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"Bernard, Joseph"
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Factors associated with antiretroviral therapy adherence among people living with HIV in Haiti: a cross-sectional study
Background
Socioeconomic, demographic and clinical factors can affect adherence to treatment among people living with HIV (PLH) and potentially have an impact on their prognosis and survival. The main objective of this study was to assess these factors as potential barriers to adherence among patients receiving care in central Haiti.
Methods
A cross-sectional study was conducted among PLH receiving antiretroviral therapy (ART) at the TB/HIV clinic at St. Therese Hospital in Hinche, Haiti. A total of 426 potential participants were approached during their follow-up visits from June to August 2019, of whom 411 participated in the study. After giving informed consent, study participants completed a structured interview that included the Self-Report Item Scale (SRIS), a standard measure, to assess adherence. Socio-demographic, economic and clinical factors were assessed for their association with adherence.
Results
The 411 participating patients represented 39% of the patient population at the TB/HIV clinic during the timeframe of the study. The mean age was 43.7 years (range: 19–80), 65.5% were female and 78.1% had only achieved a primary level of schooling. Nearly 78% had received ART for less than 10 years, 3.41% reported having poor adherence and 28% less than excellent adherence. Factors related to poor adherence in bivariate analysis were age less than 40 years (OR: 6.32, 95% CI 2.04–10.58, p < 0.01) and inability to meet basic needs (OR: 2.70, 95% CI 1.04–7.0, p = 0.03).
Conclusions
To improve medication adherence, the hospital should strengthen patient counselling of younger recipients of ART and provide financial assistance and other social service interventions. Studies should be implemented in other HIV management centers in Haiti and similar contexts to examine barriers to ART adherence with the goal of improving prognosis and survival in the long-term among PLH in resource-limited setting.
Journal Article
Factors Associated With Increased Collection of Patient-Reported Outcomes Within a Large Health Care System
The collection of patient-reported outcomes (PROs) has garnered intense interest, but dissemination of PRO programs has been limited, as have analyses of the factors associated with successful programs.
To identify factors associated with improving PRO collection rates within a large health care system using a centralized PRO infrastructure.
This cohort study included 205 medical and surgical clinics in the Partners Healthcare system in Massachusetts that implemented a PRO program between March 15, 2014, and December 31, 2018, using a standardized centralized infrastructure. Data were analyzed from March to April 2019.
Relevant clinical characteristics were recorded for each clinic launching a PRO program.
The primary outcome was the mean PRO collection rate during each clinic's most recent 6 months of collection prior to January 2019. Data were analyzed using a linear regression model with the 6-month PRO collection rate as the dependent variable and clinic characteristics as independent variables. Secondary analysis used a logistic regression model to assess clinical factors associated with successful clinics, defined as those that collected PROs at a rate greater than 50%.
Between March 2014 and December 2018, 205 Partners Healthcare clinics were available for analysis, and 4 061 205 PRO measures from 745 028 encounters were collected. Among these, 103 clinics (50.2%) collected at a rate greater than 50%. Increased collection rates were associated with more than 50% of physicians in a clinic trained on PROs (change, 19.6% [95% CI, 9.9%-29.4%]; P < .001), routine administrative oversight of collection rates (change, 16.0% [95% CI, 6.6%-25.5%]; P = .001), previous collection of PROs on paper (change, 12.5% [95% CI, 4.7%-20.3%]; P = .002), presence of a clinical champion (change, 11.2% [95% CI, 2.5%-20.0%]; P = .01) and payer incentive (change, 10.5% [95% CI, 2.0%-18.9%]; P = .02).
These findings suggest that training physicians on the use of PROs, administrative surveillance of collection rates, and the presence of a local clinical champion may be promising interventions for increasing PRO collection. Clinics that have previously collected PROs may have greater success in increasing collections. Payer incentive for collection was associated with improved collections, but not associated with successful programs.
Journal Article
Empowering and training front-line providers treating cervical cancer in Haiti: perspective of a gynecologic oncologist’s experience with international surgical missions
Innovating Health International, with limited resources, manages a vertically integrated approach towards cervical cancer treatment combining a widespread screening campaign, awareness program, chemotherapy, and surgery.2 There are few, if any, specialty fellowship-trained gynecologic oncologists in Haiti. Dr McKenzie’s mission goals mirror those of Innovating Health International, which are two-fold: (i) to provide life-saving care for women without the financial means to obtain care elsewhere, and (ii) to train at least two local obstetrician/gynecologist physicians to perform complex oncologic surgeries with a goal of independent sustainability without the need for visiting international surgeons . About 90% of all deaths from cervical cancer happen in low-income and middle-income countries.1 The etiology is multi-factorial; however, lack of radiotherapy, which is reported to benefit ~50% of all patients with cancer, is most relevant.3 The care/mortality situation is compounded by limited resources that prohibit Haiti from implementing radiation owing to the lack of proper infrastructure, reliable electricity, optimal security, and geo-political instability.4 In accordance with new guidelines for low-resource countries,1 Innovating Health International has implemented neo-adjuvant chemotherapy to expand the potential for treating patients with cervical cancer.5 A recent report has reviewed the screening and treatment methods at Innovating Health International’s program using a vertically integrated model.2 Dr McKenzie, a breast cancer survivor and fluent in Haitian Creole, describes the limited resources under which clinicians must care for these women.
Journal Article
Evaluation of antibiotic self-medication among outpatients of the state university hospital of Port-Au-Prince, Haiti: a cross-sectional study
In Haiti, where all drugs are available over the counter, self-medication with antibiotics appears as a common practice. Inappropriate use of beta-lactams and macrolides is likely to contribute to the development of antimicrobial resistance. This study aimed to (i) assess the extent of self-medication with antibiotics, (ii) explore the contributing factors (age, gender and educational background) and (iii) identify specific antibiotic drug classes used among patients attending the outpatient clinic of the State University Hospital of Port-au-Prince. A cross-sectional survey among 200 outpatients of the State University Hospital of Port-au-Prince was conducted in December 2014. Face-to-face interviews were conducted using a standardized questionnaire. Parents of pediatric patients were allowed to answer to questions on their behalf. Among the study sample, 45.5% practiced self-medication with antibiotics. It was less prevalent among patients with the highest education level (23.1%; OR: 0.89 (0.5-1.75), p = 0.001). Mild symptoms (28.6%) and vaginal itching (44.4%) were the main reasons for self-medication with antibiotics. Self-medication using amoxicillin was reported by 67.0%. Self-medication with antibiotics is a common practice among Haitian patients and is more common among the less educated. Amoxicillin for urinary tract infections is the most commonly used medication. It is crucial to raise awareness on the dangers of the practice in the population and inforce the current law regarding the use of over the counter antibiotics.
Journal Article
Lonergan's Early Economic Research
\"Lonergan's Early Economic Research delves into the origins of Bernard Lonergan's economic theory through his own writing on the subject. Michael Shute provides transcriptions of many of Lonergan's private files on economics for a deeper understanding of his groundbreaking macroeconomic theory. An introduction by the editor contextualizes the works, which also serve as archival materials relevant to the companion volume Lonergan's Discovery of the Science of Economics
eBook
Forest Carbon Storage and Tree Carbon Pool Dynamics under Natural Forest Protection Program in Northeastern China
The Natural Forest Protection (NFP) program is one of the Six Key Forestry Projects which were adopted by the Chinese Government since the 1980s to address important natural issues in China. It advanced to protecting and restoring the structures and functions of the natural forests through sustainable forest management. However, the role of forest carbon storage and tree carbon pool dynamics since the adoption of the NFP remains unknown. To address this knowledge gap, this study calculated forest carbon storage (tree, understory, forest floor and soil) in the forest region of northeastern (NE) China based on National Forest Inventory databases and field investigated databases. For tree biomass, this study utilized an improved method for biomass estimation that converts timber volume to total forest biomass; while for understory, forest floor and soil carbon storage, this study utilized forest type-specific mean carbon densities multiplied by their areas in the region. Results showed that the tree carbon pool under the NFP in NE China functioned as a carbon sink from 1998 to 2008, with an increase of 6.3 Tg C/yr, which was mainly sequestrated by natural forests (5.1 Tg C/yr). At the same time, plantations also acted as a carbon sink, reflecting an increase of 1.2 Tg C/yr. In 2008, total carbon storage in forests covered by the NFP in NE China was 4603.8 Tg C, of which 4393.3 Tg C was stored in natural forests and 210.5 Tg C in planted forests. Soil was the largest carbon storage component, contributing 69.5%–77.8% of total carbon storage; followed by tree and forest floor, accounting for 16.3%–23.0% and 5.0%–6.5% of total carbon storage, respectively. Understory carbon pool ranged from 1.9 to 42.7 Tg C, accounting for only 0.9% of total carbon storage.
Journal Article
Biomass Carbon Storage and Its Sequestration Potential of Afforestation under Natural Forest Protection Program in China
Based on the data from China’s Seventh Forest Inventory for the period of 2004–2008, area and stand volume of different types and age-classes of plantation were used to establish the relationship between biomass density and age of planted forests in different regions of the country. Combined with the plantation area in the first-stage of the Natural Forest Protection (NFP) program (1998–2010), this study calculated the biomass carbon storage of the afforestation in the first-stage of the program. On this basis, the carbon sequestration potential of these forests was estimated for the second stage of the program (2011–2020). Biomass carbon storage of plantation established in the first stage of the program was 33.67 Tg C, which was majority accounted by protection forests (30.26 Tg C). There was a significant difference among carbon storage in different regions, which depended on the relationship of biomass carbon density, forest age and plantation area. Under the natural growth, the carbon storage was forecasted to increase annually from 2011 to 2020, reaching 96.03 Tg C at the end of the second-stage of the program in 2020. The annual growth of the carbon storage was forecasted to be 6.24 Tg C/yr, which suggested that NFP program has a significant potential for enhancing carbon sequestration in plantation forests under its domain.
Journal Article
Effects of Logging Intensity on Structure and Composition of a Broadleaf-Korean Pine Mixed Forest on Changbai Mountains, Northeast China
In order to identify a harvesting model which is beneficial for broadleaf-Korean pine mixed forest （BKF） sustainability, we investigated four types of harvested stands which have been logged with intensities of 0 （T0, control）, 15% （T1, low intensity）, 35% （T2, moderate intensity）, and 100% （T3, clear-cutting）, and examined the impacts of logging intensity on composition and structure of these stands. Results showed that there were no significant differences between To and T1 for all structural characteristics, except for density of seeding and large trees. The mean diameter at breast height （DBH, 1.3 m above the ground）, stem density and basal area of large trees in T2 were significantly lower than in To, while the density of seedlings and saplings were significantly higher in T2 than in To. Structural characteristics in T3 were entirely different from To. Dominant tree species in primary BKF comprised 93%, 85%, 45% and 10% of the total basal area in T0, T1, T2 and T3, respectively. Three community similarity indices, the Jaccard＇s similarity coefficient （Cj）; the Morisita-Hom index （CMH）; and the Bray-Curtis index （CN）, were the highest for T0 and T1, followed by T0 and T2, and T0 and T3, in generally. These results suggest that effects of harvesting on forest composition and structure are related to logging intensities. Low intensity harvesting is conductive to preserving forest structure and composition, allowing it to recover in a short time period. The regime characterized by low logging intensity and short rotations appears to be a sustainable harvesting method for BKF on the Changbai Mountains.
Journal Article