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Bazzi W, Nasser A, Bakleh MM, Abu-Sitta GS, Nguyen VK, El-Dewachi O, Fayad AA, Matar GM. “Bacteria dominate weapons, soldiers and civilians”: Elucidating the molecular mechanisms and the impact of heavy metals on antimicrobial resistance in war zones. J Infect Public Health 2020. [DOI: 10.1016/j.jiph.2019.01.034] [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: 10/22/2022] Open
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Raab M, Pfadenhauer LM, Nguyen VK, Doumbouya D, Hoelscher M, Froeschl G. Period prevalence and identification challenges of viral haemorrhagic fever suspect cases in a tertiary referral hospital in Guinea: a cross-sectional, retrospective study of triage and emergency room patient profiles. BMC Infect Dis 2020; 20:838. [PMID: 33183252 PMCID: PMC7663860 DOI: 10.1186/s12879-020-05573-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/31/2020] [Indexed: 11/22/2022] Open
Abstract
Background A functioning Viral Haemorrhagic Fever (VHF) surveillance system in countries at risk for outbreaks can reduce early transmission in case of an outbreak. Surveillance performance depends on the application of suspect case definitions in daily clinical practice. Recommended suspect case criteria during outbreaks are designed for high sensitivity and include general symptoms, pyrexia, haemorrhage, epidemiological link and unexplained death in patients. Non-outbreak criteria are narrower, relying on the persistence of fever and the presence of haemorrhagic signs. Methods This study ascertains VHF suspect case prevalence based on outbreak and non-outbreak criteria in a Guinean regional hospital for a period of three months. The study further describes clinical trajectories of patients who meet non-outbreak VHF suspect case criteria in order to discuss challenges in their identification. We used cross-sectional data collection at triage and emergency room to record demographic and clinical data of all admitted patients during the study period. For the follow-up study with description of diagnostic trajectories of VHF suspect cases, we used retrospective chart review. Results The most common symptoms of all patients upon admission were fever, tiredness/weakness and abdominal pain. 686 patients met EVD outbreak criteria, ten adult patients and two paediatric patients met study-specific non-outbreak VHF suspect case criteria. None of the suspect cases was treated as VHF suspect case and none tested positive for malaria upon admission. Their most frequent discharge diagnosis was unspecific gastrointestinal infection. The most common diagnostic measures were haemoglobin level and glycaemia for both adults and for children; of the requested examinations for hospitalized suspect cases, 36% were not executed or obtained. Half of those patients self-discharged against medical advice. Conclusions Our study shows that the number of VHF suspect cases may vary greatly depending on which suspect case criteria are applied. Identification of VHF suspect cases seems challenging in clinical practice. We suggest that this may be due to the low use of laboratory diagnostics to support certain diagnoses and the non-application of VHF suspect case definitions in clinical practice. Future VHF suspect case management should aim to tackle such challenges in comparable hospital settings.
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Affiliation(s)
- Manuel Raab
- Division of Infectious Diseases and Tropical Medicine, University Hospital (LMU), Leopoldstr. 5, 80802, Munich, Germany.
| | - Lisa M Pfadenhauer
- Institute of Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public Health, Ludwig Maximilian University Munich, Marchioninistr, 15, 81377, Munich, Germany
| | - Vinh-Kim Nguyen
- Department of Anthropology and Sociology, The Graduate Institute (IHEID), Rue Eugene-Rigot 2, Case postale 1672, 1211, Geneva 1, Switzerland
| | - Dansira Doumbouya
- Paediatric Service, Hôpital Régional de N'zérékoré, Nzérékoré, Guinea
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, University Hospital (LMU), Leopoldstr. 5, 80802, Munich, Germany
| | - Guenter Froeschl
- Division of Infectious Diseases and Tropical Medicine, University Hospital (LMU), Leopoldstr. 5, 80802, Munich, Germany
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Nguyen VK, Moyer E. Collaborative conundrums and respectful partnerships. MAT 2020. [DOI: 10.17157/mat.4.2.520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Moyer E, Nguyen VK. (Re)Framing and the (medical) anthropological lens. MAT 2020. [DOI: 10.17157/mat.2.3.522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Zwijnenburg W, Hochhauser D, Dewachi O, Sullivan R, Nguyen VK. Solving the jigsaw of conflict-related environmental damage: Utilizing open-source analysis to improve research into environmental health risks. J Public Health (Oxf) 2020; 42:e352-e360. [PMID: 31740928 DOI: 10.1093/pubmed/fdz107] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/01/2019] [Accepted: 08/05/2019] [Indexed: 11/14/2022] Open
Abstract
Investigation of the environmental impacts of armed conflict has been made easier in recent years with the development of new and improved methods for documenting and monitoring environmental damage and pollution. For decades, research into conflict-linked environmental damage and its links to human health have been overlooked and research underfunded, hindering a complete humanitarian response and effective post-conflict reconstruction. Recent developments in the field of open-source investigation have shown promising results due to the increased use of mobile phones, access to the internet and freely available methods for remote observation by satellite. Utilizing and analysing these sources of data can help us to understand how conflicts are associated with environmental damage, pollution and their negative impacts upon public health. Further research and development in this field will help to inform more effective humanitarian responses, mitigate risks to health and identify priorities for post-conflict reconstruction programs. Data-driven open-source research can also strengthen international discussions on state accountability for military activities and build a case for the responsibility of warring parties to protect the environment as well as the people who depend on it.
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Affiliation(s)
| | - David Hochhauser
- Conflict & Health Research Group, King's College London, London, United Kingdom
| | | | - Richard Sullivan
- Conflict & Health Research Group, King's College London, London, United Kingdom
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Bazzi W, Abou Fayad AG, Nasser A, Haraoui LP, Dewachi O, Abou-Sitta G, Nguyen VK, Abara A, Karah N, Landecker H, Knapp C, McEvoy MM, Zaman MH, Higgins PG, Matar GM. Heavy Metal Toxicity in Armed Conflicts Potentiates AMR in A. baumannii by Selecting for Antibiotic and Heavy Metal Co-resistance Mechanisms. Front Microbiol 2020; 11:68. [PMID: 32117111 PMCID: PMC7008767 DOI: 10.3389/fmicb.2020.00068] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 01/14/2020] [Indexed: 12/29/2022] Open
Abstract
Acinetobacter baumannii has become increasingly resistant to leading antimicrobial agents since the 1970s. Increased resistance appears linked to armed conflicts, notably since widespread media stories amplified clinical reports in the wake of the American invasion of Iraq in 2003. Antimicrobial resistance is usually assumed to arise through selection pressure exerted by antimicrobial treatment, particularly where treatment is inadequate, as in the case of low dosing, substandard antimicrobial agents, or shortened treatment course. Recently attention has focused on an emerging pathogen, multi-drug resistant A. baumannii (MDRAb). MDRAb gained media attention after being identified in American soldiers returning from Iraq and treated in US military facilities, where it was termed "Iraqibacter." However, MDRAb is strongly associated in the literature with war injuries that are heavily contaminated by both environmental debris and shrapnel from weapons. Both may harbor substantial amounts of toxic heavy metals. Interestingly, heavy metals are known to also select for antimicrobial resistance. In this review we highlight the potential causes of antimicrobial resistance by heavy metals, with a focus on its emergence in A. baumanni in war zones.
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Affiliation(s)
- Wael Bazzi
- Department of Experimental Pathology, Immunology and Microbiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
- Center for Infectious Diseases Research, American University of Beirut, Beirut, Lebanon
- World Health Organisation (WHO) Collaborating Center for Reference and Research on Bacterial Pathogens, Beirut, Lebanon
| | - Antoine G. Abou Fayad
- Department of Experimental Pathology, Immunology and Microbiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
- Center for Infectious Diseases Research, American University of Beirut, Beirut, Lebanon
- World Health Organisation (WHO) Collaborating Center for Reference and Research on Bacterial Pathogens, Beirut, Lebanon
| | - Aya Nasser
- Department of Experimental Pathology, Immunology and Microbiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
- Center for Infectious Diseases Research, American University of Beirut, Beirut, Lebanon
- World Health Organisation (WHO) Collaborating Center for Reference and Research on Bacterial Pathogens, Beirut, Lebanon
| | - Louis-Patrick Haraoui
- Department of Microbiology and Infectious Diseases, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Omar Dewachi
- Rutgers, The State University of New Jersey, Newark, NJ, United States
| | | | - Vinh-Kim Nguyen
- The Graduate Institute of International and Developmental Studies, Geneva, Switzerland
| | - Aula Abara
- Department of Infection, Imperial College London, London, United Kingdom
| | - Nabil Karah
- Department of Molecular Biology, Umea University, Umea, Sweden
| | - Hannah Landecker
- Department of Sociology and Institute for Society and Genetics, University of California, Los Angeles, Los Angeles, CA, United States
| | - Charles Knapp
- Civil and Environmental Engineering, University of Strathclyde, Glasgow, United Kingdom
| | - Megan M. McEvoy
- Institute for Society and Genetics, University of California, Los Angeles, Los Angeles, CA, United States
| | - Muhammad H. Zaman
- Department of Biomedical Engineering, Boston University, Boston, MA, United States
| | - Paul G. Higgins
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Ghassan M. Matar
- Department of Experimental Pathology, Immunology and Microbiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
- Center for Infectious Diseases Research, American University of Beirut, Beirut, Lebanon
- World Health Organisation (WHO) Collaborating Center for Reference and Research on Bacterial Pathogens, Beirut, Lebanon
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Nguyen VK, Moyer E. The spaces in-between. MAT 2019. [DOI: 10.17157/mat.6.4.774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Nguyen VK, Moyer E. Evidencing in medical anthropology. MAT 2019. [DOI: 10.17157/mat.6.2.755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
The international response to the evolving Ebola epidemic in eastern Democratic Republic of Congo (DRC) has had interim successes while facing ongoing difficulties. The outbreak has occurred in an area of intractable conflict among multiple armed groups at a time of contentious national elections. Despite porous international borders and considerable population movement, however, transmission has been confined to North Kivu and Ituri provinces. Factors potentially contributing to this containment include conduct of about 55 million screenings, surveillance of contacts (12,591 under surveillance currently), testing of 280 samples per day, provision of safe and dignified burials for most deaths, vaccination of high-risk people (112,485 vaccinated as of May 7, 2019), and medical treatment including four investigational therapies. Major challenges remain. Since late February 2019, a sharp rise in cases and increased transmission have been observed. These coincide with organized attacks by armed groups targeting response teams, deteriorating security, and the population's increasing distrust of the response effort. The risk of local and regional spread remains high given the high proportion of deaths occurring outside treatment facilities, relatively low proportions of new patients who were known contacts, ongoing nosocomial transmission, and persistent delays in detection and reporting. Stopping this epidemic will require the alignment of the principal political and armed groups in eastern DRC in support of the response.
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Affiliation(s)
- Oly Ilunga Kalenga
- From the Ministry of Health, Democratic Republic of Congo (O.I.K.); the World Health Organization Regional Office for Africa, Djoue, Brazzaville, Republic of the Congo (M.M.); the Graduate Institute of International and Development Studies (V.-K.N.), and the Office of the Director-General, World Health Organization (T.A.G.) - both in Geneva; the Icahn School of Medicine at Mount Sinai, New York (A.S.); and Medstar Georgetown University Hospital, Washington, DC (D.L.)
| | - Matshidiso Moeti
- From the Ministry of Health, Democratic Republic of Congo (O.I.K.); the World Health Organization Regional Office for Africa, Djoue, Brazzaville, Republic of the Congo (M.M.); the Graduate Institute of International and Development Studies (V.-K.N.), and the Office of the Director-General, World Health Organization (T.A.G.) - both in Geneva; the Icahn School of Medicine at Mount Sinai, New York (A.S.); and Medstar Georgetown University Hospital, Washington, DC (D.L.)
| | - Annie Sparrow
- From the Ministry of Health, Democratic Republic of Congo (O.I.K.); the World Health Organization Regional Office for Africa, Djoue, Brazzaville, Republic of the Congo (M.M.); the Graduate Institute of International and Development Studies (V.-K.N.), and the Office of the Director-General, World Health Organization (T.A.G.) - both in Geneva; the Icahn School of Medicine at Mount Sinai, New York (A.S.); and Medstar Georgetown University Hospital, Washington, DC (D.L.)
| | - Vinh-Kim Nguyen
- From the Ministry of Health, Democratic Republic of Congo (O.I.K.); the World Health Organization Regional Office for Africa, Djoue, Brazzaville, Republic of the Congo (M.M.); the Graduate Institute of International and Development Studies (V.-K.N.), and the Office of the Director-General, World Health Organization (T.A.G.) - both in Geneva; the Icahn School of Medicine at Mount Sinai, New York (A.S.); and Medstar Georgetown University Hospital, Washington, DC (D.L.)
| | - Daniel Lucey
- From the Ministry of Health, Democratic Republic of Congo (O.I.K.); the World Health Organization Regional Office for Africa, Djoue, Brazzaville, Republic of the Congo (M.M.); the Graduate Institute of International and Development Studies (V.-K.N.), and the Office of the Director-General, World Health Organization (T.A.G.) - both in Geneva; the Icahn School of Medicine at Mount Sinai, New York (A.S.); and Medstar Georgetown University Hospital, Washington, DC (D.L.)
| | - Tedros A Ghebreyesus
- From the Ministry of Health, Democratic Republic of Congo (O.I.K.); the World Health Organization Regional Office for Africa, Djoue, Brazzaville, Republic of the Congo (M.M.); the Graduate Institute of International and Development Studies (V.-K.N.), and the Office of the Director-General, World Health Organization (T.A.G.) - both in Geneva; the Icahn School of Medicine at Mount Sinai, New York (A.S.); and Medstar Georgetown University Hospital, Washington, DC (D.L.)
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Abstract
PURPOSE The l'Actuel PrEP Cohort was established to monitor the uptake, effectiveness, safety and changes in sexual risk behaviours among individuals receiving pre-exposure prophylaxis (PrEP) for the prevention of HIV. This prospective dynamic cohort is based at Clinique médicale l'Actuel, a large sexual health clinic located in Montreal, Canada. PARTICIPANTS Since the cohort inception in January of 2013 through June 2018, 2156 individuals consulted for PrEP as participants in the l'Actuel PrEP Cohort. Median age was 35 years (IQR: 29-44 years) and the majority (96%) were men who have sex with men. Among 1551 individuals who initiated PrEP care, the median duration of follow-up was 9.2 months (IQR: 3.7-19.6), with substantial variation based on year of cohort entry. The l'Actuel PrEP Cohort contains both daily and intermittent 'on-demand' PrEP users and has the largest reported population of intermittent PrEP users (n=406) in North America. FINDINGS TO DATE No incident HIV infections have occurred among individuals using PrEP over 1637 person-years of follow-up. However, retention in PrEP care is essential as three individuals who discontinued PrEP subsequently acquired HIV, translating to an HIV incidence of 3.9 cases per 100 person-years (95% CI: 1.3 to 12.1). Among a sample of participants with 1 year of follow-up before and after PrEP initiation (n=109), a moderate increase in sexually transmitted infections was observed following PrEP start. FUTURE PLANS The l'Actuel PrEP Cohort continues to grow with new participants starting PrEP monthly and extended follow-up for existing users. The cohort data will be used for ongoing monitoring of PrEP and for population-level modelling of the impact of PrEP on HIV incidence in Montreal.
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Affiliation(s)
- Zoë R Greenwald
- Epidemiology, Clinique médicale l'Actuel, Montreal, Quebec, Canada
| | - Mathieu Maheu-Giroux
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Jason Szabo
- Clinical Department, Clinique médicale l'Actuel, Montreal, Quebec, Canada
| | | | | | - Vinh-Kim Nguyen
- Global Health Centre, Institut de Hautes Etudes Internationales et du Developpement, Geneva, Switzerland
| | - Réjean Thomas
- Clinical Department, Clinique médicale l'Actuel, Montreal, Quebec, Canada
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Abstract
The provision of gifts and payments for healthy volunteer subjects remains an important topic in global health research ethics. This paper provides empirical insights into theoretical debates by documenting participants' perspectives on an Ebola vaccine trial in West Africa. This trial provided hundreds of Africans with regular payments, food packages and certificates for participation. The researchers conducting the trials considered these socioeconomic provisions to be gifts in accordance with contemporary ethical standards and principles. Trial participants viewed them differently, however, approaching trial participation as a means for training and employment in what was from their perspective a new job market: the post-Ebola expansion of research and health care systems. This paper analyses participation in contemporary research by viewing the context-specific histories of trial participants through the lens of prior interventions, specifically participatory reintegration programmes conducted in Anglophone West Africa to overcome civil war crises. In particular, we argue that participation in the Ebola vaccine trial was inadvertently shaped by the design and outcomes of past reintegration programmes. Our results highlight the need to investigate existing socioeconomic landscapes which surround and indeed permeate clinical research as a prerequisite for understanding the participatory motives of vulnerable participants in West Africa and elsewhere.
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Affiliation(s)
- Arsenii Alenichev
- Department of Anthropology, University of Amsterdam, Amsterdam, Netherlands.,ISGlobal, Barcelona, Spain
| | - Vinh-Kim Nguyen
- Graduate Institute of International and Development Studies, Geneva, Switzerland
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Moyer E, Nguyen VK. Ethnography, reflexivity, knowledge. MAT 2018. [DOI: 10.17157/mat.5.5.689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Moyer E, Nguyen VK. Clinic and crisis. MAT 2018. [DOI: 10.17157/mat.5.4.656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Lévy Y, Lane C, Piot P, Beavogui AH, Kieh M, Leigh B, Doumbia S, D'Ortenzio E, Lévy-Marchal C, Pierson J, Watson-Jones D, Nguyen VK, Larson H, Lysander J, Lacabaratz C, Thiebaut R, Augier A, Ishola D, Kennedy S, Chêne G, Greenwood B, Neaton J, Yazdanpanah Y. Prevention of Ebola virus disease through vaccination: where we are in 2018. Lancet 2018; 392:787-790. [PMID: 30104048 PMCID: PMC6128979 DOI: 10.1016/s0140-6736(18)31710-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [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] [Received: 09/20/2016] [Revised: 08/11/2017] [Accepted: 07/19/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Yves Lévy
- French Institute for Health and Medical Research (Inserm), Paris, France.
| | - Clifford Lane
- National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Peter Piot
- London School of Hygiene & Tropical Medicine, London, UK
| | - Abdul Habib Beavogui
- Centre National de Formation et de Recherche en Santé Rurale de Mafèrinyah, Mafèrinyah, Guinea
| | - Mark Kieh
- Partnership for Research on Ebola Virus in Liberia (PREVAIL), Monrovia, Liberia
| | - Bailah Leigh
- College of Medicine and Allied Health Sciences (COMAHS), University of Sierra Leone, Freetown, Sierra Leone
| | - Seydou Doumbia
- University of Sciences, Technique and Technology of Bamako, Bamako, Mali
| | - Eric D'Ortenzio
- French Institute for Health and Medical Research (Inserm), Paris, France
| | | | - Jerome Pierson
- National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | | | - Vinh-Kim Nguyen
- Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Heidi Larson
- London School of Hygiene & Tropical Medicine, London, UK
| | - Julia Lysander
- Partnership for Research on Ebola Virus in Liberia (PREVAIL), Monrovia, Liberia
| | | | - Rodolphe Thiebaut
- French Institute for Health and Medical Research (Inserm), Paris, France
| | - Augustin Augier
- The Alliance for International Medical Action, Dakar, Senegal
| | - David Ishola
- London School of Hygiene & Tropical Medicine, London, UK
| | - Stephen Kennedy
- Partnership for Research on Ebola Virus in Liberia (PREVAIL), Monrovia, Liberia
| | - Geneviève Chêne
- French Institute for Health and Medical Research (Inserm), Paris, France
| | | | - James Neaton
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Yazdan Yazdanpanah
- French Institute for Health and Medical Research (Inserm), Paris, France
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Paparini S, Nutland W, Rhodes T, Nguyen VK, Anderson J. DIY HIV prevention: Formative qualitative research with men who have sex with men who source PrEP outside of clinical trials. PLoS One 2018; 13:e0202830. [PMID: 30138482 PMCID: PMC6107262 DOI: 10.1371/journal.pone.0202830] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 08/09/2018] [Indexed: 01/11/2023] Open
Abstract
Pre-exposure prophylaxis (PrEP) with antiretroviral medication is an effective, evidence-based option for HIV prevention. In England, issues of cost-effectiveness and of responsibility for commissioning prevention services have so far led National Health Service (NHS) England to decide not to commission PrEP. Given the significant lag between the awareness of PrEP efficacy and the opportunity to obtain PrEP through traditional health care routes, many gay and other men who have sex with men (MSM) have turned to ‘DIY PrEP’, purchasing generic formulations of PrEP for themselves on the internet or via other alternative routes. However, there is very little research on DIY PrEP practices and no qualitative study with DIY PrEP users in the UK. A formative qualitative study was conducted in 2017 to inform the development of an intervention (PrEP Club) to support DIY PrEP users and improve the safety and experience of this prevention strategy. Focus groups were held with 20 MSM who are based in London and are obtaining PrEP through means other than clinical trials, to explore their accounts of sourcing and using PrEP and the experiential meanings of these. In this article, we report findings from this first, formative study and present the different practices involved in finding out about PrEP, buying it and ascertaining legitimacy of sellers and products. We reflect on the uncertainties participants described related to actually using PrEP, including deciding on drug dosing and monitoring their health. Finally, we present the results of the discussions participants had about the kind of support they had received, the help they would have liked, and their views on proposed interventions to support DIY PrEP users, such as PrEP Club.
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Affiliation(s)
- Sara Paparini
- Department of Anthropology and Sociology of Development, Graduate Institute of International and Development Studies, Geneva, Switzerland
- * E-mail:
| | - Will Nutland
- Department of Social and Environmental Health Research, Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tim Rhodes
- Department of Social and Environmental Health Research, Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Vinh-Kim Nguyen
- Department of Anthropology and Sociology of Development, Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Jane Anderson
- Homerton University Hospital NHS Foundation Trust, London, United Kingdom
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Moyer E, Nguyen VK. Histories, hauntings, and methodological echoes from medical anthropology’s recent past. MAT 2018. [DOI: 10.17157/mat.5.1.619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Moyer E, Nguyen VK. Edgework in medical anthropology. MAT 2017. [DOI: 10.17157/mat.4.5.589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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22
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Peiffer-Smadja N, Ouedraogo R, D'Ortenzio E, Cissé PN, Zeggani Z, Beavogui AH, Faye SL, Le Marcis F, Yazdanpanah Y, Nguyen VK. Vaccination and blood sampling acceptability during Ramadan fasting month: A cross-sectional study in Conakry, Guinea. Vaccine 2017; 35:2569-2574. [PMID: 28385606 DOI: 10.1016/j.vaccine.2017.03.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 03/19/2017] [Accepted: 03/20/2017] [Indexed: 01/20/2023]
Abstract
INTRODUCTION There are few data on the acceptability of vaccination or blood sampling during Ramadan fasting month in Muslim countries. This could impact vaccination campaigns, clinical trials or healthcare during Ramadan. METHODS Using a semi-structured questionnaire, we conducted a cross-sectional study on 201 practising Muslims and 10 religious leaders in Conakry, Guinea in the wake of the recent epidemic Ebola epidemic. Acceptability of vaccination and blood sampling during Ramadan were investigated as well as reasons for refusal. RESULTS Vaccination was judged acceptable during Ramadan by 46% (93/201, 95% CI 0.40-0.53) of practising Muslims versus 80% (8/10, 95% CI 0.49-0.94) of religious leaders (p=0.11). Blood sampling was judged acceptable during Ramadan by 54% (108/201, 95% CI 0.47-0.60) of practising Muslims versus 80% (8/10, 95% CI 0.49-0.94) of religious leaders (p=0.19). The percentage of participants that judged both blood sampling and vaccination acceptable during Ramadan was 40% (81/201, 95% CI 0.34-0.47) for practising Muslims versus 80% (8/10, 95% CI 0.49-0.94) for religious leaders (p=0.048). The most common reasons for refusal of vaccination or blood sampling were that nothing should enter or leave the body during Ramadan (43%), that adverse events could lead to breaking the fast (32%), that blood should not be seen during Ramadan (9%) and that the Quran explicitly forbids it (9%). DISCUSSION Although most Muslims leaders and scientists consider that injections including immunization and blood sampling should be authorized during Ramadan, many Muslims in our study judged vaccination or blood sampling unacceptable when fasting. Widely available recommendations on healthcare during Ramadan would be useful to inform Muslims.
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Affiliation(s)
- Nathan Peiffer-Smadja
- Assistance Publique - Hôpitaux de Paris, Hôpital Bichat Claude Bernard, Paris, France; Inserm, IAME, UMR 1137, Université Paris Diderot, Paris, France.
| | - Ramatou Ouedraogo
- Fondation Maison des Sciences de l'Homme, Paris, France; CNRS, LAM, UMR 5115, Sciences-Po Bordeaux, Bordeaux, France.
| | - Eric D'Ortenzio
- Assistance Publique - Hôpitaux de Paris, Hôpital Bichat Claude Bernard, Paris, France; Inserm, IAME, UMR 1137, Université Paris Diderot, Paris, France.
| | - Papa Ndiaga Cissé
- Département de Sociologie, Université Cheikh Anta Diop, Dakar, Senegal.
| | | | - Abdoul Habib Beavogui
- Centre National de Formation et de Recherche en Santé Rurale, Maférinyah, Guinea; Département de Parasitologie et Mycologie, Université Gamal Abdel Nasser, Conakry, Guinea.
| | - Sylvain Landry Faye
- Département de Sociologie, Université Cheikh Anta Diop, Dakar, Senegal; École Normale Supérieure, UMR 5206, Laboratoire Triangle, Lyon, France.
| | | | - Yazdan Yazdanpanah
- Assistance Publique - Hôpitaux de Paris, Hôpital Bichat Claude Bernard, Paris, France; Inserm, IAME, UMR 1137, Université Paris Diderot, Paris, France.
| | - Vinh-Kim Nguyen
- École de santé publique de l'Université de Montréal, Montréal, Canada; Graduate Institute of International and Development Studies, Geneva, Switzerland.
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Nguyen VK. Toward a Theory of the Pharmaceutical Form of CapitalPharmocracy: Value, Politics, and Knowledge in Global Biomedicine. By Kaushik Sundar Rajan. Durham, NC: Duke University Press, 2017. Current Anthropology 2017. [DOI: 10.1086/694841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
The pre-exposure prophylaxis (PrEP) drug Truvada is a new HIV prevention technology that is predominantly promoted as relevant to HIV-negative gay men. This paper explores what PrEP represents for HIV-positive gay men living in Paris, based upon data collected through interviews and ethnographic research. While HIV-positive gay men do not directly consume Truvada through PrEP, they nonetheless hold opinions and understandings of this drug, specifically as it relates to their own sexuality. This paper expands the representations and meanings of this new technology in a different light through the voices of gay men living with HIV in Paris. The main argument of this article is that PrEP as an additional HIV prevention tool blurs the lines between science, technologies and human sexuality.
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Affiliation(s)
- Julien Brisson
- a Department of Social and Preventative Medicine , University of Montreal , Quebec , Canada
| | - Vinh-Kim Nguyen
- a Department of Social and Preventative Medicine , University of Montreal , Quebec , Canada
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Moyer E, Nguyen VK. Introduction to the 10th issue. MAT 2017. [DOI: 10.17157/mat.4.3.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Nguyen VK. Viral Speed: Infrastructure, Connectivity, Ontogeny; or, Notes on the Molecular Epidemiology of Epidemics. Cult Anthropol 2017. [DOI: 10.14506/ca32.1.04] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Moyer E, Nguyen VK. On the public and private politics of well-being. MAT 2016. [DOI: 10.17157/mat.3.2.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Aboubacrine SA, Niamba P, Boileau C, Zunzunegui MV, Machouf N, Nguyen VK, Rashed S. Inadequate adherence to antiretroviral treatment and prevention in hospital and community sites in Burkina Faso and Mali: a study by the ATARAO group. Int J STD AIDS 2016; 18:741-7. [DOI: 10.1258/095646207782212243] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Our objective was to determine the prevalence and identify the factors that influence antiretroviral therapy (ART) adherence among patients in Bamako and Ouagadougou. A cross-sectional study was conducted among 94 men and 176 women receiving ART. Data were collected through questionnaires and chart reviews. Logistic regressions were performed to isolate determinants of adherence. Overall, 58% of the patients were adherent, but there were differences in the levels of adherence according to country and treatment site. Sociodemographic factors were not associated with adherence. However, social characteristics such as having children, in Ouagadougou, or being a housewife and not planning to have a child in the next year, in Bamako were associated with adherence. Time on ART was negatively associated with adherence in both countries with decline occurring later in Bamako. Levels of adherence are inadequate particularly among more experienced patients. Further adherence research and monitoring using longitudinal designs are warranted to assess the extent to which adherence is declining with time on treatment.
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Affiliation(s)
- S Ag Aboubacrine
- Service de médecine interne, Hôpital National du Point G, Bamako, Mali
| | - P Niamba
- Unité de formation et de recherche des sciences de la santé, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - C Boileau
- Institute for Health and Social Policy, McGill University, Montreal, Canada
| | - M V Zunzunegui
- Department de Médicine Sociale et Préventive, Université de Montreal, Canada
| | | | - V K Nguyen
- Department de Médicine Sociale et Préventive, Université de Montreal, Canada
| | - S Rashed
- Unité de Santé Internationale, University of Montreal, Canada
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Sissoko D, Laouenan C, Folkesson E, M'Lebing AB, Beavogui AH, Baize S, Camara AM, Maes P, Shepherd S, Danel C, Carazo S, Conde MN, Gala JL, Colin G, Savini H, Bore JA, Le Marcis F, Koundouno FR, Petitjean F, Lamah MC, Diederich S, Tounkara A, Poelart G, Berbain E, Dindart JM, Duraffour S, Lefevre A, Leno T, Peyrouset O, Irenge L, Bangoura N, Palich R, Hinzmann J, Kraus A, Barry TS, Berette S, Bongono A, Camara MS, Munoz VC, Doumbouya L, Harouna S, Kighoma PM, Koundouno FR, Lolamou R, Loua CM, Massala V, Moumouni K, Provost C, Samake N, Sekou C, Soumah A, Arnould I, Komano MS, Gustin L, Berutto C, Camara D, Camara FS, Colpaert J, Delamou L, Jansson L, Kourouma E, Loua M, Malme K, Manfrin E, Maomou A, Milinouno A, Ombelet S, Sidiboun AY, Verreckt I, Yombouno P, Bocquin A, Carbonnelle C, Carmoi T, Frange P, Mely S, Nguyen VK, Pannetier D, Taburet AM, Treluyer JM, Kolie J, Moh R, Gonzalez MC, Kuisma E, Liedigk B, Ngabo D, Rudolf M, Thom R, Kerber R, Gabriel M, Di Caro A, Wölfel R, Badir J, Bentahir M, Deccache Y, Dumont C, Durant JF, El Bakkouri K, Uwamahoro MG, Smits B, Toufik N, Van Cauwenberghe S, Ezzedine K, D'Ortenzio E, Pizarro L, Etienne A, Guedj J, Fizet A, de Sainte Fare EB, Murgue B, Tran-Minh T, Rapp C, Piguet P, Poncin M, Draguez B, Duverger TA, Barbe S, Baret G, Defourny I, Carroll M, Raoul H, Augier A, Eholie SP, Yazdanpanah Y, Levy-Marchal C, Antierrens A, Van Herp M, Günther S, de Lamballerie X, Keïta S, Mentre F, Anglaret X, Malvy D. Correction: Experimental Treatment with Favipiravir for Ebola Virus Disease (the JIKI Trial): A Historically Controlled, Single-Arm Proof-of-Concept Trial in Guinea. PLoS Med 2016; 13:e1002009. [PMID: 27046271 PMCID: PMC4821578 DOI: 10.1371/journal.pmed.1002009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 11/19/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pmed.1001967.].
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Yazdanpanah Y, Horby P, van Griensven J, Mentre F, Nguyen VK, Malvy JMD, Dunning J, Sissoko D, Delfraissy JF, Levy Y. Drug assessment in the Ebola virus disease epidemic in west Africa. Lancet Infect Dis 2016; 15:1258. [PMID: 26531030 DOI: 10.1016/s1473-3099(15)00344-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 07/24/2015] [Accepted: 09/16/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Yazdan Yazdanpanah
- INSERM, IAME, UMR 1137, UFR de Médecine, 75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Infectious Diseases Department, Bichat-Claude Bernard Hospital, Paris, France.
| | | | | | - France Mentre
- INSERM, IAME, UMR 1137, UFR de Médecine, 75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Infectious Diseases Department, Bichat-Claude Bernard Hospital, Paris, France
| | - Vinh-Kim Nguyen
- Collège d'études Mondiales, Fondation Maison des Sciences de l'Homme, Paris, France; Ecole de santé publique de l'Université de Montréal, Montreal, Canada; University of Amsterdam, Amsterdam, Netherlands
| | - Jean Marie Denis Malvy
- INSERM 897, Tropical Medicine Branch, Bordeaux, France; Service des Maladies Infectieuses et Tropicales, CHU de Bordeaux, Bordeaux, France
| | | | - Daouda Sissoko
- INSERM 897, Tropical Medicine Branch, Bordeaux, France; Service des Maladies Infectieuses et Tropicales, CHU de Bordeaux, Bordeaux, France
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Sicotte M, Bemeur C, Diouf A, Zunzunegui MV, Nguyen VK. Nutritional status of HIV-infected patients during the first year HAART in two West African cohorts. J Health Popul Nutr 2015; 34:1. [PMID: 26825478 PMCID: PMC5026015 DOI: 10.1186/s41043-015-0001-5] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 01/13/2015] [Indexed: 04/20/2023]
Abstract
OBJECTIVE To examine the association between nutritional markers at initiation and during follow up in two different cohorts of HIV-infected adults initiating highly active antiretroviral therapy (HAART) in West Africa. METHODS The ATARAO study was a one year prospective study carried in Mali. It consisted of a sample of consecutive patients initiating HAART in one of four participating centers during that period. Data were collected at time of treatment initiation (baseline) and every 3 months thereafter. The ANRS 1290 study followed Senegalese patients recruited in similar conditions. Bivariate analyses were used to identify nutritional and immunological covariates of malnutrition at baseline. Longitudinal trajectories of body mass index, hemoglobin and albumin, and their associated factors, were evaluated using mixed linear models. RESULTS In ATARAO, 250 participants were retained for analyses; of which, 36% had a BMI < 18.5 kg/m(2), nearly 60% were anemic and 47.4% hypoalbuminemic at time of treatment initiation. At baseline, low hemoglobin, hypoalbuminemia and low CD4 levels were associated with a BMI < 18.5 kg/m(2). Similarly, low BMI, low albumin and low CD4 counts were linked to anemia; while, hypoalbuminemia was associated with low hemoglobin levels and CD4 counts. In ANRS, out of the 372 participants retained for analyses, 31% had a low BMI and almost 70% were anemic. At baseline, low BMI was associated with low hemoglobin levels and CD4 counts, while anemia was associated with low CD4 counts and female sex. While treatment contributed to early gains in BMI, hemoglobin and albumin in the first 6 months of treatment, initial improvements plateaued or subsided thereafter. Despite HAART, malnutrition persisted in both cohorts after one year, especially in those who were anemic, hypoalbuminemic or had a low BMI at baseline. CONCLUSION In ATARAO and ANRS, malnutrition was common across all indicators (BMI, hemoglobin, albumin) and persisted despite treatment. Low BMI, anemia and hypoalbuminemia were associated with attrition, and with a deficient nutritional and immunological status at baseline, as well as during treatment. In spite of therapy, malnutrition is associated with negative clinical and treatment outcomes which suggests that HAART may not be sufficient to address co-existing nutritional deficiencies.
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Affiliation(s)
- Maryline Sicotte
- Research Center of the Montreal University Hospital Center (CRCHUM), Montreal, Canada.
- School of Public Health, Montreal University, Pavilion 7101 Parc Avenue. C.P. 6128, Succ. Centre-Ville, Montreal, QC, H3C 3 J7, Canada.
- Montreal University Public Health Research Institute (IRSPUM), Montreal, Canada.
| | - Chantal Bemeur
- Research Center of the Montreal University Hospital Center (CRCHUM), Montreal, Canada.
- Department of Nutrition, Montreal University, Montreal, Canada.
| | - Assane Diouf
- School of Public Health, Montreal University, Pavilion 7101 Parc Avenue. C.P. 6128, Succ. Centre-Ville, Montreal, QC, H3C 3 J7, Canada.
- Deparment of Infectious Disease, Fann's University Hospital Center, Dakar, Senegal.
- Fann University Hospital Center, and School of Public Health, Montreal University, Montreal, Canada.
| | - Maria Victoria Zunzunegui
- Research Center of the Montreal University Hospital Center (CRCHUM), Montreal, Canada.
- School of Public Health, Montreal University, Pavilion 7101 Parc Avenue. C.P. 6128, Succ. Centre-Ville, Montreal, QC, H3C 3 J7, Canada.
- Montreal University Public Health Research Institute (IRSPUM), Montreal, Canada.
| | - Vinh-Kim Nguyen
- Research Center of the Montreal University Hospital Center (CRCHUM), Montreal, Canada.
- School of Public Health, Montreal University, Pavilion 7101 Parc Avenue. C.P. 6128, Succ. Centre-Ville, Montreal, QC, H3C 3 J7, Canada.
- Department of Social and Preventative Medicine, Montreal University, Montreal, Canada.
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Moyer E, Nguyen VK. Boundaries and crossings. MAT 2015. [DOI: 10.17157/mat.2.1.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Affiliation(s)
| | - Kevin Louis Bardosh
- Centre of African Studies and Division of Infection and Pathway Medicine, University of Edinburgh, Edinburgh, UK
| | | | - Barry Hewlett
- Department of Anthropology, Washington State University, Vancouver, WA, USA
| | - Mark Nichter
- School of Anthropology, University of Arizona, Tucson, AZ, USA
| | - Vinh-Kim Nguyen
- Collège d'études mondiales, Fondation Maison des Sciences de l'Homme, Paris, France
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Moyer E, Nguyen VK. Medicine Anthropology Theory. MAT 2014. [DOI: 10.17157/mat.1.1.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
The health consequences of the ongoing US-led war on terror and civil armed conflicts in the Arab world are much more than the collateral damage inflicted on civilians, infrastructure, environment, and health systems. Protracted war and armed conflicts have displaced populations and led to lasting transformations in health and health care. In this report, we analyse the effects of conflicts in Iraq and Syria to show how wars and conflicts have resulted in both the militarisation and regionalisation of health care, conditions that complicate the rebuilding of previously robust national health-care systems. Moreover, we show how historical and transnational frameworks can be used to show the long-term consequences of war and conflict on health and health care. We introduce the concept of therapeutic geographies--defined as the geographic reorganisation of health care within and across borders under conditions of war.
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Affiliation(s)
- Omar Dewachi
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
| | - Mac Skelton
- Department of Anthropology, The Johns Hopkins University, Baltimore, MD, USA
| | - Vinh-Kim Nguyen
- School of Public Health, University of Montréal, Montréal, QC, Canada
| | - Fouad M Fouad
- Syrian Center for Tobacco Studies Aleppo, Syria; Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Lebanon
| | - Ghassan Abu Sitta
- Plastic Surgery and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zeina Maasri
- Department of Architecture and Design, American University of Beirut, Beirut, Lebanon
| | - Rita Giacaman
- Institute of Community Health, Birzeit University, Ramallah, West Bank, occupied Palestinian territory
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Nguyen VK. Improvising medicine. An African oncology ward in an emerging cancer epidemicby Livingston, Julie. Social Anthropology/Anthropologie Sociale 2014. [DOI: 10.1111/1469-8676.12065_11] [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] [Indexed: 11/28/2022]
Affiliation(s)
- Vinh-Kim Nguyen
- Université de Montréal (Canada) and Collège d'études mondiales; (France)
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Abstract
This paper reviews approaches to vulnerability in public health, introducing a series of 10 papers addressing vulnerability in health in Africa. We understand vulnerability as simultaneously a condition and a process. Social inequalities are manifest in and exacerbate three key dimensions of vulnerability: the initial level of wellbeing, the degree of exposure to risk, and the capacity to manage risk effectively. We stress the dynamic interactions linking material and social deprivation, poverty, powerlessness and ill health: risks or shocks and their health impacts are intimately interconnected and reinforce each other in a cycle which in the absence of effective interventions, increases vulnerability. An inductive process which does not begin with an a priori definition or measurement of 'vulnerability' and which does not assume the existence of fixed 'vulnerable groups' allowed us both to re-affirm core aspects of existing conceptual frameworks, and to engage in new ways with literature specifically addressing vulnerability and resilience at the population level as well as with literature - for example in ecology, and on the concept of frailty in research on aging - with which researchers on health and poverty in Africa may not be familiar. We invite conceptual and empirical work on vulnerability in complex systems frameworks. These perspectives emphasize contexts and nonlinear causality thus supporting analyses of vulnerability and resilience as both markers and emergent properties of dynamic interactions. We accept a working definition of vulnerability, and recognize that some definable groups of people are more likely than others to suffer harm from exposure to health risks. But we suggest that the real work - at both intellectual and policy/political levels - lies in understanding and responding to the dynamics, meanings and power relations underlying actual instances and processes of vulnerability and harm.
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Abstract
This paper contextualises counselling within a broader historical formation that links disclosure to healing and deploys confessional technologies to incite disclosure and awareness of the mysterious substance of the self. Foucault's argument that sexuality was the privileged arena for using confessional technologies to 'produce' the truth of the self is particularly relevant in light of the diffusion of counselling practices in Africa in the wake of the HIV epidemic, particularly with their emphasis on inciting appropriate sexual behaviour. Examination of the historical assemblage of counselling practices shows how they articulate what the self is, the nature of truth and a politics of language. This paper focuses on the genealogy of four key assumptions that express this confessional reason. These are that: (1) people can be 'empowered' to have control on their own lives by working on themselves, (2) secrets untold become pathogens, (3) the ability to heal requires that one first overcome personal illness, (4) the experience of sharing secrets is cathartic and healing. The genealogy intertwines four strands: that of the Unconscious as revealed by Freud and his followers, attempts to treat shell-shocked veterans of World War I, group psychotherapy and participatory research after World War II.
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Affiliation(s)
- Vinh-Kim Nguyen
- a Centre de recherches du Centre hospitalier de l'Université de Montréal, École de Santé publique de l'Université de Montréal, Collège d'Études mondiales, Fondation Maison des Sciences de l'Homme , Paris , France
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Abstract
Résumé Cet article examine des approches de la vulnérabilité en santé publique et introduit une série de 10 articles qui abordent la vulnérabilité en santé en Afrique. Nous comprenons la vulnérabilité comme étant simultanément un état et un processus. Les inégalités sociales sont évidentes dans la vulnérabilité et en accentuent trois dimensions essentielles : le niveau initial de bien-être, le degré d’exposition au risque et la capacité à gérer le risque de façon efficace. Nous mettons un accent particulier sur les interactions dynamiques qui relient le manque matériel et social, la pauvreté, l’impuissance et la mauvaise santé : les risques, ou les chocs, et leurs impacts sur la santé sont intimement connectés entre eux et se renforcent l’un l’autre dans un cycle qui, en l’absence d’interventions efficaces, accroît la vulnérabilité. Un processus inductif qui ne commence pas par une définition ou une mesure a priori de la « vulnérabilité » et qui ne présume pas de l’existence de « groupes vulnérables » définis nous a permis à la fois de réaffirmer les aspects essentiels des cadres de référence conceptuels existants, et de nous engager dans de nouvelles voies avec une littérature abordant spécifiquement la vulnérabilité et la résilience au niveau de la population, de même qu’avec une littérature – par exemple en écologie, ainsi que sur le concept de fragilité dans la recherche sur le vieillissement – à laquelle les chercheurs du domaine de la santé et de la pauvreté en Afrique ne sont peut-être pas habitués. Nous encourageons le travail conceptuel et empirique sur la vulnérabilité dans des cadres systémiques complexes. Ces perspectives privilégient les contextes et la causalité non linéaire, soutenant ainsi les analyses sur la vulnérabilité et la résilience comme étant toutes deux des marqueurs et des propriétés émergentes d’interactions dynamiques. Nous acceptons une définition fonctionnelle de la vulnérabilité et nous reconnaissons que certains groupes définissables de personnes sont plus susceptibles que d’autres de subir des dommages du fait de leur exposition à des risques en matière de santé. Mais nous suggérons que le vrai travail – tant au niveau intellectuel qu’au niveau politique – réside dans la compréhension et la réponse apportée à la dynamique, à la signification et aux relations de pouvoir qui sous-tendent les cas et les processus réels de vulnérabilité et de dommages.
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Affiliation(s)
- Christina Zarowsky
- École de Santé publique et Centre de Recherche sur le VIH, Université de Western Cape, Belleville, Afrique du Sud.
| | - Slim Haddad
- Centre de recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM) & Département de Médecine Sociale et Préventive, Université de Montréal, Montréal, Canada
| | - Vinh-Kim Nguyen
- Centre de recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM) & Département de Médecine Sociale et Préventive, Université de Montréal, Montréal, Canada
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Zarowsky C, Haddad S, Nguyen VK. Ir más allá de los “grupos vulnerables”: contextos y dinámica de la vulnerabilidad. Glob Health Promot 2013. [DOI: 10.1177/1757975912470061] [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
Resumen Este artículo repasa los enfoques a la vulnerabilidad en el campo de la salud pública y presenta 10 trabajos sobre cómo abordarla en África. Entendemos la vulnerabilidad a la vez como situación y como proceso. Las desigualdades sociales son evidentes y se exacerban en tres dimensiones clave de la vulnerabilidad: el nivel inicial de bienestar, el grado de exposición al riesgo y la capacidad de gestionar el riesgo de manera efectiva. Subrayamos las interacciones dinámicas en virtud de las cuales se genera una relación entre la privación material y social, la pobreza, la impotencia y la mala salud: los riesgos o percances (shocks) y sus repercusiones sobre la salud están íntimamente interrelacionados y se refuerzan mutuamente en un círculo que multiplica la vulnerabilidad a menos que se realicen intervenciones eficaces. Gracias a un proceso inductivo que no empieza con una definición o una medición a priori de la “vulnerabilidad” y que no presupone la existencia de “grupos vulnerables” fijos, pudimos por un lado reafirmar los aspectos centrales de los marcos conceptuales existentes y por otro considerar de forma diferente la literatura que aborda específicamente la vulnerabilidad y la resiliencia a nivel de la población así como otro tipo de literatura - por ejemplo, en materia de ecología y en torno al concepto de fragilidad en los estudios sobre envejecimiento - con la que posiblemente no estén familiarizados los investigadores sobre salud y pobreza en África. Invitamos a realizar una labor conceptual y empírica sobre la vulnerabilidad en marcos de sistemas complejos. Estas perspectivas subrayan los contextos y la causalidad no lineal, dando más peso por lo tanto a los análisis de vulnerabilidad y de resiliencia en tanto que marcadores de las interacciones dinámicas y como propiedades emergentes de estas interacciones. Aceptamos una definición operativa de vulnerabilidad y reconocemos que algunos grupos de personas susceptibles de ser definidos tienen más probabilidades que otros de sufrir perjuicio como consecuencia de su exposición a los riesgos para la salud. Pero sugerimos que de lo que se trata en realidad – tanto a nivel intelectual como político y en materia de elaboración de políticas- es de comprender la dinámica, los significados y las relaciones de poder que subyacen a las instancias y procesos reales de vulnerabilidad y perjuicio y darles respuesta.
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Affiliation(s)
- Christina Zarowsky
- School of Public Health and HIV Research Centre, University of the Western Cape, Belleville, South Africa
| | - Slim Haddad
- Centre de Recherche du Centre hospitalier de l’Université de Montréal (CRCHUM) & Département de Médecine sociale et préventive, Université de Montréal, Montreal, Canada
| | - Vinh-Kim Nguyen
- Centre de Recherche du Centre hospitalier de l’Université de Montréal (CRCHUM) & Département de Médecine sociale et préventive, Université de Montréal, Montreal, Canada
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Sanou A, Kouyaté B, Bibeau G, Nguyen VK. Evaluability Assessment of an immunization improvement strategy in rural Burkina Faso: intervention theory versus reality, information need and evaluations. Eval Program Plann 2011; 34:303-315. [PMID: 21168211 DOI: 10.1016/j.evalprogplan.2010.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Revised: 07/15/2010] [Accepted: 10/31/2010] [Indexed: 05/30/2023]
Abstract
An innovative immunization improvement strategy was proposed by the CRSN (Centre de Recherche en Santé de Nouna) to improve the low coverage rate for children aged 0-11 months in the health district of Nouna in Burkina Faso. This article reports on the Evaluability Assessment (EA) study that aimed to orient decisions for its evaluation in close relationship with the information needs of the stakeholders. Various methods were used, including document reviews, individual interviews, focus group discussions, meetings, literature reviews and site visits. A description of the intervention theory and philosophy is provided with its logic models and its reality documented. Lessons on the procedure include the importance of the position of the evaluability assessor, the value of replicating some steps of the assessment and the relationships between EA and process evaluation. The evaluability study concludes that the intervention had some evaluable components. To satisfy the stakeholders' needs, the initially planned community randomized controlled trial can be maintained and complemented with a process evaluation. There is a need to provide sufficient information on the cost of the intervention. This will inform decision makers on the possibility of replicating the intervention in other contexts.
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Affiliation(s)
- Aboubakary Sanou
- Université de Montréal, Department of Social and Preventive Medicine, Québec, Canada.
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Aho J, Koushik A, Diakité SL, Loua KM, Nguyen VK, Rashed S. Biological validation of self-reported condom use among sex workers in Guinea. AIDS Behav 2010; 14:1287-93. [PMID: 19680799 DOI: 10.1007/s10461-009-9602-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [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: 12/18/2008] [Accepted: 07/27/2009] [Indexed: 11/26/2022]
Abstract
Self-reported condom use may be prone to social desirability bias. Our aim was to assess the validity of self-reported condom use in a population of female sex workers using prostate specific antigen (PSA) as a gold standard biomarker of recent unprotected vaginal intercourse. We collected data on 223 sex-workers in Conakry, Guinea in order to assess the sensitivity and specificity of self-reported condom use as well as to examine the predictors of discordance between self-report and PSA presence. PSA was detected in 38.4% of samples. Sensitivity of self-reported condom use was 14.6% and its specificity was 94.7%. Self-perceived high risk of HIV infection was the only significant independent predictor of misreported condom use. PSA could be useful to validate self-reported condom use in surveys and to allow a better understanding of factors associated with social desirability in sexual behaviour reporting.
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Affiliation(s)
- Joséphine Aho
- Département de médecine sociale et préventive, Université de Montréal, Outremont, Canada.
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Sicotte M, Ledoux M, Zunzunegui MV, Ag Aboubacrine S, Nguyen VK. Reliability of anthropometric measures in a longitudinal cohort of patients initiating ART in West Africa. BMC Med Res Methodol 2010; 10:102. [PMID: 20969785 PMCID: PMC2988008 DOI: 10.1186/1471-2288-10-102] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 10/22/2010] [Indexed: 11/10/2022] Open
Abstract
Background Anthropometric measurements are a non invasive, inexpensive, and suitable method for evaluating the nutritional status in population studies with relatively large sample sizes. However, anthropometric techniques are prone to errors that could arise, for example, from the inadequate training of personnel. Despite these concerns, anthropometrical measurement error is seldom assessed in cohort studies. We describe the reliability and challenges associated with measurement of longitudinal anthropometric data in a cohort of West African HIV+ adults . Methods In a cohort of patients initiating antiretroviral treatment in Mali, we evaluated nutritional status using anthropometric measurements(weight, height, mid-upper arm circumference, waist circumference and triceps skinfold). Observers with no prior experience in the field of anthropometry were trained to perform anthropometrical measurements. To assess the intra- and inter-observer variability of the measurements taken in the course of the study, two sub-studies were carried out: one at the beginning and one at the end of the prospective study. Twelve patients were measured twice on two consecutive days by the same observer on both study occasions. The technical error of measurement (TEM) (absolute and relative value), and the coefficient of reliability (R) were calculated and compared across reliability studies. Results According to the R and relative TEM, inter-observer reliabilities were only acceptable for height and weight. In terms of intra-observer precision, while the first and second anthropometrists demonstrated better reliability than the third, only height and weight measurements were reliable. Looking at total TEM, we observed that while measurements remained stable between studies for height and weight, circumferences and skinfolds lost precision from one occasion to the next. Conclusions Height and weight were the most reliable measurements under the study's conditions. Circumferences and skinfolds demonstrated less reliability and lost precision over time, probably as a result of insufficient supervision over the entire length of the study. Our results underline the importance of a careful observer's selection, good initial preparation, as well as the necessity of ongoing training and supervision over the entire course of a longitudinal nutritional study. Failure to do so could have major repercussions on data reliability and jeopardize its utilization.
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Affiliation(s)
- Maryline Sicotte
- Département de Médecine Sociale et Préventive, Faculté de Médecine, Université de Montréal, Pavillon 1420 Mont Royal, C,P, 6128, succursale CV, Montréal, Québec, H3C 3J7, Canada.
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Haidara A, Chamberland A, Sylla M, Aboubacrine SA, Cissé M, Traore HA, Maiga MY, Tounkara A, Nguyen VK, Tremblay C. High level of primary drug resistance in Mali. HIV Med 2010; 11:404-11. [PMID: 20146734 DOI: 10.1111/j.1468-1293.2009.00806.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND As access to antiretroviral drugs increases in developing countries, it will become increasingly important to monitor the emergence of resistance and to define the molecular pathways involved to identify optimal therapeutic regimens. METHODS We performed genotypic resistance testing on plasma obtained from 101 HIV-infected treatment-naïve individuals from Mali. Genotyping was carried out using the Virco protocols and HXB2 was used as the reference strain. RESULTS CRF02_AG was the most common subtype, present in 71.3% of our patient population. Other subtypes included B, C, G, CRF06_CPX, CRF09_CPX, CRF01_AE, A2/CRF16_A2D, A1 and CRF13_CPX. A total of 9.9% [95% confidence interval (CI) 6.9-12.9%] of patients had at least one resistance mutation. The prevalences of mutations conferring resistance to nucleoside reverse transcriptase inhibitors (NRTIs), nonnucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs) were 5% (95% CI 0.7-9.2%), 6% (95% CI 1.3-10.6%) and 0%, respectively. The most frequent mutations were T215A/Y for NRTIs and K103N/T for NNRTIs. One patient harboured three NRTI resistance mutations and one NNRTI mutation. This is the first reported case of multi-drug-resistant viral transmission in Mali. Polymorphisms at protease codons 10I/V and 33F potentially associated with resistance were observed in 18.8% and 1% of patients, respectively. Several polymorphisms in the C-terminal domain of reverse transcriptase were observed: A371V (in 63.4% of patients), G335D (76.2%), E399D (10.9%) and G333E (1%). CONCLUSION Primary resistance was seen in 9.9% of subjects, which is higher than previously reported in Mali. Taking into consideration other polymorphisms in protease such as L10I/V and 33F, primary resistance could reach 28.7% (95% CI 19.9-37.5%). Our study reflects the need to monitor the evolution of resistance on a regular basis and trends of transmitted resistance.
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Affiliation(s)
- A Haidara
- Département de Microbiologie et Immunologie, Université de Montréal, Montréal, Canada
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Schou TW, Labouriau R, Permin A, Christensen JP, Sørensen P, Cu HP, Nguyen VK, Juul-Madsen HR. MHC haplotype and susceptibility to experimental infections (Salmonella Enteritidis, Pasteurella multocida or Ascaridia galli) in a commercial and an indigenous chicken breed. Vet Immunol Immunopathol 2009; 135:52-63. [PMID: 19945754 DOI: 10.1016/j.vetimm.2009.10.030] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 10/26/2009] [Accepted: 10/27/2009] [Indexed: 10/20/2022]
Abstract
In three independent experimental infection studies, the susceptibility and course of infection of three pathogens considered of importance in most poultry production systems, Ascaridia galli, Salmonella Enteritidis and Pasteurella multocida were compared in two chicken breeds, the indigenous Vietnamese Ri and the commercial Luong Phuong. Furthermore, the association of the Major Histocompatibility Complex (MHC) with disease-related parameters was evaluated, using alleles of the LEI0258 microsatellite as markers for MHC haplotypes. The Ri chickens were found to be more resistant to A. galli and S. Enteritidis than commercial Luong Phuong chickens. In contrast, the Ri chickens were more susceptible to P. multocida, although production parameters were more affected in the Luong Phuong chickens. Furthermore, it was shown that the individual variations observed in response to the infections were influenced by the MHC. Using marker alleles of the microsatellite LEI0258, which is located within the MHC region, several MHC haplotypes were identified as being associated with infection intensity of A. galli. An association of the MHC with the specific antibody response to S. Enteritidis was also found where four MHC haplotypes were shown to be associated with high specific antibody response. Finally, one MHC haplotype was identified as being associated with pathological lesions and mortality in the P. multocida experiment. Although not statistically significant, our analysis suggested that this haplotype might be associated with resistance. These results demonstrate the presence of local genetic resources in Vietnamese chickens, which could be utilized in breeding programmes aiming at improving disease resistance.
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Affiliation(s)
- T W Schou
- Department of Veterinary Pathobiology, The Faculty of Life Sciences, University of Copenhagen, Stigbojlen 4, DK-1870 Frederiksberg C, Denmark; Department of Human Health and Safety, The DHI Group, Kogle Allé 2, 2970 Horsholm, Denmark.
| | - R Labouriau
- Department of Genetics and Biotechnology, Faculty of Agricultural Sciences, University of Aarhus, Blichers Allé 20, P.O. Box 50, DK-8830 Tjele, Denmark
| | - A Permin
- Department of Veterinary Pathobiology, The Faculty of Life Sciences, University of Copenhagen, Stigbojlen 4, DK-1870 Frederiksberg C, Denmark; Department of Human Health and Safety, The DHI Group, Kogle Allé 2, 2970 Horsholm, Denmark
| | - J P Christensen
- Department of Veterinary Pathobiology, The Faculty of Life Sciences, University of Copenhagen, Stigbojlen 4, DK-1870 Frederiksberg C, Denmark
| | - P Sørensen
- Department of Genetics and Biotechnology, Faculty of Agricultural Sciences, University of Aarhus, Blichers Allé 20, P.O. Box 50, DK-8830 Tjele, Denmark
| | - H P Cu
- Department of Bacteriology, National Institute of Veterinary Research, 86 Truong Chinh, Dong Da, Hanoi, Viet Nam
| | - V K Nguyen
- Department of Parasitology, National Institute of Veterinary Research, 86 Truong Chinh, Dong Da, Hanoi, Viet Nam
| | - H R Juul-Madsen
- Department of Animal Health and Bioscience, Faculty of Agricultural Sciences, University of Aarhus, Blichers Allé 20, P.O. Box 50, DK-8830 Tjele, Denmark
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