Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-30 (of 31 Records) |
Query Trace: Bertrand J[original query] |
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Pre-exposure prophylaxis care cascade among men who have sex with men engaging in partner notification services at a sexually transmitted infections clinic
Le Brazidec DL , Cormier K , Almonte A , Napoleon S , Chambers LC , Tao J , Bertrand TE , Gummo CL , Beltrami J , Kinsey J , Maguire-Wilkerson A , Chan PA . AIDS Res Hum Retroviruses 2024 Partner notification services (PNS) offers opportunities to discuss HIV pre-exposure prophylaxis (PrEP) and provide referrals. We evaluated the PrEP care cascade among men who have sex with men (MSM) engaging in PNS within a sexually transmitted infections clinic. Among 121 MSM eligible for PrEP during PNS, 21% subsequently initiated PrEP. |
Preserving Families of Children in Child Welfare with Fetal Alcohol Spectrum Disorders: Challenges and Opportunities
Richards T , Miller N , Eaton E , Newburg-Rinn S , Bertrand J . Child Welfare 2023 101 (3) 209-234 The mission of child welfare is to ensure children's safety, permanency, and well-being. It is also charged with preserving and strengthening families and with avoiding the removal of children who can be kept at home safely. This paper addresses some of the challenges in meeting these concurrent goals in work with children prenatally exposed to alcohol and their families. Current child welfare practices are unlikely to identify prenatal alcohol exposure or children with fetal alcohol spectrum disorders (FASD). Yet if this exposure is identified when families come into contact with child welfare, a jurisdiction's laws and safety and risk assessment processes may lead to unnecessary removal of children from their homes, particularly for Black and American Indian/Alaska Native families. Drawing from research and discourse in the field, strategies are described that could help the child welfare system care for children who may be impacted by FASD while preserving their families. A crucial strategy is partnering with key child and family service providers to identify and respond to FASD. |
Exploring child welfare practices to care for children with prenatal substance exposure
Wang K , Richards T , Kopiec K , Newburg-Rinn S , Bertrand J . Child Welfare 2023 101 (2) 141-168 This article presents findings from a mixed-methods study exploring child welfare agency practices addressing children with prenatal substance exposure and their families. Data sources include: (a) interviews with 159 professionals in child welfare; (b) surveys with 271 professionals in child welfare; and (c) a systematic review of state and local child welfare documents guiding processes in the five states in the study sample. Findings from descriptive statistics of survey data, grounded theory analysis of interviews, and content analysis of documents suggest practices center on infants identified by hospitals as affected by prenatal substance exposure. Without practice guidance and access to treatment services, the needs of older children whose prenatal exposure to substances, including alcohol and other types of legal and illegal substances, is not recognized at birth may be overlooked. |
Challenges and opportunities to care for children in child welfare with fetal alcohol spectrum disorders while working toward preserving their families
Richards Tammy , Miller Nicole , Eaton Elizabeth , Newburg-Rinn Sharon , Bertrand Jacquelyn . Child Welfare 2023 101 (3) 209-234 The article describes the challenges for child welfare professionals in meeting goals in work with children prenatally exposed to alcohol and their families, as well as ways to address those challenges. Topics include the use and misuse of information on children's prenatal exposure to alcohol, the use of information on a child's prenatal exposure to alcohol to label children as at high risk for future maltreatment, and the need for training to inform service delivery and reduce bias. |
Knowledge, training, and support needs for identification and appropriate care of children with prenatal alcohol and other drug exposures in the child welfare system
Morehouse Erin , Ingoldsby Erin , Newburg-Rinn Sharon , Bertrand Jacquelyn , Usher Kristen . Child Welfare 2023 101 (3) 51-76 This study was conducted to explore what professionals working in child welfare and caregivers know about prenatal substance exposure, emphasizing prenatal alcohol exposure, and their perceived training needs. This was part of a descriptive mixed methods study conducted in 22 local child welfare agencies across five states. Findings showed that despite widespread awareness of prenatal substance exposure, professionals have misperceptions about prenatal substance exposure effects that likely affect practice and offer important targets for improvements. Professionals and caregivers also raised targeted needs and requests for more training in many areas. Findings from this study provide initial insights into the knowledge, policies, practice, and educational needs of child welfare agencies, professionals who work in child welfare, and caregivers. Professionals and agencies can use these findings to inform approaches, practices and trainings which may help improve developmental outcomes for children and improve family functioning, thereby reducing the risk of child maltreatment and foster care placements. This study adds to the limited research published on professional's knowledge of prenatal substance exposure and to practical child welfare training applications. |
Measuring the burden of infodemics: Summary of the methods and results of the Fifth WHO Infodemic Management Conference
Wilhelm E , Ballalai I , Belanger ME , Benjamin P , Bertrand-Ferrandis C , Bezbaruah S , Briand S , Brooks I , Bruns R , Bucci LM , Calleja N , Chiou H , Devaria A , Dini L , D'Souza H , Dunn AG , Eichstaedt JC , Evers Smaa , Gobat N , Gissler M , Gonzales IC , Gruzd A , Hess S , Ishizumi A , John O , Joshi A , Kaluza B , Khamis N , Kosinska M , Kulkarni S , Lingri D , Ludolph R , Mackey T , Mandić-Rajčević S , Menczer F , Mudaliar V , Murthy S , Nazakat S , Nguyen T , Nilsen J , Pallari E , Pasternak Taschner N , Petelos E , Prinstein MJ , Roozenbeek J , Schneider A , Srinivasan V , Stevanović A , Strahwald B , Syed Abdul S , Varaidzo Machiri S , van der Linden S , Voegeli C , Wardle C , Wegwarth O , White BK , Willie E , Yau B , Purnat TD . JMIR Infodemiology 2023 3 e44207 BACKGROUND: An infodemic is excess information, including false or misleading information, that spreads in digital and physical environments during a public health emergency. The COVID-19 pandemic has been accompanied by an unprecedented global infodemic that has led to confusion about the benefits of medical and public health interventions, with substantial impact on risk-taking and health-seeking behaviors, eroding trust in health authorities and compromising the effectiveness of public health responses and policies. Standardized measures are needed to quantify the harmful impacts of the infodemic in a systematic and methodologically robust manner, as well as harmonizing highly divergent approaches currently explored for this purpose. This can serve as a foundation for a systematic, evidence-based approach to monitoring, identifying, and mitigating future infodemic harms in emergency preparedness and prevention. OBJECTIVE: In this paper, we summarize the Fifth World Health Organization (WHO) Infodemic Management Conference structure, proceedings, outcomes, and proposed actions seeking to identify the interdisciplinary approaches and frameworks needed to enable the measurement of the burden of infodemics. METHODS: An iterative human-centered design (HCD) approach and concept mapping were used to facilitate focused discussions and allow for the generation of actionable outcomes and recommendations. The discussions included 86 participants representing diverse scientific disciplines and health authorities from 28 countries across all WHO regions, along with observers from civil society and global public health-implementing partners. A thematic map capturing the concepts matching the key contributing factors to the public health burden of infodemics was used throughout the conference to frame and contextualize discussions. Five key areas for immediate action were identified. RESULTS: The 5 key areas for the development of metrics to assess the burden of infodemics and associated interventions included (1) developing standardized definitions and ensuring the adoption thereof; (2) improving the map of concepts influencing the burden of infodemics; (3) conducting a review of evidence, tools, and data sources; (4) setting up a technical working group; and (5) addressing immediate priorities for postpandemic recovery and resilience building. The summary report consolidated group input toward a common vocabulary with standardized terms, concepts, study designs, measures, and tools to estimate the burden of infodemics and the effectiveness of infodemic management interventions. CONCLUSIONS: Standardizing measurement is the basis for documenting the burden of infodemics on health systems and population health during emergencies. Investment is needed into the development of practical, affordable, evidence-based, and systematic methods that are legally and ethically balanced for monitoring infodemics; generating diagnostics, infodemic insights, and recommendations; and developing interventions, action-oriented guidance, policies, support options, mechanisms, and tools for infodemic managers and emergency program managers. |
Child Welfare Policies and Practices Regarding Children with Prenatal Exposure to Alcohol and Other Drugs: An Exploratory Study
Usher K , Brizzo A , Leicht C , Newburg-Rinn S , Reynolds MR , McCann H , Bertrand J . Child Welfare 2022 99 (6) 65-85 Research indicates that there are more children with prenatal alcohol and other drug exposures in child welfare than in the general population. Using multiple forms of data from staff and caregivers from one urban agency, this exploratory study demonstrated opportunities to inform polices, practice, and data elements regarding this vulnerable group. Findings are discussed within the context of ensuring family preservation, equity and avoiding disproportional race/ethnicity within child welfare when identifying and caring for children with prenatal exposures. |
Machine learning for detection and risk assessment of lifting action
Thomas B , Lu M , Jha R , Bertrand J . IEEE Trans Hum Mach Syst 2022 52 (6) 1-9 Repetitive occupational lifting has been shown to create an increased risk for incidence of back pain. Ergonomic workstations that promote proper lifting technique can reduce risk, but it is difficult to assess the workstations without constant risk monitoring. Machine learning systems using inertial measurement unit (IMU) data have been successful in various human activity recognition (HAR) applications, but limited work has been done regarding tasks for which it is difficult to collect significant amounts of data, such as manual lifting tasks. In this article, we discuss why traditional methods of data expansion may fail to improve performance on IMU data, and we present a machine learning system capable of detecting lifting action for assessing the risk for back pain using a relatively small amount of data. The proposed models outperform baseline HAR models and function on raw time-series data with minimal preprocessing for efficient real-time application. Author |
Performance and operational feasibility of antigen and antibody rapid diagnostic tests for COVID-19 in symptomatic and asymptomatic patients in Cameroon: a clinical, prospective, diagnostic accuracy study.
Boum Y , Fai KN , Nicolay B , Mboringong AB , Bebell LM , Ndifon M , Abbah A , Essaka R , Eteki L , Luquero F , Langendorf C , Mbarga NF , Essomba RG , Buri BD , Corine TM , Kameni BT , Mandeng N , Fanne M , Bisseck AZ , Ndongmo CB , Eyangoh S , Hamadou A , Ouamba JP , Koku MT , Njouom R , Claire OM , Esso L , Epée E , Mballa GAE . Lancet Infect Dis 2021 21 (8) 1089-1096 BACKGROUND: Real-time PCR is recommended to detect SARS-CoV-2 infection. However, PCR availability is restricted in most countries. Rapid diagnostic tests are considered acceptable alternatives, but data are lacking on their performance. We assessed the performance of four antibody-based rapid diagnostic tests and one antigen-based rapid diagnostic test for detecting SARS-CoV-2 infection in the community in Cameroon. METHODS: In this clinical, prospective, diagnostic accuracy study, we enrolled individuals aged at least 21 years who were either symptomatic and suspected of having COVID-19 or asymptomatic and presented for screening. We tested peripheral blood for SARS-CoV-2 antibodies using the Innovita (Biological Technology; Beijing, China), Wondfo (Guangzhou Wondfo Biotech; Guangzhou, China), SD Biosensor (SD Biosensor; Gyeonggi-do, South Korea), and Runkun tests (Runkun Pharmaceutical; Hunan, China), and nasopharyngeal swabs for SARS-CoV-2 antigen using the SD Biosensor test. Antigen rapid diagnostic tests were compared with Abbott PCR testing (Abbott; Abbott Park, IL, USA), and antibody rapid diagnostic tests were compared with Biomerieux immunoassays (Biomerieux; Marcy l'Etoile, France). We retrospectively tested two diagnostic algorithms that incorporated rapid diagnostic tests for symptomatic and asymptomatic patients using simulation modelling. FINDINGS: 1195 participants were enrolled in the study. 347 (29%) tested SARS-CoV-2 PCR-positive, 223 (19%) rapid diagnostic test antigen-positive, and 478 (40%) rapid diagnostic test antibody-positive. Antigen-based rapid diagnostic test sensitivity was 80·0% (95% CI 71·0-88·0) in the first 7 days after symptom onset, but antibody-based rapid diagnostic tests had only 26·8% sensitivity (18·3-36·8). Antibody rapid diagnostic test sensitivity increased to 76·4% (70·1-82·0) 14 days after symptom onset. Among asymptomatic participants, the sensitivity of antigen-based and antibody-based rapid diagnostic tests were 37·0% (27·0-48·0) and 50·7% (42·2-59·1), respectively. Cohen's κ showed substantial agreement between Wondfo antibody rapid diagnostic test and gold-standard ELISA (κ=0·76; sensitivity 0·98) and between Biosensor and ELISA (κ=0·60; sensitivity 0·94). Innovita (κ=0·47; sensitivity 0·93) and Runkun (κ=0·43; sensitivity 0·76) showed moderate agreement. An antigen-based retrospective algorithm applied to symptomatic patients showed 94·0% sensitivity and 91·0% specificity in the first 7 days after symptom onset. For asymptomatic participants, the algorithm showed a sensitivity of 34% (95% CI 23·0-44·0) and a specificity of 92·0% (88·0-96·0). INTERPRETATION: Rapid diagnostic tests had good overall sensitivity for diagnosing SARS-CoV-2 infection. Rapid diagnostic tests could be incorporated into efficient testing algorithms as an alternative to PCR to decrease diagnostic delays and onward viral transmission. FUNDING: Médecins Sans Frontières WACA and Médecins Sans Frontières OCG. TRANSLATIONS: For the French and Spanish translations of the abstract see Supplementary Materials section. |
Children prenatally exposed to alcohol and other drugs: what the literature tells us about child welfare information sources, policies, and practices to identify and care for children
Richards T , Bertrand J , Newburg-Rinn S , McCann H , Morehouse E , Ingoldsby E . J Public Child Welf 2020 1 (24) Many parents who interact with the child welfare system present with substance use issues, which means their children are at risk for prenatal exposure to alcohol and other drugs. Because child welfare agencies play an important role in identifying and providing services to mitigate negative impacts of prenatal exposures, we conducted a search for literature addressing child welfare information sources, policies, and practices related to this population. The search yielded 16 research/evaluation and 16 policy/practice papers, with most addressing exposures to both alcohol and other drugs. The literature most commonly reports that children identified as exposed are referred to child protection agencies during the newborn period. This practice may lead to underidentification, especially of children with prenatal exposure to alcohol. Research suggests that this population is at risk for poorer child welfare outcomes and that there are specific service needs for these children. This review indicates that there is an overall lack of research literature regarding identification of prenatally exposed children involved in the child welfare system that could best inform child welfare policies and practices. Studies investigating how the child welfare system identifies and cares for children with prenatal exposures are needed. |
New filovirus disease classification and nomenclature.
Kuhn JH , Adachi T , Adhikari NKJ , Arribas JR , Bah IE , Bausch DG , Bhadelia N , Borchert M , Brantsaeter AB , Brett-Major DM , Burgess TH , Chertow DS , Chute CG , Cieslak TJ , Colebunders R , Crozier I , Davey RT , de Clerck H , Delgado R , Evans L , Fallah M , Fischer WA 2nd , Fletcher TE , Fowler RA , Grunewald T , Hall A , Hewlett A , Hoepelman AIM , Houlihan CF , Ippolito G , Jacob ST , Jacobs M , Jakob R , Jacquerioz FA , Kaiser L , Kalil AC , Kamara RF , Kapetshi J , Klenk HD , Kobinger G , Kortepeter MG , Kraft CS , Kratz T , Bosa HSK , Lado M , Lamontagne F , Lane HC , Lobel L , Lutwama J , Lyon GM 3rd , Massaquoi MBF , Massaquoi TA , Mehta AK , Makuma VM , Murthy S , Musoke TS , Muyembe-Tamfum JJ , Nakyeyune P , Nanclares C , Nanyunja M , Nsio-Mbeta J , O'Dempsey T , Paweska JT , Peters CJ , Piot P , Rapp C , Renaud B , Ribner B , Sabeti PC , Schieffelin JS , Slenczka W , Soka MJ , Sprecher A , Strong J , Swanepoel R , Uyeki TM , van Herp M , Vetter P , Wohl DA , Wolf T , Wolz A , Wurie AH , Yoti Z . Nat Rev Microbiol 2019 17 (5) 261-263 The recent large outbreak of Ebola virus disease (EVD) in Western Africa resulted in greatly increased accumulation of human genotypic, phenotypic and clinical data, and improved our understanding of the spectrum of clinical manifestations. As a result, the WHO disease classification of EVD underwent major revision. |
Are low to moderate average alcohol consumption and isolated episodes of binge drinking in early pregnancy associated with facial features related to fetal alcohol syndrome in five-year-old children
Kesmodel US , Nygaard SS , Mortensen EL , Bertrand J , Denny CH , Glidewell A , Astley Hemingway S . Alcohol Clin Exp Res 2019 43 (6) 1199-1212 BACKGROUND: Fetal alcohol syndrome (FAS) typically is observed among individuals with high prenatal alcohol exposures (PAE), but exposure histories obtained in clinical diagnostic settings are often inaccurate. The present analysis used the Lifestyle During Pregnancy Study (LDPS) to assess the potential effects of low to moderate average weekly alcohol consumption and binge drinking in early pregnancy on facial features associated with FAS among children five years of age. METHODS: The analysis is a prospective follow-up study of 670 women and their children sampled from the LDPS cohort based on maternal alcohol consumption during pregnancy. The 4-Digit Code FAS Facial Photographic software was used to measure the magnitude of expression of the three diagnostic facial features of FAS from standardized digital photographs. Logistic regression was used to estimate the odds of presenting with the FAS/Partial FAS (PFAS) facial phenotypes relative to different patterns of prenatal alcohol exposure. RESULTS: Ten children presented with the FAS/PFAS facial phenotypes. None of the children sampled met the central nervous system (CNS) criteria for FAS or PFAS at age 5 years. All remained at risk for PFAS since some types of CNS dysfunction associated with this diagnosis may only be assessed at older ages. The FAS/PFAS facial phenotypes were 8.5-fold more likely among children exposed to an average of 1-4 drinks per week, and 2.5-fold more likely among children with a single binge exposure in gestational weeks 3-4 compared to children with no such exposures. The magnitude of expression of the FAS facial phenotype was significantly correlated with all other diagnostic features of FAS: growth deficiency, microcephaly, and measures of CNS dysfunction. CONCLUSIONS: These findings suggest that low to moderate levels of PAE or isolated binge exposures may place some fetuses at risk for FAS/PFAS. Thus, conservative advice is still for women to abstain from alcohol consumption during pregnancy. This article is protected by copyright. All rights reserved. |
Multi-laboratory validation study of multilocus variable-number tandem repeat analysis (MLVA) for Salmonella enterica serovar Enteritidis, 2015
Peters T , Bertrand S , Bjorkman JT , Brandal LT , Brown DJ , Erdosi T , Heck M , Ibrahem S , Johansson K , Kornschober C , Kotila SM , Le Hello S , Lienemann T , Mattheus W , Nielsen EM , Ragimbeau C , Rumore J , Sabol A , Torpdahl M , Trees E , Tuohy A , de Pinna E . Euro Surveill 2017 22 (9) Multilocus variable-number tandem repeat analysis (MLVA) is a rapid and reproducible typing method that is an important tool for investigation, as well as detection, of national and multinational outbreaks of a range of food-borne pathogens. Salmonella enterica serovar Enteritidis is the most common Salmonella serovar associated with human salmonellosis in the European Union/European Economic Area and North America. Fourteen laboratories from 13 countries in Europe and North America participated in a validation study for MLVA of S. Enteritidis targeting five loci. Following normalisation of fragment sizes using a set of reference strains, a blinded set of 24 strains with known allele sizes was analysed by each participant. The S. Enteritidis 5-loci MLVA protocol was shown to produce internationally comparable results as more than 90% of the participants reported less than 5% discrepant MLVA profiles. All 14 participating laboratories performed well, even those where experience with this typing method was limited. The raw fragment length data were consistent throughout, and the inter-laboratory validation helped to standardise the conversion of raw data to repeat numbers with at least two countries updating their internal procedures. However, differences in assigned MLVA profiles remain between well-established protocols and should be taken into account when exchanging data. |
Neurobehavioral disorder associated with prenatal alcohol exposure
Hagan JF Jr , Balachova T , Bertrand J , Chasnoff I , Dang E , Fernandez-Baca D , Kable J , Kosofsky B , Senturias YN , Singh N , Sloane M , Weitzman C , Zubler J . Pediatrics 2016 138 (4) Children and adolescents affected by prenatal exposure to alcohol who have brain damage that is manifested in functional impairments of neurocognition, self-regulation, and adaptive functioning may most appropriately be diagnosed with neurobehavioral disorder associated with prenatal exposure. This Special Article outlines clinical implications and guidelines for pediatric medical home clinicians to identify, diagnose, and refer children regarding neurobehavioral disorder associated with prenatal exposure. Emphasis is given to reported or observable behaviors that can be identified as part of care in pediatric medical homes, differential diagnosis, and potential comorbidities. In addition, brief guidance is provided on the management of affected children in the pediatric medical home. Finally, suggestions are given for obtaining prenatal history of in utero exposure to alcohol for the pediatric patient. |
Travel- and community-based transmission of multidrug-resistant Shigella sonnei lineage among international Orthodox Jewish communities
Baker KS , Dallman TJ , Behar A , Weill FX , Gouali M , Sobel J , Fookes M , Valinsky L , Gal-Mor O , Connor TR , Nissan I , Bertrand S , Parkhill J , Jenkins C , Cohen D , Thomson NR . Emerg Infect Dis 2016 22 (9) 1545-53 Shigellae are sensitive indicator species for studying trends in the international transmission of antimicrobial-resistant Enterobacteriaceae. Orthodox Jewish communities (OJCs) are a known risk group for shigellosis; Shigella sonnei is cyclically epidemic in OJCs in Israel, and sporadic outbreaks occur in OJCs elsewhere. We generated whole-genome sequences for 437 isolates of S. sonnei from OJCs and non-OJCs collected over 22 years in Europe (the United Kingdom, France, and Belgium), the United States, Canada, and Israel and analyzed these within a known global genomic context. Through phylogenetic and genomic analysis, we showed that strains from outbreaks in OJCs outside of Israel are distinct from strains in the general population and relate to a single multidrug-resistant sublineage of S. sonnei that prevails in Israel. Further Bayesian phylogenetic analysis showed that this strain emerged approximately 30 years ago, demonstrating the speed at which antimicrobial drug-resistant pathogens can spread widely through geographically dispersed, but internationally connected, communities. |
Fetal alcohol spectrum disorders are clearly brain-based
Bertrand J . Dev Med Child Neurol 2016 58 (8) 794-5 Alcohol is a well-established teratogen that can result in a wide range of adverse reproductive and developmental outcomes. One of the most serious outcomes is the probability of fetal alcohol spectrum disorders (FASDs), a group of lifelong physical, behavioral, and intellectual impairments.1 FASDs are most prevalent in countries or regions with severe alcohol abuse issues such as South Africa and Eastern Europe.2 In recent years, high prevalence rates have been reported in an aboriginal community in the Fitzroy Valley region of Western Australia.3 | As part of a larger effort in this region through the Lililwan Project, Lucas et al.4 investigated the presence of soft neurological signs among 7- to 9-year-old children using the Quick Neurological Screening Test – Second Edition (QNST-2). Overall, the research team found that the cohort performed similarly to the norming sample, but children with prenatal exposure to alcohol displayed significantly more soft neurological signs, and children with an FASD had the greatest number of these signs. The results are consistent with other evidence of the full progression from prenatal alcohol exposure through morphological brain changes to neurological impairment to adverse outcomes, including FASDs. An associative process has been replicated in animal models and was described anecdotally in clinic samples. |
The effect of low to moderate prenatal alcohol exposure and binge drinking episodes on draw-a-person at age 5 years
Jensen LU , Eriksen HF , Marchetta C , Reynolds M , Owens JR , Denny CH , Kesmodel US , Mortensen EL , Bertrand J . Med Res Arch 2015 2 (2) This study examined the effects of maternal alcohol consumption and binge drinking during pregnancy on children's Draw-A-Person (DAP) scores. Participants were 1,533 5-year-olds from the Danish National Birth Cohort. Regression analyses revealed an adverse effect of nine or more drinks per week. A drop in mean DAP score of 6.26 (95 % CI: -12.24; -0.39) was observed in the fully adjusted model. A significant interaction between average weekly consumption and binge episodes also was observed. Findings suggest that prenatal exposure to moderate weekly doses of alcohol and binge drinking episodes are associated with lowered scores on the DAP. |
The association of pre-pregnancy alcohol drinking with child neuropsychological functioning
Kesmodel US , Kjaersgaard M , Denny CH , Bertrand J , Skogerbo A , Eriksen HL , Bay B , Underbjerg M , Mortensen EL . BJOG 2015 122 (13) 1728-38 OBJECTIVE: To examine the effects of pre-pregnancy alcohol drinking on child neuropsychological functioning. DESIGN: Prospective follow-up study. SETTING AND POPULATION: 154 women and their children sampled from the Danish National Birth Cohort. METHODS: Participants were sampled based on maternal alcohol consumption before pregnancy. At 5 years of age, the children were tested with the Wechsler Preschool and Primary Scale of Intelligence-Revised, the Test of Everyday Attention for Children at Five (TEACh-5), and the Movement Assessment Battery for Children (MABC). The Behaviour Rating Inventory of Executive Function (BRIEF) was completed by the mothers and a preschool teacher. Parental education, maternal IQ, prenatal maternal smoking, child's age at testing, child's sex, and maternal alcohol intake during pregnancy were considered potential confounders. MAIN OUTCOME MEASURES: Performance on the Wechsler Preschool and Primary Scale of Intelligence-Revised, the TEACh-5, the MABC, and the BRIEF. RESULTS: Intake of 15-21 drinks/week on average prior to pregnancy was not associated with any of the outcomes, but intake of ≥22 drinks/week on average was associated with a significantly lower adjusted mean full scale IQ and lower adjusted means in overall attention and sustained attention score, but not in selective attention score or any of the BRIEF index scores or MABC scores. CONCLUSIONS: Intake of ≥22 drinks/week before pregnancy was associated with lower mean full scale IQ, overall attention and sustained attention. Assessment of pre-pregnancy drinking provides additional information regarding potential prenatal alcohol exposure and its implications for child neurodevelopment. |
Genetic Diversity and Protective Efficacy of the RTS,S/AS01 Malaria Vaccine.
Neafsey DE , Juraska M , Bedford T , Benkeser D , Valim C , Griggs A , Lievens M , Abdulla S , Adjei S , Agbenyega T , Agnandji ST , Aide P , Anderson S , Ansong D , Aponte JJ , Asante KP , Bejon P , Birkett AJ , Bruls M , Connolly KM , D'Alessandro U , Dobano C , Gesase S , Greenwood B , Grimsby J , Tinto H , Hamel MJ , Hoffman I , Kamthunzi P , Kariuki S , Kremsner PG , Leach A , Lell B , Lennon NJ , Lusingu J , Marsh K , Martinson F , Molel JT , Moss EL , Njuguna P , Ockenhouse CF , Ragama Ogutu B , Otieno W , Otieno L , Otieno K , Owusu-Agyei S , Park DJ , Pellé K , Robbins D , Russ C , Ryan EM , Sacarlal J , Sogoloff B , Sorgho H , Tanner M , Theander T , Valea I , Volkman SK , Yu Q , Lapierre D , Birren BW , Gilbert PB , Wirth DF . N Engl J Med 2015 373 (21) 2025-2037 BACKGROUND: The RTS,S/AS01 vaccine targets the circumsporozoite protein of Plasmodium falciparum and has partial protective efficacy against clinical and severe malaria disease in infants and children. We investigated whether the vaccine efficacy was specific to certain parasite genotypes at the circumsporozoite protein locus. METHODS: We used polymerase chain reaction-based next-generation sequencing of DNA extracted from samples from 4985 participants to survey circumsporozoite protein polymorphisms. We evaluated the effect that polymorphic positions and haplotypic regions within the circumsporozoite protein had on vaccine efficacy against first episodes of clinical malaria within 1 year after vaccination. RESULTS: In the per-protocol group of 4577 RTS,S/AS01-vaccinated participants and 2335 control-vaccinated participants who were 5 to 17 months of age, the 1-year cumulative vaccine efficacy was 50.3% (95% confidence interval [CI], 34.6 to 62.3) against clinical malaria in which parasites matched the vaccine in the entire circumsporozoite protein C-terminal (139 infections), as compared with 33.4% (95% CI, 29.3 to 37.2) against mismatched malaria (1951 infections) (P=0.04 for differential vaccine efficacy). The vaccine efficacy based on the hazard ratio was 62.7% (95% CI, 51.6 to 71.3) against matched infections versus 54.2% (95% CI, 49.9 to 58.1) against mismatched infections (P=0.06). In the group of infants 6 to 12 weeks of age, there was no evidence of differential allele-specific vaccine efficacy. CONCLUSIONS: These results suggest that among children 5 to 17 months of age, the RTS,S vaccine has greater activity against malaria parasites with the matched circumsporozoite protein allele than against mismatched malaria. The overall vaccine efficacy in this age category will depend on the proportion of matched alleles in the local parasite population; in this trial, less than 10% of parasites had matched alleles. (Funded by the National Institutes of Health and others.). |
Methods for surveillance of fetal alcohol syndrome: the Fetal Alcohol Syndrome Surveillance Network II (FASSNetII) - Arizona, Colorado, New York, 2009 - 2014
O'Leary LA , Ortiz L , Montgomery A , Fox DJ , Cunniff C , Ruttenber M , Breen A , Pettygrove S , Klumb D , Druschel C , Frias JL , Robinson LK , Bertrand J , Ferrara K , Kelly M , Gilboa SM , Meaney FJ . Birth Defects Res A Clin Mol Teratol 2015 103 (3) 196-202 Surveillance of fetal alcohol syndrome (FAS) is important for monitoring the effects of prenatal alcohol exposure and describing the public health burden of this preventable disorder. Building on the infrastructure of the Fetal Alcohol Syndrome Surveillance Network (FASSNet, 1997-2002), in 2009 the Centers for Disease Control and Prevention awarded 5-year cooperative agreements to three states, Arizona, Colorado, and New York, to conduct population-based surveillance of FAS. The Fetal Alcohol Syndrome Surveillance Network II (FASSNetII, 2009-2014) developed a surveillance case definition based on three clinical criteria: characteristic facial features, central nervous system abnormalities, and growth deficiency. FASSNetII modified the FASSNet methods in three important ways: (1) estimation of a period prevalence rather than birth prevalence; (2) surveillance of FAS among school-age children (ages 7-9 years) to better document the central nervous system abnormalities that are not apparent at birth or during infancy; and (3) implementation of an expert clinical review of abstracted data for probable and confirmed cases classified through a computerized algorithm. FASSNetII abstracted data from multiple sources including birth records, medical records from child development centers or other specialty clinics, and administrative databases such as hospital discharge and Medicaid. One challenge of FASSNetII was its limited access to non-medical records. The FAS prevalence that could be estimated was that of the population identified through an encounter with the healthcare system. Clinical and public health programs that identify children affected by FAS provide critical information for targeting preventive, medical and educational services in this vulnerable population. |
Fetal alcohol syndrome among children aged 7-9 years - Arizona, Colorado, and New York, 2010
Fox DJ , Pettygrove S , Cunniff C , O'Leary LA , Gilboa SM , Bertrand J , Druschel CM , Breen A , Robinson L , Ortiz L , Frias JL , Ruttenber M , Klumb D , Meaney FJ . MMWR Morb Mortal Wkly Rep 2015 64 (3) 54-7 Fetal alcohol syndrome (FAS) is a serious birth defect and developmental disorder caused by in utero exposure to alcohol. Assessment of the public health burden of FAS through surveillance has proven difficult; there is wide variation in reported prevalence depending on the study population and surveillance method. Generally, records-based birth prevalence studies report estimates of 0.2-1.5 per 1,000 live births, whereas studies that use in-person, expert assessment of school-aged children in a community report estimates of 6-9 per 1,000 population. The Fetal Alcohol Syndrome Surveillance Network II addressed some of the challenges in records-based ascertainment by assessing a period prevalence of FAS among children aged 79 years in Arizona, Colorado, and New York. The prevalence across sites ranged from 0.3 to 0.8 per 1,000 children. Prevalence of FAS was highest among American Indian/Alaska Native children and lowest among Hispanic children. These estimates continue to be much lower than those obtained from studies using in-person, expert assessment. Factors that might contribute to this discrepancy include 1) inadequate recognition of the physical and behavioral characteristics of FAS by clinical care providers; 2) insufficient documentation of those characteristics in the medical record; and 3) failure to consider prenatal alcohol exposure with diagnoses of behavioral and learning problems. Addressing these factors through training of medical and allied health providers can lead to practice changes, ultimately increasing recognition and documentation of the characteristics of FAS. |
Implications of the fast-evolving scale-up of adult voluntary medical male circumcision for quality of services in South Africa
Rech D , Spyrelis A , Frade S , Perry L , Farrell M , Fertziger R , Toledo C , Castor D , Njeuhmeli E , Loykissoonlal D , Bertrand JT . PLoS One 2014 9 (5) e80577 BACKGROUND: The scale-up of voluntary medical male circumcision (VMMC) services in South Africa has been rapid, in an attempt to achieve the national government target of 4.3 million adult male circumcisions for HIV prevention by 2016. This study assesses the effect of the scale-up on the quality of the VMMC program. METHODS AND FINDINGS: This analysis compares the quality of services at 15 sites operational in 2011 to (1) the same 15 sites in 2012 and (2) to a set of 40 sites representing the expanded program in 2012. Trained clinicians scored each site on 29 items measuring readiness to provide quality services (abbreviated version of the WHO Quality Assessment [QA] Guide) and 29 items to assess quality of surgical care provided (pre-op, surgical technique and post-op) based on the observation of VMMC procedures at each site. Declines in quality far outnumbered improvements. The negative effects in terms of readiness to provide quality services were most evident in expanded sites, whereas the declines in provision of quality services tended to affect both repeat sites and expanded sites equally. Areas of notable concern included the monitoring of adverse events, external supervision, post-operative counselling, and some infection control issues. Scores on quality of surgical technique tended to be among the highest across the 58 items observed, and the South Africa program has clearly institutionalized three "best practices" for surgical efficiency. CONCLUSIONS: These findings demonstrate the challenges of rapidly developing large numbers of new VMMC sites with the necessary equipment, supplies, and protocols. The scale-up in South Africa has diluted human resources, with negative effects for both the original sites and the expanded program. |
Development of Haiti's rural water, sanitation and hygiene workforce
Hubbard B , Lockhart G , Gelting RJ , Bertrand F . J Water Sanit Hyg Dev 2014 4 (1) 159-163 In 2009 the Haitian Directorate of Potable Water and Sanitation (DINEPA) identified an inadequately trained and under-staffed rural workforce as one of their main institutional challenges. Plans to address this challenge were impacted by the devastating earthquake of January 12, 2010 and the cholera outbreak of October 2010, both of which further complicated Haiti's already poor water and sanitation conditions. Recognizing the importance of DINEPA's institutional priorities, donor and technical assistance groups provided needed support to improve the country's conditions and build the rural water and sanitation workforce. This report describes how DINEPA and the US Centers for Disease Control and Prevention (CDC) collaborated to design and implement a training program for 264 potable water and sanitation technicians for rural areas. The paper also describes the initial field activities of the newly trained technicians and the immediate impact of their work in the rural water, sanitation and hygiene sector. |
Access to safe water in rural Artibonite, Haiti 16 months after the onset of the cholera epidemic
Patrick M , Berendes D , Murphy J , Bertrand F , Husain F , Handzel T . Am J Trop Med Hyg 2013 89 (4) 647-53 Haiti has the lowest improved water and sanitation coverage in the Western Hemisphere and is suffering from the largest cholera epidemic on record. In May of 2012, an assessment was conducted in rural areas of the Artibonite Department to describe the type and quality of water sources and determine knowledge, access, and use of household water treatment products to inform future programs. It was conducted after emergency response was scaled back but before longer-term water, sanitation, and hygiene activities were initiated. The household survey and source water quality analysis documented low access to safe water, with only 42.3% of households using an improved drinking water source. One-half (50.9%) of the improved water sources tested positive for Escherichia coli. Of households with water to test, 12.7% had positive chlorine residual. The assessment reinforces the identified need for major investments in safe water and sanitation infrastructure and the importance of household water treatment to improve access to safe water in the near term. |
The association of mild, moderate, and binge prenatal alcohol exposure and child neuropsychological outcomes: a meta-analysis
Flak AL , Su S , Bertrand J , Denny CH , Kesmodel US , Cogswell ME . Alcohol Clin Exp Res 2013 38 (1) 214-26 BACKGROUND: The objective of this review is to evaluate the literature on the association between mild, moderate, and binge prenatal alcohol exposure and child neurodevelopment. METHODS: Meta-analysis with systematic searches of MEDLINE (1970 through August 2012), EMBASE (1988 through August 2012), and PsycINFO(R) (1970 through August 2012) and examination of selected references. RESULTS: From 1,593 articles, we identified 34 presenting data from cohort studies that met our inclusion criteria. Information on study population, outcomes, measurement instruments, timing and quantification of alcohol exposure, covariates, and results was abstracted. Outcomes included academic performance, attention, behavior, cognition, language skills, memory, and visual and motor development. The quality of each article was assessed by 2 researchers using the Newcastle-Ottawa Scale. Based on 8 studies of 10,000 children aged 6 months through 14 years, we observed a significant detrimental association between any binge prenatal alcohol exposure and child cognition (Cohen's d [a standardized mean difference score] -0.13; 95% confidence interval [CI], -0.21, -0.05). Based on 3 high-quality studies of 11,900 children aged 9 months to 5 years, we observed a statistically significant detrimental association between moderate prenatal alcohol exposure and child behavior (Cohen's d -0.15; 95% CI, -0.28, -0.03). We observed a significant, albeit small, positive association between mild-to-moderate prenatal alcohol exposure and child cognition (Cohen's d 0.04; 95% CI, 0.00, 0.08), but the association was not significant after post hoc exclusion of 1 large study that assessed mild consumption nor was it significant when including only studies that assessed moderate alcohol consumption. None of the other completed meta-analyses resulted in statistically significant associations between mild, moderate, or binge prenatal alcohol exposure and child neuropsychological outcomes. CONCLUSIONS: Our findings support previous findings suggesting the detrimental effects of prenatal binge drinking on child cognition. Prenatal alcohol exposure at levels less than daily drinking might be detrimentally associated with child behavior. The results of this review highlight the importance of abstaining from binge drinking during pregnancy and provide evidence that there is no known safe amount of alcohol to consume while pregnant. |
The effect of different alcohol drinking patterns in early to mid pregnancy on the child's intelligence, attention, and executive function
Kesmodel U , Bertrand J , Stovring H , Skarpness B , Denny C , Mortensen E . BJOG 2012 119 (10) 1180-90 OBJECTIVE: To conduct a combined analysis of the estimated effects of maternal average weekly alcohol consumption, and any binge drinking, in early to mid pregnancy on general intelligence, attention, and executive function in 5-year-old children. DESIGN: Follow-up study. SETTING: Neuropsychological testing in four Danish cities 2003-2008. POPULATION: A cohort of 1628 women and their children sampled from the Danish National Birth Cohort. METHODS: Participants were sampled based on maternal alcohol consumption during early pregnancy. At age 5 years, the children were tested for general intelligence, attention, and executive function. The three outcomes were analysed together in a multivariate model to obtain joint estimates and P values for the association of alcohol across outcomes. The effects of low to moderate alcohol consumption and binge drinking in early pregnancy were adjusted for a wide range of potential confounding factors. MAIN OUTCOME MEASURES: Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R), the Test of Everyday Attention for Children at Five (TEACh-5), and the Behavior Rating Inventory of Executive Functions (BRIEF) scores. Results Multivariate analyses showed no statistically significant effects arising from average weekly alcohol consumption or any binge drinking, either individually or in combination. These results replicate findings from separate analyses of each outcome variable. CONCLUSIONS: The present study contributes comprehensive methodological and statistical approaches that should be incorporated in future studies of low to moderate alcohol consumption and binge drinking during pregnancy. Furthermore, as no safe level of drinking during pregnancy has been established, the most conservative advice for women is not to drink alcohol during pregnancy. However, the present study suggests that small volumes consumed occasionally may not present serious concern. |
The effects of low to moderate alcohol consumption and binge drinking in early pregnancy on executive function in 5-year-old children
Skogerbo A , Kesmodel U , Wimberley T , Stovring H , Bertrand J , Landro N , Mortensen E . BJOG 2012 119 (10) 1201-10 OBJECTIVE: To examine the effects of low to moderate maternal alcohol consumption and binge drinking in early pregnancy on children's executive functions at the age of 5 years. DESIGN: Follow-up study. SETTING: Neuropsychological testing in four Danish cities 2003-2008. POPULATION: A cohort of 1628 women and their children sampled from the Danish National Birth Cohort. METHODS: Participants were sampled based on maternal alcohol drinking patterns during early pregnancy. When the children were 5 years old, the parent and teacher forms of the Behaviour Rating Inventory of Executive Function (BRIEF) were completed by the mothers and a preschool teacher. Parental education, maternal IQ, prenatal maternal smoking, the child's age at testing, and the child's gender were considered core confounding factors. The full model also included maternal binge drinking or low to moderate alcohol consumption, maternal age, parity, maternal marital status, family home environment, postnatal parental smoking, pre-pregnancy maternal body mass index (BMI), and the health status of the child. Main outcome measures The BRIEF parent and teacher forms. RESULTS: Adjusted for all potential confounding factors, no statistically significant associations between maternal low to moderate average weekly consumption and BRIEF index scores were observed. In adjusted analyses, binge drinking in gestational week 9 or later was significantly associated with elevated Behavioural Regulation Index parent scores (OR 2.04, 95% CI 0.33-3.76), and with the risk of high scores on the Metacognitive Index assessed by the teacher (OR 2.06, 95% CI 1.01-4.23). CONCLUSIONS: This study did not observe significant effects of low to moderate alcohol consumption during pregnancy on executive functioning at the age of 5 years. Furthermore, only weak and no consistent associations between maternal binge drinking and executive functions were observed. |
The effects of low to moderate prenatal alcohol exposure in early pregnancy on IQ in 5-year-old children
Falgreen Eriksen HL , Mortensen E , Kilburn T , Underbjerg M , Bertrand J , Stovring H , Wimberley T , Grove J , Kesmodel U . BJOG 2012 119 (10) 1191-200 OBJECTIVE: To examine the effects of low to moderate maternal alcohol consumption during early pregnancy on children's intelligence (IQ) at age 5 years. DESIGN: Prospective follow-up study. SETTING: Neuropsychological testing in four Danish cities 2003-2008. POPULATION: A cohort of 1628 women and their children sampled from the Danish National Birth Cohort. METHODS: Participants were sampled based on maternal alcohol consumption during pregnancy. At 5 years of age, children were tested with the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R). Parental education, maternal IQ, maternal smoking in pregnancy, the child's age at testing, gender, and tester were considered core confounding factors, whereas the full model also controlled for maternal binge drinking, age, BMI, parity, home environment, postnatal smoking in the home, health status, and indicators for hearing and vision impairments. MAIN OUTCOME MEASURES: The WPPSI-R. RESULTS: No differences in test performance were observed between children whose mothers reported consuming between one and four or between five and eight drinks per week at some point during pregnancy, compared with children of mothers who abstained. For women who reported consuming nine or more drinks per week no differences were observed for mean differences; however, the risks of low full-scale IQ (OR 4.6; 95% CI 1.2-18.2) and low verbal IQ (OR 5.9; 95% CI 1.4-24.9) scores, but not low performance IQ score, were increased. CONCLUSIONS: Maternal consumption of low to moderate quantities of alcohol during pregnancy was not associated with the mean IQ score of preschool children. Despite these findings, acceptable levels of alcohol use during pregnancy have not yet been established, and conservative advice for women continues to be to avoid alcohol use during pregnancy. |
Medical expenditures of children in the United States with fetal alcohol syndrome
Amendah DD , Grosse SD , Bertrand J . Neurotoxicol Teratol 2011 33 (2) 322-4 This paper calculates the medical expenditures for pediatric Medicaid enrollees with fetal alcohol syndrome (FAS), those with and those without reported intellectual disability (ID). The pediatric portion of the MarketScan(R) Medicaid Multi-State databases for the years 2003-2005 was used. Children with FAS were identified based on International Classification of Diseases, Ninth Revision, Clinical Modification codes. Children without FAS formed the comparison group. Annual mean, median, and 95(th) percentile total expenditures were calculated for those continuously enrolled during 2005. Children with FAS incurred annual mean medical expenditures that were nine times as high as those of children without FAS during 2005 ($16,782 vs. $1,859). ID more commonly was listed as a medical diagnosis among children with FAS than among children in the comparison group (12% vs. 0.5%), and mean expenditures of children with FAS and ID were 2.8 times those of children with FAS but without reported ID. Children with FAS incurred higher medical expenditures compared with children without FAS. A subset of children with FAS who had ID sufficiently serious to be recorded in medical records increased those expenditures still further. Our estimate of mean expenditures for children with FAS was several times higher than previous estimates in the United States. |
Predictive value of C-reactive protein on 30-day and 1-year mortality in acute coronary syndromes: an analysis from the ACUITY trial
Caixeta A , Stone GW , Mehran R , Lee EA , McLaurin BT , Cox DA , Bertrand ME , Lincoff AM , Moses JW , White HD , Ohman EM , Palmerini T , Syros G , Kittas C , Fahy M , Hooper WC , Lansky AJ , Dangas GD . J Thromb Thrombolysis 2011 31 (2) 154-64 We sought to evaluate the association between C-reactive protein (CRP) sampled on admission and short- and long-term mortality in patients with acute coronary syndromes (ACS) undergoing early invasive treatment. Baseline levels of CRP were determined in 2,974 patients with moderate and high-risk ACS undergoing an early invasive treatment strategy in the large-scale randomized ACUITY trial. The relationship of CRP to 30-day and 1-year clinical outcomes were assessed according to quartiles of CRP values. Patients with CRP levels in the fourth quartile compared to the first quartile had significantly higher 30-day mortality (2.3 vs. 0.3%, P = 0.0004) and 1-year mortality (5.5 vs. 2.8%, P = 0.0003). CRP level as a continuous variable was associated with 30-day mortality (OR [95% CI] for one unit increase in logarithmically transformed CRP level = 1.42 [1.08-1.89], P = 0.01) and 1-year mortality (OR [95% CI] = 1.24, [1.04-1.47], P = 0.02). By multivariable analysis, higher baseline CRP levels independently predicted 30-day and 1-year mortality, a relationship that was particularly strong for patients with the highest quartile of CRP (OR [95% CI] = 5.19 [1.14-23.68], P = 0.009). In troponin-positive patients, increasing quartiles of CRP were associated with a trend for 30-day mortality (P (trend) = 0.08) and a significant increase in 1-year mortality (P (trend) = 0.02); this relationship was not present in troponin-negative patients. Baseline CRP level is a powerful independent predictor of both early and late mortality in patients with ACS being treated with an early invasive strategy, especially in troponin positive patients. |
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