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Search Results: 1 - 10 of 5426 matches for " Diana; Chishinga "
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Translating evidence into policy in low-income countries: lessons from co-trimoxazole preventive therapy
Hutchinson,Eleanor; Droti,Benson; Gibb,Diana; Chishinga,Nathaniel; Hoskins,Susan; Phiri,Sam; Parkhurst,Justin;
Bulletin of the World Health Organization , 2011, DOI: 10.1590/S0042-96862011000400015
Abstract: in the april 2010 issue of this journal, date et al. expressed concern over the slow scale-up in low-income settings of two therapies for the prevention of opportunistic infections in people living with the human immunodeficiency virus: co-trimoxazole prophylaxis and isoniazid preventive therapy. this short paper discusses the important ways in which policy analysis can be of use in understanding and explaining how and why certain evidence makes its way into policy and practice and what local factors influence this process. key lessons about policy development are drawn from the research evidence on co-trimoxazole prophylaxis, as such lessons may prove helpful to those who seek to influence the development of national policy on isoniazid preventive therapy and other treatments. researchers are encouraged to disseminate their findings in a manner that is clear, but they must also pay attention to how structural, institutional and political factors shape policy development and implementation. doing so will help them to understand and address the concerns raised by date et al. and other experts. mainstreaming policy analysis approaches that explain how local factors shape the uptake of research evidence can provide an additional tool for researchers who feel frustrated because their research findings have not made their way into policy and practice.
Suppressed or unsuppressed HIV in adults on antiretroviral therapy in Zambia: who is at risk?
N Chishinga,P Godfrey-Faussett,K Fielding,A Grant
Journal of the International AIDS Society , 2012, DOI: 10.7448/ias.15.6.18100
Abstract: Purpose of the study: To determine factors associated with suppressed or unsuppressed HIV in adults receiving combination antiretroviral therapy (cART) in Zambia. Methods: This was a cross-sectional study conducted between August 2008 and October 2009 in 16 Zambian communities nested within the ZAMSTAR trial [1]. Adult TB cases identified at a TB clinic of each community and their adult household members were invited to participate in the study. A structured interview was used to obtain information on the participants’ social, demographic and clinical characteristics. Socio-economic position (SEP) was measured using household wealth indices used in demographic health surveys. Principal component analysis was used to determine the cut-off for high (wealthy) and low (poor) SEP. Depression symptoms were measured using the Center for Epidemiological Studies Depression scale (CES-D). A cut-off of≥22 on the CES-D was used to define current depression [2]. Participants were included in this analysis if they were found to be receiving cART for>90 days at the time of the interview. The outcome was HIV suppression (viral load≤300 copies/ml). In both univariable and multivariable analyses, log Poisson regression models with robust standard errors adjusted for the 16 communities were used to calculate the risk ratios (RR), 95% confidence intervals (CI) and p-values of factors associated with HIV suppression. In multivariable analysis, each variable was independently assessed for its association with HIV suppression while minimally adjusting for a priori confounders (age, gender and education level). Summary of results: There were 520 patients receiving cART for>90 days. The median age was 35 years (inter-quartile range: 31–41) and 328/520 (63.1%) were married (Table).Of the 520 patients, 442 (85.0%) had HIV suppression while 78 (15.0%) did not. At univariable analysis, having high SEP was negatively associated with HIV suppression while receiving ZDV+3TC+EFV was positively associated with HIV suppression. At multivariable analysis, patients with high SEP were less likely to have HIV suppression than those with low SEP. Conclusions: Patients with high SEP were found to be at risk of having unsuppressed HIV. There is need for targeted interventions that can improve HIV outcomes in this group of patients receiving cART in Zambia.
An interview with Diana from Libya
Diana
International Journal of Inclusive Democracy , 2011,
Abstract: IJID Note:The interviewer will be referred below as JR and the interviewee as DL. Both the interviewer as well as the interviewee preferred not to reveal publicly their names for security reasons.JR’s Notes:In the 1980s, when Gaddafi’s policies veered to the left and nationalization of the economy became widespread, Diana father’s business was severely affected. So her own background is not what one might expect of someone who now is speaking up passionately against the NATO assault on Libya…Unfortunately, most mainstream western journalists seem interested only in hearing from anti-Gaddafi Libyans. So it is the fact that westerners continue to get a one-sided picture of Libya which helps support the case for NATO bombing. Here’s another side to the story…
Marriages, Polygamous, Early Fertility and Development in Congo  [PDF]
Diana Loubaki
Journal of Human Resource and Sustainability Studies (JHRSS) , 2017, DOI: 10.4236/jhrss.2017.53018
Abstract: This article uses endogenous growth theory to show that, both education and labor force participation of women are crucial mechanics of economic development. In an economic environment that prevailing polygamous and early fertility which yields inequalities among women, unemployed labor force is due to difficulties to ensure education for all the children born from different mothers. Thus increases of poverty create a feedback effect since the children’s off-springs become also parental financial support. Indeed, introducing moral hazard and corruption in the economy due to absence of skills, thus information hold is not revealed in order to win money to support the big family. The article also shows that, social inheritance rule is modified, i.e., it may decrease a lot and yield to poverty trap and famine zone or may increase a lot and reach the highest levels or may converge depending on parental polygamous degree or remain equal to the parental status. Consequently, this article provides development foundations focused on women social promotion for development take-off in poorest countries.
Validation of brief screening tools for depressive and alcohol use disorders among TB and HIV patients in primary care in Zambia
Nathaniel Chishinga, Eugene Kinyanda, Helen A Weiss, Vikram Patel, Helen Ayles, Soraya Seedat
BMC Psychiatry , 2011, DOI: 10.1186/1471-244x-11-75
Abstract: This was a cross-sectional study in 16 primary level care clinics. Consecutive sampling was used to select 649 participants who started TB treatment or ART in the preceding month. Participants were first interviewed using the CES-D and AUDIT, and subsequently with a psychiatric diagnostic interview for current major depressive disorder (MDD) and alcohol use disorders (AUDs) using the Mini-International Neuropsychiatric Interview (MINI). The diagnostic accuracy was calculated using the Area Under the Receiver Operating Characteristic curve (AUROC). The optimum cut-off scores for clinical use were calculated using sensitivity and positive predictive value (PPV).The CES-D and AUDIT had high internal consistency (Cronbach's alpha = 0.84; 0.98 respectively). Confirmatory factor analysis showed that the four-factor CES-D model was not a good fit for the data (Tucker-Lewis Fit Index (TLI) = 0.86; standardized root-mean square residual (SRMR) = 0.06) while the two-factor AUDIT model fitted the data well (TFI = 0.99; SRMR = 0.04). Both the CES-D and AUDIT demonstrated good discriminatory ability in detecting MINI-defined current MDDs and AUDs (AUROC for CES-D = 0.78; AUDIT = 0.98 for women and 0.75 for men). The optimum CES-D cut-off score in screening for current MDD was 22 (sensitivity 73%, PPV 76%) while that of the AUDIT in screening for AUD was 24 for women (sensitivity 60%, PPV 60%), and 20 for men (sensitivity 55%, PPV 50%).The CES-D and AUDIT showed high discriminatory ability in measuring MINI-defined current MDD and AUD respectively. They are suitable mental health screening tools for use among TB and ART patients in primary care in Zambia.Mental health disorders, human immunodeficiency virus (HIV) and tuberculosis (TB) have a profound impact on public health in sub-Saharan Africa [1], yet there are limited data on the interaction between major depressive disorders (MDDs), alcohol use disorders (AUDs) with HIV [2] and TB in this region. Many sub-Saharan African cou
Prevalence and Correlates of Alcohol Dependence Disorder among TB and HIV Infected Patients in Zambia
Rebecca O’Connell, Nathaniel Chishinga, Eugene Kinyanda, Vikram Patel, Helen Ayles, Helen A. Weiss, Soraya Seedat
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0074406
Abstract: Objectives To determine the prevalence and correlates of alcohol dependence disorders in persons receiving treatment for HIV and Tuberculosis (TB) at 16 Primary Health Care centres (PHC) across Zambia. Methods 649 adult patients receiving treatment for HIV and/or TB at PHCs in Zambia (363 males, 286 females) were recruited between 1st December 2009 and 31st January 2010. Data on socio-demographic variables, clinical disease features (TB and HIV), and psychopathological status were collected. The Mini International Neuropsychiatric Interview (MINI) was used to diagnose alcohol dependence disorder. Correlates of alcohol dependence were analyzed for men only, due to low prevalence in women. Univariable and multivariable logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI), using general estimating equations to allow for within-PHC clustering. Results The prevalence of alcohol dependence was 27.2% (95%CI: 17.7-39.5%) for men and 3.9% (95%CI: 1.4-0.1%) for women. Factors associated with alcohol dependence disorder in men included being single, divorced or widowed compared with married (adjusted OR = 1.47, 95%CI: 1.00-2.14) and being unemployed (adjusted OR=1.30, 95%CI: 1.01-1.67). The highest prevalence of alcohol dependence was among HIV-test unknown TB patients (34.7%), and lowest was among HIV positive patients on treatment but without TB (14.1%), although the difference was not statistically significant (p=0.38). Conclusions Male TB/HIV patients in this population have high prevalence of alcohol dependence disorder, and prevalence differs by HIV/TB status. Further work is needed to explore interventions to reduce harmful drinking in this population.
Complications of physician misdiagnosis/treatment of rheumatic fever in the United States  [PDF]
Diana C. Peterson
Advances in Bioscience and Biotechnology (ABB) , 2013, DOI: 10.4236/abb.2013.41A021
Abstract:

Rheumatic fever is an auto-immune disease caused by exposure to Streptococcus pyogenes. Over the last 50 years, reports of rheumatic fever within the United States have diminished. The decrease was attributed to the advent of penicillin in the treatment of streptococcus infections. We propose that current diagnostic and treatment methodologies may adversely increase the morbidity rate of rheumatic fever within the United States. Publication rates and interest in rheumatic fever has diminished over the last 30 years. Because of this decline, many physicians are only vaguely aware of the disorder. Additionally, the fear of antibiotic resistance has influenced theCenterofDisease Control to suggest a significant decrease in the use of antibiotics by physicians. Although extremely valid for the future health and well-being of the population, such policies must be examined for each individual case carefully. The American Heart Association prescribes long-term antibiotic prophylaxis as the only current treatment; however literature reviews indicate that such therapy is rarely used. Therefore individuals diagnosed with rheumatic fever are not being treated. Additionally, because many physicians are not routinely testing for streptococcus or early signs of endocarditis, it is likely that cases of rheumatic fever will increase in the future, and many individuals may not be diagnosed until sever damage or morbidity occurs. Physician education and clear revised guidelines are necessary to ensure adequate treatment of individuals with rheumatic fever. Mis-understandings of the disease and how it should be treated by first responders (i.e. primary care providers and pediatricians) are discussed.

Monopolar capacitive coupled Radiofrequency (mcRF) and ultrasound-guided Platelet Rich Plasma (PRP) give similar results in the treatment of enthesopathies: 18-Month follow-up  [PDF]
Joseph Cronkey, Diana Villegas
Health (Health) , 2013, DOI: 10.4236/health.2013.56A2011
Abstract:

Introduction: Emergent technologies, i.e., monopolar capacitive coupled Radiofrequency (mcRF) and Platelet Rich Plasma (PRP) are now available to treat conditions characterized by a failed Wound Healing Response. Both mcRF and PRP positively influence the chemical/cellular inflammatory cascade to promote healing. mcRF application results in temperature elevation at the targeted structure up to 50℃ stimulating heat shock proteins, thus inciting the Wound Healing Response. Ultrasound-guided PRP injections results in an inflammatory/reparative reaction through cytokinin release. Methods: Sixty-eight patients who have failed previous conservative treatment for tendinopathies and chronic ligament conditions of the elbow, hip, knee and ankle/foot, were treated either with mcRF or PRP. Treatments were delivered directly by the investigator, and patients were followed prospectively for an average of 19.7 months (range 15 to 24 months). Results: Average age for the mcRF cohort was 53 years (range 17 to 88). Average age for the PRP group was 58 (range 19 to 90). The male to female ratio for both groups was 1/1. 33 of 42 patients treated with mcRF experienced marked improvement (78%), while in the PRP group 19 of 26 patients experienced marked improvement (73%) as self-assessed by study subjects. Discussion/Conclusion: Results of this study are in agreement with reports on the use of both technologies; however, this is the first time that a side-by-side comparison is established. PRP and mcRF represent a new approach to musculoskeletal pathology; both modalities aim at inducing a biological response and are considered at the frontier of regenerative therapeutics. The high safety profile suggests that these, non-invasive (mcRF) and minimally invasive (PRP), office-based alternatives for the management of musculoskeletal conditions are valuable tools and should be used in accordance with a clear understanding of the underlying pathology.

Exploring Factors in the Systematic Use of Outcome Measures: A Multi-Disciplinary Rehabilitation Team Perspective  [PDF]
Diana Zidarov, Lise Poissant
Open Journal of Therapy and Rehabilitation (OJTR) , 2014, DOI: 10.4236/ojtr.2014.22013
Abstract: Purpose: The implementation of routine outcome measurement was initiated as a quality improvement initiative in a unit delivering intensive functional rehabilitation for people with lower limb amputation. Two years post-implementation, completion rates remained low which raised the need to gain an indepth understanding of the factors that might impact the systematic use of Outcome Measures (OMs). Method: A qualitative exploratory study embedded in the ongoing quality improvement initiative was designed. Data were gathered through a focus group with members of a multidisciplinary rehabilitation team. A deductive content analysis was performed using Consolidated Framework for Implementation Research (CFIR) as a guide to explore factors that impact routine outcome measurement. Results: Respondents perceived OMs as valid and offering clear advantages in clinical practice. At the organizational level, lack of fit with clinical practice, loss of project leaders and lack of clear management directives had negative repercussions on the use of OMs. Conclusion: Our results suggest that a dedicated project leader throughout the implementation process and effective communication may contribute to bypassing barriers associated to practice changes leading to a more systematic use of OMs among clinicians.
L-Moments and TL-Moments as an Alternative Tool of Statistical Data Analysis  [PDF]
Diana Bílková
Journal of Applied Mathematics and Physics (JAMP) , 2014, DOI: 10.4236/jamp.2014.210104
Abstract: Moments and cumulants are commonly used to characterize the probability distribution or observed data set. The use of the moment method of parameter estimation is also common in the construction of an appropriate parametric distribution for a certain data set. The moment method does not always produce satisfactory results. It is difficult to determine exactly what information concerning the shape of the distribution is expressed by its moments of the third and higher order. In the case of small samples in particular, numerical values of sample moments can be very different from the corresponding values of theoretical moments of the relevant probability distribution from which the random sample comes. Parameter estimations of the probability distribution made by the moment method are often considerably less accurate than those obtained using other methods, particularly in the case of small samples. The present paper deals with an alternative approach to the construction of an appropriate parametric distribution for the considered data set using order statistics.
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