|   | 
Details
   web
Records
Author Ross, I.; Mejia, C.; Melendez, J.; Chan, P.A.; Nunn, A.C.; Powderly, W.; Goodenberger, K.; Liu, J.; Mayer, K.H.; Patel, R.R.
Title Awareness and attitudes of pre-exposure prophylaxis for HIV prevention among physicians in Guatemala: Implications for country-wide implementation Type Journal Article
Year 2017 Publication PloS one Abbreviated Journal PLoS One
Volume 12 Issue 3 Pages e0173057
Keywords (up) Adult; Anti-HIV Agents/therapeutic use; *Attitude of Health Personnel; Cross-Sectional Studies; Female; Guatemala; HIV Infections/*prevention & control; *Health Knowledge, Attitudes, Practice; Humans; Logistic Models; Male; Middle Aged; Physicians/psychology; Practice Patterns, Physicians'/*statistics & numerical data; Pre-Exposure Prophylaxis/*statistics & numerical data; Surveys and Questionnaires
Abstract INTRODUCTION: HIV continues to be a major health concern with approximately 2.1 million new infections occurring worldwide in 2015. In Central America, Guatemala had the highest incident number of HIV infections (3,700) in 2015. Antiretroviral pre-exposure prophylaxis (PrEP) was recently recommended by the World Health Organization (WHO) as an efficacious intervention to prevent HIV transmission. PrEP implementation efforts are underway in Guatemala and success will require providers that are knowledgeable and willing to prescribe PrEP. We sought to explore current PrEP awareness and prescribing attitudes among Guatemalan physicians in order to inform future PrEP implementation efforts. METHODS: We conducted a cross-sectional survey of adult internal medicine physicians at the main teaching hospital in Guatemala City in March 2015. The survey included demographics, medical specialty, years of HIV patient care, PrEP awareness, willingness to prescribe PrEP, previous experience with post-exposure prophylaxis, and concerns about PrEP. The primary outcome was willingness to prescribe PrEP, which was assessed using a 5-point Likert scale for different at-risk population scenarios. Univariate and multivariate logistic regression was performed to identify predictors for willingness to prescribe PrEP. RESULTS: Eighty-seven physicians completed the survey; 66% were male, 64% were internal medicine residency trainees, and 10% were infectious disease (ID) specialists. Sixty-nine percent of physicians were PrEP aware, of which 9% had previously prescribed PrEP. Most (87%) of respondents were willing to prescribe PrEP to men who have sex with men (MSM), sex workers, injection drug users, or HIV-uninfected persons having known HIV-positive sexual partners. Concerns regarding PrEP included development of resistance (92%), risk compensation (90%), and cost (64%). Univariate logistic regression showed that younger age, being a resident trainee, and being a non-ID specialist were significant predictors for willingness to prescribe PrEP. In multivariate logistic regression, being a non-ID specialist was a significant predictor. CONCLUSIONS: Guatemalan physicians at an urban public hospital were PrEP aware and willing to prescribe, but few have actually done so yet. Future education programs should address the concerns identified, including the low potential for the development of antiretroviral resistance. These findings can aid PrEP implementation efforts in Guatemala.
Address Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, United States of America
Corporate Author Thesis
Publisher Place of Publication Editor
Language English Summary Language Original Title
Series Editor Series Title Abbreviated Series Title
Series Volume Series Issue Edition
ISSN 1932-6203 ISBN Medium
Area Expedition Conference
Notes PMID:28257475 Approved no
Call Number ref @ user @ Serial 97185
Permanent link to this record
 

 
Author Ross, I.; Mejia, C.; Melendez, J.; Chan, P.A.; Nunn, A.C.; Powderly, W.; Goodenberger, K.; Liu, J.; Mayer, K.H.; Patel, R.R.
Title Awareness and attitudes of pre-exposure prophylaxis for HIV prevention among physicians in Guatemala: Implications for country-wide implementation Type Journal Article
Year 2017 Publication PloS one Abbreviated Journal PLoS One
Volume 12 Issue 3 Pages e0173057
Keywords (up) Adult; Anti-HIV Agents/therapeutic use; *Attitude of Health Personnel; Cross-Sectional Studies; Female; Guatemala; HIV Infections/*prevention & control; *Health Knowledge, Attitudes, Practice; Humans; Logistic Models; Male; Middle Aged; Physicians/psychology; Practice Patterns, Physicians'/*statistics & numerical data; Pre-Exposure Prophylaxis/*statistics & numerical data; Surveys and Questionnaires
Abstract INTRODUCTION: HIV continues to be a major health concern with approximately 2.1 million new infections occurring worldwide in 2015. In Central America, Guatemala had the highest incident number of HIV infections (3,700) in 2015. Antiretroviral pre-exposure prophylaxis (PrEP) was recently recommended by the World Health Organization (WHO) as an efficacious intervention to prevent HIV transmission. PrEP implementation efforts are underway in Guatemala and success will require providers that are knowledgeable and willing to prescribe PrEP. We sought to explore current PrEP awareness and prescribing attitudes among Guatemalan physicians in order to inform future PrEP implementation efforts. METHODS: We conducted a cross-sectional survey of adult internal medicine physicians at the main teaching hospital in Guatemala City in March 2015. The survey included demographics, medical specialty, years of HIV patient care, PrEP awareness, willingness to prescribe PrEP, previous experience with post-exposure prophylaxis, and concerns about PrEP. The primary outcome was willingness to prescribe PrEP, which was assessed using a 5-point Likert scale for different at-risk population scenarios. Univariate and multivariate logistic regression was performed to identify predictors for willingness to prescribe PrEP. RESULTS: Eighty-seven physicians completed the survey; 66% were male, 64% were internal medicine residency trainees, and 10% were infectious disease (ID) specialists. Sixty-nine percent of physicians were PrEP aware, of which 9% had previously prescribed PrEP. Most (87%) of respondents were willing to prescribe PrEP to men who have sex with men (MSM), sex workers, injection drug users, or HIV-uninfected persons having known HIV-positive sexual partners. Concerns regarding PrEP included development of resistance (92%), risk compensation (90%), and cost (64%). Univariate logistic regression showed that younger age, being a resident trainee, and being a non-ID specialist were significant predictors for willingness to prescribe PrEP. In multivariate logistic regression, being a non-ID specialist was a significant predictor. CONCLUSIONS: Guatemalan physicians at an urban public hospital were PrEP aware and willing to prescribe, but few have actually done so yet. Future education programs should address the concerns identified, including the low potential for the development of antiretroviral resistance. These findings can aid PrEP implementation efforts in Guatemala.
Address Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, United States of America
Corporate Author Thesis
Publisher Place of Publication Editor
Language English Summary Language Original Title
Series Editor Series Title Abbreviated Series Title
Series Volume Series Issue Edition
ISSN 1932-6203 ISBN Medium
Area Expedition Conference
Notes PMID:28257475 Approved no
Call Number ref @ user @ Serial 97644
Permanent link to this record
 

 
Author Coll, C. de V.N.; Domingues, M.R.; Hallal, P.C.; da Silva, I.C.M.; Bassani, D.G.; Matijasevich, A.; Barros, A.; Santos, I.S.; Bertoldi, A.D.
Title Changes in leisure-time physical activity among Brazilian pregnant women: comparison between two birth cohort studies (2004 – 2015) Type Journal Article
Year 2017 Publication BMC Public Health Abbreviated Journal BMC Public Health
Volume 17 Issue 1 Pages 119
Keywords (up) Adult; Body Mass Index; Brazil; Cohort Studies; *Exercise; Female; Humans; *Leisure Activities; Maternal Age; Mothers/*statistics & numerical data; Obesity/complications; Parity; Pregnancy; Pregnancy Complications/etiology/*prevention & control; Pregnancy Trimesters/physiology; Time Factors; Young Adult; Birth cohort studies; Exercise; Motor activity; Physical activity; Pregnancy; Recommendations; Surveillance
Abstract BACKGROUND: Low levels of leisure-time physical activity (LTPA) during pregnancy have been shown in studies conducted worldwide. Surveillance is extremely important to monitor the progress of physical activity patterns over time and set goals for effective interventions to decrease inactivity among pregnant women. The aim of this study was to evaluate time changes in LTPA among Brazilian pregnant women in an 11-year period (2004-2015) by comparing data from two birth cohort studies. METHODS: Two population-based birth cohort studies were carried out in the city of Pelotas, southern Brazil, in 2004 and 2015. A total of 4244 and 4271 mothers were interviewed after delivery. Weekly frequency and duration of each session of LTPA in a typical week were reported for the pre-pregnancy period and for each trimester of pregnancy. Trends in both recommended LTPA (>/=150 min/week) and any LTPA (regardless of weekly amount) were analysed overtime. Changes were also calculated separately for subgroups of maternal age, schooling, family income, parity, pre-pregnancy body mass index and pre-pregnancy LTPA. RESULTS: The proportion of women engaged in recommended levels of LTPA pre-pregnancy increased from 11.2% (95%CI 10.0-12.2) in 2004 to 15.8% (95%CI 14.6-16.9) in 2015. During pregnancy, no changes were observed over the period for the first (10.6 to 10.9%) and second (8.7 to 7.9%) trimesters, whereas there was a decrease from 3.4% (95%CI 2.9-4.0) to 2.4% (95%CI 1.9-2.8) in the last trimester. Major decreases in LTPA in the last trimester were observed among women who were younger, with intermediate to high income, high schooling, primiparous, pre-pregnancy obese and, engaged in LTPA before pregnancy. Changes in any LTPA practice followed the same patterns described for recommended LTPA. CONCLUSIONS: Despite the increase in the proportion of women engaged in LTPA before pregnancy between 2004 and 2005, LTPA levels remained stable during the first and second trimesters of pregnancy and declined during the third gestational trimester over the period. Interventions to encourage the maintenance of LTPA practice throughout pregnancy are urgently needed.
Address Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
Corporate Author Thesis
Publisher Place of Publication Editor
Language English Summary Language Original Title
Series Editor Series Title Abbreviated Series Title
Series Volume Series Issue Edition
ISSN 1471-2458 ISBN Medium
Area Expedition Conference
Notes PMID:28122524 Approved no
Call Number ref @ user @ Serial 98029
Permanent link to this record
 

 
Author Nourallah, B.; Digpal, R.; Jena, R.; Watts, C.
Title Irradiating the Subventricular Zone in Glioblastoma Patients: Is there a Case for a Clinical Trial? Type Journal Article
Year 2017 Publication Clinical Oncology (Royal College of Radiologists (Great Britain)) Abbreviated Journal Clin Oncol (R Coll Radiol)
Volume 29 Issue 1 Pages 26-33
Keywords (up) Adult; Brain Neoplasms/*radiotherapy; Glioblastoma/*radiotherapy; Humans; Lateral Ventricles/*radiation effects; Male; Neoplastic Stem Cells/radiation effects; Stem Cell Niche/radiation effects; Cancer stem cells; glioblastoma; neural stem cells; radiotherapy; subventricular zone
Abstract Glioblastoma is the most common and aggressive adult brain tumour. Over the last 10 years it has emerged that the subventricular zone (SVZ), the largest adult neural stem cell niche, has an important role in the disease. Converging evidence has implicated transformation of adult neural stems in gliomagenesis and the permissive stem cell niche in disease recurrence. Concurrently, clinical studies have suggested that SVZ involvement is a negative prognostic marker. It would follow that irradiating the SVZ may improve outcomes in glioblastoma by directly targeting this putative sanctuary site. To investigate this potential strategy, 11 retrospective studies and 1 prospective study examined the relationship between dose to the SVZ and survival outcomes in glioblastoma patients. This review summarises the theoretical underpinning of this strategy, provides a critical evaluation of the existing evidence and discusses the rationale for a clinical trial.
Address John van Geest Centre for Repair, Cambridge, UK; Department of Clinical Neurosciences, Division of Neurosurgery, Addenbrookes Hospital, Cambridge, UK. Electronic address: cw209@cam.ac.uk
Corporate Author Thesis
Publisher Place of Publication Editor
Language English Summary Language Original Title
Series Editor Series Title Abbreviated Series Title
Series Volume Series Issue Edition
ISSN 0936-6555 ISBN Medium
Area Expedition Conference
Notes PMID:27729188 Approved no
Call Number ref @ user @ Serial 96633
Permanent link to this record
 

 
Author Del Brutto, O.H.; Mera, R.M.; Zambrano, M.; Del Brutto, V.J.
Title Severe edentulism is a major risk factor influencing stroke incidence in rural Ecuador (The Atahualpa Project) Type Journal Article
Year 2017 Publication International Journal of Stroke : Official Journal of the International Stroke Society Abbreviated Journal Int J Stroke
Volume 12 Issue 2 Pages 201-204
Keywords (up) Adult; Comorbidity; Ecuador/epidemiology; Female; Follow-Up Studies; Humans; Hypertension/complications/epidemiology; Incidence; Male; Middle Aged; Mouth, Edentulous/complications/*epidemiology; Prospective Studies; Risk Factors; Rural Population; Severity of Illness Index; Stroke/complications/*epidemiology; Ecuador; Stroke incidence; cohort study; edentulism; stroke risk factors
Abstract Background There is no information on stroke incidence in rural areas of Latin America, where living conditions and cardiovascular risk factors are different from urban centers. Aim Using a population-based prospective cohort study design, we aimed to assess risk factors influencing stroke incidence in community-dwelling adults living in rural Ecuador. Methods First-ever strokes occurring from 1 June 2012 to 31 May 2016, in Atahualpa residents aged >/=40 years, were identified from yearly door-to-door surveys and other overlapping sources. Poisson regression models adjusted for demographics, cardiovascular risk factors, edentulism and the length of observation time per subject were used to estimate stroke incidence rate ratio as well as factors influencing such incidence. Results Of 807 stroke-free individuals prospectively enrolled in the Atahualpa Project, follow-up was achieved in 718 (89%), contributing 2,499 years of follow-up (average 3.48 +/- 0.95 years). Overall stroke incidence rate was 2.97 per 100 person-years of follow-up (95% CI: 1.73-4.2), which increased to 4.77 (95% CI: 1.61-14.1) when only persons aged >/=57 years were considered. Poisson regression models, adjusted for relevant confounders, showed that high blood pressure (IRR: 5.24; 95% CI: 2.55-7.93) and severe edentulism (IRR: 5.06; 95% CI: 2.28-7.85) were the factors independently increasing stroke incidence. Conclusions Stroke incidence in this rural setting is comparable to that reported from the developed world. Besides age and high blood pressure, severe edentulism is a major factor independently predicting incident strokes. Public awareness of the consequences of poor dental care might reduce stroke incidence in rural settings.
Address 4 Department of Neurology, University of Chicago, Chicago, IL, USA
Corporate Author Thesis
Publisher Place of Publication Editor
Language English Summary Language Original Title
Series Editor Series Title Abbreviated Series Title
Series Volume Series Issue Edition
ISSN 1747-4930 ISBN Medium
Area Expedition Conference
Notes PMID:27777377 Approved no
Call Number ref @ user @ Serial 97187
Permanent link to this record