Last data update: Jun 24, 2024. (Total: 47078 publications since 2009)
Records 1-4 (of 4 Records) |
Query Trace: Polyak C [original query] |
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Advanced HIV disease in East Africa and Nigeria, in The African Cohort Study (AFRICOS)
Oboho IK , Esber AL , Dear N , Paulin HN , Iroezindu M , Bahemana E , Kibuuka H , Owuoth J , Maswai J , Shah N , Crowell TA , Ake JA , Polyak CS . J Acquir Immune Defic Syndr 2024 BACKGROUND: Earlier antiretroviral therapy (ART) may decrease progression to advanced HIV disease (AHD) with CD4 <200 cells/mm3 or clinical sequelae. We assessed factors associated with AHD among people living with HIV (PLHIV) before and during the "test and treat" era. SETTING: The African Cohort Study (AFRICOS) prospectively enrolls adults with and without HIV from 12 clinics in Uganda, Kenya, Tanzania, and Nigeria. METHODS: Enrollment evaluations included clinical history, physical examination, and laboratory testing. Generalized estimating equations were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CI) for factors associated with CD4 <200 at study visits. RESULTS: From 2013-2021, 3059 PLHIV with available CD4 at enrollment were included; median age was 38 years [interquartile range: 30-46] and 41.3% were men. From 2013 to 2021, the prevalence of CD4 <200 decreased from 10.5% to 3.1% while the percentage on ART increased from 76.6% to 100% (p <0.001). Factors associated with higher odds of CD4 <200 were male sex (aOR 1.56 [CI 1.29-1.89]), being 30-39 years (1.42 [1.11-1.82]) or older (compared to <30), World Health Organization stage 2 disease (1.91 [1.48-2.49]) or higher (compared to stage 1), and HIV diagnosis eras 2013-2015 (2.19 [1.42-3.37]) or later (compared to <2006). Compared to ART naïve, unsuppressed participants, being viral load suppressed on ART, regardless of ART duration, was associated with lower odds of CD4 <200 (<6 months on ART: 0.45 [0.34-0.58]). CONCLUSION: With ART scale-up, AHD has declined. Efforts targeting timely initiation of suppressive ART may further reduce AHD risk. |
Militaries and global health: peace, conflict, and disaster response
Michaud J , Moss K , Licina D , Waldman R , Kamradt-Scott A , Bartee M , Lim M , Williamson J , Burkle F , Polyak CS , Thomson N , Heymann DL , Lillywhite L . Lancet 2019 393 (10168) 276-286 Many countries show a growing willingness to use militaries in support of global health efforts. This Series paper summarises the varied roles, responsibilities, and approaches of militaries in global health, drawing on examples and case studies across peacetime, conflict, and disaster response environments. Militaries have many capabilities applicable to global health, ranging from research, surveillance, and medical expertise to rapidly deployable, large-scale assets for logistics, transportation, and security. Despite this large range of capabilities, militaries also have limitations when engaging in global health activities. Militaries focus on strategic, operational, and tactical objectives that support their security and defence missions, which can conflict with humanitarian and global health equity objectives. Guidelines-both within and outside militaries-for military engagement in global health are often lacking, as are structured opportunities for military and civilian organisations to engage one another. We summarise policies that can help close the gap between military and civilian actors to catalyse the contributions of all participants to enhance global health. |
Evaluation of the optimal recall period for disease symptoms in home-based morbidity surveillance in rural and urban Kenya
Feikin DR , Audi A , Olack B , Bigogo GM , Polyak C , Burke H , Williamson J , Breiman RF . Int J Epidemiol 2010 39 (2) 450-8 BACKGROUND: In African settings with poor access to health care, surveillance and surveys of disease burden are often done through home visits. The optimal recall period to capture data on symptoms and health utilization is unknown. METHODS: We collected illness data among 53 000 people during fortnightly home visits in rural and urban Kenya. Dates of cough, fever and diarrhoea in the past 2 weeks and health-seeking behaviour were recorded. Incidence rates were modelled using Poisson regression for data collected from 1 July 2006 to 30 June 2007. RESULTS: Incidence rates were higher in days 0-6 before the home visit than in days 7-13 before the home visit for all three symptoms, for the rural and urban sites, for children and adults, for self- and proxy-reported symptoms and for severe and non-severe illness in children. Recall decay was steeper in the rural than the urban sites, and for proxy- than self-reported symptoms. The daily prevalence of symptoms fell <80% of the maximum prevalence when asking about symptoms >3 days before the home visit for children and >4 days for persons ≥5 years of age. Recall of previously documented clinic visits, and prescriptions of antimalarials and antibiotics also declined by approximately 7, 15 and 23% per week, respectively, in children aged <5 years, and 6, 20 and 16%, respectively, in older persons (P < 0.0001 for each decline). CONCLUSIONS: A 2-week recall period underestimates true disease rates and health-care utilization. Shorter recall periods of 3 days in children and 4 days in adults would likely yield more accurate data. |
Typhoid fever in the United States, 1999-2006
Lynch MF , Blanton EM , Bulens S , Polyak C , Vojdani J , Stevenson J , Medalla F , Barzilay E , Joyce K , Barrett T , Mintz ED . JAMA 2009 302 (8) 859-65 CONTEXT: Typhoid fever in the United States has increasingly been due to infection with antimicrobial-resistant Salmonella ser Typhi. National surveillance for typhoid fever can inform prevention and treatment recommendations. OBJECTIVE: To assess trends in infections with antimicrobial-resistant S. Typhi. DESIGN: Cross-sectional, laboratory-based surveillance study. SETTING AND PARTICIPANTS: We reviewed data from 1999-2006 for 1902 persons with typhoid fever who had epidemiologic information submitted to the Centers for Disease Control and Prevention (CDC) and 2016 S. Typhi isolates sent by participating public health laboratories to the National Antimicrobial Resistance Monitoring System Laboratory at the CDC for antimicrobial susceptibility testing. MAIN OUTCOME MEASURES: Proportion of S. Typhi isolates demonstrating resistance to 14 antimicrobial agents and patient risk factors for antimicrobial-resistant infections. RESULTS: Patient median age was 22 years (range, <1-90 years); 1295 (73%) were hospitalized and 3 (0.2%) died. Foreign travel within 30 days of illness was reported by 1439 (79%). Only 58 travelers (5%) had received typhoid vaccine. Two hundred seventy-two (13%) of 2016 isolates tested were resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole (multidrug-resistant S. Typhi [MDRST]); 758 (38%) were resistant to nalidixic acid (nalidixic acid-resistant S. Typhi [NARST]) and 734 NARST isolates (97%) had decreased susceptibility to ciprofloxacin. The proportion of NARST increased from 19% in 1999 to 54% in 2006. Five ciprofloxacin-resistant isolates were identified. Patients with resistant infections were more likely to report travel to the Indian subcontinent: 85% of patients infected with MDRST and 94% with NARST traveled to the Indian subcontinent, while 44% of those with susceptible infections did (MDRST odds ratio, 7.5; 95% confidence interval, 4.1-13.8; NARST odds ratio, 20.4; 95% confidence interval, 12.4-33.9). CONCLUSION: Infection with antimicrobial-resistant S. Typhi strains among US patients with typhoid fever is associated with travel to the Indian subcontinent, and an increasing proportion of these infections are due to S. Typhi strains with decreased susceptibility to fluoroquinolones. |
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