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Barrett TM, Liebert MA, Eick GN, Ridgeway-Diaz JG, Madimenos FC, Blackwell AD, Urlacher SS, Sugiyama LS, Snodgrass JJ. Age-related patterns of cytomegalovirus antibodies accompanying Epstein-Barr virus co-infection. Am J Hum Biol 2022; 34:e23713. [PMID: 34914157 DOI: 10.1002/ajhb.23713] [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] [Received: 10/01/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Cytomegalovirus (CMV) infection is associated with age-related chronic disease, and co-infection with Epstein-Barr virus (EBV) may compound disease risk. We aimed to assess the frequency of CMV infection and its relationship with age among EBV seropositive individuals in an Indigenous Amazonian population. METHODS We report concentrations of CMV and EBV antibodies in dried blood spot samples collected from 157 EBV positive Shuar participants aged 15-86 years (60.5% female) to assess CMV infection rate. We used logistic and linear regression models to examine associations among CMV, EBV, and age, adjusting for sex, geographic region, and body mass index. RESULTS Nearly two-thirds (63.1%) of EBV seropositive participants were also CMV seropositive. A 1-year increase in age was associated with 3.4% higher odds of CMV infection (OR [95% CI]: 1.034 [1.009-1.064], p = .012), but CMV antibody concentration was not significantly associated with age or EBV antibody concentration among co-infected individuals. CONCLUSIONS Herpesvirus-related immunosenescence may be important to understanding chronic disease risk among Shuar. Future studies should further explore the role of co-infection in shaping age-related changes in immune function.
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Affiliation(s)
- Tyler M Barrett
- Department of Evolutionary Anthropology, Duke University, Durham, North Carolina, USA
| | - Melissa A Liebert
- Department of Anthropology, Northern Arizona University, Flagstaff, Arizona, USA
| | - Geeta N Eick
- Department of Anthropology, University of Oregon, Eugene, Oregon, USA
| | - Julia G Ridgeway-Diaz
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Felicia C Madimenos
- Department of Anthropology, Queens College, City University of New York, Flushing, New York, USA
| | - Aaron D Blackwell
- Department of Anthropology, Washington State University, Pullman, WA, USA
| | - Samuel S Urlacher
- Department of Anthropology, Baylor University, Waco, Texas, USA.,Child and Brain Development Program, CIFAR, Toronto, Canada
| | | | - J Josh Snodgrass
- Department of Anthropology, University of Oregon, Eugene, Oregon, USA.,Center for Global Health, University of Oregon, Eugene, Oregon, USA
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2
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Barrett TM, Green JA, Greer RC, Ephraim PL, Peskoe S, Pendergast JF, Hauer CL, Strigo TS, Norfolk E, Bucaloiu ID, Diamantidis CJ, Hill-Briggs F, Browne T, Jackson GL, Boulware LE. Preferences for and Experiences of Shared and Informed Decision Making Among Patients Choosing Kidney Replacement Therapies in Nephrology Care. Kidney Med 2021; 3:905-915.e1. [PMID: 34939000 PMCID: PMC8664702 DOI: 10.1016/j.xkme.2021.05.011] [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] [Indexed: 11/17/2022] Open
Abstract
RATIONALE & OBJECTIVE Chronic kidney disease (CKD) can progress rapidly, and patients are often unprepared to make kidney failure treatment decisions. We aimed to better understand patients' preferences for and experiences of shared and informed decision making (SDM) regarding kidney replacement therapy before kidney failure. STUDY DESIGN Cross-sectional study. SETTING & PARTICIPANTS Adults receiving nephrology care at CKD clinics in rural Pennsylvania. PREDICTORS Estimated glomerular filtration rate, 2-year risk for kidney failure, duration and frequency of nephrology care, and preference for SDM. OUTCOMES Occurrence and extent of kidney replacement therapy discussions and participants' satisfaction with those discussions. ANALYTIC APPROACH Multivariable logistic regression to quantify associations between participants' characteristics and whether they had discussions. RESULTS The 447 study participants had a median age of 72 (IQR, 64-80) years and mean estimated glomerular filtration rate of 33 (SD, 12) mL/min/1.73 m2. Most (96%) were White, high school educated (67%), and retired (65%). Most (72%) participants preferred a shared approach to kidney treatment decision making, and only 35% discussed dialysis or transplantation with their kidney teams. Participants who had discussions (n = 158) were often completely satisfied (63%) but infrequently discussed potential treatment-related impacts on their lives. In multivariable analyses, those with a high risk for kidney failure within 2 years (OR, 3.24 [95% CI, 1.72-6.11]; P < 0.01), longer-term nephrology care (OR, 1.12 [95% CI, 1.05-1.20] per 1 additional year; P < 0.01), and more nephrology visits in the prior 2 years (OR, 1.34 [95% CI, 1.20-1.51] per 1 additional visit; P < 0.01) had higher odds of having discussed dialysis or transplantation. LIMITATIONS Single health system study. CONCLUSIONS Most patients preferred sharing CKD treatment decisions with their providers, but treatment discussions were infrequent and often did not address key treatment impacts. Longitudinal nephrology care and frequent visits may help ensure that patients have optimal SDM experiences.
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Affiliation(s)
- Tyler M. Barrett
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC
| | - Jamie A. Green
- Department of Nephrology, Geisinger Commonwealth School of Medicine, Danville, PA
- Kidney Health Research Institute, Danville, PA
| | - Raquel C. Greer
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD
| | - Patti L. Ephraim
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sarah Peskoe
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Jane F. Pendergast
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Chelsie L. Hauer
- Center for Clinical Innovation, Institute for Advanced Application, Danville, PA
| | - Tara S. Strigo
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC
| | - Evan Norfolk
- Department of Nephrology, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Ion Dan Bucaloiu
- Department of Nephrology, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Clarissa J. Diamantidis
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC
- Division of Nephrology, Duke University School of Medicine, Durham, NC
| | - Felicia Hill-Briggs
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD
| | - Teri Browne
- College of Social Work, University of South Carolina, Columbia, SC
| | - George L. Jackson
- Center for Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - L. Ebony Boulware
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC
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3
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Barrett TM, Davenport CA, Ephraim PL, Peskoe S, Mohottige D, DePasquale N, McElroy L, Boulware LE. Disparities in Discussions about Kidney Replacement Therapy in CKD Care. Kidney360 2021; 3:158-163. [PMID: 35368562 PMCID: PMC8967603 DOI: 10.34067/kid.0004752021] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/22/2021] [Indexed: 01/10/2023]
Abstract
Participants who identified as female and Black reported more thorough discussions of dialysis than transplant.Participants with low incomes and education reported more thorough discussions of dialysis than transplant.
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Affiliation(s)
- Tyler M. Barrett
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Clemontina A. Davenport
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Patti L. Ephraim
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sarah Peskoe
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Dinushika Mohottige
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina,Division of Nephrology, Duke University School of Medicine, Durham, North Carolina
| | - Nicole DePasquale
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Lisa McElroy
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina,Division of Abdominal Transplant, Duke University School of Medicine, Durham, North Carolina
| | - L. Ebony Boulware
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina
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4
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Barrett TM, Tsui CKM. Emerging fungal pathogen: Candida auris. Evol Med Public Health 2021; 9:246-247. [PMID: 34447574 DOI: 10.1093/emph/eoab021] [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] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/15/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Tyler M Barrett
- Department of Evolutionary Anthropology, Duke University, Durham, NC, USA
| | - Clement K M Tsui
- Department of Pathology, Sidra Medicine, Doha, Qatar.,Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar.,Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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5
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Boulware LE, Sudan DL, Strigo TS, Ephraim PL, Davenport CA, Pendergast JF, Pounds I, Riley JA, Falkovic M, Alkon A, Hill-Briggs F, Cabacungan AN, Barrett TM, Mohottige D, McElroy L, Diamantidis CJ, Ellis MJ. Transplant social worker and donor financial assistance to increase living donor kidney transplants among African Americans: The TALKS Study, a randomized comparative effectiveness trial. Am J Transplant 2021; 21:2175-2187. [PMID: 33210831 DOI: 10.1111/ajt.16403] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 09/08/2020] [Revised: 10/14/2020] [Accepted: 10/31/2020] [Indexed: 01/25/2023]
Abstract
Lack of donors hinders living donor kidney transplantation (LDKT) for African Americans. We studied the effectiveness of a transplant social worker intervention (TALK SWI) alone or paired with living donor financial assistance to activate African Americans' potential living kidney donors. African Americans (N = 300) on the transplant waiting list were randomly assigned to usual care; TALK SWI; or TALK SWI plus Living Donor Financial Assistance. We quantified differences in live kidney donor activation (composite rate of live donor inquiries, completed new live donor evaluations, or live kidney donation) after 12 months. Participants' mean age was 52 years, 56% were male, and 43% had annual household income less than $40,000. Most previously pursued LDKT. Participants were highly satisfied with TALK social workers, but they rarely utilized Financial Assistance. After 12 months, few (n = 39, 13%) participants had a new donor activation event (35 [12%] new donor inquiries; 17 [6%] new donor evaluations; 4 [1%] LDKT). There were no group differences in donor activation events (subdistribution hazard ratio [95% CI]: 1.09 [0.51-2.30] for TALK SWI and 0.92 [0.42-2.02] for TALK SWI plus Financial Assistance compared to Usual Care, p = 91). Alternative interventions to increase LDKT for African Americans on the waiting list may be needed. Trial registration: ClinicalTrials.gov (NCT02369354).
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Affiliation(s)
- L Ebony Boulware
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Debra L Sudan
- Division of Abdominal Transplant, Duke Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Tara S Strigo
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Patti L Ephraim
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA
| | - Clemontina A Davenport
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Jane F Pendergast
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Iris Pounds
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Jennie A Riley
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Margaret Falkovic
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Aviel Alkon
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Felicia Hill-Briggs
- Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA.,Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ashley N Cabacungan
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Tyler M Barrett
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Dinushika Mohottige
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Lisa McElroy
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Division of Abdominal Transplant, Duke Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Clarissa J Diamantidis
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Matthew J Ellis
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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Barrett TM, Green JA, Greer RC, Ephraim PL, Peskoe S, Pendergast JF, Hauer CL, Strigo TS, Norfolk E, Bucaloiu ID, Diamantidis CJ, Hill-Briggs FF, Browne T, Jackson GL, Boulware LE. Advanced CKD Care and Decision Making: Which Health Care Professionals Do Patients Rely on for CKD Treatment and Advice? Kidney Med 2020; 2:532-542.e1. [PMID: 33089136 PMCID: PMC7568072 DOI: 10.1016/j.xkme.2020.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Rationale & Objective Chronic kidney disease (CKD) care is often fragmented across multiple health care providers. It is unclear whether patients rely mostly on their nephrologists or non-nephrologist providers for medical care, including CKD treatment and advice. Study Design Cross-sectional study. Setting & Participants Adults receiving nephrology care at CKD clinics in Pennsylvania. Predictors Frequency, duration, and patient-centeredness (range, 1 [least] to 4 [most]) of participants’ nephrology care. Outcome Participants’ reliance on nephrologists, primary care providers, or other specialists for medical care, including CKD treatment and advice. Analytical Approach Multivariable logistic regression to quantify associations between participants’ reliance on their nephrologists (vs other providers) and their demographics, comorbid conditions, kidney function, and nephrology care. Results Among 1,412 patients in clinics targeted for the study, 676 (48%) participated. Among these, 453 (67%) were eligible for this analysis. Mean age was 71 (SD, 12) years, 59% were women, 97% were white, and 65% were retired. Participants were in nephrology care for a median of 3.8 (IQR, 2.0-6.6) years and completed a median of 4 (IQR, 3-5) nephrology appointments in the past 2 years. Half (56%) the participants relied primarily on their nephrologists, while 23% relied on primary care providers, 18% relied on all providers equally, and 3% relied on other specialists. Participants’ adjusted odds of relying on their nephrologists were higher for those in nephrology care for longer (OR, 1.08 [95% CI, 1.02-1.15]; P = 0.02), those who completed more nephrology visits in the previous 2 years (OR, 1.16 [95% CI, 1.05-1.29]; P = 0.005), and those who perceived their last interaction with their nephrologists as more patient-centered (OR, 2.63 [95% CI, 1.70-4.09]; P < 0.001). Limitations Single health system study. Conclusions Many nephrology patients relied on non-nephrologist providers for medical care. Longitudinal patient-centered nephrology care may encourage more patients to follow nephrologists’ recommendations.
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Affiliation(s)
- Tyler M Barrett
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC
| | - Jamie A Green
- Department of Nephrology, Geisinger Commonwealth School of Medicine, Danville, PA.,Kidney Health Research Institute, Geisinger, Danville, PA
| | - Raquel C Greer
- Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD.,Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD
| | - Patti L Ephraim
- Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sarah Peskoe
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Jane F Pendergast
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Chelsie L Hauer
- Center for Clinical Innovation, Institute for Advanced Application, Geisinger, Danville, PA
| | - Tara S Strigo
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC
| | - Evan Norfolk
- Department of Nephrology, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Ion Dan Bucaloiu
- Department of Nephrology, Geisinger Medical Center, Danville, PA
| | - Clarissa J Diamantidis
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC.,Division of Nephrology, Duke University School of Medicine, Durham, NC
| | - Felicia F Hill-Briggs
- Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD.,Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD
| | - Teri Browne
- College of Social Work, University of South Carolina, Columbia, SC
| | - George L Jackson
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC.,Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - L Ebony Boulware
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC
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Kuzawa CW, Barrett TM, Borja JB, Lee NR, Aquino CT, Adair LS, McDade TW. Ankle brachial index (ABI) in a cohort of older women in the Philippines: Prevalence of peripheral artery disease and predictors of ABI. Am J Hum Biol 2019; 31:e23237. [PMID: 30950564 DOI: 10.1002/ajhb.23237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/17/2019] [Accepted: 03/02/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Cardiovascular disease (CVD) is rising in low and middle-income countries, but studies of CVD epidemiology in such settings often focus on risk factors rather than measures of disease progression. Here we use the ankle brachial index (ABI) to assess the prevalence of peripheral artery disease (PAD) among older women living in Metropolitan Cebu, Philippines, and relationships between ABI and CVD risk factors and body composition. METHODS ABI was measured using the Doppler technique in 538 female participants in the 2015 Cebu Longitudinal Health and Nutrition Survey (mean age 58 years, range 47-78 years). ABI was related to a panel of CVD risk factors measured in 2005 and 2012, and to 2012 body composition measures. RESULTS The prevalence of PAD (1.8%) was among the lowest reported in any comparably-aged sample, and only 9.9% of participants had an ABI indicating borderline PAD risk. Smoking (P < 0.011) and use of CVD medications (P < 0.0001) predicted lower ABI (indicating higher PAD risk), which was also lower in relation to 2012 systolic blood pressure (P < 0.054). ABI was unrelated to other CVD risk factors. An apparent protective relationship between body mass index (BMI) and ABI, noted in previous studies, was found to be confounded by protective relationships between ABI and fat free mass, height, and grip strength (all P < 0.05). CONCLUSIONS The prevalence of PAD is low in Cebu Longitudinal Health and Nutrition Survey participants, and ABI was related to few CVD risk factors. Past reports of lower PAD risk in relation to BMI may reflect confounding by lean mass, which has protective relationships with ABI.
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Affiliation(s)
- Christopher W Kuzawa
- Department of Anthropology, Northwestern University, Evanston, Illinois.,Institute for Policy Research, Northwestern University, Evanston, Illinois
| | - Tyler M Barrett
- Department of Anthropology, Northwestern University, Evanston, Illinois
| | - Judith B Borja
- USC-Office of Population Studies Foundation, Inc., University of San Carlos, Cebu City, Philippines.,Department of Nutrition and Dietetics, University of San Carlos, Cebu City, Philippines
| | - Nanette R Lee
- USC-Office of Population Studies Foundation, Inc., University of San Carlos, Cebu City, Philippines.,Department of Anthropology, Sociology and History, University of San Carlos, Cebu City, Philippines
| | - Celine T Aquino
- Department of Medicine, Cebu Institute of Medicine, Cebu City, Philippines
| | - Linda S Adair
- Carolina Population Center and Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina
| | - Thomas W McDade
- Department of Anthropology, Northwestern University, Evanston, Illinois.,Institute for Policy Research, Northwestern University, Evanston, Illinois
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Arokiasamy P, Uttamacharya, Kowal P, Capistrant BD, Gildner TE, Thiele E, Biritwum RB, Yawson AE, Mensah G, Maximova T, Wu F, Guo Y, Zheng Y, Kalula SZ, Salinas Rodríguez A, Manrique Espinoza B, Liebert MA, Eick G, Sterner KN, Barrett TM, Duedu K, Gonzales E, Ng N, Negin J, Jiang Y, Byles J, Madurai SL, Minicuci N, Snodgrass JJ, Naidoo N, Chatterji S. Chronic Noncommunicable Diseases in 6 Low- and Middle-Income Countries: Findings From Wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (SAGE). Am J Epidemiol 2017; 185:414-428. [PMID: 28399566 PMCID: PMC6075549 DOI: 10.1093/aje/kww125] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [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: 11/11/2015] [Revised: 05/01/2016] [Accepted: 05/02/2016] [Indexed: 12/20/2022] Open
Abstract
In this paper, we examine patterns of self-reported diagnosis of noncommunicable diseases (NCDs) and prevalences of algorithm/measured test-based, undiagnosed, and untreated NCDs in China, Ghana, India, Mexico, Russia, and South Africa. Nationally representative samples of older adults aged ≥50 years were analyzed from wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (2007-2010; n = 34,149). Analyses focused on 6 conditions: angina, arthritis, asthma, chronic lung disease, depression, and hypertension. Outcomes for these NCDs were: 1) self-reported disease, 2) algorithm/measured test-based disease, 3) undiagnosed disease, and 4) untreated disease. Algorithm/measured test-based prevalence of NCDs was much higher than self-reported prevalence in all 6 countries, indicating underestimation of NCD prevalence in low- and middle-income countries. Undiagnosed prevalence of NCDs was highest for hypertension, ranging from 19.7% (95% confidence interval (CI): 18.1, 21.3) in India to 49.6% (95% CI: 46.2, 53.0) in South Africa. The proportion untreated among all diseases was highest for depression, ranging from 69.5% (95% CI: 57.1, 81.9) in South Africa to 93.2% (95% CI: 90.1, 95.7) in India. Higher levels of education and wealth significantly reduced the odds of an undiagnosed condition and untreated morbidity. A high prevalence of undiagnosed NCDs and an even higher proportion of untreated NCDs highlights the inadequacies in diagnosis and management of NCDs in local health-care systems.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Somnath Chatterji
- Correspondence to Dr. Somnath Chatterji, Division of Information, Evidence and Research, World Health Organization, Avenue Appia, CH 1211 Geneva, Switzerland (e-mail: or )
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9
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Snodgrass JJ, Liebert MA, Cepon-Robins TJ, Barrett TM, Mathur A, Chatterji S, Kowal P. Accelerometer-measured physical activity among older adults in urban India: Results of a study on global AGEing and adult health substudy. Am J Hum Biol 2015; 28:412-20. [PMID: 26566593 DOI: 10.1002/ajhb.22803] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 08/21/2015] [Accepted: 10/19/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Accelerometry provides researchers with a powerful tool to measure physical activity in population-based studies, yet this technology has been underutilized in cross-cultural studies of older adults. The present study was conducted among older adults in an urban setting in India with the following three objectives: (1) to compare average activity levels obtained through different durations of monitoring (1, 3, and 7 days); (2) to document differences in physical activity patterns by sex and age; and (3) to evaluate links between measures of physical activity and anthropometrics, as well as between activity parameters and measures of household size, work status, and social cohesion. METHODS The present study uses data from a physical activity substudy of the World Health Organization's Study on global AGEing and adult health (SAGE-PA). This study of 200 older adults (49-90 years old; 72 males, 128 females) in urban India combines 7 continuous days of ActiGraph GT3X accelerometry with anthropometric and sociodemographic data. RESULTS Results reveal overall low activity levels, with significantly lower activity energy expenditure (AEE) among females (P < 0.05). No significant differences were documented in activity level by monitoring duration. Age was negatively correlated with AEE in men (P < 0.01) and women (P < 0.001). AEE was positively correlated with BMI in men (P < 0.01) and women (P < 0.05). Finally, women who were more socially integrated had greater AEE (P < 0.01). CONCLUSIONS This study illustrates the utility of accelerometry for quantifying activity levels in aging populations in non-Western nations. Am. J. Hum. Biol. 28:412-420, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- J Josh Snodgrass
- Department of Anthropology, University of Oregon, Eugene, Oregon, 97403
| | - Melissa A Liebert
- Department of Anthropology, University of Oregon, Eugene, Oregon, 97403
| | - Tara J Cepon-Robins
- Department of Anthropology, University of Colorado-Colorado Springs, Colorado Springs, Colorado, 80920
| | - Tyler M Barrett
- Department of Anthropology, University of Oregon, Eugene, Oregon, 97403
| | | | - Somnath Chatterji
- Multi-Country Studies Unit, World Health Organization, Geneva, Switzerland
| | - Paul Kowal
- Multi-Country Studies Unit, World Health Organization, Geneva, Switzerland.,University of Newcastle Research Centre on Gender, Health, and Ageing, Newcastle, New South Wales, Australia
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Barrett TM, Liebert MA, Schrock JM, Cepon-Robins TJ, Mathur A, Agarwal H, Kowal P, Snodgrass JJ. Physical function and activity among older adults in Jodhpur, India. Ann Hum Biol 2015; 43:488-91. [DOI: 10.3109/03014460.2015.1103901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
| | | | | | | | | | | | - Paul Kowal
- Study on Global AGEing and Adult Health, World Health Organisation, Geneva, Switzerland, and
- University of Newcastle Research Centre for Gender, Health, and Ageing, Newcastle, NSW, Australia
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Gildner TE, Barrett TM, Liebert MA, Kowal P, Snodgrass JJ. Does BMI generated by self-reported height and weight measure up in older adults from middle-income countries? Results from the study on global AGEing and adult health (SAGE). BMC Obes 2015; 2:44. [PMID: 26509041 PMCID: PMC4620625 DOI: 10.1186/s40608-015-0074-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 10/12/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Self-reported (SR) body mass index (BMI) values are often used to determine obesity prevalence. However, individuals frequently overestimate their height and underestimate their weight, resulting in artificially lower obesity prevalence rates. These patterns are especially apparent among older adults and overweight individuals. The present cross-sectional study uses nationally representative datasets from five countries to assess the accuracy of SR BMI values in diverse settings. METHODS Samples of older adults (≥50 years old) and comparative samples of younger adults (18-49 years old) were drawn from five middle-income countries (China, India, Mexico, Russian Federation, and South Africa) in the World Health Organization's Study on global AGEing and adult health (SAGE). Participant-reported and researcher-obtained height and weight measures were used to calculate SR and measured BMI, respectively. Paired t-tests assessed differences between SR and measured BMI values by country. Linear regressions examined the contribution of measured weight and age to differences between SR and measured BMI. RESULTS Significant differences between SR and measured BMI values were observed (p < 0.05), but the direction of these discrepancies varied by country, age, and sex. Measured weight significantly contributed to differences between SR and measured BMI in all countries (p < 0.01). Age did not contribute significantly to variation in BMI discrepancy, except in China (p < 0.001). CONCLUSIONS These results suggest that SR BMI may not accurately reflect measured BMI in middle-income countries, but the direction of this discrepancy varies by country. This has considerable implications for obesity-related disease estimates reliant on SR data.
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Affiliation(s)
- Theresa E. Gildner
- />Department of Anthropology, University of Oregon, 1321 Kincaid Street, Eugene, OR 97403 USA
| | - Tyler M. Barrett
- />Department of Anthropology, University of Oregon, 1321 Kincaid Street, Eugene, OR 97403 USA
| | - Melissa A. Liebert
- />Department of Anthropology, University of Oregon, 1321 Kincaid Street, Eugene, OR 97403 USA
| | - Paul Kowal
- />World Health Organization, 20 Avenue Appia, CH-1211, Geneva, 27 Switzerland
- />University of Newcastle Research Centre for Gender, Health and Ageing, HMRI Building Level 4 West Wing, Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
| | - J. Josh Snodgrass
- />Department of Anthropology, University of Oregon, 1321 Kincaid Street, Eugene, OR 97403 USA
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Barrett TM, Gonzales ET. Reconstruction of the female external genitalia. Urol Clin North Am 1980; 7:455-63. [PMID: 7404878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The experience of the authors with the surgical reconstruction of female external genitalia is described. In all cases in which these procedures were used, reduction clitoroplasty resulted in satisfactory cosmetic appearance and the preservation of tactile sensation, and posterior flap vaginoplasty provided adequate introital capacity.
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