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Zorn-Kruppa M, Vidal-Y-Sy S, Houdek P, Wladykowski E, Grzybowski S, Gruber R, Gorzelanny C, Harcup J, Schneider SW, Majumdar A, Brandner JM. Tight Junction barriers in human hair follicles - role of claudin-1. Sci Rep 2018; 8:12800. [PMID: 30143655 PMCID: PMC6109114 DOI: 10.1038/s41598-018-30341-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 07/27/2018] [Indexed: 12/29/2022] Open
Abstract
Barrier function of hair follicles (HFs) is of great interest because they might be an entry port for allergens/pathogens, but could on the other hand be used for drug delivery or vaccination. Therefore we investigated tight junction (TJ) barrier function in human HFs. We show that there is a TJ barrier in the outermost living layer bordering to the environment from the infundibulum to the lower central part and between Henle’s and Huxles layer of anagen HFs. In club hair typical for catagen and telogen HFs a TJ barrier is found surrounding the club. This demonstrates that there is a continuous TJ barrier along interfollicular epidermis and HFs in different phases of HF cycle. However, interestingly, in cell culture experiments we can show that barrier is less tight in HF keratinocytes compared to interfollicular keratinocytes. Knock-down of the TJ protein claudin-1, which we demonstrate here to be less expressed in HFs of lesional atopic dermatitis skin, results in impaired barrier function, decreased proliferation and increased apoptosis of hair keratinocytes. This is in line with a hair growth phenotype in claudin-1 deficient patients (NISCH syndrome) and corresponding knock-out mice and indicates an important role of claudin-1 in HF barrier function and growth.
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Cromme F, Brüner S, Wittig KS, Grzybowski S. [Desmoid tumour around the DIEP anastomosis - a rare complication after breast reconstruction]. HANDCHIR MIKROCHIR P 2014; 46:116-20. [PMID: 24777462 DOI: 10.1055/s-0033-1351330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Abdominal desmoid tumors are so called non-metastatic tumors. They occur by proliferation of fibroblasts of muscle, fascia or aponeuroses. After breast reconstruction with a DIEP flap (Deep Inferior epigastric Artery Perforator Flap), a progressive growth of a desmoid tumor was seen around the DIEP-anastomosis. A total excision was not possible without compromising the vascular pedicle. With taking into account a recurrence rate up to 65% another operation is probably necessary. In this case the main vessels of the graft have to be cut out and a necrosis of the flap can or may appear.
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Kuniecki M, Wichary S, Pacula B, Grzybowski S, Jaśkowski P. Role of color in determining attentional significance of emotional stimuli. Int J Psychophysiol 2010. [DOI: 10.1016/j.ijpsycho.2010.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Grzybowski S, Bucsky B, Stöckelhuber BM, Aach T, Condurache A, Mailänder P, Machens HG. Eine mikroangiographische Technik zur Quantifizierung fasziokutaner Blutgefäße am kleinen Versuchstier. HANDCHIR MIKROCHIR P 2005; 37:403-7. [PMID: 16388455 DOI: 10.1055/s-2005-872985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
PURPOSE A microangiographic technique is described, which allows visualization of small blood vessels with a diameter of approximately 20 microm and quantification of fasciocutaneous blood vessels by means of digital computer analysis in very small laboratory animals. METHOD The left carotid artery of 45 nu/nu mice was cannulated (26 gauge) and a mixture of gelatine, barium sulfate and green ink was injected according to standardized protocol. Fasciocutaneous blood vessels were visualized by digital mammography and analyzed for vessel length and vessel surface area as standardized units (pixel) by computer program. RESULTS With the described microangiography method fasciocutaneous blood vessels can be clearly visualized. Regions of interest (ROIs) can be defined and the containing vascular network quantified. Identical ROIs showed a high reproducibility for measured unit (pixel) < 6.5 +/- 2.4 %. By the use of digital image, processing the quantification of vessels was reliable, reproducible and fast. CONCLUSION Combining microsurgical techniques, pharmacological knowledge and modern computer imaging analysis systems, we were able to visualize and quantify blood vessels with a diameter of approximately 20 microm even in small laboratory animals.
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Machens HG, Grzybowski S, Bucsky B, Spanholtz T, Niedworok C, Maichle A, Stöckelhuber B, Condurache A, Liu F, Egana JT, Kaun M, Mailänder P, Aach T. A technique to detect and to quantify fasciocutaneous blood vessels in small laboratory animals ex vivo. J Surg Res 2005; 131:91-6. [PMID: 16274694 DOI: 10.1016/j.jss.2005.08.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2005] [Revised: 08/24/2005] [Accepted: 08/25/2005] [Indexed: 11/19/2022]
Abstract
PURPOSE A microangiographical technique is described, which allows visualization of small and capillary blood vessels and quantification of fasciocutaneous blood vessels by means of digital computer analysis in very small laboratory animals. MATERIALS AND METHODS The left carotid artery of 20 nu/nu mice was cannulated (26 gauge) and a mixture of gelatin, bariumsulfate, and green ink was injected according to standardized protocol. Fasciocutaneous blood vessels were visualized by digital mammography and analyzed for vessel length and vessel surface area as standardized units [SU] by computer program. RESULTS With the described microangiography method, fasciocutaneous blood vessels down to capillary size level can be clearly visualized. Regions of interest (ROIs) can be defined and the containing vascular network quantified. Comparable results may be obtained by calculating the microvascular area index (MAI) and the microvascular length index (MLI), related to the ROIs size. Identical ROIs showed a high reproducibility for measured [SU] < 0.01 +/- 0.0012%. CONCLUSION Combining microsurgical techniques, pharmacological knowledge, and modern digital image technology, we were able to visualize small and capillary blood vessels even in small laboratory animals. By using our own computer analytical program, quantification of vessels was reliable, highly reproducible, and fast.
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Klein MC, Grzybowski S, Harris S, Liston R, Spence A, Le G, Brummendorf D, Kim S, Kaczorowski J. Epidural analgesia use as a marker for physician approach to birth: implications for maternal and newborn outcomes. Birth 2001; 28:243-8. [PMID: 11903212 DOI: 10.1046/j.1523-536x.2001.00243.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Understanding the association between caregiver belief systems and practice patterns is an emerging area of research. We hypothesized an association between a maternity caregiver's belief system and his or her behavior. The study objective was to determine if a family physician's overall approach to maternity care, as measured by average use of epidural analgesia, was associated with maternal and fetal outcomes. METHODS Retrospective analysis was conducted of the births of three cohorts of 1992 nulliparous, low-risk women attended by 96 family physicians within an 18-month period in the department of family practice at the largest maternity hospital in Canada. Cohorts were based on the physicians' mean use of epidural analgesia for the women. Family physicians attending fewer than 5 births were excluded. The main outcome measures, by physician epidural utilization cohort, were maternal/newborn morbidity, procedure rates, consultation rates, and length of stay. RESULTS Family physicians were separated into cohorts based on their mean use of epidural analgesia at rates of: low, 0-30 percent (15 physicians, 263 births); medium, 31-50 percent (55 physicians, 1323 births); and high, 51-100 percent (26 physicians, 406 births). After adjustment for maternal age and race, patients of low versus high epidural users were admitted at a later state of cervical dilation (mean 4.0 vs 3.1 cm), received less electronic fetal monitoring (76.4 vs 87.2%) and oxytocin augmentation (12.2 vs 29.8%), sustained fewer malpositions (occiput posterior or transverse) (23.2 vs 34.2%), had fewer cesarean sections (14.0 vs 24.4%), less obstetric consultation (47.9 vs 63.8%), and fewer newborn special care admissions (7.2 vs 12.8%). CONCLUSIONS In our setting, high use of epidural analgesia is a marker for a style of practice characterized by malpositions leading to dysfunctional labors and higher intervention rates leading, in turn, to excess maternal/newborn morbidity.
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Thommasen HV, Lavanchy M, Connelly I, Berkowitz J, Grzybowski S. Mental health, job satisfaction, and intention to relocate. Opinions of physicians in rural British Columbia. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2001; 47:737-44. [PMID: 11340754 PMCID: PMC2018427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
OBJECTIVE To determine the prevalence of depression and burnout among family physicians working in British Columbia's Northern and Isolation Allowance communities. Current level of satisfaction with work and intention to move were also investigated. DESIGN Cross-sectional, mailed survey. SETTING Family practices in rural communities eligible for British Columbia's Northern and Isolation Allowance. PARTICIPANTS A random sample of family physicians practising in rural BC communities. Initial response rate was 66% (131/198 surveys returned); excluding physicians on leave and in temporary situations and those who received duplicate mailings gave a corrected response rate of 92% (131/142 surveys returned). MAIN OUTCOME MEASURES Demographics; self-reported depression and burnout; Beck Depression Inventory and Maslach Burnout Inventory scores; job satisfaction; and intention to leave. RESULTS Self-reported depression rate was 29%; the Beck Depression Inventory indicated 31% of physicians suffered from mild to severe depression. About 13% of physicians reported taking antidepressants in the past 5 years. Self-reported burnout rate was 55%; the Maslach Burnout Inventory showed that 80% of physicians suffered from moderate-to-severe emotional exhaustion, 61% suffered from moderate-to-severe depersonalization, and 44% had moderate-to-low feelings of personal accomplishment. Depression scores correlated with emotional exhaustion scores. More than half the respondents were considering relocation. CONCLUSION Physicians working in these communities suffer from high levels of depression and very high levels of burnout and are dissatisfied with their current jobs. More than half are considering relocating. Intention to move is strongly associated with poor mental health.
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Thommasen HV, Connelly I, Lavanchy M, Berkowitz J, Grzybowski S. Short report: burnout, depression, and moving away. How are they related? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2001; 47:747-9. [PMID: 11340755 PMCID: PMC2018429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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Harris S, Buchinski B, Grzybowski S, Janssen P, Mitchell GW, Farquharson D, Gryzbowski S. Induction of labour: a continuous quality improvement and peer review program to improve the quality of care. CMAJ 2000; 163:1163-6. [PMID: 11079064 PMCID: PMC80252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
This article describes a program developed to improve the process of planned induction of labour and to reduce the rates of inappropriate induction. The setting is a tertiary-care maternity hospital in urban Vancouver, BC, in which 7000 deliveries take place annually. Approximately 65% of these can be considered primary care; the remainder are secondary- or tertiary-level cases. Continuous quality improvement (CQI) methods were used by a multidisciplinary team, which included nursing staff, physicians, health records personnel and a CQI facilitator. Interventions included the development of a new induction-booking process, clear criteria for induction, feedback to caregivers about changes and a peer review system to oversee and maintain improvement. The overall induction rate for the institution decreased, and this change has been maintained.
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Grzybowski S, Lirenman D, White MI. Identifying educational influentials for formal and informal continuing medical education in the province of British Columbia. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2000; 20:85-90. [PMID: 11232224 DOI: 10.1002/chp.1340200204] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND The objective of this study was to identify physicians in the province of British Columbia (BC) who are perceived by their colleagues to be the most educationally influential. METHODS A cross-sectional study using a previously validated survey tool was mailed to a randomly selected sample of 2300 BC registered primary care physicians. Follow-up mailings were sent to nonresponders. RESULTS The survey response rate was 53%. A list of 375 educationally influential physicians (EIs) was proportionately determined and tabulated by region. IMPLICATIONS The top 5% of provincial EIs were identified to serve as a resource for formal and informal continuing medical education (CME). Their names will be brought forward in response to selected requests for CME speakers.
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Grzybowski S, Thommasen HV, Mills J, Herbert CP. Review of University of British Columbia Family Practice Resident Research Projects 1990-1997. Fam Med 1999; 31:353-7. [PMID: 10407714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND Resident research projects can be an important component of building a strong and diversified research presence in family medicine. One of the requirements for graduation from the University of British Columbia (UBC) Family Practice Residency Program is that family practice residents complete a scholarly piece of work. METHODS UBC family practice resident projects from 1990-1997 were reviewed and classified by methodology. A survey was sent to 251 former residents to determine 1) if their project was published, 2) if not, was there any interest in publication, and 3) what were the main reasons for not pursuing publication. Fifteen projects were selected as suitable for publication and were, with permission of the resident, submitted to medical journals. RESULTS Sixty-nine percent of the resident projects involved data collection and hypothesis testing, and 40% were cross-sectional, of which patient surveys were the most common method. A total of 190 former residents (71%) have responded to our survey. Seven percent of respondents stated that their project had been published, and 55% would have liked to have tried to publish their project. Of the 15 resident projects we submitted for publication, seven were accepted. CONCLUSIONS Family practice residents are capable of producing a wide variety of research projects. Only a minority of projects are being published despite the fact that the majority of residents are interested in pursuing publication. Greater assistance by faculty can increase publication of research projects.
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Grzybowski S, Allen EA. Tuberculosis: 2. History of the disease in Canada. CMAJ 1999; 160:1025-8. [PMID: 10207344 PMCID: PMC1230197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
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Kirkham CM, Grzybowski S. Maternity Care Guidelines checklist. To assist physicians in implementing CPGs. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 1999; 45:671-8. [PMID: 10099806 PMCID: PMC2328413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
PROBLEM BEING ADDRESSED Implementing the recommended clinical practice guidelines for prenatal care can be difficult for busy practitioners because the guidelines are numerous and continually being revised. OBJECTIVE OF PROGRAM To develop a checklist outlining the current recommended activities for prenatal care to assist practitioners in providing evidence-based interventions to pregnant women. MAIN COMPONENTS OF PROGRAM We reviewed guidelines for prenatal care from the Canadian Task Force on the Periodic Health Examination (CTFPHE) and from the report of the US Preventive Services Task Force (USPSTF). We searched MEDLINE for interventions commonly performed in pregnancy, but not reviewed by either task force. Interventions graded A or B are listed in bold type on the checklist. Interventions graded C by either task force or recommended by organizations not necessarily using the same rigorous criteria are listed in plain type. Recommended interventions are displayed along a time line under three headings: clinical maneuvers, investigations, and issues for discussion. Pilot testing by 12 practising physicians and 12 family practice residents showed that most respondents thought the checklist very useful. CONCLUSIONS Providing a one-page checklist summarizing recommended clinical maneuvers, investigations, and topics for discussion should help physicians with implementing the many clinical practice guidelines for prenatal care.
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Grzybowski S, Nout R, Kirkham M. Maternity care calendar wheel. Improved obstetric wheel developed in British Columbia. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 1999; 45:661-6. [PMID: 10099805 PMCID: PMC2328417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
PROBLEM BEING ADDRESSED Gestational calendar "wheels" are not well designed for routine prenatal care or for presenting the uncertainties of predicting date of delivery. OBJECTIVE OF PROGRAM To design and pilot-test a new gestational calendar wheel that predicts the range of normal due dates in a way that reflects the biological realities of pregnancy. The calendar has prompts that could facilitate provision of antenatal care, support prenatal education, and guide the timing of induction for pregnancies past their due dates. MAIN COMPONENTS OF PROGRAM The calendar sets out the key issues to be addressed with patients during pregnancy. It is designed to be photocopied while set to patients' dates: patients keep one copy; another is placed in their charts. The probability of delivering on a given date is presented graphically and as a percentage likelihood of giving birth during specified intervals. Twelve practising physicians, 12 residents, and 10 pregnant women pilot-tested and evaluated the wheel. Their responses were favourable. CONCLUSIONS The Maternity Care Calendar wheel is a substantial advance on existing obstetric calendar wheels. It incorporates evidence-based information that should facilitate prenatal care, promote prenatal education, and foster realistic expectations about the likely timing of delivery. Early in the pregnancy, it can help establish the timing of induction for pregnancies past their due dates. Further testing of the calendar's effectiveness in improving patient outcomes is needed.
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Sajan A, Corneil T, Grzybowski S. The street value of prescription drugs. CMAJ 1998; 159:139-42. [PMID: 9700324 PMCID: PMC1229518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Although most physicians are aware of the potential for abuse and resale of prescribed medications, little has been done to document it. The purpose of this study was to determine which prescription drugs have street value, what that value is and why these drugs are used. METHODS A descriptive cross-sectional survey using a semistructured interview technique was carried out on 2 weekdays (Mar. 10 and Apr. 1, 1997) in Vancouver's Downtown Eastside. A total of 58 users and dealers of prescription sedative/hypnotic and narcotic drugs were approached. Information collected included the demographic characteristics of those interviewed, the common street names of the drugs of interest, and their value and method of use. RESULTS Thirty-two people agreed to participate in the study (participation rate 55%), 7 of whom were dealers. The range in price of sedative/hypnotic drugs was $0.10 to $2. For narcotic drugs the range was much greater, at $0.25 to $75. Descriptive analysis identified the minimum and maximum price and the mode of each preparation. Among the weak narcotic drugs the index drug (highest in demand on the street) was Tylenol No. 3 and among the more potent narcotics, MS Contin 30 mg. INTERPRETATION A wide variety of prescription sedative/hypnotic and narcotic drugs are available on the street. The mark-up from pharmacy cost can be considerable. Factors influencing pricing include the relative inexperience of the buyer, the availability of illicit narcotics, the current street supply of prescription medications and the time of the month (before or after issue of social assistance cheques).
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Iglesias S, Grzybowski S, Klein MC, Gagné GP, Lalonde A. Rural obstetrics. Joint position paper on rural maternity care. Joint Working Group of the Society of Rural Physicians of Canada (SRPC), The Maternity Care Committee of the College of Family Physicians of Canada (CFPC), and the Society of Obstetricians and Gynaecologists of Canada (SOGC). CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 1998; 44:831-43. [PMID: 9585856 PMCID: PMC2277824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Grams GD, Herbert C, Heffernan C, Calam B, Wilson MA, Grzybowski S, Brown D. Haida perspectives on living with non-insulin-dependent diabetes. CMAJ 1996; 155:1563-8. [PMID: 8956833 PMCID: PMC1334994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To understand the experience of Haida people living with non-insulin-dependent diabetes mellitus (NIDDM), in order to provide a basis for a culturally sensitive community-based approach to managing NIDDM. DESIGN Qualitative study using grounded theory. SETTING The villages of Skidegate and Old Massett in Haida Gwaii (Queen Charlotte Islands), British Columbia. PARTICIPANTS Nine focus groups met at the beginning and six at the end of the project. The focus groups had 8 to 12 members each and roughly the same number of men and women overall. The groups included people with diabetes, family members of people with diabetes, community leaders and elders. FINDINGS Conceptual findings related to the participants' views on the impact of NIDDM on their lives, their views on what life was like before the effects of NIDDM were felt and their beliefs about the prevention and treatment of NIDDM. Six themes recurred in the discussions: fear; grief and loss; the loss of and desire to regain control; food and eating; physical and personal strength; and traditional ways. CONCLUSIONS Insights into the illness experience of different cultural groups can inform program development and the creation of culturally sensitive health care interventions.
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Schulzer M, Radhamani MP, Grzybowski S, Mak E, Fitzgerald JM. A mathematical model for the prediction of the impact of HIV infection on tuberculosis. Int J Epidemiol 1994; 23:400-7. [PMID: 8082969 DOI: 10.1093/ije/23.2.400] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
A mathematical model is introduced to study the accelerating impact of HIV infection on the incidence rates of tuberculosis (TB) disease. A sexually active population (15-49 years) is followed cross-sectionally over a period of time. Beginning with the year in which HIV infection was probably first present in the population, the model calculates the growing yearly incidence rates of new TB disease in HIV-positive and in HIV-negative individuals. Model equations, derived by an actuarial method, are developed recursively. Input information required for the calculations includes the age distribution of the study population, pre-HIV annual TB infection rates, annual HIV infection and mortality rates, and estimates of annual TB disease breakdown rates in the absence and in the presence of HIV infection. With correct input data, the model provides a useful blueprint for health agencies in designing effective programmes for curbing the future course of these dual epidemics in the population.
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Grzybowski S. The supply of antituberculosis drugs and national drugs policies. TUBERCLE AND LUNG DISEASE : THE OFFICIAL JOURNAL OF THE INTERNATIONAL UNION AGAINST TUBERCULOSIS AND LUNG DISEASE 1993; 74:346-347. [PMID: 8260669 DOI: 10.1016/0962-8479(93)90111-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Grzybowski S. Drugs are not enough. Failure of short-course chemotherapy in a district in India. TUBERCLE AND LUNG DISEASE : THE OFFICIAL JOURNAL OF THE INTERNATIONAL UNION AGAINST TUBERCULOSIS AND LUNG DISEASE 1993; 74:145-6. [PMID: 8369506 DOI: 10.1016/0962-8479(93)90002-f] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Schulzer M, Fitzgerald J, Enarson D, Grzybowski S. An estimate of the future size of the tuberculosis problem in sub-Saharan Africa resulting from HIV infection. ACTA ACUST UNITED AC 1992. [DOI: 10.1016/0962-8479(92)90097-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Xie HJ, Enarson DA, Chao CW, Allen EA, Grzybowski S. Deaths in tuberculosis patients in British Columbia, 1980-1984. TUBERCLE AND LUNG DISEASE : THE OFFICIAL JOURNAL OF THE INTERNATIONAL UNION AGAINST TUBERCULOSIS AND LUNG DISEASE 1992; 73:77-82. [PMID: 1643301 DOI: 10.1016/0962-8479(92)90059-s] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Records of all 1884 newly notified tuberculosis cases, over the 5-year period 1980-1984 in British Columbia, Canada, were reviewed and 201 deaths were identified, including 48 diagnosed only after death, and 153 who died while on treatment; 56 of unrelated causes, 67 in whom tuberculosis was a contributing cause, and 30 in whom it was the principal cause. Significant predictors of death while on treatment (specific to tuberculosis) were the extent of disease, history of previous disease and sputum smear-positive for acid-fast organisms. Significant predictors of failure of diagnosis, in patients who died, were the presence of disseminated disease and the absence of a history of previous disease. The presenting features were not different in those dying, in whom the diagnosis was made before, as compared with after, death. The most frequent mode of death due to tuberculosis was respiratory failure, followed by multiple organ system failure and haemoptysis. The case fatality rate was low (1.6%) and did not change over 10 years. One-half of patients whose death was due to tuberculosis were diagnosed only after death and this had not changed over 10 years. We conclude that death due to tuberculosis is uncommon in patients while on treatment and that the main reason for death due to tuberculosis is that some patients are not diagnosed, and therefore not treated, before they die of the disease.
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Schulzer M, Fitzgerald JM, Enarson DA, Grzybowski S. An estimate of the future size of the tuberculosis problem in sub-Saharan Africa resulting from HIV infection. TUBERCLE AND LUNG DISEASE : THE OFFICIAL JOURNAL OF THE INTERNATIONAL UNION AGAINST TUBERCULOSIS AND LUNG DISEASE 1992; 73:52-8. [PMID: 1525378 DOI: 10.1016/0962-8479(92)90080-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The impact of the human immunodeficiency virus (HIV) on tuberculosis is well documented. Its effect in populations with a high proportion of dually infected individuals is likely to be significant. Sub-Saharan Africa is one such region and to better document the effect of HIV infection on tuberculosis there we developed a mathematical model to predict the likely extra numbers of tuberculosis cases due to it. A mathematical model was developed using a variety of scenarios giving a range of risks for the period 1980-2000. The four scenarios included (1) a low rate of 1% risk of tuberculosis infection in year 0 (1980) with 45% tuberculosis infection prevalence, and an HIV prevalence of 2% in 1989; (2) a 2% risk of tuberculosis infection in year 0 with 60% tuberculosis infection prevalence, and a 2% HIV prevalence in 1989; (3) a 2% risk of tuberculosis infection in year 0 with 60% tuberculosis infection prevalence, and a 10% HIV prevalence in 1989; and (4) a 2% risk of tuberculosis infection in year 0 with 60% tuberculosis infection prevalence and a 20% HIV prevalence in 1989. Under scenarios 1 and 2, a 50-60% increase in smear-positive rates in the subpopulation (15-45 years old) is predicted for the year 2000, under scenario 3, smear-positive rates in the subpopulation in the year 2000 are expected to increase four-fold from the 1980 baseline. Under scenario 4, a 10-fold increase in smear-positive rates in 2000 is expected in the subpopulation. Under this scenario, total disease will have increased 12-fold in the subpopulation.(ABSTRACT TRUNCATED AT 250 WORDS)
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