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Maddren R, Collyer B, Phillips AE, Rayment Gomez S, Abtew B, Anjulo U, Tadele D, Sharma A, Tamiru A, Liyew EF, Chernet M, Anderson RM. Patterns of individual compliance with anthelmintic treatment for soil-transmitted helminth infections in southern Ethiopia over six rounds of community-wide mass drug administration. Trans R Soc Trop Med Hyg 2024; 118:304-312. [PMID: 37965994 PMCID: PMC11062190 DOI: 10.1093/trstmh/trad079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/05/2023] [Accepted: 10/30/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND The mainstay of soil-transmitted helminth (STH) control is repeated mass drug administration (MDA) of anthelmintics to endemic populations. Individual longitudinal compliance treatment patterns are important for identifying pockets of infected individuals who remain untreated and serve as infection reservoirs. METHODS The Geshiyaro Project censused the study population in Wolaita, Ethiopia at baseline in 2018. Individual longitudinal compliance was recorded for six rounds of community-wide MDA (cMDA). The probability distribution of treatment frequency was analysed by age and gender stratifications. Probabilities of transmission interruption for different compliance patterns were calculated using an individual-based stochastic model of Ascaris lumbricoides transmission. RESULTS The never-treated (0.42%) population was smaller than expected from a random positive binomial distribution. The observed compliance frequency was well described by the beta-binomial distribution. Preschool-age children (odds ratio [OR] 10.1 [95% confidence interval {CI} 6.63 to 15.4]) had the highest never-treated proportion of the age groups. Conversely, school-age children (SAC) and adults (OR 1.03 [95% CI 0.98 to 1.09]) had the highest always-treated proportion of the age groups. CONCLUSIONS The study reports the largest dataset of individual longitudinal compliance to cMDA for STH control. Clear pattens are shown in the age-dependent distribution of individual compliance behaviour. The impact of compliance on the probability of elimination is significant, highlighting the importance of recording the full frequency distribution, not just the never-treated proportion.
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Affiliation(s)
- R Maddren
- Imperial College London, St Mary's Campus, Praed Street, London W2 1NY, UK
| | - B Collyer
- Imperial College London, St Mary's Campus, Praed Street, London W2 1NY, UK
| | - A E Phillips
- FHI360, 359 Blackwell Street, Suite 200, Durham, NC, USA
| | - S Rayment Gomez
- Imperial College London, St Mary's Campus, Praed Street, London W2 1NY, UK
| | - B Abtew
- Imperial College London, St Mary's Campus, Praed Street, London W2 1NY, UK
| | - U Anjulo
- Federal Ministry of Health, 1234 Sudan Street, Addis Ababa, Ethiopia
| | - D Tadele
- Simprints, Cambridge CB1 2FH, UK
| | - A Sharma
- Simprints, Cambridge CB1 2FH, UK
| | - A Tamiru
- Federal Ministry of Health, 1234 Sudan Street, Addis Ababa, Ethiopia
| | - E Firdawek Liyew
- Ethiopian Public Health Institute, Swaziland Street, 2PWJ P8C, Addis Ababa, Ethiopia
| | - M Chernet
- Ethiopian Public Health Institute, Swaziland Street, 2PWJ P8C, Addis Ababa, Ethiopia
| | - R M Anderson
- Imperial College London, St Mary's Campus, Praed Street, London W2 1NY, UK
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Martin JV, Epstein K, Anderson RM, Charnley S. Coexistence Praxis: The Role of Resource Managers in Wolf-Livestock Interactions on Federal Lands. Front Conserv Sci 2021. [DOI: 10.3389/fcosc.2021.707068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In resource management, new terms are frequently introduced, reflecting ongoing evolution in the theory and practice of ecology and governance. Yet understandings of what new concepts mean, for whom, and what they imply for management on the ground can vary widely. Coexistence—a prominent concept within the literature and practices around human-wildlife conflict and predator management—is one such term: widely invoked and yet poorly defined. While for some coexistence is the latest paradigm in improving human-wildlife relations, the concept remains debated and indeed even hotly contested by others—particularly on the multiple-use public lands of the American West, where gray wolf conservation, livestock production, and the claims of diverse stakeholders share space.The multiple meanings of coexistence present serious challenges for conservation practice, as what the concept implies or requires can be contested by those most central to its implementation. In this study we examine wolf-livestock management—a classic case of human-wildlife conflict—by focusing on the experiences and perspectives of U.S. Forest Service (USFS) managers. We reviewed coexistence's multivalence in the literature, complementing semi-structured interviews conducted with USFS employees on case study forests from across the western states. Through this, we highlight the complexity and multi-dimensionality of the concept, and the unique yet under-explored perspective that resource managers bring to these debates.This work draws on insights from political ecology to emphasize the situatedness of manager practice—taking place within a broader set of relations and contextual pressures—while extending political ecologists' traditional focus on the resource user to a concern with the resource manager as a key actor in environmental conflicts. Through our engagement with the experiences and perceptions of USFS managers, who must balance conservation aims with long-established land uses like livestock grazing, we hope to clarify the various dimensions of coexistence. Our hope is that this work thus increases the possibility for empathy and collaboration among managers and stakeholders engaged in this complex socio-ecological challenge.
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Anderson RM. The Visually Impaired Mentally Retarded: A Selected Bibliography. Journal of Visual Impairment & Blindness 2020. [DOI: 10.1177/0145482x6505901011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Robert M. Anderson
- Department of Special Education and Rehabilitation, University of Pittsburgh. University of North Carolina, at Chapel Hill, N. C
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McRae-McKee K, Evans S, Hadjichrysanthou C, Wong MM, de Wolf F, Anderson RM. Combining hippocampal volume metrics to better understand Alzheimer's disease progression in at-risk individuals. Sci Rep 2019; 9:7499. [PMID: 31097733 PMCID: PMC6522521 DOI: 10.1038/s41598-019-42632-w] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 04/03/2019] [Indexed: 12/28/2022] Open
Abstract
To date nearly all clinical trials of Alzheimer’s disease (AD) therapies have failed. These failures are, at least in part, attributable to poor endpoint choice and to inadequate recruitment criteria. Recently, focus has shifted to targeting at-risk populations in the preclinical stages of AD thus improved predictive markers for identifying individuals likely to progress to AD are crucial to help inform the sample of individuals to be recruited into clinical trials. We focus on hippocampal volume (HV) and assess the added benefit of combining HV and rate of hippocampal atrophy over time in relation to disease progression. Following the cross-validation of previously published estimates of the predictive value of HV, we consider a series of combinations of HV metrics and show that a combination of HV and rate of hippocampal atrophy characterises disease progression better than either measure individually. Furthermore, we demonstrate that the risk of disease progression associated with HV metrics does not differ significantly between clinical states. HV and rate of hippocampal atrophy should therefore be used in tandem when describing AD progression in at-risk individuals. Analyses also suggest that the effects of HV metrics are constant across the continuum of the early stages of the disease.
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Affiliation(s)
- K McRae-McKee
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, St Mary's Campus, Norfolk Place, W2 1PG, London, United Kingdom.
| | - S Evans
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, St Mary's Campus, Norfolk Place, W2 1PG, London, United Kingdom
| | - C Hadjichrysanthou
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, St Mary's Campus, Norfolk Place, W2 1PG, London, United Kingdom
| | - M M Wong
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, St Mary's Campus, Norfolk Place, W2 1PG, London, United Kingdom
| | - F de Wolf
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, St Mary's Campus, Norfolk Place, W2 1PG, London, United Kingdom.,Janssen Prevention Center, Archimedesweg 4, 2333 CN, Leiden, The Netherlands
| | - R M Anderson
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, St Mary's Campus, Norfolk Place, W2 1PG, London, United Kingdom
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Chen SY, Chang SCS, Lin CC, Lou Q, Anderson RM. Psychometric evaluation of the Informed Consent Process Scale in Chinese. Nurs Ethics 2019; 26:2456-2466. [PMID: 30614395 DOI: 10.1177/0969733018819126] [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: 11/16/2022]
Abstract
BACKGROUND Informed consent is essential for the ethical conduct of clinical research and is a culturally sensitive issue. But, a measurable Chinese version of the scale to evaluate the informed consent process has not yet been explored in the existing literature. RESEARCH OBJECTIVES This study aimed to develop and psychometrically test the Chinese version of the Informed Consent Process Scale. RESEARCH DESIGN Back-translation was conducted to develop the Chinese version of the questionnaire. A cross-sectional survey was administered, after which an exploratory factor analysis was conducted. PARTICIPANTS We recruited a total of 375 participants who had experience in signing an informed consent form within the previous 3 years in Taiwan. ETHICAL CONSIDERATIONS This study was approved by two Institutional Review Boards and the autonomy of the participants was respected. FINDINGS The Chinese version of the Informed Consent Process Scale is composed of three factors with 23 items showing evidence of acceptable reliability and validity. Three major factors were extracted and labeled: Factor 1 - 'Understanding of the research', Factor 2 - 'Trust and confidence' and Factor 3 - 'Doubt and uncertainty'. The three factors accounted for is 52.954 of the total variance with Cronbach's α of .917. DISCUSSION AND CONCLUSION The finding corroborates previous studies showing that participants had too little understanding on the informed consent forms they signed and implied the need to clarify the critical points in clinical research. The psychometric results indicated good internal consistency and validity for this newly constructed instrument, and it was found worthy of conducting further testing and application.
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Affiliation(s)
- Shu Yu Chen
- Changhua Christian Hospital; School of Nursing, Dayeh University
| | | | - Chiu-Chu Lin
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Truscott JE, Gurarie D, Alsallaq R, Toor J, Yoon N, Farrell SH, Turner HC, Phillips AE, Aurelio HO, Ferro J, King CH, Anderson RM. A comparison of two mathematical models of the impact of mass drug administration on the transmission and control of schistosomiasis. Epidemics 2018; 18:29-37. [PMID: 28279453 PMCID: PMC5340850 DOI: 10.1016/j.epidem.2017.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/02/2017] [Accepted: 02/03/2017] [Indexed: 11/24/2022] Open
Abstract
This paper compares two mathematical models describing the transmission dynamics of schistosome infection and the impact of mass drug administration. The models differ structurally in a number of ways, including the dynamics of the intermediate snail host and the treatment of adult worms within the human host. The models are validated against data taken from a mass-drug administration trial in Mozambique. The differences between the model predictions and the data are discussed in the context of the structural differences between the models.
The predictions of two mathematical models describing the transmission dynamics of schistosome infection and the impact of mass drug administration are compared. The models differ in their description of the dynamics of the parasites within the host population and in their representation of the stages of the parasite lifecycle outside of the host. Key parameters are estimated from data collected in northern Mozambique from 2011 to 2015. This type of data set is valuable for model validation as treatment prior to the study was minimal. Predictions from both models are compared with each other and with epidemiological observations. Both models have difficulty matching both the intensity and prevalence of disease in the datasets and are only partially successful at predicting the impact of treatment. The models also differ from each other in their predictions, both quantitatively and qualitatively, of the long-term impact of 10 years’ school-based mass drug administration. We trace the dynamical differences back to basic assumptions about worm aggregation, force of infection and the dynamics of the parasite in the snail population in the two models and suggest data which could discriminate between them. We also discuss limitations with the datasets used and ways in which data collection could be improved.
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Affiliation(s)
- J E Truscott
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Imperial College, Norfolk Place, St. Mary's Campus, London, UK.
| | - D Gurarie
- Department of Mathematics, Case Western Reserve University, 10900 Euclid Avenue LC: 4983, Cleveland, OH 44106, United States
| | - R Alsallaq
- Department of Mathematics, Case Western Reserve University, 10900 Euclid Avenue LC: 4983, Cleveland, OH 44106, United States
| | - J Toor
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Imperial College, Norfolk Place, St. Mary's Campus, London, UK
| | - N Yoon
- Center for Global Health and Diseases, Case Western Reserve University, 10900 Euclid Avenue LC: 4983, Cleveland, OH 44106, United States
| | - S H Farrell
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Imperial College, Norfolk Place, St. Mary's Campus, London, UK
| | - H C Turner
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Imperial College, Norfolk Place, St. Mary's Campus, London, UK
| | - A E Phillips
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College, Norfolk Place, St. Mary's Campus, London, UK
| | - H O Aurelio
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College, Norfolk Place, St. Mary's Campus, London, UK
| | - J Ferro
- Universidade Catholica de Moçambique, Beira, Mozambique
| | - C H King
- Center for Global Health and Diseases, Case Western Reserve University, 10900 Euclid Avenue LC: 4983, Cleveland, OH 44106, United States
| | - R M Anderson
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Imperial College, Norfolk Place, St. Mary's Campus, London, UK
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González E, Sher AA, Anderson RM, Bay RF, Bean DW, Bissonnete GJ, Bourgeois B, Cooper DJ, Dohrenwend K, Eichhorst KD, El Waer H, Kennard DK, Harms-Weissinger R, Henry AL, Makarick LJ, Ostoja SM, Reynolds LV, Robinson WW, Shafroth PB. Vegetation response to invasive Tamarix control in southwestern U.S. rivers: a collaborative study including 416 sites. Ecol Appl 2017; 27:1789-1804. [PMID: 28445000 DOI: 10.1002/eap.1566] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 02/21/2017] [Accepted: 04/12/2017] [Indexed: 06/07/2023]
Abstract
Most studies assessing vegetation response following control of invasive Tamarix trees along southwestern U.S. rivers have been small in scale (e.g., river reach), or at a regional scale but with poor spatial-temporal replication, and most have not included testing the effects of a now widely used biological control. We monitored plant composition following Tamarix control along hydrologic, soil, and climatic gradients in 244 treated and 172 reference sites across six U.S. states. This represents the largest comprehensive assessment to date on the vegetation response to the four most common Tamarix control treatments. Biocontrol by a defoliating beetle (treatment 1) reduced the abundance of Tamarix less than active removal by mechanically using hand and chain-saws (2), heavy machinery (3) or burning (4). Tamarix abundance also decreased with lower temperatures, higher precipitation, and follow-up treatments for Tamarix resprouting. Native cover generally increased over time in active Tamarix removal sites, however, the increases observed were small and was not consistently increased by active revegetation. Overall, native cover was correlated to permanent stream flow, lower grazing pressure, lower soil salinity and temperatures, and higher precipitation. Species diversity also increased where Tamarix was removed. However, Tamarix treatments, especially those generating the highest disturbance (burning and heavy machinery), also often promoted secondary invasions of exotic forbs. The abundance of hydrophytic species was much lower in treated than in reference sites, suggesting that management of southwestern U.S. rivers has focused too much on weed control, overlooking restoration of fluvial processes that provide habitat for hydrophytic and floodplain vegetation. These results can help inform future management of Tamarix-infested rivers to restore hydrogeomorphic processes, increase native biodiversity and reduce abundance of noxious species.
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Affiliation(s)
- Eduardo González
- EcoLab (Laboratoire Ecologie Fonctionnelle et Environnement), CNRS, INPT, UPS, Université de Toulouse, 118 Route de Narbonne Bâtiment 4R1, 31062, Toulouse Cedex 9, France
- Department of Biological Sciences, University of Denver, F. W. Olin Hall, 2190 E Iliff Avenue, Denver, Colorado, 80208, USA
| | - Anna A Sher
- Department of Biological Sciences, University of Denver, F. W. Olin Hall, 2190 E Iliff Avenue, Denver, Colorado, 80208, USA
| | - Robert M Anderson
- Department of Biological Sciences, University of Denver, F. W. Olin Hall, 2190 E Iliff Avenue, Denver, Colorado, 80208, USA
| | - Robin F Bay
- Department of Biological Sciences, University of Denver, F. W. Olin Hall, 2190 E Iliff Avenue, Denver, Colorado, 80208, USA
| | - Daniel W Bean
- Colorado Department of Agriculture, Biological Pest Control, Palisade Insectary, 750 37.8 Road, Palisade, Colorado, 81526, USA
| | | | - Bérenger Bourgeois
- Département de Phytologie, Faculté des Sciences de l'Agriculture et de l'Alimentation, Université Laval, 2425 rue de l'agriculture, Quebec City, Quebec, G1V 0A6, Canada
- Department of Biology, Québec Centre for Biodiversity Science, McGill University, Stewart Biology Building, 1205 Dr. Penfield Avenue, Montreal, Quebec, H3A 1B1, Canada
| | - David J Cooper
- Department of Forest and Rangeland Stewardship, Colorado State University, Fort Collins, Colorado, 80523, USA
| | - Kara Dohrenwend
- Rim to Rim Restoration, P.O. Box 297, Moab, Utah, 84532, USA
| | - Kim D Eichhorst
- Department of Biology, Bosque Ecosystem Monitoring Program (BEMP), University of New Mexico, MSC 03 2020, Albuquerque, New Mexico, 87131, USA
| | - Hisham El Waer
- Department of Biological Sciences, University of Denver, F. W. Olin Hall, 2190 E Iliff Avenue, Denver, Colorado, 80208, USA
| | - Deborah K Kennard
- Department of Physical and Environmental Sciences, Colorado Mesa University, Grand Junction, Colorado, 81501, USA
| | | | - Annie L Henry
- Department of Biological Sciences, University of Denver, F. W. Olin Hall, 2190 E Iliff Avenue, Denver, Colorado, 80208, USA
| | - Lori J Makarick
- Grand Canyon National Park, 1824 S, Thompson Street, Suite 200, Flagstaff, Arizona, 86001, USA
| | - Steven M Ostoja
- USDA California Climate Hub, Agricultural Research Service, University of California, Davis, California, 95616, USA
| | - Lindsay V Reynolds
- Department of Biology, Colorado State University, Fort Collins, Colorado, 80523, USA
| | - W Wright Robinson
- Grand County Weed Department, 125 East Center Street, Moab, Utah, 84532, USA
| | - Patrick B Shafroth
- U.S. Geological Survey, Fort Collins Science Center, 2150 Centre Avenue, Building C, Fort Collins, Colorado, 80526, USA
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Zobaer MS, Anderson RM, Kerr CC, Robinson PA, Wong KKH, D'Rozario AL. K-complexes, spindles, and ERPs as impulse responses: unification via neural field theory. Biol Cybern 2017; 111:149-164. [PMID: 28251306 DOI: 10.1007/s00422-017-0713-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 02/12/2017] [Indexed: 06/06/2023]
Abstract
To interrelate K-complexes, spindles, evoked response potentials (ERPs), and spontaneous electroencephalography (EEG) using neural field theory (NFT), physiology-based NFT of the corticothalamic system is used to model cortical excitatory and inhibitory populations and thalamic relay and reticular nuclei. The impulse response function of the model is used to predict the responses to impulses, which are compared with transient waveforms in sleep studies. Fits to empirical data then allow underlying brain physiology to be inferred and compared with other waves. Spontaneous K-complexes, spindles, and other transient waveforms can be reproduced using NFT by treating them as evoked responses to impulsive stimuli with brain parameters appropriate to spontaneous EEG in sleep stage 2. Using this approach, spontaneous K-complexes and sleep spindles can be analyzed using the same single theory as previously been used to account for waking ERPs and other EEG phenomena. As a result, NFT can explain a wide variety of transient waveforms that have only been phenomenologically classified to date. This enables noninvasive fitting to be used to infer underlying physiological parameters. This physiology-based model reproduces the time series of different transient EEG waveforms; it has previously reproduced experimental EEG spectra, and waking ERPs, and many other observations, thereby unifying transient sleep waveforms with these phenomena.
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Affiliation(s)
- M S Zobaer
- School of Physics, The University of Sydney, Sydney, NSW, 2006, Australia.
- Center for Integrative Brain Function, University of Sydney, Sydney, NSW, 2006, Australia.
- Center for Research Excellence, Neurosleep, 431 Glebe Point Rd, Glebe, NSW, 2037, Australia.
- Department of Physics, Bangladesh University of Textiles, Dhaka, 1208, Bangladesh.
| | - R M Anderson
- School of Physics, The University of Sydney, Sydney, NSW, 2006, Australia
| | - C C Kerr
- School of Physics, The University of Sydney, Sydney, NSW, 2006, Australia
- Center for Integrative Brain Function, University of Sydney, Sydney, NSW, 2006, Australia
- Department of Physiology and Pharmacology, State University of New York Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY, USA
| | - P A Robinson
- School of Physics, The University of Sydney, Sydney, NSW, 2006, Australia
- Center for Integrative Brain Function, University of Sydney, Sydney, NSW, 2006, Australia
- Center for Research Excellence, Neurosleep, 431 Glebe Point Rd, Glebe, NSW, 2037, Australia
| | - K K H Wong
- CIRUS, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Respiratory and Sleep Disorders Department, Royal Prince Alfred Hospital and Sydney Local Health District, Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - A L D'Rozario
- CIRUS, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Respiratory and Sleep Disorders Department, Royal Prince Alfred Hospital and Sydney Local Health District, Sydney, NSW, Australia
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
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Abstract
Diabetes educators use theories all the time, even if they are not aware of it. To teach, one must have some assumptions about how people learn and what constitutes effective teaching. The purpose of this article is to help diabetes educators interested in research and evaluation choose appropriate theories. The article will review the 4 purposes of theories, that is, description, explanation, prediction, and control, as well as the degree to which a theory has been articulated and elaborated. The importance of a theory’s personal resonance, its explanatory power, and its utility will also be examined. The article will also review how to use 1 or more theories at each stage of a research or evaluation project.
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Affiliation(s)
- Robert M Anderson
- The Department of Medical Education, University of Michigan Medical School, Ann Arbor (Dr Anderson)
| | - Martha M Funnell
- Michigan Diabetes Research and Training Center, University of Michigan Medical School, Ann Arbor (Ms Funnell)
| | - Cheri Ann Hernandez
- The Faculty of Nursing, University of Windsor, Ontario, Canada (Dr Hernandez)
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Abdurrahman ST, Lawson L, Blakiston M, Obasanya J, Yassin MA, Anderson RM, Oladimeji O, Ramsay A, Cuevas LE. Are patients with pulmonary tuberculosis who are identified through active case finding in the community different than those identified in healthcare facilities? New Microbes New Infect 2016; 15:35-39. [PMID: 27942386 PMCID: PMC5137337 DOI: 10.1016/j.nmni.2016.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 04/25/2016] [Revised: 10/07/2016] [Accepted: 10/14/2016] [Indexed: 11/30/2022] Open
Abstract
The lack of healthcare access contributes to large numbers of tuberculosis (TB) cases being missed and has led to renewed interest in outreach approaches to increase detection. It is however unclear whether outreach activities increase case detection or merely identify patients before they attend health facilities. We compared adults with cough of >2 weeks' duration recruited in health facilities (1202 participants) or in urban slums (2828 participants) in Nigeria. Participants provided demographic and clinical information and were screened using smear microscopy. The characteristics of smear-positive and smear-negative individuals were compared stratified by place of enrolment. Two hundred nine health facility participants (17.4%) and 485 community-based participants (16.9%) were smear positive for pulmonary TB. Community-based smear-positive cases were older (mean age, 36.3 vs. 31.8 years), had longer cough duration (10.3 vs. 6.8 weeks) and longer duration of weight loss (4.6 vs. 3.6 weeks) than facility-based cases; and they complained more of fever (87.4% vs. 74.6%), chest pain (89.0% vs. 67.0%) and anorexia (79.5% vs. 55.5%). Community smear-negative participants were older (mean, 39.4 vs. 34.0 years), were more likely to have symptoms and were more likely to have symptoms of longer duration than smear-negative facility-based participants. Patients with pulmonary TB identified in the community had more symptoms and longer duration of illness than facility-based patients, which appeared to be due to factors differentially affecting access to healthcare. Community-based activities targeted at urban slum populations may identify a different TB case population than that accessing stationary services.
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Affiliation(s)
- S T Abdurrahman
- Federal Capital Territory Tuberculosis and Leprosy Control Programme, Nigeria
| | - L Lawson
- Zankli Medical Centre, Nigeria; Bingham University, Karu, Nassarawa State, Nigeria
| | | | - J Obasanya
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - M A Yassin
- Liverpool School of Tropical Medicine, UK; Global Fund to Fight Aids, Tuberculosis and Malaria, Switzerland
| | - R M Anderson
- Bingham University, Karu, Nassarawa State, Nigeria; University of Liverpool, Liverpool, UK
| | - O Oladimeji
- Zankli Medical Centre, Nigeria; Liverpool School of Tropical Medicine, UK
| | - A Ramsay
- Special Program for Research in Tropical Diseases, WHO/TDR, Geneva, Switzerland
| | - L E Cuevas
- Liverpool School of Tropical Medicine, UK
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11
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Truscott JE, Turner HC, Farrell SH, Anderson RM. Soil-Transmitted Helminths: Mathematical Models of Transmission, the Impact of Mass Drug Administration and Transmission Elimination Criteria. Adv Parasitol 2016; 94:133-198. [PMID: 27756454 DOI: 10.1016/bs.apar.2016.08.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Infections caused by soil-transmitted helminthias (STHs) affect over a billion people worldwide, causing anaemia and having a large social and economic impact through poor educational outcomes. They are identified in the World Health Organization (WHO) 2020 goals for neglected tropical diseases as a target for renewed effort to ameliorate their global public health burden through mass drug administration (MDA) and water and hygiene improvement. In this chapter, we review the underlying biology and epidemiology of the three causative intestinal nematode species that are mostly considered under the STH umbrella term. We review efforts to model the transmission cycle of these helminths in populations and the effects of preventative chemotherapy on their control and elimination. Recent modelling shows that the different epidemiological characteristics of the parasitic nematode species that make up the STH group can lead to quite distinct responses to any given form of MDA. When connected with models of treatment cost-effectiveness, these models are potentially a powerful tool for informing public policy. A number of shortcomings are identified; lack of critical types of data and poor understanding of diagnostic sensitivities hamper efforts to test and hence improve models.
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Affiliation(s)
- J E Truscott
- London Centre for Neglected Tropical Disease Research, London, United Kingdom; School of Public Health, Imperial College London, London, United Kingdom
| | - H C Turner
- London Centre for Neglected Tropical Disease Research, London, United Kingdom; School of Public Health, Imperial College London, London, United Kingdom
| | - S H Farrell
- London Centre for Neglected Tropical Disease Research, London, United Kingdom; School of Public Health, Imperial College London, London, United Kingdom
| | - R M Anderson
- London Centre for Neglected Tropical Disease Research, London, United Kingdom; School of Public Health, Imperial College London, London, United Kingdom
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Abstract
The problem of noncompliance has troubled diabetes educators for years. This paper will argue that the problem of noncompliance in diabetes is not so much a problem of patient behavior, but rather stems from the inadequacy of the traditional medical approach to care. The view of the patients' and practitioners' roles embodied in the traditional medical approach to treat ing disease is inappropriate in diabetes because of the self-care requirements. Diabetes requires a new way of con ceptualizing and implementing the patient/practitioner relationship such as the educational approach offered by counseling psychology. This ap proach would view noncompliance a communication problem and advo cate renegotiation of the treatment plan. The first step in successfully ap plying a new approach to relating to patients requires practitioners to examine and become aware of the as sumptions that currently influence their behavior with patients.
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Affiliation(s)
- Robert M. Anderson
- University of Virginia Diabetes Research and Training Center Charlottesville, Virginia
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Fitzgerald JT, Funnell MM, Anderson RM, Nwankwo R, Stansfield RB, Piatt GA. Validation of the Revised Brief Diabetes Knowledge Test (DKT2). Diabetes Educ 2016; 42:178-87. [DOI: 10.1177/0145721715624968] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose The purpose of this study is to examine the reliability and validity of the revised Diabetes Knowledge Test (DKT2). The original test was updated to reflect current diabetes care and education guidelines. The test has 2 components: a 14-item general test and a 9-item insulin use subscale. Methods Two samples were used to evaluate the DKT2. The first came from an online survey company (Qualtrics, LCC) (n = 101) and the second from University of Michigan’s (UofM) Diabetes Registry (n = 89). Cronbach’s coefficient alpha was used to calculate reliability. To examine validity, comparisons by type of diabetes, insulin use and oral medication use, and educational level were completed. Correlations between diabetes duration and both the general test and insulin subscale were calculated for the UofM sample. Results The two samples differed demographically. While the reliabilities between the samples were disparate, when combined, the coefficient alphas demonstrated reliability for both the general test (.77) and the insulin use subscale (.84). The validation comparisons proved to be similar; different results occurred between samples but when combined demonstrated validity. Conclusions The reliability and validity tests were inconsistent by sample. The different results can, in part, be attributed to the demographic differences between the 2 samples. With the exception of age, the samples differed in every other measured variable. However, when the samples were combined, the analyses supported the reliability and validity of the Diabetes Knowledge Test 2. The DKT2 is a quick and low-cost method of assessing general knowledge of diabetes and diabetes self-care.
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Affiliation(s)
- James T. Fitzgerald
- Department of Learning Health Sciences, University of Michigan, Ann Arbor VA Geriatrics Research, Education, and Clinical Center, Ann Arbor, Michigan (Prof Fitzgerald)
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan (Mrs Funnell, Dr Anderson, Ms Nwankwo, Dr Stansfield, Dr Piatt)
| | - Martha M. Funnell
- Department of Learning Health Sciences, University of Michigan, Ann Arbor VA Geriatrics Research, Education, and Clinical Center, Ann Arbor, Michigan (Prof Fitzgerald)
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan (Mrs Funnell, Dr Anderson, Ms Nwankwo, Dr Stansfield, Dr Piatt)
| | - Robert M. Anderson
- Department of Learning Health Sciences, University of Michigan, Ann Arbor VA Geriatrics Research, Education, and Clinical Center, Ann Arbor, Michigan (Prof Fitzgerald)
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan (Mrs Funnell, Dr Anderson, Ms Nwankwo, Dr Stansfield, Dr Piatt)
| | - Robin Nwankwo
- Department of Learning Health Sciences, University of Michigan, Ann Arbor VA Geriatrics Research, Education, and Clinical Center, Ann Arbor, Michigan (Prof Fitzgerald)
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan (Mrs Funnell, Dr Anderson, Ms Nwankwo, Dr Stansfield, Dr Piatt)
| | - R. Brent Stansfield
- Department of Learning Health Sciences, University of Michigan, Ann Arbor VA Geriatrics Research, Education, and Clinical Center, Ann Arbor, Michigan (Prof Fitzgerald)
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan (Mrs Funnell, Dr Anderson, Ms Nwankwo, Dr Stansfield, Dr Piatt)
| | - Grecthen A. Piatt
- Department of Learning Health Sciences, University of Michigan, Ann Arbor VA Geriatrics Research, Education, and Clinical Center, Ann Arbor, Michigan (Prof Fitzgerald)
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan (Mrs Funnell, Dr Anderson, Ms Nwankwo, Dr Stansfield, Dr Piatt)
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Anderson RM, Turner HC, Farrell SH, Truscott JE. Studies of the Transmission Dynamics, Mathematical Model Development and the Control of Schistosome Parasites by Mass Drug Administration in Human Communities. Adv Parasitol 2016; 94:199-246. [PMID: 27756455 DOI: 10.1016/bs.apar.2016.06.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Schistosomiasis is global in extent within developing countries, but more than 90% of the at-risk population lives in sub-Saharan Africa. In total, 261 million people are estimated to require preventive treatment. However, with increasing drug availability through donation, the World Health Organization has set a goal of increasing coverage to 75% of at-risk children in endemic countries and elimination in some regions. In this chapter, we discuss key biological and epidemiological processes involved in the schistosome transmission cycle and review the history of modelling schistosomiasis and the impact of mass drug administration, including both deterministic and stochastic approaches. In particular, we look at the potential impact of the WHO 2020 schistosomiasis treatment goals.
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Affiliation(s)
- R M Anderson
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - H C Turner
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - S H Farrell
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - J E Truscott
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
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Truscott JE, Turner HC, Anderson RM. What impact will the achievement of the current World Health Organisation targets for anthelmintic treatment coverage in children have on the intensity of soil transmitted helminth infections? Parasit Vectors 2015; 8:551. [PMID: 26490544 PMCID: PMC4618937 DOI: 10.1186/s13071-015-1135-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [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: 09/04/2015] [Accepted: 10/02/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND It is the aim of the World Health Organisation to eliminate soil-transmitted helminths (STH) as a health problem in children. To this end, the goal is to increase anthelmintic treatment coverage for soil transmitted helminths to reach 75 % in pre-school aged and school aged children by 2020 in endemic countries. In this paper, we use mathematical models to investigate the impact of achieving this goal on the burdens of Ascaris lumbricoides, Trichuris trichuria and hookworm. METHODS We employ a deterministic fully age-structured model of STH transmission and mass drug administration to examine the changes in worm burden in response to the known and projected coverage trends in children up to 2020 and beyond. Parameters are estimated from worm expulsion data and age intensity profiles before treatment using maximum likelihood methods. Model validation is performed using reinfection studies for Ascaris and analyses are conducted to assess the sensitivity of the predicted outcomes to variation in parameter estimates including transmission intensity (R0), children's contributions to the pool of infective stages and drug coverage levels. RESULTS The impact of the required increase in coverage trends are quite different across the three species. Ascaris burdens are reduced dramatically by 2020 with elimination predicted within studied the setting a further 10 years. For Trichuris and hookworm, however, impact is more limited, due to issues of drug efficacy (Trichuris) and distribution of worms in the population (hookworm). Sensitivity analysis indicates that results are largely robust. However, validation against Ascaris data indicates that assumptions concerning re-infection among children may have to be revised. CONCLUSIONS The 2020 coverage target is predicted to have a major impact on Ascaris levels by 2020. However, there is evidence from model validation that Ascaris in children is more resilient to treatment than currently assumed in the model. Broader coverage across all age classes is required to break transmission for hookworm and alternative dual drug treatment approaches are needed for Trichuris.
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Affiliation(s)
- J E Truscott
- London Centre for Neglected Tropical Disease Research, London, UK.
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, Norfolk Place, London, W2 1PG, , UK.
| | - H C Turner
- London Centre for Neglected Tropical Disease Research, London, UK
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, Norfolk Place, London, W2 1PG, , UK
| | - R M Anderson
- London Centre for Neglected Tropical Disease Research, London, UK
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, Norfolk Place, London, W2 1PG, , UK
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Anderson RM, Turner HC, Farrell SH, Yang J, Truscott JE. What is required in terms of mass drug administration to interrupt the transmission of schistosome parasites in regions of endemic infection? Parasit Vectors 2015; 8:553. [PMID: 26489831 PMCID: PMC4618750 DOI: 10.1186/s13071-015-1157-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Schistosomiasis is endemic in 54 countries, but has one of the lowest coverages by mass drug administration of all helminth diseases. However, with increasing drug availability through donation, the World Health Organisation has set a goal of increasing coverage to 75 % of at-risk children in endemic countries and elimination in some regions. In this paper, we assess the impact on schistosomiasis of the WHO goals in terms of control and elimination. METHODS We use an age-structured deterministic model of schistosome transmission in a human community and the effect of mass drug administration. The model is fitted to baseline data from a longitudinal re-infection study in Kenya and validated against the subsequent re-infection data. We examine the impact on host worm burden of the current treatment trend, extrapolated to meet the WHO goals, and its sensitivity to uncertainty in important parameters. We assess the feasibility of achieving elimination. RESULTS Model results show that the current treatment trend, extrapolated to the WHO goals, is able to greatly reduce host worm burdens. If coverage is continued at the same level beyond 2020, elimination is possible for low to moderate transmission settings, where transmission intensity is defined by the basic reproduction number, R0. Low levels of adult coverage have a significant impact on worm burden in all settings. Model validation against the re-infection survey demonstrates that the age-structured model is able to match post-treatment data well in terms of egg output, but that some details of re-infection among school children and young adults are not currently well represented. CONCLUSIONS Our work suggests that the current WHO treatment goals should be successful in bringing about a major reduction in schistosome infection in treated communities. If continued over a 15 year period, they are likely to result in elimination, at least in areas with lower transmission.
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Affiliation(s)
- R M Anderson
- London Centre for Neglected Tropical Disease Research, London, UK. .,Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - H C Turner
- London Centre for Neglected Tropical Disease Research, London, UK. .,Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - S H Farrell
- London Centre for Neglected Tropical Disease Research, London, UK. .,Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Jie Yang
- London Centre for Neglected Tropical Disease Research, London, UK. .,Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - J E Truscott
- London Centre for Neglected Tropical Disease Research, London, UK. .,Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, Norfolk Place, London, W2 1PG, UK.
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Yao JL, Fang J, Lou QQ, Anderson RM. A systematic review of the identification of seniors at risk (ISAR) tool for the prediction of adverse outcome in elderly patients seen in the emergency department. Int J Clin Exp Med 2015; 8:4778-4786. [PMID: 26131052 PMCID: PMC4483958] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 03/20/2015] [Indexed: 06/04/2023]
Abstract
The purpose of this systematic review was to evaluate the predictive validity of the Identification of Seniors at Risk (ISAR) Tool in identifying elderly patients at risk of adverse outcomes after a visit to the emergency department (ED). Since older adults are frequently sent to the ED, screening for risk of adverse outcomes in elderly patients is increasingly important in the ED. Also it is a way to ensure that interventions based on a comprehensive geriatric assessment (CGA) are provided to patients identified at risk to reduce the risk of adverse outcomes. The ISAR is a six-item risk-screening tool for elderly patients seen in the ED. However the predictive validity of ISAR is controversial. Relevant studies from January 1999 through December 2014 were searched systematically in PubMed, Cochrane Library, Web of Knowledge, Scopus, CINAHL, Elsevier ScienceDirect databases. The language was restricted to English. This review was based on the recommendations of the Cochrane Handbook of Diagnostic Test Accuracy Reviews. Ten studies (8680 patients) were included in this review. With a cutoff score at least 2, the ISAR was proved to have poor validity related to revisiting the ED (AUC: 0.59-0.60) and hospital readmission (AUC: 0.59-0.60). The predictive validity of the ISAR related to mortality and composite outcomes was graded as poor to fair. It is not suitable to use the ISAR alone for identifying seniors at risk for adverse outcomes in the ED.
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Affiliation(s)
- Jin-Lan Yao
- School of Nursing, Huzhou UniversityHuzhou 313000, China
| | - Juan Fang
- School of Nursing, Huzhou UniversityHuzhou 313000, China
| | - Qing-Qing Lou
- Department of Health Education, Jiangsu Province Hospital on Integration of Chinese and Western MedicineNanjing 210028, China
| | - Robert M Anderson
- Department of Medical Education, University of Michigan Medical SchoolAnn Arbor, USA
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Fang Z, Zhao J, Shi G, Shu Y, Ni Y, Wang H, Ding L, Lu R, Li J, Zhu X, Cheng S, Zhang X, Liu Y, Wang J, Luo Y, Fan Q, Guo C, Jiang T, Wu Q, Fan L, Ling H, Cui L, Luo Y, Yang H, Anderson RM. Shenzhu Tiaopi granule combined with lifestyle intervention therapy for impaired glucose tolerance: a randomized controlled trial. Complement Ther Med 2014; 22:842-50. [PMID: 25440374 DOI: 10.1016/j.ctim.2014.08.004] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 07/12/2014] [Accepted: 08/05/2014] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE The purpose of the study was to evaluate the clinical effects of the Shenzhu Tiaopi granule (SZTP) combined with a lifestyle intervention in patients with impaired glucose tolerance (IGT), who also had a spleen deficiency and damp overabundance syndrome (SDDOS). METHODS After a one-month washout period, a total of 514 patients were randomly assigned to the control (lifestyle intervention) and experimental (SZTP plus lifestyle intervention) groups, with 257 patients in each group. Patients in the control group received the lifestyle intervention (diet and exercise) for 12 months, while the patients in the experimental group were treated with SZTP plus the lifestyle intervention for 12 months. The Traditional Chinese Medicinal (TCM) symptom scores were observed in each group before and after treatment; the conversion rates from IGT to diabetes mellitus (DM) were also measured. RESULTS Following 12 months of treatment, the conversion rate from IGT to DM in the experimental group was significantly lower than in the control group (8.52% vs. 15.28%, P<0.05). A significantly higher number of patients with IGT reverted to normal blood glucose levels in the experimental group than in the control group (42.15% vs. 32.87%, P<0.05). In addition, after following the treatment for 12 months, the TCM symptoms of patients in the experimental group were markedly alleviated, as compared to the control group (P<0.01). CONCLUSION The combination of SZTP and lifestyle intervention showed a reduction in the conversion from IGT to DM, and an increase in the conversion from IGT to normal blood glucose levels.
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Affiliation(s)
- Zhaohui Fang
- Department of Endocrinology, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, Anhui Province, China; Institute of Chinese Medicine Prevention and Therapy Diabetes Mellitus, Anhui Academy of Chinese Medicine, Hefei 230031, Anhui Province, China.
| | - Jindong Zhao
- Department of Endocrinology, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, Anhui Province, China; Institute of Chinese Medicine Prevention and Therapy Diabetes Mellitus, Anhui Academy of Chinese Medicine, Hefei 230031, Anhui Province, China
| | - Guobing Shi
- Department of Endocrinology, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, Anhui Province, China
| | - Yiqiong Shu
- Department of Endocrinology, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, Anhui Province, China
| | - Yingqun Ni
- Department of Endocrinology, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, Anhui Province, China
| | - Huan Wang
- Department of Endocrinology, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, Anhui Province, China
| | - Lei Ding
- Department of Endocrinology, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, Anhui Province, China
| | - Ruimin Lu
- Department of Endocrinology, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, Anhui Province, China
| | - Jiayun Li
- Department of Endocrinology, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, Anhui Province, China
| | - Xiaojin Zhu
- Department of Endocrinology, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, Anhui Province, China
| | - Senhua Cheng
- Department of Endocrinology, Shangyu City Hospital of Chinese Medicine, Shangyu 312300, Zhejiang Province, China
| | - Xinyi Zhang
- Department of Endocrinology, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, Anhui Province, China
| | - Yan Liu
- Department of Endocrinology, the Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, Anhui Province, China
| | - Jun Wang
- Department of Endocrinology, Wuhu City Hospital of Chinese Medicine, Wuhu 241000, Anhui Province, China
| | - Yuan Luo
- Department of Endocrinology, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, Anhui Province, China
| | - Qingyun Fan
- Department of Endocrinology, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, Anhui Province, China
| | - Chenglin Guo
- Department of Endocrinology, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, Anhui Province, China
| | - Ting Jiang
- Department of Endocrinology, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, Anhui Province, China
| | - Qian Wu
- Department of Endocrinology, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, Anhui Province, China
| | - Lihong Fan
- Department of Endocrinology, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, Anhui Province, China
| | - Hanpeng Ling
- Department of Endocrinology, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, Anhui Province, China
| | - Liqun Cui
- Department of Endocrinology, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, Anhui Province, China
| | - Yun Luo
- Department of Endocrinology, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, Anhui Province, China
| | - Hui Yang
- Department of Endocrinology, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, Anhui Province, China
| | - Robert M Anderson
- Institute of Chinese Medicine Prevention and Therapy Diabetes Mellitus, Anhui Academy of Chinese Medicine, Hefei 230031, Anhui Province, China; The Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
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Abstract
Historically, the issue of sexual health has been largely considered with respect to the associated negative health outcomes. The dangers of sexual activity such as sexually transmitted infections (STIs), HIV/AIDS, unintended pregnancy, sexual coercion, and sexual violence have dominated the attention of those working in the field. Over the last 20 years, and particularly in the last decade, an increasing number of people from a variety disciplines that address issues of sexual health have developed a new discourse concerning the positive aspects of sexuality. This review of the literature explores this emerging discourse. The results indicate that sexual health, physical health, mental health, and overall well-being are all positively associated with sexual satisfaction, sexual self-esteem, and sexual pleasure. The beneficial effects of sexual satisfaction should be integrated into programs that seek to improve these diverse health outcomes through service delivery, prevention, and sexuality education.
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Affiliation(s)
- R M Anderson
- Guttmacher Institute, New York, New York 10038, USA.
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Anderson RM, Calhoun K, Choate CB, De Loney EH, Paberzs A, Sampselle CM, Vereen DR, Zimmerman MA. Guidelines for community-based partners for reviewing research grant applications: lessons from the Michigan Institute for Clinical and Health Research (MICHR) Community Engagement Research Core (CERC). Clin Transl Sci 2013; 6:421-3. [PMID: 24330687 DOI: 10.1111/cts.12126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Robert M Anderson
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, Michigan, USA; Medical Education, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Ehrmann BJ, Anderson RM, Piatt GA, Funnell MM, Rashid H, Shedden K, Douyon L. Digital photography as an educational food logging tool in obese patients with type 2 diabetes: lessons learned from a randomized, crossover pilot trial. Diabetes Educ 2013; 40:89-99. [PMID: 24168836 DOI: 10.1177/0145721713508826] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this pilot study is to investigate the utility of, and areas of refinement for, digital photography as an educational tool for food logging in obese patients with type 2 diabetes (T2DM). METHODS Thirty-three patients aged 18 to 70 with T2DM, body mass index at least 30 kg/m(2), and A1C 7.5% to 9% were recruited from an endocrinology clinic and randomized to a week of food logging using a digital camera (DC) or paper diary (PD), crossing over for week 2. Patients then viewed a presentation about dietary effects on blood glucose, using patient DC and blood glucose entries. Outcomes of adherence (based on number of weekly entries), changes in mean blood glucose and frequency of blood glucose checks, and patient satisfaction were compared between methods. Patient feedback on the DC intervention and presentation was also analyzed. RESULTS Thirty patients completed the study. Adherence was identical across methods. The mean difference in number of entries was not significant between methods. This difference increased and neared statistical significance (favoring DC) among patients who were adherent for at least 1 week (21 entries, with 2 entries per day for 5 of 7 days, n = 25). Mean blood glucose did not significantly decrease in either method. Patient satisfaction was similar between interventions. Feedback indicated concerns over photograph accuracy, forgetting to use the cameras, and embarrassment using them in public. CONCLUSION Although the DC method was comparable to PD in adherence, blood glucose changes, and patient satisfaction in this pilot trial, patient feedback suggested specific areas of refinement to maximize utility of DC-based food logging as an educational tool in T2DM.
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Affiliation(s)
- Brett J Ehrmann
- Department of Internal Medicine, Division of Metabolism, University of Michigan Health System, Endocrinology, and Diabetes, Ann Arbor, Michigan (Mr Ehrmann, Ms Rashid, Dr Douyon)
| | - Robert M Anderson
- Michigan Center for Diabetes Translational Research, Ann Arbor, Michigan (Dr Anderson, Dr Piatt, Ms Funnell),Department of Medical Education, University of Michigan Medical School, Ann Arbor, Michigan (Dr Anderson, Dr Piatt, Ms Funnell)
| | - Gretchen A Piatt
- Michigan Center for Diabetes Translational Research, Ann Arbor, Michigan (Dr Anderson, Dr Piatt, Ms Funnell),Department of Medical Education, University of Michigan Medical School, Ann Arbor, Michigan (Dr Anderson, Dr Piatt, Ms Funnell)
| | - Martha M Funnell
- Michigan Center for Diabetes Translational Research, Ann Arbor, Michigan (Dr Anderson, Dr Piatt, Ms Funnell),Department of Medical Education, University of Michigan Medical School, Ann Arbor, Michigan (Dr Anderson, Dr Piatt, Ms Funnell)
| | - Hira Rashid
- Department of Internal Medicine, Division of Metabolism, University of Michigan Health System, Endocrinology, and Diabetes, Ann Arbor, Michigan (Mr Ehrmann, Ms Rashid, Dr Douyon)
| | - Kerby Shedden
- Department of Biostatistics, University of Michigan College of Literature, Science, and the Arts, Ann Arbor, Michigan (Dr Shedden)
| | - Liselle Douyon
- Department of Internal Medicine, Division of Metabolism, University of Michigan Health System, Endocrinology, and Diabetes, Ann Arbor, Michigan (Mr Ehrmann, Ms Rashid, Dr Douyon)
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Baumeister SE, Schomerus G, Anderson RM. Personality-related factors as predictors of help-seeking for depression: A population-based study applying the Behavioral Model of Health Services Use. Gesundheitswesen 2013. [DOI: 10.1055/s-0033-1354236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lin CC, Wu CC, Anderson RM, Chang CS, Chang SC, Hwang SJ, Chen HC. The chronic kidney disease self-efficacy (CKD-SE) instrument: development and psychometric evaluation. Nephrol Dial Transplant 2012; 27:3828-34. [PMID: 22344776 DOI: 10.1093/ndt/gfr788] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Self-management has been associated with positive health outcomes among adults with chronic kidney disease (CKD). Perceived disease-related self-efficacy (DSE) is considered a critical component in the successful self-management of chronic disease. A valid and reliable instrument for measuring CKD patients' self-efficacy is needed. This study aims to develop and test a new instrument to measure the DSE of patients with early stage CKD. METHODS A total of 594 Taiwanese patients with early stage CKD recruited from two medical centers and one regional hospital in southern Taiwan completed the questionnaire. The CKD self-efficacy (CKD-SE) was evaluated using exploratory factor analyses (EFA) and measures of reliability. RESULTS EFA identified four distinct factors with loadings ranging from 0.557 to 0.970: autonomy, self-integration, problem solving and seeking social support, accounting for 64.348% of the total variance. Cronbach's alpha coefficients for the subscales ranged from 0.843 to 0.901. CONCLUSION This promising 25-item CKD-SE instrument can be used for the early identification of patients with low DSE, thus allowing the development of interventions to help these patients attain an appropriate level of DSE.
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Affiliation(s)
- Chiu-Chu Lin
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Piatt GA, Songer TJ, Brooks MM, Anderson RM, Simmons D, Orchard TJ, Siminerio LM, Korytkowski MT, Zgibor JC. Impact of patient level factors on the improvement of the ABCs of diabetes. Patient Educ Couns 2011; 82:266-270. [PMID: 20434290 DOI: 10.1016/j.pec.2010.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 02/04/2010] [Accepted: 04/02/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To determine which patient factors contribute to improvements in the ABCs of diabetes following a multi-faceted diabetes care intervention. METHODS A multi-level, cluster design, randomized controlled trial examined the effectiveness of a Chronic Care Model (CCM) intervention in an underserved community (n=119). RESULTS Improvements in glycemic control were experienced among older subjects (p=0.02), those with higher scores on the WHO-10 Quality of Well-Being Subscale 1 (p=0.05), and those in the CCM group (p=0.04). Insulin use was associated with greater improvements in SBP and DBP. Those taking insulin (p=0.07), and those more satisfied with their diabetes care and ready to make a behavior change (p=0.08) experienced larger improvements in Non-HDLc. Medication treatment intensification (TI) did not significantly impact the ABCs. CONCLUSION Psychosocial and sociodemographic factors explained more of the variation in the ABCs than TI, and are important contributors to clinical improvement. PRACTICE IMPLICATIONS Providers may be able to identify and intervene on patients who are at risk for developing diabetes complications and improve the consistency, quality, and effectiveness of patient care.
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Affiliation(s)
- Gretchen A Piatt
- Division of Endocrinology and Metabolism, University of Pittsburgh, PA, USA.
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Anderson RM, Funnell MM. Patient empowerment: myths and misconceptions. Patient Educ Couns 2010; 79:277-82. [PMID: 19682830 PMCID: PMC2879465 DOI: 10.1016/j.pec.2009.07.025] [Citation(s) in RCA: 365] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Revised: 07/16/2009] [Accepted: 07/16/2009] [Indexed: 05/22/2023]
Abstract
OBJECTIVE The purpose of this article is to clarify the concept of empowerment and to correct common misconceptions about its use in diabetes care and education. METHODS The patient empowerment approach is well suited to helping patients make self-selected changes related to weight, nutrition, and physical activity. Although the concept of patient empowerment has become an integral part of diabetes education, an accurate understanding and authentic application of empowerment has not occurred as readily. The empowerment approach is clarified and common misconceptions have been corrected. RESULTS Embracing empowerment means making a paradigm shift that is often difficult because the traditional approach to care is embedded in the training and socialization of most health care professionals (HCPs). CONCLUSION Unlike the traditional approach, empowerment is not something one does to patients. Rather, empowerment begins when HCPs acknowledge that patient are in control of their daily diabetes care. Empowerment occurs when the HCPs goal is to increase the capacity of patients to think critically and make autonomous, informed decisions. Empowerment also occurs when patients are actually making autonomous, informed decisions about their diabetes self-management. PRACTICE IMPLICATIONS Clarity about all aspects of the empowerment approach is essential if it is to be used effectively.
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Affiliation(s)
- Robert M Anderson
- University of Michigan Medical School, Department of Medical Education, Ann Arbor, USA.
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Piatt GA, Anderson RM, Brooks MM, Songer T, Siminerio LM, Korytkowski MM, Zgibor JC. 3-year follow-up of clinical and behavioral improvements following a multifaceted diabetes care intervention: results of a randomized controlled trial. Diabetes Educ 2010; 36:301-9. [PMID: 20200284 DOI: 10.1177/0145721710361388] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to determine if improvements observed in clinical, behavioral, and psychosocial outcomes measured at 12 months following a multifaceted diabetes care intervention were sustained at 3-year follow-up. METHODS This study was a multilevel, nonblinded, cluster design, randomized controlled trial that took place in an underserved suburb of Pittsburgh, Pennsylvania, between 1999 and 2005. Eleven primary care practices, and their patients, were randomly assigned to 3 groups: chronic care model (CCM) intervention (n = 30), provider education only (PROV) (n = 38), and usual care (UC) (n = 51). Subjects were followed for 3 years. RESULTS Improvements observed at 12-month follow-up in glycemic (-0.5%) and blood pressure control (-4.8 mm Hg), and the proportion of participants who self-monitor their blood glucose (86.7%-100%), were sustained at 3-year follow-up in the CCM group. Additional improvements occurred in non-HDLc levels in all study groups and quality of well-being scores in the CCM intervention group. All associations remained after controlling for medication treatment intensification. CONCLUSIONS We have demonstrated that improvements in outcomes can be sustained over time following a multifaceted diabetes care intervention. Future research in this area is necessary to understand if improvements in outcomes can be sustained following diabetes self-management education (DSME) and what type of patient fares the best from multifaceted diabetes care interventions.
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Affiliation(s)
- Gretchen A Piatt
- The Division of Endocrinology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Piatt, Dr Siminerio, Dr Korytkowski)
| | - Robert M Anderson
- The Department of Medical Education, University of Michigan, Ann Arbor, Michigan (Dr Anderson)
| | - Maria M Brooks
- The Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Brooks, Dr Songer, Dr Zgibor)
| | - Thomas Songer
- The Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Brooks, Dr Songer, Dr Zgibor)
| | - Linda M Siminerio
- The Division of Endocrinology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Piatt, Dr Siminerio, Dr Korytkowski)
| | - Mary M Korytkowski
- The Division of Endocrinology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Piatt, Dr Siminerio, Dr Korytkowski)
| | - Janice C Zgibor
- The Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Brooks, Dr Songer, Dr Zgibor)
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Anderson RM, Funnell MM, Aikens JE, Krein SL, Fitzgerald JT, Nwankwo R, Tannas CL, Tang TS. Evaluating the Efficacy of an Empowerment-Based Self-Management Consultant Intervention: Results of a Two-Year Randomized Controlled Trial. ACTA ACUST UNITED AC 2009; 1:3-11. [PMID: 20076768 DOI: 10.1051/tpe/2009002] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES: This study was conducted to determine if an empowerment-based Diabetes Self-Management Consultant (DSMC) was more effective than a group receiving Mailed metabolic Assessments Only (MAO) in improving diabetes-related quality of life and blood glucose control. MATERIALS AND METHODS: A two-year clinical trial, in which 310 patients with type 2 diabetes were randomized to the DSMC intervention or the MAO group. The DSMC met with the patient to review the baseline assessments, then met with this review was patient and the patient's physician. Subsequently patients received monthly telephone calls from the DSMC who used the empowerment approach to help patients identify self-management problems, consider options, set goals and make adjustments to their diabetes self-management plans. RESULTS: The Diabetes Self-Management Consultant (DSMC) intervention resulted in improvements in diabetes related quality of life (PAID) p= .008, the Empowerment Scale p= .024, A1C p= .016, Perceived understanding of diabetes p= .001 and satisfaction with diabetes care p= .019 as compared to the MAO group. DISCUSSION/CONCLUSION: The DSMC the intervention resulted in a broad array of modest diabetes related improvements. A promising area for future research would be to test the efficacy of combining an empowerment-based DSMC intervention with case management using algorithm-based medication adjustments for higher risk patients.
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Lin CC, Anderson RM, Chang CS, Hagerty BM, Loveland-Cherry CJ. Development and testing of the Diabetes Self-management Instrument: a confirmatory analysis. Res Nurs Health 2008; 31:370-80. [PMID: 18213627 DOI: 10.1002/nur.20258] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The purpose of this study was to develop and psychometrically test a new instrument for measuring self-management of adults with type 2 diabetes. Data were collected from 634 diabetic adults recruited from three teaching hospitals in Taiwan. Construct validity was determined by confirmatory factor analysis (CFA). Tests of internal consistency and test-retest were used to assess the reliability of the diabetes self-management instrument (DSMI). Initial results of CFA did not fully support the proposed five-factor model. After the model was modified, the fit indices indicated that this model fits the data best. This model was further cross validated in a second sample. Cronbach's alpha coefficient of the DSMI total scale was .94. The test-retest correlations for the DSMI total scale were acceptable (r = .73, p < .01).
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Affiliation(s)
- Chiu-Chu Lin
- Kaohsiung Medical University, College of Nursing, Kaohsiung, Taiwan
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Tang TS, Brown MB, Funnell MM, Anderson RM. Social support, quality of life, and self-care behaviors amongAfrican Americans with type 2 diabetes. Diabetes Educ 2008; 34:266-76. [PMID: 18375776 DOI: 10.1177/0145721708315680] [Citation(s) in RCA: 195] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE The purpose of this study was to examine social support and its relationship to diabetes-specific quality of life and self-care behaviors in African Americans with type 2 diabetes. METHODS The study followed a cross-sectional, observational design and recruited 89 African American adults, age 40 and older (mean = 60, SD = 10.5), diagnosed with type 2 diabetes. Participants completed measures assessing diabetes-specific quality of life, self-care behaviors (healthy eating, physical activity, self-monitoring of blood glucose, foot care, medication and/or insulin use), demographic background, and diabetes-related social support. Diabetes-related social support variables included amount of social support received, satisfaction with support, positive support behavior, negative support behavior, and primary source of support. RESULTS Stepwise regressions, controlling for demographic variables, were conducted to identify predictors of diabetes-specific quality of life and self-care behaviors from the diabetes-related social support variables. Satisfaction with support was a predictor for improved diabetes-specific quality of life (r = -.579, P < .001) and blood glucose monitoring (r = .258, P < .05). Positive support behavior was a predictor for following a healthy eating plan (r = .280, P < .05), spacing out carbohydrates evenly throughout the day (r = .367, P < .01), and performing physical activity at least 30 minutes per day (r = .296, P < .05). Negative support behavior was a predictor for not taking medication as recommended (r = -.348, P < .01). CONCLUSIONS Findings indicate that social support plays a role in diabetes-specific quality of life and self-management practices. Social support encompasses multiple dimensions that differentially influence specific diabetes health-related outcomes and behaviors.
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Affiliation(s)
- Tricia S Tang
- The University of Michigan Department of Medical Education, University of Michigan Medical School, and Michigan Diabetes Research and Training Center
| | - Morton B Brown
- The University of Michigan Department of Medical Education, University of Michigan Medical School, and Michigan Diabetes Research and Training Center
| | - Martha M Funnell
- The University of Michigan Department of Medical Education, University of Michigan Medical School, and Michigan Diabetes Research and Training Center
| | - Robert M Anderson
- The University of Michigan Department of Medical Education, University of Michigan Medical School, and Michigan Diabetes Research and Training Center
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Abstract
In the past 20 years, behavioral science has helped create a growing body of theoretically derived, evidenced-based approaches to diabetes patient education. Health care professionals in all disciplines are being required to demonstrate that their practice is evidence based. For diabetes educators, behavioral science is the source of much of that evidence. However, effective diabetes education involves a combination of art and science. Establishing a therapeutic alliance with patients is an art. Diabetes educators must have the interpersonal skills, values, and personal traits needed to cultivate relationships with patients that are characterized by trust, respect, and acceptance. They must feel and be able to express compassion, empathy, and warmth. However, if someone outside the field were reviewing diabetes education evaluation research, they would probably conclude that diabetes educators are interchangeable cogs in a wheel. The positive impact of the therapeutic alliance is well documented in the counseling, psychotherapy, education, and nursing literature. However, evidence to support the important role of the diabetes educator's values, interpersonal skills, and ability to establish a therapeutic alliance with patients is absent from that literature. Valid and reliable measures used to document the impact of interpersonal skills counselors and teachers could be used in diabetes education with little or no adaptation. The evidence and tools exist; we now need to determine if the will exists.
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Affiliation(s)
- Robert M Anderson
- The Department of Medical Education, University of Michigan Medical School, Ann Arbor
| | - Martha M Funnell
- The Department of Medical Education, University of Michigan Medical School, Ann Arbor
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Lin CC, Anderson RM, Hagerty BM, Lee BO. Diabetes self-management experience: a focus group study of Taiwanese patients with type 2 diabetes. J Clin Nurs 2008; 17:34-42. [DOI: 10.1111/j.1365-2702.2007.01962.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tang TS, Stansfield RB, Oh M, Anderson RM, Fitzgerald JT. Patient-provider perceptions of diabetes and its impact on self-management: a comparison of African-American and White patients. Diabet Med 2008; 25:341-8. [PMID: 18307461 DOI: 10.1111/j.1464-5491.2007.02371.x] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To compare patient-provider differences in diabetes-related perceptions between African-American and White patients and to examine its association with self-care behaviours. METHODS One hundred and thirty patient-provider pairs were recruited from the greater Detroit area. Patients and providers completed a survey assessing perceptions about diabetes-related concepts and demographic background. The Diabetes Semantic Differential Scale was used to measure diabetes-related perceptions. Patients also reported the frequency of performing self-care behaviours, including following a healthy eating plan, engaging in physical activity, blood glucose monitoring, and taking medication and/or insulin. RESULTS There were a greater number of patient-provider differences in diabetes-related perceptions for the African-American patients (nine of 18 concepts) compared with the White patients (four of 18 concepts). Stepwise regression analyses found patients' semantic differential scores to be significantly associated with five self-care behaviours for African-American patients and two self-care behaviours for White patients. Providers' semantic differential scores emerged as predictors of self-care behaviours for African-American patients, but not for White patients. CONCLUSIONS Our findings suggest that compared with White patients, African-Americans differ in a greater number of diabetes-related perceptions than their providers. Patients' and providers' perceptions of diabetes care concepts have a significant impact on a greater number of self-care behaviours for African-American patients than White patients.
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Affiliation(s)
- T S Tang
- University of Michigan Department of Medical Education, University of Michigan Medical School, Ann Arbor, MI, USA.
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Lee MA, Manley TR, Glass BC, Anderson RM, Wilson SJ, O'keefe JS, Tisdall DJ, McEwan JC, Phua SH, Tate ML. Distribution of prion protein genotypes in breeds of sheep in New Zealand. N Z Vet J 2007; 55:222-7. [PMID: 17928898 DOI: 10.1080/00480169.2007.36772] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM To use an established high through-put genotyping procedure to gain an estimate of the frequency of alleles of the prion protein (PrP) gene in some common sheep breeds in New Zealand. METHODS Using a genotyping procedure based on matrix-assisted laser desorption ionisation-time of flight (MALDI-TOF), DNA samples from 3,024 sheep from New Zealand, including breeds such as Romney, Texel, Coopworth, Merino and mixed breed, were isolated, genotyped and the results analysed. RESULTS The 15 scrapie genotypes commonly reported, and derived from the five commonly reported allelic variants (ARR, ARQ, AHQ, ARH and VRQ), were all observed in the samples analysed. The estimates were indicative of the frequencies in the population of alleles present in breeds of sheep in New Zealand. There was a significant difference between the frequencies of alleles between breeds, but the ARQ, followed by the ARR allele, were, except in Carwell sheep, the most common alleles present. CONCLUSION This study gave an indication of the percentages of PrP gene alleles in sheep in New Zealand, including data previously unreported from breeds in this country. It is of interest because of the relatively large size of the sheep population in New Zealand compared with many countries, and it provides some useful information on the genetic susceptibility or resistance of the sheep population in New Zealand to scrapie. The frequencies of the alleles can be different for an individual breed compared between countries.
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Affiliation(s)
- M A Lee
- Department of Economics, University of Otago, Dunedin, New Zealand
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Boily MC, Lowndes CM, Vickerman P, Kumaranayake L, Blanchard J, Moses S, Ramesh BM, Pickles M, Watts C, Washington R, Reza-Paul S, Labbe AC, Anderson RM, Deering KN, Alary M. Evaluating large-scale HIV prevention interventions: study design for an integrated mathematical modelling approach. Sex Transm Infect 2007; 83:582-9. [PMID: 17942574 DOI: 10.1136/sti.2007.027516] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND There is an urgent need to evaluate HIV prevention interventions, thereby improving our understanding of what works, under what circumstances and what is cost effective. OBJECTIVES To describe an integrated mathematical evaluation framework designed to assess the population-level impact of large-scale HIV interventions and applied in the context of Avahan, the Indian AIDS Initiative, in southern India. The Avahan Initiative is a large-scale HIV prevention intervention, funded by the Bill & Melinda Gates Foundation, which targets high-risk groups in selected districts of the six states most affected by the HIV/AIDS epidemic (Maharashtra, Karnataka, Tamil Nadu, Andhra Pradesh, Nagaland and Manipur) and along the national highways. METHODS One important component of the monitoring and evaluation of Avahan relies on an integrated mathematical framework that combines empirical biological and behavioural data from different subpopulations in the intervention areas, with the use of tailor-made transmission dynamics models embedded within a Bayesian framework. RESULTS An overview of the Avahan Initiative and the objectives of the monitoring and evaluation of the intervention is given. The rationale for choosing this evaluation design compared with other possible designs is presented, and the different components of the evaluation framework are described and its advantages and challenges are discussed, with illustrated examples. CONCLUSIONS This is the first time such an approach has been applied on such a large scale. Lessons learnt from the CHARME project could help in the design of future evaluations of large-scale interventions in other settings, whereas the results of the evaluation will be of programmatic and public health relevance.
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Affiliation(s)
- M-C Boily
- Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College, Norfolk Place, W2 1PG, London, UK.
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Maqbool NJ, Tate ML, Dodds KG, Anderson RM, McEwan KM, Mathias HC, McEwan JC, Hall RJ. A QTL study of growth and body shape in the inter-species hybrid of Père David's deer (Elaphurus davidianus) and red deer (Cervus elaphus). Anim Genet 2007; 38:270-6. [PMID: 17433011 DOI: 10.1111/j.1365-2052.2007.01597.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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: 11/27/2022]
Abstract
An interspecies deer hybrid resource population developed from a cross of Père David's and red deer was used to detect QTL that account for species differences. A genome scan, coupled with composite interval mapping, was conducted to search for QTL controlling body measurements at pre-pubescent age (6 months of age) and puberty (15 months of age) in this interspecies hybrid. Five linkage groups that harbour QTL affecting morphology were identified. A joint-traits analysis was used to search for putative pleiotropic QTL on four of these linkage groups, and three were significantly associated with pleiotropic QTL for nose width and foot length (metacarpal and phalanges), which collectively accounted for 29-58% of the phenotypic difference between the two deer species. This study suggests that a few loci with large pleiotropic effects may be responsible for species-specific differences in growth and structure-related traits.
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Affiliation(s)
- N J Maqbool
- AgResearch Ltd, Invermay Agricultural Centre, Private Bag 50034, Mosgiel 9053, New Zealand.
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Uhley VE, Mangrulkar RS, Anderson RM, Mullan PB, Bernat CK, Sandretto AM, Heisler M, Chapman CM, Stephens MR, White CB, Fantone JC. The Integration of Web‐Based Educational Modules on Collaborative Care Interviewing Skills into a Standardized Patient experience focused on Nutrition Assessment to Enhance Medical Students Communication Skills. FASEB J 2007. [DOI: 10.1096/fasebj.21.5.a303-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Virginia Ellen Uhley
- Medical School Administration, University of Michigan, 1080 S. UniversityRm 3765Ann ArborMI48109
| | - Rajesh S Mangrulkar
- Medical School Administration, University of Michigan, 1080 S. UniversityRm 3765Ann ArborMI48109
| | - Robert M Anderson
- Medical School Administration, University of Michigan, 1080 S. UniversityRm 3765Ann ArborMI48109
| | - Patricia B Mullan
- Medical School Administration, University of Michigan, 1080 S. UniversityRm 3765Ann ArborMI48109
| | - Carrie K Bernat
- Medical School Administration, University of Michigan, 1080 S. UniversityRm 3765Ann ArborMI48109
| | - Anita M Sandretto
- Medical School Administration, University of Michigan, 1080 S. UniversityRm 3765Ann ArborMI48109
| | - Michele Heisler
- Medical School Administration, University of Michigan, 1080 S. UniversityRm 3765Ann ArborMI48109
| | - Chris M Chapman
- Medical School Administration, University of Michigan, 1080 S. UniversityRm 3765Ann ArborMI48109
| | - Marc R Stephens
- Medical School Administration, University of Michigan, 1080 S. UniversityRm 3765Ann ArborMI48109
| | - Casey B White
- Medical School Administration, University of Michigan, 1080 S. UniversityRm 3765Ann ArborMI48109
| | - Joseph C Fantone
- Medical School Administration, University of Michigan, 1080 S. UniversityRm 3765Ann ArborMI48109
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Ferguson NM, Donnelly CA, Hooper J, Ghani AC, Fraser C, Bartley LM, Rode RA, Vernazza P, Lapins D, Mayer SL, Anderson RM. Adherence to antiretroviral therapy and its impact on clinical outcome in HIV-infected patients. J R Soc Interface 2006; 2:349-63. [PMID: 16849193 PMCID: PMC1578278 DOI: 10.1098/rsif.2005.0037] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [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: 11/12/2022] Open
Abstract
We analyse data on patient adherence to prescribed regimens and surrogate markers of clinical outcome for 168 human immunodeficiency virus infected patients treated with antiretroviral therapy. Data on patient adherence consisted of dose-timing measurements collected for an average of 12 months per patient via electronic monitoring of bottle opening events. We first discuss how such data can be presented to highlight suboptimal adherence patterns and between-patient differences, before introducing two novel methods by which such data can be statistically modelled. Correlations between adherence and subsequent measures of viral load and CD4+T-cell counts are then evaluated. We show that summary measures of short-term adherence, which incorporate pharmacokinetic and pharmacodynamic data on the monitored regimen, predict suboptimal trends in viral load and CD4+T-cell counts better than measures based on adherence data alone.
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Affiliation(s)
- N M Ferguson
- Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, Norfolk Place, London W2 1PG, UK.
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Funnell MM, Anderson RM, Nwankwo R, Gillard ML, Butler PM, Fitzgerald JT, Feathers JT. A study of certified diabetes educators: influences and barriers. Diabetes Educ 2006; 32:359-62, 364-6, 368-72. [PMID: 16772652 DOI: 10.1177/0145721706288041] [Citation(s) in RCA: 14] [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: 11/17/2022]
Abstract
PURPOSE There were 2 related goals for this study. The first purpose was to describe the structure (type, staffing, and number of educational sessions provided), process (preferred learning approaches), and outcome measures commonly used to provide patient education. The second purpose was to identify the influences, resources, and constraints that affect and alter the attitudes and practices of diabetes educators. METHODS A 30-item questionnaire that addressed 4 areas--demographics, practice characteristics, education program structure, and educational processes--was mailed to a sample of American Association of Diabetes Educators members. Three hundred sixty-one registered nurse and registered dietician certified diabetes educators completed the questionnaire and were included in the final analysis. RESULTS This survey indicated that this group of certified diabetes educators has incorporated new research findings and innovative teaching methods into their practices. They experience few barriers and tend to make changes in their attitudes and practices based on scientific and experiential evidence. The 3 most highly rated influences on these changes were related to patient responses to their teaching, followed by continuing education conferences and new research findings. CONCLUSIONS Based on these findings, providing continuing education that first and foremost incorporates experience-based examples of effective strategies supported by research published in professional journals appears to have the most influence on the practice of educators.
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Affiliation(s)
- Martha M Funnell
- The Michigan Diabetes Research and Training Center (Ms Funnell, Dr Anderson)
- The Department of Medical Education, University of Michigan Medical School, Ann Arbor (Ms Funnell, Dr Anderson, Ms Nwankwo, Ms Gillard, Dr Fitzgerald)
| | - Robert M Anderson
- The Michigan Diabetes Research and Training Center (Ms Funnell, Dr Anderson)
- The Department of Medical Education, University of Michigan Medical School, Ann Arbor (Ms Funnell, Dr Anderson, Ms Nwankwo, Ms Gillard, Dr Fitzgerald)
| | - Robin Nwankwo
- The Department of Medical Education, University of Michigan Medical School, Ann Arbor (Ms Funnell, Dr Anderson, Ms Nwankwo, Ms Gillard, Dr Fitzgerald)
| | - Mary Lou Gillard
- The Department of Medical Education, University of Michigan Medical School, Ann Arbor (Ms Funnell, Dr Anderson, Ms Nwankwo, Ms Gillard, Dr Fitzgerald)
| | | | - James T Fitzgerald
- The Department of Medical Education, University of Michigan Medical School, Ann Arbor (Ms Funnell, Dr Anderson, Ms Nwankwo, Ms Gillard, Dr Fitzgerald)
| | - Jackie Two Feathers
- The Cancer Research and Treatment Center, University of New Mexico, Albuquerque (Dr Two Feathers)
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Anderson RM, Sumption ND, Papworth DG, Goodhead DT. Chromosome breakpoint distribution of damage induced in peripheral blood lymphocytes by densely ionizing radiation. Int J Radiat Biol 2006; 82:49-58. [PMID: 16546903 DOI: 10.1080/09553000600579231] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE To assess the chromosomal breakpoint distribution in human peripheral blood lymphocytes (PBL) after exposure to a low dose of high linear energy transfer (LET) alpha-particles using the technique of multiplex fluorescence in situ hybridization (m-FISH). MATERIALS AND METHODS Separated PBL were exposed in G0 to 0.5 Gy 238Pu alpha-particles, stimulated to divide and harvested approximately 48 - 50 hours after exposure. Metaphase cells were assayed by m-FISH and chromosome breaks identified. The observed distribution of breaks were then compared with expected distributions of breaks, calculated on the assumption that the distribution of breaks is random with regard to either chromosome volume or chromosome surface area. RESULTS More breaks than expected were observed on chromosomes 2 and 11, however no particular region of either chromosome was identified as significantly contributing to this over-representation. The identification of hot or cold chromosome regions (pter,p,cen,q,qter) varied depending on whether the data were compared according to chromosome volume or surface area. CONCLUSIONS A deviation from randomness in chromosome breakpoint distribution was observed, and this was greatest when data were compared according to the relative surface area of each individual chromosome (or region). The identification of breaks by m-FISH (i.e., more efficient observation of interchanges than intrachanges) and importance of territorial boundaries on interchange formation are thought to contribute to these differences. The significance of the observed non-random distribution of breaks on chromosomes 2 and 11 in relation to chromatin organization is unclear.
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Affiliation(s)
- R M Anderson
- MRC Radiation and Genome Stability Unit, Harwell, Didcot, Oxfordshire, UK.
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McLean CA, Ironside JW, Alpers MP, Brown PW, Cervenakova L, Anderson RM, Masters CL. Comparative neuropathology of Kuru with the new variant of Creutzfeldt-Jakob disease: evidence for strain of agent predominating over genotype of host. Brain Pathol 2006; 8:429-37. [PMID: 9669694 PMCID: PMC8098151 DOI: 10.1111/j.1750-3639.1998.tb00165.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [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: 11/27/2022] Open
Abstract
The three major influences on the phenotype of the transmissible spongiform encephalopathies are believed to be strain of agent, route of infection and host genotype. We have compared the pathologic profiles and genotypes of the new variant of Creutzfeldt-Jakob disease (vCJD) and kuru. The comparison reveals that there are distinct lesional differences particularly in the prion protein (PrP) load and distribution as seen by immunohistochemistry. The clinico-pathologic phenotypes and the genotypes of these two diseases are sufficiently different to suggest that the strain of agent may play a greater role than any presumptive common route of peripherally acquired infection.
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Affiliation(s)
- C A McLean
- Department of Pathology, The University of Melbourne, Victoria, Australia.
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Leung GM, Lim WW, Ho LM, Lam TH, Ghani AC, Donnelly CA, Fraser C, Riley S, Ferguson NM, Anderson RM, Hedley AJ. Seroprevalence of IgG antibodies to SARS-coronavirus in asymptomatic or subclinical population groups. Epidemiol Infect 2006; 134:211-21. [PMID: 16490123 PMCID: PMC2870380 DOI: 10.1017/s0950268805004826] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2005] [Indexed: 01/12/2023] Open
Abstract
We systematically reviewed the current understanding of human population immunity against SARS-CoV in different groups, settings and geography. Our meta-analysis, which included all identified studies except those on wild animal handlers, yielded an overall seroprevalence of 0.10% [95% confidence interval (CI) 0.02-0.18]. Health-care workers and others who had close contact with SARS patients had a slightly higher degree of seroconversion (0.23%, 95% CI 0.02-0.45) compared to healthy blood donors, others from the general community or non-SARS patients recruited from the health-care setting (0.16%, 95% CI 0-0.37). When analysed by the two broad classes of testing procedures, it is clear that serial confirmatory test protocols resulted in a much lower estimate (0.050%, 95% CI 0-0.15) than single test protocols (0.20%, 95% CI 0.06-0.34). Potential epidemiological and laboratory pitfalls are also discussed as they may give rise to false or inconsistent results in measuring the seroprevalence of IgG antibodies to SARS-CoV.
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Affiliation(s)
- G M Leung
- Department of Community Medicine, University of Hong Kong, Pokfulam, Hong Kong, ChinaTakemi Program, Harvard School of Public Health, Boston, MA, USA.
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Abstract
A cat with clinical signs Indicating rickets was diagnosed as having a defect of vitamin D receptors. Clinical signs had been seen from four months of age. Treatment with calcium supplementation and various forms of vitamin D did not alter plasma calcium levels or reverse skeletal lesions of lateral antebrachial bowing, lumbar spinal lordosis and costochondral beading. Analgesics were effective for relieving skeletal pain during the bone growth phase and were withdrawn when the animal reached skeletal maturity. Therapy for hip osteoarthritis was given from five years of age until the cat was euthanased at nine years of age as a result of refractory hip pain.
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Affiliation(s)
- D R Godfrey
- Nine Lives Veterinary Practice for Cats, Hockley Heath, West Midlands
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Gregson S, Nyamukapa CA, Garnett GP, Wambe M, Lewis JJC, Mason PR, Chandiwana SK, Anderson RM. HIV infection and reproductive health in teenage women orphaned and made vulnerable by AIDS in Zimbabwe. AIDS Care 2005; 17:785-94. [PMID: 16120495 DOI: 10.1080/09540120500258029] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AIDS has increased the number of orphans and vulnerable children (OVCs) in sub-Saharan Africa who could suffer detrimental life experiences. We investigated whether OVCs have heightened risks of adverse reproductive health outcomes including HIV infection. Data on HIV infection, sexually transmitted infection (STI) symptoms and pregnancy, and common risk factors were collected for OVCs and non-OVCs in a population survey of 1523 teenage children in eastern Zimbabwe between July 2001 and March 2003. Multivariate logistic regression was used to test for statistical association between OVC status, adverse reproductive health outcomes and suspected risk factors. Amongst women aged 15-18 years, OVCs had higher HIV prevalence than non-OVCs (3.2% versus 0.0%; p = 0.002) and more common experience of STI symptoms (5.9% versus 3.3%; adjusted odds ratio = 1.75, 95% CI 0.80-3.80) and teenage pregnancy (8.3% versus 1.9%; 4.25, 1.58-11.42). OVCs (overall), maternal orphans and young women with an infected parent were more likely to have received no secondary school education and to have started sex and married, which, in turn, were associated with poor reproductive health. Amongst men aged 17-18 years, OVC status was not associated with HIV infection (0.5% versus 0.0%; p = 1.000) or STI symptoms (2.7% versus 1.6%; p = 0.529). No association was found between history of medical injections and HIV risk amongst teenage women and men. High proportions of HIV infections, STIs and pregnancies among teenage girls in eastern Zimbabwe can be attributed to maternal orphanhood and parental HIV. Many of these could be averted through further female secondary school education. Predicted substantial expanded increases in orphanhood could hamper efforts to slow the acquisition of HIV infection in successive generations of young adults, perpetuating the vicious cycle of poverty and disease.
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Affiliation(s)
- S Gregson
- Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College, London, UK.
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Anderson RM, Papworth DG, Stevens DL, Sumption ND, Goodhead DT. Increased complexity of radiation-induced chromosome aberrations consistent with a mechanism of sequential formation. Cytogenet Genome Res 2005; 112:35-44. [PMID: 16276088 DOI: 10.1159/000087511] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2005] [Accepted: 06/20/2005] [Indexed: 11/19/2022] Open
Abstract
Complex chromosome aberrations (any exchange involving three or more breaks in two or more chromosomes) are effectively induced in peripheral blood lymphocytes (PBL) after exposure to low doses (mostly single particles) of densely ionising high-linear energy transfer (LET) alpha-particle radiation. The complexity, when observed by multiplex fluorescence in situ hybridisation (m-FISH), shows that commonly four but up to eight different chromosomes can be involved in each rearrangement. Given the territorial organisation of chromosomes in interphase and that only a very small fraction of the nucleus is irradiated by each alpha-particle traversal, the aim of this study is to address how aberrations of such complexity can be formed. To do this, we applied theoretical "cycle" analyses using m-FISH paint detail of PBL in their first cell division after exposure to high-LET alpha-particles. In brief, "cycle" analysis deconstructs the aberration "observed" by m-FISH to make predictions as to how it could have been formed in interphase. We propose from this that individual high-LET alpha-particle-induced complex aberrations may be formed by the misrepair of damaged chromatin in single physical "sites" within the nucleus, where each "site" is consistent with an "area" corresponding to the interface of two to three different chromosome territories. Limited migration of damaged chromatin is "allowed" within this "area". Complex aberrations of increased size, reflecting the path of alpha-particle nuclear intersection, are formed through the sequential linking of these individual sites by the involvement of common chromosomes.
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Affiliation(s)
- R M Anderson
- MRC Radiation and Genome Stability Unit, Harwell, Didcot, Oxon, UK.
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Abstract
OBJECTIVES To test and characterize the dependence of viral load on gender in different countries and racial groups as a function of CD4 T-cell count. METHODS Plasma viral load data were analysed for > 30,000 HIV-infected patients attending clinics in the USA [HIV Insight (Cerner Corporation, Vienna, VA, USA) and Plum Data Mining LLC (East Meadow, NY, USA) databases] and the Netherlands (Athena database; HIV Monitoring Foundation, Amsterdam, Netherlands). Log-normal regression models were used to test for an effect of gender on viral load while adjusting for covariates and allowing the effect to depend on CD4 T-cell count. Sensitivity analyses were performed to test the robustness of conclusions to assumptions regarding viral loads below the lower limit of quantification (LLOQ). RESULTS After adjusting for covariates, women had (nonsignificantly) lower viral loads than men (HIV Insight: -0.053 log(10) HIV-1 RNA copies/mL, P = 0.202; Athena: -0.005 log(10) copies/mL, P = 0.667; Plum: -0.072 log(10) copies/mL, P = 0.273). However, further investigation revealed that the gender effect depended on CD4 T-cell count. Women had consistently higher viral loads than men when CD4 T-cell counts were at most 50 cells/microL, and consistently lower viral loads than men when CD4 T-cell counts were greater than 350 cells/microL. These effects were remarkably consistent when estimated independently for the racial groups with sufficient data available in the HIV Insight and Plum databases. CONCLUSIONS The consistent relationship between gender-related differences in viral load and CD4 T-cell count demonstrated here explains the diverse findings previously published.
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Affiliation(s)
- C A Donnelly
- Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK.
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Ghani AC, Donnelly CA, Cox DR, Griffin JT, Fraser C, Lam TH, Ho LM, Chan WS, Anderson RM, Hedley AJ, Leung GM. Methods for estimating the case fatality ratio for a novel, emerging infectious disease. Am J Epidemiol 2005; 162:479-86. [PMID: 16076827 PMCID: PMC7109816 DOI: 10.1093/aje/kwi230] [Citation(s) in RCA: 174] [Impact Index Per Article: 9.2] [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] [Indexed: 01/12/2023] Open
Abstract
During the course of an epidemic of a potentially fatal disease, it is important that the case fatality ratio be well estimated. The authors propose a novel method for doing so based on the Kaplan-Meier survival procedure, jointly considering two outcomes (death and recovery), and evaluate its performance by using data from the 2003 epidemic of severe acute respiratory syndrome in Hong Kong, People's Republic of China. They compare this estimate obtained at various points in the epidemic with the case fatality ratio eventually observed; with two commonly quoted, naïve estimates derived from cumulative incidence and mortality statistics at single time points; and with estimates in which a parametric mixture model is used. They demonstrate the importance of patient characteristics regarding outcome by analyzing subgroups defined by age at admission to the hospital.
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Affiliation(s)
- A C Ghani
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom.
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Affiliation(s)
- Robert M Anderson
- Michigan Diabetes Research and Training Center, University of Michigan, Ann Arbor, MI 48109-0201, USA.
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Anderson RM, Funnell MM. Patient empowerment: reflections on the challenge of fostering the adoption of a new paradigm. Patient Educ Couns 2005; 57:153-7. [PMID: 15911187 DOI: 10.1016/j.pec.2004.05.008] [Citation(s) in RCA: 252] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2003] [Revised: 04/03/2004] [Accepted: 05/17/2004] [Indexed: 05/02/2023]
Abstract
Diabetes is a self-managed illness in which the decisions most affecting the health and well being of patients are made by the patients themselves. Many of these decisions involve routine activities of daily living (e.g., nutrition, physical activity). Effective diabetes care requires patients and health care professionals to collaborate in the development of self-management plans that integrate the clinical expertise of health care professionals with the concerns, priorities and resources of the patient. Collaborative diabetes care requires a new "empowerment" paradigm that involves a fundamental redefinition of roles and relationships of health care professionals and patients. The challenges of fostering the adoption of a new paradigm differ substantially from those associated with the introduction of new technology. Those challenges are discussed in this paper.
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Affiliation(s)
- Robert M Anderson
- Department of Medical Education, The Michigan Diabetes Research and Training Center, The University of Michigan Medical School, 1500 E. Medical Ctr. Dr., 0201 Towsley Center, Room G-1111, Ann Arbor, MI 48109-0201, USA.
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