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Mujtaba M, Sapna, Khanzada FAISAL, Qayyum DANISH, Saghir TAHIR, Buraro SHARF. Impact of Covid-19 on cardiovascular clinics: are we ready for tele-medicine? Eur Heart J 2022. [PMCID: PMC9383367 DOI: 10.1093/eurheartj/ehab849.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Funding Acknowledgements Type of funding sources: None. Background World is facing Coronavirus disease (COVID-19) pandemic since December 2019. [1, 2]. COVID-19 has significantly decreased the influx of patients presenting with cardiovascular diseases at hospitals. The aim of this study was to determine the difficulties faced by patients in visiting the cardiac outpatient department during COVID-19 era and to assess the awareness regarding telemedicine and wiliness to adopt if offered in future. Methods This cross sectional study was carried out on patients presenting to the outpatient department in a National Institute of Cardiovascular Diseases. Data was collected after verbal consent from patients. The collected data was entered using IBM SPSS version 21, mean ± SD was calculated for continuous variables and frequency and percentages were calculated for the categorical variables. Results A total of 404 patients were interviewed, 42% female and 58% male with 77.5% from urban areas and 22.5% from rural areas. A total of 32.1% patients presented with shortness of breath, 28.8% with chest pain and 19% with palpitations. Regarding cardiovascular diagnosis 69.5% had ischemic heart disease, 38.3% had hypertension, 29.3% suffered from heart failure and 10.3% had valvular heart disease. A total of 26.7% visited the emergency room during the pandemic, 81.9% were compliant with medication and only 66% were compliant with a healthy lifestyle. A total of 52.8% patients found it difficult to attend the out patients department due to limited appointments, 24% due to limited mobility due to lockdown, 18.2% due to financial issues, 14.2% due to fear of acquiring infection from the hospital. Regarding telemedicine, 11.2% of the patients were aware of it and only 4.5% had previously used it, with 41.3% patients willing to opt for telemedicine in future. Regarding barriers to usage of telemedicine, a total of 40.7% of patients had no access to internet, 32.7% did not have a smart device and 11.6% were afraid of being diagnosed incorrectly. Conclusion It was found that distancing measures, lockdowns and restricted mobility of the masses has made it difficult for patients to visit the clinics which has led to patients visiting the emergency room. Telemedicine awareness was found to be limited, however many patients were willing to adopt provided their limitations can be overcame.
Abstract Figure. Difficulty faced during OPD visit
Abstract Figure. Barriers to Tele-medicine ![]()
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Affiliation(s)
- M Mujtaba
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | | | | | - DANISH Qayyum
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - TAHIR Saghir
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - SHARF Buraro
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
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Chillrud SN, Ae-Ngibise KA, Gould CF, Owusu-Agyei S, Mujtaba M, Manu G, Burkart K, Kinney PL, Quinn A, Jack DW, Asante KP. The effect of clean cooking interventions on mother and child personal exposure to air pollution: results from the Ghana Randomized Air Pollution and Health Study (GRAPHS). J Expo Sci Environ Epidemiol 2021; 31:683-698. [PMID: 33654272 DOI: 10.1038/s41370021-00309-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 05/27/2023]
Abstract
BACKGROUND Clean cooking interventions to reduce air pollution exposure from burning biomass for daily cooking and heating needs have the potential to reduce a large burden of disease globally. OBJECTIVE The objective of this study is to evaluate the air pollution exposure impacts of a fan-assisted efficient biomass-burning cookstove and a liquefied petroleum gas (LPG) stove intervention in rural Ghana. METHODS We randomized 1414 households in rural Ghana with pregnant mothers into a control arm (N = 526) or one of two clean cooking intervention arms: a fan-assisted efficient biomass-burning cookstove (N = 527) or an LPG stove and cylinder refills as needed (N = 361). We monitored personal maternal carbon monoxide (CO) at baseline and six times after intervention and fine particulate matter (PM2.5) exposure twice after intervention. Children received three CO exposure monitoring sessions. RESULTS We obtained 5655 48-h maternal CO exposure estimates and 1903 for children, as well as 1379 maternal PM2.5 exposure estimates. Median baseline CO exposures in the control, improved biomass, and LPG arms were 1.17, 1.17, and 1.30 ppm, respectively. Based on a differences-in-differences approach, the LPG arm showed a 47% reduction (95% confidence interval: 34-57%) in mean 48-h CO exposure compared to the control arm. Mean maternal PM2.5 exposure in the LPG arm was 32% lower than the control arm during the post-intervention period (52 ± 29 vs. 77 ± 44 μg/m3). The biomass stove did not meaningfully reduce CO or PM2.5 exposure. CONCLUSIONS We show that LPG interventions lowered air pollution exposure significantly compared to three-stone fires. However, post-intervention exposures still exceeded health-relevant targets. SIGNIFICANCE In a large controlled trial of cleaner cooking interventions, an LPG stove and fuel intervention reduced air pollution exposure in a vulnerable population in a low-resource setting.
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Affiliation(s)
- Steven N Chillrud
- Lamont-Doherty Earth Observatory of Columbia University, Palisades, NY, USA
| | | | - Carlos F Gould
- Department of Environmental Health Science, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Mohammed Mujtaba
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | - Grace Manu
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | - Katrin Burkart
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Patrick L Kinney
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Ashlinn Quinn
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Darby W Jack
- Department of Environmental Health Science, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
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Chillrud SN, Ae-Ngibise KA, Gould CF, Owusu-Agyei S, Mujtaba M, Manu G, Burkart K, Kinney PL, Quinn A, Jack DW, Asante KP. The effect of clean cooking interventions on mother and child personal exposure to air pollution: results from the Ghana Randomized Air Pollution and Health Study (GRAPHS). J Expo Sci Environ Epidemiol 2021; 31:683-698. [PMID: 33654272 PMCID: PMC8273075 DOI: 10.1038/s41370-021-00309-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 05/26/2023]
Abstract
BACKGROUND Clean cooking interventions to reduce air pollution exposure from burning biomass for daily cooking and heating needs have the potential to reduce a large burden of disease globally. OBJECTIVE The objective of this study is to evaluate the air pollution exposure impacts of a fan-assisted efficient biomass-burning cookstove and a liquefied petroleum gas (LPG) stove intervention in rural Ghana. METHODS We randomized 1414 households in rural Ghana with pregnant mothers into a control arm (N = 526) or one of two clean cooking intervention arms: a fan-assisted efficient biomass-burning cookstove (N = 527) or an LPG stove and cylinder refills as needed (N = 361). We monitored personal maternal carbon monoxide (CO) at baseline and six times after intervention and fine particulate matter (PM2.5) exposure twice after intervention. Children received three CO exposure monitoring sessions. RESULTS We obtained 5655 48-h maternal CO exposure estimates and 1903 for children, as well as 1379 maternal PM2.5 exposure estimates. Median baseline CO exposures in the control, improved biomass, and LPG arms were 1.17, 1.17, and 1.30 ppm, respectively. Based on a differences-in-differences approach, the LPG arm showed a 47% reduction (95% confidence interval: 34-57%) in mean 48-h CO exposure compared to the control arm. Mean maternal PM2.5 exposure in the LPG arm was 32% lower than the control arm during the post-intervention period (52 ± 29 vs. 77 ± 44 μg/m3). The biomass stove did not meaningfully reduce CO or PM2.5 exposure. CONCLUSIONS We show that LPG interventions lowered air pollution exposure significantly compared to three-stone fires. However, post-intervention exposures still exceeded health-relevant targets. SIGNIFICANCE In a large controlled trial of cleaner cooking interventions, an LPG stove and fuel intervention reduced air pollution exposure in a vulnerable population in a low-resource setting.
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Affiliation(s)
- Steven N Chillrud
- Lamont-Doherty Earth Observatory of Columbia University, Palisades, NY, USA
| | | | - Carlos F Gould
- Department of Environmental Health Science, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Mohammed Mujtaba
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | - Grace Manu
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | - Katrin Burkart
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Patrick L Kinney
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Ashlinn Quinn
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Darby W Jack
- Department of Environmental Health Science, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
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Carrión D, Prah R, Gould CF, Agbokey F, Mujtaba M, Pillarisetti A, Tumasi M, Agyei O, Chillrud S, Tawiah T, Jack D, Asante KP. Using longitudinal survey and sensor data to understand the social and ecological determinants of clean fuels use and discontinuance in rural Ghana. Environ Res Commun 2020; 2:095003. [PMID: 34504994 PMCID: PMC8425314 DOI: 10.1088/2515-7620/abb831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Efforts to reduce the health and ecological burdens of household biomass combustion are underway in Ghana, principally by promoting clean cookstoves and fuels. Recent studies have focused on the sustained use of clean cookstoves, but sometimes household adopt a new cookstove and then end use of that stove. In this study, we introduce a novel framework for understanding and encouraging household transitions to cleaner cooking: clean fuel discontinuance. We leveraged data from the Ghana Randomized Air Pollution and Health Study (GRAPHS) (N = 1412) where pregnant women received either improved biomass (BioLite) or dual burner LPG stoves for free. LPG users were given free LPG refills during GRAPHS. Weekly questionnaires were administered. Stove use monitors tracked a sub-cohort (n = 220) 6 months before and after the fuel subsidy. We examined social and ecological determinants of stove use and discontinuance. Overall intervention stove use adherence was high throughout GRAPHS, with self-reported use at 69% and 86% of participant-weeks for BioLite and LPG arms respectively. Participants used intervention stoves less for meals requiring vigorous stirring. Burns from intervention stoves decreased use among BioLite (RR: 0.96, p = 0.009), but not LPG users. Device breakage was mentioned as an impediment in 18% of free-text responses for LPG users and 1% for BioLite. Tree canopy within a spatial buffer-a plausible proxy for biomass fuels access-was the only variable explaining LPG discontinued stove use in adjusted Cox time-to-event analyses (HR = -0.56, p < 0.001). Future studies should consider the stove use discontinuance framework.
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Affiliation(s)
- D Carrión
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - R Prah
- Kintampo Health Research Centre, Kintampo, Ghana
| | - C F Gould
- Department of Environmental Health Sciences, Columbia University, New York, United States of America
| | - F Agbokey
- Kintampo Health Research Centre, Kintampo, Ghana
| | - M Mujtaba
- Kintampo Health Research Centre, Kintampo, Ghana
| | - A Pillarisetti
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - M Tumasi
- Kintampo Health Research Centre, Kintampo, Ghana
| | - O Agyei
- Kintampo Health Research Centre, Kintampo, Ghana
| | - S Chillrud
- Lamont-Doherty Earth Observatory, Columbia University, New York, United States of America
| | - T Tawiah
- Kintampo Health Research Centre, Kintampo, Ghana
| | - D Jack
- Department of Environmental Health Sciences, Columbia University, New York, United States of America
| | - K P Asante
- Kintampo Health Research Centre, Kintampo, Ghana
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Ae-Ngibise KA, Wylie BJ, Boamah-Kaali E, Jack DW, Oppong FB, Chillrud SN, Gyaase S, Kaali S, Agyei O, Kinney PL, Mujtaba M, Wright RJ, Asante KP, Lee AG. Prenatal maternal stress and birth outcomes in rural Ghana: sex-specific associations. BMC Pregnancy Childbirth 2019; 19:391. [PMID: 31664941 PMCID: PMC6819589 DOI: 10.1186/s12884-019-2535-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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] [Received: 02/27/2019] [Accepted: 09/24/2019] [Indexed: 01/08/2023] Open
Abstract
Background In developed countries, prenatal maternal stress has been associated with poor fetal growth, however this has not been evaluated in rural sub-Saharan Africa. We evaluated the effect of prenatal maternal stress on fetal growth and birth outcomes in rural Ghana. Methods Leveraging a prospective, rural Ghanaian birth cohort, we ascertained prenatal maternal negative life events, categorized scores as 0-2 (low stress; referent), 3-5 (moderate), and > 5 (high) among 353 pregnant women in the Kintampo North Municipality and Kintampo South District located within the middle belt of Ghana. We employed linear regression to determine associations between prenatal maternal stress and infant birth weight, head circumference, and length. We additionally examined associations between prenatal maternal stress and adverse birth outcome, including low birth weight, small for gestational age, or stillbirth. Effect modification by infant sex was examined. Results In all children, high prenatal maternal stress was associated with reduced birth length (β = − 0.91, p = 0.04; p-value for trend = 0.04). Among girls, moderate and high prenatal maternal stress was associated with reduced birth weight (β = − 0.16, p = 0.02; β = − 0.18, p = 0.04 respectively; p-value for trend = 0.04) and head circumference (β = − 0.66, p = 0.05; β = − 1.02, p = 0.01 respectively; p-value for trend = 0.01). In girls, high prenatal stress increased odds of any adverse birth outcome (OR 2.41, 95% CI 1.01-5.75; p for interaction = 0.04). Sex-specific analyses did not demonstrate significant effects in boys. Conclusions All infants, but especially girls, were vulnerable to effects of prenatal maternal stress on birth outcomes. Understanding risk factors for impaired fetal growth may help develop preventative public health strategies. Trial registration NCT01335490 (prospective registration). Date of Registration: April 14, 2011. Status of Registration: Completed.
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Affiliation(s)
- Kenneth Ayuurebobi Ae-Ngibise
- Ghana Health Service, Kintampo Health Research Centre, Brong Ahafo Region, Kintampo, Ghana.,School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Blair J Wylie
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ellen Boamah-Kaali
- Ghana Health Service, Kintampo Health Research Centre, Brong Ahafo Region, Kintampo, Ghana
| | - Darby W Jack
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Felix Boakye Oppong
- Ghana Health Service, Kintampo Health Research Centre, Brong Ahafo Region, Kintampo, Ghana
| | - Steven N Chillrud
- Lamont-Doherty Earth Observatory at Columbia University, Palisades, NY, USA
| | - Stephaney Gyaase
- Ghana Health Service, Kintampo Health Research Centre, Brong Ahafo Region, Kintampo, Ghana
| | - Seyram Kaali
- Ghana Health Service, Kintampo Health Research Centre, Brong Ahafo Region, Kintampo, Ghana
| | - Oscar Agyei
- Ghana Health Service, Kintampo Health Research Centre, Brong Ahafo Region, Kintampo, Ghana
| | - Patrick L Kinney
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Mohammed Mujtaba
- Ghana Health Service, Kintampo Health Research Centre, Brong Ahafo Region, Kintampo, Ghana
| | - Rosalind J Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kwaku Poku Asante
- Ghana Health Service, Kintampo Health Research Centre, Brong Ahafo Region, Kintampo, Ghana
| | - Alison G Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY, 10029, USA.
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Van Vliet EDS, Kinney PL, Owusu-Agyei S, Schluger NW, Ae-Ngibise KA, Whyatt RM, Jack DW, Agyei O, Chillrud SN, Boamah EA, Mujtaba M, Asante KP. Current respiratory symptoms and risk factors in pregnant women cooking with biomass fuels in rural Ghana. Environ Int 2019; 124:533-540. [PMID: 30685455 PMCID: PMC7069526 DOI: 10.1016/j.envint.2019.01.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 01/16/2019] [Accepted: 01/16/2019] [Indexed: 05/31/2023]
Abstract
BACKGROUND More than 75% of the population in Ghana relies on biomass fuels for cooking and heating. Household air pollution (HAP) emitted from the incomplete combustion of these fuels has been associated with adverse health effects including respiratory effects in women that can lead to chronic obstructive pulmonary disease (COPD), a major contributor to global HAP-related mortality. HAP is a modifiable risk factor in the global burden of disease, exposure to which can be reduced. OBJECTIVE This study assessed the prevalence of respiratory symptoms, as well as associations between respiratory symptoms and HAP exposure, as measured using continuous personal carbon monoxide (CO), in nonsmoking pregnant women in rural Ghana. METHODS We analyzed current respiratory health symptoms and CO exposures upon enrollment in a subset (n = 840) of the population of pregnant women cooking with biomass fuels and enrolled in the GRAPHS randomized clinical control trial. Personal CO was measured using Lascar continuous monitors. Associations between CO concentrations as well as other sources of pollution exposures and respiratory health symptoms were estimated using logistic regression models. CONCLUSION There was a positive association between CO exposure per 1 ppm increase and a composite respiratory symptom score of current cough (lasting >5 days), wheeze and/or dyspnea (OR: 1.2, p = 0.03). CO was also positively associated with wheeze (OR: 1.3, p = 0.05), phlegm (OR: 1.2, p = 0.08) and reported clinic visit for respiratory infection in past 4 weeks (OR: 1.2, p = 0.09). Multivariate models showed significant associations between second-hand tobacco smoke and a composite outcome (OR: 2.1, p < 0.01) as well as individual outcomes of cough >5 days (OR: 3.1, p = 0.01), wheeze (OR: 2.7, p < 0.01) and dyspnea (OR: 2.2, p = 0.01). Other covariates found to be significantly associated with respiratory outcomes include involvement in charcoal production business and dyspnea, and involvement in burning grass/field and wheeze. Results suggest that exposure to HAP increases the risk of adverse respiratory symptoms among pregnant women using biomass fuels for cooking in rural Ghana.
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Affiliation(s)
| | | | | | - Neil W Schluger
- Columbia University College of Physicians and Surgeons, New York, NY, USA; Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Robin M Whyatt
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Darby W Jack
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Oscar Agyei
- Kintampo Health Research Centre, Kintampo, Ghana
| | - Steven N Chillrud
- Lamont-Doherty Earth Observatory, Columbia University, Palisades, NY, USA
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Nadar SK, Mujtaba M, Al-Hadi H, Sadiq M, Al-Riyami A, Ali M, Al-Lawati H. Epidemiology, Outcomes and Coronary Angiography Findings of Patients Following Out-of-Hospital Cardiac Arrest: A single-centre experience from Oman. Sultan Qaboos Univ Med J 2018; 18:e155-e160. [PMID: 30210844 DOI: 10.18295/squmj.2018.18.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 02/07/2018] [Accepted: 03/01/2018] [Indexed: 11/16/2022] Open
Abstract
Objectives Out-of-hospital cardiac arrests (OHCAs) are a leading cause of death worldwide. However, data regarding the management and outcomes of affected patients are lacking in the Middle East. The current study aimed to present the angiographic findings and outcomes of patients presenting with OHCA in Muscat, Oman. Methods This retrospective study took place between January 2012 and December 2016 at the Sultan Qaboos University Hospital (SQUH), Muscat, Oman. All adult patients who presented following an OHCA to the Emergency Department of SQUH during the study period were included. Demographic and clinical data were collected from electronic medical records. Results A total of 216 patients were included in the study. The majority (63.9%) presented after having collapsed, while 22.3% presented with chest pains. Asystole was the most frequent initial cardiac rhythm (62.5%), with only 10% having ventricular tachycardia/fibrillation. Very few patients (1.4%) had received cardiopulmonary resuscitation (CPR) prior to presentation. In total, 85 patients (39.4%) returned to spontaneous circulation (RSC); of these, post-RSC electrocardiography revealed an ST-segment elevation in 41.2% and normal findings in 23.5%. There were 63 patients who underwent coronary angiography, with 28 requiring stenting. Overall, 13% of patients survived and were discharged, although three survivors suffered permanent hypoxic brain damage. Conclusion The overall survival rate of patients who had experienced an OHCA was low. Education programmes should focus on the benefits of immediate CPR for individuals experiencing an OHCA, with more opportunities for CPR training to be made available to the general public in Oman.
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Affiliation(s)
- Sunil K Nadar
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Mohammed Mujtaba
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hafidh Al-Hadi
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Muhammed Sadiq
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Adil Al-Riyami
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Mehar Ali
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hatim Al-Lawati
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
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Carrión D, Dwommoh R, Tawiah T, Agyei O, Agbokey F, Twumasi M, Mujtaba M, Jack D, Asante KP. Enhancing LPG adoption in Ghana (ELAG): a factorial cluster-randomized controlled trial to Enhance LPG Adoption & Sustained use. BMC Public Health 2018; 18:689. [PMID: 29866127 PMCID: PMC5987623 DOI: 10.1186/s12889-018-5622-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/28/2018] [Indexed: 11/23/2022] Open
Abstract
Background Three billion individuals worldwide rely on biomass fuel [dung, wood, crops] for cooking and heating. Further, health conditions resulting from household air pollution (HAP) are responsible for approximately 3.9 million premature deaths each year. Though transition away from traditional biomass stoves is projected curb the health effects of HAP by mitigating exposure, the benefits of newer clean cookstove technologies can only be fully realized if use of these new stoves is exclusive and sustained. However, the conditions under which individuals adopt and sustain use of clean cookstoves is not well understood. Methods The Enhancing LPG Adoption in Ghana (ELAG) study is a cluster-randomized controlled trial employing a factorial intervention design. The first component is a behavior change intervention based on the Risks, Attitudes, Norms, Abilities, and Self-regulation (RANAS) model. This intervention seeks to align these five behavioral factors with clean cookstove adoption and sustained use. A second intervention is access-related and will improve LPG availability by offering a direct-delivery refueling service. These two interventions will be integrated via a factorial design whereby 27 communities are assigned to one of the following: the control arm, the educational intervention, the delivery, or a combined intervention. Intervention allocation is determined by a covariate-constrained randomization approach. After intervention, approximately 900 households’ individual fuel use is tracked for 12 months via iButton stove use monitors. Analysis will include hierarchical linear models used to compare intervention households’ fuel use to control households. Discussion Literature to-date demonstrates that recipients of improved cookstoves rarely completely adopt the new technology. Instead, they often practice partial adoption (fuel stacking). Consequently, interventions are needed to influence adoption patterns and simultaneously to understand drivers of fuel adoption. Ensuring uptake, adoption, and sustained use of improved cookstove technologies can then lead to HAP-reductions and consequent improvements in public health. Trial registration NCT03352830 (November 24, 2017). Electronic supplementary material The online version of this article (10.1186/s12889-018-5622-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel Carrión
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street - 11th Floor, New York, NY, 10032, USA
| | | | | | - Oscar Agyei
- Kintampo Health Research Centre, Kintampo, Ghana
| | | | | | | | - Darby Jack
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street - 11th Floor, New York, NY, 10032, USA.
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Quinn AK, Ae-Ngibise KA, Kinney PL, Kaali S, Wylie BJ, Boamah E, Shimbo D, Agyei O, Chillrud SN, Mujtaba M, Schwartz JE, Abdalla M, Owusu-Agyei S, Jack DW, Asante KP. Ambulatory monitoring demonstrates an acute association between cookstove-related carbon monoxide and blood pressure in a Ghanaian cohort. Environ Health 2017; 16:76. [PMID: 28732501 PMCID: PMC5521137 DOI: 10.1186/s12940-017-0282-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 06/26/2017] [Indexed: 05/05/2023]
Abstract
BACKGROUND Repeated exposure to household air pollution may intermittently raise blood pressure (BP) and affect cardiovascular outcomes. We investigated whether hourly carbon monoxide (CO) exposures were associated with acute increases in ambulatory blood pressure (ABP); and secondarily, if switching to an improved cookstove was associated with BP changes. We also evaluated the feasibility of using 24-h ambulatory blood pressure monitoring (ABPM) in a cohort of pregnant women in Ghana. METHODS Participants were 44 women enrolled in the Ghana Randomized Air Pollution and Health Study (GRAPHS). For 27 of the women, BP was measured using 24-h ABPM; home blood pressure monitoring (HBPM) was used to measure BP in the remaining 17 women. Personal CO exposure monitoring was conducted alongside the BP monitoring. RESULTS ABPM revealed that peak CO exposure (defined as ≥4.1 ppm) in the 2 hours prior to BP measurement was associated with elevations in hourly systolic BP (4.3 mmHg [95% CI: 1.1, 7.4]) and diastolic BP (4.5 mmHg [95% CI: 1.9, 7.2]), as compared to BP following lower CO exposures. Women receiving improved cookstoves had lower post-intervention SBP (within-subject change in SBP of -2.1 mmHg [95% CI: -6.6, 2.4] as compared to control), though this result did not reach statistical significance. 98.1% of expected 24-h ABPM sessions were successfully completed, with 92.5% of them valid according to internationally defined criteria. CONCLUSIONS We demonstrate an association between acute exposure to carbon monoxide and transient increases in BP in a West African setting. ABPM shows promise as an outcome measure for assessing cardiovascular health benefits of cookstove interventions. TRIAL REGISTRATION The GRAPHS trial was registered with clinicaltrials.gov on 13 April 2011 with the identifier NCT01335490 .
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Affiliation(s)
- Ashlinn K. Quinn
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 West 168th St, 11th floor, New York, 10032 NY USA
| | | | - Patrick L. Kinney
- Department of Environmental Health, Boston University School of Public Health, Boston, MA USA
| | - Seyram Kaali
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Blair J. Wylie
- Division of Maternal-Fetal Medicine, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Ellen Boamah
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Daichi Shimbo
- Department of Medicine, Columbia University Medical Center, New York, NY USA
| | - Oscar Agyei
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Steven N. Chillrud
- Lamont-Doherty Earth Observatory of Columbia University, Palisades, NY USA
| | - Mohammed Mujtaba
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Joseph E. Schwartz
- Institute for Applied Behavioral Medicine Research, Stony Brook University, Stony Brook, NY USA
- Center for Behavioral Cardiovascular Health, Columbia University, New York, NY USA
| | - Marwah Abdalla
- Center for Behavioral Cardiovascular Health, Columbia University, New York, NY USA
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Darby W. Jack
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 West 168th St, 11th floor, New York, 10032 NY USA
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
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Wylie BJ, Ae-Ngibise KA, Boamah EA, Mujtaba M, Messerlian C, Hauser R, Coull B, Calafat AM, Jack D, Kinney PL, Whyatt R, Owusu-Agyei S, Asante KP. Urinary Concentrations of Insecticide and Herbicide Metabolites among Pregnant Women in Rural Ghana: A Pilot Study. Int J Environ Res Public Health 2017; 14:ijerph14040354. [PMID: 28353657 PMCID: PMC5409555 DOI: 10.3390/ijerph14040354] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 03/02/2017] [Accepted: 03/21/2017] [Indexed: 11/16/2022]
Abstract
Use of pesticides by households in rural Ghana is common for residential pest control, agricultural use, and for the reduction of vectors carrying disease. However, few data are available about exposure to pesticides among this population. Our objective was to quantify urinary concentrations of metabolites of organophosphate (OP), pyrethroid, and select herbicides during pregnancy, and to explore exposure determinants. In 2014, 17 pregnant women from rural Ghana were surveyed about household pesticide use and provided weekly first morning urine voids during three visits (n = 51 samples). A total of 90.1% (46/51) of samples had detectable OP metabolites [geometric mean, GM (95% CI): 3,5,6-trichloro-2-pyridinol 0.54 µg/L (0.36–0.81), para-nitrophenol 0.71 µg/L (0.51–1.00)], 75.5% (37/49) had detectable pyrethroid metabolites [GM: 3-phenoxybenzoic acid 0.23 µg/L (0.17, 0.32)], and 70.5% (36/51) had detectable 2,4-dichlorophenoxyacetic acid levels, a herbicide [GM: 0.46 µg/L (0.29–0.73)]. Concentrations of para-nitrophenol and 2,4-dichlorophenoxyacetic acid in Ghanaian pregnant women appear higher when compared to nonpregnant reproductive-aged women in a reference U.S. population. Larger studies are necessary to more fully explore predictors of exposure in this population.
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Affiliation(s)
- Blair J Wylie
- Division of Maternal-Fetal Medicine, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
| | - Kenneth A Ae-Ngibise
- Kintampo Health Research Centre, Ghana Health Service, P.O. Box 200, Brong Ahafo Region, Kintampo 00233, Ghana.
| | - Ellen A Boamah
- Kintampo Health Research Centre, Ghana Health Service, P.O. Box 200, Brong Ahafo Region, Kintampo 00233, Ghana.
| | - Mohammed Mujtaba
- Kintampo Health Research Centre, Ghana Health Service, P.O. Box 200, Brong Ahafo Region, Kintampo 00233, Ghana.
| | - Carmen Messerlian
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
| | - Brent Coull
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
- Department of Statistics, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
| | - Antonia M Calafat
- Centers for Disease Control and Prevention, 4770 Buford Hwy, Atlanta, GA 30341, USA.
| | - Darby Jack
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA.
| | - Patrick L Kinney
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA.
| | - Robin Whyatt
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA.
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, P.O. Box 200, Brong Ahafo Region, Kintampo 00233, Ghana.
| | - Kwaku P Asante
- Kintampo Health Research Centre, Ghana Health Service, P.O. Box 200, Brong Ahafo Region, Kintampo 00233, Ghana.
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Jack DW, Asante KP, Wylie BJ, Chillrud SN, Whyatt RM, Ae-Ngibise KA, Quinn AK, Yawson AK, Boamah EA, Agyei O, Mujtaba M, Kaali S, Kinney P, Owusu-Agyei S. Ghana randomized air pollution and health study (GRAPHS): study protocol for a randomized controlled trial. Trials 2015; 16:420. [PMID: 26395578 PMCID: PMC4579662 DOI: 10.1186/s13063-015-0930-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [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: 03/23/2015] [Accepted: 08/27/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Household air pollution exposure is a major health risk, but validated interventions remain elusive. METHODS/DESIGN The Ghana Randomized Air Pollution and Health Study (GRAPHS) is a cluster-randomized trial that evaluates the efficacy of clean fuels (liquefied petroleum gas, or LPG) and efficient biomass cookstoves in the Brong-Ahafo region of central Ghana. We recruit pregnant women into LPG, efficient cookstove, and control arms and track birth weight and physician-assessed severe pneumonia incidence in the first year of life. A woman is eligible to participate if she is in the first or second trimester of pregnancy and carrying a live singleton fetus, if she is the primary cook, and if she does not smoke. We hypothesize that babies born to intervention mothers will weigh more and will have fewer cases of physician-assessed severe pneumonia in the first year of life. Additionally, an extensive personal air pollution exposure monitoring effort opens the way for exposure-response analyses, which we will present alongside intention-to-treat analyses. Major funding was provided by the National Institute of Environmental Health Sciences, The Thrasher Research Fund, and the Global Alliance for Clean Cookstoves. DISCUSSION Household air pollution exposure is a major health risk that requires well-tested interventions. GRAPHS will provide important new evidence on the efficacy of both efficient biomass cookstoves and LPG, and will thus help inform health and energy policies in developing countries. TRIAL REGISTRATION The trial was registered with clinicaltrials.gov on 13 April 2011 with the identifier NCT01335490 .
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Affiliation(s)
- Darby W Jack
- Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana.
| | - Blair J Wylie
- Division of Maternal-Fetal Medicine, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Steve N Chillrud
- Lamont-Doherty Earth Observatory of Columbia University, New York, NY, USA.
| | - Robin M Whyatt
- Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Kenneth A Ae-Ngibise
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana.
| | - Ashlinn K Quinn
- Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Abena Konadu Yawson
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana.
| | - Ellen Abrafi Boamah
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana.
| | - Oscar Agyei
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana.
| | - Mohammed Mujtaba
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana.
| | - Seyram Kaali
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana.
| | - Patrick Kinney
- Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana.
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Ae-Ngibise KA, Kinney PL, Asante KP, Jack D, Boamah EA, Whyatt R, Mujtaba M, Manu A, Owusu-Agyei S, Wylie BJ. Pesticide exposures in a malarious and predominantly farming area in Central Ghana. ACTA ACUST UNITED AC 2015; 9:655-661. [PMID: 27239261 PMCID: PMC4879974 DOI: 10.5897/ajest2015.1912] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In areas where malaria is endemic, pesticides are widely deployed for vector control, which has contributed to reductions in malaria deaths. Pesticide use for agrarian purposes reduces pest populations, thus improving crop production and post-harvest losses. However, adverse health effects have been associated with pesticide exposure, ranging from skin irritation to neurotoxicity and carcinogenicity. Though misuse of these pesticides can lead to widespread potential dangers, the debilitating effects are usually underappreciated in many developing countries. To evaluate the pattern of pesticide usage among rural communities in the Kintampo area of Ghana, a cross-sectional survey was conducted among 1455 heads of households randomly sampled from among 29,073 households in the Kintampo Health and Demographic Surveillance System area of Ghana to estimate the prevalence of pesticide use and indications for use among this rural populace. Seventy-one percent (1040/1455) of household heads reported having used pesticides on either their farms or homes, most commonly for control of weeds (96.4%, 1003/1040) or insects (85.4%, 888/1040). Dichlorodiphenyltrichloroethane (DDT) was used by 22.9% (238/1040) of respondents. The majority of households who reported use of pesticides said women in their households assisted in the spraying efforts (69.3%, 721/1040); of these women, 50.8% (366/721) did so while carrying their babies on their backs. Only 28.9% (301/1040) of the study participants wore protective devices during pesticide applications. Frequent symptoms that were reported after spraying, included cough (32.3%; 336/1040), difficulty in breathing (26.7%; 278/1040) and skin irritation (39.0%; 406/1040). Pesticide use among community members in the Kintampo area of Ghana is common and its potential health impacts warrant further investigation.
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Affiliation(s)
| | - Patrick L Kinney
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Brong Ahafo Region, Kintampo, Ghana
| | - Darby Jack
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ellen Abrafi Boamah
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Brong Ahafo Region, Kintampo, Ghana
| | - Robin Whyatt
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mohammed Mujtaba
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Brong Ahafo Region, Kintampo, Ghana
| | - Alexander Manu
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Brong Ahafo Region, Kintampo, Ghana
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Brong Ahafo Region, Kintampo, Ghana
| | - Blair J Wylie
- Division of Maternal-Fetal Medicine, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Tandon T, Mujtaba M, Mishler D, Phillips C, Sharfuddin A. Early Enterococcus-associated acute postinfectious glomerulonephritis after kidney transplant. Clin Kidney J 2015; 7:426-7. [PMID: 25852929 PMCID: PMC4377814 DOI: 10.1093/ckj/sfu069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/10/2014] [Indexed: 11/29/2022] Open
Affiliation(s)
- Teena Tandon
- Division of Nephrology, Department of Medicine , Indiana University School of Medicine, University Hospital , Indianapolis, IN , USA
| | - M Mujtaba
- Division of Nephrology, Department of Medicine , Indiana University School of Medicine, University Hospital , Indianapolis, IN , USA
| | - Dennis Mishler
- Division of Nephrology, Department of Medicine , Indiana University School of Medicine, University Hospital , Indianapolis, IN , USA
| | - Carrie Phillips
- Department of Pathology , Indiana University School of Medicine , Indianapolis, IN , USA
| | - Asif Sharfuddin
- Division of Nephrology, Department of Medicine , Indiana University School of Medicine, University Hospital , Indianapolis, IN , USA
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Jeelani A, Malik W, Haq I, Aleem S, Mujtaba M, Syed N. Cross-sectional studies published in Indian journal of community medicine: evaluation of adherence to strengthening the reporting of observational studies in epidemiology statement. Ann Med Health Sci Res 2014; 4:875-8. [PMID: 25506479 PMCID: PMC4250984 DOI: 10.4103/2141-9248.144889] [Citation(s) in RCA: 8] [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: 11/23/2022] Open
Abstract
Background: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement is a set of recommendations about what should be included in a more accurate and complete description of observational studies. Aim: The aim was to assess the quality of reporting of cross-sectional studies by evaluating the extent to which they adhere to the STROBE statement. Materials and Methods: This study has a cross-sectional design. All the articles published as original articles in Indian Journal of Community Medicine from January 2010 to September 2011 were downloaded from the journal website. A total of 96 articles were downloaded out of which 80 were found to have a cross-sectional design. Variables were: (1) Percentage of STROBE items included in a report and (2) percentage of articles reporting each item in the STROBE checklist. Data analysis was done by descriptive statistics using frequencies and percentages. Results: A total of 80 articles were evaluated. About 46% (37/80) articles reported 12–15 items of the STROBE checklist. Bias, nonparticipants and reasons for nonparticipation, other analyses done, generalizability, and source of funding were reported by < 25% of studies. The most frequently reported items of the checklist were summary of what was done and what was found in the abstract, background/rationale, objectives, setting, outcome data, key results in discussion, interpretation of results. None of the articles reported all items of the STROBE checklist. Conclusion: This study reveals that the quality of reporting cross-sectional studies in Indian Journal of Community Medicine is not satisfactory and there is room for improvement.
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Affiliation(s)
- A Jeelani
- Department of Community Medicine, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Wr Malik
- Department of Community Medicine, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - I Haq
- Department of Community Medicine, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - S Aleem
- Medical College for Women and Hospital, Uttara, Bangladesh, Bangladesh
| | - M Mujtaba
- Department of Surgery, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - N Syed
- Department of Community Medicine, Government Medical College, Srinagar, Jammu and Kashmir, India
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Tareen A, Mirza I, Mujtaba M, Chaudhry HR, Jenkins R. Primary care treatment for child and adolescent neuropsychiatric conditions in remote rural Punjab, Pakistan - a cross-sectional survey. Child Care Health Dev 2008; 34:801-5. [PMID: 18786132 DOI: 10.1111/j.1365-2214.2008.00859.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pakistan is one of the most populous regions of the world. Previous work has demonstrated that there is reliance on traditional healthcare systems when seeking psychiatric care; however, there is a lack of information on help seeking for child and adolescent population. The aim of this study was to describe types of treatments and families' perceptions of the effectiveness of those treatments for childhood neuropsychiatric disorders in remote rural Punjab. METHOD Cross-sectional survey of consecutive attendees at an advertised mental health consultation day in a remote rural area. RESULTS The effectiveness of these treatments, as rated by patients and their families, was variable, with highest reported effectiveness for general practitioner treatments. In families with a past history of care from a general practitioner, those who had epilepsy reported treatments to be more effective than those with mental retardation. Carers and users described consulting five different types of primary healthcare practitioners that used both physical and psychotherapeutic treatments. CONCLUSIONS There is considerable variation in treatments available for child and adolescent neuropsychiatric disorders in remote rural areas of Punjab, a large proportion of which are considered ineffective by the users and carers. This highlights the need to develop effective interventions for child and adolescent neuropsychiatric conditions that can be administered by primary health workers. Our data suggest that the need for this is greatest for mental retardation.
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Affiliation(s)
- A Tareen
- Human Development Research Foundation, Islamabad, Pakistan
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Mujtaba M, Madhrira M, Agarwala R, Mohan S, Park C, Anderson H, Pogue V, Cheng J. 178: Management and Toxicokinetics of Metformin Associated Lactic Acidosis (MALA) By Continuous Venovenous Hemodiafiltration (CVVHDF). Am J Kidney Dis 2008. [DOI: 10.1053/j.ajkd.2008.02.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Su ET, DeWal H, Sanders R, Kummer FJ, Mujtaba M, Koval KJ. Effect of piriformis versus trochanteric starting point on fixation stability of short intramedullary reconstruction nails. Bull Hosp Jt Dis 2002; 60:67-71. [PMID: 12003356] [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] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Recently, a new, shorter IM nail using two 6 mm reconstruction screws for proximal fixation was introduced in two versions for femoral insertion: piriformis fossa (FAN) and greater trochanter (TAN). These nails were compared experimentally for their fixation stability, proximal load transmission, and failure strength in an unstable intertrochanteric fracture model in cadaveric femurs. Vertical and axial loads were first applied to the intact femurs. Fractures were created, subsequent fixation applied, and the femurs underwent a series of both vertical and axial loading tests. There was no significant difference in strain readings between the nails for either axial loading or cyclical loading. There was no statistically significant difference between the loads to failure for the trochanteric nails and the standard antegrade nails. The average ultimate loadfor the FAN and TAN nails were 3010 N and 2830 N respectively. These two nails performed very similarly throughout our testing.
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Affiliation(s)
- E T Su
- NYU-Hospital for Joint Diseases Department of Orthopaedic Surgery, New York, New York 10003, USA
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Chen AL, Mujtaba M, Zuckerman JD, Jeong GK, Joseph TN, Wright K, Di Cesare PE. Midterm clinical and radiographic results with the genesis I total knee prosthesis. J Arthroplasty 2001; 16:1055-62. [PMID: 11740763 DOI: 10.1054/arth.2001.27667] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The midterm results of primary posterior cruciate ligament-retaining, minimally conforming, cemented modular total knee arthroplasties using the Genesis I prosthesis in 110 knees in 72 patients were reviewed. Patients were evaluated at a mean follow-up of 7.3 years by Knee Society pain and functional scores, radiographic and survivorship analysis, and Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC) health status questionnaire. Range of motion increased from an average of 96.3 degrees to 112.5 degrees. Knee Society pain and functional scores increased from preoperative averages of 55 and 44 to 92 and 88, respectively. There were 91 excellent, 16 good, 1 fair, and 2 poor results. WOMAC scores were increased significantly in each subcategory examined (pain, stiffness, and physical function). Kaplan-Meier survivorship was 97% at 10 years. An increase in loosening as a result of eccentric stress concentration secondary to the nonconforming design of this prosthesis, theoretically a matter of some clinical concern, was not shown in this investigation.
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Affiliation(s)
- A L Chen
- Department of Orthopaedic Surgery, NYU-Hospital for Joint Diseases, New York, New York 10003, USA
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Joseph TN, Mujtaba M, Chen AL, Maurer SL, Zuckerman JD, Maldjian C, Di Cesare PE. Efficacy of combined technetium-99m sulfur colloid/indium-111 leukocyte scans to detect infected total hip and knee arthroplasties. J Arthroplasty 2001; 16:753-8. [PMID: 11547374 DOI: 10.1054/arth.2001.24446] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The reliability of combined indium-111 leukocyte/technetium-99m sulfur colloid scans, with and without the addition of blood pooling and blood flow studies, in the diagnosis of infected total joint arthroplasty was investigated. Both scans were performed on 58 patients before reoperation of total hip or knee arthroplasty in the period 1996-1999. Results for imaging alone included 100% specificity, 46% sensitivity, 100% positive predictive value, 84% negative predictive value, and 88% accuracy. Inclusion of blood pooling and flow phase data improved results to 66% sensitivity, 89% negative predictive value, and 90% accuracy, with reductions in specificity (98%) and positive predictive value (91%). Routine use of these radionuclide scans is not supported by these data.
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Affiliation(s)
- T N Joseph
- Musculoskeletal Research Center, Department of Orthopaedic Surgery, NYU-Hospital for Joint Diseases, New York, New York 10003, USA
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Abstract
BACKGROUND Amitriptyline, a tricyclic antidepressant, is frequently used orally for the management of chronic pain. To date there is no report of amitriptyline producing peripheral nerve blockade. The authors therefore investigated the local anesthetic properties of amitriptyline in rats and in vitro. METHODS Sciatic nerve blockade was performed with 0.2 ml amitriptyline or bupivacaine at selected concentrations, and the motor, proprioceptive, and nociceptive blockade was evaluated. Cultured rat GH3 cells were externally perfused with amitriptyline or bupivacaine, and the drug affinity toward inactivated and resting Na+ channels was assessed under whole-cell voltage clamp conditions. In addition, use-dependent blockade of these drugs at 5 Hz was evaluated. RESULTS Complete sciatic nerve blockade for nociception was obtained with amitriptyline for 217 +/- 19 min (5 mM, n = 8, mean +/- SEM) and for 454 +/- 38 min (10 mM, n = 7) versus bupivacaine for 90 +/- 13 min (15.4 mM, n = 6). The time to full recovery of nociception for amitriptyline was 353 +/- 12 min (5 mM) and 656 +/- 27 min (10 mM) versus 155 +/- 9 min for bupivacaine (15.4 mM). Amitriptyline was approximately 4.7-10.6 times more potent than bupivacaine in binding to the resting channels (50% inhibitory concentration [IC50] of 39.8 +/- 2.7 vs. 189.6 +/- 22.3 microM) at - 150 mV, and to the inactivated Na+ channels (IC50 of 0.9 +/- 0.1 vs. 9.6 +/- 0.9 microM) at -60 mV. High-frequency stimulation at 3 microM caused an additional approximately 14% blockade for bupivacaine, but approximately 50% for amitriptyline. CONCLUSION Amitriptyline is a more potent blocker of neuronal Na+ channels than bupivacaine in vivo and in vitro. These findings suggest that amitriptyline could extend its clinical usefulness for peripheral nerve blockade.
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Affiliation(s)
- P Gerner
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
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