Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-13 (of 13 Records) |
Query Trace: Tierney E[original query] |
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High HIV prevalence and associated factors in Lesotho: Results from a population-based survey
Schwitters A , McCracken S , Frederix K , Tierney R , Koto M , Ahmed N , Thin K , Dobbs T , Sithole S , Letsie M , Parekh B , Patel H , Birhanu S , Wiesner L , Low A . PLoS One 2022 17 (7) e0271431 Despite extensive global efforts, sub-Saharan Africa remains disproportionately affected by the HIV epidemic. This generalized epidemic can be seen in Lesotho which in 2014 the HIV prevalence rate of those aged 15-49 years was 24.6%, with and incidence of 1.9 new infections per 100-person-year exposures. To better understand the impact of Lesotho's national HIV response and significant predictors associated with HIV infection, the Lesotho Population-based HIV Impact Assessment was conducted. This survey provided a nationally representative sample of individuals aged 15-59 years old in which participants were tested for HIV and given an individual questionnaire that included socio-demographic and behavioral risk questions. The association of factors between survey questions and HIV incident was assessed using logistic regression. Multivariate logistic regression models for men and women were constructed for each outcome using variables known to be or plausibly associated with recent or chronic infection. Overall annualized incidence among people aged 15-49 was 1.19% (95% CI 0.73-1.65) per year. The overall prevalence of HIV was 25.6% with women having significantly higher prevalence. Multiple variables, including decreased wealth status, lower education levels, marital status, condom use at first sex, and circumcision (men only) were identified as being significantly associated with HIV infection for both men and women. In combination with improving the awareness of HIV status, an increased focus is needed on AGYW and men 35-49 years old to prevent new infections. HIV education and prevention programs should focus heavily on younger age groups prior to and soon after sexual debut to prevent HIV transmission. The findings of the survey showed significant room for improvement in increasing awareness of HIV status and reinforcing the need for continued HIV prevention and treatment efforts in Lesotho to prevent new infections. |
Evaluating opioid analgesic prescribing limits: A narrative review
Seitz AE , Janiszewski KA , Guy GPJr , Tapscott RT , Einstein EB , Meyer TE , Tierney J , Staffa J , Jones CM , Compton WM . Pharmacoepidemiol Drug Saf 2022 31 (6) 605-613 PURPOSE: In response to the opioid crisis, opioid analgesic guidelines and prescribing limits have proliferated. The purpose of this narrative review is to examine evidence from studies evaluating the patient or public health impact of federal and state opioid analgesic prescribing guidelines and laws, describe gaps and challenges in current research, and highlight opportunities for improving future research. METHODS: We focused on evidence from a literature review covering 2013 through 2019. We identified 30 studies evaluating opioid analgesic thresholds based on federal policies and guidelines, state laws, and Medicaid state plans that attempt to influence the course of patient care at or when the limit is exceeded (e.g., prior authorization). RESULTS: Most studies evaluated changes in prescribing or dispensing patterns of opioid analgesics, largely finding decreases in prescribing after policy enactment. Fewer studies evaluated patient or public health outcomes beyond changes in prescribing and dispensing patterns; results were infrequently stratified by potentially important sociodemographic and clinical factors. No studies assessed the potential for adverse patient outcomes for which we have emerging evidence of harms. CONCLUSIONS: We describe knowledge gaps and propose opportunities for future research to sufficiently assess the potential impact and unintended consequences of opioid analgesic prescribing laws, regulations, guidelines, and policies. |
Carbapenemase production among less-common Enterobacterales genera: 10 US sites, 2018.
Shugart A , Mahon G , Huang JY , Karlsson M , Valley A , Lasure M , Gross A , Pattee B , Vaeth E , Brooks R , Maruca T , Dominguez CE , Torpey D , Francis D , Bhattarai R , Kainer MA , Chan A , Dubendris H , Greene SR , Blosser SJ , Shannon DJ , Jones K , Brennan B , Hun S , D'Angeli M , Murphy CN , Tierney M , Reese N , Bhatnagar A , Kallen A , Brown AC , Spalding Walters M . JAC Antimicrob Resist 2021 3 (3) dlab137 BACKGROUND: Historically, United States' carbapenem-resistant Enterobacterales (CRE) surveillance and mechanism testing focused on three genera: Escherichia, Klebsiella, and Enterobacter (EsKE); however, other genera can harbour mobile carbapenemases associated with CRE spread. OBJECTIVES: From January through May 2018, we conducted a 10 state evaluation to assess the contribution of less common genera (LCG) to carbapenemase-producing (CP) CRE. METHODS: State public health laboratories (SPHLs) requested participating clinical laboratories submit all Enterobacterales from all specimen sources during the surveillance period that were resistant to any carbapenem (Morganellaceae required resistance to doripenem, ertapenem, or meropenem) or were CP based on phenotypic or genotypic testing at the clinical laboratory. SPHLs performed species identification, phenotypic carbapenemase production testing, and molecular testing for carbapenemases to identify CP-CRE. Isolates were categorized as CP if they demonstrated phenotypic carbapenemase production and ≥1 carbapenemase gene (bla (KPC), bla (NDM), bla (VIM), bla (IMP), or bla (OXA-48-like)) was detected. RESULTS: SPHLs tested 868 CRE isolates, 127 (14.6%) were from eight LCG. Overall, 195 (26.3%) EsKE isolates were CP-CRE, compared with 24 (18.9%) LCG isolates. LCG accounted for 24 (11.0%) of 219 CP-CRE identified. Citrobacter spp. was the most common CP-LCG; the proportion of Citrobacter that were CP (11/42, 26.2%) was similar to the proportion of EsKE that were CP (195/741, 26.3%). Five of 24 (20.8%) CP-LCG had a carbapenemase gene other than bla (KPC). CONCLUSIONS: Participating sites would have missed approximately 1 in 10 CP-CRE if isolate submission had been limited to EsKE genera. Expanding mechanism testing to additional genera could improve detection and prevention efforts. |
Maternal and infant bone mineral density 1 year after delivery in a randomized, controlled trial of maternal tenofovir disoproxil fumarate to prevent mother-to-child transmission of hepatitis B virus
Salvadori N , Fan B , Teeyasoontranon W , Ngo-Giang-Huong N , Phanomcheong S , Luvira A , Puangsombat A , Suwannarat A , Srirompotong U , Putiyanun C , Cressey TR , Decker L , Khamduang W , Harrison L , Tierney C , Shepherd JA , Kourtis AP , Bulterys M , Siberry GK , Jourdain G . Clin Infect Dis 2019 69 (1) 144-146 In a randomized, double-blind, placebo-controlled trial of tenofovir disoproxil fumarate (TDF) use from 28 weeks gestational age to 2 months postpartum to prevent mother-to-child transmission of hepatitis B virus, there was no significant effect of maternal TDF use on maternal or infant bone mineral density 1 year after delivery/birth. Clinical Trials Registration. NCT01745822. |
Tenofovir exposure during pregnancy and postpartum in women receiving tenofovir disoproxil fumarate for the prevention of mother-to-child transmission of hepatitis B virus
Cressey TR , Harrison L , Achalapong J , Kanjanavikai P , Patamasingh Na Ayudhaya O , Liampongsabuddhi P , Siriwachirachai T , Putiyanun C , Suriyachai P , Tierney C , Salvadori N , Chinwong D , Decker L , Tawon Y , Murphy TV , Ngo-Giang-Huong N , Siberry GK , Jourdain G . Antimicrob Agents Chemother 2018 62 (12) We assessed tenofovir exposure during pregnancy and postpartum in hepatitis B virus (HBV)-infected, HIV-uninfected, women receiving tenofovir disoproxil fumarate (TDF) to prevent mother-to-child transmission of HBV. Data from 154 women who received TDF within a randomized-controlled trial were included. Individual plasma tenofovir exposures (AUC0-24) were estimated using a population pharmacokinetic approach. Estimated geometric mean tenofovir AUC0-24 was 20% (95% CI: 19-21%) lower during pregnancy compared to postpartum; this modest reduction in the absence of HBV transmission suggests no dose adjustment is needed. |
Building on the HIV chronic care platform to address noncommunicable diseases in sub-Saharan Africa: a research agenda
Vorkoper S , Kupfer LE , Anand N , Patel P , Beecroft B , Tierney WM , Ferris R , El-Sadr WM . AIDS 2018 32 Suppl 1 S107-s113 OBJECTIVE: The remarkable progress made in confronting the global HIV epidemic offers a unique opportunity to address the increasing threat of noncommunicable diseases (NCDs). However, questions remain about how to enhance the HIV platforms to deliver integrated HIV and NCD care to people living with HIV (PLHIV) in sub-Saharan Africa (SSA). We aimed to develop a priority research agenda to advance this effort. METHODS: Researchers, policymakers, and implementers from the United States and SSA conducted three scoping reviews on HIV/NCD prevention and care focused on clinical, health system, and community levels. Based on the review findings and expert inputs, we conducted iterative consensus-development activities to generate a prioritized research agenda. RESULTS: Population-level data on NCD prevalence among PLHIV in SSA are sparse. The review identified NCD screening and management approaches that could be integrated into HIV programs in SSA. However, few studies focused on the effectiveness, cost, and best practices for integrated chronic care platforms, making it difficult to derive policy recommendations. To address these gaps, we propose a prioritized research agenda focused on developing evidence-based service delivery models, increasing human capacity through workforce education, generating data through informatics platforms and research, managing the medication supply chain, developing new financing and sustainability models, advancing research-informed policy, and addressing other crosscutting health system issues. CONCLUSION: Based on collaborative, interdisciplinary efforts, a research agenda was developed to provide guidance that advances efforts to adapt the current health system to deliver integrated chronic care for PLHIV and the population at large. |
Tenofovir versus Placebo to Prevent Perinatal Transmission of Hepatitis B.
Jourdain G , Ngo-Giang-Huong N , Harrison L , Decker L , Khamduang W , Tierney C , Salvadori N , Cressey TR , Sirirungsi W , Achalapong J , Yuthavisuthi P , Kanjanavikai P , Na Ayudhaya OP , Siriwachirachai T , Prommas S , Sabsanong P , Limtrakul A , Varadisai S , Putiyanun C , Suriyachai P , Liampongsabuddhi P , Sangsawang S , Matanasarawut W , Buranabanjasatean S , Puernngooluerm P , Bowonwatanuwong C , Puthanakit T , Klinbuayaem V , Thongsawat S , Thanprasertsuk S , Siberry GK , Watts DH , Chakhtoura N , Murphy TV , Nelson NP , Chung RT , Pol S , Chotivanich N . N Engl J Med 2018 378 (10) 911-923 BACKGROUND: Pregnant women with an elevated viral load of hepatitis B virus (HBV) have a risk of transmitting infection to their infants, despite the infants' receiving hepatitis B immune globulin. METHODS: In this multicenter, double-blind clinical trial performed in Thailand, we randomly assigned hepatitis B e antigen (HBeAg)-positive pregnant women with an alanine aminotransferase level of 60 IU or less per liter to receive tenofovir disoproxil fumarate (TDF) or placebo from 28 weeks of gestation to 2 months post partum. Infants received hepatitis B immune globulin at birth and hepatitis B vaccine at birth and at 1, 2, 4, and 6 months. The primary end point was a hepatitis B surface antigen (HBsAg)-positive status in the infant, confirmed by the HBV DNA level at 6 months of age. We calculated that a sample of 328 women would provide the trial with 90% power to detect a difference of at least 9 percentage points in the transmission rate (expected rate, 3% in the TDF group vs. 12% in the placebo group). RESULTS: From January 2013 to August 2015, we enrolled 331 women; 168 women were randomly assigned to the TDF group and 163 to the placebo group. At enrollment, the median gestational age was 28.3 weeks, and the median HBV DNA level was 8.0 log10 IU per milliliter. Among 322 deliveries (97% of the participants), there were 319 singleton births, two twin pairs, and one stillborn infant. The median time from birth to administration of hepatitis B immune globulin was 1.3 hours, and the median time from birth to administration of hepatitis B vaccine was 1.2 hours. In the primary analysis, none of the 147 infants (0%; 95% confidence interval [CI], 0 to 2) in the TDF group were infected, as compared with 3 of 147 (2%; 95% CI, 0 to 6) in the placebo group (P=0.12). The rate of adverse events did not differ significantly between groups. The incidence of a maternal alanine aminotransferase level of more than 300 IU per liter after discontinuation of the trial regimen was 6% in the TDF group and 3% in the placebo group (P=0.29). CONCLUSIONS: In a setting in which the rate of mother-to-child HBV transmission was low with the administration of hepatitis B immune globulin and hepatitis B vaccine in infants born to HBeAg-positive mothers, the additional maternal use of TDF did not result in a significantly lower rate of transmission. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development; ClinicalTrials.gov number, NCT01745822 .). |
Per- and polyfluoroalkyl substances in human serum and urine samples from a residentially exposed community
Worley RR , Moore SM , Tierney BC , Ye X , Calafat AM , Campbell S , Woudneh MB , Fisher J . Environ Int 2017 106 135-143 BACKGROUND: Per- and polyfluoroalkyl substances (PFAS) are considered chemicals of emerging concern, in part due to their environmental and biological persistence and the potential for widespread human exposure. In 2007, a PFAS manufacturer near Decatur, Alabama notified the United States Environmental Protection Agency (EPA) it had discharged PFAS into a wastewater treatment plant, resulting in environmental contamination and potential exposures to the local community. OBJECTIVES: To characterize PFAS exposure over time, the Agency for Toxic Substances and Disease Registry (ATSDR) collected blood and urine samples from local residents. METHODS: Eight PFAS were measured in serum in 2010 (n=153). Eleven PFAS were measured in serum, and five PFAS were measured in urine (n=45) from some of the same residents in 2016. Serum concentrations were compared to nationally representative data and change in serum concentration over time was evaluated. Biological half-lives were estimated for perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), and perfluorohexane sulfonic acid (PFHxS) using a one-compartment pharmacokinetic model. RESULTS: In 2010 and 2016, geometric mean PFOA and PFOS serum concentrations were elevated in participants compared to the general U.S. POPULATION: In 2016, the geometric mean PFHxS serum concentration was elevated compared to the general U.S. POPULATION: Geometric mean serum concentrations of PFOA, PFOS, and perfluorononanoic acid (PFNA) were significantly (p≤0.0001) lower (49%, 53%, and 58%, respectively) in 2016 compared to 2010. Half-lives for PFOA, PFOS, and PFHxS were estimated to be 3.9, 3.3, and 15.5years, respectively. Concentrations of PFOA in serum and urine were highly correlated (r=0.75) in males. CONCLUSIONS: Serum concentrations of some PFAS are decreasing in this residentially exposed community, but remain elevated compared to the U.S. general population. |
Prevention of mother-to-child transmission of hepatitis B virus: a phase III, placebo-controlled, double-blind, randomized clinical trial to assess the efficacy and safety of a short course of tenofovir disoproxil fumarate in women with hepatitis B virus e-antigen
Jourdain G , Ngo-Giang-Huong N , Cressey TR , Hua L , Harrison L , Tierney C , Salvadori N , Decker L , Traisathit P , Sirirungsi W , Khamduang W , Bowonwatanuwong C , Puthanakit T , Siberry GK , Watts DH , Murphy TV , Achalapong J , Hongsiriwon S , Klinbuayaem V , Thongsawat S , Chung RT , Pol S , Chotivanich N . BMC Infect Dis 2016 16 393 BACKGROUND: Chronic hepatitis B virus (HBV) infection is complicated by cirrhosis and liver cancer. In Thailand, 6-7 % of adults are chronically infected with HBV. The risk of mother-to-child transmission (MTCT) of HBV has been estimated to be about 12 % when mothers have a high hepatitis B viral load, even if infants receive passive-active prophylaxis with HBV immunoglobulin (HBIg) and initiate the hepatitis B vaccine series at birth. We designed a study to assess the efficacy and safety of a short course of maternal tenofovir disoproxil fumarate (TDF) among women with a marker of high viral load for the prevention of MTCT of HBV. METHODS: The study is a phase III, multicenter (17 sites in Thailand), placebo-controlled, double-blind, randomized 1:1, two-arm clinical trial of TDF 300 mg once daily versus placebo among pregnant women from 28 weeks' gestation through 2-month post-partum. All infants receive HBIg at birth, and a hepatitis B (HB) vaccination series according to Thai guidelines: birth, and age 1, 2, 4 and 6 months. Participant women at study entry must be age ≥18 years, hepatitis B surface antigen (HBsAg) and e-antigen (HBeAg) positive, have alanine aminotransferase (ALT) level < 30 IU/L at screening (confirmed < 60 IU/L pre-entry), negative hepatitis C serology, creatinine clearance >50 mL/min, and no history of anti-HBV antiviral treatment. The target sample size of 328 mother/infant pairs assumed 156 evaluable cases per arm to detect a ≥9 % difference in MTCT transmission (3 % experimental arm versus 12 % placebo arm) with 90 % power. Mothers and infants are followed until 12 months after delivery. The primary infant endpoint is detection of HBsAg, confirmed by detection of HBV DNA at six months of age. Secondary endpoints are maternal and infant adverse events, acute exacerbations of maternal hepatitis B disease (ALT >300 IU/L, defined as a "flare") following discontinuation of study treatment, infant HBV infection status and growth up to 12 months of age. DISCUSSION: The results of this randomized trial will clarify the efficacy and safety of a short course of antiviral treatment to prevent mother-to-child transmission of HBV and inform international guidelines. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT01745822 . |
The association of statin use with peripheral neuropathy in the US population 40 years of age or older
Tierney EF , Thurman DJ , Beckles GL , Cadwell BL . J Diabetes 2012 5 (2) 207-15 BACKGROUND: Peripheral neuropathy is a serious complication of diabetes and several conditions that may lead to loss of lower extremity function and even amputations. Since their introduction, the use of statin drugs has increased dramatically. Recent reports suggest a role for statins in the development of peripheral neuropathy. Our aims in this study were to assess the association between statin use and peripheral neuropathy and to determine whether this association varied by diabetes status. METHOD: We used the lower extremity examination supplement in the 1999-2004 National Health and Nutrition Examination Survey (NHANES). RESULTS: Overall prevalence of statin use was 15%, and the prevalence of peripheral neuropathy was 14.9%. The prevalence of peripheral neuropathy was significantly higher among those who used statins compared to those who did not (23.5% vs. 13.5%; p < 0.01). In multivariate logistic regression, statin use (Adj. OR 1.3, 95% CI 1.1-1.6, Wald p-value 0.04) was significantly associated with peripheral neuropathy, controlling for diabetes status, age, gender, race, height, weight, blood lead levels, poverty, glycohemoglobin, use of vitamin B, alcohol abuse, hypertension, and non-HDL cholesterol. Diabetes status, age, gender, height, weight, blood lead levels, poverty, and glycohemoglobin were also significantly associated with peripheral neuropathy. We found no effect modification between statin use and diabetes status, race, gender, age, vitamin B12, blood lead levels, or alcohol abuse. CONCLUSIONS: In this cross-sectional study, we found a modest association between peripheral neuropathy and statin use. Prospective studies are required to determine the causal direction. (Published 2012. This article is a U.S. Government work and is in the public domain in the USA.) |
Patients' willingness to discuss trade-offs to lower their out-of-pocket drug costs
Tseng CW , Waitzfelder BE , Tierney EF , Gerzoff RB , Marrero DG , Piette JD , Karter AJ , Curb JD , Chung R , Mangione CM , Crosson JC , Dudley RA . Arch Intern Med 2010 170 (16) 1502-4 Efforts to reform the U.S. health care system have placed considerable attention on patients’ financial burden from out-of-pocket drug costs. Patients frequently have difficulty paying for medications and although they are encouraged to discuss ways to lower drug costs with physicians, such communication frequently fails to occur.1-4 Physicians may be reluctant to initiate these cost discussions because some cost-cutting strategies involve potential trade-offs such as increased dosing frequency, or risk of side effects, or lower treatment effectiveness.1 Knowing patients’ willingness to consider such less than optimal cost-lowering strategies could encourage physicians to discuss drug costs with their patients. |
A multidisciplinary investigation of a polycythemia vera cancer cluster of unknown origin
Seaman V , Dearwent SM , Gable D , Lewis B , Metcalf S , Orloff K , Tierney B , Zhu J , Logue J , Marchetto D , Ostroff S , Hoffman R , Xu M , Carey D , Erlich P , Gerhard G , Roda P , Iannuzzo J , Lewis R , Mellow J , Mulvihill L , Myles Z , Wu M , Frank A , Gross-Davis CA , Klotz J , Lynch A , Weissfeld J , Weinberg R , Cole H . Int J Environ Res Public Health 2010 7 (3) 1139-1153 Cancer cluster investigations rarely receive significant public health resource allocations due to numerous inherent challenges and the limited success of past efforts. In 2008, a cluster of polycythemia vera, a rare blood cancer with unknown etiology, was identified in northeast Pennsylvania. A multidisciplinary group of federal and state agencies, academic institutions, and local healthcare providers subsequently developed a multifaceted research portfolio designed to better understand the cause of the cluster. This research agenda represents a unique and important opportunity to demonstrate that cancer cluster investigations can produce desirable public health and scientific outcomes when necessary resources are available. copyright 2010 by the authors. |
Physicians' participatory decision-making and quality of diabetes care processes and outcomes: results from the triad study
Heisler M , Tierney E , Ackermann RT , Tseng C , Narayan KM , Crosson J , Waitzfelder B , Safford MM , Duru K , Herman WH , Kim C . Chronic Illn 2009 5 (3) 165-76 OBJECTIVES: In participatory decision-making (PDM), physicians actively engage patients in treatment and other care decisions. Patients who report that their physicians engage in PDM have better disease self-management and health outcomes. We examined whether physicians' diabetes-specific treatment PDM preferences as well as their self-reported practices are associated with the quality of diabetes care their patients receive. METHODS: 2003 cross-sectional survey and medical record review of a random sample of diabetes patients (n=4198) in 10 US health plans across the country and their physicians (n=1217). We characterized physicians' diabetes care PDM preferences and practices as 'no patient involvement,' 'physician-dominant,' 'shared,' or 'patient-dominant' and conducted multivariate analyses examining their effects on the following: (1) three diabetes care processes (annual hemoglobin A1c test; lipid test; and dilated retinal exam); (2) patients'satisfaction with physician communication; and (3) whether patients' A1c, systolic blood pressure (SBP), and low-density lipoprotein cholesterol (LDL) were in control. RESULTS: Most physicians preferred 'shared' PDM (58%) rather than 'no patient involvement' (9%), 'physician-dominant' (28%) or 'patient dominant' PDM (5%). However, most reported practicing 'physician-dominant' PDM (43%) with most of their patients, rather than 'no patient involvement' (13%), 'shared' (37%) or 'patient-dominant' PDM (7%). After adjusting for patient and physician-level characteristics and clustering by health plan, patients of physicians who preferred 'shared' PDM were more likely to receive A1c tests [90% vs. 82%, AOR: 2.05, 95% CI: 1.03-3.07] and patients of physicians who preferred 'patient-dominant' treatment decision-making were more likely to receive lipid tests [60% vs. 50%, AOR: 1.58, 95% CI: 1.04-2.39] than those of providers who preferred 'no patient involvement' in treatment decision-making. There were no differences in patients' satisfaction with their doctor's communication or control of A1c, SBP or LDL depending on their physicians' PDM preferences. Physicians' self-reported PDM practices were not associated with any of the examined aspects of diabetes care in multivariate analyses. CONCLUSIONS: Patients whose physicians prefer more patient involvement in decision-making are more likely than patients whose physicians prefer more physician-directed styles to receive some recommended risk factor screening tests, an important first step toward improved diabetes outcomes. Involving patients in treatment decision-making alone, however, appears not to be sufficient to improve biomedical outcomes. |
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