1
|
Tine R, Herrera S, Badji MA, Daniels K, Ndiaye P, Smith Gueye C, Tairou F, Slutsker L, Hwang J, Ansah E, Littrell M. Defining operational research priorities to improve malaria control and elimination in sub-Saharan Africa: results from a country-driven research prioritization setting process. Malar J 2023; 22:219. [PMID: 37517990 PMCID: PMC10387205 DOI: 10.1186/s12936-023-04654-8] [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] [Received: 05/09/2023] [Accepted: 07/22/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND In order to reignite gains and accelerate progress toward improved malaria control and elimination, policy, strategy, and operational decisions should be derived from high-quality evidence. The U.S. President's Malaria Initiative (PMI) Insights project together with the Université Cheikh Anta Diop of Dakar, Senegal, conducted a broad stakeholder consultation process to identify pressing evidence gaps in malaria control and elimination across sub-Saharan Africa (SSA), and developed a priority list of country-driven malaria operational research (OR) and programme evaluation (PE) topics to address these gaps. METHODS Five key stakeholder groups were engaged in the process: national malaria programmes (NMPs), research institutions in SSA, World Health Organization (WHO) representatives in SSA, international funding agencies, and global technical partners who support malaria programme implementation and research. Stakeholders were engaged through individual or small group interviews and an online survey, and asked about key operational challenges faced by NMPs, pressing evidence gaps in current strategy and implementation guidance, and priority OR and PE questions to address the challenges and gaps. RESULTS Altogether, 47 interviews were conducted with 82 individuals, and through the online survey, input was provided by 46 global technical partners. A total of 33 emergent OR and PE topics were identified through the consultation process and were subsequently evaluated and prioritized by an external evaluation committee of experts from NMPs, research institutions, and the WHO. The resulting prioritized OR and PE topics predominantly focused on generating evidence needed to close gaps in intervention coverage, address persistent challenges faced by NMPs in the implementation of core strategic interventions, and inform the effective deployment of new tools. CONCLUSION The prioritized research list is intended to serve as a key resource for informing OR and PE investments, thereby ensuring future investments focus on generating the evidence needed to strengthen national strategies and programme implementation and facilitating a more coordinated and impactful approach to malaria operational research.
Collapse
Affiliation(s)
- Roger Tine
- Université Cheikh Anta Diop, Dakar, Senegal
| | | | | | - Kyle Daniels
- PMI Insights Project/University of California, San Francisco Malaria Elimination Initiative, San Francisco, USA
| | | | - Cara Smith Gueye
- PMI Insights Project/University of California, San Francisco Malaria Elimination Initiative, San Francisco, USA
| | | | | | - Jimee Hwang
- U.S. President's Malaria Initiative, Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Evelyn Ansah
- University of Health and Allied Sciences, Accra, Ghana
| | | |
Collapse
|
2
|
Herrera S, Torralbo B, Herranz S, Bernal-Maurandi J, Rubio E, Pitart C, Fortes I, Valls S, Rodríguez L, Santana G, Bodro M, Garcia-Vidal C, Hernández-Meneses M, Puerta P, Morata L, Villella A, Bertran MJ, Brey M, Soriano A, Del Río A, Martinez JA. Carriage of multidrug-resistant Gram-negative bacilli: duration and risk factors. Eur J Clin Microbiol Infect Dis 2023; 42:631-638. [PMID: 36964885 DOI: 10.1007/s10096-023-04581-1] [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] [Received: 11/24/2022] [Accepted: 02/24/2023] [Indexed: 03/26/2023]
Abstract
Identification of risk factors influencing the duration of carriage of multidrug-resistant Gram-negative bacilli (MDR-GNB) may be useful for infection control. The aim of this study is to estimate the impact of several factors collected for routine hospital surveillance on the duration of carriage of selected MDR-GNB. From January 2015 to July 2021, patients with at least two clinical/surveillance samples positive for MDR-GNB different from ESBL-producing E. coli or AmpC - exclusively producing Enterobacterales were assessed. Microorganisms, age, number of admissions, clinical or rectal sample, sex, and admission service were evaluated as risk factors. Multivariate analysis was performed by a Cox proportional hazard model. A total of 1981 episodes of colonization were included. Involved microorganisms were ESBL-Klebsiella pneumoniae (KP) in 1057 cases (53.4%), other ESBL-non-E. coli Enterobacterales in 91 (4.6%), OXA-48-KP in 263 (13.3%), KPC-KP in 90 (4.5%), VIM-KP in 29 (1.5%), carbapenemase-producing non-KP Enterobacterales (CP-non-KP) in 124 (6.3%), and MDR Pseudomonas aeruginosa (MDR-PAER) in 327 (16.5%). No differences in duration of colonization were observed among ESBL-KP (median colonization time 320 days), ESBL-non-E. coli Enterobacterales (226 days), OXA48-KP (305 days), and MDR-PAER (321 days). For each group, duration of colonization was significantly longer than that of KPC-KP (median colonization time 60 days), VIM-KP (138 days), and CP-non-KP (71 days). Male sex (HR = 0.88; 95% CI 0.78-0.99), detection in Hepatology-Gastroenterology (HR = 0.71; 95% CI 0.54-0.93), clinical sample (HR = 0.61; 95% CI 0.53-0.69), and > 2 admissions after first detection (HR = 0.47; 95% CI 0.42-0.52) were independent predictors of longer carriage, whereas VIM-KP (HR = 1.61; 95% CI 1.04-2.48), KPC-KP (HR = 1.85; 95% CI 1.49-2.3), and CP-non-KP (HR = 1.92; 95% CI 1.49-2.47) were associated with shorter colonization time. Duration of colonization was significantly longer for ESBL-KP, other ESBL-non-E. coli Enterobacterales, OXA-48-KP, and MDR-PAER. For these microorganisms, prolonging surveillance up to 2.5-3 years should be considered. Male sex, clinical sample, multiple readmissions, admission service, and type of microorganism are independent predictors of the duration of carriage.
Collapse
Affiliation(s)
- S Herrera
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - B Torralbo
- Preventive Medicine, Hospital Clinic of Barcelona-IDIBAPS, Barcelona, Spain
| | - S Herranz
- Preventive Medicine, Hospital Clinic of Barcelona-IDIBAPS, Barcelona, Spain
| | - J Bernal-Maurandi
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - E Rubio
- Department of Microbiology, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | - C Pitart
- Department of Microbiology, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | - I Fortes
- Preventive Medicine, Hospital Clinic of Barcelona-IDIBAPS, Barcelona, Spain
| | - S Valls
- Preventive Medicine, Hospital Clinic of Barcelona-IDIBAPS, Barcelona, Spain
| | - L Rodríguez
- Preventive Medicine, Hospital Clinic of Barcelona-IDIBAPS, Barcelona, Spain
| | - G Santana
- Preventive Medicine, Hospital Clinic of Barcelona-IDIBAPS, Barcelona, Spain
| | - M Bodro
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - C Garcia-Vidal
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - M Hernández-Meneses
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - P Puerta
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - L Morata
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - A Villella
- Preventive Medicine, Hospital Clinic of Barcelona-IDIBAPS, Barcelona, Spain
| | - M J Bertran
- Preventive Medicine, Hospital Clinic of Barcelona-IDIBAPS, Barcelona, Spain
| | - M Brey
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - A Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - A Del Río
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - J A Martinez
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, C. de Villarroel, 170, 08036, Barcelona, Spain.
| |
Collapse
|
3
|
Sánchez-Marcos C, Jacob J, Llorens P, Rodríguez B, Martín-Sánchez F, Herrera S, Castillero-Díaz L, Herrero P, Gil V, Miró Ò. Análisis de la efectividad y seguridad de las unidades de estancia corta en la hospitalización de pacientes con insuficiencia cardíaca aguda. Propensity Score UCE-EAHFE. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2022.03.011] [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: 10/18/2022]
|
4
|
Sánchez-Marco C, Jacob J, Llorens P, Rodríguez B, Martín-Sánchez FJ, Herrera S, Castillero-Díaz LE, Herrero P, Gil V, Miró Ò. Original articleAnalysis of the effectiveness and safety of short-stay units in the hospitalization of patients with acute heart failure. Propensity Score SSU-EAHFE. Rev Clin Esp 2022; 222:443-457. [PMID: 35842410 DOI: 10.1016/j.rceng.2022.03.009] [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] [Received: 02/02/2022] [Accepted: 03/27/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES This work aims to analyze if hospitalization in short-stay units (SSU) of patients diagnosed in the emergency department with acute heart failure (AHF) is effective in terms of the length of hospital stay and if it is associated with differences in short-term progress. METHOD Patients from the EAHFE registry diagnosed with AHF who were admitted to the SSU (SSU group) were included and compared to those hospitalized in other departments (non-SSU group) from all hospitals (comparison A) and, separately, those from hospitals with an SSU (comparison B) and without an SSU (comparison C). For each comparison, patients in the SSU/non-SSU groups were matched by propensity score. The length of hospital stay (efficacy), 30-day mortality, and post-discharge adverse events at 30 days (safety) were compared. RESULTS A total of 2,003 SSU patients and 12,193 non-SSU patients were identified. Of them, 674 pairs of patients were matched for comparison A, 634 for comparison B, and 588 for comparison C. The hospital stay was significantly shorter in the SSU group in all comparisons (A: median 4 days (IQR = 2-5) versus 8 (5-12) days, p < 0.001; B: 4 (2-5) versus 8 (5-12), p < 0.001; C: 4 (2-5) versus 8 (6-12), p < 0.001). Admission to the SSU was not associated with differences in mortality (A: HR = 1.027, 95%CI = 0.681-1.549; B: 0.976, 0.647-1.472; C: 0.818, 0.662-1.010) or post-discharge adverse events (A: HR = 1.002, 95%CI = 0.816-1.232; B: 0.983, 0.796-1.215; C: 1.135, 0.905-1.424). CONCLUSION The hospitalization of patients with AHF in the SSU is associated with shorter hospital stays but there were no differences in short-term progress.
Collapse
Affiliation(s)
- C Sánchez-Marco
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - J Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - P Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - B Rodríguez
- Servicio de Urgencias, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - F J Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - S Herrera
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - P Herrero
- Servicio de Urgencias, Hospital Central de Asturias, Oviedo, Spain
| | - V Gil
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Ò Miró
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
| | | |
Collapse
|
5
|
Azad R, Billah SM, Bhui BR, Ali NB, Herrera S, de Graft-Johnson J, Garg L, Priyanka SS, Zubair S, Rokonuzzaman SM, Rahman MM, Meena USJ, Arifeen SE. Mother's care-seeking behavior for neonatal danger signs from qualified providers in rural Bangladesh: A generalized structural equation modeling and mediation analysis. Front Pediatr 2022; 10:929157. [PMID: 36683813 PMCID: PMC9846223 DOI: 10.3389/fped.2022.929157] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 11/23/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Neonatal deaths contribute to nearly half (47%) of under-five mortality globally and 67% in Bangladesh. Despite high neonatal mortality, care-seeking from qualified providers for newborn danger signs remains low. Identification of direct and indirect factors and their pathways affecting care-seeking will help to design a well-targeted intervention. This study assessed the direct, indirect, and total effect of the predictive factors on neonatal care-seeking in Bangladesh. MATERIALS AND METHODS This was a cross-sectional baseline household survey conducted in 14 districts of Bangladesh in 2019 with 17,251 recently delivered women (RDW) with a live birth outcome in the preceding 15 months. We used a two-stage stratified cluster sampling process to select the samples from 14 districts. We investigated the inter-relationship of maternal background characteristics, maternal health utilizations, child/neonate factors, health service delivery-related factors and newborn danger sign knowledge with newborn care-seeking practices and estimated the direct, indirect, and total effects using Generalized Structural Equation Modeling (GSEM) and mediation analysis. p-value = 0.05 was considered statistically significant. The result of the mediation analysis was reported in Log Odds (LOD). The positive LOD (LOD > 0) implies a positive association. RESULTS Half of the mothers (50.8%) reported a neonatal illness and among them, only 36.5% mothers of sick neonates sought care from qualified providers. Our mediation analysis showed that maternal health utilization factors, i.e., 4 + antenatal care visits (ANC) from a qualified provider (LOD: 0.63, 95% CI: 0.49, 0.78), facility delivery (LOD: 0.74, 95% CI: 0.30, 1.17) and postnatal care (PNC) from a qualified provider (LOD: 0.50, 95% CI: 0.21, 0.78) showed the highest total effect over other factors domains, and therefore, were the most important modifiable predictors for qualified neonatal care-seeking. Other important factors that directly and/or indirectly increased the chance of newborn care-seeking from qualified providers were household wealth (LOD: 0.86, 95% CI: 0.70, 1.02), maternal education (LOD: 0.48, 95% CI: 0.32, 0.63), distance to nearest health facility (LOD: 0.20, 95% CI: 0.10, 0.30), community health worker's (CHWs) home visits during ANC (LOD: 0.24, 95% CI: 0.13, 0.36), neonatal danger sign counseling after delivery (LOD: 0.20, 95% CI: 0.06, 0.34) and women's knowledge of neonatal danger signs (LOD: 0.37, 95% CI: 0.09, 0.64). CONCLUSION The inter-relationship and highest summative effect of ANC, facility delivery, and PNC on newborn care-seeking suggested the maternal care continuum altogether from ANC to facility delivery and PNC to improve care-seeking for the sick newborn. Additionally, referral training for unqualified providers, targeted intervention for poorer households, increasing CHWs home visits and neonatal danger sign counseling at the facility and community should also be considered.
Collapse
Affiliation(s)
- Rashidul Azad
- International Centre for Diarrhoeal Disease Research, Bangladesh (Icddr,b), Dhaka, Bangladesh
| | - Sk Masum Billah
- International Centre for Diarrhoeal Disease Research, Bangladesh (Icddr,b), Dhaka, Bangladesh.,The University of Sydney School of Public Health, Sydney, NSW, Australia
| | | | - Nazia Binte Ali
- International Centre for Diarrhoeal Disease Research, Bangladesh (Icddr,b), Dhaka, Bangladesh.,Harvard T.H. Chan School of Public Health, Boston, United States
| | | | | | - Lyndsey Garg
- Save the Children, Washington, DC, United States
| | | | | | - S M Rokonuzzaman
- International Centre for Diarrhoeal Disease Research, Bangladesh (Icddr,b), Dhaka, Bangladesh
| | | | | | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Bangladesh (Icddr,b), Dhaka, Bangladesh
| |
Collapse
|
6
|
Ali NB, Priyanka SS, Bhui BR, Herrera S, Azad MR, Karim A, Shams Z, Rahman M, Rokonuzzaman SM, Meena USJ, El Arifeen S, Billah SM. Prevalence and factors associated with skin-to-skin contact (SSC) practice: findings from a population-based cross-sectional survey in 10 selected districts of Bangladesh. BMC Pregnancy Childbirth 2021; 21:709. [PMID: 34686143 PMCID: PMC8532372 DOI: 10.1186/s12884-021-04189-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Skin-to-skin contact (SSC) practice improves newborn survival and child development through preventing hypothermia in newborns, improving early initiation of breastfeeding practice, and strengthening mother-child bonding. Despite having numerous benefits, it is one of the least practiced interventions in low and middle-income countries (1 to 74%). In Bangladesh, the prevalence of SSC was 26% in 2014. In this study, we aimed to estimate the prevalence of SSC in the study districts and identify factors that facilitate or inhibit SSC practice so that context-specific recommendations can be made to advance the use of this intervention. METHODS We used baseline household survey data of USAID's MaMoni MNCSP project conducted in 10 districts of Bangladesh in 2019. Our analysis included 13,695 recently delivered women (RDW) with a live birth outcome. Our primary outcome was the mother's reported practice of SSC. We examined various antepartum, intrapartum, newborn, and sociodemographic factors associated with SSC using a multivariable generalized linear model. Our findings were reported using adjusted Prevalence Risk Ratios (aPRRs) and 95% Confidence Intervals (CIs). RESULTS Overall, 28% of RDW reported practicing SSC across the 10 surveyed districts. Our multivariable analysis showed that public facility delivery (aPRR 2.01; 95%CI: 1.80, 2.26), private facility delivery (aPRR 1.23; 95%CI: 1.06, 1.42) and ≥ 4 antenatal care (ANC) visits at least one from a medically trained provider (MTP) (aPRR 1.17; 95%CI: 1.03, 1.26) had a significant positive association with SSC practice. Caesarean section (aPRR 0.64; 95%CI: 0.56, 0.73) had a significant negative association with SSC practice compared to vaginal births. We also found a significant positive association of SSC practice with mothers' who perceived the birth size of their baby to be small, mothers with a higher education level (≥10 years), and mothers from households in the highest wealth quintile. CONCLUSIONS The prevalence of SSC is very low in the surveyed districts of Bangladesh. Considering the factors associated with SSC, relevant stakeholders need to increase their efforts on improving ANC and facility delivery coverages as well as improving SSC practice in the facilities especially after caesarean deliveries. Countries with a high burden of home deliveries, also need to emphasize community-based interventions and increasing coverage of skilled birth attendance for improving this life-saving intervention.
Collapse
Affiliation(s)
- Nazia Binte Ali
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
| | - Sabrina Sharmin Priyanka
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | - Md Rashidul Azad
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | - Mahmoodur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - S M Rokonuzzaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sk Masum Billah
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.,The University of Sydney School of Public Health, Sydney, NSW, 2006, Australia
| |
Collapse
|
7
|
Herrera S, Diaz-Coronado JC, Monsalve S, Guerra-Zarama S, Saavedra Chacón MF, Barbosa J, Serna Giraldo JD, Lopez JD, Gutiérrez JM, Vega T, Orozco D, Ocampo D, Zuluaga N, Hernandez-Parra D, Rojas-Gualdrón D, Pineda.Tamayo R. POS0749 ASSOCIATION BETWEEN IMMUNE-SEROLOGICAL PROFILE AND PULMONARY MANIFESTATIONS IN COLOMBIAN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS (LES). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Pulmonary involvement is common in Systemic Lupus Erythematosus (SLE) patients with varying degrees of parenchymal, vascular, and pleural compromise. In GLADEL, pulmonary involvement was reported in 28.4% of the cohort, but its occurrence ranges between 30-90% due to diversity in populations and the methods used to define it.Objectives:To describe the immune-serological profile of a Colombian cohort of SLE patients and to establish its association with pulmonary manifestations.Methods:Retrospective analysis of observational data from the follow-up of a cohort of adult patients with SLE. We included 559 patients that fulfilled the SLICC 2012 classification criteria with at least 6 months of disease history and being treated in a rheumatology specialized medical center between 2015 and 2018. The immuno-serological profile was characterized, and pulmonary involvement was monitored for 1 year. Diagnosis of pulmonary involvement was performed with the rheumatologist report in the clinical chart. Prevalence of pulmonary manifestations and immune-serological profile was determined, and logistic regression was performed afterward adjusted by age, sex, and level of education to establish the association between pulmonary manifestations and a positive auto-antibodies profile.Results:The median age of the cohort was 45 years, 96.5% were female. Pulmonary involvement was documented in 113 patients (20.5%) at the beginning of the study. Their frequency was: pleuritis (14.3%), lupus pneumonitis (3.6%), pulmonary hypertension (3.2%), interstitial lung disease (ILD) (2.3%), pulmonary embolism (2.3%), lung fibrosis (2.14%), alveolar hemorrhage (1.4%), shrinking lung (0.2%). At 1 year of follow up. there were no statistically significant differences in the frequency of pulmonary manifestations. As for the immune-serological profile, there were positive ANA in 92%, anti-dsDNA in 53.1%, anti-B2GP IgM 15.2%, anti- B2GP IgG in 17.2%, and ENA in 97.2%; as for the ENA 41.7% had positive anti-RNP, 40.2% anti-Ro, 36.4% anti-SM and 16.5% anti-La. Low complement levels was characterized as follows: C3 53.1% and C4 29.2%. In the logistic regression adjusted by age, sex and level of education, there was an association between anti-SM and pulmonary manifestations with an adjusted OR of 1.85; 95% CI 1.13-3.01.Conclusion:An association between anti-SM positivity and pleuro-pulmonary manifestations was found. In other cohorts with a greater size, anti-La and anti-RNP have been associated with pulmonary involvement (OR 2.51; 95% CI 1.39-4.57 and OR 1.32; 95% CI 1-1.75 respectively). Anti-RNP positivity has been associated in particular with ILD, pulmonary hypertension and shrinking lung. Although these manifestations prevalence was similar in our cohort, an association with this antibody was not found (OR 1.01, 95% CI: 0.2-4.9). This could be explained by the smaller sample size. As for anti-La positivity, its prevalence in our cohort was less than what was found in the GLADEL cohort (16.5% vs 24.3% respectively). It is possible that this could explain the poor association between anti-La positivity with the presence of pulmonary manifestations in our study compared with those of the GLADEL cohort. There are data that indicates that anti-SM and anti-RNP simultaneous positivity is related mainly to pleuritis OR 1.98 (95% CI: 1.31-3); and this kind of involvement was found to be more frequent in our study. Our results suggest an association between positive anti-SM and pulmonary manifestations in Colombian patients with SLE, pleuritis in particular.References:[1]Haye Salinas MJ, Caeiro F, Saurit V et al. Pleuropulmonary involvement in patients with systemic lupus erythematosus from a Latin American inception cohort (GLADEL). Lupus. 2017;26(13):1368–77.[2]Emad Y, Gheita T, Darweesh H, Klooster P, et al. Antibodies to extractable nuclear antigens (ENAS) in systemic lupus erythematosus patients: Correlations with clinical manifestations and disease activity. Reumatismo. 2018;70(2):85–91.Disclosure of Interests:None declared
Collapse
|
8
|
Herrera S, Diaz-Coronado JC, Monsalve S, Guerra-Zarama S, Saavedra Chacón MF, Barbosa J, Serna Giraldo JD, Lopez JD, Gutiérrez JM, Vega T, Orozco D, Ocampo D, Zuluaga N, Hernandez-Parra D, Rojas-Gualdrón D, Pineda.Tamayo R. AB0336 PULMONARY MANIFESTATIONS IN A COLOMBIAN COHORT OF PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Pulmonary manifestations are frequent in systemic lupus erythematosus (SLE) with a frequency of 30-90% that depends on the cohort and the methods used for their identification. The association of this compromise with mortality highlights its importance and the need for biomarkers to adequately predict this complication. We describe the prevalence of pulmonary manifestations, and the clinic and immunoserological characteristics of 551 Colombian patients with SLEObjectives:We performed an observational and analytic study of a retrospective cohort with adult SLE patients who fulfilled the 2012 SLICC classification criteria and that had a history of at least 6 months of the disease. These patients were treated in a specialized center of rheumatology with presence in six cities of Colombia between 2015 and 2018. We excluded pregnant patients and those with incomplete data for our survey. The first clinic consult occurred between 2015 and 2018, being defined as moment one. The follow up one year later was defined as moment two. We obtained 710 registries that were potentially eligible and analyzed 465 patients at moment two after applying the exclusion criteriaMethods:In 465 eligible patients, 20,5% had pulmonary compromise (93.8% female) with a median age of 42,4 years. The average SLICC Damage Index of 551 patients with SLE was 0,9 in women and 1.05 in men, while the average SDI of patients with pulmonary compromise was 1. The most frequent manifestation was pleural (14.3%), followed by Lupus pneumonitis (3.6%) and pulmonary hypertension (3.2%). Other manifestations and serological characteristics are recorded in Table 1. Of note, ANA homogeneous pattern was the most common (34.5%), anti-RNP positivity was 41.7%, anti-dsDNA positivity was 53.1% and 53.1% had hypocomplementemia.Results:The prevalence of pulmonary manifestations in our cohort was 20,5%, which is lower that in the previous described GLADEL cohort (28,4%). This could be explained by the regional differences of ethnicities in Latin America and in immune-serological profiles. Anti-RNP positivity was frequent (41.7%) and new pulmonary compromise for one year follow-up was rare. Of not, the mean damage index for our patients with pulmonary manifestations was 1, this could highlight the importance of this organ as a causa of higher damage accrual and mortality, which we will explore in the futureConclusion:The prevalence of pulmonary manifestations in our cohort was 20,5%, which is lower that in the previous described GLADEL cohort (28,4%). This could be explained by the regional differences of ethnicities in Latin America and in immune-serological profiles. Anti-RNP positivity was frequent (41.7%) and new pulmonary compromise for one year follow-up was rare. Of not, the mean damage index for our patients with pulmonary manifestations was 1, this could highlight the importance of this organ as a causa of higher damage accrual and mortality, which we will explore in the futureReferences:[1]G. Aguilera-Pickens, C. Abud-Mendoza. Pulmonary Manifestations in Systemic Lupus Erythematosus: Pleural Involvement, Acute Pneumonitis, Chronic Interstitial Lung Disease and Diffuse Alveolar Hemorrhage. Reumatol Clin. 2018;14(5):294–300.[2]Haye Salinas MJ, Caeiro F, Saurit V. Pleuropulmonary involvement in patients with systemic lupus erythematosus from a Latin American inception cohort (GLADEL). Lupus (2017) 0, 1–10.[3]Santamaria-Alza Y, Sanchez-Bautista J, Fajardo-Rivero J. Acute respiratory involvement in Colombian patients with systemic lupus erythematosus undergoing chest computed tomography. Int J Rheum Dis. 2019;00:1–7.Table 1.clinical and immunoserological characteristicsn%Women10693,8Global mortality468,3Pulmonary compromise mortality87,1ANA10492Anti-DNA6053,1ENAS97,2Ro35/8740,2La14/8516,5SM32/8836,4RNP35/8441,7Follow up 1 %Follow up 2 %P Value *Pulmonary hypertension3,22,80,28Pulmonary fibrosis2,142,61Shrunken lung0,20,21Pleuritis14,315,050,42Lupus pneumonitis3,63,010,85Alveolar hemorrhage1,41,30,76Pulmonary embolism2,31,930,72Disclosure of Interests:None declared
Collapse
|
9
|
Herrera S, Marenco Maldonado J, Diaz-Coronado JC, Rojas-Gualdrón D, Hernandez-Parra D, Pineda.Tamayo R. AB0351 PROGRESSION TO SEVERE LUPUS NEPHRITIS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOUS: UPDATE FROM A COLOMBIAN COHORT. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.4284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Continuous monitoring of patients with Systemic lupus erythematosus (SLE) provides relevant informationObjectives:To update the analysis of clinical and immunological characteristics associated with time to severe renal involvement in patients with Systemic Lupus Erythematous in a Colombian cohort followed from January 2015 to October 2020Methods:A retrospective follow-up study based on clinical records. Patients with SLE diagnosis fulfilled either 1987 American College of Rheumatology Classification Criteria for SLE or 2011 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for SLE. We included patients with the diagnosis of lupus nephritis according to Wallace and Dubois criteria. Patients who did not have at least two follow-up measurements or had a cause of nephritis other than lupus were excluded. The primary outcome was defined as the time from diagnosis to severe renal involvement defined as creatinine clearance ≤50ml/min, 24-hour proteinuria ≥3.5 grams o end-stage renal disease. Updated age and sex-adjusted survival functions and Hazard ratios (HR) with 95% confidence intervals and p-values were estimated using parametric Weibull models for interval-censored data. P values <0.05 were considered statistically significant. Descriptive statistics were previously reported in EULAR 2020 (1)Results:548 patients were analyzed: 67 were left-censored as they presented renal involvement at entry, 25 were interval censored as outcome occurred between study visits (19 new events), and 456 were right-censored as involvement was not registered during follow-up. In this cohort update Age and sex-adjusted Hazard Ratios for high blood pressure were HR = 3.1 (95%CI 1.5-6.3; p-value = 0.003) and Anti-RO (per unit increase) HR = 1.003 (95%CI 1.001-1.005; p-value = 0.029). Figure 1 shows the updated age and sex-adjusted survival functionConclusion:In this cohort update, we found similar clinical and immunological characteristics associated with time to severe renal involvement in SLE patients to those reported in (1). However, continuous follow-up allows us to deepen our understanding of the progression to severe renal involvement in SLE patientsReferences:[1]Herrera S, Diaz-Coronado JC, Rojas-Gualdrón D, Betancur-Vasquez L, Gonzalez-Hurtado D, Gonzalez-Arango J, et al. SAT0210 factors associated with time to severe lupus nephritis in a cohort of colombian patients. Ann Rheum Dis. junio de 2020;79(Suppl 1):1048.2-1048Disclosure of Interests:None declared
Collapse
|
10
|
Herrera S, Diaz-Coronado JC, Monsalve S, Guerra-Zarama S, Saavedra Chacón MF, Barbosa J, Serna Giraldo JD, Lopez JD, Gutiérrez JM, Vega T, Orozco D, Ocampo D, Zuluaga N, Hernandez-Parra D, Rojas-Gualdrón D, Pineda.Tamayo R. AB0335 SURVIVAL ASSESSMENT IN PATIENTS WITH SLE AND PULMONARY MANIFESTATIONS IN A COLOMBIAN COHORT WITH 2-YEAR FOLLOW-UP. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease with heterogenous and variable behavior. The frequency of pulmonary involvement ranges from 10-90%, with this variability in occurrence attributed to differences in populations and heterogeneity in detection methods and study designs.Objectives:To analyze survival in patients with SLE and the presence of pulmonary manifestations according to clinical and demographic characteristics in a cohort of patients in ColombiaMethods:Observational-analytical, retrospective, follow-up study of a cohort of adult patients with SLE. We included 559 adult patients who fulfilled the 2012 SLICC SLE classification criteria and with at least 6 months of disease evolution, treated in a medical center specialized in rheumatology with locations in 6 cities in Colombia between 2015 and 2018. Pregnant patients and those who had incomplete data or visits were excluded. Immunoserological profile was characterized and pulmonary involvement was followed for 1 year. The diagnosis of pulmonary involvement was obtained from the rheumatology report in the clinical chart. The prevalence of pulmonary manifestations and the immunoserological profile were determined and subsequently a logistic regression adjusted for age, sex and level of education was performed to establish the association between pulmonary manifestations and a positive autoantibody profileResults:Median age was 44.5 ± 14 years, 96.6% were women. In patients with pulmonary compromise 9.7% were smokers, 12.4% had an active alcohol intake, 58.4% had a low socioeconomic status, 38.1% medium and 4.7% high. Pulmonary involvement was present in 20% of patients, the most common manifestations were pleuritis (14.3%), lupus pneumonitis (3.6%), pulmonary hypertension (3.2%), interstitial lung disease (2.3%), pulmonary embolism (2.3%), pulmonary fibrosis (2.14%), alveolar hemorrhage (1.4%), shrinking lung (0.2%). there was no significant difference in the follow up at one year. Immunoserological characteristics shows ANA positivity in 92%, anti-DNA in 53%, ENAS in 97%, with anti-RNP being the most common (41.7%), and low complement levels in 53%. Mortality for pulmonary compromise was 1.4%, and survival at 2 years did not have a statistically significant difference (p=0.155)Conclusion:Survival was not found to be lower in patients with SLE and pulmonary involvement (p=0.155) when compared to SLE patients without pulmonary involvement after 2-year follow-up. This finding was independent of age, gender, and educational level. Previous large cohorts like GLADEL and RELESSER describe an association between pulmonary involvement and lower survival HR 2,79 (95% CI: 1,80-4,31), p <0,001 and HR 3.13, (95% IC: 1.56– 6.28, P = 0.00 respectively. In the RELESSER cohort pleural involvement and pulmonary embolism was found to have low to minimal impact on survival.In our cohort pleuritis was the most common finding whereas the other pulmonary manifestations were reported in less than 4% of patients. This difference could explain our differences with other cohorts. Other causes for this difference are a smaller sample size and a short follow-up.The results of our study do not suggest that there is an association between pulmonary involvement and mortality in Colombian patients with SLE during a 2-year follow-up. We will continue to monitor and report in this regardReferences:[1]Narváez J, Borrell H, Sánchez-Alonso F, Rúa-Figueroa I, López-Longo FJ, Galindo-Izquierdo M, et al. Primary respiratory disease in patients with systemic lupus erythematosus. (RELESSER) cohort. Arthritis Res Ther. 2018;20(1):1–10.[2]Keane MP, Lynch JP. Pleuropulmonary manifestations of systemic lupus erythematosus. Vol. 55, Thorax. Thorax; 2000. p. 159–66.[3]Haye Salinas MJ, Caeiro F, Saurit V, Alvarellos A, Wojdyla D, Scherbarth HR, et al. Pleuropulmonary involvement in patients with systemic lupus erythematosus from a Latin American inception cohort (GLADEL). Lupus. 2017;26(13):1368–77Disclosure of Interests:None declared
Collapse
|
11
|
Fifer KM, Small K, Herrera S, Liu YD, Peccoralo L. A Novel Approach to Depression Care: Efficacy of an Adapted Interpersonal Therapy in a Large, Urban Primary Care Setting. Psychiatr Q 2021; 92:63-72. [PMID: 32449131 DOI: 10.1007/s11126-020-09750-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The Collaborative Care Model (CoCM), in which social workers, primary care physicians, and a consulting psychiatrist work as a team, is an established approach to the treatment of common mental health conditions in primary care settings. Following implementation of a CoCM depression care program at our hospital-based academic primary care practice, we observed a low rate of retention with the use of problem solving therapy/behavioral activation (PST/BA). Our aim in this study was to evaluate the effectiveness of interpersonal psychotherapy (IPT), an evidence-based, flexible strategy that focuses on the relationship between depression and interpersonal challenges, compared to PST/BA. In 2015, most patients enrolled in our CoCM received PST/BA. In 2016, most patients received IPT. Patients who were enrolled and discharged from our CoCM depression care program in the years 2015 and 2016 and received either PST/BA or IPT, were included. Our primary measure was the difference in change in PHQ-9 score between the PST/BA and the IPT groups. Secondary outcomes included the difference in the change in GAD-7 score and measures of glycemic and blood pressure control between the two groups. Two hundred thirty four patients were included in our analysis. One hundred sixty five received PST/BA and 69 received IPT. There was no difference between groups in baseline demographics or measures of depression, anxiety, presence of hypertension, or presence of prediabetes/diabetes. Our primary analysis demonstrated a greater decrease in PHQ-9 score in patients receiving IPT (9.93) compared to those receiving PST/BA (5.41) (p < 0.0001). The proportion of patients achieving a clinical response (PHQ-9 < 10) was also greater in the IPT group (71%) compared to the PST/BA group (44%). In a CoCM depression care program, IPT was a more effective strategy in improving depression symptoms as measured by PHQ-9 scores than PST/BA.
Collapse
Affiliation(s)
- Kenneth M Fifer
- Icahn School of Medicine at Mount Sinai Department of Medicine, The Mount Sinai Hospital, New York, NY, USA.
| | - Katherine Small
- Icahn School of Medicine at Mount Sinai Department of Medicine, The Mount Sinai Hospital, New York, NY, USA
| | - Samantha Herrera
- Icahn School of Medicine at Mount Sinai Department of Social Work, The Mount Sinai Hospital, New York, NY, USA
| | - Yang Doris Liu
- Icahn School of Medicine at Mount Sinai Department of Medicine, The Mount Sinai Hospital, New York, NY, USA
| | - Lauren Peccoralo
- Icahn School of Medicine at Mount Sinai Department of Medicine, The Mount Sinai Hospital, New York, NY, USA
| |
Collapse
|
12
|
Goren A, Wambier CG, McCoy J, Shapiro J, Vaño-Galván S, Herrera S, Glode LM. Clock genes may drive seasonal variation in SARS-CoV-2 infectivity: are we due for a second wave of COVID-19 in the fall? J BIOL REG HOMEOS AG 2020; 34:1455-1457. [PMID: 32700513 DOI: 10.23812/20-359-l-35] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A Goren
- Applied Biology, Inc. Irvine, CA, United States
| | - C G Wambier
- Department of Dermatology, Alpert Medical School of Brown University, Providence, RI, United States
| | - J McCoy
- Applied Biology, Inc. Irvine, CA, United States
| | - J Shapiro
- Ronald O. Perelman Department of Dermatology at the New York University School of Medicine, NY, USA
| | - S Vaño-Galván
- Dermatology Department, Ramón y Cajal Hospital, Madrid, Spain
| | - S Herrera
- Infectious Diseases Unit, Ramón y Cajal Hospital, Madrid, Spain
| | - L M Glode
- University of Colorado Cancer Center, Golden, CO., USA
| |
Collapse
|
13
|
McCoy J, Cadegiani FA, Wambier CG, Herrera S, Vaño-Galván S, Mesinkovska NA, Ramos PM, Shapiro J, Sinclair R, Tosti A, Goren A. 5-alpha-reductase inhibitors are associated with reduced frequency of COVID-19 symptoms in males with androgenetic alopecia. J Eur Acad Dermatol Venereol 2020; 35:e243-e246. [PMID: 33135263 DOI: 10.1111/jdv.17021] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J McCoy
- Applied Biology, Inc., Irvine, CA, USA
| | - F A Cadegiani
- Department of Clinical Endocrinology, Federal University of São Paulo Medical School, Sao Paulo, Brazil
| | - C G Wambier
- Department of Dermatology, Alpert Medical School of Brown University, Providence, RI, USA
| | - S Herrera
- Infectious Diseases Unit, Ramón y Cajal Hospital, Madrid, Spain
| | - S Vaño-Galván
- Dermatology Department, Ramón y Cajal Hospital, Madrid, Spain
| | - N A Mesinkovska
- Department of Dermatology, University of Claifornia, Irvine, CA, USA
| | - P M Ramos
- Department of Dermatology, São Paulo State University - UNESP, São Paulo, Brazil
| | - J Shapiro
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
| | - R Sinclair
- Sinclair Dermatology, Melbourne, Vic., Australia
| | - A Tosti
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - A Goren
- Applied Biology, Inc., Irvine, CA, USA
| |
Collapse
|
14
|
Vaz LME, Franco L, Guenther T, Simmons K, Herrera S, Wall SN. Operationalising health systems thinking: a pathway to high effective coverage. Health Res Policy Syst 2020; 18:132. [PMID: 33143734 PMCID: PMC7641804 DOI: 10.1186/s12961-020-00615-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 08/03/2020] [Indexed: 01/25/2023] Open
Abstract
Background The global health community has recognised the importance of defining and measuring the effective coverage of health interventions and their implementation strength to monitor progress towards global mortality and morbidity targets. Existing health system models and frameworks guide thinking around these measurement areas; however, they fall short of adequately capturing the dynamic and multi-level relationships between different components of the health system. These relationships must be articulated for measurement and managed to effectively deliver health interventions of sufficient quality to achieve health impacts. Save the Children’s Saving Newborn Lives programme and EnCompass LLC, its evaluation partner, developed and applied the Pathway to High Effective Coverage as a health systems thinking framework (hereafter referred to as the Pathway) in its strategic planning, monitoring and evaluation. Methods We used an iterative approach to develop, test and refine thinking around the Pathway. The initial framework was developed based on existing literature, then shared and vetted during consultations with global health thought leaders in maternal and newborn health. Results The Pathway is a robust health systems thinking framework that unpacks system, policy and point of intervention delivery factors, thus encouraging specific actions to address gaps in implementation and facilitate the achievement of high effective coverage. The Pathway includes six main components – (1) national readiness; (2) system structures; (3) management capacity; (4) implementation strength; (5) effective coverage; and (6) impact. Each component is comprised of specific elements reflecting the range of facility-, community- and home-based interventions. We describe applications of the Pathway and results for in-country strategic planning, monitoring of progress and implementation strength, and evaluation. Conclusions The Pathway provides a cohesive health systems thinking framework that facilitates assessment and coordinated action to achieve high coverage and impact. Experiences of its application show its utility in guiding strategic planning and in more comprehensive and effective monitoring and evaluation as well as its potential adaptability for use in other health areas and sectors.
Collapse
Affiliation(s)
- Lara M E Vaz
- Population Reference Bureau, 1875 Connecticut Avenue, NW Suite 520, Washington, DC, 20009, United States of America.
| | - Lynne Franco
- EnCompass LLC, 1451 Rockville Pike Suite 600, Rockville, MD, 20852, USA
| | - Tanya Guenther
- Formerly with Save the Children US, 899 North Capitol St NE Suite 900, Washington DC, 20001, USA
| | - Kelsey Simmons
- Ford Foundation, 320 E 43rd St, New York, NY, 10017, USA
| | - Samantha Herrera
- Save the Children US, 899 North Capitol St NE Suite 900, Washington DC, 20001, USA
| | - Stephen N Wall
- Save the Children US, 899 North Capitol St NE Suite 900, Washington DC, 20001, USA
| |
Collapse
|
15
|
Goren A, Wambier CG, Herrera S, McCoy J, Vaño-Galván S, Gioia F, Comeche B, Ron R, Serrano-Villar S, Ramos PM, Cadegiani FA, Kovacevic M, Tosti A, Shapiro J, Sinclair R. Anti-androgens may protect against severe COVID-19 outcomes: results from a prospective cohort study of 77 hospitalized men. J Eur Acad Dermatol Venereol 2020; 35:e13-e15. [PMID: 32977363 PMCID: PMC7536996 DOI: 10.1111/jdv.16953] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 11/30/2022]
Affiliation(s)
- A Goren
- Applied Biology, Inc., Irvine, CA, USA
| | - C G Wambier
- Department of Dermatology, Alpert Medical School of Brown University, Providence, RI, USA
| | - S Herrera
- Infectious Diseases Unit, Ramón y Cajal Hospital, Madrid, Spain
| | - J McCoy
- Applied Biology, Inc., Irvine, CA, USA
| | - S Vaño-Galván
- Dermatology Department, Ramón y Cajal Hospital, Madrid, Spain
| | - F Gioia
- Infectious Diseases Unit, Ramón y Cajal Hospital, Madrid, Spain
| | - B Comeche
- Infectious Diseases Unit, Ramón y Cajal Hospital, Madrid, Spain
| | - R Ron
- Infectious Diseases Unit, Ramón y Cajal Hospital, Madrid, Spain
| | | | - P M Ramos
- Department of Dermatology, São Paulo State University, Botucatu, Brazil
| | - F A Cadegiani
- Department of Clinical Endocrinology, Federal University of São Paulo Medical School, Sao Paulo, Brazil
| | - M Kovacevic
- Department of Dermatology and Venereology, Hospital Sestre Milosrdnice, Zagreb, Croatia
| | - A Tosti
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - J Shapiro
- Ronald O. Perelman Department of Dermatology at the New York University School of Medicine, New York, NY, USA
| | - R Sinclair
- Sinclair Dermatology, Melbourne, VIC, Australia
| |
Collapse
|
16
|
McCoy J, Wambier CG, Herrera S, Vaño-Galván S, Gioia F, Comeche B, Ron R, Serrano-Villar S, Iwasiow RM, Tayeb MA, Cadegiani FA, Mesinkovska NA, Shapiro J, Sinclair R, Goren A. Androgen receptor genetic variant predicts COVID-19 disease severity: a prospective longitudinal study of hospitalized COVID-19 male patients. J Eur Acad Dermatol Venereol 2020; 35:e15-e17. [PMID: 32977355 PMCID: PMC7536899 DOI: 10.1111/jdv.16956] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- J McCoy
- Applied Biology, Inc., Irvine, CA, USA
| | - C G Wambier
- Department of Dermatology, Alpert Medical School of Brown University, Providence, RI, USA
| | - S Herrera
- Infectious Diseases Unit, Ramón y Cajal Hospital, Madrid, Spain
| | - S Vaño-Galván
- Dermatology Department, Ramón y Cajal Hospital, Madrid, Spain
| | - F Gioia
- Infectious Diseases Unit, Ramón y Cajal Hospital, Madrid, Spain
| | - B Comeche
- Infectious Diseases Unit, Ramón y Cajal Hospital, Madrid, Spain
| | - R Ron
- Infectious Diseases Unit, Ramón y Cajal Hospital, Madrid, Spain
| | | | | | - M A Tayeb
- DNA Genotek Inc., Ottawa, ON, Canada
| | - F A Cadegiani
- Department of Clinical Endocrinology, Federal University of São Paulo Medical School, Sao Paulo, Brazil
| | - N A Mesinkovska
- Department of Dermatology, University of Claifornia, Irvine, CA, USA
| | - J Shapiro
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, NY, USA
| | - R Sinclair
- Sinclair Dermatology, Melbourne, VIC, Australia
| | - A Goren
- Applied Biology, Inc., Irvine, CA, USA
| |
Collapse
|
17
|
Herrera S, Diaz-Coronado JC, Rojas-Gualdrón D, Betancur-Vasquez L, Gonzalez-Hurtado D, Gonzalez-Arango J, Uribe-Arango L, Saavedra Chacón MF, Lacouture-Fierro J, Monsalve S, Guerra-Zarama S, Lopez JD, Serna JD, Barbosa J, Sierra A, Hernandez-Parra D, Pineda-Tamayo R. SAT0210 FACTORS ASSOCIATED WITH TIME TO SEVERE LUPUS NEPHRITIS IN A COHORT OF COLOMBIAN PATIENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Systemic lupus erythematosus (SLE) clinical manifestations, and their severity, vary according to age, ethnicity and socioeconomic status. Both Hispanic and Afro-Americans have a higher incidence and more sever presentation when compared to Caucasian patients with SLEObjectives:To analyze clinical and immunological characteristics associated with time to severe renal involvement in patients with Systemic Lupus Erythematous in a Colombian cohort followed for one year, between January 2015 and December 2018Methods:Retrospective follow-up study based in clinical records. Patients with SLE diagnosis that fulfilled either 1987 American College of Rheumatology Classification Criteria for SLE or 2011 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for SLE. We included patients with diagnosis of lupus nephritis according to Wallace and Dubois criteria. Patients who did not have at least two follow-up measurements or had a cause of nephritis other than lupus were excluded. The main outcome was defined as time from diagnosis to sever renal involvement defined as creatinine clearance ≤50 ml/min, 24-hour proteinuria ≥3.5 grams o end stage renal disease.We analyzed clinical and immunological characteristics. Descriptive statistical analyses of participant data during the first evaluation are reported as frequencies and percentages for categorical variables, and as medians and interquartile ranges (IQR) for quantitative variables. Age and sex adjusted survival functions and Hazard ratios (HR) with 95% confidence intervals and p-values were estimated using parametric Weibull models por interval-censored data. P values < 0.05 were considered statistically significantResults:548 patients were analyzed: 67 were left-censored as they presented renal involvement at entry, 6 were interval censored as outcome occurred between study visits, and 475 were right-censored as involvement was not registered during follow-up. 529 (96.5%) patients were female, median age at entry was 46 (IQR = 23) and median age to diagnosis was 29.5 (IQR = 20.6). 67% were mestizo, 13% Caucasian and 0.3% Afro-Colombian. Age and sex adjusted variables associated with time to severe lupus nephritis were high blood pressure HR = 3.5 (95%CI 2.2-5.6; p-value <0.001) and Anti-RO (per unit increase) HR = 1.002 (95%CI 1.001-1.004; p-value = 0.04). Figure 1 shows age and sex adjusted survival function.Conclusion:In our cohort the appearance of severe lupus nephritis occurs in less than 15% of patients at 10 years. Both high blood pressure and elevated anti-Ro titers were associated with a higher rate of onset in the presentation of severe lupus nephritis, as seen in some polymorphs of anti Ro.References:Disclosure of Interests:Sebastian Herrera Speakers bureau: academic conference, Juan camilo Diaz-Coronado: None declared, Diego Rojas-Gualdrón: None declared, Laura Betancur-Vasquez: None declared, Daniel Gonzalez-Hurtado: None declared, Juanita Gonzalez-Arango: None declared, laura Uribe-Arango: None declared, Maria Fernanda Saavedra Chacón: None declared, Jorge Lacouture-Fierro: None declared, Santiago Monsalve: None declared, Sebastian Guerra-Zarama: None declared, Juan david Lopez: None declared, Juan david Serna: None declared, Julian Barbosa: None declared, Ana Sierra: None declared, Deicy Hernandez-Parra: None declared, Ricardo Pineda.Tamayo: None declared
Collapse
|
18
|
Herrera S, Diaz-Coronado JC, Hernandez-Parra D, Durango-Durango Y, Perez-Rios C, Posada-Velásquez M, Rojas-Londoño J, Vallejo-Patiño M, Marín K, Guerrero-Calderón C, Jaramillo S, Usuga-Graciano V, López-Flórez MI, Restrepo-Raigosa C, Restrepo-Hincapié JP, Carvajal-Naranjo C, Restrepo-Upegui S, Pineda Tamayo R. THU0269 CLINICAL COMPARISON OF NEW CRITERIA FOR SYSTEMIC LUPUS ERYTHEMATOSUS IN A COLOMBIAN COHORT. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Due to heterogeneity of the disease, there has been several classification criteria for Systemic Lupus Erythematosus (SLE). These have considered the knowledge obtained through the years and have strived for increased sensibility and specificity. Recently, both EULAR and ACR have proposed new criteria for disease classification that mandate a positive ANA result to apply the criteria.Objectives:To compare the 2019 EULAR/ACR classification criteria (1) with the Systemic Lupus International Collaborating Clinics (SLICC) 2012 classification criteria (2) and the American College of Rheumatology (ACR) 1997 classification criteria in a Colombian cohort (3).Methods:A cross-section retrospective study was done with data collected between 2014 and 2018 from a population diagnosed with SLE by a group of rheumatology in an autoimmunity referral centre and followed for one year. The new 2019 EULAR/ACR classification criteria were applied to the information collected from the clinical records. Three sets of criteria were compared using Cohen´s kappa coefficient and concordance was evaluatedResults:We obtained information for 480 patients, in this analysis were mostly females (96%). Anti-nuclear antibody (ANA) results were available for 95% of the patients. According to SLICC classification criteria the diagnosis of SLE was definite in 92% of patients, 81% by ACR 1997 and 89% using ACR/EULAR 2019. The sensibility was 93% and 97% for ACR/EULAR 2019 and SLICC 2012, and the specificity was 67% and 48% respectively. The concordance analysis between the two sets of criteria showed agreement of 92% (kappa 0.52 p <0.001) in the whole group.Conclusion:We found good agreement between SLICC 2012 criteria and EULAR/ACR 2019 classification criteria. In contrast with previous studies, where the new criteria had a sensitivity of 96.1% and specificity of 93.4%, in our cohort the sensitivity was maintained in 93% but the specificity decreased to 67%. A possible explanation could be the ANA negativity that was seen in 5% of the patients and would force to discard patients with false negative results. Despite this, the agreement of the criteria is good and should continue to be applied in our population, without abandoning the expert’s clinical criteria.References:[1]Aringer M, Costenbader K, Daikh D, et al. 2019 European League against Rheumatism/American College of rheumatology classification criteria for systemic lupus erythematosus. Ann Rheum Dis2019;78:1151–9[2]Petri M, Orbai A-M, Alarcón GS, et al. Derivation and validation of the systemic lupus international collaborating clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum2012;64:2677–86.[3]Hochberg MC. Updating the American College of rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum1997;40:1725.Disclosure of Interests:Sebastian Herrera Speakers bureau: academic conference, Juan camilo Diaz-Coronado: None declared, Deicy Hernandez-Parra: None declared, Yecenia Durango-Durango: None declared, Carolina Perez-Rios: None declared, Marcela Posada-Velásquez: None declared, Jennifer Rojas-Londoño: None declared, Manuela Vallejo-Patiño: None declared, Katherine Marín: None declared, Carlos Guerrero-Calderón: None declared, Sara jaramillo: None declared, Veronica Usuga-Graciano: None declared, Martha Isabel López-Flórez: None declared, Camilo Restrepo-Raigosa: None declared, Juan Pablo Restrepo-Hincapié: None declared, Catalina Carvajal-Naranjo: None declared, Sarita Restrepo-Upegui: None declared, Ricardo Pineda.Tamayo: None declared
Collapse
|
19
|
Magallares López BP, Park H, Cerda D, Betancourt J, Fraga G, Boronat S, Gich I, Marín AM, Herrera S, Malouf J, Casademont J, García-Guillén A, Corominas H. AB0997 IS HEIGHT ADJUSTMENT NECESSARY IN PEDIATRIC DENSITOMETRY IN ALL CHILDREN? Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:The current guidelines of the International Society for Clinical Densitometry (1) recommend that in children with linear growth or maturational delay, Z score results should be adjusted. Height for age Z score (HAZ) adjustment is valid and can be calculated using the formula the formula proposed by Zemmel et al(2).It is possible that pediatric populations without linear growth or maturational delay, also benefit from HAZ, to prevent bone size from influencing the final Z score.Objectives:To evaluate Z score variability adjusted and without adjusting for height for age.Methods:We analysed data from densitometry performed on patients 2-20 years of age, from 2016 to 2018, assessed in the pediatric rheumatology office of our hospital for presenting risk factors for low bone mass/osteoporosis. The HAZ was calculated according to Zemel’s formula.Results:Data from 103 patients are presented. Its characteristics are summarized in Table 1Table 1.Mean age9,8 yearsFemale52,4%Height Percentil ≤ 36,8%Height Percentil ≥ 974,9%LBM (Z score ≤ -2) spine8,2%LBM HAZ spine6,4%LBM whole body10,5%LBM HAZ whole body7,2%The table shows that the proportion of patients with BMD decreases in both the spine region and the whole body when adjusting for HAZ.When evaluating the relationship between densitometric measurements we found that spine Z score (ZsS) and whole body Z score (ZsWB) had a correlation coefficient of 0,73 (p<0,001). There were no differences between their averages (p=0,170).At the LBM cut-off point (Z score ≤ -2) there were discrepancies in 7%, where 5% presented LBM in ZsWB but not in ZsS. The concordance index at this point was 0,557.When comparing these measures with their HAZ adjusted equivalents, we observe:HAZ adjusted ZsS vs ZsS without adjusting: There were no differences between their averages (p=0,913) with a correlation coefficient of 0,78 (p<0,001). Concordance index at cut-off point for LBM was 0,498, with a discrepancy of7%, where2%had LBM according to HAZ adjusted ZsS, but not to ZsS without adjusting.HAZ adjusted ZsWB vs ZsWB without adjusting: There were no differences between their averages (p=0, 367) with a correlation coefficient of 0,82 (p<0,001). Concordance index at cut-off point for LBM was 0,557, with a discrepancy of7%, where2%had LBM according to HAZ adjusted ZsWB, but not to ZsWB without adjusting.Conclusion:There are discrepancies at the LBM cut-off point depending on the HAZ adjustment.The pediatric population without linear growth or maturational delay, can also benefit from HAZ adjustment, especially those with high height percentiles in which their size can hide a diagnosis of LBM.References:[1]Weber DR, Boyce A, Gordon C, Hogler W, Kecskemethy HH, Misra M, et al. The Utility of DXA Assessment at the Forearm, Proximal Femur, and Lateral Distal Femur, and Vertebral Fracture Assessment in the Pediatric Population: 2019 ISCD Official Position. Journal of clinical densitometry: the official journal of the International Society for Clinical Densitometry. 2019;22(4):567-89.[2]Zemel BS, Leonard MB, Kelly A, Lappe JM, Gilsanz V, Oberfield S, et al. Height adjustment in assessing dual energy x-ray absorptiometry measurements of bone mass and density in children. The Journal of clinical endocrinology and metabolism. 2010;95(3):1265-73.Disclosure of Interests:None declared
Collapse
|
20
|
Diaz-Coronado JC, Herrera S, Hernandez-Parra D, Betancur-Vasquez L, Gonzalez-Hurtado D, Gonzalez-Arango J, Uribe-Arango L, Saavedra Chacón MF, Lacouture-Fierro J, Guerra-Zarama S, Monsalve S, Serna Giraldo JD, Serna JD, Barbosa J, Pineda Tamayo R. SAT0463 SEVERE OSTEOPOROSIS IN COLOMBIAN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Osteoporosis predominantly affects post-menopausal women. There is an important percentage of the population that have additional risk factors that decrease bone mineral density. Patients with Systemic Lupus Erythematosus (SLE) have an increased risk for osteoporosis due to corticosteroid use and chronic inflammation. This population could have a higher prevalence of osteoporosis when compared to post-menopausal women of equal or older age. There is a paucity of information regarding bone mineral density and SLE in Latin America.Objectives:To describe the prevalence and incidence of osteoporosis and osteoporotic fractures in a Colombian population with Systemic Lupus ErythematosusMethods:We collected 464 clinical records of patients who met either the American College of Rheumatology 1997 or Systemic Lupus International Collaborating Clinics (SLICC) 2012 classification criteria for systemic lupus erythematosus between January 2015 and June 2019. The clinical and immunoserological characteristics, and damage accrual were monitored for one year. The diagnosis of osteoporosis was confirmed with densitometry by energy x-ray absorptiometry (DXA) and the presence of fragility fractures according to the rheumatologist’s report in the clinical history. The description of proportions and incidence rate of osteoporosis and fragility fracture is performed.Results:The mean age was 45 years, 96.5% were women and the mean disease duration was 12 years. Others clinical characteristics in table 1. The prevalence of osteoporosis was 13.8% with an incidence of 1.1 fractures / 100 person-months in the general population with SLE. In postmenopausal women, over 50 years the prevalence of osteoporosis was 28.4% with an incidence of 0.8 fractures / 100 months person. In the densitometric characteristics, the mean bone mineral density was 0.772 gr / cm2, T-score spine -2.9 and T-score femoral -2.6. SLEDAI mean 1.5 (SD 2.92) and SLICC mean 1.Table 1.clinical characteristicsn%Active Smoking8317.9Premature gonadal failure81.7Lupic Nephritis17838.4Proteinuria >2.5grams/24hours347.3End Stage Renal Disease163.4Anti-dsDNA14631.4Anti-Sm11023.7Anti-Ro13829.7Prednisone Cumulative Dose2.8grAntimalarial5712Conclusion:Low bone mineral density and severe osteoporosis are prevalent in our cohort with SLE. We have found a fracture rate of 1080 per 100.000 people, which is well over what has been reported in the general population (53-443 per 100.000 people in women). Osteoporotic fractures are part of damage accrual and thus have an association with morbidity and mortality. Data regarding osteoporotic fractures are necessary in order to develop guidance and health policy in the region. SLE is an important risk factor for severe osteoporosis and must be kept in mind when developing guidance and health policyReferences:[1]Jumei Xia, Ran Luo, Shuiming Guo, et al. Prevalence and Risk Factors of Reduced Bone Mineral Density in Systemic Lupus Erythematosus Patients: A Meta-Analysis. BioMed Research International. Volume 2019, Article ID 3731648, 10 pages.[2]Irene E.M. Bultinka, Willem F. Lemsa. Lupus and fractures. Curr Opin Rheumatol 2016, 28:426–432.Disclosure of Interests:Juan camilo Diaz-Coronado: None declared, Sebastian Herrera Speakers bureau: academic conference, Deicy Hernandez-Parra: None declared, Laura Betancur-Vasquez: None declared, Daniel Gonzalez-Hurtado: None declared, Juanita Gonzalez-Arango: None declared, laura Uribe-Arango: None declared, Maria Fernanda Saavedra Chacón: None declared, Jorge Lacouture-Fierro: None declared, Sebastian Guerra-Zarama: None declared, Santiago Monsalve: None declared, Jose David Serna Giraldo: None declared, Juan david Serna: None declared, Julian Barbosa: None declared, Ricardo Pineda.Tamayo: None declared
Collapse
|
21
|
Magallares López BP, Park H, Cerda D, Betancourt J, Fraga G, Boronat S, Herrera S, Marín AM, Gich I, Malouf J, Casademont J, García-Guillén A, Corominas H. AB0998 TRABECULAR BONE SCORE IN PEDIATRICS, IS IT USEFUL? Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Bone fragility depends not only on bone mineral density (BMD), but also on bone microarchitecture. In adults, Trabecular Bone Score (TBS) is being used as an indirect marker of bone microarchitectureIt is a software that applicated to the vertebral image obtained by conventional densitometry, informs about the thickness of the trabeculae, the trabecular connectivity and the space between them. A high score indicates a better bone microstructure. In adults, a TBS equal to or greater than 1,350 is considered to represent a normal microarchitectureObjectives:To evaluate the usefulness of TBS in pediatric population with risk factors for Low Bone Mass (LBM)Methods:TBS was assessed by analyzing vertebral densitometries performed on patients from 4 to 20 years of age, assessed in the pediatric rheumatology office of our hospital for presenting risk factors for LBM, consecutively from 2016 until 2018Data were compared with normal pediatric populationResults:Data from 83 patients are shown, with an average age of 11.2 years, 62% female, 80% CaucasianThe main risk factors for LBM were (%): Insufficient calcium intake (84,5), medications with osteopenizing potential (31), corticosteroids (39), sedentary lifestyle (13,6), fractures of long or vertebral bones (12,6) and hypovitaminosis D (8,1)Table 1.TBS por age groups and in patients with and without LBMAge groupsnMeanSDMinimum-MaximumScholars (4-9a)221,3210,0931,119-1,502Adolescence (10-17a)541,3090,0881,073-1,493Youth (18-20a)61,3590,0851,258-1,460Spine Z scorenMean (SD)pMinimum-Maximum ≤-281,270 (0,075)0,1261,419-1,162 >-2741,321 (0,090)1,502-1,073Whole Body Z score ≤-291,246 (0,060)0,0121,323-1,145 >-2731,324 (0,089)1,502-1,073Table 2.TBS in healthy population and study population for ageHealthy girls (n=2535)Healthy boys (n=1459)Study girls (n=47)Study boys (n=36)Age (y)Spine BMDTBSSpine BMDTBSTBSTBS1-20,401,3250,371,2722-30,511,3630,461,2671,1273-40,521,3460,511,2641,2044-50,601,3460,601,2671,2371,2435-60,601,2880,561,2691,3301,3686-70,651,2800,601,2321,3181,4227-80,671,2680,641,2441,3391,3458-90,711,2660,681,2281,2449-100,751,2780,701,2081,2531,34110-110,81,2850,731,2311,2291,29211-120,841,3370,761,2501,3031,31512-130,991,3550,811,2481,3811,36813-141,061,3860,891,2731,3941,33814-151,101,3980,991,3031,4741,28515-161,141,4051,081,3111,3681,40616-171,171,4051,151,3341,3321,37117-181,171,4041,201,3281,3741,28518-191,171,4041,161,314Conclusion:TBS was lower in the patients with LBM by whole body Z score, but not in those with LBM by spine Z score. We observed a decrease in TBS in adolescence, not corresponding with a decrease in BMD, and that should not be interpreted as a pathological findingSimilar results have been described in other pediatric populations (1, 2), but larger studies are needed to evaluate this phenomenon. We hypothesize that it may be due to a higher rate of growth in adolescence, with a lower rate of calcium apposition into the osteoid materialReferences:[1]Del Rio DS, Winthenrieth R. BONE MICROARCHITECTURE (TBS) AND BONE MASS DEVELOPMENT DURING CHILDHOOD AND ADOLESCENCE IN A SPANISH POPULATION GROUP. . WCO-IOF-ESCEO; Seville2014.[2]Shawwa K, Arabi A, Nabulsi M, et al. Predictors of trabecular bone score in school children. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2016;27(2):703-10.Disclosure of Interests:None declared
Collapse
|
22
|
Herrera S, Diaz-Coronado JC, Rojas-Gualdrón D, Betancur-Vasquez L, Gonzalez-Hurtado D, Gonzalez-Arango J, Uribe-Arango L, Saavedra Chacón MF, Lacouture-Fierro J, Monsalve S, Guerra-Zarama S, Serna JD, Barbosa J, Hernandez-Parra D, Sierra A, Pined R, Tamayo A. AB0246 FACTORS ASSOCIATED WITH THE TIME OF PRESENTATION OF CARDIOVASCULAR EVENTS IN A COHORT OF COLOMBIAN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Systemic lupus erythematosus is a systemic disease characterized by a compromise of vital organs. The autoimmune activity has been linked to accelerated endothelial damage and increased cardiovascular risk and its outcomes such as heart attack, stroke, and peripheral arterial disease(1). Patients with Lupic nephritis have been characterized by requiring aggressive immunosuppressive therapies apart from prolonged and progressive use of corticosteroids, what you have shown can accelerate these outcomes(2). Other factors such as secondary arterial hypertension, dyslipidemia among others are factors to consider (3).Objectives:To analyze clinical and immunological characteristics associated with time to severe renal involvement in patients with Systemic Lupus Erythematous in a Colombian cohort followed for one year, between January 2015 and December 2018.Methods:Retrospective follow-up study based on clinical records of patients with SLE diagnosis that fulfilled either 1987 American College of Rheumatology Classification Criteria for SLE or 2011 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for SLE. Patients with cardiovascular disease outcomes such as angina, acute myocardial infarction, stroke, transient cerebral ischemia and chronic arterial occlusive disease were included. Patients who did not have at least two follow-up measurements or had structural heart disease, valvulopathies, arrhythmias, myocarditis, pericarditis were excluded. The main outcome was defined as the time from diagnosis to cardiovascular diseases.Clinical and immunological characteristics were analyzed. Descriptive statistical analyses of participant data during the first evaluation are reported as frequencies and percentages for categorical variables, and as medians and interquartile ranges for quantitative variables. Age and sex adjusted survival functions and Hazard Ratios (HR) with 95% confidence intervals and p-values were estimated using parametric Weibull models for interval-censored data. P values < 0.05 were considered statistically significantResults:547 patients were analyzed: 29 were left-censored as they presented renal involvement at entry, 22 were interval censored as outcome occurred between study visits, and 496 were right-censored as involvement was not registered during follow-up. 528 (96.5%) patients were female, median age at entry was 46 (IQR = 23) and median age to diagnosis was 29.4 (IQR = 20.9). Statistically significant age and sex adjusted variables were High Blood Pressure (HBP) HR = 2.0 (95%CI 1.1-3.6; p-value <0.018) and cumulative prednisolone dose (>10 gr vs <2 gr) HR = 2.4 (95%CI 1. 1-5.1; p-value = 0.023). Figure 1 shows the age and sex adjusted survival function for HBPConclusion:HBP and cumulative steroid doses accelerate the onset of cardiovascular diseases in patients with lupus more than two times. Maintaining blood pressure in goals and performing early clearance of glucocorticoids could improve outcomes in these patients who are already considered a high cardiovascular riskReferences:[1]Hans-Joachim Anders, Ramesh Saxena, Ming-Hui Zhao. Lupus Nephritis. Nat Rev Dis Primers. 2020 Jan 23;6(1):7.[2]Shanthini Kasturi, Lisa R Sammaritano. Corticosteroids in Lupus. Rheum Dis Clin North Am, 42 (1), 47-62, viii[3]César Magro-Checa, Juan Salvatierra, José Luis Rosales-Alexander, et al. Cardiovascular risk in systemic lupus erythematosus: implicated factors and assessment methods. Semin Fund Esp Reumatol. 2012;13(3):95–102Disclosure of Interests:Sebastian Herrera Speakers bureau: academic conference, Juan camilo Diaz-Coronado: None declared, Diego Rojas-Gualdrón: None declared, Laura Betancur-Vasquez: None declared, Daniel Gonzalez-Hurtado: None declared, Juanita Gonzalez-Arango: None declared, laura Uribe-Arango: None declared, Maria Fernanda Saavedra Chacón: None declared, Jorge Lacouture-Fierro: None declared, Santiago Monsalve: None declared, Sebastian Guerra-Zarama: None declared, Juan david Serna: None declared, Julian Barbosa: None declared, Deicy Hernandez-Parra: None declared, Ana Sierra: None declared, Ricardo Pineda.Tamayo: None declared
Collapse
|
23
|
Herrera S, Diaz-Coronado JC, Hernandez-Parra D, Perez-Rios C, Durango-Durango Y, Pineda.Tamayo R. AB0245 RHEUMATOID ARTHRITIS DISEASE ACTIVITY AND VITAMIN D LEVELS IN A COLOMBIAN COHORT. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:There seems to be a relationship between 25-hydroxyvitamin D [25(OH)D] level and rheumatoid arthritis (RA)(1). It has been proposed that susceptibility for RA exists in selected patients with low 25(OH) with conflicting results (2,3) Regarding disease activity, most of the evidence suggests an inverse relationship of disease activity with 25(OH)D levels(4). To our knowledge, there is only a small study that suggests low 25(oh) D levels as a predictor of disease activity (5) in our regionObjectives:We aimed to evaluate the possible association of low 25(OH) D levels and disease activity in a large cohort of patients with Rheumatoid Arthritis in ColombiaMethods:We evaluated the clinical records of 3576 patients with RA that fulfilled the 2010 EULAR Classification Criteria for Rheumatoid Arthritis and that were managed in our autoimmunity center between 2014 and 2017. Registries that contained both the measurement of 25(OH)D levels and DAS28 VSG with no more than 6 months apart and that also had at least a mean 12-month follow-up were included. We classified 25(OH) D insufficiency as levels ≤ 20ng/ml. We evaluated differences in achieving disease control depending on the 25(OH) D levels with McNemar’s test. Disease control was defined as DAS28VSG≤3.2Results:A total of 880 patients were included, 90% were female and their mean age was 63 years and 24.3% had 25(OH) D insufficiency. The vast majority were seropositive and only 13% were on biologics (Table 1). A 25% of patients who 25(OH)D insufficiency had DAS28 3.2 and a year of follow-up decreased to 24% with medical intervention (p=0,1), while patients without 25(OH)D insufficiency at the beginning of follow-up, 27% had DAS28 3.2 and after one year follow-up decreased to 17% (p=0.001)Table 1Mean (SD)Age (years)63.3 (10.6)Disease Duration14.7 (10.8)Age at diagnosis48.6(13.5)N%Sex (Feminine)79390.1Rheumatoid Factor (Positive)N=81769985.6ACPA (Positive)N=36632.377.6Actual Steroid use61169.4Actual Biologic Therapy12313.9DMARD Methotrexate57064.8 Leflunomide68277.5 Sulfasalazine21824.8 Azathioprine50.6 Antimalarials14716.7Conclusion:In Colombian patients with rheumatoid arthritis low 25(OH) D status has an inverse correlation with disease control. Even in an equatorial country, up to 24% of RA patients had low vitamin levels. A strategy of active detection of 25(OH) D insufficiency could have an impact on disease activity and health statusReferences:[1]Ishikawa LLW, Colavite PM, Fraga-Silva TF de C, Mimura LAN, França TGD, Zorzella-Pezavento SFG, et al. Vitamin D Deficiency and Rheumatoid Arthritis. Vol. 52, Clinical Reviews in Allergy and Immunology. Humana Press Inc.; 2017. p. 373–88.[2]Bragazzi NL, Watad A, Neumann SG, Simon M, Brown SB, Abu Much A, et al. Vitamin D and rheumatoid arthritis: An ongoing mystery. Vol. 29, Current Opinion in Rheumatology. Lippincott Williams and Wilkins; 2017. p. 378–88.[3]Bae SC, Lee YH. Vitamin D level and risk of systemic lupus erythematosus and rheumatoid arthritis: a Mendelian randomization. Clin Rheumatol. 2018 Sep 1;37(9):2415–21.[4]Lee YH, Bae SC. Vitamin D level in rheumatoid arthritis and its correlation with the disease activity: A meta-analysis. Clin Exp Rheumatol. 2016;34(5):827–33.[5]Quintana-Duque MA, Caminos JE, Varela-Nariño A, Calvo-Paramo E, Yunis JJ, Iglesias-Gamarra A. The role of 25-hydroxyvitamin D as a predictor of clinical and radiological outcomes in early onset rheumatoid arthritis. J Clin Rheumatol. 2017;23(1):33–9.Disclosure of Interests:Sebastian Herrera Speakers bureau: academic conference, Juan camilo Diaz-Coronado: None declared, Deicy Hernandez-Parra: None declared, Carolina Perez-Rios: None declared, Yecenia Durango-Durango: None declared, Ricardo Pineda.Tamayo: None declared
Collapse
|
24
|
Rahman AE, Herrera S, Rubayet S, Banik G, Hasan R, Ahsan Z, Siraj W, Ahmed A, Siddique AB, Rahman QSU, Vaz LME, Islam MJ, Hossain MA, Shahidullah M, Osmani MM, E. l. Arifeen S, Wall SN. Managing possible serious bacterial infection of young infants where referral is not possible: Lessons from the early implementation experience in Kushtia District learning laboratory, Bangladesh. PLoS One 2020; 15:e0232675. [PMID: 32392209 PMCID: PMC7213695 DOI: 10.1371/journal.pone.0232675] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/20/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Serious infections account for 25% of global newborn deaths annually, most in low-resource settings where hospital-based treatment is not accessible or feasible. In Bangladesh, one-third of neonatal deaths are attributable to serious infection; in 2014, the government adopted new policy for outpatient management of danger signs indicating possible serious bacterial infections (PSBI) when referral was not possible. We conducted implementation research to understand what it takes for a district health team to implement quality outpatient PSBI management per national guidelines. METHODS PSBI management was introduced as part of the Comprehensive Newborn Care Package in 2015. The study piloted this package through government health systems with limited partner support to inform scale-up efforts. Data collection included facility register reviews for cases seen at primary level facilities; facility readiness and provider knowledge and skills assessments; household surveys capturing caregiver knowledge of newborn danger signs and care-seeking for newborn illness; and follow-up case tracking, capturing treatment adherence and outcomes. Analysis consisted of descriptive statistics. RESULTS Over the 15-month implementation period, 1432 young infants received care, of which 649 (45%) were classified as PSBI. Estimated coverage of care-seeking increased from 22% to 42% during the implementation period. Although facility readiness and providers' skills increased, providers' adherence to guidelines was not optimal. Among locally managed PSBI cases, 75% completed the oral antibiotic course and 15% received the fourth day follow-up. Care-seeking remained high among private providers (95%), predominantly village health doctors (over 80%). CONCLUSIONS Facility readiness, including health care provider knowledge and skills were strengthened; future efforts should focus on improving provider adherence to guidelines. Social and behavior change strategies targeting families and communities should explore shifting care-seeking from private, possibly less-qualified providers. Strategies to improve private sector management of PSBI cases and improved linkages between private and public sector providers could be explored.
Collapse
Affiliation(s)
- Ahmed Ehsanur Rahman
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Samantha Herrera
- Save the Children, Saving Newborn Lives, Washington, DC, United States of America
- * E-mail:
| | - Sayed Rubayet
- Ipas (formerly Save the Children International, Saving Newborn Lives), Dhaka, Bangladesh
| | - Goutom Banik
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rezaul Hasan
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ziaul Ahsan
- Ipas (formerly Save the Children International, Saving Newborn Lives), Dhaka, Bangladesh
| | - Wahida Siraj
- Save the Children International (formerly Saving Newborn Lives), Dhaka, Bangladesh
| | - Anisuddin Ahmed
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abu Bakkar Siddique
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Qazi Sadeq-ur Rahman
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Lara M. E. Vaz
- Population Reference Bureau (formerly Save the Children, Saving Newborn Lives), Washington DC, United States of America
| | - M. Jahurul Islam
- National Newborn Health Program & Integrated Management of Childhood Illness (NNHP & IMCI), DGHS, MoHFW, Dhaka, Bangladesh
| | - M. Altaf Hossain
- Ministry of Health and Family Welfare (MoHFW), Dhaka, Bangladesh
| | - M. Shahidullah
- Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | | | - Shams E. l. Arifeen
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Stephen N. Wall
- Save the Children, Saving Newborn Lives, Washington, DC, United States of America
| |
Collapse
|
25
|
Ashton RA, Prosnitz D, Andrada A, Herrera S, Yé Y. Evaluating malaria programmes in moderate- and low-transmission settings: practical ways to generate robust evidence. Malar J 2020; 19:75. [PMID: 32070357 PMCID: PMC7027277 DOI: 10.1186/s12936-020-03158-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 02/09/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Many countries have made substantial progress in scaling-up and sustaining malaria intervention coverage, leading to more focalized and heterogeneous transmission in many settings. Evaluation provides valuable information for programmes to understand if interventions have been implemented as planned and with quality, if the programme had the intended impact on malaria burden, and to guide programmatic decision-making. Low-, moderate-, and heterogeneous-transmission settings present unique evaluation challenges because of dynamic and targeted intervention strategies. This paper provides illustration of evaluation approaches and methodologies for these transmission settings, and suggests how to answer evaluation questions specific to the local context. METHODS The Roll Back Malaria Monitoring and Evaluation Reference Group formed a task force in October 2017 to lead development of this framework. The task force includes representatives from National Malaria Programmes, funding agencies, and malaria research and implementing partners. The framework builds on existing guidance for process and outcome evaluations and impact evaluations specifically in high transmission settings. RESULTS The theory of change describes how evaluation questions asked by national malaria programmes in different contexts influence evaluation design. The transmission setting, existing stratification, and data quality and availability are also key considerations. The framework is intended for adaption by countries to their local context, and use for evaluation at sub-national level. Confirmed malaria incidence is recommended as the primary impact indicator due to its sensitivity to detect changes in low-transmission settings. It is expected that process evaluations provide sufficient evidence for programme monitoring and improvement, while impact evaluations are needed following adoption of new mixes of interventions, operational strategies, tools or policies, particularly in contexts of changing malaria epidemiology. Impact evaluations in low-, moderate-, or heterogeneous-transmission settings will likely use plausibility designs, and methods highlighted by the framework include interrupted time series, district-level dose-response analyses, and constructed control methods. Triangulating multiple data sources and analyses is important to strengthen the plausibility argument. CONCLUSIONS This framework provides a structure to assist national malaria programmes and partners to design evaluations in low-, moderate- or heterogeneous-transmission settings. Emphasizing a continuous cycle along the causal pathway linking process evaluation to impact evaluation and then programmatic decision-making, the framework provides practical guidance in evaluation design, analysis, and interpretation to ensure that the evaluation meets national malaria programme priority questions and guides decision-making at national and sub-national levels.
Collapse
Affiliation(s)
- Ruth A Ashton
- MEASURE Evaluation, Center for Applied Malaria Research and Evaluation, Tulane School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2300, New Orleans, LA, USA.
| | | | | | - Samantha Herrera
- MEASURE Evaluation, ICF, Rockville, MD, USA.,Save the Children, Washington, DC, USA
| | - Yazoumé Yé
- MEASURE Evaluation, ICF, Rockville, MD, USA
| |
Collapse
|
26
|
Ballesta S, Güerri-Fernández RC, Chillarón JJ, Güell A, Herrera S, Torres E, Ascoeta NG, Flores Le-Roux JA, Díez A. The use of microindentation for the study of bone properties in type 1 diabetes mellitus patients. Osteoporos Int 2020; 31:175-180. [PMID: 31641800 DOI: 10.1007/s00198-019-05178-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/24/2019] [Indexed: 11/27/2022]
Abstract
UNLABELLED Diabetes mellitus is associated with a higher risk of fracture. In this study, we analysed the bone quality of premenopausal women with type 1 diabetes mellitus by microindentation. No differences in bone quality were identified between patients and healthy controls, suggesting that intensive insulin therapy can preserve bone health. PURPOSE To compare the bone quality of women with type 1 diabetes mellitus (T1DM) and healthy controls, and to determine the relationship with bone mineral density (BMD). METHODS This was a cross-sectional study of 45 premenopausal women with T1DM and 21 healthy controls, matched according to age and BMI. Clinical parameters, BMD and bone tissue mechanical properties (assessed using the bone material strength index [BMSi]) were evaluated in each group using microindentation. In T1DM patients, glycosylated haemoglobin (HbA1c), the number of hypoglycaemic events and the status of chronic complications were also analysed. RESULTS No differences in BMSi or BMD between T1DM patients and healthy controls were identified. In the T1DM patients, the mean HbA1c was 7.52% ± 1.00% and the mean time elapsed since diagnosis was 22.6 ± 12.2 years. Eight patients (17.7%) met the criteria for metabolic syndrome (MetS), and microvascular complications were present in 12 patients (26.7%). Neither the number of features of MetS present nor the presence of microangiopathy was found to be associated with BMSi. CONCLUSIONS T1DM premenopausal patients showed bone tissue properties comparable to those shown by controls. Further larger-scale studies should be conducted to confirm these results.
Collapse
Affiliation(s)
- S Ballesta
- Department of Endocrinology and Nutrition, Hospital del Mar, PasseigMarítim, 25-29, 08003, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - R C Güerri-Fernández
- Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Department of Internal Medicine, Hospital del Mar, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - J J Chillarón
- Department of Endocrinology and Nutrition, Hospital del Mar, PasseigMarítim, 25-29, 08003, Barcelona, Spain.
- Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain.
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
| | - A Güell
- Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Department of Medicine, Universitat Pompeu Fabra, Barcelona, Spain
| | - S Herrera
- Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Department of Internal Medicine, Hospital del Mar, Barcelona, Spain
| | - E Torres
- Department of Internal Medicine, Hospital del Mar, Barcelona, Spain
| | - N G Ascoeta
- Department of Endocrinology and Nutrition, Hospital del Mar, PasseigMarítim, 25-29, 08003, Barcelona, Spain
| | - J A Flores Le-Roux
- Department of Endocrinology and Nutrition, Hospital del Mar, PasseigMarítim, 25-29, 08003, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - A Díez
- Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Department of Internal Medicine, Hospital del Mar, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| |
Collapse
|
27
|
Barriga X, Rodriguez J, Herrera S, Pacheco V, Fernandez F, Reategui R. EVALUACION DE LIPOPROTEINAS DE BAJA DENSIDAD Y YEMA DE HUEVO COMO CRIOPROTECTORES NO PENETRANTES EN SEMEN DE CABALLO PERUANO DE PASO. SPERMOVA 2019. [DOI: 10.18548/aspe/0007.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
28
|
Andrada A, Herrera S, Yé Y. Are new national malaria strategic plans informed by the previous ones? A comprehensive assessment of sub-Saharan African countries from 2001 to present. Malar J 2019; 18:253. [PMID: 31358012 PMCID: PMC6664540 DOI: 10.1186/s12936-019-2898-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND New national malaria strategic plans (NMSPs) should build upon the achievements and challenges identified during the implementation of previous plans, but there is limited research on the transition process between NMSPs. This study aims to fill this gap through an assessment of NMSPs across sub-Saharan Africa. METHODS The study reviewed the two most recent NMSPs for selected sub-Saharan African countries. Targets for six core malaria indicators were extracted from each NMSP and compared to the coverage achieved according to corresponding population-based surveys completed near the end of the NMSP term. Implementation challenges and proposed solutions identified through the NMSP analysis were documented. The current NMSP was reviewed to determine whether proposed solutions had been integrated into the strategy. RESULTS Twenty-two countries in sub-Saharan Africa were included in the assessment. Of the 135 verified targets, only 4 were achieved. No country reached more than one of the six targets assessed in each NMSP. Despite this low success rate, only four of the 22 countries lowered a subsequent target, with most setting the next target at an equal or greater level. Most NMSPs identified solutions to address implementation challenges faced, but the solutions were not always fully incorporated in the new strategy. CONCLUSIONS The results show a disconnect between NMSPs. Most targets were set according to global goals rather than the individual country's previous achievements and limitations. This indicates a need to revise the NMSP development process to guide programmes in defining targets based on their country context and incorporate strategies to address challenges identified in the previous NMSP. This will allow countries to set and meet achievable targets as they work toward global goals.
Collapse
Affiliation(s)
- Andrew Andrada
- ICF, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA.
| | - Samantha Herrera
- ICF, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA.,Save the Children, 899 North Capitol Street NE, #900, Washington, DC, 20002, USA
| | - Yazoumé Yé
- ICF, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA
| |
Collapse
|
29
|
Prosnitz D, Herrera S, Coelho H, Moonzwe Davis L, Zalisk K, Yourkavitch J. Evidence of Impact: iCCM as a strategy to save lives of children under five. J Glob Health 2019; 9:010801. [PMID: 31263547 PMCID: PMC6594661 DOI: 10.7189/jogh.09.010801] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background In 2013, the World Health Organization (WHO) launched the Rapid Access Expansion (RAcE) programme in the Democratic Republic of Congo, Malawi, Mozambique, Niger, and Nigeria to increase coverage of diagnostic, treatment, and referral services for malaria, pneumonia, and diarrhea among children ages 2-59 months. In 2017, a final evaluation of the six RAcE sites was conducted to determine whether the programme goal was reached. A key evaluation objective was to estimate the reduction in childhood mortality and the number of under-five lives saved over the project period in the RAcE project areas. Methods The Lives Saved Tool (LiST) was used to estimate reductions in all-cause child mortality due to changes in coverage of treatment for the integrated community case management (iCCM) illnesses – malaria, pneumonia, and diarrhea – while accounting for other changes in maternal and child health interventions in each RAcE project area. Data from RAcE baseline and endline household surveys, Demographic and Health Surveys, and routine health service data were used in each LiST model. The models yielded estimated change in under-five mortality rates, and estimated number of lives saved per year by malaria, pneumonia and diarrhea treatment. We adjusted the results to estimate the number of lives saved by community health worker (CHW)-provided treatment. Results The LiST model accounts for coverage changes in iCCM intervention coverage and other health trends in each project area to estimate mortality reduction and child lives saved. Under five mortality declined in all six RAcE sites, with an average decline of 10 percent. An estimated 6200 under-five lives were saved by malaria, pneumonia, and diarrhea treatment in the DRC, Malawi, Niger, and Nigeria, of which approximately 4940 (75 percent) were saved by treatment provided by CHWs. This total excludes Mozambique, where there were no estimated under-five lives saved likely due to widespread stockouts of key medications. In all other project areas, lives saved by CHW-provided treatment contributed substantially to the estimated decline in under-five mortality. Conclusions Our results suggest that iCCM is a strategy that can save lives and measurably decrease child mortality in settings where access to health facility services is low and adequate resources for iCCM implementation are provided for CHW services.
Collapse
Affiliation(s)
| | - Samantha Herrera
- ICF, Rockville, Maryland, USA.,Save the Children, Washington, D.C., USA
| | | | | | | | | |
Collapse
|
30
|
Yourkavitch J, Prosnitz D, Herrera S. Data quality assessments stimulate improvements to health management information systems: evidence from five African countries. J Glob Health 2019; 9:010806. [PMID: 31263551 PMCID: PMC6594668 DOI: 10.7189/jogh.09.010806] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Health service data are used to inform decisions about planning and implementation, as well as to evaluate performance and outcomes, and the quality of those data are important. Data quality assessments (DQA) afford the opportunity to collect information about health service data. Through its Rapid Access Expansion Programme (RAcE), the World Health Organization (WHO) funded non-governmental organizations (NGO) to support Ministries of Health (MOH) in implementing integrated community case management (iCCM) programs in the Democratic Republic of Congo, Malawi, Mozambique, Niger and Nigeria. WHO contracted ICF to support grantee monitoring and evaluation efforts, part of which was to conduct DQAs to enhance program monitoring and decision making. The contribution of DQAs to data-driven decision making has been documented and the purpose of this paper is to describe how DQAs contributed to health management information system (HMIS) strengthening and the findings of subsequent DQAs in those areas. Methods ICF created a mixed-methods DQA for iCCM data, comprising a review of the data collection and management system, a data tracing component and key informant interviews. The DQA was applied twice in each RAcE site, which enables a general comparison of system-level attributes before and after the first DQA application. For this qualitative assessment, we reviewed DQA reports to collate information about DQA recommendations and how they were addressed before a subsequent DQA, along with the findings of the second DQA. Results Findings from the first DQA in each RAcE site stimulated NGO and MOH efforts to strengthen different aspects of the HMIS in each country, including modifying data collection tools in the Democratic Republic of Congo; training community health workers (CHWs) and supervisors in Malawi; strengthening supervision in Mozambique; improving CHW registers and strengthening staff capacity at all levels to report data in Niger; establishing a data review system in Abia State, Nigeria; and, establishing processes to improve data use and quality in Niger State, Nigeria. Conclusion Data quality assessments stimulated context-specific efforts by NGOs and MOHs to improve iCCM data quality. DQAs can serve as a collaborative and evidence-based activity to influence discussions of data quality and stimulate HMIS strengthening efforts.
Collapse
|
31
|
Isiguzo C, Herrera S, Ufere J, Enebeli U, Oluoha C, Anyanti J, Prosnitz D. Improving access to appropriate case management for common childhood illnesses in hard-to-reach areas of Abia State, Nigeria. Journal of Global Health Reports 2019. [DOI: 10.29392/joghr.3.e2019030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
32
|
Veeraraghavan J, De Angelis C, Mao R, Wang T, Herrera S, Pavlick AC, Contreras A, Nuciforo P, Mayer IA, Forero A, Nanda R, Goetz MP, Chang JC, Wolff AC, Krop IE, Fuqua SAW, Prat A, Hilsenbeck SG, Weigelt B, Reis-Filho JS, Gutierrez C, Osborne CK, Rimawi MF, Schiff R. A combinatorial biomarker predicts pathologic complete response to neoadjuvant lapatinib and trastuzumab without chemotherapy in patients with HER2+ breast cancer. Ann Oncol 2019; 30:927-933. [PMID: 30903140 PMCID: PMC6594453 DOI: 10.1093/annonc/mdz076] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND HER2-positive (+) breast cancers, defined by HER2 overexpression and/or amplification, are often addicted to HER2 to maintain their malignant phenotype. Yet, some HER2+ tumors do not benefit from anti-HER2 therapy. We hypothesize that HER2 amplification levels and PI3K pathway activation are key determinants of response to HER2-targeted treatments without chemotherapy. PATIENTS AND METHODS Baseline HER2+ tumors from patients treated with neoadjuvant lapatinib plus trastuzumab [with endocrine therapy for estrogen receptor (ER)+ tumors] in TBCRC006 (NCT00548184) were evaluated in a central laboratory for HER2 amplification by fluorescence in situ hybridization (FISH) (n = 56). HER2 copy number (CN) and FISH ratios, and PI3K pathway status, defined by PIK3CA mutations or PTEN levels by immunohistochemistry were available for 41 tumors. Results were correlated with pathologic complete response (pCR; no residual invasive tumor in breast). RESULTS Thirteen of the 56 patients (23%) achieved pCR. None of the 11 patients with HER2 ratio <4 and/or CN <10 achieved pCR, whereas 13/45 patients (29%) with HER2 ratio ≥4 and/or CN ≥10 attained pCR (P = 0.0513). Of the 18 patients with tumors expressing high PTEN or wild-type (WT) PIK3CA (intact PI3K pathway), 7 (39%) achieved pCR, compared with 1/23 (4%) with PI3K pathway alterations (P = 0.0133). Seven of the 16 patients (44%) with HER2 ratio ≥4 and intact PI3K pathway achieved pCR, whereas only 1/25 (4%) patients not meeting these criteria achieved pCR (P = 0.0031). CONCLUSIONS Our findings suggest that there is a clinical subtype in breast cancer with high HER2 amplification and intact PI3K pathway that is especially sensitive to HER2-targeted therapies without chemotherapy. A combination of HER2 FISH ratio and PI3K pathway status warrants validation to identify patients who may be treated with HER2-targeted therapy without chemotherapy.
Collapse
Affiliation(s)
- J Veeraraghavan
- Lester and Sue Smith Breast Center; Dan L. Duncan Comprehensive Cancer Center
| | - C De Angelis
- Lester and Sue Smith Breast Center; Dan L. Duncan Comprehensive Cancer Center
| | - R Mao
- Lester and Sue Smith Breast Center; Dan L. Duncan Comprehensive Cancer Center
| | - T Wang
- Lester and Sue Smith Breast Center; Dan L. Duncan Comprehensive Cancer Center; Departments of Medicine
| | - S Herrera
- Lester and Sue Smith Breast Center; Dan L. Duncan Comprehensive Cancer Center; Pathology, Baylor College of Medicine, Houston, USA
| | - A C Pavlick
- Lester and Sue Smith Breast Center; Dan L. Duncan Comprehensive Cancer Center
| | - A Contreras
- Lester and Sue Smith Breast Center; Dan L. Duncan Comprehensive Cancer Center; Pathology, Baylor College of Medicine, Houston, USA
| | - P Nuciforo
- Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Hospital Clinic de Barcelona, Barcelona, Spain
| | - I A Mayer
- Medicine, Hematology/Oncology, Vanderbilt University, Nashville
| | - A Forero
- Medicine, University of Alabama at Birmingham, Birmingham
| | - R Nanda
- Medicine, University of Chicago, Chicago
| | - M P Goetz
- Department of Oncology, Mayo Clinic, Rochester
| | - J C Chang
- Houston Methodist Cancer Center, Houston Methodist Hospital, Houston
| | - A C Wolff
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore
| | - I E Krop
- Department of Medicine, Dana-Farber Cancer Institute, Boston
| | - S A W Fuqua
- Lester and Sue Smith Breast Center; Dan L. Duncan Comprehensive Cancer Center
| | - A Prat
- Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Hospital Clinic de Barcelona, Barcelona, Spain
| | - S G Hilsenbeck
- Lester and Sue Smith Breast Center; Dan L. Duncan Comprehensive Cancer Center; Departments of Medicine
| | - B Weigelt
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York
| | - J S Reis-Filho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York
| | - C Gutierrez
- Lester and Sue Smith Breast Center; Dan L. Duncan Comprehensive Cancer Center; Pathology, Baylor College of Medicine, Houston, USA
| | - C K Osborne
- Lester and Sue Smith Breast Center; Dan L. Duncan Comprehensive Cancer Center; Departments of Medicine; Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, USA
| | - M F Rimawi
- Lester and Sue Smith Breast Center; Dan L. Duncan Comprehensive Cancer Center; Departments of Medicine
| | - R Schiff
- Lester and Sue Smith Breast Center; Dan L. Duncan Comprehensive Cancer Center; Departments of Medicine; Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, USA.
| |
Collapse
|
33
|
Davis LM, Zalisk K, Herrera S, Prosnitz D, Coelho H, Yourkavitch J. iCCM data quality: an approach to assessing iCCM reporting systems and data quality in 5 African countries. J Glob Health 2019; 9:010805. [PMID: 31263550 PMCID: PMC6594667 DOI: 10.7189/jogh.09.010805] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 12/01/2022] Open
Abstract
BACKGROUND Ensuring the quality of health service data is critical for data-driven decision-making. Data quality assessments (DQAs) are used to determine if data are of sufficient quality to support their intended use. However, guidance on how to conduct DQAs specifically for community-based interventions, such as integrated community case management (iCCM) programs, is limited. As part of the World Health Organization's (WHO) Rapid Access Expansion (RAcE) Programme, ICF conducted DQAs in a unique effort to characterize the quality of community health worker-generated data and to use DQA findings to strengthen reporting systems and decision-making. METHODS We present our experience implementing assessments using standardized DQA tools in the six RAcE project sites in the Democratic Republic of Congo, Malawi, Mozambique, Niger, and Nigeria. We describe the process used to create the RAcE DQA tools, adapt the tools to country contexts, and develop the iCCM DQA Toolkit, which enables countries to carry out regular and rapid DQAs. We provide examples of how we used results to generate recommendations. RESULTS The DQA tools were customized for each RAcE project to assess the iCCM data reporting system, trace iCCM indicators through this system, and to ensure that DQAs were efficient and generated useful recommendations. This experience led to creation of an iCCM DQA Toolkit comprised of simplified versions of RAcE DQA tools and a guidance document. It includes system assessment questions that elicit actionable responses and a simplified data tracing tool focused on one treatment indicator for each iCCM focus illness: diarrhea, malaria, and pneumonia. The toolkit is intended for use at the national or sub-national level for periodic data quality checks. CONCLUSIONS The iCCM DQA Toolkit was designed to be easily tailored to different data reporting system structures because iCCM data reporting tools and data flow vary substantially. The toolkit enables countries to identify points in the reporting system where data quality is compromised and areas of the reporting system that require strengthening, so that countries can make informed adjustments that improve data quality, strengthen reporting systems, and inform decision-making.
Collapse
Affiliation(s)
| | | | - Samantha Herrera
- ICF, Rockville, Maryland, USA
- Save the Children, Washington, D.C., USA
| | | | | | | |
Collapse
|
34
|
Barajas A, Pelaez T, González O, Usall J, Iniesta R, Arteaga M, Jackson C, Baños I, Sánchez B, Dolz M, Obiols JE, Haro JM, Ochoa S, Arranz B, Arteaga M, Asensio R, Autonell J, Baños I, Bañuelos M, Barajas A, Barceló M, Blanc M, Borrás M, Busquets E, Carlson J, Carral V, Castro M, Corbacho C, Coromina M, Dachs I, De Miquel L, Dolz M, Domenech MD, Elias M, Espezel I, Falo E, Fargas A, Foix A, Fusté M, Godrid M, Gómez D, González O, Granell L, Gumà L, Haro JM, Herrera S, Huerta E, Lacasa F, Mas N, Martí L, Martínez R, Matalí J, Miñambres A, Muñoz D, Muñoz V, Nogueroles R, Ochoa S, Ortiz J, Pardo M, Planella M, Pelaez T, Peruzzi S, Rivero S, Rodriguez MJ, Rubio E, Sammut S, Sánchez M, Sánchez B, Serrano E, Solís C, Stephanotto C, Tabuenca P, Teba S, Torres A, Urbano D, Usall J, Vilaplana M, Villalta V. Predictive capacity of prodromal symptoms in first-episode psychosis of recent onset. Early Interv Psychiatry 2019; 13:414-424. [PMID: 29116670 DOI: 10.1111/eip.12498] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 07/16/2017] [Accepted: 08/20/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Both the nature and number of a wide range of prodromal symptoms have been related to the severity and type of psychopathology in the psychotic phase. However, at present there is an incomplete picture focused mainly on the positive pre-psychotic dimension. AIM To characterize the prodromal phase retrospectively, examining the number and nature of prodromal symptoms as well as their relationship with psychopathology at the onset of first-episode psychosis. METHODS Retrospective study of 79 patients experiencing a first-episode psychosis of less than 1 year from the onset of full-blown psychosis. All patients were evaluated with a comprehensive battery of instruments including socio-demographic and clinical questionnaire, IRAOS interview, PANSS, stressful life events scale (PERI) and WAIS/WISC (vocabulary subtest). Bivariate associations and multiple regression analysis were performed. RESULTS Regression models revealed that several prodromal dimensions of IRAOS (delusions, affect, language, behaviour and non-hallucinatory disturbances of perception) predicted the onset of psychosis, with positive (22.4% of the variance) and disorganized (25.6% of the variance) dimensions being the most widely explained. CONCLUSION In addition to attenuated positive symptoms, other symptoms such as affective, behavioural and language disturbances should also be considered in the definitions criteria of at-high-risk people.
Collapse
Affiliation(s)
- Ana Barajas
- Department of Research, Centre d'Higiene Mental Les Corts, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,Hospital Sant Joan de Déu de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Esplugues de Llobregat, Barcelona, Spain.,Fundació Sant Joan de Déu de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain.,Department of Clinical and Psychology, School of Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Trinidad Pelaez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Olga González
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Judith Usall
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Raquel Iniesta
- Fundació Sant Joan de Déu de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain
| | - Maria Arteaga
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Chris Jackson
- Birmingham Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - Iris Baños
- Fundació Sant Joan de Déu de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain
| | - Bernardo Sánchez
- Hospital Sant Joan de Déu de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Esplugues de Llobregat, Barcelona, Spain
| | - Montserrat Dolz
- Hospital Sant Joan de Déu de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Esplugues de Llobregat, Barcelona, Spain
| | - Jordi E Obiols
- Department of Clinical and Psychology, School of Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Josep M Haro
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | | | - Susana Ochoa
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Andrada A, Herrera S, Inyang U, Mohammed AB, Uhomoibhi P, Yé Y. A subnational profiling analysis reveals regional differences as the main predictor of ITN ownership and use in Nigeria. Malar J 2019; 18:185. [PMID: 31138216 PMCID: PMC6540480 DOI: 10.1186/s12936-019-2816-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To reduce the malaria burden in Nigeria, the country is scaling up prevention and treatment interventions, especially household ownership and use of insecticide-treated nets (ITNs). Nevertheless, large gaps remain to achieve the goals of the National Malaria Strategic Plan 2014-2020 of universal access to ITNs and their increased use. To inform the targeting of intervention strategies and to maximize impact, the authors conducted a sub-national profiling of household ITN ownership and use in the general population to identify key predictors of ITN ownership and use, and the sub-groups that are at higher risk of low ITN coverage and use. METHODS The authors conducted a secondary analysis of data from the 2015 Nigeria Malaria Indicator Survey. Using the Chi square automatic interaction detector (CHAID) and multiple logistic regression analysis, the authors examined the key predictors of ITN ownership and use in the general population throughout Nigeria. RESULTS The CHAID models identified region of the country as the best predictor of household ownership of at least one ITN and its use in the general population, with higher ownership and use observed in the northern regions. The odds of a household owning an ITN were five times greater in the North West region compared with the North Central region (odds ratio [OR] = 5.47, 95% confidence interval [CI] 4.46-6.72, p < 0.001). The odds of ITN use were two times greater for those living in the North West region compared with the North Central region (OR = 2.04, 95% CI 1.73-2.41, p < 0.001). Other significant predictors were household size, head of household education level, household wealth quintile, and place of residence. The CHAID gain index results identified households in the South West, North Central and South Central regions with low ITN ownership, and the general population in the South South, South East and North Central regions with low ITN use. CONCLUSIONS This study reveals regional differences in ITN ownership and use in Nigeria. Therefore, the findings from this analysis provide evidence that could inform the NMEP to better target future campaign and routine distribution of ITNs, to achieve universal access and increased use by 2020 in Nigeria.
Collapse
Affiliation(s)
- Andrew Andrada
- MEASURE Evaluation, ICF, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA.
| | - Samantha Herrera
- MEASURE Evaluation, ICF, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA.,Save the Children, 899 North Capitol Street, NE, #900, Washington, DC, 20002, USA
| | - Uwem Inyang
- President's Malaria Initiative/United States Agency for International Development, Plot 1075 Diplomatic Drive, Central District Area, Abuja, Nigeria
| | - Audu Bala Mohammed
- National Malaria Elimination Programme, Federal Ministry of Health, 1st Floor, Abia Plaza, 1 Avenue, Cadastral Zone A0, Central Business District, Abuja, Nigeria
| | - Perpetua Uhomoibhi
- National Malaria Elimination Programme, Federal Ministry of Health, 1st Floor, Abia Plaza, 1 Avenue, Cadastral Zone A0, Central Business District, Abuja, Nigeria
| | - Yazoumé Yé
- MEASURE Evaluation, ICF, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA
| |
Collapse
|
36
|
Zalisk K, Herrera S, Inyang U, Mohammed AB, Uhomoibhi P, Yé Y. Caregiver exposure to malaria social and behaviour change messages can improve bed net use among children in an endemic country: secondary analysis of the 2015 Nigeria Malaria Indicator Survey. Malar J 2019; 18:121. [PMID: 30954073 PMCID: PMC6451249 DOI: 10.1186/s12936-019-2750-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/28/2019] [Indexed: 11/10/2022] Open
Abstract
Background To reduce the malaria burden in Nigeria, the National Malaria Strategic Plan (NMSP) 2014‒2020 calls for the scale-up of prevention and treatment interventions, including social and behaviour change (SBC). SBC interventions can increase awareness and improve the demand for and uptake of malaria interventions. However, there is limited evidence supporting the implementation of SBC interventions to improve key malaria behaviours, such as insecticide-treated bed net (ITN) use, among children in Nigeria. Methods Using data from 2015 Nigeria Malaria Indicator Survey, this study used multiple logistic regression to assess the relationship between caregiver exposure to malaria messages and ITN use among children under five. Results Caregiver exposure to ITN-related messages was significantly associated with ITN use among children under five (odds ratio [OR] = 1.63, p < 0.001). Conclusions The results suggest that caregiver exposure to topic-specific SBC messages improves the use of ITNs among children. Given these results, Nigeria should strive to scale up SBC interventions to help increase ITN use among children in line with the objectives of the NMSP. Further evidence is needed to determine which SBC interventions are the most effective and scalable in Nigeria.
Collapse
Affiliation(s)
- Kirsten Zalisk
- MEASURE Evaluation, ICF, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA.
| | - Samantha Herrera
- MEASURE Evaluation, ICF, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA.,Save the Children, 899 North Capitol Street NE #900, Washington, DC, 20002, USA
| | - Uwem Inyang
- President's Malaria Initiative/United States Agency for International Development, Plot 1075 Diplomatic Drive, Central District Area, Abuja, Nigeria
| | - Audu Bala Mohammed
- National Malaria Elimination Programme, Federal Ministry of Health Nigeria, 1st Floor, Abia Plaza, 1 Avenue, Cadastral Zone A0, Central Business District, Abuja, Nigeria
| | - Perpetua Uhomoibhi
- National Malaria Elimination Programme, Federal Ministry of Health Nigeria, 1st Floor, Abia Plaza, 1 Avenue, Cadastral Zone A0, Central Business District, Abuja, Nigeria
| | - Yazoumé Yé
- MEASURE Evaluation, ICF, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA
| |
Collapse
|
37
|
Herrera S, Farooq A, Davoudi S, Martinu T, Kumar D, Humar A, Rotstein C, Singer L, Keshavjee S, Husain S. Late Onset Invasive Pulmonary Aspergillosis in Lung Transplant Recipients Treated with a Preemptive/ Targeted Antifungal Therapy Strategy: 4 Year Follow Up. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
38
|
Herrera S, Peccoralo L, Hinrichsen GA. Treating depression in an urban primary care setting: Introducing an adapted therapeutic approach to improve behavioral health engagement in primary care. Soc Work Health Care 2018; 57:607-619. [PMID: 30071188 DOI: 10.1080/00981389.2018.1474162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Depression is common in patients attending primary care clinics especially for those in socioeconomically disadvantaged urban neighborhoods. A number of behavioral health collaborative care models exist to screen, assess, and treat patients within primary care clinics. This paper discusses the implementation of a behavioral health care program using the Improving Mood Promoting Access to Collaborative Treatment (IMPACT) model within an urban primary care clinic setting in New York City, that serves a large population of ethnically diverse and socioeconomically disadvantaged patients. While elements of the structured IMPACT model in the clinic were effective, the therapeutic approaches did not always meet the needs of all the patients. Therefore, the article describes the challenges this program faced and highlights how the IMPACT model was modified to meet the specific needs of the patients by using an adapted version of Interpersonal Psychotherapy as an alternative psychosocial intervention to the traditional Problem Solving Treatment psychosocial treatment in IMPACT.
Collapse
Affiliation(s)
- Samantha Herrera
- a Internal Medicine Associates, Center for Advanced Medicine , The Mount Sinai Hospital , New York , NY , USA
| | - Lauren Peccoralo
- b Department of Medicine Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Gregory A Hinrichsen
- c Department of Geriatrics and Palliative Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| |
Collapse
|
39
|
Gabrielli L, Saavedra R, Herrera S, Vega J, Salinas M, Fernandez R, Contreras F, Vergara L, Yanez F, Jalil J, Ocaranza MP, Lavandero S, Chiong M, Castro P, Sitges M. P653Cardiac remodeling in highly trained athletes is associated with rho kinase activation and increased levels of cardiotrophin-1. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p653] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L Gabrielli
- Pontifical Catholic University of Chile, Cardiovascular Disease Division, Santiago, Chile
| | - R Saavedra
- Pontifical Catholic University of Chile, Cardiovascular Disease Division, Santiago, Chile
| | - S Herrera
- Pontifical Catholic University of Chile, Cardiovascular Disease Division, Santiago, Chile
| | - J Vega
- Pontifical Catholic University of Chile, Cardiovascular Disease Division, Santiago, Chile
| | - M Salinas
- Pontifical Catholic University of Chile, Cardiovascular Disease Division, Santiago, Chile
| | - R Fernandez
- Pontifical Catholic University of Chile, Cardiovascular Disease Division, Santiago, Chile
| | - F Contreras
- Pontifical Catholic University of Chile, Cardiovascular Disease Division, Santiago, Chile
| | - L Vergara
- Pontifical Catholic University of Chile, Cardiovascular Disease Division, Santiago, Chile
| | - F Yanez
- Pontifical Catholic University of Chile, Cardiovascular Disease Division, Santiago, Chile
| | - J Jalil
- Pontifical Catholic University of Chile, Cardiovascular Disease Division, Santiago, Chile
| | - M P Ocaranza
- Pontifical Catholic University of Chile, Cardiovascular Disease Division, Santiago, Chile
| | - S Lavandero
- University of Chile, Advanced Center for Chronic Diseases (ACCDiS) & CEMC, Facultad Ciencias Químicas y Farmacéuticas y F, Santiago, Chile
| | - M Chiong
- University of Chile, Advanced Center for Chronic Diseases (ACCDiS) & CEMC, Facultad Ciencias Químicas y Farmacéuticas y F, Santiago, Chile
| | - P Castro
- Pontifical Catholic University of Chile, Cardiovascular Disease Division, Santiago, Chile
| | - M Sitges
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Cardiology Department, Barcelona, Spain
| |
Collapse
|
40
|
Heard J, Pape K, Romanowski K, Liu Y, Herrera S, Granchi T, Wibbenmeyer L. 287 Invasive Fungal Infections in Burns: Case Series and Review of the Literature. J Burn Care Res 2018. [DOI: 10.1093/jbcr/iry006.209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- J Heard
- University of Iowa Hospitals and Clinics, Iowa City, IA
| | - K Pape
- University of Iowa Hospitals and Clinics, Iowa City, IA
| | - K Romanowski
- University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Y Liu
- University of Iowa Hospitals and Clinics, Iowa City, IA
| | - S Herrera
- University of Iowa Hospitals and Clinics, Iowa City, IA
| | - T Granchi
- University of Iowa Hospitals and Clinics, Iowa City, IA
| | - L Wibbenmeyer
- University of Iowa Hospitals and Clinics, Iowa City, IA
| |
Collapse
|
41
|
Herrera S, Gohir W, Aguilar C, Juvet S, Martinu T, Singer L, Keshavjee S, Rotstein C, Kumar D, Humar A, Husain S. Predictive Cytokine Profile for Invasive Aspergillosis in Lung Transplant Recipients in the Setting of Pre-emptive Prophylaxis. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.530] [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: 10/17/2022] Open
|
42
|
de Frutos M, López-Urrutia L, Berbel C, Allue M, Herrera S, Azcona JM, Beristaín X, Aznar E, Albert M, Ruiz C, Eiros JM. [Monophasic Salmonella Typhimurium outbreak due to the consumption of roast pork meat]. Rev Esp Quimioter 2018; 31:156-159. [PMID: 29564869 PMCID: PMC6159379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 12/05/2017] [Accepted: 12/05/2017] [Indexed: 10/26/2022]
Abstract
This report presents an outbreak of monophasic Salmonella enteric serovar Typhimurium fagotipe 4, 5, 12: i:-, in a motorcycle concentration in Valladolid. Information was collected to one hundred and twelve affected from seven Spanish Autonomous Communities. The epidemiological investigation associated the outbreak with the consumption of roast pork with sauce sandwiches sold at a street market in that event.
Collapse
Affiliation(s)
- M de Frutos
- Mónica de Frutos, Servicio de Microbiología. Hospital Universitario Rio Hortega Calle Dulzaina, 2 47012 Valladolid, Spain.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Caballero F, Puig M, Leal J, Trejo O, Díaz I, Herrera S, Turbau M, Ris J, Benito S. A helpful approach to organ donation: From end-of-life care to effective organ transplantation. Am J Transplant 2018; 18:528-529. [PMID: 28891206 DOI: 10.1111/ajt.14493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- F Caballero
- Department of Emergency Medicine and Transplant Coordination, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Puig
- Department of Emergency Medicine and Transplant Coordination, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Leal
- Department of Emergency Medicine and Transplant Coordination, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - O Trejo
- Department of Emergency Medicine and Transplant Coordination, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - I Díaz
- Department of Emergency Medicine and Transplant Coordination, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Herrera
- Department of Emergency Medicine and Transplant Coordination, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Turbau
- Department of Emergency Medicine and Transplant Coordination, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Ris
- Department of Emergency Medicine and Transplant Coordination, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Benito
- Department of Emergency Medicine and Transplant Coordination, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
44
|
Herrera S, Soriano R, Nogués X, Güerri-Fernandez R, Grinberg D, García-Giralt N, Martínez-Gil N, Castejón S, González-Lizarán A, Balcells S, Diez-Perez A. Discrepancy between bone density and bone material strength index in three siblings with Camurati-Engelmann disease. Osteoporos Int 2017; 28:3489-3493. [PMID: 28842728 DOI: 10.1007/s00198-017-4198-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 08/14/2017] [Indexed: 10/19/2022]
Abstract
UNLABELLED Camurati-Engelmann (CE) is a very rare disease affecting one in every million persons worldwide. It is characterized by an enlargement of long bones. We aimed to assess bone characteristics in three siblings with different tools. Even if there was an excess of bone density, quality seemed to be deteriorated. INTRODUCTION CE disease is a rare monogenic disorder affecting approximately one in every million persons worldwide. It is mainly characterized by a progressive hyperostosis of the periosteum and endosteum of the diaphysis of long bones. Limited data are available about bone characteristics in these patients. In three siblings with CE disease, we aimed to assess bone mineral density (BMD) and trabecular bone score (TBS) by dual-energy X-ray absorptiometry (DXA) and material characteristics at tissue level using bone impact reference point indentation. METHODS Clinical data were collected and a general laboratory workup was performed. At the lumbar spine and hip, BMD and TBS were measured using DXA imaging. Bone material strength index (BMSi) was measured by bone impact microindentation using an Osteoprobe instrument. RESULTS All three cases had densitometric values consistent with high bone mass (sum of Z-score at the lumbar spine and hip > 4). Hip BMD was extremely high in all three siblings at both total hip and femoral neck, while at the lumbar spine, two of them had normal values but the third again had very high BMD. TBS values were in the normal range. In contrast, BMSi measurements were at low or very low levels, compared with normal controls. CONCLUSION Despite strikingly increased BMD and normal microarchitecture, BMSi is affected in patients with CE. Microindentation could be an appropriate tool for assessing bone fragility in these patients. Bone disease in this group of patients requires further study to better understand the underlying regulatory mechanisms and their alterations.
Collapse
Affiliation(s)
- S Herrera
- Hospital del Mar Institute of Medical Research, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - R Soriano
- Hospital del Mar Institute of Medical Research, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - X Nogués
- Hospital del Mar Institute of Medical Research, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - R Güerri-Fernandez
- Hospital del Mar Institute of Medical Research, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - D Grinberg
- Department of Genetics, Microbiology and Statistics, University of Barcelona, IBUB, IDSJD, and CIBERER, Instituto Carlos III, Barcelona, Spain
| | - N García-Giralt
- Hospital del Mar Institute of Medical Research, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - N Martínez-Gil
- Department of Genetics, Microbiology and Statistics, University of Barcelona, IBUB, IDSJD, and CIBERER, Instituto Carlos III, Barcelona, Spain
| | - S Castejón
- Hospital del Mar Institute of Medical Research, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - A González-Lizarán
- Hospital del Mar Institute of Medical Research, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - S Balcells
- Department of Genetics, Microbiology and Statistics, University of Barcelona, IBUB, IDSJD, and CIBERER, Instituto Carlos III, Barcelona, Spain
| | - A Diez-Perez
- Hospital del Mar Institute of Medical Research, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain.
- Department of Internal Medicine, Hospital del Mar, P. Maritim 25-29, 08003, Barcelona, Spain.
| |
Collapse
|
45
|
Herrera S, Enuameh Y, Adjei G, Ae-Ngibise KA, Asante KP, Sankoh O, Owusu-Agyei S, Yé Y. A systematic review and synthesis of the strengths and limitations of measuring malaria mortality through verbal autopsy. Malar J 2017; 16:421. [PMID: 29058621 PMCID: PMC5651608 DOI: 10.1186/s12936-017-2071-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/16/2017] [Indexed: 01/08/2023] Open
Abstract
Background Lack of valid and reliable data on malaria deaths continues to be a problem that plagues the global health community. To address this gap, the verbal autopsy (VA) method was developed to ascertain cause of death at the population level. Despite the adoption and wide use of VA, there are many recognized limitations of VA tools and methods, especially for measuring malaria mortality. This study synthesizes the strengths and limitations of existing VA tools and methods for measuring malaria mortality (MM) in low- and middle-income countries through a systematic literature review. Methods The authors searched PubMed, Cochrane Library, Popline, WHOLIS, Google Scholar, and INDEPTH Network Health and Demographic Surveillance System sites’ websites from 1 January 1990 to 15 January 2016 for articles and reports on MM measurement through VA. Inclusion criteria: article presented results from a VA study where malaria was a cause of death; article discussed limitations/challenges related to measurement of MM through VA. Two authors independently searched the databases and websites and conducted a synthesis of articles using a standard matrix. Results The authors identified 828 publications; 88 were included in the final review. Most publications were VA studies; others were systematic reviews discussing VA tools or methods; editorials or commentaries; and studies using VA data to develop MM estimates. The main limitation were low sensitivity and specificity of VA tools for measuring MM. Other limitations included lack of standardized VA tools and methods, lack of a ‘true’ gold standard to assess accuracy of VA malaria mortality. Conclusions Existing VA tools and methods for measuring MM have limitations. Given the need for data to measure progress toward the World Health Organization’s Global Technical Strategy for Malaria 2016–2030 goals, the malaria community should define strategies for improving MM estimates, including exploring whether VA tools and methods could be further improved. Longer term strategies should focus on improving countries’ vital registration systems for more robust and timely cause of death data. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-2071-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Samantha Herrera
- MEASURE Evaluation, ICF, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA.
| | - Yeetey Enuameh
- Kintampo Health Research Centre, Kintampo, Ghana.,School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - George Adjei
- Kintampo Health Research Centre, Kintampo, Ghana
| | | | | | - Osman Sankoh
- INDEPTH Network, 38 & 40 Mensah Wood Street, East Legon, Accra, Ghana.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Mathematics and Statistics, Njala University, Njala, Sierra Leone
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Kintampo, Ghana.,Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Yazoume Yé
- MEASURE Evaluation, ICF, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA
| |
Collapse
|
46
|
Hershey CL, Bhattarai A, Florey LS, McElroy PD, Nielsen CF, Yé Y, Eckert E, Franca-Koh AC, Shargie E, Komatsu R, Smithson P, Thwing J, Mihigo J, Herrera S, Taylor C, Shah J, Mouzin E, Yoon SS, Salgado SR. Implementing Impact Evaluations of Malaria Control Interventions: Process, Lessons Learned, and Recommendations. Am J Trop Med Hyg 2017; 97:20-31. [PMID: 28990921 PMCID: PMC5619934 DOI: 10.4269/ajtmh.17-0064] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 05/30/2017] [Indexed: 11/07/2022] Open
Abstract
As funding for malaria control increased considerably over the past 10 years resulting in the expanded coverage of malaria control interventions, so did the need to measure the impact of these investments on malaria morbidity and mortality. Members of the Roll Back Malaria (RBM) Partnership undertook impact evaluations of malaria control programs at a time when there was little guidance in terms of the process for conducting an impact evaluation of a national-level malaria control program. The President's Malaria Initiative (PMI), as a member of the RBM Partnership, has provided financial and technical support for impact evaluations in 13 countries to date. On the basis of these experiences, PMI and its partners have developed a streamlined process for conducting the evaluations with a set of lessons learned and recommendations. Chief among these are: to ensure country ownership and involvement in the evaluations; to engage stakeholders throughout the process; to coordinate evaluations among interested partners to avoid duplication of efforts; to tailor the evaluation to the particular country context; to develop a standard methodology for the evaluations and a streamlined process for completion within a reasonable time; and to develop tailored dissemination products on the evaluation for a broad range of stakeholders. These key lessons learned and resulting recommendations will guide future impact evaluations of malaria control programs and other health programs.
Collapse
Affiliation(s)
- Christine L. Hershey
- President’s Malaria Initiative, U.S. Agency for International Development, Washington, District of Columbia
| | - Achuyt Bhattarai
- Malaria Branch and President’s Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lia S. Florey
- The DHS Program, ICF International, Rockville, Maryland
| | - Peter D. McElroy
- Malaria Branch and President’s Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carrie F. Nielsen
- Malaria Branch and President’s Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yazoume Yé
- MEASURE Evaluation, ICF International, Rockville, Maryland
| | - Erin Eckert
- President’s Malaria Initiative, U.S. Agency for International Development, Washington, District of Columbia
| | | | - Estifanos Shargie
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Ryuichi Komatsu
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | | | - Julie Thwing
- Malaria Branch and President’s Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jules Mihigo
- President’s Malaria Initiative, Centers for Disease Control and Prevention, Bamako, Mali
| | | | | | - Jui Shah
- MEASURE Evaluation, ICF International, Rockville, Maryland
| | - Eric Mouzin
- Roll Back Malaria Partnership, Geneva, Switzerland
| | - Steven S. Yoon
- Malaria Branch and President’s Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - S. René Salgado
- President’s Malaria Initiative, U.S. Agency for International Development, Washington, District of Columbia
| |
Collapse
|
47
|
Pérez-Sáez MJ, Herrera S, Prieto-Alhambra D, Vilaplana L, Nogués X, Vera M, Redondo-Pachón D, Mir M, Güerri R, Crespo M, Díez-Pérez A, Pascual J. Bone density, microarchitecture, and material strength in chronic kidney disease patients at the time of kidney transplantation. Osteoporos Int 2017; 28:2723-2727. [PMID: 28497224 DOI: 10.1007/s00198-017-4065-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 04/19/2017] [Indexed: 10/19/2022]
Abstract
UNLABELLED Bone health is assessed by bone mineral density (BMD). Other techniques such as trabecular bone score and microindentation could improve the risk of fracture's estimation. Our chronic kidney disease (CKD) patients presented worse bone health (density, microarchitecture, mechanical properties) than controls. More than BMD should be done to evaluate patients at risk of fracture. INTRODUCTION BMD measured by dual-energy X-ray absorptiometry (DXA) is used to assess bone health in end-stage renal disease (ESRD) patients. Recently, trabecular bone score (TBS) and microindentation that can measure microarchitectural and mechanical properties of bone have demonstrated better correlation with fractures than DXA in different populations. We aimed to characterize bone health (BMD, TBS, and strength) and calcium/phosphate metabolism in a cohort of 53 ESRD patients undergoing kidney transplantation (KT) and 94 controls with normal renal function. METHODS Laboratory workout, lumbar spine/hip BMD measurements (using DXA), lumbar spine TBS, and bone strength were carried out. The latter was assessed with an impact microindentation device, standardized as percentage of a reference value, and expressed as bone material strength index (BMSi) units. Multivariable linear regression was used to study differences between cases and controls adjusted by age, gender, and body mass index. RESULTS Among cases, serum calcium was 9.6 ± 0.7 mg/dl, phosphorus 4.4 ± 1.2 mg/dl, and intact parathyroid hormone 214 pg/ml [102-390]. Fourteen patients (26.4%) had prevalent asymptomatic fractures in spinal X-ray. BMD was significantly lower among ESRD patients compared to controls: lumbar 0.966 ± 0.15 vs 0.982 ± 0.15 (adjusted p = 0.037), total hip 0.852 ± 0.15 vs 0.902 ± 0.13 (adjusted p < 0.001), and femoral neck 0.733 ± 0.15 vs 0.775 ± 0.12 (adjusted p < 0.001), as were TBS (1.20 [1.11-1.30] vs 1.31 [1.19-1.43] (adjusted p < 0.001)) and BMSi (79 [71.8-84.2] vs 82. [77.5-88.9] (adjusted p = 0.005)). CONCLUSIONS ESRD patients undergoing transplant surgery have damaged bone health parameters (density, microarchitecture, and mechanical properties) despite acceptably controlled hyperparathyroidism. Detecting these abnormalities may assist in identifying patients at high risk of post-transplantation fractures.
Collapse
Affiliation(s)
- M J Pérez-Sáez
- Department of Nephrology, Hospital del Mar, Autonomous University of Barcelona, Passeig Maritim 25-29, 08003, Barcelona, Spain
- Institut Mar d'Investigacions Mediques, Barcelona, Spain
- REDINREN, Instituto Carlos III, Madrid, Spain
| | - S Herrera
- Institut Mar d'Investigacions Mediques, Barcelona, Spain
- Department of Internal Medicine, Hospital del Mar, Autonomous University of Barcelona, Passeig Maritim 25-29, 08003, Barcelona, Spain
- RETICEF, Instituto Carlos III, Madrid, Spain
| | - D Prieto-Alhambra
- Institut Mar d'Investigacions Mediques, Barcelona, Spain
- RETICEF, Instituto Carlos III, Madrid, Spain
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7HE, UK
| | - L Vilaplana
- Institut Mar d'Investigacions Mediques, Barcelona, Spain
- Department of Internal Medicine, Hospital del Mar, Autonomous University of Barcelona, Passeig Maritim 25-29, 08003, Barcelona, Spain
- RETICEF, Instituto Carlos III, Madrid, Spain
| | - X Nogués
- Institut Mar d'Investigacions Mediques, Barcelona, Spain
- Department of Internal Medicine, Hospital del Mar, Autonomous University of Barcelona, Passeig Maritim 25-29, 08003, Barcelona, Spain
- RETICEF, Instituto Carlos III, Madrid, Spain
| | - M Vera
- Department of Nephrology, Hospital del Mar, Autonomous University of Barcelona, Passeig Maritim 25-29, 08003, Barcelona, Spain
- Institut Mar d'Investigacions Mediques, Barcelona, Spain
| | - D Redondo-Pachón
- Department of Nephrology, Hospital del Mar, Autonomous University of Barcelona, Passeig Maritim 25-29, 08003, Barcelona, Spain
- Institut Mar d'Investigacions Mediques, Barcelona, Spain
- REDINREN, Instituto Carlos III, Madrid, Spain
| | - M Mir
- Department of Nephrology, Hospital del Mar, Autonomous University of Barcelona, Passeig Maritim 25-29, 08003, Barcelona, Spain
- Institut Mar d'Investigacions Mediques, Barcelona, Spain
| | - R Güerri
- Institut Mar d'Investigacions Mediques, Barcelona, Spain
- Department of Internal Medicine, Hospital del Mar, Autonomous University of Barcelona, Passeig Maritim 25-29, 08003, Barcelona, Spain
- RETICEF, Instituto Carlos III, Madrid, Spain
| | - M Crespo
- Department of Nephrology, Hospital del Mar, Autonomous University of Barcelona, Passeig Maritim 25-29, 08003, Barcelona, Spain
- Institut Mar d'Investigacions Mediques, Barcelona, Spain
- REDINREN, Instituto Carlos III, Madrid, Spain
| | - A Díez-Pérez
- Institut Mar d'Investigacions Mediques, Barcelona, Spain.
- Department of Internal Medicine, Hospital del Mar, Autonomous University of Barcelona, Passeig Maritim 25-29, 08003, Barcelona, Spain.
- RETICEF, Instituto Carlos III, Madrid, Spain.
| | - J Pascual
- Department of Nephrology, Hospital del Mar, Autonomous University of Barcelona, Passeig Maritim 25-29, 08003, Barcelona, Spain.
- Institut Mar d'Investigacions Mediques, Barcelona, Spain.
- REDINREN, Instituto Carlos III, Madrid, Spain.
| |
Collapse
|
48
|
Reátegui J, Herrera S, Boluarte J, Fernández F, Pacheco V, Bernardi S. Comparación de tres técnicas en la preparación de nuestras para la cristalización del flujo cérvical en bovinos lecheros. SPERMOVA 2017. [DOI: 10.18548/aspe/0005.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
49
|
González JM, Olano V, Vergara J, Arévalo-Herrera M, Carrasquilla G, Herrera S, López JA. Unstable, low-level transmission of malaria on the Colombian Pacific Coast. Annals of Tropical Medicine & Parasitology 2016. [DOI: 10.1080/00034983.1997.11813149] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
50
|
Arévalo-Herrera M, Roggero MA, Gonzalez JM, Vergara J, Corradin G, López JA, Herrera S. Mapping and comparison of the B-cell epitopes recognized on thePlasmodium vivaxcircumsporozoite protein by immune Colombians and immunizedAotusmonkeys. Annals of Tropical Medicine & Parasitology 2016. [DOI: 10.1080/00034983.1998.11813311] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|