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Cooper S, Gadanya MA, Kaawa-Mafigiri D, Katoto PDMC, Sambala EZ, Temfack E, Wiysonge CS. Using social media to build confidence in vaccines: lessons from community engagement and social science research in Africa. BMJ 2024; 384:e075564. [PMID: 38228329 PMCID: PMC10789190 DOI: 10.1136/bmj-2023-075564] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Affiliation(s)
- Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | | | - Patrick D M C Katoto
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Centre for Tropical Diseases and Global Health, Catholic University of Bukavu, Democratic Republic of the Congo
- Centre for General Medicine and Global Health, University of Cape Town, South Africa
| | - Evanson Z Sambala
- Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Elvis Temfack
- Division of Public Health Institutes and Research, Africa Centres for Disease Control and Prevention, African Union Commission
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Durban, South Africa
- Vaccine Preventable Diseases Programme, World Health Organization Regional Office for Africa, Brazzaville, Congo
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Nnaji CA, Wiysonge CS, Cooper S, Mayeye A, Luphondo L, Mabuya T, Kalui N, Lesosky M, Ndwandwe D. Contextualising missed opportunities for children's vaccination: A theory-informed qualitative study in primary care settings in Cape Town, South Africa. Hum Vaccin Immunother 2023; 19:2162771. [PMID: 36601915 PMCID: PMC9980502 DOI: 10.1080/21645515.2022.2162771] [Citation(s) in RCA: 2] [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] [Indexed: 01/06/2023] Open
Abstract
This study aimed to explore the contextual factors that may be associated with missed opportunities for vaccination (MOV) from the perspectives of healthcare providers and caregivers attending primary healthcare facilities in the Cape Town Metro Health District, South Africa. The ultimate goal of the assessment was to help inform the design and implementation of a contextually appropriate quality improvement programme targeted at reducing MOV in primary healthcare settings. We used a theory-informed exploratory qualitative research design involving focus group discussions with caregivers of children aged 0-23 months; and in-depth interviews of facility staff. A thematic template analysis approach, integrating the theoretical domains framework (TDF) and the capability, opportunity and motivation model of behavior (COM-B) was used to code and analyze the data. Three focus group sessions were conducted, each consisting of 5-8 caregivers and five in-depth interviews involving facility staff. Capability factors comprised caregivers' knowledge, attitude and behavior toward children's immunization. Opportunity factors included the organization of immunization services, long waiting time, vaccine stock out, staff shortage and health workers' attitude, knowledge and capability to assess children's immunization status and needs. Motivation factors included optimism and beliefs about immunization, fear of vaccine-preventable diseases and immunization safety concerns. This study identified important caregiver-, provider- and health system-related factors, which influence immunization outcomes; offering useful contextual insights for informing quality improvement strategies for reducing MOV at primary healthcare level.
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Affiliation(s)
- Chukwudi A. Nnaji
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa,Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa,CONTACT Chukwudi A. Nnaji, Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, 1 Anzio Road, Observatory, Cape Town 7925, South Africa
| | - Charles S. Wiysonge
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa,Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa,Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa,HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Durban, South Africa
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa,Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa,Division of Social & Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Asanda Mayeye
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Lucy Luphondo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Thobile Mabuya
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Ntomboxolo Kalui
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
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Cooper S, Gupta M, Sim VR, Mullasery V, Winship A, Taylor B, White I. Single Institute Experience with MRI-Guided Adaptive Brachytherapy for Locally Advanced Cervix Cancer: Long Term Outcomes and Toxicity Analysis. Int J Radiat Oncol Biol Phys 2023; 117:e508. [PMID: 37785591 DOI: 10.1016/j.ijrobp.2023.06.1762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) We report over 10 years' experience of MRI-guided adaptive brachytherapy (MRIGABT) in locally advanced cervix cancer (LACC). MATERIALS/METHODS A total of 162 patients with LACC FIGO stage IB-IVB were treated at our institute between 2010 and 2020. Treatment consisted of chemoradiotherapy (weekly intravenous cisplatin 40 mg/m², 5 cycles, 1 day per cycle, 45-50.4 Gy external beam radiotherapy (EBRT) in 1·8-2 Gy fractions, followed by MRIGABT. Target volume definition and dose reporting for MRIGABT was according to GEC-ESTRO recommendations. MRIGABT dose prescription was according to our institutional practice. Overall survival (OS) and disease-free survival (DFS) were the primary endpoints. Kaplan-Meier estimates were calculated for OS and DFS at 2, 5 and 10-years. Organ-specific late toxicity grade ≥3 (≥G3) (CTCAEv5.0) was reported, alongside rates of bowel fistula, stricture, and perforation. Using logistic regression, we explored the relationship between EQD2 D2cc bladder and ≥G3 genitourinary (GU) toxicity. We compared patient proportions developing ≥ G3 GU toxicity in those who received EQD2 ≥85 Gy versus <85 Gy. We examined the following predictors of ≥G3 gastrointestinal (GI) toxicity: EQD2 dose (≥65 Gy versus <65 Gy), pre-existing bowel conditions, nodal boost, and extended field EBRT. RESULTS Median follow up was 4.7 years (IQR 3.3-7.1 years). Median EBRT dose was 50.4 Gy (IQR 50.4-50.4 Gy); 91% received chemotherapy. Median high-risk clinical target volume (HRCTV) was 23.6 cm3 (IQR 16.6-31.3 cm3). Median doses were as follows; D90 HRCTV 88.9 Gy EQD210 (IQR 84.1-91.3 Gy), median D2cc bladder 81.6 (IQR 76.9-85.7 Gy), rectum 62.2 (IQR 57.9-65.3 Gy), sigmoid 67.4 (IQR 60.8-71.1 Gy), and bowel 55 (IQR 49.9-63.2 Gy), (all EQD23). The 2, 5 and-10-year OS were 98%, 80% and 75%. The 2, 5 and 10-year DFS were 98%, 75% and 60%. Late toxicity ≥G3 was 9% GU, 6% GI and 3% vaginal. There was a significant relationship between EQD2 and ≥G3 GU toxicity (OR: 1.11, 95% CI: 1.01-1.25; P = 0.04). When comparing those who received EQD2≥ 85Gy versus <85Gy, higher doses were associated with a greater proportion of ≥G3 GU toxicity (13% vs 6%). No significant predictors of ≥ G3 GI toxicity were observed. CONCLUSION We observed excellent LC and OS. A significant relationship was found between EQD2 >85 Gy and bladder toxicity, although ≥G3 toxicity was low. We did not identify predictors of bowel toxicity. New predictors of bowel toxicity are required. Mean EBRT dose, D1.0 cc rectum, sigmoid and bowel are being investigated further.
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Affiliation(s)
- S Cooper
- Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - M Gupta
- Guy's and St Thomas' Hospital NHS Trust, London, United Kingdom
| | - V R Sim
- Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - V Mullasery
- Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - A Winship
- Guy's and St Thomas' Hospital NHS Trust, London, United Kingdom
| | - B Taylor
- Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - I White
- Guy's and St Thomas' NHS Trust, London, United Kingdom
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Moloi H, Daniels K, Brooke-Sumner C, Cooper S, Odendaal WA, Thorne M, Akama E, Leon N. Healthcare workers' perceptions and experiences of primary healthcare integration: a scoping review of qualitative evidence. Cochrane Database Syst Rev 2023; 7:CD013603. [PMID: 37466272 PMCID: PMC10355136 DOI: 10.1002/14651858.cd013603.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Primary healthcare (PHC) integration has been promoted globally as a tool for health sector reform and universal health coverage (UHC), especially in low-resource settings. However, for a range of reasons, implementation and impact remain variable. PHC integration, at its simplest, can be considered a way of delivering PHC services together that sometimes have been delivered as a series of separate or 'vertical' health programmes. Healthcare workers are known to shape the success of implementing reform interventions. Understanding healthcare worker perceptions and experiences of PHC integration can therefore provide insights into the role healthcare workers play in shaping implementation efforts and the impact of PHC integration. However, the heterogeneity of the evidence base complicates our understanding of their role in shaping the implementation, delivery, and impact of PHC integration, and the role of contextual factors influencing their responses. OBJECTIVES To map the qualitative literature on healthcare workers' perceptions and experiences of PHC integration to characterise the evidence base, with a view to better inform future syntheses on the topic. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 28 July 2020. We did not search for grey literature due to the many published records identified. SELECTION CRITERIA We included studies with qualitative and mixed methods designs that reported on healthcare worker perceptions and experiences of PHC integration from any country. We excluded settings other than PHC and community-based health care, participants other than healthcare workers, and interventions broader than healthcare services. We used translation support from colleagues and Google Translate software to screen non-English records. Where translation was not feasible we categorised these records as studies awaiting classification. DATA COLLECTION AND ANALYSIS For data extraction, we used a customised data extraction form containing items developed using inductive and deductive approaches. We performed independent extraction in duplicate for a sample on 10% of studies allowed for sufficient agreement to be reached between review authors. We analysed extracted data quantitatively by counting the number of studies per indicator and converting these into proportions with additional qualitative descriptive information. Indicators included descriptions of study methods, country setting, intervention type, scope and strategies, implementing healthcare workers, and client target population. MAIN RESULTS The review included 184 studies for analysis based on 191 included papers. Most studies were published in the last 12 years, with a sharp increase in the last five years. Studies mostly employed methods with cross-sectional qualitative design (mainly interviews and focus group discussions), and few used longitudinal or ethnographic (or both) designs. Studies covered 37 countries, with close to an even split in the proportions of high-income countries (HICs) and low- and middle-income countries (LMICs). There were gaps in the geographical spread for both HICs and LMICs and some countries were more dominant, such as the USA for HICs, South Africa for middle-income countries, and Uganda for low-income countries. Methods were mainly cross-sectional observational studies with few longitudinal studies. A minority of studies used an analytical conceptual model to guide the design, implementation, and evaluation of the integration study. The main finding was the various levels of diversity found in the evidence base on PHC integration studies that examined healthcare workers' perceptions and experiences. The review identified six different configurations of health service streams that were being integrated and these were categorised as: mental and behavioural health; HIV, tuberculosis (TB) and sexual reproductive health; maternal, women, and child health; non-communicable diseases; and two broader categories, namely general PHC services, and allied and specialised services. Within the health streams, the review mapped the scope of the interventions as full or partial integration. The review mapped the use of three different integration strategies and categorised these as horizontal integration, service expansion, and service linkage strategies. The wide range of healthcare workers who participated in the implementation of integration interventions was mapped and these included policymakers, senior managers, middle and frontline managers, clinicians, allied healthcare professionals, lay healthcare workers, and health system support staff. We mapped the range of client target populations. AUTHORS' CONCLUSIONS This scoping review provides a systematic, descriptive overview of the heterogeneity in qualitative literature on healthcare workers' perceptions and experience of PHC integration, pointing to diversity with regard to country settings; study types; client populations; healthcare worker populations; and intervention focus, scope, and strategies. It would be important for researchers and decision-makers to understand how the diversity in PHC integration intervention design, implementation, and context may influence how healthcare workers shape PHC integration impact. The classification of studies on the various dimensions (e.g. integration focus, scope, strategy, and type of healthcare workers and client populations) can help researchers to navigate the way the literature varies and for specifying potential questions for future qualitative evidence syntheses.
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Affiliation(s)
- Hlengiwe Moloi
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Carrie Brooke-Sumner
- Alcohol Tobacco and Other Drug Research Unit, The South African Medical Research Council, Cape Town, South Africa
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- Social & Behavioural Sciences Division, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Willem A Odendaal
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | | | - Eliud Akama
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Natalie Leon
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
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Moloi H, Daniels K, Brooke-Sumner C, Cooper S, Odendaal WA, Thorne M, Akama E, Leon N. Healthcare workers' perceptions and experiences of primary healthcare integration: a scoping review of qualitative evidence. Cochrane Database Syst Rev 2023; 7:CD013603. [PMID: 37434293 PMCID: PMC10335778 DOI: 10.1002/14651858.cd013603.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
BACKGROUND Primary healthcare (PHC) integration has been promoted globally as a tool for health sector reform and universal health coverage (UHC), especially in low-resource settings. However, for a range of reasons, implementation and impact remain variable. PHC integration, at its simplest, can be considered a way of delivering PHC services together that sometimes have been delivered as a series of separate or 'vertical' health programmes. Healthcare workers are known to shape the success of implementing reform interventions. Understanding healthcare worker perceptions and experiences of PHC integration can therefore provide insights into the role healthcare workers play in shaping implementation efforts and the impact of PHC integration. However, the heterogeneity of the evidence base complicates our understanding of their role in shaping the implementation, delivery, and impact of PHC integration, and the role of contextual factors influencing their responses. OBJECTIVES To map the qualitative literature on healthcare workers' perceptions and experiences of PHC integration to characterise the evidence base, with a view to better inform future syntheses on the topic. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 28 July 2020. We did not search for grey literature due to the many published records identified. SELECTION CRITERIA We included studies with qualitative and mixed methods designs that reported on healthcare worker perceptions and experiences of PHC integration from any country. We excluded settings other than PHC and community-based health care, participants other than healthcare workers, and interventions broader than healthcare services. We used translation support from colleagues and Google Translate software to screen non-English records. Where translation was not feasible we categorised these records as studies awaiting classification. DATA COLLECTION AND ANALYSIS For data extraction, we used a customised data extraction form containing items developed using inductive and deductive approaches. We performed independent extraction in duplicate for a sample on 10% of studies allowed for sufficient agreement to be reached between review authors. We analysed extracted data quantitatively by counting the number of studies per indicator and converting these into proportions with additional qualitative descriptive information. Indicators included descriptions of study methods, country setting, intervention type, scope and strategies, implementing healthcare workers, and client target population. MAIN RESULTS The review included 184 studies for analysis based on 191 included papers. Most studies were published in the last 12 years, with a sharp increase in the last five years. Studies mostly employed methods with cross-sectional qualitative design (mainly interviews and focus group discussions), and few used longitudinal or ethnographic (or both) designs. Studies covered 37 countries, with close to an even split in the proportions of high-income countries (HICs) and low- and middle-income countries (LMICs). There were gaps in the geographical spread for both HICs and LMICs and some countries were more dominant, such as the USA for HICs, South Africa for middle-income countries, and Uganda for low-income countries. Methods were mainly cross-sectional observational studies with few longitudinal studies. A minority of studies used an analytical conceptual model to guide the design, implementation, and evaluation of the integration study. The main finding was the various levels of diversity found in the evidence base on PHC integration studies that examined healthcare workers' perceptions and experiences. The review identified six different configurations of health service streams that were being integrated and these were categorised as: mental and behavioural health; HIV, tuberculosis (TB) and sexual reproductive health; maternal, women, and child health; non-communicable diseases; and two broader categories, namely general PHC services, and allied and specialised services. Within the health streams, the review mapped the scope of the interventions as full or partial integration. The review mapped the use of three different integration strategies and categorised these as horizontal integration, service expansion, and service linkage strategies. The wide range of healthcare workers who participated in the implementation of integration interventions was mapped and these included policymakers, senior managers, middle and frontline managers, clinicians, allied healthcare professionals, lay healthcare workers, and health system support staff. We mapped the range of client target populations. AUTHORS' CONCLUSIONS This scoping review provides a systematic, descriptive overview of the heterogeneity in qualitative literature on healthcare workers' perceptions and experience of PHC integration, pointing to diversity with regard to country settings; study types; client populations; healthcare worker populations; and intervention focus, scope, and strategies. It would be important for researchers and decision-makers to understand how the diversity in PHC integration intervention design, implementation, and context may influence how healthcare workers shape PHC integration impact. The classification of studies on the various dimensions (e.g. integration focus, scope, strategy, and type of healthcare workers and client populations) can help researchers to navigate the way the literature varies and for specifying potential questions for future qualitative evidence syntheses.
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Affiliation(s)
- Hlengiwe Moloi
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Carrie Brooke-Sumner
- Alcohol Tobacco and Other Drug Research Unit, The South African Medical Research Council, Cape Town, South Africa
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- Social & Behavioural Sciences Division, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Willem A Odendaal
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | | | - Eliud Akama
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Natalie Leon
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
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Smitherman EA, Chahine RA, Beukelman T, Lewandowski LB, Rahman AKMF, Wenderfer SE, Curtis JR, Hersh AO, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar‐Smiley F, Barillas‐Arias L, Basiaga M, Baszis K, Becker M, Bell‐Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang‐Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel‐Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie‐Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui‐Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein‐Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PM, McGuire S, McHale I, McMonagle A, McMullen‐Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O'Brien B, O'Brien T, Okeke O, Oliver M, Olson J, O'Neil K, Onel K, Orandi A, Orlando M, Osei‐Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan‐Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas‐Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth‐Wojcicki E, Rouster – Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert‐Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner‐Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Childhood-Onset Lupus Nephritis in the Childhood Arthritis and Rheumatology Research Alliance Registry: Short-Term Kidney Status and Variation in Care. Arthritis Care Res (Hoboken) 2023; 75:1553-1562. [PMID: 36775844 PMCID: PMC10500561 DOI: 10.1002/acr.25002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 07/14/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The goal was to characterize short-term kidney status and describe variation in early care utilization in a multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE) and nephritis. METHODS We analyzed previously collected prospective data from North American patients with cSLE with kidney biopsy-proven nephritis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from March 2017 through December 2019. We determined the proportion of patients with abnormal kidney status at the most recent registry visit and applied generalized linear mixed models to identify associated factors. We also calculated frequency of medication use, both during induction and ever recorded. RESULTS We identified 222 patients with kidney biopsy-proven nephritis, with 64% class III/IV nephritis on initial biopsy. At the most recent registry visit at median (interquartile range) of 17 (8-29) months from initial kidney biopsy, 58 of 106 patients (55%) with available data had abnormal kidney status. This finding was associated with male sex (odds ratio [OR] 3.88, 95% confidence interval [95% CI] 1.21-12.46) and age at cSLE diagnosis (OR 1.23, 95% CI 1.01-1.49). Patients with class IV nephritis were more likely than class III to receive cyclophosphamide and rituximab during induction. There was substantial variation in mycophenolate, cyclophosphamide, and rituximab ever use patterns across rheumatology centers. CONCLUSION In this cohort with predominately class III/IV nephritis, male sex and older age at cSLE diagnosis were associated with abnormal short-term kidney status. We also observed substantial variation in contemporary medication use for pediatric lupus nephritis between pediatric rheumatology centers. Additional studies are needed to better understand the impact of this variation on long-term kidney outcomes.
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Cooper S, Wiysonge CS. Towards a More Critical Public Health Understanding of Vaccine Hesitancy: Key Insights from a Decade of Research. Vaccines (Basel) 2023; 11:1155. [PMID: 37514971 PMCID: PMC10386194 DOI: 10.3390/vaccines11071155] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023] Open
Abstract
Vaccine hesitancy has gained renewed attention as an important public health concern worldwide. Against this backdrop, over the last decade, we have conducted various qualitative, social science studies with the broad shared aim of better understanding this complex phenomenon. This has included various Cochrane systematic reviews of qualitative research globally, systematic reviews of qualitative research in Africa, and primary research studies in South Africa. These studies have also explored vaccine hesitancy for various vaccines, including routine childhood vaccination, HPV vaccination and other routine vaccinations for adolescents, and, most recently, COVID-19 vaccination. In this reflective and critical commentary piece we reflect on seven key overarching insights we feel we have gained about this complex phenomenon from the varying studies we have conducted over the past decade. These insights comprise the following: (1) the relationship between vaccine knowledge and hesitancy is complex and may operate in multiple directions; (2) vaccine hesitancy is driven by multiple socio-political forces; (3) vaccine hesitancy may be many things, rather than a single phenomenon; (4) vaccine hesitancy may be an ongoing 'process', rather than a fixed 'stance'; (5) vaccine hesitancy may sometimes be about a 'striving', rather than a 'resisting'; (6) 'distrust' as a driver of vaccine hesitancy needs to be better contextualized and disaggregated; and (7) the 'demand-side' versus 'supply/access-side' distinction of the drivers of suboptimal vaccination may be misleading and unhelpful. In unpacking these insights, we problematize some of the common assumptions within the vaccine hesitancy literature and flag topics that we think could benefit from further scrutiny and debate. Our hope is that this can provide a platform for further engagement on these issues and ultimately contribute towards fostering a more critical public health understanding of vaccine hesitancy.
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Affiliation(s)
- Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town 7505, South Africa;
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town 7505, South Africa;
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Durban 4091, South Africa
- Vaccine Preventable Diseases Programme, Universal Health Coverage/Communicable and Non-Communicable Diseases Cluster, World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo
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Mavundza EJ, Cooper S, Wiysonge CS. A Systematic Review of Factors That Influence Parents’ Views and Practices around Routine Childhood Vaccination in Africa: A Qualitative Evidence Synthesis. Vaccines (Basel) 2023; 11:vaccines11030563. [PMID: 36992146 DOI: 10.3390/vaccines11030563] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/21/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023] Open
Abstract
A Cochrane review which explored the factors that influence caregivers’ views and practices around routine childhood vaccines worldwide was conducted by Cooper and colleagues. After sampling 154 studies that met their inclusion criteria, the authors included 27 studies in their synthesis, of which 6 were from Africa. The aim of the current review was to synthesise all 27 studies conducted in Africa. We wanted to determine if the inclusion of additional African studies will change any of the themes, concepts or theory generated in the Cochrane review. Our review found that parents’ views and practices regarding childhood vaccination in Africa were influenced by various factors, which we categorised into five themes, namely, ideas and practices surrounding health and illness (Theme 1); social communities and networks (Theme 2); political events, relations, and processes (Theme 3); lack of information or knowledge (Theme 4); and access-supply-demand interactions (Theme 5). All of the themes identified in our review were also identified in the Cochrane review except for one theme, which was lack of information or knowledge. This finding will help to promote vaccine acceptance and uptake in Africa by developing and implementing interventions tailored to address lack of knowledge and information around vaccines.
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Affiliation(s)
- Edison J Mavundza
- Cochrane South Africa, South African Medical Research Council, Cape Town 7500, South Africa
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town 7500, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa
- Department of Global Health, Stellenbosch University, Cape Town 7505, South Africa
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town 7500, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa
- Department of Global Health, Stellenbosch University, Cape Town 7505, South Africa
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Durban 4091, South Africa
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Cooper S, van Rooyen H, Wiysonge CS. Addressing COVID-19 vaccine hesitancy in South Africa- moving beyond a reliance on information-based responses. Hum Vaccin Immunother 2022; 18:2107851. [PMID: 35993844 DOI: 10.1080/21645515.2022.2107851] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
It has been over a year since South Africa officially began its national COVID-19 vaccination programme. Yet, currently only half of the adult population is fully vaccinated. While supply-related challenges continue to contribute to suboptimal vaccination coverage, so too does vaccine hesitancy. Drawing on research conducted over the last year, we highlight some overarching insights around the nature and drivers of COVID-19 vaccine hesitancy in South Africa and how this complex phenomenon might be addressed. We have found multiple socio-economic and political root causes of COVID-19 vaccine hesitancy, many of which are not knowledge-related. These include inter alia fear and uncertainty, practical challenges around access, experiences of poverty and marginalization, and the ongoing geopolitics surrounding the pandemic. Intervention strategies therefore need to form part of broader development and trust-building measures that focus on relationships, transparency, inclusion, equity and justice. This is essential if we hope to bolster acceptance of and demand for vaccines during and beyond the COVID-19 pandemic.
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Affiliation(s)
- Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Heidi van Rooyen
- Impact Centre, Human Sciences Research Council, Pretoria, South Africa.,SAMRC-Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Durban, South Africa
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Hahn T, Daymont C, Beukelman T, Groh B, Hays K, Bingham CA, Scalzi L, Abel N, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar-Smiley F, Barillas-Arias L, Basiaga M, Baszis K, Becker M, Bell-Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang-Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel-Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie-Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui-Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein-Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PMC, McGuire S, McHale I, McMonagle A, McMullen-Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O’Brien B, O’Brien T, Okeke O, Oliver M, Olson J, O’Neil K, Onel K, Orandi A, Orlando M, Osei-Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan-Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas-Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth-Wojcicki E, Rouster-Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert-Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner-Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry. Pediatr Rheumatol Online J 2022; 20:107. [PMID: 36434731 PMCID: PMC9701017 DOI: 10.1186/s12969-022-00770-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Children with juvenile idiopathic arthritis (JIA) who achieve a drug free remission often experience a flare of their disease requiring either intraarticular steroids (IAS) or systemic treatment with disease modifying anti-rheumatic drugs (DMARDs). IAS offer an opportunity to recapture disease control and avoid exposure to side effects from systemic immunosuppression. We examined a cohort of patients treated with IAS after drug free remission and report the probability of restarting systemic treatment within 12 months. METHODS We analyzed a cohort of patients from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry who received IAS for a flare after a period of drug free remission. Historical factors and clinical characteristics and of the patients including data obtained at the time of treatment were analyzed. RESULTS We identified 46 patients who met the inclusion criteria. Of those with follow up data available 49% had restarted systemic treatment 6 months after IAS injection and 70% had restarted systemic treatment at 12 months. The proportion of patients with prior use of a biologic DMARD was the only factor that differed between patients who restarted systemic treatment those who did not, both at 6 months (79% vs 35%, p < 0.01) and 12 months (81% vs 33%, p < 0.05). CONCLUSION While IAS are an option for all patients who flare after drug free remission, it may not prevent the need to restart systemic treatment. Prior use of a biologic DMARD may predict lack of success for IAS. Those who previously received methotrexate only, on the other hand, are excellent candidates for IAS.
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Affiliation(s)
- Timothy Hahn
- Department of Pediatrics, Penn State Children's Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA, 17033-0855, USA.
| | - Carrie Daymont
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Timothy Beukelman
- grid.265892.20000000106344187Department of Pediatrics, University of Alabama at Birmingham, CPPN G10, 1600 7th Ave South, Birmingham, AL 35233 USA
| | - Brandt Groh
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | | | - Catherine April Bingham
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Lisabeth Scalzi
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
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Kalra N, Livermore J, Spink S, Boyer G, O'Malley L, Flatley M, Maguire M, Fairclough S, Wright E, Armstrong C, Stephenson E, Ewan S, Cooper S, Guy D, Saunders D, Igra M, Macmullen-Price J, Currie S, Zaman A, Derbyshire C, Chakrabarty A, Gooden J, Chumas P, Mathew R. NCOG-28. LEEDS LOW GRADE GLIOMA SERVICE 2010-2022: A 12-YEAR EXPERIENCE. Neuro Oncol 2022. [PMCID: PMC9660792 DOI: 10.1093/neuonc/noac209.779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
INTRODUCTION
We present our 12-year experience of the surgical management of lower-grade gliomas (LGGs) by a multidisciplinary team in a large tertiary UK brain tumour centre.
METHODS
Retrospective analysis of all adult patients who underwent surgery in the Leeds Low Grade Glioma Service between January 2010 and January 2022. Data collected included demographics, procedure type, extent of resection, histological diagnosis, morbidity, mortality, tumour location, seizure control, adjuvant therapy, cognitive outcomes, progression-free survival (PFS) and overall survival (OS). Results were statistically analysed by Kaplan-Meier and Log Rank (Cox Proportional Regression Hazard) Testing (p< 0.05).
RESULTS
254 patients underwent surgery between 2010-2022. Of these, 77 patients underwent a second resection surgery, 9 a third, and 1 patient had a total of 4 resections. 184 operations were carried out awake, 115 asleep and 42 patients underwent biopsy only. The most common histology at initial surgery was astrocytoma, IDH1m, WHO Grade 2 (41.7%) with oligodendroglioma, IDH1m, WHO Grade 2 being the second most common. The majority of tumors were located in the right frontal lobe (24%) followed by the left frontal lobe (18%). 32% of tumors were on the left side. The median time between diagnosis and first surgery was 36.5 months. 8 patients died during this time frame, 7 who had resection, 1 had biopsy.
CONCLUSION
Our experience of the surgical management of LGG over the last 12 years shows that maximal safe surgical resection remains important as first-line treatment. Greater extent of resection (EOR) can delay transformation, control seizures and improve survival. Awake surgery is well tolerated and can preserve eloquent function. A multidisciplinary team approach achieves the best outcomes, and is appreciated by our patients
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Affiliation(s)
- Neeraj Kalra
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
| | - James Livermore
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
| | - Suzanne Spink
- Department of Speech and Language Therapy, Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
| | - Gillian Boyer
- Department of Neuro-Oncology, Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
| | - Lianne O'Malley
- Department of Neuro-Oncology, Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
| | - Michael Flatley
- Department of Neuro-Oncology, Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
| | - Melissa Maguire
- Department of Neurology, Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
| | - Sam Fairclough
- Department of Neurology, Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
| | - Elizabeth Wright
- Department of Neurology, Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
| | - Caroline Armstrong
- Department of Neurology, Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
| | - Elisa Stephenson
- Department of Physiotherapy, Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
| | - Seonaid Ewan
- Department of Physiotherapy, Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
| | - Sara Cooper
- Department of Physiotherapy, Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
| | - Danielle Guy
- Department of Orthoptics, Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
| | - David Saunders
- Department of Neuro-Radiology, Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
| | - Mark Igra
- Department of Neuro-Radiology, Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
| | - Jeremy Macmullen-Price
- Department of Neuro-Radiology, Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
| | - Stuart Currie
- Department of Neuro-Radiology, Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
| | - Arshad Zaman
- Department of Neuro-Radiology, Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
| | - Catherine Derbyshire
- Department of Neuropsychology, Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
| | - Arundhati Chakrabarty
- Department of Histopathology, Leeds Teaching Hospitals NHS Trust, Leeds , England , United Kingdom
| | - John Gooden
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
| | - Paul Chumas
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust , Leeds , United Kingdom
| | - Ryan Mathew
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds , England , United Kingdom
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Paskey A, Ackerley L, Buckley C, Cooper S, Bainbridge S. Promoting the key moments of hand hygiene in a Targeted Hygiene intervention at COP26. Eur J Public Health 2022. [PMCID: PMC9594181 DOI: 10.1093/eurpub/ckac131.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The COP26 conference in Glasgow, November 2021 presented a unique public health challenge in the midst of the COVID-19 pandemic. With 38,457 delegates attending, this international event posed a risk for SARS-CoV-2 infection. We used Targeted Hygiene theory to carry out a large event risk assessment process that focused on how spaces were used, referred to evidence from scientific literature, and identified key moments for surface and hand hygiene interventions. We relied on behavioural science evidence to optimize hand hygiene compliance at the event. To do so, we secured the opportunity to use hand sanitizer by determining the most suitable locations for over 500 hand sanitizing stations. To further motivate uptake of personal hygiene, kits were provided for each delegate with hygiene messaging to improve knowledge of the importance of hand hygiene in breaking the chain of infection. A COP26-branded face covering, personal hand gel and wipes were provided in the pack. Training and cleaning protocols centred on Targeted Hygiene were developed for cleaning teams to implement. Compliance monitoring through observation and daily real-time reporting of over 250 adenosine triphosphate (ATP) checks on just-cleaned surfaces provided reassurance for public health agencies that our Targeted Hygiene approach was effective. The messaging and cleaning interventions were carried out for the duration of the COP26 conference. The number of individuals officially affiliated with COP26 that tested positive was ∼2 in 1,000 as compared to ∼11-12 in 1,000 individuals in Scotland during the same period (6-13 November 2021 as reported by Public Health Scotland). Whilst no single control can be attributed to this achievement, effective hand and surface hygiene interventions contributed by helping to break the chain of infection. This risk-based approach to Targeted Hygiene serves as a blueprint for effective, sustainable and measurable nonpharmaceutical interventions at large scale events. Key messages • To mitigate risk of infection at COP26, key moments for surface and hand hygiene were identified and emphasized in cleaning protocols and education. • Using a risk-based approach to Targeted Hygiene serves as a blueprint for effective, sustainable and measurable nonpharmaceutical interventions at large scale events such as COP26.
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Affiliation(s)
- A Paskey
- Medical Sciences - Germ Protection , Reckitt, Montvale, USA
| | - L Ackerley
- Medical and Scientific Engagement , Reckitt, Slough, UK
| | - C Buckley
- Medical Sciences - Germ Protection , Reckitt, Hull, UK
| | - S Cooper
- Medical Sciences - Germ Protection , Reckitt, Hull, UK
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Thakkar R, Wharf O, Hanson M, Badenoch T, Hunter I, Bamford R, Cooper S. 1001 Surgical Escape Rooms: A Novel Approach for Teaching Surgical Skills. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Aim
Traditional classroom-based teaching of surgical skills has been used commonly in the past. Although, use of an escape room is a new form of a practical teaching method to deliver surgical skills teaching. We compared and assessed effectiveness of the traditional classroom teaching versus practical escape room teaching of the basic surgical skills.
Method
Two teaching sessions were delivered to third year medical students. Each session consisted of two groups and two sessions. Each group received either the classroom-based teaching or the escape room teaching, then switching over to the other teaching. Each student was asked to complete a questionnaire before the session, after the first and the second teaching session. Teaching covered interrupted suturing, wound management, and administration of local aesthetic. Likert scores were used to collect feedback.
Results
Total 24 third year medical students attended the two teaching sessions. 100% either agreed or strongly agreed the classroom teaching was useful, compared to 75% for the escape room. 67% either agreed or strongly agreed that escape room style teaching is a better learning method than traditional teaching. Although, 79% either agree or strongly agree that escape room style teaching is a useful adjunct to the traditional teaching. 100% either agree or strongly agree that this teaching will improve their clinical practice.
Conclusions
Traditional classroom-based teaching is a more useful form of teaching compared to the escape room. Although escape room teaching is a useful adjunct to the current common form of classroom based surgical teaching.
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Affiliation(s)
- R Thakkar
- Somerset NHS Foundation Trust , Taunton , United Kingdom
| | - O Wharf
- Somerset NHS Foundation Trust , Taunton , United Kingdom
| | - M Hanson
- Somerset NHS Foundation Trust , Taunton , United Kingdom
| | - T Badenoch
- Somerset NHS Foundation Trust , Taunton , United Kingdom
| | - I Hunter
- Somerset NHS Foundation Trust , Taunton , United Kingdom
| | - R Bamford
- Somerset NHS Foundation Trust , Taunton , United Kingdom
| | - S Cooper
- Somerset NHS Foundation Trust , Taunton , United Kingdom
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Evans RA, Leavy OC, Richardson M, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Aul R, Beirne P, Bolton CE, Brown JS, Choudhury G, Diar-Bakerly N, Easom N, Echevarria C, Fuld J, Hart N, Hurst J, Jones MG, Parekh D, Pfeffer P, Rahman NM, Rowland-Jones SL, Shah AM, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Greening NJ, Heaney LG, Heller S, Howard LS, Jacob J, Jenkins RG, Lord JM, Man WDC, McCann GP, Neubauer S, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Semple MG, Singh SJ, Thomas DC, Toshner M, Lewis KE, Thwaites RS, Briggs A, Docherty AB, Kerr S, Lone NI, Quint J, Sheikh A, Thorpe M, Zheng B, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Harrison EM, Wain LV, Brightling CE, Abel K, Adamali H, Adeloye D, Adeyemi O, Adrego R, Aguilar Jimenez LA, Ahmad S, Ahmad Haider N, Ahmed R, Ahwireng N, Ainsworth M, Al-Sheklly B, Alamoudi A, Ali M, Aljaroof M, All AM, Allan L, Allen RJ, Allerton L, Allsop L, Almeida P, Altmann D, Alvarez Corral M, Amoils S, Anderson D, Antoniades C, Arbane G, Arias A, Armour C, Armstrong L, Armstrong N, Arnold D, Arnold H, Ashish A, Ashworth A, Ashworth M, Aslani S, Assefa-Kebede H, Atkin C, Atkin P, Aung H, Austin L, Avram C, Ayoub A, Babores M, Baggott R, Bagshaw J, Baguley D, Bailey L, Baillie JK, Bain S, Bakali M, Bakau M, Baldry E, Baldwin D, Ballard C, Banerjee A, Bang B, Barker RE, Barman L, Barratt S, Barrett F, Basire D, Basu N, Bates M, Bates A, Batterham R, Baxendale H, Bayes H, Beadsworth M, Beckett P, Beggs M, Begum M, Bell D, Bell R, Bennett K, Beranova E, Bermperi A, Berridge A, Berry C, Betts S, Bevan E, Bhui K, Bingham M, Birchall K, Bishop L, Bisnauthsing K, Blaikely J, Bloss A, Bolger A, Bonnington J, Botkai A, Bourne C, Bourne M, Bramham K, Brear L, Breen G, Breeze J, Bright E, Brill S, Brindle K, Broad L, Broadley A, Brookes C, Broome M, Brown A, Brown A, Brown J, Brown J, Brown M, Brown M, Brown V, Brugha T, Brunskill N, Buch M, Buckley P, Bularga A, Bullmore E, Burden L, Burdett T, Burn D, Burns G, Burns A, Busby J, Butcher R, Butt A, Byrne S, Cairns P, Calder PC, Calvelo E, Carborn H, Card B, Carr C, Carr L, Carson G, Carter P, Casey A, Cassar M, Cavanagh J, Chablani M, Chambers RC, Chan F, Channon KM, Chapman K, Charalambou A, Chaudhuri N, Checkley A, Chen J, Cheng Y, Chetham L, Childs C, Chilvers ER, Chinoy H, Chiribiri A, Chong-James K, Choudhury N, Chowienczyk P, Christie C, Chrystal M, Clark D, Clark C, Clarke J, Clohisey S, Coakley G, Coburn Z, Coetzee S, Cole J, Coleman C, Conneh F, Connell D, Connolly B, Connor L, Cook A, Cooper B, Cooper J, Cooper S, Copeland D, Cosier T, Coulding M, Coupland C, Cox E, Craig T, Crisp P, Cristiano D, Crooks MG, Cross A, Cruz I, Cullinan P, Cuthbertson D, Daines L, Dalton M, Daly P, Daniels A, Dark P, Dasgin J, David A, David C, Davies E, Davies F, Davies G, Davies GA, Davies K, Dawson J, Daynes E, Deakin B, Deans A, Deas C, Deery J, Defres S, Dell A, Dempsey K, Denneny E, Dennis J, Dewar A, Dharmagunawardena R, Dickens C, Dipper A, Diver S, Diwanji SN, Dixon M, Djukanovic R, Dobson H, Dobson SL, Donaldson A, Dong T, Dormand N, Dougherty A, Dowling R, Drain S, Draxlbauer K, Drury K, Dulawan P, Dunleavy A, Dunn S, Earley J, Edwards S, Edwardson C, El-Taweel H, Elliott A, Elliott K, Ellis Y, Elmer A, Evans D, Evans H, Evans J, Evans R, Evans RI, Evans T, Evenden C, Evison L, Fabbri L, Fairbairn S, Fairman A, Fallon K, Faluyi D, Favager C, Fayzan T, Featherstone J, Felton T, Finch J, Finney S, Finnigan J, Finnigan L, Fisher H, Fletcher S, Flockton R, Flynn M, Foot H, Foote D, Ford A, Forton D, Fraile E, Francis C, Francis R, Francis S, Frankel A, Fraser E, Free R, French N, Fu X, Furniss J, Garner L, Gautam N, George J, George P, Gibbons M, Gill M, Gilmour L, Gleeson F, Glossop J, Glover S, Goodman N, Goodwin C, Gooptu B, Gordon H, Gorsuch T, Greatorex M, Greenhaff PL, Greenhalgh A, Greenwood J, Gregory H, Gregory R, Grieve D, Griffin D, Griffiths L, Guerdette AM, Guillen Guio B, Gummadi M, Gupta A, Gurram S, Guthrie E, Guy Z, H Henson H, Hadley K, Haggar A, Hainey K, Hairsine B, Haldar P, Hall I, Hall L, Halling-Brown M, Hamil R, Hancock A, Hancock K, Hanley NA, Haq S, Hardwick HE, Hardy E, Hardy T, Hargadon B, Harrington K, Harris E, Harrison P, Harvey A, Harvey M, Harvie M, Haslam L, Havinden-Williams M, Hawkes J, Hawkings N, Haworth J, Hayday A, Haynes M, Hazeldine J, Hazelton T, Heeley C, Heeney JL, Heightman M, Henderson M, Hesselden L, Hewitt M, Highett V, Hillman T, Hiwot T, Hoare A, Hoare M, Hockridge J, Hogarth P, Holbourn A, Holden S, Holdsworth L, Holgate D, Holland M, Holloway L, Holmes K, Holmes M, Holroyd-Hind B, Holt L, Hormis A, Hosseini A, Hotopf M, Howard K, Howell A, Hufton E, Hughes AD, Hughes J, Hughes R, Humphries A, Huneke N, Hurditch E, Husain M, Hussell T, Hutchinson J, Ibrahim W, Ilyas F, Ingham J, Ingram L, Ionita D, Isaacs K, Ismail K, Jackson T, James WY, Jarman C, Jarrold I, Jarvis H, Jastrub R, Jayaraman B, Jezzard P, Jiwa K, Johnson C, Johnson S, Johnston D, Jolley CJ, Jones D, Jones G, Jones H, Jones H, Jones I, Jones L, Jones S, Jose S, Kabir T, Kaltsakas G, Kamwa V, Kanellakis N, Kaprowska S, Kausar Z, Keenan N, Kelly S, Kemp G, Kerslake H, Key AL, Khan F, Khunti K, Kilroy S, King B, King C, Kingham L, Kirk J, Kitterick P, Klenerman P, Knibbs L, Knight S, Knighton A, Kon O, Kon S, Kon SS, Koprowska S, Korszun A, Koychev I, Kurasz C, Kurupati P, Laing C, Lamlum H, Landers G, Langenberg C, Lasserson D, Lavelle-Langham L, Lawrie A, Lawson C, Lawson C, Layton A, Lea A, Lee D, Lee JH, Lee E, Leitch K, Lenagh R, Lewis D, Lewis J, Lewis V, Lewis-Burke N, Li X, Light T, Lightstone L, Lilaonitkul W, Lim L, Linford S, Lingford-Hughes A, Lipman M, Liyanage K, Lloyd A, Logan S, Lomas D, Loosley R, Lota H, Lovegrove W, Lucey A, Lukaschuk E, Lye A, Lynch C, MacDonald S, MacGowan G, Macharia I, Mackie J, Macliver L, Madathil S, Madzamba G, Magee N, Magtoto MM, Mairs N, Majeed N, Major E, Malein F, Malim M, Mallison G, Mandal S, Mangion K, Manisty C, Manley R, March K, Marciniak S, Marino P, Mariveles M, Marouzet E, Marsh S, Marshall B, Marshall M, Martin J, Martineau A, Martinez LM, Maskell N, Matila D, Matimba-Mupaya W, Matthews L, Mbuyisa A, McAdoo S, Weir McCall J, McAllister-Williams H, McArdle A, McArdle P, McAulay D, McCormick J, McCormick W, McCourt P, McGarvey L, McGee C, Mcgee K, McGinness J, McGlynn K, McGovern A, McGuinness H, McInnes IB, McIntosh J, McIvor E, McIvor K, McLeavey L, McMahon A, McMahon MJ, McMorrow L, Mcnally T, McNarry M, McNeill J, McQueen A, McShane H, Mears C, Megson C, Megson S, Mehta P, Meiring J, Melling L, Mencias M, Menzies D, Merida Morillas M, Michael A, Milligan L, Miller C, Mills C, Mills NL, Milner L, Misra S, Mitchell J, Mohamed A, Mohamed N, Mohammed S, Molyneaux PL, Monteiro W, Moriera S, Morley A, Morrison L, Morriss R, Morrow A, Moss AJ, Moss P, Motohashi K, Msimanga N, Mukaetova-Ladinska E, Munawar U, Murira J, Nanda U, Nassa H, Nasseri M, Neal A, Needham R, Neill P, Newell H, Newman T, Newton-Cox A, Nicholson T, Nicoll D, Nolan CM, Noonan MJ, Norman C, Novotny P, Nunag J, Nwafor L, Nwanguma U, Nyaboko J, O'Donnell K, O'Brien C, O'Brien L, O'Regan D, Odell N, Ogg G, Olaosebikan O, Oliver C, Omar Z, Orriss-Dib L, Osborne L, Osbourne R, Ostermann M, Overton C, Owen J, Oxton J, Pack J, Pacpaco E, Paddick S, Painter S, Pakzad A, Palmer S, Papineni P, Paques K, Paradowski K, Pareek M, Parfrey H, Pariante C, Parker S, Parkes M, Parmar J, Patale S, Patel B, Patel M, Patel S, Pattenadk D, Pavlides M, Payne S, Pearce L, Pearl JE, Peckham D, Pendlebury J, Peng Y, Pennington C, Peralta I, Perkins E, Peterkin Z, Peto T, Petousi N, Petrie J, Phipps J, Pimm J, Piper Hanley K, Pius R, Plant H, Plein S, Plekhanova T, Plowright M, Polgar O, Poll L, Porter J, Portukhay S, Powell N, Prabhu A, Pratt J, Price A, Price C, Price C, Price D, Price L, Price L, Prickett A, Propescu J, Pugmire S, Quaid S, Quigley J, Qureshi H, Qureshi IN, Radhakrishnan K, Ralser M, Ramos A, Ramos H, Rangeley J, Rangelov B, Ratcliffe L, Ravencroft P, Reddington A, Reddy R, Redfearn H, Redwood D, Reed A, Rees M, Rees T, Regan K, Reynolds W, Ribeiro C, Richards A, Richardson E, Rivera-Ortega P, Roberts K, Robertson E, Robinson E, Robinson L, Roche L, Roddis C, Rodger J, Ross A, Ross G, Rossdale J, Rostron A, Rowe A, Rowland A, Rowland J, Roy K, Roy M, Rudan I, Russell R, Russell E, Saalmink G, Sabit R, Sage EK, Samakomva T, Samani N, Sampson C, Samuel K, Samuel R, Sanderson A, Sapey E, Saralaya D, Sargant J, Sarginson C, Sass T, Sattar N, Saunders K, Saunders P, Saunders LC, Savill H, Saxon W, Sayer A, Schronce J, Schwaeble W, Scott K, Selby N, Sewell TA, Shah K, Shah P, Shankar-Hari M, Sharma M, Sharpe C, Sharpe M, Shashaa S, Shaw A, Shaw K, Shaw V, Shelton S, Shenton L, Shevket K, Short J, Siddique S, Siddiqui S, Sidebottom J, Sigfrid L, Simons G, Simpson J, Simpson N, Singh C, Singh S, Sissons D, Skeemer J, Slack K, Smith A, Smith D, Smith S, Smith J, Smith L, Soares M, Solano TS, Solly R, Solstice AR, Soulsby T, Southern D, Sowter D, Spears M, Spencer LG, Speranza F, Stadon L, Stanel S, Steele N, Steiner M, Stensel D, Stephens G, Stephenson L, Stern M, Stewart I, Stimpson R, Stockdale S, Stockley J, Stoker W, Stone R, Storrar W, Storrie A, Storton K, Stringer E, Strong-Sheldrake S, Stroud N, Subbe C, Sudlow CL, Suleiman Z, Summers C, Summersgill C, Sutherland D, Sykes DL, Sykes R, Talbot N, Tan AL, Tarusan L, Tavoukjian V, Taylor A, Taylor C, Taylor J, Te A, Tedd H, Tee CJ, Teixeira J, Tench H, Terry S, Thackray-Nocera S, Thaivalappil F, Thamu B, Thickett D, Thomas C, Thomas S, Thomas AK, Thomas-Woods T, Thompson T, Thompson AAR, Thornton T, Tilley J, Tinker N, Tiongson GF, Tobin M, Tomlinson J, Tong C, Touyz R, Tripp KA, Tunnicliffe E, Turnbull A, Turner E, Turner S, Turner V, Turner K, Turney S, Turtle L, Turton H, Ugoji J, Ugwuoke R, Upthegrove R, Valabhji J, Ventura M, Vere J, Vickers C, Vinson B, Wade E, Wade P, Wainwright T, Wajero LO, Walder S, Walker S, Walker S, Wall E, Wallis T, Walmsley S, Walsh JA, Walsh S, Warburton L, Ward TJC, Warwick K, Wassall H, Waterson S, Watson E, Watson L, Watson J, Welch C, Welch H, Welsh B, Wessely S, West S, Weston H, Wheeler H, White S, Whitehead V, Whitney J, Whittaker S, Whittam B, Whitworth V, Wight A, Wild J, Wilkins M, Wilkinson D, Williams N, Williams N, Williams J, Williams-Howard SA, Willicombe M, Willis G, Willoughby J, Wilson A, Wilson D, Wilson I, Window N, Witham M, Wolf-Roberts R, Wood C, Woodhead F, Woods J, Wormleighton J, Worsley J, Wraith D, Wrey Brown C, Wright C, Wright L, Wright S, Wyles J, Wynter I, Xu M, Yasmin N, Yasmin S, Yates T, Yip KP, Young B, Young S, Young A, Yousuf AJ, Zawia A, Zeidan L, Zhao B, Zongo O. Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. Lancet Respir Med 2022; 10:761-775. [PMID: 35472304 PMCID: PMC9034855 DOI: 10.1016/s2213-2600(22)00127-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. FINDINGS 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. INTERPRETATION The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. FUNDING UK Research and Innovation and National Institute for Health Research.
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Druetz T, van den Hoogen L, Stresman G, Joseph V, Hamre KES, Fayette C, Monestime F, Presume J, Romilus I, Mondélus G, Elismé T, Cooper S, Impoinvil D, Ashton RA, Rogier E, Existe A, Boncy J, Chang MA, Lemoine JF, Drakeley C, Eisele TP. Etramp5 as a useful serological marker in children to assess the immediate effects of mass drug campaigns for malaria. BMC Infect Dis 2022; 22:643. [PMID: 35883064 PMCID: PMC9321307 DOI: 10.1186/s12879-022-07616-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/14/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Serological methods provide useful metrics to estimate age-specific period prevalence in settings of low malaria transmission; however, evidence on the use of seropositivity as an endpoint remains scarce in studies to evaluate combinations of malaria control measures, especially in children. This study aims to evaluate the immediate effects of a targeted mass drug administration campaign (tMDA) in Haiti by using serological markers. METHODS The tMDA was implemented in September-October 2018 using sulfadoxine-pyrimethamine and single low-dose primaquine. A natural quasi-experimental study was designed, using a pretest and posttest in a cohort of 754 randomly selected school children, among which 23% reported having received tMDA. Five antigens were selected as outcomes (MSP1-19, AMA-1, Etramp5 antigen 1, HSP40, and GLURP-R0). Posttest was conducted 2-6 weeks after the intervention. RESULTS At baseline, there was no statistical difference in seroprevalence between the groups of children that were or were not exposed during the posttest. A lower seroprevalence was observed for markers informative of recent exposure (Etramp5 antigen 1, HSP40, and GLURP-R0). Exposure to tMDA was significantly associated with a 50% reduction in the odds of seropositivity for Etramp5 antigen 1 and a 21% reduction in the odds of seropositivity for MSP119. CONCLUSION Serological markers can be used to evaluate the effects of interventions against malaria on the risk of infection in settings of low transmission. Antibody responses against Etramp5 antigen 1 in Haitian children were reduced in the 2-6 weeks following a tMDA campaign, confirming its usefulness as a short-term marker in child populations.
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Affiliation(s)
- T Druetz
- Center for Applied Malaria Research and Evaluation, School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA. .,Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada. .,Centre de Recherche en Santé Publique, Montreal, Canada.
| | - L van den Hoogen
- Center for Applied Malaria Research and Evaluation, School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
| | - G Stresman
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - V Joseph
- Center for Applied Malaria Research and Evaluation, School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA.,Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada
| | - K E S Hamre
- Malaria Branch, Centers for Diseases Control and Prevention, Atlanta, USA.,CDC Foundation, Atlanta, USA
| | - C Fayette
- IMA World Health, Port-au-Prince, Haiti
| | | | - J Presume
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
| | - I Romilus
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
| | - G Mondélus
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
| | - T Elismé
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
| | - S Cooper
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada
| | - D Impoinvil
- Malaria Branch, Centers for Diseases Control and Prevention, Atlanta, USA
| | - R A Ashton
- Center for Applied Malaria Research and Evaluation, School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
| | - E Rogier
- Malaria Branch, Centers for Diseases Control and Prevention, Atlanta, USA
| | - A Existe
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
| | - J Boncy
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
| | - M A Chang
- Malaria Branch, Centers for Diseases Control and Prevention, Atlanta, USA
| | - J F Lemoine
- Programme National de Contrôle du Paludisme, Port-au-Prince, Haiti
| | - C Drakeley
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - T P Eisele
- Center for Applied Malaria Research and Evaluation, School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
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Alobwede SM, Kidzeru EB, Katoto PDMC, Lumngwena EN, Cooper S, Goliath R, Jackson A, Wiysonge CS, Shey MS. Influenza Vaccination Uptake and Hesitancy among Healthcare Workers in Early 2021 at the Start of the COVID-19 Vaccine Rollout in Cape Town, South Africa. Vaccines (Basel) 2022; 10:1176. [PMID: 35893825 PMCID: PMC9332543 DOI: 10.3390/vaccines10081176] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/09/2022] [Accepted: 07/10/2022] [Indexed: 01/27/2023] Open
Abstract
Vaccination attitudes among healthcare workers (HCWs) predict their level of vaccination uptake and intention to recommend vaccinations to their patients. To our knowledge, no study has been conducted in South Africa to assess hesitancy toward influenza vaccines among HCWs. We adapted a questionnaire developed and validated by Betsch and colleagues and used it to conduct online and face-to-face interviews among HCWs at the start of the COVID-19 vaccine rollout. Multivariate logistic regression was used to assess predictors of influenza vaccine hesitancy. Of 401 participants, 64.5% were women, 49.2% were nurses, and 12.5% were physicians. A total of 54.9% were willing to accept, 20.4% were undecided, and 24.7% intended to refuse influenza vaccination. Participants who were above 25 years of age and physicians were more likely to accept the vaccine. Key predictors of vaccine acceptance were confidence in the effectiveness, consideration of benefits and risks, and willingness to be vaccinated to protect others. Influenza vaccine hesitancy was highest in those who did not trust that influenza vaccines are safe. For future flu seasons, tailored education programs on the safety and effectiveness of flu vaccines targeting younger HCWs, could be vital to improving vaccine uptake.
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Affiliation(s)
- Samuel M. Alobwede
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa;
- Clinical Division, Department of Research and Innovation, Partners in Sexual Health, Cape Town 7500, South Africa
| | - Elvis B. Kidzeru
- Centre for Research on Health and Priority Pathologies (CRHPP), Institute of Medical Research and Medicinal Plant Studies (IMPM), Ministry of Scientific Research and Innovation, Yaounde P.O. Box 13033, Cameroon;
- Hair and Skin Research Laboratory, Division of Dermatology, Department of Medicine and Groote Schuur Hospital, University of Cape Town, Cape Town 7925, South Africa
- Division of Radiation Oncology, Department of Radiation Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town 7925, South Africa
| | - Patrick D. M. C. Katoto
- Cochrane South Africa, South African Medical Research Council, Cape Town 7500, South Africa; (P.D.M.C.K.); (S.C.); (C.S.W.)
- Centre for General Medicine and Global Health, Department of Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Evelyn N. Lumngwena
- School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg 2193, South Africa;
- Centre for the Study of Emerging and Re-Emerging Infections (CREMER), Institute of Medical Research and Medicinal Plant Studies (IMPM), Ministry of Scientific Research and Innovation, Yaounde P.O. Box 13033, Cameroon
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town 7500, South Africa; (P.D.M.C.K.); (S.C.); (C.S.W.)
- School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa
- Department of Global Health, Stellenbosch University, Francie Van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Rene Goliath
- Wellcome Centre for Infectious Disease Research in Africa (CIDRI-Africa), Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; (R.G.); (A.J.)
| | - Amanda Jackson
- Wellcome Centre for Infectious Disease Research in Africa (CIDRI-Africa), Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; (R.G.); (A.J.)
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town 7500, South Africa; (P.D.M.C.K.); (S.C.); (C.S.W.)
- School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa
- Department of Global Health, Stellenbosch University, Francie Van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Durban 4091, South Africa
| | - Muki S. Shey
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa;
- Wellcome Centre for Infectious Disease Research in Africa (CIDRI-Africa), Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; (R.G.); (A.J.)
- Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
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Schmidt BM, Cooper S, Young T, Jessani NS. Characteristics of knowledge translation platforms and methods for evaluating them: a scoping review protocol. BMJ Open 2022; 12:e061185. [PMID: 35705347 PMCID: PMC9204454 DOI: 10.1136/bmjopen-2022-061185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Knowledge translation platforms (KTPs) are intermediary organisations, initiatives or networks whose intent is to bridge the evidence into action divide. Strategies and tools include collaborative knowledge production, capacity building, information exchange and dialogue to facilitate relevant and timely engagement between researchers and decision-makers and other relevant stakeholders. With the wide range of definitions and descriptions of KTPs, there is a need to (1) provide a nuanced understanding of characteristics of KTPs and (2) assess and consolidate research methods used in mapping and evaluating KTPs to inform standardised process and impact evaluation. METHODS AND ANALYSIS This scoping review will follow the recommended and accepted methods for scoping reviews and reporting guidelines. Eligibility for inclusion is any conceptual or empirical health-related qualitative, quantitative and/or mixed method studies including (1) definitions, descriptions and models or frameworks of KTPs (including those that do not self-identify as KTPs, eg, university research centres) and (2) research methods for mapping and/or evaluating KTPs. Searches will be carried out in PubMed, Scopus, CINAHL, Embase, Global Health and Web of Science using a predetermined search strategy, without any date, language or geographical restrictions. Two reviewers will independently screen titles and abstracts. One reviewer will complete data extraction for all included studies, and another will check a sample of 50% of the included studies. The analysis and synthesis will provide (1) an understanding of the various characteristics of KTPs; (2) insight into characteristics or factors that make them resilient and/or adaptive to facilitate impact (ie, influence policy and practice); and (3) an overview of the various methods for mapping and evaluating KTPs. We will explore enhancing an existing framework for classifying KTPs, or perhaps even developing a new framework for identifying and monitoring KTPs if necessary and relevant. ETHICS AND DISSEMINATION This scoping review does not require ethics approval, as we will only include information from previously conducted studies and we will not involve human participants. The results will be submitted to a peer-reviewed scientific journal for publication and as conference presentations.
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Affiliation(s)
- Bey-Marrie Schmidt
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Taryn Young
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nasreen S Jessani
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Hufton M, Hussaini Y, Desai M, Saleem N, Srikantaiah R, Fairbank J, Cooper S, Paskin L. WS20.05 Cystic fibrosis, lockdown and CFTR modulators - a perfect storm. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00271-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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19
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Nance RL, Cooper S, Starenki D, Wang X, Sandey M, Koehler J, Agarwal P, Matz B, Lindley S, Smith A, Smith A, Bergman N, Smith BF. Abstract A039: Transcriptomic analysis of canine osteosarcoma from a precision medicine perspective reveals limitations of differential gene expression studies. Cancer Res 2022. [DOI: 10.1158/1538-7445.evodyn22-a039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Despite significant advances in cancer diagnosis and treatment, osteosarcoma (OSA), an aggressive primary bone tumor, has eluded attempts at improving patient survival for many decades. Spontaneously occurring OSA in the dog shares remarkably similar clinical, histological, and molecular characteristics and therefore serves as an excellent model for the disease. The difficulty in managing OSA lies in its extreme genetic complexity, drug-resistance, and heterogeneity, making it improbable that a single-target treatment would be beneficial for the majority of affected individuals. Precision medicine seeks to fill this gap by addressing the intra- and inter-tumoral heterogeneity to improve patient outcome and survival. Characterization of differentially expressed genes (DEGs) provides insight into the phenotype and can be useful for informing appropriate therapies as well as development of novel treatments. To identify relevant DEGs, RNA profiles of primary tumor should be contrasted with that of normal tissue derived from the same cell-of-origin as the tumor prior to chemotherapy, as convoluted drug-resistant pathways make interpretation difficult. Traditional DEG analysis combines patient data to derive statistically inferred genes that are dysregulated in the group; however, the results from this approach are not necessarily consistent across individual patients, thus contradicting the basis of precision medicine. In this preliminary study, we use transcriptomic sequencing of RNA isolated from primary canine OSA tumor and patient-matched normal bone from seven dogs prior to chemotherapy to identify DEGs in the group. We then evaluate the universality of these changes in transcript levels among patients by deriving individual-level fold-change values using strict filtering parameters. The results from this study can be useful for reframing our perspective of transcriptomic analysis from a precision medicine perspective by identifying variations in DEGs among individuals.
Citation Format: Rebecca L. Nance, Sara Cooper, Dmytro Starenki, Xu Wang, Maninder Sandey, Jey Koehler, Payal Agarwal, Brad Matz, Stephanie Lindley, Annette Smith, Ashley Smith, Noelle Bergman, Bruce F. Smith. Transcriptomic analysis of canine osteosarcoma from a precision medicine perspective reveals limitations of differential gene expression studies [abstract]. In: Proceedings of the AACR Special Conference on the Evolutionary Dynamics in Carcinogenesis and Response to Therapy; 2022 Mar 14-17. Philadelphia (PA): AACR; Cancer Res 2022;82(10 Suppl):Abstract nr A039.
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Affiliation(s)
| | | | | | - Xu Wang
- Auburn University College of Veterinary Medicine, Auburn, AL,
| | - Maninder Sandey
- Auburn University College of Veterinary Medicine, Auburn, AL,
| | - Jey Koehler
- Auburn University College of Veterinary Medicine, Auburn, AL,
| | - Payal Agarwal
- Auburn University College of Veterinary Medicine, Auburn, AL,
| | - Brad Matz
- Auburn University College of Veterinary Medicine, Auburn, AL,
| | | | - Annette Smith
- Auburn University College of Veterinary Medicine, Auburn, AL,
| | - Ashley Smith
- Auburn University College of Veterinary Medicine, Auburn, AL,
| | - Noelle Bergman
- Auburn University College of Veterinary Medicine, Auburn, AL,
| | - Bruce F. Smith
- Auburn University College of Veterinary Medicine, Auburn, AL,
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20
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Farmer A, Bobrow K, Leon N, Williams N, Phiri E, Namadingo H, Cooper S, Prince J, Crampin A, Besada D, Daviaud E, Yu LM, N'goma J, Springer D, Pauly B, Tarassenko L, Norris S, Nyirenda M, Levitt N. Correction to: Digital messaging to support control for type 2 diabetes (StAR2D): a multicentre randomised controlled trial. BMC Public Health 2022; 22:710. [PMID: 35413890 PMCID: PMC9006479 DOI: 10.1186/s12889-022-13085-0] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- A Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - K Bobrow
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
| | - N Leon
- Health Systems Research Unit, South-African Medical Research Council, Cape Town, South Africa
| | - N Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - E Phiri
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - H Namadingo
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - S Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - J Prince
- Institute of Biomedical Engineering, Oxford, UK
| | - A Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - D Besada
- Health Systems Research Unit, South-African Medical Research Council, Cape Town, South Africa
| | - E Daviaud
- Health Systems Research Unit, South-African Medical Research Council, Cape Town, South Africa
| | - L-M Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - J N'goma
- Kamuzu Central Hospital, Lilongwe, Malawi
| | | | - B Pauly
- Department of Diabetes and Endocrinology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | | | - S Norris
- Human Nutrition Unit, South African Medical Research Council, Johannesberg, South Africa
| | - M Nyirenda
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - N Levitt
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
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21
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J Maria AR, Cooper S, Glenton C, Lewin S, Meskell P, Suleman M, Shepperd S. Adults' views and experiences of vaccines developed in response to the COVID-19 pandemic: a qualitative evidence synthesis. Hippokratia 2022. [DOI: 10.1002/14651858.cd015291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ana Rita J Maria
- Nova Medical School, Faculdade de Ciências Médicas; Universidade NOVA de Lisboa; Lisbon Portugal
| | - Sara Cooper
- Cochrane South Africa; South African Medical Research Council; Cape Town South Africa
| | | | - Simon Lewin
- Division of Health Services; Norwegian Institute of Public Health; Oslo Norway
- Health Systems Research Unit; South African Medical Research Council; Cape Town South Africa
| | - Pauline Meskell
- Department of Nursing and Midwifery; University of Limerick; Limerick Ireland
| | - Mehrunisha Suleman
- Ethox Centre; Nuffield Department of Population Health, University of Oxford; Oxford UK
| | - Sasha Shepperd
- Nuffield Department of Population Health; University of Oxford; Oxford UK
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22
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Wiysonge CS, Alobwede SM, de Marie C Katoto P, Kidzeru EB, Lumngwena EN, Cooper S, Goliath R, Jackson A, Shey MS. COVID-19 vaccine acceptance and hesitancy among healthcare workers in South Africa. Expert Rev Vaccines 2022; 21:549-559. [PMID: 34990311 DOI: 10.1080/14760584.2022.2023355] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/23/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND We assessed willingness to accept vaccination against coronavirus disease 2019 (COVID-19) among healthcare workers(HCWs) at the start of South Africa's vaccination roll-out. RESEARCH DESIGN AND METHODS We conducted a cross-sectional survey among HCWs in Cape Town in March-May 2021 and assessed predictors of vaccination intentions. RESULTS We recruited 395 participants; 64% women, 49% nurses, and 13% physicians. Of these, 233(59.0%) would accept and 163 (41.0%) were vaccine hesitant i.e. would either refuse or were unsure whether they would accept COVID-19 vaccination. People who did not trust that COVID-19 vaccines are effective were the most hesitant (p = 0.038). Older participants and physicians were more likely to accept vaccination than younger participants (p < 0.01) and other HCWs (p = 0.042) respectively. Other predictors of vaccine acceptance were trust that vaccines are compatible with religion (p < 0.001), consideration of benefits and risks of vaccination (p < 0.001), willingness to be vaccinated to protect others (p < 0.001), and viewing vaccination as a collective action for COVID-19 control (p = 0.029). CONCLUSIONS COVID-19 vaccine hesitancy is high among HCWs in Cape Town. Reducing this would require trust-building interventions, including tailored education.
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Affiliation(s)
- Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Samuel M Alobwede
- Department of Medicine, Faculty of Health Sciences and Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Patrick de Marie C Katoto
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Francie van Zijl Drive, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Elvis B Kidzeru
- Hair and Skin Research Laboratory, Division of Dermatology, Department of Medicine, Faculty of Health Sciences and Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- The Medical Research Centre (CRM), Institute of Medical Research and Medicinal Plant Studies (Impm), Ministry of Scientific Research and Innovation, Yaoundé, Cameroon
| | - Evelyn N Lumngwena
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Cape Heart Institute, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Centre for the Study of Emerging and Re-emerging Infections (CREMER), Institute of Medical Research and Medicinal Plant Studies (Impm), Ministry of Scientific Research and Innovation, Yaoundé, Cameroon
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Rene Goliath
- Wellcome Centre for Infectious Disease Research in Africa (Cidri-africa), University of Cape Town, Cape Town, South Africa
| | - Amanda Jackson
- Wellcome Centre for Infectious Disease Research in Africa (Cidri-africa), University of Cape Town, Cape Town, South Africa
| | - Muki S Shey
- Department of Medicine, Faculty of Health Sciences and Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Wellcome Centre for Infectious Disease Research in Africa (Cidri-africa), University of Cape Town, Cape Town, South Africa
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Soulsby WD, Balmuri N, Cooley V, Gerber LM, Lawson E, Goodman S, Onel K, Mehta B, Abel N, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar-Smiley F, Barillas-Arias L, Basiaga M, Baszis K, Becker M, Bell-Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang-Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel-Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie-Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui-Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein-Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PMC, McGuire S, McHale I, McMonagle A, McMullen-Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O’Brien B, O’Brien T, Okeke O, Oliver M, Olson J, O’Neil K, Onel K, Orandi A, Orlando M, Osei-Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan-Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas-Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth-Wojcicki E, Rouster-Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert-Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner-Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Social determinants of health influence disease activity and functional disability in Polyarticular Juvenile Idiopathic Arthritis. Pediatr Rheumatol Online J 2022; 20:18. [PMID: 35255941 PMCID: PMC8903717 DOI: 10.1186/s12969-022-00676-9] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/07/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Social determinants of health (SDH) greatly influence outcomes during the first year of treatment in rheumatoid arthritis, a disease similar to polyarticular juvenile idiopathic arthritis (pJIA). We investigated the correlation of community poverty level and other SDH with the persistence of moderate to severe disease activity and functional disability over the first year of treatment in pJIA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry. METHODS In this cohort study, unadjusted and adjusted generalized linear mixed effects models analyzed the effect of community poverty and other SDH on disease activity, using the clinical Juvenile Arthritis Disease Activity Score-10, and disability, using the Child Health Assessment Questionnaire, measured at baseline, 6, and 12 months. RESULTS One thousand six hundred eighty-four patients were identified. High community poverty (≥20% living below the federal poverty level) was associated with increased odds of functional disability (OR 1.82, 95% CI 1.28-2.60) but was not statistically significant after adjustment (aOR 1.23, 95% CI 0.81-1.86) and was not associated with increased disease activity. Non-white race/ethnicity was associated with higher disease activity (aOR 2.48, 95% CI: 1.41-4.36). Lower self-reported household income was associated with higher disease activity and persistent functional disability. Public insurance (aOR 1.56, 95% CI 1.06-2.29) and low family education (aOR 1.89, 95% CI 1.14-3.12) was associated with persistent functional disability. CONCLUSION High community poverty level was associated with persistent functional disability in unadjusted analysis but not with persistent moderate to high disease activity. Race/ethnicity and other SDH were associated with persistent disease activity and functional disability.
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Affiliation(s)
- William Daniel Soulsby
- University of California, San Francisco, 550 16th Street, 4th Floor, Box #0632, San Francisco, CA, 94158, USA.
| | - Nayimisha Balmuri
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Victoria Cooley
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Linda M. Gerber
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Erica Lawson
- grid.266102.10000 0001 2297 6811University of California, San Francisco, 550 16th Street, 4th Floor, Box #0632, San Francisco, CA 94158 USA
| | - Susan Goodman
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Karen Onel
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Bella Mehta
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
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van Pinxteren M, Colvin CJ, Cooper S. Using health information for community activism: A case study of the movement for change and social justice in South Africa. PLOS Glob Public Health 2022; 2:e0000664. [PMID: 36962538 PMCID: PMC10022230 DOI: 10.1371/journal.pgph.0000664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 08/17/2022] [Indexed: 11/18/2022]
Abstract
The access to, use, and exchange of health information is crucial when strengthening public health services and improving access to care. However, many health system stakeholders, including community groups are perpetually excluded from accessing and using health information. This is problematic as community groups, themselves end-users of care, are well-positioned to keep the health system accountable, provide feedback on the quality of services, and identify emerging health concerns. Using qualitative, ethnographic methods, this paper investigates different strategies used by the Movement for Change and Social Justice (MCSJ)-a local health activism group-to collect, use and distribute health information to improve health care in Gugulethu, a low-income neighbourhood in Cape Town, South Africa. Through participant observation, shadowing, informal conversations and semi-structured interviews that were analysed using iterative thematic analysis, findings revealed that MCSJ effectively collected, used and exchanged health information to develop short-term health campaigns. To get access to the needed health information, they used innovative strategies, including cultivating allies in the health system, finding safe spaces, and using community brokers to effectively mobilise community members to keep the health system accountable. MCSJ's strategies highlight that stakeholders' engagement with health information is not only a technical exercise, but a complex social process that requires constant negotiation and relationship building. Therefore, to make meaningful improvements to health services and create adaptive and responsive health systems, we need to include community groups as active stakeholders in the health system, provide relevant, up-to-date and locally relevant health information, and facilitate opportunities to socially engage with health information and those who produce it.
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Affiliation(s)
- Myrna van Pinxteren
- Department of Medicine, Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
| | - Christopher J Colvin
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, United States of America
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
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Sivam S, Wang D, Wong KKH, Piper AJ, Zheng YZ, Gauthier G, Hockings C, McGuinness O, Menadue C, Melehan K, Cooper S, Hilmisson H, Phillips CL, Thomas RJ, Yee BJ, Grunstein RR. Cardiopulmonary coupling and serum cardiac biomarkers in obesity hypoventilation syndrome and obstructive sleep apnea with morbid obesity. J Clin Sleep Med 2021; 18:1063-1071. [PMID: 34879904 DOI: 10.5664/jcsm.9804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The main cause of death in patients with obesity hypoventilation syndrome (OHS) is cardiac rather than respiratory failure. Here, we investigated autonomic-respiratory coupling and serum cardiac biomarkers in patients with OHS and obstructive sleep apnea (OSA) with comparable body mass index (BMI) and apnea-hypopnea index (AHI). METHODS Cardiopulmonary coupling (CPC) and cyclic variation of heart rate (CVHR) analysis was performed on the electrocardiogram signal from the overnight polysomnogram. Cardiac serum biomarkers were obtained in patients with OHS and OSA with a BMI > 40kg/m2. Samples were obtained at baseline and after 3 months of positive airway pressure (PAP) therapy in both groups. RESULTS Patients with OHS (n=15) and OSA (n=36) were recruited. No group differences in CPC, CVHR and serum biomarkers were observed at baseline and after 3 months of PAP therapy. An improvement in several CPC metrics, including the sleep apnea index, unstable sleep (low frequency coupling and elevated low frequency coupling narrow band [e-LFCNB]) and CVHR were observed in both groups with PAP use. However, distinct differences in response characteristics were noted. e-LFCNB coupling correlated with highly sensitive troponin (hs-troponin-T, p<0.05) in the combined cohort. Baseline hs-troponin-T inversely correlated with awake oxygen saturation in the OHS group (p<0.05). CONCLUSIONS PAP therapy can significantly improve CPC stability in obese patients with OSA or OHS, with key differences. e-LFCNB may function as a surrogate biomarker for early subclinical cardiac disease. Low awake oxygen saturation could also increase this biomarker in OHS. CLINICAL TRIAL REGISTRATION Registry: Australian New Zealand Clinical Trials Registry; Name: Obesity Hypoventilation Syndrome and Neurocognitive Dysfunction; URL: https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367492; Identifier: ACTRN12615000122550.
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Affiliation(s)
- Sheila Sivam
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
| | - David Wang
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
| | - Keith K H Wong
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
| | - Amanda J Piper
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
| | - Yi Zhong Zheng
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
| | - Gislaine Gauthier
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Christine Hockings
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Olivia McGuinness
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Collette Menadue
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Kerri Melehan
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Sara Cooper
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
| | | | - Craig L Phillips
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
| | - Robert J Thomas
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Brendon J Yee
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
| | - Ronald R Grunstein
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
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Mcculloch A, Jones I, Malhi H, Fletcher J, Cooper S. Experiences of the Covid-19 pandemic: a survey of patients on home parenteral nutrition. Clin Nutr ESPEN 2021. [PMCID: PMC8629560 DOI: 10.1016/j.clnesp.2021.09.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hawkins C, Jones A, Ziebro J, Gordon E, Libby C, Williford S, Allegood J, Cooper S, Ramanadham S, Doan N, Hjelmeland A. DDRE-06. TARGETING THE SPHINGOLIPID BALANCE VIA ACID CERAMIDASE INHIBITION TO DECREASE GROWTH OF TMZ-RESISTANT GLIOBLASTOMA AND BLOCK MIGRATION. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Dysregulated sphingolipid metabolism is associated with many cancers; allowing cells to evade apoptosis through increases in sphingosine-1-phosphate (S1P) and decreases in ceramides. Ceramides can be hydrolyzed by ceramidases to sphingosine, which can then be phosphorylated by sphingosine kinases to S1P. S1P allows cells to evade apoptosis and increase migration, while shifts toward ceramides favor cell death. Glioblastoma (GBM) exhibits shifts in the sphingolipid balance towards S1P, contributing to chemoresistance and migration. Understanding of sphingolipid metabolism in GBM is still limited, and currently, there are no approved treatments to target the dysregulation. Acid ceramidase (ASAH1), a key enzyme in the production of S1P, is highly expressed in GBM and is associated with worse survival of GBM patients, as per The Cancer Genome Atlas data. To address the altered sphingolipid metabolism and therapeutic resistance in GBM, we explored the efficacy of pharmacologic and genetic inhibition of ASAH1 in both parental and temozolomide (TMZ)-resistant patient-derived xenografts. Cells were infected with ASAH1 shRNA or treated with ASAH1 inhibitors and assessed for cell growth and migration. Our work suggests that pharmacologic inhibition of ASAH1 induces cell death and that this effect is maintained in TMZ-resistant cells. Furthermore, we find a novel role for carmofur, an ASAH1 inhibitor, in the inhibition of GBM migration. Together, these data suggest the potential utility of normalizing the sphingolipid balance in the context of GBM TMZ resistance.
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Affiliation(s)
| | - Amber Jones
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Julia Ziebro
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | | | | | | | - Ninh Doan
- Baptist South Medical Center, Montgomery, AL, USA
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Cooper S, Schmidt BM, Sambala EZ, Swartz A, Colvin CJ, Leon N, Wiysonge CS. Factors that influence parents' and informal caregivers' views and practices regarding routine childhood vaccination: a qualitative evidence synthesis. Cochrane Database Syst Rev 2021; 10:CD013265. [PMID: 34706066 PMCID: PMC8550333 DOI: 10.1002/14651858.cd013265.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Childhood vaccination is one of the most effective ways to prevent serious illnesses and deaths in children. However, worldwide, many children do not receive all recommended vaccinations, for several potential reasons. Vaccines might be unavailable, or parents may experience difficulties in accessing vaccination services; for instance, because of poor quality health services, distance from a health facility, or lack of money. Some parents may not accept available vaccines and vaccination services. Our understanding of what influences parents' views and practices around childhood vaccination, and why some parents may not accept vaccines for their children, is still limited. This synthesis links to Cochrane Reviews of the effectiveness of interventions to improve coverage or uptake of childhood vaccination. OBJECTIVES - Explore parents' and informal caregivers' views and practices regarding routine childhood vaccination, and the factors influencing acceptance, hesitancy, or nonacceptance of routine childhood vaccination. - Develop a conceptual understanding of what and how different factors reduce parental acceptance of routine childhood vaccination. - Explore how the findings of this review can enhance our understanding of the related Cochrane Reviews of intervention effectiveness. SEARCH METHODS We searched MEDLINE, Embase, CINAHL, and three other databases for eligible studies from 1974 to June 2020. SELECTION CRITERIA We included studies that: utilised qualitative methods for data collection and analysis; focused on parents' or caregivers' views, practices, acceptance, hesitancy, or refusal of routine vaccination for children aged up to six years; and were from any setting globally where childhood vaccination is provided. DATA COLLECTION AND ANALYSIS We used a pre-specified sampling frame to sample from eligible studies, aiming to capture studies that were conceptually rich, relevant to the review's phenomenon of interest, from diverse geographical settings, and from a range of income-level settings. We extracted contextual and methodological data from each sampled study. We used a meta-ethnographic approach to analyse and synthesise the evidence. We assessed methodological limitations using a list of criteria used in previous Cochrane Reviews and originally based on the Critical Appraisal Skills Programme quality assessment tool for qualitative studies. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. We integrated the findings of this review with those from relevant Cochrane Reviews of intervention effectiveness. We did this by mapping whether the underlying theories or components of trial interventions included in those reviews related to or targeted the overarching factors influencing parental views and practices regarding routine childhood vaccination identified by this review. MAIN RESULTS We included 145 studies in the review and sampled 27 of these for our analysis. Six studies were conducted in Africa, seven in the Americas, four in South-East Asia, nine in Europe, and one in the Western Pacific. Studies included urban and rural settings, and high-, middle-, and low-income settings. Many complex factors were found to influence parents' vaccination views and practices, which we divided into four themes. Firstly, parents' vaccination ideas and practices may be influenced by their broader ideas and practices surrounding health and illness generally, and specifically with regards to their children, and their perceptions of the role of vaccination within this context. Secondly, many parents' vaccination ideas and practices were influenced by the vaccination ideas and practices of the people they mix with socially. At the same time, shared vaccination ideas and practices helped some parents establish social relationships, which in turn strengthened their views and practices around vaccination. Thirdly, parents' vaccination ideas and practices may be influenced by wider political issues and concerns, and particularly their trust (or distrust) in those associated with vaccination programmes. Finally, parents' vaccination ideas and practices may be influenced by their access to and experiences of vaccination services and their frontline healthcare workers. We developed two concepts for understanding possible pathways to reduced acceptance of childhood vaccination. The first concept, 'neoliberal logic', suggests that many parents, particularly from high-income countries, understood health and healthcare decisions as matters of individual risk, choice, and responsibility. Some parents experienced this understanding as in conflict with vaccination programmes, which emphasise generalised risk and population health. This perceived conflict led some parents to be less accepting of vaccination for their children. The second concept, 'social exclusion', suggests that some parents, particularly from low- and middle-income countries, were less accepting of childhood vaccination due to their experiences of social exclusion. Social exclusion may damage trustful relationships between government and the public, generate feelings of isolation and resentment, and give rise to demotivation in the face of public services that are poor quality and difficult to access. These factors in turn led some parents who were socially excluded to distrust vaccination, to refuse vaccination as a form of resistance or a way to bring about change, or to avoid vaccination due to the time, costs, and distress it creates. Many of the overarching factors our review identified as influencing parents' vaccination views and practices were underrepresented in the interventions tested in the four related Cochrane Reviews of intervention effectiveness. AUTHORS' CONCLUSIONS Our review has revealed that parents' views and practices regarding childhood vaccination are complex and dynamic social processes that reflect multiple webs of influence, meaning, and logic. We have provided a theorised understanding of the social processes contributing to vaccination acceptance (or not), thereby complementing but also extending more individualistic models of vaccination acceptance. Successful development of interventions to promote acceptance and uptake of childhood vaccination will require an understanding of, and then tailoring to, the specific factors influencing vaccination views and practices of the group(s) in the target setting. The themes and concepts developed through our review could serve as a basis for gaining this understanding, and subsequent development of interventions that are potentially more aligned with the norms, expectations, and concerns of target users.
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Affiliation(s)
- Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Bey-Marrié Schmidt
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Evanson Z Sambala
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- School of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Alison Swartz
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Christopher J Colvin
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Natalie Leon
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Farmer A, Bobrow K, Leon N, Williams N, Phiri E, Namadingo H, Cooper S, Prince J, Crampin A, Besada D, Daviaud E, Yu LM, N'goma J, Springer D, Pauly B, Tarassenko L, Norris S, Nyirenda M, Levitt N. Digital messaging to support control for type 2 diabetes (StAR2D): a multicentre randomised controlled trial. BMC Public Health 2021; 21:1907. [PMID: 34674688 PMCID: PMC8529732 DOI: 10.1186/s12889-021-11874-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 09/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Failure to take medicines for diabetes as prescribed contributes to poor outcomes from the condition. Mobile phones are ubiquitous and short message service (SMS) texts have shown promise as a low-cost intervention. We tested the effectiveness of SMS-text messaging in improving outcomes in adults with type 2 diabetes. Methods StAR2D was a 12-month two-arm randomised trial of SMS-text messaging and usual care in Cape Town, South Africa and Lilongwe, Malawi. Messages used behaviour change theory and were developed with patients and staff. The intervention group received four messages each week. The primary outcome was change in HbA1c. Secondary outcomes were the proportion of patients who collected > 80% medication and changes in systolic blood pressure, lipids, cardiovascular risk, and the proportion of the participants reaching treatment goals. Results The trial took place between 1 October, 2016 and 1 October 2018, 1186 participants were randomised to intervention (593) and control (593) groups. 91% of participants completed follow-up. There was a reduction in HbA1c (DCCT) in both groups but not in mean change (95% CI) between groups (− 0.08% (− 0.31 to 0.16) (IFCC − 0.82 mmol/mol (− 3.44 to 1.79). There was a small but not significant increase in the proportions of participants likely to have collected 80% or more of medication (Relative risk 1.11 (0.84 to 1.47; P = 0.47). There was a significant difference between groups in change in systolic blood pressure from baseline of 3.46 mmHg (1.48 to 5.44, P = 0.001) in favour of the intervention group. The between group difference in change in 10-year risk of coronary heart disease was − 0.71% (− 1.46 to 0.04, P = 0.064). The proportion of participants meeting treatment goals in the intervention group was 36.0% and in the control group 26.8% (Relative risk 1.36 (1.13 to 1.63, P = 0.001). Participants reported many challenges to adherence despite finding messages acceptable and useful. Conclusions Whilst SMS text messages do not lead to improved glycaemia in these low-resource settings there appeared to be an impact on blood pressure and achievement of treatment goals but the mechanisms for this are unclear. Text messages alone, may be unsuccessful unless accompanied by health system strengthening and other forms of self-management support for type 2 diabetes. Trial registration Trial registration: ISRCTN, ISRCTN70768808. Registered 1 July 2015, http://www.isrctn.com/I ISRCTN70768808. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11874-7.
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Affiliation(s)
- A Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - K Bobrow
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
| | - N Leon
- Health Systems Research Unit, South-African Medical Research Council, Cape Town, South Africa
| | - N Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - E Phiri
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - H Namadingo
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - S Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - J Prince
- Institute of Biomedical Engineering, Oxford, UK
| | - A Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - D Besada
- Health Systems Research Unit, South-African Medical Research Council, Cape Town, South Africa
| | - E Daviaud
- Health Systems Research Unit, South-African Medical Research Council, Cape Town, South Africa
| | - L-M Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - J N'goma
- Kamuzu Central Hospital, Lilongwe, Malawi
| | | | - B Pauly
- Department of Diabetes and Endocrinology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | | | - S Norris
- Human Nutrition Unit, South African Medical Research Council, Johannesberg, South Africa
| | - M Nyirenda
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - N Levitt
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
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Cooper S, Wiysonge CS. Editorial overview: applying an implementation science lens to vaccines. Curr Opin Immunol 2021; 71:iii-vi. [PMID: 34503765 DOI: 10.1016/j.coi.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - Charles S Wiysonge
- Cochrane South Africa, So uth African Medical Research Council, Cape Town, South Africa; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
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31
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Leon N, Namadingo H, Cooper S, Bobrow K, Mwantisi C, Nyasulu M, Sicwebu N, Crampin A, Levitt N, Farmer A. Process evaluation of a brief messaging intervention to improve diabetes treatment adherence in sub-Saharan Africa. BMC Public Health 2021; 21:1576. [PMID: 34418987 PMCID: PMC8379852 DOI: 10.1186/s12889-021-11552-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 07/26/2021] [Indexed: 11/16/2022] Open
Abstract
Background The SMS text Adherence suppoRt for people with type 2 diabetes (StAR2D) intervention is a pragmatic randomised controlled trial, testing the effectiveness of brief text messaging for improving clinical outcomes and medication adherence. The intervention did not impact glycaemic control. We conducted a pre-and post-trial process evaluation alongside the StAR2D study in Malawi and South Africa, exploring the experiences and perceptions of patient participants, to better understand potential underlying reasons for the trial outcomes. Methods We employed a qualitative research design, including conducting semi structured in-depth interviews and focus groups at both trial sites. Purposive sampling was used to ensure representation of a wide range of patients with type 2 diabetes with regards to age, gender, ethnicity, language, and duration of diabetes. We interviewed the same participants at baseline and at the end of the trial. We used within-case and across-case thematic analysis to identify key themes. Results Brief messages delivered by text were acceptable and useful for addressing informational and support needs for participants. Some participants reported behaviour changes because of the text reminders and advice on a healthy lifestyle. Both participating in the trial and the messages were experienced as a source of support, caring, and motivation. Participants’ ability to act on the messages was limited. A common theme was frustration over the lack of ability to effectively control one’s blood glucose level. They reported a range of routinised, partial diabetes care adherence behaviours, shaped by complex and interacting individual, social, and health service factors. Participant responses and intervention impact were similar across sites, despite differences in health services. Conclusion This process evaluation provided context and insight into the factors influencing participants’ engagement with the text messaging intervention. The complex context in which patients take their diabetes medication, may explain in part, why brief text messaging may have been insufficient to bring about changes in health outcomes. The scale of need for self-management and health service support, suggests that health system strengthening, and other forms of self-management support should accompany digital communication interventions. (Current Controlled Trials ISRCTN70768808, registered 03/08/2015.) Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11552-8.
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Affiliation(s)
- N Leon
- South African Medical Research Council, Fransie van Zyl Drive, 7535, Tygerberg, Cape Town, South Africa. .,Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.
| | - H Namadingo
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - S Cooper
- South African Medical Research Council, Fransie van Zyl Drive, 7535, Tygerberg, Cape Town, South Africa
| | - K Bobrow
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
| | - C Mwantisi
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - M Nyasulu
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - N Sicwebu
- Division of Social and Behavioural Science, School of Family Medicine and Public Health, University of Cape Town, Cape Town, South Africa
| | - A Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi.,London School of Hygiene and Tropical Medicine, London, UK
| | - N Levitt
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
| | - A Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Ussher M, Best C, Lewis S, McKell J, Coleman T, Cooper S, Orton S, Bauld L. Financial Incentives for Preventing Postpartum return to Smoking (FIPPS): study protocol for a three-arm randomised controlled trial. Trials 2021; 22:512. [PMID: 34340694 PMCID: PMC8327045 DOI: 10.1186/s13063-021-05480-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/22/2021] [Indexed: 02/08/2023] Open
Abstract
Background Financial incentives are an effective way of helping women to stop smoking during pregnancy. Unfortunately, most women who stop smoking at this time return to smoking within 12 months of the infant’s birth. There is no evidence for interventions that are effective at preventing postpartum smoking relapse. Financial incentives provided after the birth may help women to sustain cessation. This randomised controlled trial will assess the effectiveness and cost-effectiveness of financial incentives to help women who are abstinent from smoking at end-of-pregnancy to avoid return to smoking up to 12 months postpartum. Methods This is a UK-based, multi-centre, three-arm, superiority, parallel group, individually randomised controlled trial, with 1:1:1 allocation. It will compare the effectiveness of two financial incentive interventions with each other (one intervention for up to 3 months postpartum offering up to £120 of incentives (£60 for the participant and £60 for a significant other support); the other for up to 12 months postpartum with up to £300 of incentives (£240 for the participant and £60 for a significant other support) and with a no incentives/usual care control group. Eligible women will be between 34 weeks gestation and 2 weeks postpartum, abstinent from smoking for at least 4 weeks, have an expired carbon monoxide (CO) reading < 4 parts per million (ppm), aged at least 16 years, intend remaining abstinent from smoking after the birth and able to speak and read English. The primary outcome is self-reported, lapse-free, smoking abstinence from the last quit attempt in pregnancy until 12 months postpartum, biochemically validated by expired CO and/or salivary cotinine or anabasine. Outcomes will be analysed by intention-to-treat and regression models used to compare the proportion of abstinent women between the two intervention groups and between each intervention group and the control group. An economic evaluation will assess the cost-effectiveness of offering incentives and a qualitative process evaluation will examine barriers and facilitators to trial retention, effectiveness and implementation. Discussion This pragmatic randomised controlled trial will test whether offering financial incentives is effective and cost-effective for helping women to avoid smoking relapse during the 12 months after the birth of their baby. Trial registration International Standard Randomised Controlled Trial Number 55218215. Registered retrospectively on 5th June 2019 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05480-6.
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Affiliation(s)
- M Ussher
- Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, UK. .,Population Health Research Institute, St George's, University of London, SW17 ORE, London, UK.
| | - C Best
- Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, UK
| | - S Lewis
- Division of Epidemiology and Public Health, Medical School, University of Nottingham, Nottingham, NG7 2UH, UK
| | - J McKell
- Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, UK
| | - T Coleman
- Division of Primary Care, Medical School, University of Nottingham, Nottingham, NG7 2UH, UK
| | - S Cooper
- Division of Primary Care, Medical School, University of Nottingham, Nottingham, NG7 2UH, UK
| | - S Orton
- Division of Primary Care, Medical School, University of Nottingham, Nottingham, NG7 2UH, UK
| | - L Bauld
- Usher Institute, University of Edinburgh, Edinburgh, EH8 9AG, UK
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Abstract
Introduction: Acceptance of COVID-19 vaccines is critical to personal health, protecting vulnerable populations, reopening socio-economic life, and achieving population health and safety through immunity. The primary aim of this review was to investigate the extent and determinants of COVID-19 vaccine hesitancy in South Africa to inform the development of strategies to address it. A secondary aim was to enhance understandings of and responses to vaccine hesitancy more generally in South Africa, with potential positive effect on vaccination uptake during and beyond the COVID-19 pandemic.Areas covered: We reviewed the findings from surveys conducted in South Africa from February 2020 to March 2021 that investigated acceptance of COVID-19 vaccines. Surveys were identified through searching electronic databases of peer-reviewed and gray literature and contacting experts.Expert opinion: The review reveals the inherently social nature of COVID-19 vaccine hesitancy in South Africa, potentially influenced by age, race, education, politics, geographical location, and employment. Along with the provision of information, COVID-19 vaccine communication strategies need to form part of broader trust-building measures that focus on relationships, transparency, participation, and justice. The pandemic also provides a unique opportunity to positively intervene and reduce vaccine hesitancy trends more generally in South Africa and potentially elsewhere.
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Affiliation(s)
- Sara Cooper
- Cochrane South Africa, South African Medical Research Council Francie van Zijl Drive,Parow Valley Cape Town 7501, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Heidi van Rooyen
- The Impact Centre, Human Sciences Research, Parow, South Africa.,SAMRC-Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council Francie van Zijl Drive,Parow Valley Cape Town 7501, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Tyrer P, Wang D, Crawford M, Dupont S, Cooper S, Nourmand S, Lazarevic V, Philip A, Tyrer H. Sustained benefit of cognitive behaviour therapy for health anxiety in medical patients (CHAMP) over eight years: randomised controlled trial - CORRIGENDUM. Psychol Med 2021; 51:1723. [PMID: 32489159 DOI: 10.1017/s0033291720001932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/05/2022]
Affiliation(s)
- P Tyrer
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
| | - D Wang
- Department of Statistics, Liverpool School of Tropical Medicine, Liverpool, UK
| | - M Crawford
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
| | - S Dupont
- Central Northwest London Foundation NHS Trust, London, UK
| | - S Cooper
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
| | - S Nourmand
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
| | - V Lazarevic
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
| | - A Philip
- South London and Maudsley NHS Foundation Trust, London, UK
| | - H Tyrer
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
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Tyrer P, Wang D, Crawford M, Dupont S, Cooper S, Nourmand S, Lazarevic V, Philip A, Tyrer H. Sustained benefit of cognitive behaviour therapy for health anxiety in medical patients (CHAMP) over 8 years: a randomised-controlled trial. Psychol Med 2021; 51:1714-1722. [PMID: 32174296 DOI: 10.1017/s003329172000046x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Health anxiety is an under-recognised but a frequent cause of distress. It is particularly common in general hospitals. METHODS We carried out an 8-year follow-up of medical out-patients with health anxiety (hypochondriasis) enrolled in a randomised-controlled trial in five general hospitals in London, Middlesex and Nottinghamshire. Randomisation was to a mean of six sessions of cognitive behaviour therapy adapted for health anxiety (CBT-HA) or to standard care in the clinics. The primary outcome was a change in score on the Short Health Anxiety Inventory, with generalised anxiety and depression as secondary outcomes. Of 444 patients aged 16-75 years seen in cardiology, endocrinology, gastroenterology, neurology and respiratory medicine clinics, 306 (68.9%) were followed-up 8 years after randomisation, including 36 who had died. The study is registered with controlled-trials.com, ISRCTN14565822. RESULTS There was a significant difference in the HAI score in favour of CBT-HA over standard care after 8 years [1.83, 95% confidence interval (CI) 0.25-3.40, p = 0.023], between group differences in generalised anxiety were less (0.54, 95% CI -0.29 to 1.36), p = 0.20, ns), but those for depression were greater at 8 years (1.22, 95% CI 0.42-2.01, p < 0.003) in CBT-HA than in standard care, most in standard care satisfying the criteria for clinical depression. Those seen by nurse therapists and in cardiology and gastrointestinal clinics achieved the greatest gains with CBT-HA, with greater improvement in both symptoms and social function. CONCLUSIONS CBT-HA is a highly long-term effective treatment for pathological health anxiety with long-term benefits. Standard care for health anxiety in medical clinics promotes depression. Nurse therapists are effective practitioners.
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Affiliation(s)
- P Tyrer
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
| | - D Wang
- Department of Statistics, Liverpool School of Tropical Medicine, Liverpool, UK
| | - M Crawford
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
| | - S Dupont
- Central Northwest London Foundation NHS Trust, London, UK
| | - S Cooper
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
| | - S Nourmand
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
| | - V Lazarevic
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
| | - A Philip
- South London and Maudsley NHS Foundation Trust, London, UK
| | - H Tyrer
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
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Deignan C, Swartz A, Cooper S, Colvin CJ. Stakeholders' Understandings of Human Papillomavirus (HPV) Vaccination in Sub-Saharan Africa: A Rapid Qualitative Systematic Review. Vaccines (Basel) 2021; 9:vaccines9050496. [PMID: 34065961 PMCID: PMC8150903 DOI: 10.3390/vaccines9050496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/21/2021] [Accepted: 04/29/2021] [Indexed: 12/11/2022] Open
Abstract
Cervical cancer rates in Sub-Saharan Africa (SSA) are amongst the highest worldwide. All three of the Human Papillomavirus (HPV) vaccines (9-valent, quadrivalent and bivalent HPV vaccine) provide primary protection against the most common cancer-causing strains of HPV (types 16 and 18) that are known to cause 70% of cervical cancers. Over the last five years, there has been an increase in Sub-Saharan African countries that have introduced the HPV vaccine. The majority of research has been conducted on supply-side barriers and facilitators to HPV vaccination uptake in SSA, yet little research has been conducted on demand-side or end-user perspectives of, and decisions around, HPV vaccination. In order to complement existing research, and inform current and future HPV vaccination implementation approaches, this qualitative systematic review explored Stakeholders' understandings of HPV vaccination in SSA. This review searched the following databases: Embase (via Scopus), Scopus, MEDLINE (via PubMed), PubMed, EBSCOhost, Academic Search Premier, Africa-Wide Information, CINAHL, PsycARTICLES, PsycINFO, SocINDEX, Web of Science, and the Cochrane Controlled Register of Trials (CENTRAL) and found a total of 259 articles. Thirty-one studies were found eligible for inclusion and were analyzed thematically using Braun and Clarke's methods for conducting a thematic analysis. The quality of included studies was assessed using the Critical Appraisal Skills Programme (CASP) checklist. Three major themes emerged from this analysis; knowledge of HPV vaccination and cervical cancer is intertwined with misinformation; fear has shaped contradictory perceptions about HPV vaccination and gender dynamics are relevant in how stakeholders understand HPV vaccination in SSA.
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Affiliation(s)
- Caroline Deignan
- The Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7935, South Africa; (A.S.); (C.J.C.)
- Correspondence: ; Tel.: +27-(0)66-422-3846
| | - Alison Swartz
- The Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7935, South Africa; (A.S.); (C.J.C.)
| | - Sara Cooper
- South African Medical Research Council, Cape Town 7501, South Africa;
| | - Christopher J. Colvin
- The Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7935, South Africa; (A.S.); (C.J.C.)
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Bowker K, Lewis S, Phillips L, Orton S, Ussher M, Naughton F, Bauld L, Coleman T, Sinclair L, McRobbie H, Khan A, Cooper S. Pregnant women's use of e-cigarettes in the UK: a cross-sectional survey. BJOG 2021; 128:984-993. [PMID: 33012050 DOI: 10.1111/1471-0528.16553] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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] [Accepted: 09/24/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To estimate prevalence of vaping in pregnancy. Compare characteristics and attitudes between exclusive smokers and vapers, and between exclusive vapers and dual users (smoke and vape). DESIGN Cross-sectional survey. SETTING Hospitals across England and Scotland. POPULATION Pregnant women attending antenatal clinics in 2017. METHODS Women at 8-24 weeks' gestation completed screening questions about their smoking and vaping. Current or recent ex-smokers and/or vapers completed a full detailed survey about vaping and smoking. MAIN OUTCOME MEASURES The prevalence of vaping, characteristics and attitudes of women who vape and/or smoke. RESULTS Of 3360 pregnant women who completed screening questions, 515 (15.3%, 95% CI 14.1-16.6) were exclusive smokers, 44 (1.3%, 95% CI 1.0-1.8) exclusive vapers and 118 (3.5%, 95% CI 2.9-4.2) dual users. In total, 867 (25.8%) women completed the full survey; compared with smokers (n = 434), vapers (n = 140) were more likely to hold higher educational qualifications (odds ratio [OR) 1.51, 95% CI 1.01-2.25). Compared with exclusive vapers (n = 33), dual users (n = 107) were younger (OR 0.91 95% CI 0.85-0.98) and less likely to hold high qualifications (OR 0.43, 95% CI 0.20-0.96). Compared with smokers, dual users were more likely to be planning to quit smoking (OR 2.27, 95% CI 1.24-4.18). Compared with smokers, vapers were more likely to think vaping was safer than smoking (78.6% versus 36.4%). CONCLUSIONS One in 20 pregnant women report vaping, and most also smoke. Dual users are more motivated towards stopping smoking than smokers. Where women have tried but cannot stop smoking, clinicians could encourage them to consider vaping for smoking cessation. TWEETABLE EXTRACT One in 20 women report vaping during pregnancy but of those that do vape, most also smoke, despite having intentions to quit.
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Affiliation(s)
- K Bowker
- Division of Primary Care Research and UK Centre for Tobacco and Alcohol Studies, School of Medicine, University of Nottingham, Nottingham, UK
| | - S Lewis
- Division of Epidemiology and Public Health and UK Centre for Tobacco and Alcohol Studies, Nottingham City Hospital, University of Nottingham, Nottingham, UK
| | - L Phillips
- Division of Primary Care Research and UK Centre for Tobacco and Alcohol Studies, School of Medicine, University of Nottingham, Nottingham, UK
| | - S Orton
- Division of Primary Care Research and UK Centre for Tobacco and Alcohol Studies, School of Medicine, University of Nottingham, Nottingham, UK
| | - M Ussher
- Population Health Research Institute, St George's, University of London, London, UK
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - F Naughton
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - L Bauld
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - T Coleman
- Division of Primary Care Research and UK Centre for Tobacco and Alcohol Studies, School of Medicine, University of Nottingham, Nottingham, UK
| | - L Sinclair
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - H McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - A Khan
- Division of Primary Care Research and UK Centre for Tobacco and Alcohol Studies, School of Medicine, University of Nottingham, Nottingham, UK
| | - S Cooper
- Division of Primary Care Research and UK Centre for Tobacco and Alcohol Studies, School of Medicine, University of Nottingham, Nottingham, UK
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Cooper S. PTSD in jewish holocaust survivors’ as a risk factor in the development of mental health conditions in their offspring. Eur Psychiatry 2021. [PMCID: PMC9476035 DOI: 10.1192/j.eurpsy.2021.1200] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionTransgenerational transmission of trauma (TTT) describes the residual ‘presence of the past’ through generations. This phenomenon has an established evidence base with Holocaust survivors (HS) and their offspring, who are hypothesised to be at a greater risk of psychiatric conditions. This advanced literature review explores the relationship between Post Traumatic Stress Disorder (PTSD) in survivors and mental health conditions (MHC) in survivor’s offspring.ObjectivesThe objective is to review the literature, looking for evidence of TTT and exploring the mechanisms of action of such phenomenon.MethodsAn advanced search was performed in three databases; Medline, Ovid PsycInfo and the Yehuda Schwarzbaum Online library using the following search terms; (Post Traumatic Stress Disorder OR PTSD) AND (Holocaust OR Shoah) AND (Offspring OR Children)’. 190 articles were identified and a following 163 were excluded. 26 studies were reviewed.ResultsParental PTSD is circumstantially influential in parenting and attachment quality. Unfavourable attachments in offspring are associated with psychiatric conditions. Furthermore, poor health behaviour can be transmitted; for example, poor diet is an independent risk factor for depression. Psychopathology may pass intergenerationally; parental PTSD increases the risk of developing PTSD in response to one’s trauma. Parental PTSD can also result in impaired cortisol function and epigenetic changes.ConclusionsPTSD in HS is an important risk factor for development of MHC in offspring. However, this does not mean all offspring develop MHC. The variability in offspring proneness to psychiatric conditions may reflect specific vulnerabilities. Further research is pertinent for an understanding of TTT. The poster will discuss clinical value.
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Wiysonge CS, Ndwandwe D, Ryan J, Jaca A, Batouré O, Anya BPM, Cooper S. Vaccine hesitancy in the era of COVID-19: could lessons from the past help in divining the future? Hum Vaccin Immunother 2021; 18:1-3. [PMID: 33684019 PMCID: PMC8920215 DOI: 10.1080/21645515.2021.1893062] [Citation(s) in RCA: 134] [Impact Index Per Article: 44.7] [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: 12/18/2022] Open
Abstract
Vaccine hesitancy, which embodies the unwillingness to receive vaccines when vaccination services are available and accessible, is one of the greatest threats to global health. Although vaccine hesitancy has existed among a small percentage of people for centuries, its harmful effects are likely to be more pronounced during the COVID-19 pandemic than ever before. COVID-19 vaccine hesitancy will pose substantial risks for both people who delay or refuse to be vaccinated and the wider community. It will make communities unable to reach thresholds of coverage necessary for herd immunity against COVID-19, thus unnecessarily perpetuating the pandemic and resulting in untold suffering and deaths. Vaccine hesitancy is pervasive, misinformed, contagious, and is not limited to COVID-19 vaccination. Our work shows that vaccine hesitancy is a complex and dynamic social process that reflects multiple webs of influence, meaning, and logic. People’s vaccination views and practices usually comprise an ongoing engagement that is contingent on unfolding personal and social circumstances, which can potentially change over time. Therefore, as COVID-19 vaccination rolls out globally, scientists and decision-makers need to investigate the scale and determinants of vaccine hesitancy in each setting; so that tailored and targeted strategies can be developed to address it.
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Affiliation(s)
- Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Rondebosch, South Africa
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Jill Ryan
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Anelisa Jaca
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | | | | | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Rondebosch, South Africa
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Van Pinxteren M, Cooper S, Colvin CJ. Barriers and opportunities to using health information in policy implementation: The case of adolescent and youth friendly health services in the Western Cape. Afr J Prim Health Care Fam Med 2021; 13:e1-e9. [PMID: 33764136 PMCID: PMC8008031 DOI: 10.4102/phcfm.v13i1.2654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 11/24/2022] Open
Abstract
Background The production, use and exchange of health information is an essential part of the health services, as it is used to inform daily decision-making and to develop new policies, guidelines and programmes. However, there is little insight into how health care workers (HCWs) get access to and use health information when implementing new health programmes. Aim This study explored the multifaceted role of health information within policy implementation processes and aimed to understand the complexities experienced by HCWs who need to develop adolescent health profiles (AHPs), a criterion of implementing a larger Adolescent and Youth Friendly Services Programme (AYFSP). Setting This case study was undertaken in Gugulethu, a peri-urban, low-income neighbourhood in Cape Town, South Africa. Methods Data were collected through ethnographic qualitative methods, including participant observation, interviews and workshops, and 15 participants were enrolled for this purpose. Results Findings showed that HCWs experienced different barriers when accessing information to develop the AHPs, including a lack of access to databases, a lack of support and inadequate guidelines. Nevertheless, HCWs were resourceful in using informal information and building strategic relationships to navigate and gain access to the necessary data to develop AHPs. Conclusion This case study provided insights into the practical difficulties and innovative strategies which arise when HCWs attempt to access and use health information within a real-life health programme. Findings highlighted the need for more training, support and guidance for HCWs to improve the meaningful use of health information during policy implementation processes and to strengthen health services in South African primary care clinics.
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Affiliation(s)
- Myrna Van Pinxteren
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town.
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Leon N, Namadingo H, Bobrow K, Cooper S, Crampin A, Pauly B, Levitt N, Farmer A. Intervention development of a brief messaging intervention for a randomised controlled trial to improve diabetes treatment adherence in sub-Saharan Africa. BMC Public Health 2021; 21:147. [PMID: 33451308 PMCID: PMC7811237 DOI: 10.1186/s12889-020-10089-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 12/17/2020] [Indexed: 01/04/2023] Open
Abstract
Background Brief messaging interventions, including Short Message Service (SMS) text-messages, delivered via mobile device platforms, show promise to support and improve treatment adherence. To understand how these interventions work, and to facilitate transparency, we need clear descriptions of the intervention development process. Method We describe and reflect on the process of designing and pretesting an evidence- and theory-informed brief messaging intervention, to improve diabetes treatment adherence in sub-Saharan Africa. We followed the stepwise approach recommended by the Medical Research Council, United Kingdom (MRC UK) Framework for Development and Evaluation of Complex Health Interventions and guidance for mobile health intervention development. Results We used a four-phase, iterative approach that first generated primary and secondary evidence on the lived experience of diabetes, diabetes treatment services and mobile-phone use. Second, we designed a type 2 diabetes-specific, brief text-message library, building on our previous hypertension text-message library, as well as drawing on the primary and secondary data from phase one, and on expert opinion. We then mapped the brief text-messages onto behaviour change (COM-B) theoretical constructs. Third, we refined and finalised the newly developed brief text-message library through stakeholder consultation and translated it into three local languages. Finally, we piloted the intervention by pre-testing the automated delivery of the brief text-messages in the trial sites in Malawi and South Africa. The final SMS text Adherence suppoRt for people with type 2 diabetes (StAR2D) intervention was tested in a randomised controlled trial in Malawi and South Africa (trial registration: ISRCTN70768808). Conclusion The complexity of public health interventions requires that we give more attention to intervention development work. Our documentation and reflection on the StAR2D intervention development process promotes transparency, replicability, assessment of intervention quality, and comparison with other studies. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-10089-6.
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Affiliation(s)
- Natalie Leon
- South African Medical Research Council, Cape Town, South Africa.
| | - Hazel Namadingo
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Kirsty Bobrow
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
| | - Sara Cooper
- South African Medical Research Council, Cape Town, South Africa
| | - Amelia Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi.,London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bruno Pauly
- Department of Diabetes and Endocrinology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Naomi Levitt
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Singh J, Ravindranathan H, Awad J, Cooper S, Grant P. P44 Posterior Tracheopexy in Severe Tracheobronchomalacia in Children. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.03.247] [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: 10/21/2022]
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Wong W, Bryen S, Bournazos A, Bommireddipall S, Waddell L, Menezes M, Webster R, Davis M, Liang C, Cooper S, Jones K. MITOCHONDRIAL DISEASES & METABOLIC MYOPATHIES. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.320] [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: 10/23/2022]
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Abstract
Difficulties in facial emotion recognition (FER) are associated with a range of mental health and antisocial presentations in adolescents and adults. Externalising behaviours in children are often one of the earliest signs of risk for the development of such difficulties. This article systematically reviews the evidence (from both group and correlational studies) for whether there is a relationship between FER and externalising behaviours in pre-adolescent children (aged 12 and under), both across and within externalising behaviour domains (hyperactivity, conduct problems, callous-unemotional traits, and aggression). Four electronic databases were searched producing 1,296 articles. Articles were included if they used validated measures of FER and externalising behaviours. Sixteen articles met criteria for inclusion in the review. Overall, the results suggested FER problems are present in ADHD, CP and callous-unemotional presentations, and in samples of children with higher levels of externalising problems rather than in community samples. However, there was no consistent evidence for specific emotions being implicated in the studies reviewed. Clinically, the findings suggest that FER difficulties are commonly associated with externalising behaviours, and hence this review offers some support that FER deficits could be a relevant target of intervention for externalising behaviours. However, more longitudinal studies are required, that control for other variables that might underlie FER difficulties (e.g. IQ or basic Theory of Mind abilities), to inform our knowledge of whether FER difficulties are a causal factor in externalising behaviours.
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Affiliation(s)
- Sara Cooper
- School of Psychology, Cardiff University, Cardiff, UK
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45
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Ndwandwe D, Ngcobo NJ, Adamu AA, Nnaji C, Mashunye T, Leufak AM, Cooper S, Uthman OA, Wiysonge CS. Country-Level Assessment of Missed Opportunities for Vaccination in South Africa: Protocol for Multilevel Analysis. JMIR Res Protoc 2020; 9:e16672. [PMID: 32985990 PMCID: PMC7551109 DOI: 10.2196/16672] [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: 10/14/2019] [Revised: 04/04/2020] [Accepted: 04/21/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Vaccination is one of the greatest public health interventions of all time. Vaccination coverage in South Africa has shown a steady improvement in reaching the national target. However, while there is progress nationally, there are districts within the country that are below the set target for vaccination coverage. One of the main drivers of suboptimal vaccination coverage is thought to be missed opportunities for vaccination. OBJECTIVE This study aims to understand the magnitude and determinants of missed opportunities for vaccination in South Africa. METHODS The 2016 South African Demographic and Health Survey will be used to conduct multilevel regression analyses to determine individual and contextual factors associated with missed opportunities for vaccination in South Africa. The perspectives of parents attending health care facilities in South Africa will be explored through exit interviews and focus group discussions. Similarly, perspectives of the health care providers will be sought to understand enablers and barriers to vaccination coverage at the facility level. Insights to such factors will aid in designing tailor-made interventions to improve vaccination coverage in South Africa. RESULTS Ethical review submission is planned for October 2020. Data collection is expected to be underway in January 2021. CONCLUSIONS The extent of missed opportunities in South Africa coupled with the associated factors presents an opportunity for efforts to increase uptake in districts where vaccination coverage is below the national target. Population-level data such as those from the 2016 South African Demographic Health Survey will provide an idea of the magnitude of missed opportunities for vaccination in South Africa at the national and subnational levels. The findings of the study will inform national and subnational policy implementation on vaccinations and help to find context-specific interventions to improve vaccination coverage. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/16672.
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Affiliation(s)
- Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Ntombenhle J Ngcobo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Abdu A Adamu
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Chukwudi Nnaji
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Thandiwe Mashunye
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Arlette M Leufak
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Olalekan A Uthman
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Warwick-Centre for Applied Health Research and Delivery, Division of Health Sciences, University of Warwick Medical School, Coventry, United Kingdom
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Iwu CJ, Ngcobo N, Cooper S, Mathebula L, Mangqalaza H, Magwaca A, Chikte U, Wiysonge CS. Mobile reporting of vaccine stock-levels in primary health care facilities in the Eastern Cape Province of South Africa: perceptions and experiences of health care workers. Hum Vaccin Immunother 2020; 16:1911-1917. [PMID: 32096687 PMCID: PMC7482903 DOI: 10.1080/21645515.2019.1700713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 11/18/2019] [Accepted: 11/30/2019] [Indexed: 11/03/2022] Open
Abstract
The use of mobile and wireless digital technologies - mobile health (mhealth)- is increasingly been adopted in low- and middle-income countries (LMICs) to improve data visibility, improve decision-making, and consequently help ensure availability of health commodities in health facilities. In a bid to improve availability of medicines in primary health care facilities, the South African department of Health launched the Stock Visibility Solution (SVS), a mobile application developed for the purpose of capturing and monitoring stock levels of medicines including vaccines using mobile phones. The stock levels of medicines in facilities are usually uploaded to the central stock management system so that managers can act promptly to address stock-out situations. Pilot studies show that the SVS has the potential to reduce stock-outs from occurring. This study aimed to explore the perceptions and experiences of the SVS system amongst healthcare workers (HCWs) who are involved with managing stock levels of medicines in primary health care facilities in the Eastern Cape Province. This will help identify potential barriers and facilitators to implementation of the system and contribute to the development of strategies to improve its efficiency and effectiveness. A qualitative research design was employed, including semi-structured interviews with 64 HCWs working in primary health care facilities in the OR Tambo district, Eastern Cape Province in South Africa. Data was transcribed verbatim and analyzed using thematic analysis. Most HCWs understood the SVS as a system for reporting stock levels to managers and conveyed commitment to ensuring the system works. However, they highlighted a number of factors that demotivated efficient usage of the system: inadequate training, staff shortages and high staff turnover, lack of responses from the managers, the extra workload that comes with the system, amongst others. HCWs made various suggestions for how the system might be improved, most pertinently the need for more pharmacists and pharmacy assistants and for these cadres to be primarily in-charge of stock management and the use of the SVS. While HCWs are committed to addressing vaccine stock-outs, they face various barriers to an effective and efficient implementation of the SVS system. We make various recommendations for how these barriers might be addressed.
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Affiliation(s)
- Chinwe Juliana Iwu
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Ntombenhle Ngcobo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Independent consultant, Pretoria, South Africa
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Lindi Mathebula
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Hlokoma Mangqalaza
- School of Public Leadership, Stellenbosch University, Cape Town, South Africa
| | | | - Usuf Chikte
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Wiysonge CS, Mahasha PW, Ndwandwe DE, Ngcobo N, Grimmer K, Dizon J, Burnett RJ, Cooper S. Contextualised strategies to increase childhood and adolescent vaccination coverage in South Africa: a mixed-methods study. BMJ Open 2020; 10:e028476. [PMID: 32503865 PMCID: PMC7279621 DOI: 10.1136/bmjopen-2018-028476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Despite the unparalleled success of immunisation in the control of vaccine preventable diseases, immunisation coverage in South Africa remains suboptimal. While many evidence-based interventions have successfully improved vaccination coverage in other countries, they are not necessarily appropriate to the immunisation needs, barriers and facilitators of South Africa. The aim of this research is to investigate barriers and facilitators to optimal vaccination uptake, and develop contextualised strategies and implementation plans to increase childhood and adolescent vaccination coverage in South Africa. METHODS The study will employ a mixed-methods research design. It will be conducted over three iterative phases and use the Adopt, Contextualise or Adapt (ACA) model as an overarching conceptual framework. Phase 1 will identify, and develop a sampling frame of, immunisation stakeholders involved in the design, planning and implementation of childhood and human papillomavirus immunisation programmes in South Africa. Phase 2 will identify the main barriers and facilitators to, and solutions for, increasing vaccination coverage. This phase will comprise exploratory qualitative research with stakeholders and a review of existing systematic reviews on interventions for improving vaccination coverage. Using the findings from Phase 2 and the ACA model, Phase 3 will develop a set of proposed interventions and implementation action plans for improving immunisation coverage in South Africa. These plans will be discussed, revised and finalised through a series of participatory stakeholder workshops and an online questionnaire, conducted as part of Phase 3. ETHICS Ethical approval was obtained from the South African Medical Research Council (EC018-11/2018). No risks to participants are expected. Various steps will be taken to ensure the anonymity and confidentiality of participants. DISSEMINATION The study findings will be shared at stakeholder workshops, the website of Cochrane South Africa and academic publications and conferences.
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Affiliation(s)
- Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | | | | | | | - Karen Grimmer
- Department of Physiotherapy, Stellenbosch University, Cape Town, South Africa
| | - Janine Dizon
- International Centre for Allied Health Evidence, University of South Australia - City East Campus, Adelaide, South Australia, Australia
| | - Rosemary J Burnett
- South African Vaccination and Immunisation Centre, Department of Virology, Sefako Makgatho Health Sciences University, Pretoria, UK
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
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Kredo T, Cooper S, Abrams AL, Muller J, Schmidt BM, Volmink J, Atkins S. 'Building on shaky ground'-challenges to and solutions for primary care guideline implementation in four provinces in South Africa: a qualitative study. BMJ Open 2020; 10:e031468. [PMID: 32474422 PMCID: PMC7264636 DOI: 10.1136/bmjopen-2019-031468] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 03/24/2020] [Accepted: 04/03/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Clinical guidelines support evidence-informed quality patient care. Our study explored perspectives of South African subnational health managers regarding barriers to and enablers for implementation for all available primary care guidelines. DESIGN We used qualitative research methods, including semistructured, individual interviews and an interpretative perspective. Thematic content analysis was used to develop data categories and themes. SETTING We conducted research in four of nine South African provinces with diverse geographic, economic and health system arrangements (Eastern Cape, Western Cape, KwaZulu-Natal, Limpopo). South Africa is a middle-income country with high levels of inequality. The settings represented public sector rural and peri-urban health facilities. PARTICIPANTS Twenty-two participants with provincial and district health management roles, that comprised implementation and/or training on primary care guidelines, were included. RESULTS Participants recommended urgent consideration of health system challenges, particularly financial constraints, impacting on access to the guidelines themselves and to medical equipment and supplies necessary to adhere to guidelines. They suggested that overcoming service delivery gaps requires strengthening of leadership, clarification of roles and enhanced accountability. Participants suggested that inadequate numbers of skilled clinical staff hampered guideline use and, ultimately, patient care. Quality assurance of training programmes for clinicians-particularly nurses-interdisciplinary training, and strengthening post-training mentorship were recommended. Furthermore, fit-for-purpose guideline implementation necessitates considering the unique settings of facilities, including local culture and geography. This requires guideline development to include guideline end users. CONCLUSIONS Guidelines are one of the policy tools to achieve evidence-informed, cost-effective and universal healthcare. But, if not effectively implemented, they have no impact. Subnational health managers in poorly resourced settings suggested that shortcomings in the health system, along with poor consultation with end users, affect implementation. Short-term improvements are possible through increasing access to and training on guidelines. However, health system strengthening and recognition of socio-cultural-geographic diversity are prerequisites for context-appropriate evidence-informed practice.
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Affiliation(s)
- Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa
- Department of Medicine, Division of Clinical Pharmacology, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa
- School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa
| | - Amber Louise Abrams
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa
| | - Jocelyn Muller
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa
| | - Bey-Marrié Schmidt
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa
| | - Jimmy Volmink
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa
- Deans office and Centre for Evidence Based Health Care, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | - Salla Atkins
- New Social Research and Faculty of Social Sciences, Tampere University, Tampere, Pirkanmaa, Finland
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Stockholm County, Sweden
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Cooper S, Okeibunor JC, Wiyeh A, Wiysonge CS. Knowledge advances and gaps on the demand side of vaccination. Lancet Infect Dis 2020; 19:13-15. [PMID: 30587281 DOI: 10.1016/s1473-3099(18)30733-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 11/22/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Sara Cooper
- Cochrane South Africa, South African Medical Research Council, 7501 Cape Town, South Africa; School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | | | - Alison Wiyeh
- Cochrane South Africa, South African Medical Research Council, 7501 Cape Town, South Africa
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, 7501 Cape Town, South Africa; School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Cooper S, Wiyeh A, Schmidt BM, Wiysonge CS. Cochrane corner: factors that influence compliance by healthcare workers with infection prevention and control guidelines for COVID-19 and other respiratory infections. Pan Afr Med J 2020; 35:23. [PMID: 33623548 PMCID: PMC7875751 DOI: 10.11604/pamj.supp.2020.35.2.23012] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/04/2020] [Indexed: 11/14/2022] Open
Abstract
As rates of novel coronavirus disease 2019 (COVID-19) continue rising in Africa, usage of infection prevention and control (IPC) strategies by healthcare workers (HCW) is critical. We highlight a Cochrane review of qualitative evidence that explored barriers and facilitators to HCW compliance with IPC recommendations for COVID-19 and other respiratory infectious diseases. The review found various individual- and organizational- level barriers and facilitators. The findings suggest that healthcare system constraints that make it difficult for healthcare workers to implement IPC guidelines require urgent prioritisation. This will help lay the foundation for addressing the more individual-level barriers potentially discouraging HCW from implementing IPC guidelines. We draw attention to pan-African initiatives for enhancing healthcare workers’ capacity to undertake IPC measures at such a critical time.
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Affiliation(s)
- Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Alison Wiyeh
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Bey-Marrié Schmidt
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.,Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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