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Capelastegui F, Trickey A, Thompson LH, Reza T, Emmanuel F, Cholette F, Blanchard JF, Archibald C, Vickerman P, Lim AG. Risk factors of HIV and variation in access to clean needles among people who inject drugs in Pakistan. Pathog Glob Health 2023; 117:696-707. [PMID: 36950726 PMCID: PMC10614703 DOI: 10.1080/20477724.2023.2191234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
We identified key risk factors for HIV among people who inject drugs (PWID) in Pakistan and explored access to free clean needles. Multivariable logistic regression was used to investigate associations between HIV prevalence and demographic, behavioral, and socio-economic characteristics of PWID. Data came from the Government of Pakistan's Integrated Biological and Behavioral Surveillance (IBBS) Round 5 (2016-17; 14 cities). A secondary analysis investigated associations with reported access to clean needles. Unweighted HIV prevalence among 4,062 PWID (99% male) was 21.0%. Longer injecting duration (Odds ratio [OR] 1.06 [95% confidence interval: 1.02-1.10]; per year), higher injecting frequency (OR 1.67 [1.30-2.13]; per unit increase), and injecting heroin (OR 1.90 [1.11-3.25]) were positively associated with HIV prevalence. There was no association between using a used syringe at last injection and HIV. Having>10 years of education had lower odds of HIV than being illiterate (OR 0.58 [0.35-0.95]). Having a regular sexual partner (OR 0.74 [0.57-0.97]) or paying for sex with the opposite sex (OR = 0.62 [0.45-0.85]) had lower odds of HIV than not. Conversely, PWID paying a man/hijra for sex had higher odds of HIV (OR 1.20 [1.00-1.43]). Receipt of clean needles varied by city of residence (0-97% coverage), whilst PWID with knowledge of HIV service delivery programs had higher odds of receiving clean needles (OR 4.58 [3.50-5.99]). Injecting behaviors were associated with HIV prevalence among PWID, though risks related to paying for sex remain complicated. Geographical variation in access to clean needles suggests potential benefits of more widely spread public health services.
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Affiliation(s)
- Fernando Capelastegui
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Adam Trickey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Laura H. Thompson
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Tahira Reza
- Canada-Pakistan HIV/AIDS Surveillance Project, Centre for Global Public Health, Islamabad, Pakistan
| | - Faran Emmanuel
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
- Canada-Pakistan HIV/AIDS Surveillance Project, Centre for Global Public Health, Islamabad, Pakistan
| | - Francois Cholette
- National HIV and Retrovirology Laboratories, JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - James F. Blanchard
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Chris Archibald
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Canada
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Aaron G. Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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2
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Pavan C, Jin J, Jong S, Strbenac D, Davis RL, Sue CM, Johnston J, Lynch T, Halliday G, Kirik D, Parish CL, Thompson LH, Ovchinnikov DA. Generation of the iPSC line FINi002-A from a male Parkinson's disease patient carrying compound heterozygous mutations in the PRKN gene. Stem Cell Res 2023; 73:103211. [PMID: 37890334 DOI: 10.1016/j.scr.2023.103211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
The most common cause of autosomal recessive familial Parkinson's disease (PD) are mutations in the PRKN/PARK2 gene encoding an E3 ubiquitin protein-ligase PARKIN. We report the generation of an iPSC cell line from the fibroblasts of a male PD patient carrying a common missense variant in exon 7 (p.Arg275Trp), and a 133 kb deletion encompassing exon 8, using transiently-present Sendai virus. The established line displays typical human primed iPSC morphology and expression of pluripotency-associated markers, normal karyotype without SNP array-detectable copy number variations and can give rise to derivatives of all three embryonic germ layers. We envisage the usefulness of this iPSC line, carrying a common and well-studied missense mutation in the RING1 domain of the PARKIN protein, for the elucidation of PARKIN-dependent mechanisms of PD using in vitro and in vivo models.
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Affiliation(s)
- C Pavan
- The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne VIC 3010 Australia
| | - J Jin
- The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne VIC 3010 Australia
| | - S Jong
- The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne VIC 3010 Australia
| | - D Strbenac
- University of Sydney, Sydney, NSW 2006, Australia
| | - R L Davis
- University of Sydney, Sydney, NSW 2006, Australia
| | - C M Sue
- Neuroscience Research Australia and University of New South Wales, Sydney, NSW 2031, Australia
| | | | - T Lynch
- Mater Misericordiae University Hospital, Dublin, D07 R2WY, Ireland
| | - G Halliday
- University of Sydney, Sydney, NSW 2006, Australia
| | - D Kirik
- University of Sydney, Sydney, NSW 2006, Australia; Lund University, Lund, 22184 Sweden
| | - C L Parish
- The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne VIC 3010 Australia
| | - L H Thompson
- The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne VIC 3010 Australia; University of Sydney, Sydney, NSW 2006, Australia.
| | - D A Ovchinnikov
- The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne VIC 3010 Australia
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3
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Dziegielewski C, Fernando SM, Milani C, Mahdavi R, Talarico R, Thompson LH, Tanuseputro P, Kyeremanteng K. Outcomes and cost analysis of patients with dementia in the intensive care unit: a population-based cohort study. BMC Health Serv Res 2023; 23:1124. [PMID: 37858178 PMCID: PMC10588096 DOI: 10.1186/s12913-023-10095-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 09/30/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Dementia is a neurological syndrome affecting the growing elderly population. While patients with dementia are known to require significant hospital resources, little is known regarding the outcomes and costs of patients admitted to the intensive care unit (ICU) with dementia. METHODS We conducted a population-based retrospective cohort study of patients with dementia admitted to the ICU in Ontario, Canada from 2016 to 2019. We described the characteristics and outcomes of these patients alongside those with dementia admitted to non-ICU hospital settings. The primary outcome was hospital mortality but we also assessed length of stay (LOS), discharge disposition, and costs. RESULTS Among 114,844 patients with dementia, 11,341 (9.9%) were admitted to the ICU. ICU patients were younger, more comorbid, and had less cognitive impairment (81.8 years, 22.8% had ≥ 3 comorbidities, 47.5% with moderate-severe dementia), compared to those in non-ICU settings (84.2 years, 15.0% had ≥ 3 comorbidities, 54.1% with moderate-severe dementia). Total mean LOS for patients in the ICU group was nearly 20 days, compared to nearly 14 days for the acute care group. Mortality in hospital was nearly three-fold greater in the ICU group compared to non-ICU group (22.2% vs. 8.8%). Total healthcare costs were increased for patients admitted to ICU vs. those in the non-ICU group ($67,201 vs. $54,080). CONCLUSIONS We find that patients with dementia admitted to the ICU have longer length of stay, higher in-hospital mortality, and higher total healthcare costs. As our study is primarily descriptive, future studies should investigate comprehensive goals of care planning, severity of illness, preventable costs, and optimizing quality of life in this high risk and vulnerable population.
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Affiliation(s)
- C Dziegielewski
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - S M Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Critical Care, Lakeridge Health Corporation, Oshawa, ON, Canada
| | - C Milani
- ICES, University of Ottawa, Ottawa, ON, Canada
| | - R Mahdavi
- ICES, University of Ottawa, Ottawa, ON, Canada
| | - R Talarico
- ICES, University of Ottawa, Ottawa, ON, Canada
| | | | - P Tanuseputro
- ICES, University of Ottawa, Ottawa, ON, Canada
- Bruyere Research Institute, Ottawa, ON, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - K Kyeremanteng
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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Cholette F, Lazarus L, Macharia P, Thompson LH, Githaiga S, Mathenge J, Walimbwa J, Kuria I, Okoth S, Wambua S, Albert H, Mwangi P, Adhiambo J, Kasiba R, Juma E, Battacharjee P, Kimani J, Sandstrom P, Meyers AFA, Joy JB, Thomann M, McLaren PJ, Shaw S, Mishra S, Becker ML, McKinnon L, Lorway R. Community Insights in Phylogenetic HIV Research: The CIPHR Project Protocol. Glob Public Health 2023; 18:2269435. [PMID: 37851872 DOI: 10.1080/17441692.2023.2269435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 10/04/2023] [Indexed: 10/20/2023]
Abstract
Inferring HIV transmission networks from HIV sequences is gaining popularity in the field of HIV molecular epidemiology. However, HIV sequences are often analyzed at distance from those affected by HIV epidemics, namely without the involvement of communities most affected by HIV. These remote analyses often mean that knowledge is generated in absence of lived experiences and socio-economic realities that could inform the ethical application of network-derived information in 'real world' programmes. Procedures to engage communities are noticeably absent from the HIV molecular epidemiology literature. Here we present our team's protocol for engaging community activists living in Nairobi, Kenya in a knowledge exchange process - The CIPHR Project (Community Insights in Phylogenetic HIV Research). Drawing upon a community-based participatory approach, our team will (1) explore the possibilities and limitations of HIV molecular epidemiology for key population programmes, (2) pilot a community-based HIV molecular study, and (3) co-develop policy guidelines on conducting ethically safe HIV molecular epidemiology. Critical dialogue with activist communities will offer insight into the potential uses and abuses of using such information to sharpen HIV prevention programmes. The outcome of this process holds importance to the development of policy frameworks that will guide the next generation of the global response.
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Affiliation(s)
- François Cholette
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Sexually Transmitted and Blood-Borne Infections, National Microbiology Laboratory at JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
| | - Lisa Lazarus
- Institute for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Pascal Macharia
- Health Options for Young Men on HIV/AIDS and STIs (HOYMAS), Nairobi, Kenya
| | - Laura H Thompson
- Sexually Transmitted and Blood-Borne Infections Surveillance Division, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Canada
| | - Samuel Githaiga
- Health Options for Young Men on HIV/AIDS and STIs (HOYMAS), Nairobi, Kenya
| | - John Mathenge
- Health Options for Young Men on HIV/AIDS and STIs (HOYMAS), Nairobi, Kenya
| | | | - Irene Kuria
- Key Population Consortium of Kenya, Nairobi, Kenya
| | - Silvia Okoth
- Bar Hostess Empowerment and Support Programme, Nairobi, Kenya
| | | | - Harrison Albert
- Health Options for Young Men on HIV/AIDS and STIs (HOYMAS), Nairobi, Kenya
| | - Peninah Mwangi
- Bar Hostess Empowerment and Support Programme, Nairobi, Kenya
| | - Joyce Adhiambo
- Partners for Health Development in Africa (PHDA), Nairobi, Kenya
- Sex Worker Outreach Programme (SWOP), Nairobi, Kenya
| | | | - Esther Juma
- Sex Worker Outreach Programme (SWOP), Nairobi, Kenya
| | | | - Joshua Kimani
- Sex Worker Outreach Programme (SWOP), Nairobi, Kenya
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Paul Sandstrom
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Sexually Transmitted and Blood-Borne Infections, National Microbiology Laboratory at JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
| | - Adrienne F A Meyers
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Sexually Transmitted and Blood-Borne Infections, National Microbiology Laboratory at JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
| | - Jeffrey B Joy
- British Columbia Centre for Excellence in HIV/AIDS (BCCfE), St. Paul's Hospital, Vancouver, Canada
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, Canada
- Bioinformatics Programme, University of British Columbia, Vancouver, Canada
| | - Matthew Thomann
- Department of Anthropology, University of Maryland, College Park, MD, USA
| | - Paul J McLaren
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Sexually Transmitted and Blood-Borne Infections, National Microbiology Laboratory at JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
| | - Souradet Shaw
- Institute for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Sharmistha Mishra
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Marissa L Becker
- Institute for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lyle McKinnon
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
| | - Robert Lorway
- Institute for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
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Cantor N, Durr KM, McNeill K, Thompson LH, Fernando SM, Tanuseputro P, Kyeremanteng K. Increased Mortality and Costs Associated with Adverse Events in Intensive Care Unit Patients. J Intensive Care Med 2022; 37:1075-1081. [PMID: 35238691 DOI: 10.1177/08850666221084908] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Adverse events (AEs) are defined as unintended complications occurring to patients as a result of medical care. AEs are especially prevalent in the intensive care unit (ICU) setting and may lead to negative patient outcomes. Although many studies have examined the impact of AEs on patient outcomes, few have investigated their associated costs. Methods: The study population consisted of 17 173 adult patients (≥18 years of age) who were admitted to the ICU at The Ottawa Hospital (TOH) between 2011 and 2016. AEs were categorized using an established International Classification of Diseases 10th revision (ICD-10) patient safety indicators (PSI) system for AE detection. Logistic regression was performed to determine the association between AEs and in-hospital outcomes, including mortality. In addition, we constructed a generalized linear model to assess the independent association between AEs and total hospital costs. Results: Patients who experienced an AE had longer total hospital and ICU lengths of stay, required more invasive ICU interventions, had more complex discharge plans, and experienced higher rates of in-hospital mortality compared to those who did not experience an AE. Average total hospital costs and ICU-specific costs were higher among patients who experienced an AE ($72 718; $46 715) relative to their counterparts ($20 543; $16 217), but the per day cost was comparable in both groups. After controlling for age, sex, patient comorbidities, and illness severity, AEs were significantly associated with an increased odds of mortality (OR = 1.13, 95% CIs = 1.04, 1.22) and total average costs (Cost Ratio = 1.04, 95% CIs = 1.06, 1.08). The most impactful AE subtypes from a cost- and patient-perspective were hospital-acquired infections (HAI) and cardiac-related AEs. Conclusion: Incidence of AEs among ICU patients is associated with higher patient mortality and elevated costs. Specific causes of these AEs should be investigated, with further protocols and interventions developed to reduce their occurrence.
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Affiliation(s)
- Nathan Cantor
- 10055The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kevin M Durr
- Department of Emergency Medicine, 6363University of Ottawa, Ottawa, Canada
| | - Kylie McNeill
- Department of Medicine, 6363University of Ottawa, Ottawa, Canada
| | | | - Shannon M Fernando
- Department of Emergency Medicine, 6363University of Ottawa, Ottawa, Canada.,Division of Critical Care, Department of Medicine, 6363University of Ottawa, Ottawa, Canada
| | - Peter Tanuseputro
- Division of Palliative Care, Department of Medicine, 6363University of Ottawa, Ottawa, Canada.,152971Bruyère Research Institute, Ottawa, Canada.,ICES uOttawa, Ottawa, Canada
| | - Kwadwo Kyeremanteng
- Division of Critical Care, Department of Medicine, 6363University of Ottawa, Ottawa, Canada.,Division of Palliative Care, Department of Medicine, 6363University of Ottawa, Ottawa, Canada.,Clinical Epidemiology Program, 10055Ottawa Hospital Research Institute, 6363University of Ottawa, Ottawa, Ontario, Canada.,Institut du Savoir Montfort, Montfort Hospital, Ottawa, Ontario, Canada
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6
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Dziegielewski C, Talarico R, Imsirovic H, Qureshi D, Choudhri Y, Tanuseputro P, Thompson LH, Kyeremanteng K. Characteristics and resource utilization of high-cost users in the intensive care unit: a population-based cohort study. BMC Health Serv Res 2021; 21:1312. [PMID: 34872546 PMCID: PMC8647444 DOI: 10.1186/s12913-021-07318-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 02/22/2021] [Accepted: 11/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background Healthcare expenditure within the intensive care unit (ICU) is costly. A cost reduction strategy may be to target patients accounting for a disproportionate amount of healthcare spending, or high-cost users. This study aims to describe high-cost users in the ICU, including health outcomes and cost patterns. Methods We conducted a population-based retrospective cohort study of patients with ICU admissions in Ontario from 2011 to 2018. Patients with total healthcare costs in the year following ICU admission (including the admission itself) in the upper 10th percentile were defined as high-cost users. We compared characteristics and outcomes including length of stay, mortality, disposition, and costs between groups. Results Among 370,061 patients included, 37,006 were high-cost users. High-cost users were 64.2 years old, 58.3% male, and had more comorbidities (41.2% had ≥3) when likened to non-high cost users (66.1 years old, 57.2% male, 27.9% had ≥3 comorbidities). ICU length of stay was four times greater for high-cost users compared to non-high cost users (22.4 days, 95% confidence interval [CI] 22.0–22.7 days vs. 5.56 days, 95% CI 5.54–5.57 days). High-cost users had lower in-hospital mortality (10.0% vs.14.2%), but increased dispositioning outside of home (77.4% vs. 42.2%) compared to non-high-cost users. Total healthcare costs were five-fold higher for high-cost users ($238,231, 95% CI $237,020–$239,442) compared to non-high-cost users ($45,155, 95% CI $45,046–$45,264). High-cost users accounted for 37.0% of total healthcare costs. Conclusion High-cost users have increased length of stay, lower in-hospital mortality, and higher total healthcare costs when compared to non-high-cost users. Further studies into cost patterns and predictors of high-cost users are necessary to identify methods of decreasing healthcare expenditure. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07318-y.
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Affiliation(s)
| | | | | | - Danial Qureshi
- ICES, University of Ottawa, Ottawa, Ontario, Canada.,Bruyere Research Institute, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Yasmeen Choudhri
- Department of Life Sciences, Queen's University, Kingston, Ontario, Canada
| | - Peter Tanuseputro
- ICES, University of Ottawa, Ottawa, Ontario, Canada.,Bruyere Research Institute, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Kwadwo Kyeremanteng
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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7
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Lim AG, Trickey A, Thompson LH, Emmanuel F, Reza TE, Reynolds R, Cholette F, Melesse DY, Archibald C, Sandstrom P, Blanchard JF, Vickerman P. Elucidating Drivers for Variations in the Explosive Human Immunodeficiency Virus Epidemic Among People Who Inject Drugs in Pakistan. Open Forum Infect Dis 2021; 8:ofab457. [PMID: 34584901 PMCID: PMC8465332 DOI: 10.1093/ofid/ofab457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/01/2021] [Indexed: 11/23/2022] Open
Abstract
Background Pakistan’s explosive human immunodeficiency virus (HIV) epidemic among people who inject drugs (PWID) varies widely across cities. We evaluated possible drivers for these variations. Methods Multivariable regression analyses were undertaken using data from 5 national surveys among PWID (n = 18 467; 2005–2017) to determine risk factors associated with variations in city-level HIV prevalence. A dynamic HIV model was used to estimate the population-attributable fraction (PAF; proportion of HIV infections prevented over 10 years when that risk factor is removed) of these risk factors to HIV transmission and impact on HIV incidence of reducing their prevalence. Results Regression analyses suggested that city-level HIV prevalence is strongly associated with the prevalence of using professional injectors at last injection, heroin use in last month, and injecting ≥4 times per day. Through calibrating a model to these associations, we estimate that the 10-year PAFs of using professional injectors, heroin use, and frequent injecting are 45.3% (95% uncertainty interval [UI], 4.3%–79.7%), 45.9% (95% UI, 8.1%–78.4%), and 22.2% (95% UI, 2.0%–58.4%), respectively. Reducing to lowest city-level prevalences of using professional injectors (2.8%; median 89.9% reduction), heroin use (0.9%; median 91.2% reduction), and frequent injecting (0.1%; median 91.8% reduction) in 2020 reduces overall HIV incidence by 52.7% (95% UI, 6.1%–82.0%), 53.0% (95% UI, 11.3%–80.2%), and 28.1% (95% UI, 2.7%–66.6%), respectively, over 10 years. Conclusions Interventions should focus on these risk factors to control Pakistan’s explosive HIV epidemic among PWID, including a concomitant expansion of high-coverage needle/syringe provision, opioid substitution therapy, and antiretroviral therapy.
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Affiliation(s)
- Aaron G Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Adam Trickey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Laura H Thompson
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Faran Emmanuel
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada.,Canada-Pakistan HIV/AIDS Surveillance Project, Islamabad, Pakistan
| | - Tahira E Reza
- Canada-Pakistan HIV/AIDS Surveillance Project, Islamabad, Pakistan
| | - Rosy Reynolds
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - François Cholette
- National HIV and Retrovirology Laboratories, JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada.,Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | | | - Chris Archibald
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Canada
| | - Paul Sandstrom
- National HIV and Retrovirology Laboratories, JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
| | - James F Blanchard
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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8
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Schouela N, Kyeremanteng K, Thompson LH, Neilipovitz D, Shamy M, D'Egidio G. Cost of Futile ICU Care in One Ontario Hospital. Inquiry 2021; 58:469580211028577. [PMID: 34218711 PMCID: PMC8261843 DOI: 10.1177/00469580211028577] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Critical care is a costly and finite resource that provides the ability to manage
patients with life-threatening illnesses in the most advanced forms available.
However, not every condition benefits from critical care. There are
unrecoverable health states in which it should not be used to perpetuate. Such
situations are considered futile. The determination of medical futility remains
controversial. In this study we describe the length of stay (LOS), cost, and
long-term outcomes of 12 cases considered futile and that have been or were
considered for adjudication by Ontario’s Consent and Capacity Board (CBB). A
chart review was undertaken to identify patients admitted to the Intensive Care
Unit (ICU), whose care was deemed futile and cases were considered for, or
brought before the CCB. Costs for each of these admissions were determined using
the case-costing system of The Ottawa Hospital Data Warehouse. All 12 patients
identified had a LOS of greater than 4 months (range: 122-704 days) and a median
age 83.5 years. Seven patients died in hospital, while 5 were transferred to
long term or acute care facilities. All patients ultimately died without
returning to independent living situations. The total cost of care for these 12
patients was $7 897 557.85 (mean: $658 129.82). There is a significant economic
cost of providing resource-intensive critical care to patients in which these
treatments are considered futile. Clinicians should carefully consider the
allocation of finite critical care resources in order to utilize them in a way
that most benefits patients.
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Affiliation(s)
| | | | | | | | - Michel Shamy
- University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
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9
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Fernando SM, Qureshi D, Sood MM, Pugliese M, Talarico R, Myran DT, Herridge MS, Needham DM, Rochwerg B, Cook DJ, Wunsch H, Fowler RA, Scales DC, Bienvenu OJ, Rowan KM, Kisilewicz M, Thompson LH, Tanuseputro P, Kyeremanteng K. Suicide and self-harm in adult survivors of critical illness: population based cohort study. BMJ 2021; 373:n973. [PMID: 33952509 PMCID: PMC8097311 DOI: 10.1136/bmj.n973] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To analyse the association between survival from critical illness and suicide or self-harm after hospital discharge. DESIGN Population based cohort study using linked and validated provincial databases. SETTING Ontario, Canada between January 2009 and December 2017 (inclusive). PARTICIPANTS Consecutive adult intensive care unit (ICU) survivors (≥18 years) were included. Linked administrative databases were used to compare ICU hospital survivors with hospital survivors who never required ICU admission (non-ICU hospital survivors). Patients were categorised based on their index hospital admission (ICU or non-ICU) during the study period. MAIN OUTCOME MEASURES The primary outcome was the composite of death by suicide (as noted in provincial death records) and deliberate self-harm events after discharge. Each outcome was also assessed independently. Incidence of suicide was evaluated while accounting for competing risk of death from other causes. Analyses were conducted by using overlap propensity score weighted, cause specific Cox proportional hazard models. RESULTS 423 060 consecutive ICU survivors (mean age 61.7 years, 39% women) were identified. During the study period, the crude incidence (per 100 000 person years) of suicide, self-harm, and the composite of suicide or self-harm among ICU survivors was 41.4, 327.9, and 361.0, respectively, compared with 16.8, 177.3, and 191.6 in non-ICU hospital survivors. Analysis using weighted models showed that ICU survivors (v non-ICU hospital survivors) had a higher risk of suicide (adjusted hazards ratio 1.22, 95% confidence interval 1.11 to 1.33) and self-harm (1.15, 1.12 to 1.19). Among ICU survivors, several factors were associated with suicide or self-harm: previous depression or anxiety (5.69, 5.38 to 6.02), previous post-traumatic stress disorder (1.87, 1.64 to 2.13), invasive mechanical ventilation (1.45, 1.38 to 1.54), and renal replacement therapy (1.35, 1.17 to 1.56). CONCLUSIONS Survivors of critical illness have increased risk of suicide and self-harm, and these outcomes were associated with pre-existing psychiatric illness and receipt of invasive life support. Knowledge of these prognostic factors might allow for earlier intervention to potentially reduce this important public health problem.
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Affiliation(s)
- Shannon M Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Danial Qureshi
- ICES, Toronto, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Manish M Sood
- ICES, Toronto, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Michael Pugliese
- ICES, Toronto, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Robert Talarico
- ICES, Toronto, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Daniel T Myran
- ICES, Toronto, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Margaret S Herridge
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Dale M Needham
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Deborah J Cook
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Hannah Wunsch
- ICES, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Robert A Fowler
- ICES, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Damon C Scales
- ICES, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - O Joseph Bienvenu
- Department of Psychiatry and Behavioural Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathryn M Rowan
- Intensive Care National Audit and Research Centre, Napier House, London, UK
| | | | - Laura H Thompson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Peter Tanuseputro
- ICES, Toronto, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kwadwo Kyeremanteng
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
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10
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Cholette F, Joy J, Pelcat Y, Thompson LH, Pilon R, Ho J, Capina R, Archibald C, Blanchard JF, Emmanuel F, Reza T, Dar N, Harrigan R, Kim J, Sandstrom P. HIV-1 phylodynamic analysis among people who inject drugs in Pakistan correlates with trends in illicit opioid trade. PLoS One 2020; 15:e0237560. [PMID: 32857765 PMCID: PMC7454939 DOI: 10.1371/journal.pone.0237560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 07/30/2020] [Indexed: 12/26/2022] Open
Abstract
Pakistan is considered by the World Health Organization to currently have a "concentrated" HIV-1 epidemic due to a rapid rise in infections among people who inject drugs (PWID). Prevalence among the country's nearly 105,000 PWID is estimated to be 37.8% but has been shown to be higher in several large urban centers. A lack of public health resources, the common use of professional injectors and unsafe injection practices are believed to have fueled the outbreak. Here we evaluate the molecular characteristics of HIV-1 sequences (n = 290) from PWID in several Pakistani cities to examine transmission dynamics and the association between rates of HIV-1 transmission with regards to regional trends in opioid trafficking. Tip-to-tip (patristic) distance based phylogenetic cluster inferences and BEAST2 Bayesian phylodynamic analyses of time-stamped data were performed on HIV-1 pol sequences generated from dried blood spots collected from 1,453 PWID as part of a cross-sectional survey conducted in Pakistan during 2014/2015. Overall, subtype A1 strains were dominant (75.2%) followed by CRF02_AG (14.1%), recombinants/unassigned (7.2%), CRF35_AD (2.1%), G (1.0%) and C (0.3%). Nearly three quarters of the PWID HIV-1 sequences belonged to one of five distinct phylogenetic clusters. Just below half (44.4%) of individuals in the largest cluster (n = 118) did seek help injecting from professional injectors which was previously identified as a strong correlate of HIV-1 infection. Spikes in estimated HIV-1 effective population sizes coincided with increases in opium poppy cultivation in Afghanistan, Pakistan's western neighbor. Structured coalescent analysis was undertaken in order to investigate the spatial relationship of HIV-1 transmission among the various cities under study. In general terms, our analysis placed the city of Larkana at the center of the PWID HIV-1 epidemic in Pakistan which is consistent with previous epidemiological data.
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Affiliation(s)
- François Cholette
- National HIV and Retrovirology Laboratories, National Microbiology Laboratory at the JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jeffrey Joy
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Bioinformatics Programme, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yann Pelcat
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Saint-Hyacinthe, Québec, Canada
| | - Laura H. Thompson
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Richard Pilon
- National HIV and Retrovirology Laboratories, National Microbiology Laboratory at the JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - John Ho
- National HIV and Retrovirology Laboratories, National Microbiology Laboratory at the JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Rupert Capina
- National HIV and Retrovirology Laboratories, National Microbiology Laboratory at the JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Chris Archibald
- Centre for Communicable Diseases and Infection Control, Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - James F. Blanchard
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Faran Emmanuel
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Tahira Reza
- Centre for Global Public Health, Pakistan, Chak Shahzad, Islamabad, Pakistan
| | - Nosheen Dar
- Canada-Pakistan HIV/AIDS Surveillance Project, Islamabad, Pakistan
| | - Richard Harrigan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - John Kim
- National HIV and Retrovirology Laboratories, National Microbiology Laboratory at the JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Paul Sandstrom
- National HIV and Retrovirology Laboratories, National Microbiology Laboratory at the JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
- Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
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11
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Krechowicz R, Gupta M, Gratton V, Hickey C, Thompson LH, Kyeremanteng K. Case Discussions in Advanced Care Planning. Am J Hosp Palliat Care 2020; 38:366-370. [PMID: 32787564 DOI: 10.1177/1049909120948495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Advanced care planning (ACP) provides an opportunity for individuals to explore and document their values concerning medical care decisions prior to an acute event. This manuscript explores the value of ACP and compares and contrasts 2 ACP models currently in practice. METHODS This hypothetical case describes an elderly, frail patient with end-stage chronic obstructive pulmonary disease who is also a high user of health care resources. A new palliative care-led outpatient ACP clinic model is described using this example. RESULTS Using the ACP clinic model in this case reveals how different a patient's end of life experience may be when proper, proactive planning measures are in place. With proper education and discussion around this patient and family's wishes pertaining to the end of his life, this man was able to change his plan of care from aggressive resuscitation treatment in hospital to a peaceful palliative experience at home. CONCLUSIONS In this case description, the valuable role of ACP in preserving quality of life for patients, increasing satisfaction with care, and decreasing distress among family members during a medical event is demonstrated.
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Affiliation(s)
- Regine Krechowicz
- Department of Medicine, 153006University of Ottawa, Ottawa, Ontario, Canada
| | - Melini Gupta
- Department of Medicine, 153006University of Ottawa, Ottawa, Ontario, Canada
| | - Valerie Gratton
- Department of Medicine, 153006University of Ottawa, Ottawa, Ontario, Canada.,551435Institut du Savoir Montfort, Ottawa, Ontario, Canada
| | - Carly Hickey
- 60378Queensway Carleton Hospital, Ottawa, Ontario, Canada
| | - Laura H Thompson
- 10055Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kwadwo Kyeremanteng
- Division of Palliative Care, 153006Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Critical Care, 153006Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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12
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Warwick M, Fernando SM, Aaron SD, Rochwerg B, Tran A, Thavorn K, Mulpuru S, McIsaac DI, Thompson LH, Tanuseputro P, Kyeremanteng K. Outcomes and Resource Utilization Among Patients Admitted to the Intensive Care Unit Following Acute Exacerbation of Chronic Obstructive Pulmonary Disease. J Intensive Care Med 2020; 36:1091-1097. [PMID: 32720561 DOI: 10.1177/0885066620944865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE Chronic obstructive pulmonary disease (COPD) is a common condition, accounting for a significant number of intensive care unit (ICU) admissions. However, little is known about outcomes and costs among ICU patients admitted with acute exacerbations of COPD (AECOPD). We studied predictors of inhospital mortality and costs of ICU admissions for AECOPD. METHODS Data were obtained from a prospectively maintained registry from 2 ICUs from 2011 to 2016, including adult patients (age ≥ 18) with an ICU discharge diagnosis of AECOPD. The primary outcome was hospital mortality. Secondary outcomes included ICU length of stay, resource utilization, total hospital costs, and cost per survivor. RESULTS We included 390 patients, of which 27.2% died in hospital. Independent predictors of inhospital mortality included age (odds ratio [OR]: 1.95, CI: 1.58-2.67) and the presence of clinical frailty (OR: 4.12, CI: 2.26-6.95). The mean total hospital costs were Can$35 059, with a cost per survivor of Can$48 191. Factors associated with increased cost included transfer from an inpatient setting, severity of illness, and previous ICU admission. CONCLUSIONS Approximately a quarter of patients admitted to ICU with AECOPD died during hospitalization, and these patients accrued significant costs. This study identifies important factors associated with poor outcome in this at-risk population, which has value in risk stratification and patient or family discussions addressing goals of care.
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Affiliation(s)
- Madeleine Warwick
- Division of Respirology and Sleep Medicine, Department of Medicine, 4257Queen's University, Kingston, Ontario, Canada
| | - Shannon M Fernando
- Division of Critical Care, Department of Medicine, 6363University of Ottawa, Ontario, Canada.,Department of Emergency Medicine, 6363University of Ottawa, Ontario, Canada
| | - Shawn D Aaron
- Division of Respiratory Medicine, Department of Medicine, 6363University of Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, 6363University of Ottawa, Ontario, Canada.,Clinical Epidemiology Program, 10055Ottawa Hospital Research Institute, Ontario, Canada
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, 3710McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alexandre Tran
- School of Epidemiology and Public Health, 6363University of Ottawa, Ontario, Canada.,Department of Surgery, 6363University of Ottawa, Ontario, Canada
| | - Kednapa Thavorn
- School of Epidemiology and Public Health, 6363University of Ottawa, Ontario, Canada.,Clinical Epidemiology Program, 10055Ottawa Hospital Research Institute, Ontario, Canada
| | - Sunita Mulpuru
- Division of Respiratory Medicine, Department of Medicine, 6363University of Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, 6363University of Ottawa, Ontario, Canada.,Clinical Epidemiology Program, 10055Ottawa Hospital Research Institute, Ontario, Canada
| | - Daniel I McIsaac
- School of Epidemiology and Public Health, 6363University of Ottawa, Ontario, Canada.,Clinical Epidemiology Program, 10055Ottawa Hospital Research Institute, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, 6363University of Ottawa, Ontario, Canada
| | - Laura H Thompson
- Clinical Epidemiology Program, 10055Ottawa Hospital Research Institute, Ontario, Canada
| | - Peter Tanuseputro
- School of Epidemiology and Public Health, 6363University of Ottawa, Ontario, Canada.,Clinical Epidemiology Program, 10055Ottawa Hospital Research Institute, Ontario, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Kwadwo Kyeremanteng
- Division of Critical Care, Department of Medicine, 6363University of Ottawa, Ontario, Canada.,Clinical Epidemiology Program, 10055Ottawa Hospital Research Institute, Ontario, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ontario, Canada.,Institut du Savoir Montfort, Ottawa, Ontario, Canada
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13
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Thompson LH, Lang JJ, Olibris B, Gauthier-Beaupré A, Cook H, Gillies D, Orpana H. Participatory model building for suicide prevention in Canada. Int J Ment Health Syst 2020; 14:27. [PMID: 32266005 PMCID: PMC7118927 DOI: 10.1186/s13033-020-00359-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/20/2020] [Indexed: 01/02/2023] Open
Abstract
Background Suicide is a behaviour that results from a complex interplay of factors, including biological, psychological, social, cultural, and environmental factors, among others. A participatory model building workshop was conducted with fifteen employees working in suicide prevention at a federal public health organization to develop a conceptual model illustrating the interconnections between such factors. Through this process, knowledge emerged from participants and consensus building occurred, leading to the development of a conceptual model that is useful to organize and communicate the complex interrelationships between factors related to suicide. Methods A model building script was developed for the facilitators to lead the participants through a series of group and individual activities that were designed to elicit participants' implicit models of risk and protective factors for suicide in Canada. Participants were divided into three groups and tasked with drawing the relationships between factors associated with suicide over a simplified suicide process model. Participants were also tasked with listing prevention levers that are in use in Canada and/or described in the scientific literature. Results Through the workshop, risk and prevention factors and prevention levers were listed and a conceptual model was drafted. Several "lessons learned" which could improve future workshops were generated through reflection on the process. Conclusions This workshop yielded a helpful conceptual model contextualising upstream factors that can be used to better understand suicide prevention efforts in Canada.
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Affiliation(s)
- Laura H Thompson
- 1Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Canada.,2Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Justin J Lang
- 1Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Canada
| | - Brieanne Olibris
- 3Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Amélie Gauthier-Beaupré
- 3Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada.,4Centre for Chronic Disease Prevention and Health Equity, Public Health Agency of Canada, Ottawa, Canada
| | - Heather Cook
- 5Centre for Health Promotion, Public Health Agency of Canada, Ottawa, Canada.,6Faculty of Humanities and Social Sciences, Memorial University of Newfoundland, St. John's, Canada
| | - Dakota Gillies
- 1Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Canada
| | - Heather Orpana
- 1Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Canada.,7School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
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14
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Zheng B, Reardon PM, Fernando SM, Webber C, Thavorn K, Thompson LH, Tanuseputro P, Munshi L, Kyeremanteng K. Costs and Outcomes of Patients Admitted to the Intensive Care Unit With Cancer. J Intensive Care Med 2020; 36:203-210. [PMID: 31950870 DOI: 10.1177/0885066619899653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Cancer is associated with significant health-care expenditure, but few studies have examined the cost of patients with cancer in the intensive care unit (ICU). We aimed to describe the costs and outcomes of patients admitted to the ICU with cancer. METHODS We conducted a retrospective cohort study of patients admitted between 2011 and 2016 to 2 tertiary-care ICUs. We included patients with a cancer-related most responsible diagnosis using International Classification of Disease, 10th Revision, Canada codes. We compared costs and outcomes of patients having cancer with noncancer controls matched for age, sex, and Elixhauser comorbidity score. We used logistic regression to determine predictors of mortality among patients with cancer. RESULTS There were 1022 patients with cancer during the study period. Mean age was 63.2 years and 577 (56.5%) were male. Inhospital mortality for all patients with cancer was 24.0%. Total cost per patient was higher for patients with cancer compared to noncancer patients (CAD$57 084 vs CAD$40 730; P < .001) but there were no differences in the cost per day (CAD$2868 vs CAD$2887; P = .76) or ICU cost (CAD$30 495 vs CAD$29 382; P = .42). Among patients with cancer, the cost per day was higher for nonsurvivors (CAD$3477 vs CAD$2677; P < .001). Liver disease (odds ratio [OR]: 2.96; 95% confidence interval [CI]: 1.22-7.81), mechanical ventilation (OR: 1.73; 95% CI: 1.25-2.39), hematologic malignancy (OR: 3.88; 95% CI: 2.31-6.54), and unknown primary site (OR: 2.13; 95% CI: 1.36-3.35) were independently associated with mortality in patients with cancer. CONCLUSION Patients admitted to the ICU with cancer did not differ in cost per day, ICU cost, or mortality compared to matched noncancer controls. Among patients with cancer, nonsurvivors had significantly higher cost per day compared to survivors. Hematologic and unknown primaries, liver disease, and mechanical ventilation were independently associated with mortality in patients with cancer.
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Affiliation(s)
- Bo Zheng
- Department of Emergency Medicine, 6363University of Ottawa, Ontario, Canada
| | - Peter M Reardon
- Department of Emergency Medicine, 6363University of Ottawa, Ontario, Canada.,Division of Critical Care, Department of Medicine, 6363University of Ottawa, Ontario, Canada
| | - Shannon M Fernando
- Department of Emergency Medicine, 6363University of Ottawa, Ontario, Canada.,Division of Critical Care, Department of Medicine, 6363University of Ottawa, Ontario, Canada
| | - Colleen Webber
- Clinical Epidemiology Program, 10055Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, 10055Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Laura H Thompson
- Clinical Epidemiology Program, 10055Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, 10055Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Division of Palliative Care, Department of Medicine, 6363University of Ottawa, Ontario, Canada
| | - Laveena Munshi
- Division of Critical Care Medicine, 12366University of Toronto, Ontario, Canada
| | - Kwadwo Kyeremanteng
- Division of Critical Care, Department of Medicine, 6363University of Ottawa, Ontario, Canada.,Clinical Epidemiology Program, 10055Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Division of Palliative Care, Department of Medicine, 6363University of Ottawa, Ontario, Canada
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15
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Thompson LH, Dutta S, Bhattacharjee P, Leung S, Bhowmik A, Prakash R, Isac S, Lorway RR. Violence and Mental Health Among Gender-Diverse Individuals Enrolled in a Human Immunodeficiency Virus Program in Karnataka, South India. Transgend Health 2019; 4:316-325. [PMID: 31701013 PMCID: PMC6837158 DOI: 10.1089/trgh.2018.0051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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] [Indexed: 01/09/2023] Open
Abstract
Purpose: Gender-diverse individuals in India face considerable discrimination, stigma, and violence. There is a dearth of published literature describing experiences of violence among this population and potential links to mental health. Methods: A questionnaire was administered to 282 study participants, 18 years of age and older, who self-identified as hijra, kothi, double decker, or bisexual and were actively enrolled in a local HIV prevention program in Bangalore, India in 2012. Responses were used to calculate a composite depression/anxiety score. Associations between sociodemographic characteristics and experiences of physical and sexual violence in the previous six months were tested and differences in depression/anxiety score based on experiences of violence were explored. Results: Recent physical violence was common among study participants and was reported among 46% of nirvan (emasculated) hijras (transgender), 42% of akwa (not emasculated) hijras, and 25% of kothis (feminine acting males). Rape in the previous year was particularly common among akwa hijras (39%). Factors associated with being raped included younger age, less education, and employment in basti (blessings), sex work, chela (disciple of hijra guru), or at a community-based organization. Kothis had the highest depression/anxiety score. No significant difference in depression/anxiety score based on recent history of physical violence or rape was found. Conclusions: Physical violence and poor mental health are common among gender-diverse individuals in Bangalore, Karnataka. There is a need for services that cater to the unique mental health needs of gender-diverse individuals in India, following rights-based approaches that address the underlying roots of oppression they encounter.
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Affiliation(s)
- Laura H Thompson
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Sumit Dutta
- Department of Social Studies, Dr. K.N. Modi University, Newai, India.,Philips Innovation Campus, Bangalore, India
| | - Parinita Bhattacharjee
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Stella Leung
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | | | - Ravi Prakash
- Karnataka Health Promotion Trust, Bangalore, India
| | - Shajy Isac
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Canada.,Karnataka Health Promotion Trust, Bangalore, India
| | - Robert R Lorway
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
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16
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Thompson LH, Nugent Z, Wylie JL, Loeppky C, Van Caeseele P, Blanchard JF, Yu N. Laboratory Detection of First and Repeat Chlamydia Cases Influenced by Testing Patterns: A Population-Based Study. Microbiol Insights 2019; 12:1178636119827975. [PMID: 30833813 PMCID: PMC6393833 DOI: 10.1177/1178636119827975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 12/28/2018] [Indexed: 12/03/2022] Open
Abstract
Objectives: The purpose of this study was to describe and explore potential driving factors of trends in reported chlamydia infections over time in Manitoba, Canada. Methods: Surveillance and laboratory testing data from Manitoba Health, Seniors and Active Living were analysed using SAS v9.4. Kaplan-Meier plots of time from the first to second chlamydia infection were constructed, and Cox proportional hazards regression was used to estimate the risk of second repeat chlamydia infections in males and females. Results: Overall, the number of reported infections found mirrored the number of tests conducted. From 2008 to 2014, the number of first infections found among females decreased as the number of first tests conducted among females also decreased. Between 2008 and 2012, the number of repeat tests among females increased and was accompanied by an increase in the number of repeat positive results from 2009 to 2013. From 2008 to 2016, the number of repeat tests and repeat positive results increased steadily among males. Conclusions: Chlamydia infection rates consistently included a subset composed of repeat infections. The number of cases identified appears to mirror testing volumes, drawing into question incidence calculations that do not include testing volumes. Summary Box: 1) What is the current understanding of this subject? Chlamydia incidence is high in Manitoba, particularly among young women and in northern Manitoba. 2) What does this report add to the literature? This report suggests that incidence calculated using case-based surveillance data alone does not provide an accurate estimate of chlamydia incidence in Manitoba and is heavily influenced by testing patterns. 3) What are the implications for public health practice? In general, improving testing rates in clinical practices as well as through the provision of rapid services in non-clinical venues could result in higher screening and treatment rates. In turn, this could lead to a better understanding of true disease occurrence.
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Affiliation(s)
- Laura H Thompson
- Centre for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | | | - John L Wylie
- Cadham Provincial Laboratory, Manitoba Health, Seniors and Active Living, Winnipeg, MB, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Carla Loeppky
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Epidemiology and Surveillance Unit, Public Health and Primary Health Care Division, Manitoba Health, Seniors and Active Living, Winnipeg, MB, Canada
| | - Paul Van Caeseele
- Cadham Provincial Laboratory, Manitoba Health, Seniors and Active Living, Winnipeg, MB, Canada
| | - James F Blanchard
- Centre for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | - Nancy Yu
- Centre for Global Public Health, University of Manitoba, Winnipeg, MB, Canada.,Epidemiology and Surveillance Unit, Public Health and Primary Health Care Division, Manitoba Health, Seniors and Active Living, Winnipeg, MB, Canada
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Becker M, Mishra S, Aral S, Bhattacharjee P, Lorway R, Green K, Anthony J, Isac S, Emmanuel F, Musyoki H, Lazarus L, Thompson LH, Cheuk E, Blanchard JF. The contributions and future direction of Program Science in HIV/STI prevention. Emerg Themes Epidemiol 2018; 15:7. [PMID: 29872450 PMCID: PMC5972407 DOI: 10.1186/s12982-018-0076-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 09/08/2017] [Accepted: 05/18/2018] [Indexed: 01/19/2023] Open
Abstract
Background Program Science is an iterative, multi-phase research and program framework where programs drive the scientific inquiry, and both program and science are aligned towards a collective goal of improving population health. Discussion To achieve this, Program Science involves the systematic application of theoretical and empirical knowledge to optimize the scale, quality and impact of public health programs. Program Science tools and approaches developed for strategic planning, program implementation, and program management and evaluation have been incorporated into HIV and sexually transmitted infection prevention programs in Kenya, Nigeria, India, and the United States. Conclusion In this paper, we highlight key scientific contributions that emerged from the growing application of Program Science in the field of HIV and STI prevention, and conclude by proposing future directions for Program Science.
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Affiliation(s)
- Marissa Becker
- 1Centre for Global Public Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Sharmistha Mishra
- 2Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,3Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sevgi Aral
- 4Division of STD Prevention, The National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Parinita Bhattacharjee
- 1Centre for Global Public Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Karnataka Health Promotion Trust, Bangalore, India
| | - Rob Lorway
- 1Centre for Global Public Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Kalada Green
- 1Centre for Global Public Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - John Anthony
- 1Centre for Global Public Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Shajy Isac
- Karnataka Health Promotion Trust, Bangalore, India
| | - Faran Emmanuel
- 1Centre for Global Public Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Helgar Musyoki
- 6National AIDS and STI Control Program, Ministry of Health, Nairobi, Kenya
| | - Lisa Lazarus
- 1Centre for Global Public Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Laura H Thompson
- 1Centre for Global Public Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Eve Cheuk
- 1Centre for Global Public Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - James F Blanchard
- 1Centre for Global Public Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Shaw SY, Lorway R, Bhattacharjee P, Reza-Paul S, du Plessis E, McKinnon L, Thompson LH, Isac S, Ramesh BM, Washington R, Moses S, Blanchard JF. Descriptive Epidemiology of Factors Associated with HIV Infections Among Men and Transgender Women Who Have Sex with Men in South India. LGBT Health 2016; 3:292-9. [PMID: 27058882 PMCID: PMC4976224 DOI: 10.1089/lgbt.2015.0023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose: Men and transgender women who have sex with men (MTWSM) continue to be an at-risk population for human immunodeficiency virus (HIV) infection in India. Identification of risk factors and determinants of HIV infection is urgently needed to inform prevention and intervention programming. Methods: Data were collected from cross-sectional biological and behavioral surveys from four districts in Karnataka, India. Multivariable logistic regression models were constructed to examine factors related to HIV infection. Sociodemographic, sexual history, sex work history, condom practices, and substance use covariates were included in regression models. Results: A total of 456 participants were included; HIV prevalence was 12.4%, with the highest prevalence (26%) among MTWSM from Bellary District. In bivariate analyses, district (P = 0.002), lack of a current regular female partner (P = 0.022), and reported consumption of an alcoholic drink in the last month (P = 0.004) were associated with HIV infection. In multivariable models, only alcohol use remained statistically significant (adjusted odds ratios: 2.6, 95% confidence intervals: 1.2–5.8; P = 0.02). Conclusion: The prevalence of HIV continues to be high among MTWSM, with the highest prevalence found in Bellary district.
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Affiliation(s)
- Souradet Y Shaw
- 1 Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba , Winnipeg, Manitoba, Canada
| | - Robert Lorway
- 1 Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba , Winnipeg, Manitoba, Canada
| | | | - Sushena Reza-Paul
- 1 Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba , Winnipeg, Manitoba, Canada
| | - Elsabé du Plessis
- 1 Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba , Winnipeg, Manitoba, Canada
| | - Lyle McKinnon
- 3 Department of Medicine, University of Toronto , Toronto, Ontario, Canada .,4 Department of Medical Microbiology, University of Nairobi , Nairobi, Kenya
| | - Laura H Thompson
- 1 Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba , Winnipeg, Manitoba, Canada
| | - Shajy Isac
- 2 Karnataka Health Promotion Trust , Bangalore, India
| | | | - Reynold Washington
- 2 Karnataka Health Promotion Trust , Bangalore, India .,5 St. John's Research Institute , Bangalore, India
| | - Stephen Moses
- 1 Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba , Winnipeg, Manitoba, Canada .,6 Department of Medical Microbiology, University of Manitoba , Winnipeg, Manitoba, Canada
| | - James F Blanchard
- 1 Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba , Winnipeg, Manitoba, Canada
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Thompson LH, Nugent Z, Blanchard JF, Ens C, Yu BN. Increasing incidence of anogenital warts with an urban-rural divide among males in Manitoba, Canada, 1990-2011. BMC Public Health 2016; 16:219. [PMID: 26939696 PMCID: PMC4778275 DOI: 10.1186/s12889-016-2885-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 07/27/2015] [Accepted: 02/17/2016] [Indexed: 11/24/2022] Open
Abstract
Background Anogenital warts (AGW) are caused by the most common sexually transmitted infection, human papillomavirus. The objective of this study was to examine AGW incidence from 1990 to 2011 by sex, age, income quintile, and residential area category (urban/rural). The study period included the initiation of school-based HPV vaccination for girls in the sixth grade, which began in 2008. The data presented in this paper may also be useful for establishing baseline rates of AGW incidence which may be used to evaluate the success of the school-based HPV immunization program. Methods Cases of anogenital warts were identified using Manitoba’s administrative databases of Physician Claims and Hospital Discharge Abstracts. Annual age-standardized incidence in Manitoba from 1990 to 2011 was calculated. Incident AGW rates were compared by sex, age group, residential area category (urban/rural), and household income quintile using logistic regression. Joinpoint regression analyses were used to evaluate the time trends of AGW. Results Prior to 2000, AGW incidence was higher among females than males. However, from 2000 to 2011 the incidence was higher among males and increased steadily over time. AGW incidence tended to peak in younger age groups among females compared to males. Females and males living in urban areas had nearly twice the odds of AGW occurrence compared to those in rural areas. Conclusions There is a need for education about AGW in male population. The upcoming initiation of HPV vaccination among boys may reduce the incidence and should be evaluated. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-2885-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laura H Thompson
- Epidemiology and Surveillance Unit, Public Health and Primary Health Care Division, Manitoba Health, Healthy Living & Seniors, Winnipeg, R3B 3 M9, Manitoba, Canada.,Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Zoann Nugent
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - James F Blanchard
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Carla Ens
- Epidemiology and Surveillance Unit, Public Health and Primary Health Care Division, Manitoba Health, Healthy Living & Seniors, Winnipeg, R3B 3 M9, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Bo Nancy Yu
- Epidemiology and Surveillance Unit, Public Health and Primary Health Care Division, Manitoba Health, Healthy Living & Seniors, Winnipeg, R3B 3 M9, Manitoba, Canada. .,Centre for Global Public Health, University of Manitoba, Winnipeg, Canada.
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Melesse DY, Shafer LA, Shaw SY, Thompson LH, Achakzai BK, Furqan S, Reza T, Emmanuel F, Blanchard JF. Heterogeneity Among Sex Workers in Overlapping HIV Risk Interactions With People Who Inject Drugs: A Cross-Sectional Study From 8 Major Cities in Pakistan. Medicine (Baltimore) 2016; 95:e3085. [PMID: 27015178 PMCID: PMC4998373 DOI: 10.1097/md.0000000000003085] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Concerns remain regarding the heterogeneity in overlapping human immunodeficiency virus (HIV) risk behaviors among sex workers (SWs) in Pakistan; specifically, the degree to which SWs interact with people who inject drugs (PWID) through sex and/or needle sharing.Following an in-depth mapping performed in 2011 to determine the size and distribution of key populations at highest risk of HIV acquisition in Pakistan, a cross-sectional biological and behavioral survey was conducted among PWID, female (FSWs), male (MSWs), and hijra/transgender (HSWs) sex workers, and data from 8 major cities were used for analyses. Logistic regression was used to identify factors, including city of residence and mode of SW-client solicitation, contributing to the overlapping risks of drug injection and sexual interaction with PWID.The study comprised 8483 SWs (34.5% FSWs, 32.4% HSWs, and 33.1% MSWs). Among SWs who had sex with PWID, HSWs were 2.61 (95% confidence interval [CI], 1.19-5.74) and 1.99 (95% CI, 0.94-4.22) times more likely to inject drugs than MSWs and FSWs, respectively. There was up to a 3-fold difference in drug injecting probability, dependent on where and/or how the SW solicited clients. Compared with SWs in Larkana, the highest likelihood of drug injection use was among SWs in Multan (OR = 4.52; 95% CI: 3.27-6.26), followed by those in Lahore, Quetta, and Faisalabad.Heterogeneity exists in the overlapping patterns of HIV risk behaviors of SWs. The risk of drug injection among SWs also varies by city. Some means of sexual client solicitation may be along the pathway to overlapping HIV risk vulnerability due to increased likelihood of drug injection among SWs. There is a need to closely to monitor the mixing patterns between SWs and PWID and underlying structural factors, such as means of sexual client solicitation, that mediate HIV risk, and implement prevention programs customized to local subepidemics.
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Affiliation(s)
- Dessalegn Y Melesse
- From the Centre for Global Public Health, Department of Community Health Sciences (DYM, SYS, LHT, FE, JFB); Department of Internal Medicine (LAS), Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; and National AIDS Control Program (BKA, SF, TR), National Institute of Health, Islamabad, Pakistan
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Deering KN, Shaw SY, Thompson LH, Ramanaik S, Raghavendra T, Doddamane M, Bhattacharjee P, Moses S, Lorway R. Fertility intentions, power relations and condom use within intimate and other non-paying partnerships of women in sex work in Bagalkot District, South India. AIDS Care 2015; 27:1241-9. [PMID: 26295360 DOI: 10.1080/09540121.2015.1050981] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study aimed to: (1) examine the relationship between interpersonal as well as social-demographic, cultural and structural factors, and condom non-use by sex workers' main intimate or other non-paying male sex partners (NPPs), as reported by a sample of sex workers (SWs); and (2) understand HIV/sexually transmitted infections (STIs) risk (e.g., numbers of sexual partners; condom use with different partners) among couples comprised of a sub-set of SWs and their NPPs. Bivariate and multivariable logistic regression was used to identify factors associated with condom non-use at last sex by the main NPP, as reported by SWs. Adjusted odds ratios and 95% confidence intervals are reported (AOR[95%CIs]). Data were drawn from cross-sectional surveys in Bagalkot District, Karnataka State, South India. Responses by SWs whose main NPPs agreed to enrol in the study and the main NPP enroled were linked; these responses by couples (pairs of SWs and NPPs) were examined to assess sexual risk for HIV/STIs. Overall, this study included 257 SWs and 76 NPPs. The data from 67 couples (88.2%) could be linked. In over a quarter of partnerships, at least one (SW or NPP) partner reported having another type of partner besides each other (and clients of SWs). In multivariable analysis, significantly increased odds of condom non-use at last sex with the main NPP were found for the following key factors: planning to have a child with their main NPP (AOR = 3.71[1.44-9.58]); and having decisions about condom use made by their main NPP (AOR = 9.87[4.03-24.16]) or both equally (AOR = 3.18[1.39-7.80]) (versus by the SWs herself). Our study highlights the potential risk for HIV/STI acquisition and transmission between NPPs and SWs, and between NPPs and their non-SWs wives and other sex partners. Study results underscore the need for HIV/STI prevention approaches that incorporate informed decision-making about childbearing and parenting, and empowerment strategies for SWs in the context of their relationships with NPPs.
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Affiliation(s)
- Kathleen N Deering
- a Faculty of Medicine, Division of AIDS , University of British Columbia , Vancouver , Canada.,b BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada
| | - Souradet Y Shaw
- c Faculty of Medicine, Community Health Sciences , University of Manitoba , Winnipeg , Canada
| | - Laura H Thompson
- c Faculty of Medicine, Community Health Sciences , University of Manitoba , Winnipeg , Canada
| | | | - T Raghavendra
- d Karnataka Health Promotion Trust , Bangalore , India
| | | | | | - Stephen Moses
- c Faculty of Medicine, Community Health Sciences , University of Manitoba , Winnipeg , Canada.,e Faculty of Medicine, Medical Microbiology , University of Manitoba , Winnipeg , Canada
| | - Robert Lorway
- c Faculty of Medicine, Community Health Sciences , University of Manitoba , Winnipeg , Canada
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Lambert PJ, Dyck M, Thompson LH, Hammond GW. Population-Based Surveillance of Clostridium difficile Infection in Manitoba, Canada, by Using Interim Surveillance Definitions. Infect Control Hosp Epidemiol 2015; 30:945-51. [DOI: 10.1086/605719] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective.TO apply interim surveillance definitions of Clostridium difficile infection (CDI) cases to 1 year of data from the provincewide surveillance system of Manitoba, Canada, to determine the epidemiology of CDI incident cases in a population.Methods.CDI cases were categorized with interim surveillance definitions developed by an ad hoc C. difficile surveillance working group. Incident cases recorded in the provincial CDI database between July 2005 and June 2006 were linked to the provincial hospitalization and nursing home databases and analyzed.Results.One thousand six incident cases were identified over 1 year. Five hundred fifteen (51%) cases were associated with and began in a healthcare facility (HCF), whereas 275 (27%) were associated with and began in the community. An additional 131 (13%) cases were HCF associated but began in the community, while 85 (8%) were of indeterminate origin. Cases of HCF-associated CDI occurred in patients who were older than did cases of community-associated CDI (P < .0001). The provincial rate of community-onset cases was 23.4 per 100,000 person-years, and rates varied among geographic areas. HCF-associated CDI rates among the 10 largest hospitals varied from 0.5 to 8.4 per 10,000 patient-days. The time to CDI onset after hospital admission indicated that 25% of nosocomial cases began by the 8th day, and 50% began by the 17th day.Conclusions.Although the majority of CDI cases were associated with exposure to a HCF, 40% of incident CDI began in the community. Populations with HCF- and community-associated CDI demonstrated significantly different age distributions. The wide variation of rates among HCFs requires explanation. The high percentage of incident cases in the community warrants increased study.
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Melesse DY, Becker M, McClarty LM, Hodge K, Thompson LH, Blanchard JF, Kaufert J. Programmatic and ethical challenges in the implementation of treatment-as-prevention in the context of HIV and drug-resistant tuberculosis co-infection in sub-Saharan Africa. Glob Public Health 2014; 11:336-347. [PMID: 25513964 DOI: 10.1080/17441692.2014.988164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
There is limited literature on programmatic challenges in the implementation of a treatment-as-prevention (TasP) strategy among human immunodeficiency virus (HIV) and drug-resistant tuberculosis (DR-TB) co-infected individuals in sub-Saharan Africa (SSA). This paper highlights specific programmatic challenges surrounding the implementation of this strategy among HIV and DR-TB co-infected populations in SSA. In SSA, limitations in administrative, human and financial resources and poor health infrastructure, as well as increased duration and complexity of providing long-term treatment for HIV individuals co-infected with DR-TB, pose substantial challenges to the implementation of a TasP strategy and warrant further investigation. A comprehensive approach must be devised to implement TasP strategy, with special attention paid to the sizable HIV and DR-TB co-infected populations. We suggest that evidence-informed and human rights-based guidelines for participant protection and strategies for programme delivery must be developed and tailored to maximise the benefits to those most at risk of developing HIV and DR-TB co-infection. Assessing regional circumstances is crucial, and TasP programmes in the region should be complemented by combined prevention strategies to achieve the intended goals.
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Affiliation(s)
- Dessalegn Y Melesse
- a Department of Community Health Sciences, The Centre for Global Public Health , University of Manitoba , Winnipeg , MB , Canada.,b Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada
| | - Marissa Becker
- a Department of Community Health Sciences, The Centre for Global Public Health , University of Manitoba , Winnipeg , MB , Canada.,b Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada
| | - Leigh M McClarty
- a Department of Community Health Sciences, The Centre for Global Public Health , University of Manitoba , Winnipeg , MB , Canada.,b Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada
| | - Kellee Hodge
- b Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada
| | - Laura H Thompson
- a Department of Community Health Sciences, The Centre for Global Public Health , University of Manitoba , Winnipeg , MB , Canada.,b Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada
| | - James F Blanchard
- a Department of Community Health Sciences, The Centre for Global Public Health , University of Manitoba , Winnipeg , MB , Canada.,b Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada
| | - Joseph Kaufert
- b Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada
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Ramanaik S, Thompson LH, du Plessis E, Pelto P, Annigeri V, Doddamane M, Bhattacharjee P, Shaw SY, Deering K, Khan S, Halli SS, Lorway R. Intimate relationships of Devadasi sex workers in South India: An exploration of risks of HIV/STI transmission. Glob Public Health 2014; 9:1198-210. [PMID: 25162730 DOI: 10.1080/17441692.2014.948480] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Global literature on female sex workers suggests that being in an intimate relationship is associated with barriers to practising safe sex behaviours. Condom use within intimate relationships is often seen as a sign of infidelity and fosters mistrust which could affect longevity, trust and intimacy within partnerships. Using qualitative data from Devadasi sex workers and their intimate male partners in Bagalkot District, Karnataka, India, we examined both partners' perspectives to understand the quality and dynamics of these relationships and the factors that influence condom use in intimate relationships. Our thematic analysis of individual interviews conducted in May 2011 with 20 couples suggests that many Devadasi sex workers and their intimate partners define their relationships as 'like marriage' which reduced their motivation to use condoms. Evidence from this study suggests that active participation in sex workers' collectives (sanghas) can increase condom use, education and family planning services, among other things, and could be helpful for both Devadasis and their intimate partners to better understand and accept safer sexual practices. Our work has direct implications for designing couple-based health interventions for traditional Devadasi sex workers and their intimate partners in India.
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Ikpeazu A, Momah-Haruna A, Madu Mari B, Thompson LH, Ogungbemi K, Daniel U, Aboki H, Isac S, Gorgens M, Mziray E, Njie N, Akala FA, Emmanuel F, Odek WO, Blanchard JF. An appraisal of female sex work in Nigeria--implications for designing and scaling up HIV prevention programmes. PLoS One 2014; 9:e103619. [PMID: 25118691 PMCID: PMC4131880 DOI: 10.1371/journal.pone.0103619] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 06/30/2014] [Indexed: 11/19/2022] Open
Abstract
Background The HIV epidemic in Nigeria is complex with diverse factors driving the epidemic. Accordingly, Nigeria's National Agency for the Control of AIDS is coordinating a large-scale initiative to conduct HIV epidemic appraisals across all states. These appraisals will help to better characterize the drivers of the epidemic and ensure that the HIV prevention programmes match the local epidemic context, with resources allocated to interventions that have the greatest impact locally. Currently, the mapping and size estimation of Female Sex Workers (FSWs) - a major component of the appraisal has been completed in seven states. These states are using the data generated to plan, prioritize and scale-up sub-national HIV prevention programmes. Methodology It involved a two-level process of identifying and validating locations where FSWs solicit and/or meet clients (“hotspots”). In the first level, secondary key informants were interviewed to collect information about the geographic location and description of the hotspots. For the second level, FSWs were interviewed at each hotspot and information on population size estimates, typologies and operational dynamics of the FSWs were collected. Results Across the seven states, a total of 17,266 secondary key informants and 5,732 FSWs were interviewed. 10,233 hotspots were identified with an estimated 126,489 FSWs ranging from 5,920 in Anambra to 46,691 in Lagos. The most common hotspots were bars/nightclubs (30%), hotels/lodges (29.6%), streets (16.6%), and brothels (14.6%). Furthermore, the population density of FSWs (per thousand adult men) across the states ranged from 2 in Anambra to 17 in the Federal Capital Territory. Conclusion FSW populations in Nigeria are large and diverse, with substantial differences between and within states. Improved understanding of the location, population size, density, organizational typologies and clients of sex work has informed and is central to Nigeria's planning process for scaling up focused HIV prevention programmes.
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Affiliation(s)
- Akudo Ikpeazu
- National Agency for the Control of AIDS, Abuja, Nigeria
| | - Amaka Momah-Haruna
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Baba Madu Mari
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Laura H. Thompson
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Uduak Daniel
- National Agency for the Control of AIDS, Abuja, Nigeria
| | - Hafsatu Aboki
- National Agency for the Control of AIDS, Abuja, Nigeria
| | - Shajy Isac
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | | | - Ndella Njie
- World Bank, Washington, DC, United States of America
| | | | - Faran Emmanuel
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Willis Omondi Odek
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - James F. Blanchard
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- * E-mail:
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Blanchard JF, Thompson LH, Aral SO. Second generation HIV surveillance in Pakistan: evidence for understanding the epidemic and planning a response. Sex Transm Infect 2013; 89 Suppl 2:ii1-3. [PMID: 23956339 PMCID: PMC3756448 DOI: 10.1136/sextrans-2013-051297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- James F Blanchard
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, , Winnipeg, Canada
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Munro M, Holte-McKenzie M, Ahmed S, Archibald CP, Blanchard JF, Thompson LH. Second generation HIV surveillance in Pakistan: policy challenges and opportunities. Sex Transm Infect 2013; 89 Suppl 2:ii48-52. [PMID: 23220785 PMCID: PMC3756436 DOI: 10.1136/sextrans-2012-050773] [Citation(s) in RCA: 4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2012] [Indexed: 11/04/2022] Open
Abstract
From 2004 to 2011, the Canada-Pakistan HIV/AIDS Surveillance Project (HASP) worked with government and non-government partners in Pakistan to design and implement an HIV second generation surveillance (SGS) system. Insights into the development of scalable cost effective surveillance methodologies, implementation, use of data for HIV prevention and human rights were gained over the course of HASP. An ideal SGS system would be affordable, able to be implemented independently by local partners and produce data that could be readily applied in policy and programmes. Flexibility in design and implementation is important to ensure that any SGS system is responsive to information needs, political changes and changes in key population dynamics and HIV epidemics. HASP's mapping methodology is innovative and widely accepted as best practice, but sustainability of the SGS system it developed is a challenge.
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Affiliation(s)
- Michelle Munro
- Agriteam Canada Consulting Ltd., Gatineau, Quebec, Canada
| | | | - Sadia Ahmed
- Canadian High Commission, Islamabad, Pakistan
| | - Chris P Archibald
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - James F Blanchard
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laura H Thompson
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Reza T, Melesse DY, Shafer LA, Salim M, Altaf A, Sonia A, Jayaraman GC, Emmanuel F, Thompson LH, Blanchard JF. Patterns and trends in Pakistan's heterogeneous HIV epidemic. Sex Transm Infect 2013; 89 Suppl 2:ii4-10. [PMID: 23633670 PMCID: PMC3756441 DOI: 10.1136/sextrans-2012-050872] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 03/20/2013] [Accepted: 04/01/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Considerable HIV transmission occurs among injection drug users (IDUs) in Pakistan and recently the HIV prevalence has been increasing among male (MSW), hijra (transgender; HSW) and female (FSW) sex workers. We describe past and estimate future patterns of HIV emergence among these populations in several cities in Pakistan. METHODS The density of these key populations per 1000 adult men was calculated using 2011 mapping data from Karachi, Lahore, Faisalabad, Larkana, Peshawar and Quetta, and surveillance data were used to assess bridging between these key populations. We used the UNAIDS Estimation and Projection Package model to estimate and project HIV epidemics among these key populations in Karachi, Lahore, Faisalabad and Larkana. RESULTS The density and bridging of key populations varied across cities. Lahore had the largest FSW population (11.5/1000 adult men) and the smallest IDU population (1.7/1000 adult men). Quetta had the most sexual and drug injection bridging between sex workers and IDUs (6.7%, 7.0% and 3.8% of FSW, MSW and HSW, respectively, reported injecting drugs). Model evidence suggests that by 2015 HIV prevalence is likely to reach 17-22% among MSWs/HSWs in Karachi, 44-49% among IDUs in Lahore and 46-66% among IDUs in Karachi. Projection suggests the prevalence may reach as high as 65-75% among IDUs in Faisalabad by 2025. HIV prevalence is also estimated to increase among FSWs, particularly in Karachi and Larkana. CONCLUSIONS There is a need to closely monitor regional and subpopulation epidemic patterns and implement prevention programmes customised to local epidemics.
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Affiliation(s)
- Tahira Reza
- Canada-Pakistan HIV/AIDS Surveillance Project, Islamabad, Pakistan
| | - Dessalegn Y Melesse
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Leigh Anne Shafer
- Department of Internal Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, Canada
| | - Momina Salim
- Canada-Pakistan HIV/AIDS Surveillance Project, Islamabad, Pakistan
| | - Arshad Altaf
- Canada-Pakistan HIV/AIDS Surveillance Project, Islamabad, Pakistan
| | - Altaf Sonia
- Canada-Pakistan HIV/AIDS Surveillance Project, Islamabad, Pakistan
| | - Gayatri C Jayaraman
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
| | - Faran Emmanuel
- Canada-Pakistan HIV/AIDS Surveillance Project, Islamabad, Pakistan
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Laura H Thompson
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - James F Blanchard
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
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Thompson LH, Khan S, du Plessis E, Lazarus L, Reza-Paul S, Hafeez Ur Rahman S, Pasha A, Lorway R. Beyond internalised stigma: daily moralities and subjectivity among self-identified kothis in Karnataka, South India. Cult Health Sex 2013; 15:1237-1251. [PMID: 23941386 DOI: 10.1080/13691058.2013.818714] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The Bill and Melinda Gates Foundation has poured a tremendous amount of resources into epidemic prevention in India's high HIV prevalence zones, through their Avahan initiative. These community-centred programmes operate under the assumption that fostering community-based organisational development and empowering the community to take charge of HIV prevention and education will help to transform the wider social inequalities that inhibit access to health services. Focusing on the South Indian state of Karnataka, this paper explores a troubling set of local narratives that, we contend, hold broader implications for future programme planning and implementation. Although confronting stigma and discrimination has become a hallmark in community mobilisation discourse, communities of self-identified kothis (feminine men) who were involved in Avahan programme activities continued to articulate highly negative attitudes about their own sexualities in relation to various spheres of social life. Rather than framing an understanding of these narratives in psychological terms of 'internalized stigma', we draw upon medical anthropological approaches to the study of stigma that emphasise how social, cultural and moral processes create stigmatising conditions in the everyday lives of people. The way stigma continues to manifest itself in the self-perceptions of participants points to an area that warrants critical public health attention.
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Affiliation(s)
- Laura H Thompson
- a Department of Community Health Sciences, Faculty of Medicine , Centre for Global Public Health, University of Manitoba , Winnipeg , Canada
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Emmanuel F, Thompson LH, Salim M, Akhtar N, Reza TE, Hafeez H, Ahmed S, Blanchard JF. The size and distribution of key populations at greater risk of HIV in Pakistan: implications for resource allocation for scaling up HIV prevention programmes. Sex Transm Infect 2013; 89 Suppl 2:ii11-7. [PMID: 23843454 PMCID: PMC3756450 DOI: 10.1136/sextrans-2013-051017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background With competing interests, limited funding and a socially conservative context, there are many barriers to implementing evidence-informed HIV prevention programmes for sex workers and injection drug users in Pakistan. Meanwhile, the HIV prevalence is increasing among these populations across Pakistan. We sought to propose and describe an approach to resource allocation which would maximise the impact and allocative efficiency of HIV prevention programmes. Methods Programme performance reports were used to assess current resource allocation. Population size estimates derived from mapping conducted in 2011 among injection drug users and hijra, male and female sex workers and programme costs per person documented from programmes in the province of Sindh and also in India were used to estimate the cost to deliver services to 80% of these key population members across Pakistan. Cities were prioritised according to key population size. Results To achieve 80% population coverage, HIV prevention programmes should be implemented in 10 major cities across Pakistan for a total annual operating cost of approximately US$3.5 million, which is much less than current annual expenditures. The total cost varies according to the local needs and the purchasing power of the local currency. Conclusions By prioritising key populations at greatest risk of HIV in cities with the largest populations and limited resources, may be most effectively harnessed to quell the spread of HIV in Pakistan.
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Affiliation(s)
- Faran Emmanuel
- Centre for Global Public Health, University of Manitoba, , Winnipeg, Manitoba, Canada
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Emmanuel F, Thompson LH, Athar U, Salim M, Sonia A, Akhtar N, Blanchard JF. The organisation, operational dynamics and structure of female sex work in Pakistan. Sex Transm Infect 2013; 89 Suppl 2:ii29-33. [PMID: 23771032 PMCID: PMC3756447 DOI: 10.1136/sextrans-2013-051062] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [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] [Indexed: 11/14/2022] Open
Abstract
Background Pakistan is known to have large populations of female sex workers (FSWs) with considerable geographic heterogeneity in their characteristics. In this paper, we describe the social organisation and structural patterns of female sex work in different geographic regions of Pakistan. Methods We report geographic and network mapping data collected among FSWs in 15 cities across Pakistan in 2011 as part of the Canada-Pakistan HIV/AIDS Surveillance Project. Results A total number of 89 178 FSWs were estimated in the target cities for an average of 7.2 FSWs per 1000 adult males. 55% of the estimated number of FSWs concentrated in Karachi and Lahore. Based on the operations of female sex work, two major typologies of FSWs were identified: establishment-based and non-establishment-based. FSWs were further subtyped into those operating through brothels, homes, kothikhanas, streets and by cell phone. Cities varied considerably in terms of predominance of different FSW typologies. Conclusions There is considerable heterogeneity among FSWs in Pakistan, geographically and in terms of operational typology. Understanding the social organisation of sex work and the influence of social-cultural and legal factors in Pakistan is essential for the design of HIV prevention programmes and other services for FSWs.
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Affiliation(s)
- Faran Emmanuel
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, , Winnipeg, Canada
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Lorway R, Thompson LH, Lazarus L, du Plessis E, Pasha A, Fathima Mary P, Khan S, Reza-Paul S. Going beyond the clinic: confronting stigma and discrimination among men who have sex with men in Mysore through community-based participatory research. Critical Public Health 2013. [DOI: 10.1080/09581596.2013.791386] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Thompson LH, Salim M, Baloch CR, Musa N, Reza T, Dar N, Arian S, Blanchard JF, Emmanuel F. Heterogeneity of characteristics, structure, and dynamics of male and hijra sex workers in selected cities of Pakistan. Sex Transm Infect 2013; 89 Suppl 2:ii43-47. [PMID: 23605854 PMCID: PMC3756430 DOI: 10.1136/sextrans-2012-050901] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND We sought to describe the characteristics and operational dynamics of male sex workers (MSW) and hijra sex workers (HSWs) in 11 cities across Pakistan in 2011. METHODS We report descriptive statistics of self-reported sexual behaviour data from cross-sectional mapping and biological and behavioural surveys conducted among 1431 MSWs and 1415 HSWs in four cities across Pakistan in 2011. RESULTS While Karachi had the largest numbers of MSWs and HSWs, Quetta had the largest relative population sizes, with 3.6 MSWs per 1000 male adults and 3.3 HSWs per 1000 male adults. There was considerable variability in the proportion of HSWs who operate through deras, ranging from 2.2% in Peshawar to 62.7% in Karachi. The number of HSWs per guru varies by city, from 1.5 in Quetta to 16.5 HSWs per guru in Karachi. Among HSWs, the use of mobile phones for solicitation ranged from 37.6% in Quetta to 83% in Peshawar and among MSWs the use of mobile phones ranged from 27% in Karachi to 52% in Quetta. In Quetta, a large proportion of HSWs (41%) find clients through gurus. Client volume tended to be higher among HSWs and among both MSWs and HSWs in Quetta and Peshawar. Condom use with clients was most consistent in Quetta, with 31% of MSWs and 41% of HSWs reporting always using condoms with clients. Peshawar had the greatest proportion reporting never using condoms. CONCLUSIONS There is considerable geographic heterogeneity in the characteristics and operational dynamics of MSWs and HSWs across Pakistan.
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Affiliation(s)
- Laura H Thompson
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, , Winnipeg, Manitoba, Canada
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Mishra S, Thompson LH, Sonia A, Khalid N, Emmanuel F, Blanchard JF. Sexual behaviour, structural vulnerabilities and HIV prevalence among female sex workers in Pakistan. Sex Transm Infect 2013; 89 Suppl 2:ii34-42. [PMID: 23413402 PMCID: PMC3756444 DOI: 10.1136/sextrans-2012-050776] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background We sought to describe differences in individual and structural vulnerabilities faced by female sex workers (FSWs) in Pakistan between 2006 and 2011, and to characterise risk factors for inconsistent condom use and HIV prevalence in this population. Methods To describe differences in vulnerabilities, we analysed behavioural data from serial cross-sectional surveys conducted across nine cities in 2006 and 2011. Using data from 12 cities in 2011, we used logistic regression to characterise risk factors for (a) inconsistent condom use in the past month (N=6987), and (b) HIV (N=4301). Results Compared to FSWs in 2006, FSWs in 2011 were significantly more likely to solicit clients via cell phones, and to report a larger client volume and anal sex with clients, but also consistent condom use with clients (30.0% vs 23.6% in 2006). In 2011, independent risk factors for inconsistent condom use with clients included: recent sexual violence, recent sex with a person who injects drugs, and absence of programme exposure. HIV prevalence was 0.63% (95% CI 0.43% to 0.92%) in 2011, and was associated with a recent history of injection drug use and absence of programme exposure. Conclusions While condom use with clients was higher in 2011, protective behaviours remained low and vulnerabilities related to sex work may have risen. HIV is emerging in this population and an adaptive HIV prevention programme that addresses different vulnerabilities and the intersection of sexual networks with injection drug use is needed.
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Affiliation(s)
- Sharmistha Mishra
- Department of Infectious Disease Epidemiology, Imperial College London, , London, UK
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Archibald CP, Shaw SY, Emmanuel F, Otho S, Reza T, Altaf A, Musa N, Thompson LH, Blanchard JF. Geographical and temporal variation of injection drug users in Pakistan. Sex Transm Infect 2013; 89 Suppl 2:ii18-28. [PMID: 23314301 PMCID: PMC3756445 DOI: 10.1136/sextrans-2012-050775] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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] [Indexed: 11/28/2022] Open
Abstract
Objectives We describe the characteristics of injecting drug users (IDU) in Pakistan in 2006 and 2011, and assess the heterogeneity of IDU characteristics across different cities and years as well as factors associated with HIV infection. Methods Cross-sectional, integrated behavioural-biological surveys of IDU were conducted in 10 cities across Pakistan in 2006 and 2011. Univariate and multivariable analyses were used to describe the differences in HIV prevalence and risk behaviours between cities and over time. Results Large increases in HIV prevalence among injection drug users in Pakistan were observed, with overall HIV prevalence increasing from 16.2% in 2006 to 31.0% in 2011; an increase in HIV prevalence was also seen in all geographic areas except one. There was an increase in risk behaviours between 2006 and 2011, anecdotally related to a reduction in the availability of services for IDU. In 2011, larger proportions of IDU reported injecting several times a day and using professional injectors, and fewer reported always using clean syringes. An increase in the proportion living on the street was also observed and this was associated with HIV infection. Cities differ in terms of HIV prevalence, risk profiles, and healthcare seeking behaviours. Conclusions There is a high prevalence of HIV among injection drug users in Pakistan and considerable potential for further transmission through risk behaviours. HIV prevention programs may be improved through geographic targeting of services within a city and for involving groups that interact with IDU (such as pharmacy staff and professional injectors) in harm reduction initiatives.
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Affiliation(s)
- Chris P Archibald
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, , Ottawa, Ontario, Canada
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Adrien A, Thompson LH, Archibald CP, Sandstrom PA, Munro M, Emmanuel F, Blanchard JF. Translating knowledge from Pakistan's second generation surveillance system to other global contexts. Sex Transm Infect 2012; 89 Suppl 2:ii53-7. [PMID: 23258896 PMCID: PMC3756434 DOI: 10.1136/sextrans-2012-050774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background From 2004 to 2011, a collaborative project was undertaken to enhance the capacity of the Government of Pakistan to implement an effective second-generation surveillance system for HIV/AIDS, known as the HIV/AIDS Surveillance Project (HASP). In four separate rounds, behavioural questionnaires were administered among injection drug users, and female, male and hijra (transgender) sex workers. Dried blood spots were collected for HIV testing. Methods Through interviews with project staff in Pakistan and Canada, we have undertaken a critical review of the role of HASP in generating, using and translating knowledge, with an emphasis on capacity building within both the donor and recipient countries. We also documented ongoing and future opportunities for the translation of knowledge produced through HASP. Results Knowledge translation activities have included educational workshops and consultations held in places as diverse as Colombia and Cairo, and the implementation of HASP methodologies in Asia, the Middle East and sub-Saharan Africa. HASP methodologies have been incorporated in multiple WHO reports. Importantly, the donor country, Canada, has benefited in significant ways from this partnership. Operational and logistical lessons from HASP have, in turn, improved how surveillance is performed in Canada. Through this project, significant capacity was built among the staff of HASP, non-governmental organisations which were engaged as implementation partners, data coordination units which were established in each province, and in the laboratory. As is to be expected, different organisations have different agendas and priorities, requiring negotiation, at times, to ensure the success of collaborative activities. Overall, there has been considerable interest in and opportunities made for learning about the methodologies and approaches employed by HASP. Conclusions Generally, the recognition of the strengths of the approaches and methodologies used by HASP has ensured an appetite for opportunities of mutual learning.
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Affiliation(s)
- Alix Adrien
- Direction de Santé Publique, Agence de la Santé et des Services Sociaux de Montreal, , Montréal, Quebec, Canada
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Mahmud SM, Thompson LH, Nowicki DL, Plourde PJ. Outbreaks of influenza-like illness in long-term care facilities in Winnipeg, Canada. Influenza Other Respir Viruses 2012; 7:1055-61. [PMID: 23145997 PMCID: PMC4634272 DOI: 10.1111/irv.12052] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [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] [Indexed: 12/04/2022] Open
Abstract
Please cite this paper as: Mahmud et al. (2012) Outbreaks of influenza‐like illness in long‐term care facilities in Winnipeg, Canada. Influenza and Other Respiratory Viruses 10.1111/irv.12052 Background Outbreaks of influenza‐like illness (ILI) are common in long‐term care facilities (LTCFs) and result in significant morbidity and mortality among residents. Objectives We describe patterns of reported ILI outbreaks in LTCFs in Winnipeg, Canada, and examine LTCF and outbreak characteristics that influence the clinical outcomes of these outbreaks. Methods We analyzed the electronic records of all ILI outbreaks reported by LTCFs in Winnipeg from 2003 to 2011. Outbreak duration, ILI attack rates among staff and residents, and residents’ death rates were calculated by presumed viral etiology, staff vaccination rates, type of influenza chemoprophylaxis used, and time to notification to public health. Results Of a total of 154 reported outbreaks, most (N = 80) were attributed to influenza, and these outbreaks tended to have higher attack and death rates among LTCF residents compared with outbreaks caused by other respiratory viruses (12) or those of unknown etiology (62). About 92% of residents and 38% of staff of the average LTCFs were vaccinated. Chemoprophylaxis was used in 57·5% of influenza outbreaks. Regardless of presumed viral etiology, outbreaks reported within 3 days of onset ended sooner and had lower attack and mortality rates among residents. Conclusions Influenza‐like illness outbreaks still occur among highly immunized LTCF residents, so in addition to vaccination of staff and residents, it is important to maintain competent infection control practices. Early identification and notification to public health authorities and possibly early initiation of control measures could improve clinical outcomes of ILI outbreaks.
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Affiliation(s)
- Salaheddin M Mahmud
- Department of Community Health Sciences, University of Manitoba.Winnipeg Regional Health Authority.Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada
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Muzyka CN, Thompson LH, Bombak AE, Driedger SM, Lorway R. A Kenyan newspaper analysis of the limitations of voluntary medical male circumcision and the importance of sustained condom use. BMC Public Health 2012; 12:465. [PMID: 22720748 PMCID: PMC3491023 DOI: 10.1186/1471-2458-12-465] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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: 01/12/2012] [Accepted: 06/15/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since the completion of three clinical trials indicating that voluntary medical male circumcision (VMMC) is an effective method to reduce men's chances of acquiring HIV, use of the procedure has been advocated in Kenya. Media messages shape popular understandings of the benefits and limitations of male circumcision. The objectives of this study were to (1) investigate promotion messages in a popular online newspaper to determine how the limitations of male circumcision are represented, and whether condom use is still being promoted; and (2) gain insight into popular understandings of the limitations of this new procedure through newspaper reader comments. METHODS A content analysis was conducted on 34 online media articles published by the Daily Nation between January 1, 2008 and December 31, 2010. Information about condom promotion, partial immunity, limitations and complications of the procedure, as well as emergent themes, were analyzed. RESULTS Results demonstrated an irregular and occasionally misleading presentation of these topics and a perceived lack of objective information about the risks and limitations of VMMC. CONCLUSIONS There is a need for governmental and non-governmental public health organizations to engage with the media to improve risk messaging.
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Affiliation(s)
- Charlene N Muzyka
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
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Thompson LH, Sochocki M, Friesen T, Bresler K, Keynan Y, Kasper K, Becker M. Medical ward admissions among HIV-positive patients in Winnipeg, Canada, 2003–10. Int J STD AIDS 2012; 23:287-8. [DOI: 10.1258/ijsa.2011.011309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Canadian data regarding the characteristics of HIV-positive patients admitted to hospital as well as the causes and patterns of admissions remain limited. Chart reviews were performed to ascertain admission diagnosis, co-morbidities and CD4 counts among this sub-population, which had an over-representation of Aboriginal persons. Infectious diseases, particularly pneumonia, represent the most common admission diagnosis for HIV-positive persons in Winnipeg. Further, individuals presenting to hospital often have very low CD4 counts, representing significant immune suppression. Earlier HIV diagnosis and treatment in an effort to delay the onset of advanced disease and hospitalization is needed.
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Affiliation(s)
- L H Thompson
- Centre for Global Public Health, University of Manitoba
| | - M Sochocki
- Department of Medicine, University of Manitoba
| | - T Friesen
- Department of Medicine, University of Manitoba
| | - K Bresler
- Manitoba HIV Program, Winnipeg, Canada
| | - Y Keynan
- Department of Medicine, University of Manitoba
- Manitoba HIV Program, Winnipeg, Canada
| | - K Kasper
- Department of Medicine, University of Manitoba
- Manitoba HIV Program, Winnipeg, Canada
| | - M Becker
- Centre for Global Public Health, University of Manitoba
- Department of Medicine, University of Manitoba
- Manitoba HIV Program, Winnipeg, Canada
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Mishra S, Sgaier SK, Thompson LH, Moses S, Ramesh BM, Alary M, Wilson D, Blanchard JF. HIV epidemic appraisals for assisting in the design of effective prevention programmes: shifting the paradigm back to basics. PLoS One 2012; 7:e32324. [PMID: 22396756 PMCID: PMC3291609 DOI: 10.1371/journal.pone.0032324] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 01/24/2012] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND To design HIV prevention programmes, it is critical to understand the temporal and geographic aspects of the local epidemic and to address the key behaviours that drive HIV transmission. Two methods have been developed to appraise HIV epidemics and guide prevention strategies. The numerical proxy method classifies epidemics based on current HIV prevalence thresholds. The Modes of Transmission (MOT) model estimates the distribution of incidence over one year among risk-groups. Both methods focus on the current state of an epidemic and provide short-term metrics which may not capture the epidemiologic drivers. Through a detailed analysis of country and sub-national data, we explore the limitations of the two traditional methods and propose an alternative approach. METHODS AND FINDINGS We compared outputs of the traditional methods in five countries for which results were published, and applied the numeric and MOT model to India and six districts within India. We discovered three limitations of the current methods for epidemic appraisal: (1) their results failed to identify the key behaviours that drive the epidemic; (2) they were difficult to apply to local epidemics with heterogeneity across district-level administrative units; and (3) the MOT model was highly sensitive to input parameters, many of which required extraction from non-regional sources. We developed an alternative decision-tree framework for HIV epidemic appraisals, based on a qualitative understanding of epidemiologic drivers, and demonstrated its applicability in India. The alternative framework offered a logical algorithm to characterize epidemics; it required minimal but key data. CONCLUSIONS Traditional appraisals that utilize the distribution of prevalent and incident HIV infections in the short-term could misguide prevention priorities and potentially impede efforts to halt the trajectory of the HIV epidemic. An approach that characterizes local transmission dynamics provides a potentially more effective tool with which policy makers can design intervention programmes.
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Affiliation(s)
- Sharmistha Mishra
- Department of Infectious Diseases Epidemiology, Imperial College, London, United Kingdom
- St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Sema K. Sgaier
- Global Health Program, Bill and Melinda Gates Foundation, New Delhi, India
| | - Laura H. Thompson
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Stephen Moses
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - B. M. Ramesh
- Karnataka Health Promotion Trust, Bangalore, India
| | - Michel Alary
- URESP, Centre de recherche FRSQ du CHA universitaire de Québec, Université Laval, Québec, Canada
| | - David Wilson
- Global HIV/AIDS Program, World Bank, Washington, D.C., United States of America
| | - James F. Blanchard
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
- * E-mail:
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41
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Malik MT, Gumel A, Thompson LH, Strome T, Mahmud SM. "Google flu trends" and emergency department triage data predicted the 2009 pandemic H1N1 waves in Manitoba. Can J Public Health 2011. [PMID: 21913587 DOI: 10.1007/bf03404053] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES We assessed the performance of syndromic indicators based on Google Flu Trends (GFT) and emergency department (ED) data for the early detection and monitoring of the 2009 H1N1 pandemic waves in Manitoba. METHODS Time-series curves for the weekly counts of laboratory-confirmed H1N1 cases in Manitoba during the 2009 pandemic were plotted against the three syndromic indicators: 1) GFT data, based on flu-related Internet search queries, 2) weekly count of all ED visits triaged as influenza-like illness (ED ILI volume), and 3) percentage of all ED visits that were triaged as an ILI (ED ILI percent). A linear regression model was fitted separately for each indicator and correlations with weekly virologic data were calculated for different lag periods for each pandemic wave. RESULTS All three indicators peaked 1-2 weeks earlier than the epidemic curve of laboratory-confirmed cases. For GFT data, the best-fitting model had about a 2-week lag period in relation to the epidemic curve. Similarly, the best-fitting models for both ED indicators were observed for a time lag of 1-2 weeks. All three indicators performed better as predictors of the virologic time trends during the second wave as compared to the first. There was strong congruence between the time series of the GFT and both the ED ILI volume and the ED ILI percent indicators. CONCLUSION During an influenza season characterized by high levels of disease activity, GFT and ED indicators provided a good indication of weekly counts of laboratory-confirmed influenza cases in Manitoba 1-2 weeks in advance.
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Mahmud SM, Becker M, Keynan Y, Elliott L, Thompson LH, Fowke K, Avery L, Van Caeseele P, Harlos S, Blanchard J, Dawood M. Estimated cumulative incidence of pandemic (H1N1) influenza among pregnant women during the first wave of the 2009 pandemic. CMAJ 2010; 182:1522-4. [PMID: 20823167 DOI: 10.1503/cmaj.100488] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Hospitalization and lab confirmed cases of H1N1 have been reported during the first wave of the 2009 pandemic but these are not accurate measures of influenza incidence in the population. We estimated the cumulative incidence of pandemic (H1N1) influenza among pregnant women in the province of Manitoba during the first wave of the 2009 pandemic. METHODS Two panels of stored frozen serum specimens collected for routine prenatal screening were randomly selected for testing before (March 2009, n = 252) and after (August 2009, n = 296) the first wave of the pandemic. A standard hemagglutination inhibition assay was used to detect the presence of IgG antibodies against the pandemic (H1N1) 2009 virus. The cumulative incidence of pandemic (H1N1) influenza was calculated as the difference between the point prevalence rates in the first and second panels. RESULTS Of the specimens collected in March, 7.1% were positive for the IgG antibodies (serum antibody titre ≥ 1:40). The corresponding prevalence was 15.7% among the specimens collected in August. The difference indicated a cumulative incidence of 8.6% (95% confidence interval [CI] 3.2%-13.7%). The rate differed geographically, the highest being in the northern regions (20.8%, 95% CI 7.9%-31.8%), as compared with 4.0% (95% CI 0.0%-11.9%) in Winnipeg and 8.9% (95% CI 0.0%-18.8%) in the rest of the province. INTERPRETATION We estimated that the cumulative incidence of pandemic (H1N1) influenza among pregnant women in Manitoba during the first wave of the 2009 pandemic was 8.6%. It was 20.8% in the northern regions of the province.
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Affiliation(s)
- Salaheddin M Mahmud
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Man.
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Abstract
In vitro biochemical studies indicate that Ape1 is the major mammalian enzyme responsible for repairing abasic lesions in DNA and a significant factor in the processing of specific 3'-replication-blocking termini. Toward addressing the role of Ape1 in cellular resistance to specific DNA-damaging and anticancer agents, we constructed a chinese hamster ovary (CHO) cell line, AA8-Ape1, that exhibits a 7-fold higher Ape1-dependent nuclease activity; this overexpression is abolished upon exposure to tetracycline (Tc). In comparison to the AA8 parental control, our data indicates that Ape1 activity is not rate-limiting for the repair of cytotoxic damages induced by the alkylating agent methyl methanesulfonate (MMS), the oxidizing agent hydrogen peroxide (H2O2), or ionizing radiation (IR). AA8-Ape1 cells did exhibit increased resistance to bleomycin following a chronic 3-day exposure, but not to more acute challenges of 1 h. Most notably, the AA8-Ape1 line displayed approximately 1.7-fold elevated resistance to the replication-blocking nucleoside analog dioxolane cytidine (L-OddC); this improved resistance was abrogated by the addition of Tc to the medium. These studies demonstrate that Ape1 is not rate-limiting in the repair of MMS- or H2O2-induced DNA damage, that Ape1 may dictate the sensitivity of bleomycin, depending on dosing scheme, and for the first time, that Ape1 can influence cellular resistance to the anticancer/antiviral antimetabolite L-OddC.
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Affiliation(s)
- L J Schild
- Biology and Biotechnology Research Program, L441, Lawrence Livermore National Laboratory, Livermore, CA 94551-0808, USA
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George JW, Salazar EP, Vreeswijk MP, Lamerdin JE, Reardon JT, Zdzienicka MZ, Sancar A, Kadkhodayan S, Tebbs RS, Mullenders LH, Thompson LH. Restoration of nucleotide excision repair in a helicase-deficient XPD mutant from intragenic suppression by a trichothiodystrophy mutation. Mol Cell Biol 2001; 21:7355-65. [PMID: 11585917 PMCID: PMC99909 DOI: 10.1128/mcb.21.21.7355-7365.2001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [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: 11/20/2022] Open
Abstract
The UV-sensitive V-H1 cell line has a T46I substitution mutation in the Walker A box in both alleles of XPD and lacks DNA helicase activity. We characterized three partial revertants that curiously display intermediate UV cytotoxicity (2- to 2.5-fold) but normal levels of UV-induced hprt mutations. In revertant RH1-26, the efficient removal of pyrimidine (6-4) pyrimidone photoproducts from both strands of hprt suggests that global-genomic nucleotide excision repair is normal, but the pattern of cyclobutane pyrimidine dimer removal suggests that transcription-coupled repair (TCR) is impaired. To explain the intermediate UV survival and lack of RNA synthesis recovery in RH1-26 after 10 J of UV/m(2), we propose a defect in repair-transcription coupling, i.e., the inability of the cells to resume or reinitiate transcription after the first TCR event within a transcript. All three revertants carry an R658H suppressor mutation, in one allele of revertants RH1-26 and RH1-53 and in both alleles of revertant RH1-3. Remarkably, the R658H mutation produces the clinical phenotype of trichothiodystrophy (TTD) in several patients who display intermediate UV sensitivity. The XPD(R658H) TTD protein, like XPD(T46I/R658H), is codominant when overexpressed in V-H1 cells and partially complements their UV sensitivity. Thus, the suppressing R658H substitution must restore helicase activity to the inactive XPD(T46I) protein. Based on current knowledge of helicase structure, the intragenic reversion mutation may partially compensate for the T46I mutation by perturbing the XPD structure in a way that counteracts the effect of this mutation. These findings have implications for understanding the differences between xeroderma pigmentosum and TTD and illustrate the value of suppressor genetics for studying helicase structure-function relationships.
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Affiliation(s)
- J W George
- Biology and Biotechnology Research Program, Lawrence Livermore National Laboratory, Livermore, California 94551-0808, USA
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Abstract
The process of homologous recombinational repair (HRR) is a major DNA repair pathway that acts on double-strand breaks and interstrand crosslinks, and probably to a lesser extent on other kinds of DNA damage. HRR provides a mechanism for the error-free removal of damage present in DNA that has replicated (S and G2 phases). Thus, HRR acts in a critical way, in coordination with the S and G2 checkpoint machinery, to eliminate chromosomal breaks before the cell division occurs. Many of the human HRR genes, including five Rad51 paralogs, have been identified, and knockout mutants for most of these genes are available in chicken DT40 cells. In the mouse, most of the knockout mutations cause embryonic lethality. The Brca1 and Brca2 breast cancer susceptibility genes appear to be intimately involved in HRR, but the mechanistic basis is unknown. Biochemical studies with purified proteins and cell extracts, combined with cytological studies of nuclear foci, have begun to establish an outline of the steps in mammalian HRR. This pathway is subject to complex regulatory controls from the checkpoint machinery and other processes, and there is increasing evidence that loss of HRR gene function can contribute to tumor development. This review article is meant to be an update of our previous review [Biochimie 81 (1999) 87].
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Affiliation(s)
- L H Thompson
- Biology and Biotechnology Research Program, Lawrence Livermore National Laboratory, L-441, P.O. Box 808, Livermore, CA 94551-0808, USA.
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Takata M, Sasaki MS, Tachiiri S, Fukushima T, Sonoda E, Schild D, Thompson LH, Takeda S. Chromosome instability and defective recombinational repair in knockout mutants of the five Rad51 paralogs. Mol Cell Biol 2001; 21:2858-66. [PMID: 11283264 PMCID: PMC86915 DOI: 10.1128/mcb.21.8.2858-2866.2001] [Citation(s) in RCA: 428] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The Rad51 protein, a eukaryotic homologue of Escherichia coli RecA, plays a central role in both mitotic and meiotic homologous DNA recombination (HR) in Saccharomyces cerevisiae and is essential for the proliferation of vertebrate cells. Five vertebrate genes, RAD51B, -C, and -D and XRCC2 and -3, are implicated in HR on the basis of their sequence similarity to Rad51 (Rad51 paralogs). We generated mutants deficient in each of these proteins in the chicken B-lymphocyte DT40 cell line and report here the comparison of four new mutants and their complemented derivatives with our previously reported rad51b mutant. The Rad51 paralog mutations all impair HR, as measured by targeted integration and sister chromatid exchange. Remarkably, the mutant cell lines all exhibit very similar phenotypes: spontaneous chromosomal aberrations, high sensitivity to killing by cross-linking agents (mitomycin C and cisplatin), mild sensitivity to gamma rays, and significantly attenuated Rad51 focus formation during recombinational repair after exposure to gamma rays. Moreover, all mutants show partial correction of resistance to DNA damage by overexpression of human Rad51. We conclude that the Rad51 paralogs participate in repair as a functional unit that facilitates the action of Rad51 in HR.
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Affiliation(s)
- M Takata
- CREST Research Project, Radiation Genetics, Faculty of Medicine, Kyoto University, Sakyo-ku, Kyoto 606-8501, Japan
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Abstract
Mutations in the XPD gene are associated with three complex clinical phenotypes, namely xeroderma pigmentosum (XP), XP in combination with Cockayne syndrome (XP-CS), and trichothiodystrophy (TTD). XP is caused by a deficiency in nucleotide excision repair (NER) that results in a high risk of skin cancer. TTD is characterized by severe developmental and neurological defects, with hallmark features of brittle hair and scaly skin, and sometimes has defective NER. We used CHO cells as a system to study how specific mutations alter the dominant/recessive behavior of XPD protein. Previously we identified the T46I and R75W mutations in two highly UV-sensitive hamster cell lines that were reported to have paradoxically high levels of unscheduled DNA synthesis. Here we report that these mutants have greatly reduced XPD helicase activity and fully defective NER in a cell-extract excision assay. We conclude that the unscheduled DNA synthesis seen in these mutants is caused by abortive "repair" that does not contribute to cell survival. These mutations, as well as the K48R canonical helicase-domain mutation, each produced codominant negative phenotypes when overexpressed in wild-type CHO cells. The common XP-specific R683W mutation also behaved in a codominant manner when overexpressed, which is consistent with the idea that this mutation may affect primarily the enzymatic activity of the protein rather than impairing protein interactions, which may underlie TTD. A C-terminal mutation uniquely found in TTD (R722W) was overexpressed but not to levels sufficiently high to rigorously test for a codominant phenotype. Overexpression of mutant XPD alleles may provide a simple means of producing NER deficiency in other cell lines.
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Affiliation(s)
- S Kadkhodayan
- Biology and Biotechnology Research Program, L441, Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, CA 94551-0808, USA
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Abstract
We highlight selected contributions of Dr. Richard Setlow that contributed to our earlier understanding of excision repair processes and set the stage for dissecting nucleotide excision repair (NER) in mammalian cells through molecular genetics. More than 20 years ago, large-scale screens for UV-sensitive mutants of hamster CHO cells isolated approximately 200 mutants, many of which were assigned to the XPD/ERCC2 complementation group, but the nature of the mutations was not determined. The XPD protein performs not only an essential viability function as a structural component of transcription initiation factor TFIIH, but also an NER function as a 5' to 3' DNA helicase within TFIIH that unwinds DNA on the 3' side of bulky lesions. Alterations in these XPD functions are responsible for three UV-sensitivity genetic disorders that have distinguishable clinical features. In this study, we sequenced six UV-sensitive ICR170-induced Chinese hamster ovary (CHO) cell mutants that previously were assigned to the XPD complementation group to determine whether they carry frameshift mutations. All six mutants show 3- to 5-fold increased hypersensitivity to UV irradiation, similar to the XPD mutant prototype UV5. Even though ICR170 is a strong frameshift mutagen, all six cell lines contain base substitution mutations, five of which are unique among all mutations identified so far in human and rodent cells. The sixth mutation was identical to the R75W mutation previously found in CHO UVL-1. The results presented here contribute to a mutation database that should prove useful in structure-function studies of this unique DNA-structure-specific helicase and its complex mutant phenotypes.
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Affiliation(s)
- R S Tebbs
- Biology and Biotechnology Research Program, Lawrence Livermore National Laboratory, Livermore, California 94551-0808, USA
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Takata M, Sasaki MS, Sonoda E, Fukushima T, Morrison C, Albala JS, Swagemakers SM, Kanaar R, Thompson LH, Takeda S. The Rad51 paralog Rad51B promotes homologous recombinational repair. Mol Cell Biol 2000; 20:6476-82. [PMID: 10938124 PMCID: PMC86122 DOI: 10.1128/mcb.20.17.6476-6482.2000] [Citation(s) in RCA: 212] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The highly conserved Saccharomyces cerevisiae Rad51 protein plays a central role in both mitotic and meiotic homologous DNA recombination. Seven members of the Rad51 family have been identified in vertebrate cells, including Rad51, Dmc1, and five Rad51-related proteins referred to as Rad51 paralogs, which share 20 to 30% sequence identity with Rad51. In chicken B lymphocyte DT40 cells, we generated a mutant with RAD51B/RAD51L1, a member of the Rad51 family, knocked out. RAD51B(-/-) cells are viable, although spontaneous chromosomal aberrations kill about 20% of the cells in each cell cycle. Rad51B deficiency impairs homologous recombinational repair (HRR), as measured by targeted integration, sister chromatid exchange, and intragenic recombination at the immunoglobulin locus. RAD51B(-/-) cells are quite sensitive to the cross-linking agents cisplatin and mitomycin C and mildly sensitive to gamma-rays. The formation of damage-induced Rad51 nuclear foci is much reduced in RAD51B(-/-) cells, suggesting that Rad51B promotes the assembly of Rad51 nucleoprotein filaments during HRR. These findings show that Rad51B is important for repairing various types of DNA lesions and maintaining chromosome integrity.
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Affiliation(s)
- M Takata
- Bayer-Chair Department of Molecular Immunology and Allergy, Faculty of Medicine, Japan
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50
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Cappelli E, Degan P, Thompson LH, Frosina G. Efficient repair of 8-oxo-7,8-dihydrodeoxyguanosine in human and hamster xeroderma pigmentosum D cells. Biochemistry 2000; 39:10408-12. [PMID: 10956030 DOI: 10.1021/bi992610l] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The repair of the endogenous lesion 8-oxo-7,8-dihydrodeoxyguanosine (8-oxodG) was investigated in the nucleotide excision repair mutant xeroderma pigmentosum D (XPD), using human normal or transformed XPD fibroblasts and the Chinese hamster XPD cell line UV5. In vivo repair of 8-oxodG induced by hydrogen peroxide treatment and analyzed by high-performance liquid chromatography/electrochemical detection was normal in the XPD mutant fibroblasts XP15PV and GM434, as compared to normal human fibroblasts GM970, GM5757, and GM6114. Similar results were obtained with the human SV40-transformed XPD mutant cell line GM8207 in comparison to the control cell line GM637. Repair of 8-oxodG was even slightly (2-3-fold) but reproducibly increased in Chinese hamster XPD mutant UV5 cells, as compared to parental AA8 cells. This unexpected effect was reversed by transfection in UV5 cells of a wild-type XPD cDNA and confirmed in in vitro experiments in which a plasmid substrate containing a single 8-oxoG was repaired by UV5 cell extracts. The data show that repair of 8-oxodG is normal in XPD cells, thus indicating that the neurological complications of XPD patients may not be linked to in vivo accumulation of this lesion.
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Affiliation(s)
- E Cappelli
- DNA Repair Unit and Mutagenesis Laboratory, Istituto Nazionale Ricerca Cancro, 16132 Genova, Italy
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