | | - Maria Kravchenko
- Medicine, US Army Brooke Army Medical Center, San Antonio, TX, USA
| | - Darrick Beckman
- Medicine, Wilford Hall Ambulatory Surgical Center, San Antonio, TX, USA
| | - Joshua Tate
- Medicine, Keesler Air Force Base, Biloxi, MS, USA
| | - Alexis Beauvais
- International Health Specialist HQ USSOUTHCOM, Command Surgeon's Office, Miami, FL, USA
| | - Philip Clerc
- Medicine, US Army Brooke Army Medical Center, San Antonio, TX, USA
| | - Desarae Davila
- Medicine, Wilford Hall Ambulatory Surgical Center, San Antonio, TX, USA
| | - Whitney Forbes
- Medicine, Wilford Hall Ambulatory Surgical Center, San Antonio, TX, USA
| | - Jana Wardian
- Medicine, Wilford Hall Ambulatory Surgical Center, San Antonio, TX, USA
| | - Matthew Kemm
- Medicine, US Army Brooke Army Medical Center, San Antonio, TX, USA
| | - Abegail Hubberd
- Medicine, Wilford Hall Ambulatory Surgical Center, San Antonio, TX, USA
| | - Mark True
- Medicine, US Army Brooke Army Medical Center, San Antonio, TX, USA
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Konje ET, Magoma MT, Hatfield J, Kuhn S, Sauve RS, Dewey D. No difference in perinatal mortality between home and facility delivery in rural Tanzania: a prospective community-based study. Journal of Global Health Reports 2020. [DOI: 10.29392/001c.14599] [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: 11/08/2022] Open
Affiliation(s)
- Eveline T Konje
- Department of Biostatistics & Epidemiology, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Moke T Magoma
- Options Tanzania Ltd 76 Ali Hassan Mwinyi Road, Dar es Salaam Tanzania
| | - Jennifer Hatfield
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Susan Kuhn
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Reginald S Sauve
- Department of Paediatrics, Cumming School of Medicine University of Calgary, Calgary, Alberta Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Deborah Dewey
- Department of Paediatrics, Cumming School of Medicine University of Calgary, Calgary, Alberta Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
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De Visser A, Hatfield J, Ellaway R, Buchner D, Seni J, Arubaku W, Najjuma JN, Hollaar G. Global health electives: Ethical engagement in building global health capacity. Med Teach 2020; 42:628-635. [PMID: 32083958 DOI: 10.1080/0142159x.2020.1724920] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Purpose: Little is known about the impact medical trainees undertaking global health electives (GHEs) have on host institutions and their communities in low-and middle-income countries. The goal of this study was to explore the relationship dynamics associated with GHEs as perceived by host stakeholders at three sites in sub-Saharan Africa.Method: This case-based interpretive phenomenological study examined stakeholder perspectives in Mwanza, Tanzania, and Mbarara and Rugazi, Uganda, where the University of Calgary, Alberta, Canada has long-standing institutional collaborations. Between September and November 2017, 33 host stakeholders participated in semi-structured interviews and 28 host stakeholders participated in focus group discussions. Participant experiences were analyzed using interpretive phenomenological techniques.Results: The findings revealed that, although GHEs are well-established and a common experience for host stakeholders, their perceptions about who visiting medical trainees (VMTs) are remains indistinct. Participants acknowledged that there are a variety of benefits to GHEs, but overall VMTs appear to benefit the most from this unique learning opportunity. Host stakeholders described significant challenges and burdens of GHEs and recommended ways in which GHEs could be improved.Conclusions: GHEs need to be designed to better embrace ethical engagement and reciprocity with host stakeholders to ensure equity in benefits and responsibilities.
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Affiliation(s)
- Adriena De Visser
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jennifer Hatfield
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Rachel Ellaway
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Denise Buchner
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jeremiah Seni
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Wilfred Arubaku
- Department of Dental Surgery, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Josephine Nambi Najjuma
- Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Gwendolyn Hollaar
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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11
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Konje ET, Hatfield J, Kuhn S, Sauve RS, Magoma M, Dewey D. Is it home delivery or health facility? Community perceptions on place of childbirth in rural Northwest Tanzania using a qualitative approach. BMC Pregnancy Childbirth 2020; 20:270. [PMID: 32375691 PMCID: PMC7201655 DOI: 10.1186/s12884-020-02967-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In low and middle-income countries, pregnancy and delivery complications may deprive women and their newborns of life or the realization of their full potential. Provision of quality obstetric emergency and childbirth care can reduce maternal and newborn deaths. Underutilization of maternal and childbirth services remains a public health concern in Tanzania. The aim of this study was to explore elements of the local social, cultural, economic, and health systems that influenced the use of health facilities for delivery in a rural setting in Northwest Tanzania. METHODS A qualitative approach was used to explore community perceptions of issues related to low utilization of health facilities for childbirth. Between September and December 2017, 11 focus group discussions were conducted with women (n = 33), men (n = 5) and community health workers (CHWs; n = 28); key informant interviews were conducted with traditional birth attendants (TBAs; n = 2). Coding, identification, indexing, charting, and mapping of these interviews was done using NVIVO 12 after manual familiarization of the data. Data saturation was used to determine when no further interviews or discussions were required. RESULTS Four themes emerge; self-perceived obstetric risk, socio-cultural issues, economic concerns and health facility related factors. Health facility delivery was perceived to be crucial for complicated labor. However, the idea that childbirth was a "normal" process and lack of social and cultural acceptability of facility services, made home delivery appealing to many women and their families. In addition, out of pocket payments for suboptimal quality of health care was reported to hinder facility delivery. CONCLUSION Home delivery persists in rural settings due to economic and social issues, and the cultural meanings attached to childbirth. Accessibility to and affordability of respectful and culturally acceptable childbirth services remain challenging in this setting. Addressing barriers on both the demand and supply side could result in improved maternal and child outcomes during labor and delivery.
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Affiliation(s)
- Eveline T. Konje
- Department of Biostatistics & Epidemiology, School of Public Health, Catholic University of Health and Allied Sciences, P.O. BOX 1464 BUGANDO AREA, Mwanza, Tanzania
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive, NW, Calgary, AB Canada
| | - Jennifer Hatfield
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive, NW, Calgary, AB Canada
| | - Susan Kuhn
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, 28 OKE Dr. NW, Calgary, AB Canada
| | - Reginald S. Sauve
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive, NW, Calgary, AB Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, 28 OKE Dr. NW, Calgary, AB Canada
| | - Moke Magoma
- Engender Health Tanzania, Dar es Salaam, Tanzania
| | - Deborah Dewey
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive, NW, Calgary, AB Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, 28 OKE Dr. NW, Calgary, AB Canada
- Owerko Centre at the Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, 2500 University Dr. NW, Calgary, AB Canada
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12
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Nyanza EC, Dewey D, Manyama M, Martin JW, Hatfield J, Bernier FP. Maternal exposure to arsenic and mercury and associated risk of adverse birth outcomes in small-scale gold mining communities in Northern Tanzania. Environ Int 2020; 137:105450. [PMID: 32014788 DOI: 10.1016/j.envint.2019.105450] [Citation(s) in RCA: 25] [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] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/22/2019] [Accepted: 12/25/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Exposure to arsenic and mercury in artisanal and small-scale gold mining (ASGM) communities is an issue that predominantly affects low and middle-income countries. Large epidemiology studies in these communities are rare, and the impact of such exposures on reproductive outcomes are not well understood. OBJECTIVE To examine associations between prenatal maternal arsenic and mercury exposure and birth outcomes in both ASGM and non-ASGM communities in Northern Tanzania. METHODS This longitudinal prospective study included 961 women (ASGM = 788, non-ASGM = 173) of the original cohort of 1056 who were followed until a pregnancy outcome was registered. Maternal spot urine samples and dried blood spots were used to measure total arsenic (T-As) and total mercury (T-Hg) in the second trimester of pregnancy. Data on adverse birth outcomes were collected in 5 categories: spontaneous abortion, stillbirth, preterm birth, low birth weight, and visible congenital anomalies. Mann-Whitney U-tests were used to test for differences between median T-As and T-Hg by area of residence. Logistic regression models were used to estimate the odds of stillbirth and visible congenital anomalies given maternal T-As and T-Hg levels. Modified Poisson regressions were used to estimate relative risk ratios between maternal T-As and T-Hg levels and composite adverse birth outcome, spontaneous abortion, low birth weight, and preterm birth. RESULTS Statistically significant differences were found in median T-As (9.6 vs. 6.3 µg/L, Mann-Whitney U-tests, Z = -3.50, p < 0.001) and median T-Hg blood concentrations (1.2 vs. 0.70 µg/L, Z = -9.88, p-value < 0.001) between women living in ASGM and non-ASGM areas respectively. In ASGM areas, the adjusted relative risk (aRR) of a composite adverse birth outcome increased with increasing T-As (aRR 1.23, 95%CI: 1.14-1.33, p < 0.0001) and T-Hg (aRR 1.17, 95%CI: 1.1-1.25, p < 0.0001) exposure. Spontaneous abortion (aRR 1.53, 95%CI: 1.28-1.83), stillbirth (adjusted odds ratio (aOR) 1.97, 95%CI: 1.45-2.66) and preterm birth (1.17, 95%CI: 1.01-1.36) were significantly associated with elevated T-As, whereas elevated T-Hg was significantly associated with stillbirth (aOR 2.49, 95%CI: 1.88-3.29) and visible congenital anomalies (aOR 2.24, 95%CI: 1.3-3.87). CONCLUSION Over half (54.7%) of women in ASGM areas of Northern Tanzania had adverse birth outcomes and the risk of adverse birth outcomes was significantly associated with increased prenatal exposure to arsenic and mercury.
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Affiliation(s)
- Elias C Nyanza
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Department of Environmental, Occupational Health and GIS, School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Bugando, Mwanza, Tanzania; Alberta Children's Hospital Research Institute, University of Calgary, Room 294, Heritage Medical Research Building, 3330 Hospital Drive, NW, Calgary, AB T2N 4N1, Canada
| | - Deborah Dewey
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Room 294, Heritage Medical Research Building, 3330 Hospital Drive, NW, Calgary, AB T2N 4N1, Canada; Department of Pediatrics, Cumming School of Medicine, University of Calgary, #397 Child Development Centre, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Mange Manyama
- Division of Medical Education, Weill-Cornell Medicine-Qatar, Doha, Qatar
| | - Jonathan W Martin
- Science for Life Laboratory, Department of Environmental Sciences and Analytical Chemistry, Stockholm University, Stockholm 114 18, Sweden
| | - Jennifer Hatfield
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Francois P Bernier
- Alberta Children's Hospital Research Institute, University of Calgary, Room 294, Heritage Medical Research Building, 3330 Hospital Drive, NW, Calgary, AB T2N 4N1, Canada; Department of Pediatrics, Cumming School of Medicine, University of Calgary, #397 Child Development Centre, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada; Department of Medical Genetics, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada.
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13
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Hatfield J, Poulos RG, Murphy SM, Flack LK, Rissel C, Grzebieta R, McIntosh AS. Safety aspects of riding with children: Descriptive analysis of adult riders' self-report. Accid Anal Prev 2019; 131:33-44. [PMID: 31233994 DOI: 10.1016/j.aap.2019.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 04/04/2019] [Accepted: 06/13/2019] [Indexed: 06/09/2023]
Abstract
Active transport, including cycling, is promoted as an effective way of increasing children's physical activity and health. Parents can support children's riding by riding with them and it is important to address relevant safety issues. Little is known about parents' experience of safety-relevant aspects of riding with children. Participants in the Safer Cycling Study in New South Wales, Australia, who reported that they had ridden with children in the last 12 months were questioned about how they ride with children, and their experience of safety issues and crashes. Among the 187 respondents who had ridden with children on their bicycle, the most common form of carrier was a rear-mounted seat (48%) followed by a trailer (29%). Many respondents (79%) identified risks specific to riding carrying children, including those linked with specific carrier types and with use of footpaths. Most (92%) indicated that they change their behaviour when carrying a child on their bicycle; for example, riding more slowly, more carefully, and away from roads. Among crashes with a child on the bicycle, most were falls. Among the 345 participants who had ridden to accompany a child on a bicycle, approximately three quarters identified risks specific to accompanying children, such as managing the child's limited skill, awareness and predictability. Ninety-seven percent reported behavioural changes including positioning themselves as a barrier for their child and caution crossing roads. Findings suggest strategies to support parents in riding safely with children.
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Affiliation(s)
- J Hatfield
- Transport and Road Safety Research Centre, University of New South Wales, Sydney, Australia.
| | - R G Poulos
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - S M Murphy
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - L K Flack
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - C Rissel
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - R Grzebieta
- Transport and Road Safety Research Centre, University of New South Wales, Sydney, Australia; Department of Forensic Medicine, Monash University, Melbourne, Australia
| | - A S McIntosh
- Monash University Accident Research Centre, Monash University, Melbourne, Australia; School of Engineering and Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Edith Cowan University, Joondalup, Australia
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14
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Nyanza EC, Dewey D, Bernier F, Manyama M, Hatfield J, Martin JW. Validation of Dried Blood Spots for Maternal Biomonitoring of Nonessential Elements in an Artisanal and Small-Scale Gold Mining Area of Tanzania. Environ Toxicol Chem 2019; 38:1285-1293. [PMID: 30900767 DOI: 10.1002/etc.4420] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 10/26/2018] [Revised: 11/22/2018] [Accepted: 03/15/2019] [Indexed: 06/09/2023]
Abstract
Biomonitoring studies of vulnerable populations in low- and middle-income countries are limited because traditional sampling methods are challenging to implement in low-resource settings. The present study examined the feasibility, precision, and accuracy of dried blood spots (DBS) for human biomonitoring of nonessential elements (cadmium [Cd], mercury [Hg], and lead [Pb]) in an area of northern Tanzania with artisanal and small-scale gold mining activities. Pregnant women (n = 44) were recruited in Geita during antenatal clinic visits, and DBS from capillary blood were collected on filter paper. As a gold-standard comparison, venous blood was sampled from the same participants and compared with the DBS. Venous blood, DBS, and quality control samples were analyzed for chemical elements by inductively coupled plasma mass spectrometry. Field blanks were very clean for most elements, generally only twice as high as corresponding laboratory filter blanks. No significant differences were found between duplicate DBS samples taken from the same participants, with near perfect intraclass correlation coefficients (0.99) for Cd, Hg, and Pb, indicating excellent reliability. Moreover, correlation was strong (r2 > 0.9) and significant (p < 0.0001) between DBS and the quantitative venous blood, with regression line slopes close to 1.0 (0.847, 0.976, and 0.969 for Cd, Hg, and Pb, respectively), indicating high accuracy of the DBS method compared with the gold-standard approach. The DBS method is minimally invasive and was a feasible, precise, and accurate means of measuring exposure to Cd, Hg, and Pb in pregnant women in a low-resource setting. Environ Toxicol Chem 2019;38:1285-1293. © 2019 SETAC.
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Affiliation(s)
- Elias C Nyanza
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Environmental, Occupational Health and GIS, School of Public Health, Catholic University of Health and Allied Sciences, Bugando Area, Mwanza, Tanzania
| | - Deborah Dewey
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Francois Bernier
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mange Manyama
- Division of Medical Education, Weill-Cornell Medicine-Qatar, Doha, Qatar
| | - Jennifer Hatfield
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan W Martin
- Science for Life Laboratory, Department of Environmental Sciences and Analytical Chemistry, Stockholm University, Stockholm, Sweden
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15
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Nyanza EC, Bernier FP, Manyama M, Hatfield J, Martin JW, Dewey D. Maternal exposure to arsenic and mercury in small-scale gold mining areas of Northern Tanzania. Environ Res 2019; 173:432-442. [PMID: 30974369 DOI: 10.1016/j.envres.2019.03.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 02/25/2019] [Accepted: 03/14/2019] [Indexed: 06/09/2023]
Abstract
Artisanal and small-scale gold mining (ASGM) in Tanzania results in occupational exposures and environmental contamination to toxic chemical elements such as arsenic and mercury. Populations living in such areas may be exposed by various routes, and prenatal exposure to arsenic and mercury has been associated with adverse birth outcomes and developmental delays. The aim of this study was to determine if levels of arsenic and mercury differed among pregnant women living in areas with and without ASGM activities in Northern Tanzania. This cross-sectional study is part of the ongoing Mining and Health prospective longitudinal study. Spot urine samples and dried blood spots were collected at the antenatal health clinics from pregnant women (n = 1056) at 16-27 weeks gestation. Urine samples were analyzed for total arsenic (T-As) and dried blood spots were analyzed for total mercury (T-Hg). Women in the ASGM cohort had median T-As levels (9.4 μg/L; IQR: 4.9-15.1) and T-Hg levels (1.2 μg/L; IQR: 0.8-1.86) that were significantly higher than the median T-As levels (6.28 μg/L; IQR: 3.7-14.1) and T-Hg levels (0.66 μg/L; IQR: 0.3-1.2) of women in the non-ASGM cohort (Mann-Whitney U test, T-As: z = -9.881, p = 0.0005; T-Hg: z = -3.502, p < 0.0001). Among pregnant women from ASGM areas, 25% had urinary T-As and 75% had blood T-Hg above the established human biomonitoring reference values of 15 and 0.80 μg/L. In the ASGM cohort, lower maternal education and low socioeconomic status increased the odds of higher T-As levels by 20% (p < 0.05) and 10% (p < 0.05), respectively. Women involved in mining activities and those of low socioeconomic status had increased odds of higher T-Hg by 70% (p < 0.001) and 10% (p < 0.05), respectively. Arsenic and mercury concentrations among women in non-ASGM areas suggest exposure sources beyond ASGM activities that need to be identified. Arsenic and mercury levels in women in Tanzania are of public health concern and their association with adverse birth and child developmental outcomes will be examined in future studies on this cohort.
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Affiliation(s)
- Elias C Nyanza
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada; Department of Environmental, Occupational Health and GIS, School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Bugando, Mwanza, Tanzania; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Room 294, Heritage Medical Research Building, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada
| | - Francois P Bernier
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, AB, T3A 6A8, Canada; Department of Medical Genetics, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Room 294, Heritage Medical Research Building, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada
| | - Mange Manyama
- Division of Medical Education, Weill-Cornell Medicine-Qatar, Doha, Qatar
| | - Jennifer Hatfield
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Jonathan W Martin
- Science for Life Laboratory, Department of Environmental Sciences and Analytical Chemistry, Stockholm University, Stockholm, 114 18. Sweden
| | - Deborah Dewey
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada; Department of Pediatrics, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, AB, T3A 6A8, Canada; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Room 294, Heritage Medical Research Building, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada.
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Hatfield J, Boufous S, Eveston T. An evaluation of the effects of an innovative school-based cycling education program on safety and participation. Accid Anal Prev 2019; 127:52-60. [PMID: 30831538 DOI: 10.1016/j.aap.2019.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 12/07/2018] [Accepted: 02/18/2019] [Indexed: 06/09/2023]
Abstract
Cycling education programs for children could play a role in promoting both cycling participation and cycling safety, and they exist in many countries - often in school settings. Evaluations have generally shown improvements in skills and knowledge, but effects on less-researched outcomes such as safety-related behaviour, crashes or injuries, cycling participation, and cycling confidence, are unclear. The present research evaluated Safe Cycle, an innovative Australian school-based program that addresses hazard awareness and overconfidence in addition to more typical content (e.g. handling skills), in terms of a comprehensive range of outcomes. Students from Years 4 to 8 (n = 108) completed online surveys in class before, immediately after, and approximately 14 weeks after, the 8-week program was delivered. Significant increases in knowledge and confidence were observed, while results also suggested increases in cycling participation. The program appeared to address illusory invulnerability effectively, but there was no evidence that the program improved safety-relevant cycling behaviours or experience of crashes. The benefits of Safe Cycle might be enhanced by including elements to increase motivation to perform safety-relevant behaviours and durability of program effects.
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Affiliation(s)
- J Hatfield
- Transport and Road Safety [TARS] Research, The University of NSW, Australia.
| | - S Boufous
- Transport and Road Safety [TARS] Research, The University of NSW, Australia
| | - T Eveston
- ACT Education and Training Directorate, Australia
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Abstract
Gender analysis methodology is increasingly being considered as essential to health research because 'women's social, economic and political status undermine their ability to protect and promote their own physical, emotional and mental health, including their effective use of health information and services' {World Health Organization [Gender Analysis in Health: a review of selected tools. 2003; www.who.int/gender/documents/en/Gender. ANALYSIS pdf (20 February 2008, date last accessed)]}. By examining gendered roles, responsibilities and norms through the lens of gender analysis, we can develop an in-depth understanding of social power differentials, and be better able to address gender inequalities and inequities within institutions and between men and women. When conducting gender analysis, tools and frameworks may help to aid community engagement and to provide a framework to ensure that relevant gendered nuances are assessed. The capacities and vulnerabilities approach (CVA) is one such gender analysis framework that critically considers gender and its associated roles, responsibilities and power dynamics in a particular community and seeks to meet a social need of that particular community. Although the original intent of the CVA was to guide humanitarian intervention and disaster preparedness, we adapted this framework to a different context, which focuses on identifying and addressing emerging problems and social issues in a particular community or area that affect their specific needs, such as an infectious disease outbreak or difficulty accessing health information and resources. We provide an example of our CVA adaptation, which served to facilitate a better understanding of how health-related disparities affect Maasai women in a remote, resource-poor setting in Northern Tanzania.
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Affiliation(s)
- Lauren Birks
- Community Health Sciences, University of Calgary, Calgary, Canada
| | | | - Jennifer Hatfield
- Global Health and International Partnerships, University of Calgary, Calgary, Canada
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Hatfield J, Dozza M, Patton DA, Maharaj P, Boufous S, Eveston T. On the use of naturalistic methods to examine safety-relevant behaviours amongst children and evaluate a cycling education program. Accid Anal Prev 2017; 108:91-99. [PMID: 28865315 DOI: 10.1016/j.aap.2017.08.025] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 07/18/2017] [Accepted: 08/21/2017] [Indexed: 06/07/2023]
Abstract
School-based cycling education programs aim to improve cycling safety and participation amongst children. Available research suggests that typical programs, which focus on bicycle manoeuvring skills, have limited effects on behaviour observed on a track or planned route. The current study uses theoretically more valid, naturalistic cycling data, to evaluate Safe Cycle, a program that incorporates hazard and self-awareness training. Soon after Safe Cycle was delivered at treatment schools, research bicycles instrumented with a rearward- and a forward-facing camera were loaned to six children from treatment schools and six children from (waitlist) control schools. In each group half the children were in Year 6, and half were in Year 7/8. Each child was instructed to ride the research bicycle instead of their own bicycle for the 1-2 weeks that they had a research bicycle. Video data were reduced using a purpose-designed coding scheme that identified whether participants performed specific safety-relevant behaviours in appropriate circumstances. While the participants controlled their bicycles well, gave way appropriately to traffic at intersections, and stopped at red lights, participants frequently removed one or both hands from the handlebars, and seldom signalled turns, conducted over-shoulder-checks when changing lanes, or looked in multiple directions at intersections (except when crossing a road). While aspects of design and small sample sizes limited evaluation findings, this research demonstrated the feasibility and potential of naturalistic data to support cycling education program evaluation. Further, the study substantially extended available naturalistic study of children's cycling behaviour to highlight behaviours which might be targeted by cycling safety initiatives.
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Affiliation(s)
- J Hatfield
- Transport and Road Safety [TARS] Research, The University of NSW, Sydney, Australia.
| | - M Dozza
- Department of Applied Mechanics, Chalmers University of Technology, Gothenburg, Sweden
| | - D A Patton
- Transport and Road Safety [TARS] Research, The University of NSW, Sydney, Australia
| | - P Maharaj
- Transport and Road Safety [TARS] Research, The University of NSW, Sydney, Australia
| | - S Boufous
- Transport and Road Safety [TARS] Research, The University of NSW, Sydney, Australia
| | - T Eveston
- ACT Education and Training Directorate, Canberra, Australia
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Plamondon K, Walters D, Campbell S, Hatfield J. Promoting equitable global health research: a policy analysis of the Canadian funding landscape. Health Res Policy Syst 2017; 15:72. [PMID: 28851388 PMCID: PMC5576339 DOI: 10.1186/s12961-017-0236-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 07/28/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Recognising radical shifts in the global health research (GHR) environment, participants in a 2013 deliberative dialogue called for careful consideration of equity-centred principles that should inform Canadian funding polices. This study examined the existing funding structures and policies of Canadian and international funders to inform the future design of a responsive GHR funding landscape. METHODS We used a three-pronged analytical framework to review the ideas, interests and institutions implicated in publically accessible documents relevant to GHR funding. These data included published literature and organisational documents (e.g. strategic plans, progress reports, granting policies) from Canadian and other comparator funders. We then used a deliberative approach to develop recommendations with the research team, advisors, industry informants and low- and middle-income country (LMIC) partners. RESULTS In Canada, major GHR funders invest an estimated CA$90 M per annum; however, the post-2008 re-organization of funding structures and policies resulted in an uncoordinated and inefficient Canadian strategy. Australia, Denmark, the European Union, Norway, Sweden, the United Kingdom and the United States of America invest proportionately more in GHR than Canada. Each of these countries has a national strategic plan for global health, some of which have dedicated benchmarks for GHR funding and policy to allow funds to be held by partners outside of Canada. Key constraints to equitable GHR funding included (1) funding policies that restrict financial and cost burden aspects of partnering for GHR in LMICs; and (2) challenges associated with the development of effective governance mechanisms. There were, however, some Canadian innovations in funding research that demonstrated both unconventional and equitable approaches to supporting GHR in Canada and abroad. Among the most promising were found in the International Development Research Centre and the (no longer active) Global Health Research Initiative. CONCLUSION Promoting equitable GHR funding policies and practices in Canada requires cooperation and actions by multiple stakeholders, including government, funding agencies, academic institutions and researchers. Greater cooperation and collaboration among these stakeholders in the context of recent political shifts present important opportunities for advancing funding policies that enable and encourage more equitable investments in GHR.
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Affiliation(s)
- Katrina Plamondon
- Research Department, Interior Health, Kelowna, BC Canada
- School of Nursing, University of British Columbia, 3333 University Drive, Kelowna, BC V1V 1V7 Canada
| | - Dylan Walters
- Canadian Centre for Health Economics, Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON M5T 3M6 Canada
| | | | - Jennifer Hatfield
- Global Health & International Partnerships Office, Cumming School of Medicine, University of Calgary, Dean’s Office, 7th Floor, Teaching Research & Wellness Building, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
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Poulos RG, Hatfield J, Rissel C, Flack LK, Shaw L, Grzebieta R, McIntosh AS. Near miss experiences of transport and recreational cyclists in New South Wales, Australia. Findings from a prospective cohort study. Accid Anal Prev 2017; 101:143-153. [PMID: 28236684 DOI: 10.1016/j.aap.2017.01.020] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 11/17/2016] [Accepted: 01/27/2017] [Indexed: 06/06/2023]
Abstract
This paper investigates events in which cyclists perceive a cycling crash is narrowly avoided (henceforth, a near miss). A cohort of 2038 adult transport and recreational cyclists from New South Wales (Australia) provided self-reported prospectively collected data from cycling diaries to allow the calculation of an exposure-based rate of near misses and investigation of near miss circumstances. During 25,971days of cycling, 3437 near misses were reported. For a given time cycling, cyclists who rode mainly for transport (compared with those who rode mainly for recreation), and cyclists with less experience (compared to those with more experience) were more likely to report a near miss; older cyclists (60+ years) were less likely to report a near miss than younger cyclists (25-59 years). Where type of near miss was recorded, 72.0% involved motor vehicles, 10.9% involved pedestrians and 6.9% involved other cyclists. Results indicate some similarities between near misses and crashes reported by this cohort during the same reporting period. A bias toward reporting near misses with motor vehicles was suggested, which likely reflects cyclists' perceptions that crashes involving motor vehicles are particularly serious, and highlights their impact on perceived safety. Given the relative rarity of crashes, and the limited breadth and depth of administrative data, collection of near miss data may contribute to our understanding of cycling safety by increasing the volume and detail of information available for analysis. Addressing the causes of near misses may offer an opportunity to improve both perceived and actual safety for cyclists.
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Affiliation(s)
- R G Poulos
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
| | - J Hatfield
- Transport and Road Safety Research Centre, University of New South Wales, Sydney, Australia
| | - C Rissel
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - L K Flack
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - L Shaw
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - R Grzebieta
- Transport and Road Safety Research Centre, University of New South Wales, Sydney, Australia
| | - A S McIntosh
- Australian Collaboration for Research into Injury in Sport and its Prevention, Federation University Australia, Ballarat, Australia
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Hetherington E, Eggers M, Wamoyi J, Hatfield J, Manyama M, Kutz S, Bastien S. Participatory science and innovation for improved sanitation and hygiene: process and outcome evaluation of project SHINE, a school-based intervention in Rural Tanzania. BMC Public Health 2017; 17:172. [PMID: 28173789 PMCID: PMC5297194 DOI: 10.1186/s12889-017-4100-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 09/15/2016] [Accepted: 02/01/2017] [Indexed: 11/23/2022] Open
Abstract
Background Diarrheal disease is a major cause of mortality and morbidity in low and middle income countries with children being disproportionately affected. Project SHINE (Sanitation & Hygiene INnovation in Education) is a grassroots participatory science education and social entrepreneurship model to engage youth and the wider community in the development of sustainable strategies to improve sanitation and hygiene. Methods Based in rural and remote Tanzania, this pilot study engaged pastoralist high-school students and communities in the development and evaluation of culturally and contextually relevant strategies to improve sanitation and hygiene. Using a train-the-trainer approach, key activities included teacher workshops, school-based lessons, extra-curricular activities, community events and a One Health sanitation science fair which showcased projects related to water, sanitation and hygiene in relation to human and animal health. The process and outcome of the study were evaluated through qualitative interviews and focus group discussions with diverse project participants, as well as pre- and post- questionnaires completed by students on knowledge, attitudes and practices concerning sanitation and hygiene. Results The questionnaire results at baseline and follow-up showed statistically significant improvements on key measures including a decrease in unhygienic behaviors, an increase in the perceived importance of handwashing and intention to use the toilet, and increased communication in the social network about the importance of clean water and improved sanitation and hygiene practices, however there were no significant changes in sanitation related knowledge. Qualitative data highlighted strong leadership emerging from youth and enthusiasm from teachers and students concerning the overall approach in the project, including the use of participatory methods. There was a high degree of community engagement with hundreds of community members participating in school-based events. Sanitation science fair projects addressed a range of pastoralist questions and concerns regarding the relationship between water, sanitation and hygiene. Several projects, such as making soap from local materials, demonstrate potential as a sustainable strategy to improve health and livelihoods in the long-term. Conclusions The Project SHINE model shows promise as an innovative capacity building approach and as an engagement and empowerment strategy for youth and communities to develop locally sustainable strategies to improve sanitation and hygiene.
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Affiliation(s)
- Erin Hetherington
- Cumming School of Medicine, University of Calgary, TRW 3rd Floor, 3330 Hospital Dr. NW, Calgary, AB, T2N 4N1, Canada
| | - Matthijs Eggers
- Maastricht University, School for Public Health and Primary Care (Caphri), P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Joyce Wamoyi
- National Institute for Medical Research, P.O Box 1462, Mwanza, Tanzania
| | - Jennifer Hatfield
- Cumming School of Medicine, University of Calgary, TRW 3rd Floor, 3330 Hospital Dr. NW, Calgary, AB, T2N 4N1, Canada
| | - Mange Manyama
- Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, P.O Box 24144, Doha, Qatar
| | - Susan Kutz
- Faculty of Veterinary Medicine, University of Calgary, Health Sciences Centre, 3330 Hospital Dr. NW, Calgary, AB, T2N 4N1, Canada
| | - Sheri Bastien
- Cumming School of Medicine, University of Calgary, TRW 3rd Floor, 3330 Hospital Dr. NW, Calgary, AB, T2N 4N1, Canada. .,Department of Public Health Science, Faculty of Landscape and Society, Norwegian University of Life Sciences, Post Box 5003, Akershus, 1432, Ås, Norway.
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van der Meer F, Clancy E, Thomas A, Kutz S, Hatfield J, Orsel K. "The Maasai Need Cows and the Cows Need Maasai," the Use of a Photovoice Approach to Assess Animal Health Needs. Front Vet Sci 2015; 2:46. [PMID: 26664973 PMCID: PMC4672238 DOI: 10.3389/fvets.2015.00046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 10/02/2015] [Indexed: 11/13/2022] Open
Abstract
The Maasai pastoralists in sub-Saharan Africa depend on their livestock for income and food. Livestock production can be significantly improved by addressing animal health concerns. We explored the use of photovoice, a participatory action research method, to strengthen our understanding of the Maasai's animal health needs. Nine interviewees, representing warriors, elders, and women, identified animal, social, and human health themes. The use of photography provided a new medium for Maasai to express their needs and a focus for researcher-participant communications, thereby facilitating new insights across language and cultural barriers.
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Affiliation(s)
- Frank van der Meer
- Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary , Calgary, AB , Canada ; Department of Community Health Sciences, Cummings School of Medicine, University of Calgary , Calgary, AB , Canada
| | - Eoin Clancy
- Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary , Calgary, AB , Canada
| | - Adam Thomas
- Department of Community Health Sciences, Cummings School of Medicine, University of Calgary , Calgary, AB , Canada
| | - Susan Kutz
- Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary , Calgary, AB , Canada
| | - Jennifer Hatfield
- Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary , Calgary, AB , Canada ; Department of Community Health Sciences, Cummings School of Medicine, University of Calgary , Calgary, AB , Canada
| | - Karin Orsel
- Department of Community Health Sciences, Cummings School of Medicine, University of Calgary , Calgary, AB , Canada ; Department of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary , Calgary, AB , Canada
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Poulos RG, Hatfield J, Rissel C, Flack LK, Murphy S, Grzebieta R, McIntosh AS. An exposure based study of crash and injury rates in a cohort of transport and recreational cyclists in New South Wales, Australia. Accid Anal Prev 2015; 78:29-38. [PMID: 25732133 DOI: 10.1016/j.aap.2015.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/10/2015] [Accepted: 02/11/2015] [Indexed: 06/04/2023]
Abstract
This paper examines self-reported prospectively collected data from 2038 adult transport and recreational cyclists from New South Wales (Australia) to determine exposure-based incident crash and injury rates. During 25,971 days of cycling, 198 crashes were reported, comprising approximately equal numbers of falls and collisions. The overall crash rate was 0.290 (95% CI, 0.264-0.319) per 1000km or 6.06 (95% CI, 5.52-6.65) per 1000h of travel. The rate of crashes causing any injury (self-treated, or medically attended without overnight hospital stay) was 0.148 (95% CI, 0.133-0.164) per 1000km or 3.09 (95% CI, 2.79-3.43) per 1000h of travel. The rate of crashes causing a medically attended injury (without overnight hospital stay) was 0.023 (95% CI, 0.020-0.027) per 1000km or 0.49 (95% CI, 0.43-0.56) per 1000h of travel. No injuries requiring an overnight stay in hospital were reported on days meeting the inclusion criteria. After adjustment for exposure in hours, or for the risks associated with different infrastructure utilisation, the rates of crashes and medically attended injuries were found to be greater for females than males, less experienced than more experienced cyclists, and for those who rode mainly for transport rather than mainly for recreation. Comparison of estimated crash and injury rates on different infrastructure types were limited by the small number of events, however findings suggest that the separation of cyclists from motorised traffic is by itself not sufficient to ensure safe cycling.
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Affiliation(s)
- R G Poulos
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
| | - J Hatfield
- Transport and Road Safety Research, University of New South Wales, Sydney, Australia
| | - C Rissel
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - L K Flack
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - S Murphy
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - R Grzebieta
- Transport and Road Safety Research, University of New South Wales, Sydney, Australia
| | - A S McIntosh
- Australian Centre for Research into Injury in Sport and its Prevention, Federation University Australia, Ballarat, Australia
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Poulos RG, Hatfield J, Rissel C, Flack LK, Murphy S, Grzebieta R, McIntosh AS. Characteristics, cycling patterns, and crash and injury experiences at baseline of a cohort of transport and recreational cyclists in New South Wales, Australia. Accid Anal Prev 2015; 78:155-164. [PMID: 25790974 DOI: 10.1016/j.aap.2015.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/10/2015] [Accepted: 02/11/2015] [Indexed: 06/04/2023]
Abstract
This paper examines self-reported retrospective data for a 12 month period from 2038 adult cyclists from New South Wales (Australia), and compares cyclists according to whether they self-identify as riding mainly for transport or mainly for recreation. Statistically significant differences were found in the demographic characteristics, cycling patterns, and crash experiences between these two groups of cyclists. Transport cyclists tended to be younger, travel more days per week, and within morning and evening peak hours than recreational cyclists; recreational cyclists were more likely to identify fitness as a purpose for cycling. The proportion of cyclists experiencing a crash or crash-related injury in the previous 12 months was similar for transport and recreational cyclists, but there were differences in crash types and location which likely reflect different cycling environments. Heterogeneity within transport and recreational cyclists was also found, based on self-reported riding intensity. An understanding of the different cycling patterns and experiences of various types of cyclists is useful to inform road safety, transport and health promotion policy.
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Affiliation(s)
- R G Poulos
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
| | - J Hatfield
- Transport and Road Safety Research Australia, Bar University of New South Wales, Sydney, Australia
| | - C Rissel
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - L K Flack
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - S Murphy
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - R Grzebieta
- Transport and Road Safety Research Australia, Bar University of New South Wales, Sydney, Australia
| | - A S McIntosh
- Australian Centre for Research into Injury in Sport and its Prevention, Federation University Australia, Ballarat, Australia
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Murphy J, Hatfield J, Afsana K, Neufeld V. Making a commitment to ethics in global health research partnerships: a practical tool to support ethical practice. J Bioeth Inq 2015; 12:137-146. [PMID: 25648123 DOI: 10.1007/s11673-014-9604-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/11/2014] [Indexed: 06/04/2023]
Abstract
Global health research partnerships have many benefits, including the development of research capacity and improving the production and use of evidence to improve global health equity. These partnerships also include many challenges, with power and resource differences often leading to inequitable and unethical partnership dynamics. Responding to these challenges and to important gaps in partnership scholarship, the Canadian Coalition for Global Health Research (CCGHR) conducted a three-year, multi-regional consultation to capture the research partnership experiences of stakeholders in South Asia, Latin America, and sub-Saharan Africa. The consultation participants described persistent inequities in the conduct of global health research partnerships and called for a mechanism through which to improve accountability for ethical conduct within partnerships. They also called for a commitment by the global health research community to research partnership ethics. The Partnership Assessment Toolkit (PAT) is a practical tool that enables partners to openly discuss the ethics of their partnership and to put in place structures that create ethical accountability. Clear mechanisms such as the PAT are essential to guide ethical conduct to ensure that global health research partnerships are beneficial to all collaborators, that they reflect the values of the global health endeavor more broadly, and that they ultimately lead to improvements in health outcomes and health equity.
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Affiliation(s)
- Jill Murphy
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada,
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Mawji A, Vollman AR, Fung T, Hatfield J, McNeil DA, Sauvé R. Risk factors for positional plagiocephaly and appropriate time frames for prevention messaging. Paediatr Child Health 2014; 19:423-7. [PMID: 25382999 PMCID: PMC4220526 DOI: 10.1093/pch/19.8.423] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To determine potential risk factors for developing positional plagiocephaly in infants seven to 12 weeks of age in Calgary, Alberta. METHODS A prospective cohort design was used. Healthy term infants (n=440), seven to 12 weeks of age, from well-child clinics at four community health centres in Calgary, Alberta were assessed by the primary author and a registered nurse research assistant using Argenta's plagiocephaly assessment tool. Parents completed a questionnaire surveying risk factors. RESULTS The incidence of positional plagiocephaly was estimated to be 46.6%. The following risk factors were identified using multiple logistic regression: right-sided head positional preference (OR 4.66 [95% CI 2.85 to 7.58]; P<0.001), left-sided head positional preference (OR 4.21 [95% CI 2.45 to 7.25]; P<0.001), supine sleep position (OR 2.67 [95% CI 1.58 to 4.51]; P<0.001), vacuum/forceps assisted delivery (OR 1.88 [95% CI 1.02 to 3.49]; P=0.04) and male sex (OR 1.55 [95% CI 1.00 to 2.38]; P=0.05). CONCLUSION Advice to vary infants' head positions needs to be communicated to parents/guardians well before the two-month well-child clinic visit. This could occur in the prenatal period by prenatal care providers or educators, or during the neonatal period by postpartum and public health nurses. Prevention education may be emphasized for parents/guardians of male infants and infants who have had assisted deliveries.
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Affiliation(s)
- Aliyah Mawji
- School of Nursing, Faculty of Health and Community Studies, Mount Royal
University
| | | | - Tak Fung
- Information Technologies, University of Calgary
| | - Jennifer Hatfield
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary
| | - Deborah A McNeil
- Faculty of Nursing, University of Calgary
- Population and Public Health, Alberta Health Services
| | - Reginald Sauvé
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary
- Department of Paediatrics, Faculty of Medicine, University of Calgary, Calgary,
Alberta
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Abstract
OBJECTIVE The objective of this study was to estimate the incidence of positional plagiocephaly in infants 7 to 12 weeks of age who attend the 2-month well-child clinic in Calgary, Alberta, Canada. METHODS A prospective cohort design was used to recruit 440 healthy full-term infants (born at ≥37 weeks of gestation) who presented at 2-month well-child clinics for public health nursing services (eg, immunization) in the city of Calgary, Alberta. The study was completed in 4 community health centers (CHCs) from July to September 2010. The CHCs were selected based on their location, each CHC representing 1 quadrant of the city. Argenta's (2004) plagiocephaly assessment tool was used to identify the presence or absence of plagiocephaly. RESULTS Of the 440 infants assessed, 205 were observed to have some form of plagiocephaly. The incidence of plagiocephaly in infants at 7 to 12 weeks of age was estimated to be 46.6%. Of all infants with plagiocephaly, 63.2% were affected on the right side and 78.3% had a mild form. CONCLUSIONS To our knowledge, this is the first population-based study to investigate the incidence of positional plagiocephaly using 4 community-based data collection sites. Future studies are required to corroborate the findings of our study. Research is required to assess the incidence of plagiocephaly using Argenta's plagiocephaly assessment tool across more CHCs and to assess prevalence at different infant age groups. The utility of using Argenta's plagiocephaly assessment tool by public health nurses and/or family physicians needs to be established.
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Affiliation(s)
- Aliyah Mawji
- School of Nursing, Faculty of Health and Community Studies, Mount Royal University, Calgary, Alberta, Canada.
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Roggeveen Y, Birks L, Kats JV, Manyama M, Hatfield J, Bunders J, Scheele F, Roosmalen JV. Low utilization of skilled birth attendants in Ngorongoro Conservation Area, Tanzania: A complex reality requiring action. Health (London) 2013. [DOI: 10.4236/health.2013.57a4011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hatfield J, Garrard J, Tørsløv N, Crist P, Houdmont A, van Damme O, Gaardbo AM, Jouannot T, Ocampo A, Malasek J. CYCLING SAFETY: KEY MESSAGES OF THE INTERNATIONAL TRANSPORT FORUM OF THE OECD'S WORKING GROUP ON CYCLE SAFETY. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040580c.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hatfield J, Williamson A, Brander R, Sherker S, Hayen A, Dunn N. Development and evaluation of campaigns to reduce rip current-related beach drowning in Australia. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040590h.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Brown J, Burton D, Nikolin S, Crooks P, Hatfield J, Bilston L. USING THE INTEGRATED BEHAVIOUR CHANGE MODEL (IBCM) TO IDENTIFY INTERVENTION ELEMENTS FOR PROMOTING OPTIMAL CHILD RESTRAINT PRACTICES IN NSW. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040580a.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hetherington E, Hatfield J. "I really wanted to be able to contribute something": understanding health science student motivations to create meaningful global health experiences. Can Med Educ J 2012; 3:e107-e117. [PMID: 26451180 PMCID: PMC4563628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Global health is an area of increasing interest among health professionals, students and educators. This study aims to explore students' motivations and experiences with an undergraduate global health research program in low and middle-income countries and to assess student learning and areas for program improvement. METHODS All students participating in the Global Health Research Program at the University of Calgary in the summer of 2009 were asked to participate in the study (n=11). In-depth interviews were conducted with students prior to departure and upon their return. Discourse analysis was used to identify interpretive repertoires and to determine how the use of repertoires improves our understanding of students' experiences. RESULTS Prior to departure, students were highly motivated to "give back" to host communities. Upon return, students felt that their experience had been more about "building relationships" with others than individual contributions to hosts. DISCUSSION Students' altruistic motivations dominated the discourse, and most students incorporated core concepts from a preparation course only after their international experience. Extensive preparation, supervision and follow-up support can mitigate many of the risks of short-term global health experiences while providing a safe opportunity for significant learning.
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Affiliation(s)
- Erin Hetherington
- Correspondence: Erin Hetherington, Global Health and International Partnerships, Faculty of Medicine, University of Calgary, 7 Floor TRW building, 3330 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4N1; E-mail:
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Fenton C, Hatfield J, McIntyre L. A qualitative pilot study of food insecurity among Maasai women in Tanzania. Pan Afr Med J 2012; 12:81. [PMID: 23077702 PMCID: PMC3473967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 07/19/2012] [Indexed: 10/30/2022] Open
Abstract
BACKGROUND Food insecurity is an ongoing threat in rural sub-Saharan Africa and is complicated by cultural practices, the rise of chronic conditions such as HIV and land use availability. In order to develop a successful food security intervention program, it is important to be informed of the realities and needs of the target population. The purpose of this study was to pilot a qualitative method to understand food insecurity based on the lived experience of women of the Maasai population in the Ngorongoro Conservation Area of Tanzania. METHODS Short semi-structured qualitative interviews with 4 Maasai women. RESULTS FOOD INSECURITY WAS PRESENT IN THE MAASAI COMMUNITY: the participants revealed that they did not always have access to safe and nutritious food that met the needs of themselves and their families. Themes that emerged from the data fell into three categories: Current practices (food sources, planning for enough, food preparation, and food preservation), food Insecurity (lack of food, emotions, coping strategies, and possible solutions), and division (co-wives, food distribution, and community relationships). CONCLUSION This pilot study suggested the presence of food insecurity in the Maasai community. Larger sample studies are needed to clarify the extent and severity of food insecurity among this population. Having a detailed understanding of the various aspects of the food insecurity lived experience could inform a targeted intervention program.
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Affiliation(s)
- Carol Fenton
- Undergraduate Medical Education, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, Calgary, Alberta, Canada,Corresponding author: Carol Fenton, Undergraduate Medical Education, Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1
| | - Jennifer Hatfield
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, 3E14 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada
| | - Lynn McIntyre
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, 3E14 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada
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Carradice D, Samuel N, Wallace T, Mazari FAK, Hatfield J, Chetter I. Comparing the treatment response of great saphenous and small saphenous vein incompetence following surgery and endovenous laser ablation: a retrospective cohort study. Phlebology 2011; 27:128-34. [DOI: 10.1258/phleb.2011.011014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective Many venous trials mix patients with great saphenous vein (GSV) and small saphenous vein (SSV) diseases. There is no evidence that both respond similarly to treatment and our aim was to test this assumption. Method This cohort study compares patients with isolated GSV and SSV incompetence following treatment with open surgical ligation or endovenous laser ablation (EVLA). Outcomes included: quality of life (QoL; Aberdeen Varicose Vein Questionnaire [AVVQ]; Short Form 36 [SF36]; Euroqol [EQ5D]; and Venous Clinical Severity Score [VCSS]). Results A total of 370 patients with no differences in baseline QoL, underwent treatment. Despite equivalent morbidity, SSV sufferers had a lower VCSS ( P < 0.001). Following surgery, SSV patients scored higher (worse) on AVVQ ( P = 0.045) than GSV sufferers, but lower (better) following EVLA ( P = 0.042). Conclusion The morbidity associated with SSV incompetence is greater than suggested by its clinical severity and responds differently following treatment to that of the GSV. Trials should consider patients with GSV and SSV reflux separately. EVLA may offer additional benefits to SSV sufferers.
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Affiliation(s)
- D Carradice
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - N Samuel
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - T Wallace
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - F A K Mazari
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - J Hatfield
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - I Chetter
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
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Carradice D, Mekako AI, Mazari FAK, Samuel N, Hatfield J, Chetter IC. Clinical and technical outcomes from a randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins. Br J Surg 2011; 98:1117-23. [PMID: 21638277 DOI: 10.1002/bjs.7615] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2011] [Indexed: 11/09/2022]
Abstract
Abstract
Background
This report describes the clinical effectiveness and recurrence rates from a randomized trial of endovenous laser ablation (EVLA) and surgery for varicose veins.
Methods
Some 280 patients were randomized equally using sealed opaque envelopes to two parallel groups: surgery and EVLA. Inclusion criteria included symptomatic disease secondary to primary, unilateral, isolated saphenofemoral junction incompetence, leading to reflux into the great saphenous vein (GSV). Outcomes were: technical success, recurrent varicose veins on clinical examination, patterns of reflux on duplex ultrasound examination, and the effect of recurrence on quality of life, assessed by the Aberdeen Varicose Vein Questionnaire (AVVQ). Assessments were at 1, 6, 12 and 52 weeks after the procedure.
Results
Initial technical success was greater following EVLA: 99·3 versus 92·4 per cent (P = 0·005). Surgical failures related mainly to an inability to strip the above-knee GSV. The clinical recurrence rate at 1 year was lower after EVLA: 4·0 versus 20·4 per cent (P < 0·001). The number of patients needed to treat with EVLA rather than surgery to avoid one recurrence at 1 year was 6·3 (95 per cent confidence interval 4·0 to 12·5). Twelve of 23 surgical recurrences were related to an incompetent below-knee GSV and ten to neovascularization. Of five recurrences after EVLA, two were related to neoreflux in the groin tributaries and one to recanalization. Clinical recurrence was associated with worse AVVQ scores (P < 0·001).
Conclusion
EVLA treatment had lower rates of clinical recurrence than conventional surgery in the short term. Registration number: NCT00759434 (http://www.clinicaltrials.gov).
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Affiliation(s)
- D Carradice
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - A I Mekako
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - F A K Mazari
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - N Samuel
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - J Hatfield
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - I C Chetter
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
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Carradice D, Mazari FAK, Samuel N, Allgar V, Hatfield J, Chetter IC. Modelling the effect of venous disease on quality of life. Br J Surg 2011; 98:1089-98. [DOI: 10.1002/bjs.7500] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2011] [Indexed: 11/08/2022]
Abstract
Abstract
Background
A clear understanding of the relationship between venous reflux, clinical venous disease and the effects on quality of life (QoL) remains elusive. This study aimed to explore the impact of venous disease, and assess any incremental direct effect of progressive disease on health-related QoL, with the ultimate aim to model venous morbidity.
Methods
Consecutive patients with venous disease were assessed for inclusion in the study. Patients with isolated, unilateral, single superficial axial incompetence diagnosed on duplex imaging were included. Clinical grading was performed with the Clinical Etiologic Anatomic Pathophysiologic (CEAP) classification and Venous Clinical Severity Score (VCSS). Patients completed generic (Short Form 36, SF-36®; EuroQol 5D, EQ-5D™) and disease-specific (Aberdeen Varicose Vein Questionnaire, AVVQ) QoL instruments. Multivariable regression modelling was performed, taking account of demographic and anatomical factors, to explore the effect of clinical severity on QoL impairment.
Results
Some 456 patients with C2–6 venous disease were included, along with control data for 105 people with C0–1 disease. Increasing clinical grade corresponded strongly with deterioration in disease-specific QoL (P < 0·001). This could be stratified into three distinguishable groups: C0–1, C2–4 and C5–6 (P < 0·001 to P = 0·006). Increasing clinical grade also corresponded with deterioration in the physical domains of SF-36® (P < 0·001 to P = 0·016), along with EQ-5D™ index utility (quality-adjusted life year) scores (P < 0·001).
Conclusion
Demonstrable morbidity was seen, even with uncomplicated venous disease. The physical impairment seen with venous ulceration was comparable with that seen in congestive cardiac failure and chronic lung disease.
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Affiliation(s)
- D Carradice
- Academic Vascular Surgical Unit, University of Hull and Hull York Medical School, Hull, UK
| | - F A K Mazari
- Academic Vascular Surgical Unit, University of Hull and Hull York Medical School, Hull, UK
| | - N Samuel
- Academic Vascular Surgical Unit, University of Hull and Hull York Medical School, Hull, UK
| | - V Allgar
- Department of Statistics, Hull York Medical School, Hull, UK
| | - J Hatfield
- Academic Vascular Surgical Unit, University of Hull and Hull York Medical School, Hull, UK
| | - I C Chetter
- Academic Vascular Surgical Unit, University of Hull and Hull York Medical School, Hull, UK
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Williamson A, Hatfield J, Sherker S, Brander R, Hayen A. Improving the development of an effective beach safety intervention through an observational study of risky beach behaviour. Inj Prev 2011. [DOI: 10.1136/ip.2010.029215.186] [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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McIntyre L, Rondeau K, Kirkpatrick S, Hatfield J, Islam KS, Huda SN. Food provisioning experiences of ultra poor female heads of household living in Bangladesh. Soc Sci Med 2011; 72:969-76. [PMID: 21345564 DOI: 10.1016/j.socscimed.2011.01.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 01/07/2011] [Accepted: 01/10/2011] [Indexed: 10/18/2022]
Abstract
Ultra poor women in Bangladesh are especially vulnerable to poverty and food insecurity, and they have generally been excluded from recent improvements in hunger and poverty rates in the country. An examination of the food provisioning narratives of 43 ultra poor female heads of household in Bangladesh was conducted in order to deepen understanding of this obstacle to the country's achievement of the First Millennium Development Goal. All participants were the household's sole income provider, had dependent children, and earned less than $1 USD per day. Women were purposively selected based on occupational group, context, and personal characteristics. Ethnographic interviews were conducted in January and February, 2008. Analysis of women's accounts of their daily food routine revealed chronic and pervasive food insecurity punctuated by acute episodes of absolute food deprivation that resulted from seasonal fluctuations in earnings, rising food prices, illness disrupting work, and healthcare costs. Women's accounts of their daily food provisioning experiences suggested compromises in, and trade-offs between, multiple basic needs as a result of inadequate income. Women were further constrained by social norms and gender roles that influenced their ability to work outside the home. Our method of inquiry led us to construct an organizing framework that extends knowledge of ultra poor women in Bangladesh's complex and multi-sphered experience of poverty and food insecurity. Based on these findings, we propose a strategy called whole person development (WPD), which seeks small adjustments to services, programs, and policies based on leverage points identified through in-depth narratives.
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Affiliation(s)
- Lynn McIntyre
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, 3E43 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada.
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Carradice D, Mekako AI, Mazari FAK, Samuel N, Hatfield J, Chetter IC. Randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins. Br J Surg 2011; 98:501-10. [DOI: 10.1002/bjs.7394] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2010] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Endovenous laser ablation (EVLA) is a popular minimally invasive treatment for varicose veins. Surgical treatment, featuring junctional ligation and inversion stripping, has shown excellent clinical and cost effectiveness. The clinical effectiveness of both treatments was compared within a randomized trial.
Methods
Some 280 patients were randomized equally into groups receiving either surgery or EVLA. Participants had primary, symptomatic, unilateral venous insufficiency, with isolated saphenofemoral junction incompetence, leading to reflux into the great saphenous vein. Outcomes included: quality of life (QoL), Venous Clinical Severity Score (VCSS), pain scores and time taken to return to normal function. Owing to the nature of the procedures, blinding was not possible.
Results
Both groups had significant improvements in VCSS after treatment (P < 0·001), which resulted in improved disease-specific QoL (Aberdeen Varicose Vein Questionnaire, P < 0·001) and quality-adjusted life year (QALY) gain (P < 0·001). The pain and disability following surgery impaired normal function, with a significant decline in five of eight Short Form 36 (SF-36®) domains (P < 0·001 to P = 0·029). Periprocedural QoL was relatively preserved following EVLA, leading to a significant difference between the two treatments in pain scores (P < 0·001), six of eight SF-36® domains (P = 0·004 to P = 0·049) and QALYs (P = 0·003). As a result, surgical patients took longer to return to work and normal activity (14 versus 4 days; P < 0·001). Complications were rare.
Conclusion
EVLA was as effective as surgery for varicose veins, but had a less negative impact on early postintervention QoL. Registration number: NCT00759434 (http://www.clinicaltrials.gov).
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Affiliation(s)
- D Carradice
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - A I Mekako
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - F A K Mazari
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - N Samuel
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - J Hatfield
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - I C Chetter
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
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Williamson A, Hatfield J, Sherker S, Brander R, Hayen A. Improving beach safety: The science of the surf research project. Stage 3—evaluation of the effectiveness of the “Don’t get sucked in by the rip” campaign. J Sci Med Sport 2010. [DOI: 10.1016/j.jsams.2009.10.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Williamson A, Hatfield J, Sherker S, Brander R, Hayen A. Improving beach safety: The science of the surf research project stage 1: Collection of baseline data to inform a tailored intervention. J Sci Med Sport 2010. [DOI: 10.1016/j.jsams.2009.10.061] [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: 11/30/2022]
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Hatfield J, Williamson A, Sherker S, Brander R, Hayen A. Improving beach safety: The science of the surf research project stage 2: Development and process evaluation of the “Don’t get sucked in by the rip” campaign. J Sci Med Sport 2010. [DOI: 10.1016/j.jsams.2009.10.202] [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: 11/25/2022]
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Hetherington E, Hatfield J. Review: Our Bodies, Ourselves: Mirroring the Journey of Feminist Consciousness. Theory & Psychology 2009. [DOI: 10.1177/0959354309345639] [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: 11/17/2022]
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Mekako AI, Chetter IC, Coughlin PA, Hatfield J, McCollum PT. Randomized clinical trial of co-amoxiclav versus no antibiotic prophylaxis in varicose vein surgery. Br J Surg 2009; 97:29-36. [DOI: 10.1002/bjs.6849] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background
Wound infection rates of up to 16 per cent are reported following varicose vein surgery and the value of antibiotic prophylaxis in clean surgery remains unclear.
Methods
Some 443 patients undergoing varicose vein surgery randomly received a single prophylactic dose of 1·2 g co-amoxiclav (219 patients) or no antibiotic (224). Patients completed a wound diary on postoperative days 3, 5, 7, 9 and 10 using an adapted ASEPSIS method of wound assessment, and were reviewed after 14 days.
Results
Patients who had prophylaxis had lower ASEPSIS wound scores on days 3, 5 and 7 (P = 0·043, P = 0·032 and P = 0·003 respectively), and lower total ASEPSIS scores (median (interquartile range) 3 (0–9) versus 6 (0–15); P = 0·013). They were less likely to consult their general practitioner (16.0 versus 24·3 per cent; P = 0·040) or to receive postoperative antibiotics (4·7 versus 13·5 per cent; P = 0·002) for wound-related problems. Wound outcomes were worse with higher body mass index (odds ratio (OR) 0·92 (95 per cent confidence interval (c.i.) 0·87 to 0·97); P = 0·005) and current smoking (OR 0·5 (0·3 to 0·9); P = 0·033). Prophylactic antibiotics conferred satisfactory wound healing (OR 2·2 (95 per cent c.i. 1·3 to 3·6); P = 0·003).
Conclusion
Antibiotic prophylaxis reduced wound-related problems after varicose vein surgery. Registration number ISRCTN12467340 (http://www.controlled-trials.com).
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Affiliation(s)
- A I Mekako
- Academic Vascular Surgery Unit, Alderson House, Hull Royal Infirmary, Hull HU3 2JZ, UK
| | - I C Chetter
- Academic Vascular Surgery Unit, Alderson House, Hull Royal Infirmary, Hull HU3 2JZ, UK
| | - P A Coughlin
- Academic Vascular Surgery Unit, Alderson House, Hull Royal Infirmary, Hull HU3 2JZ, UK
| | - J Hatfield
- Academic Vascular Surgery Unit, Alderson House, Hull Royal Infirmary, Hull HU3 2JZ, UK
| | - P T McCollum
- Academic Vascular Surgery Unit, Alderson House, Hull Royal Infirmary, Hull HU3 2JZ, UK
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Blows E, Hatfield J, Scanlon K, Richardson A, Ream E. 4174 Information and support for Asian and African Caribbean women affected by breast cancer: role of voluntary organisations in meeting needs. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70806-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Carradice D, Mekako AI, Hatfield J, Chetter IC. Randomized clinical trial of concomitant or sequential phlebectomy after endovenous laser therapy for varicose veins. Br J Surg 2009; 96:369-75. [DOI: 10.1002/bjs.6556] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background
The management of residual varicosities following endovenous laser therapy (EVLT) for varicose veins is contentious. Ambulatory phlebectomy may be performed concomitantly with the initial EVLT, or sequentially as a secondary procedure. This randomized trial compared these two approaches.
Methods
Fifty patients with great saphenous varicose veins were randomized to EVLT alone or EVLT with concomitant ambulatory phlebectomies (EVLTAP). Principal outcomes were procedure duration, pain scores, requirement for secondary procedures and quality of life after 3 months.
Results
EVLTAP took longer, but significantly decreased the requirement for subsequent interventions. There was no impairment in immediate postprocedural pain, Short Form 36 or EuroQol 5D scores with EVLTAP. Median (i.q.r.) Venous Clinical Severity Score (VCSS) at 3 months was lower for EVLTAP than for EVLT alone (0 (0–1) versus 2 (0–2); P < 0·001), with lower Aberdeen Varicose Vein Questionnaire (AVVQ) scores at 6 weeks (7·9 (4·1–10·7) versus 13·5 (10·9–18·1); P < 0·001) and 3 months (2·0 (0·4–7·7) versus 9·6 (2·2–13·8); P = 0·015). At 1 year, there were no differences in VCSS or AVVQ scores.
Conclusion
Concomitant phlebectomy with EVLT prolonged the procedure, but reduced the need for secondary procedures and significantly improved quality of life and the severity of venous disease.
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Affiliation(s)
- D Carradice
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - A I Mekako
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - J Hatfield
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - I C Chetter
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
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Bilston LE, Finch C, Hatfield J, Brown J. Age-specific parental knowledge of restraint transitions influences appropriateness of child occupant restraint use. Inj Prev 2008; 14:159-63. [DOI: 10.1136/ip.2007.017608] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [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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Mekako A, Hatfield J, Bryce J, Heng M, Lee D, McCollum P, Chetter I. Combined endovenous laser therapy and ambulatory phlebectomy: refinement of a new technique. Eur J Vasc Endovasc Surg 2006; 32:725-9. [PMID: 16863696 DOI: 10.1016/j.ejvs.2006.06.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2006] [Accepted: 06/04/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Sclerotherapy (IS) or ambulatory phlebectomy (AP) are required as subsequent interventions in majority of cases following endovenous laser therapy (EVLT). We assessed whether AP performed concomitantly with EVLT (EVLTAP), is effective, acceptable, and reduces subsequent requirement for interventions. METHOD 67 patients (70 limbs) with great saphenous varicosities underwent EVLTAP. Pain was assessed on days 1, 4 and 7 using a visual analogue scale (VAS) of 0 to 10. Clinical and ultrasound assessments were done at 1, 6 and 12 weeks (no ultrasound at 6 weeks). Residual varicosities underwent further AP or IS. Patients' satisfaction with the cosmetic outcome and overall treatment was assessed at 12 weeks using a VAS rating. RESULTS 49 patients (70%) completed follow-up. Median pain scores were 1.6 (IQR 0.2-4.8), 0.3 (0-1.4) and 0.2 (0-1.1) on days 1, 4 and 7 respectively. Ultrasound demonstrated 69 (99%) and 47 (96%) occluded long saphenous veins at 1 and 12 weeks respectively. Subsequent IS or AP was performed on 3 (4%) or 1 (1%) limbs respectively. Cosmetic satisfaction was 9.6 (IQR 8.9-10) and overall satisfaction 9.8 (IQR 9.3-10). CONCLUSION EVLTAP produces excellent results, is feasible and acceptable, and obviates need for subsequent procedures in the short-term.
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Affiliation(s)
- A Mekako
- Academic Vascular Surgery Unit, Hull Royal Infirmary, Hull, UK.
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Saavedra-Lozano J, Cao Y, Callison J, Sarode R, Sodora D, Edgar J, Hatfield J, Picker L, Peterson D, Ramilo O, Vitetta ES. An anti-CD45RO immunotoxin kills HIV-latently infected cells from individuals on HAART with little effect on CD8 memory. Proc Natl Acad Sci U S A 2004; 101:2494-9. [PMID: 14983037 PMCID: PMC356978 DOI: 10.1073/pnas.0308381100] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
CD4+ CD45RO+ T cells are the major latent viral reservoir in HIV-infected individuals and hence a major obstacle in curing the disease. An anti-CD45RO immunotoxin (IT) can decrease the number of both productively and latently infected CD4+ T cells obtained from HIV-infected individuals with detectable viremia. In this study, we determined whether this IT could also kill latently infected replication-competent CD4+ T cells obtained from infected individuals without detectable plasma viremia. Our results demonstrate that ex vivo treatment with the anti-CD45RO IT significantly reduced the frequency of these cells. In contrast, the IT had only a modest effect on the cytomegalovirus-specific memory responses of CD8+ T cells. These results suggest that purging latent cells from infected individuals on highly active antiretroviral therapy with the anti-CD45RO IT might reduce the HIV latent reservoir without seriously compromising CD8+ T cell memory responses.
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Affiliation(s)
- J Saavedra-Lozano
- Cancer Immunobiology Center, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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