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1.
JMIR Public Health Surveill ; 10: e48738, 2024 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-38502183

RESUMO

BACKGROUND: Population size, prevalence, and incidence are essential metrics that influence public health programming and policy. However, stakeholders are frequently tasked with setting performance targets, reporting global indicators, and designing policies based on multiple (often incongruous) estimates of these variables, and they often do so in the absence of a formal, transparent framework for reaching a consensus estimate. OBJECTIVE: This study aims to describe a model to synthesize multiple study estimates while incorporating stakeholder knowledge, introduce an R Shiny app to implement the model, and demonstrate the model and app using real data. METHODS: In this study, we developed a Bayesian hierarchical model to synthesize multiple study estimates that allow the user to incorporate the quality of each estimate as a confidence score. The model was implemented as a user-friendly R Shiny app aimed at practitioners of population size estimation. The underlying Bayesian model was programmed in Stan for efficient sampling and computation. RESULTS: The app was demonstrated using biobehavioral survey-based population size estimates (and accompanying confidence scores) of female sex workers and men who have sex with men from 3 survey locations in a country in sub-Saharan Africa. The consensus results incorporating confidence scores are compared with the case where they are absent, and the results with confidence scores are shown to perform better according to an app-supplied metric for unaccounted-for variation. CONCLUSIONS: The utility of the triangulator model, including the incorporation of confidence scores, as a user-friendly app is demonstrated using a use case example. Our results offer empirical evidence of the model's effectiveness in producing an accurate consensus estimate and emphasize the significant impact that the accessible model and app offer for public health. It offers a solution to the long-standing problem of synthesizing multiple estimates, potentially leading to more informed and evidence-based decision-making processes. The Triangulator has broad utility and flexibility to be adapted and used in various other contexts and regions to address similar challenges.


Assuntos
Profissionais do Sexo , Minorias Sexuais e de Gênero , Masculino , Humanos , Feminino , Prevalência , Teorema de Bayes , Consenso , Homossexualidade Masculina , Densidade Demográfica
2.
Metron ; 81(1): 21-35, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37284420

RESUMO

Networked populations consist of inhomogeneous individuals connected via relational ties. The individuals typically vary in multivariate attributes. In some cases primary interest focuses on individual attributes and in others the understanding of the social structure of the ties. In many circumstances both are of interest, as is their relationship. In this paper we consider this last, most general, case. We model the joint distribution of social ties and individual attributes when the population is only partially observed. Of central interest is when the population is surveyed using a network sampling design. A second situation is when data about a subset of the ties and/or the individual attributes is unintentionally missing. Exponential-family random network models (ERNM)s are capable of specifying a joint statistical representation of both the ties of a network and individual attributes. This class of models allow the nodal attributes to be modeled as stochastic processes, expanding the range and realism of exponential-family approaches to network modeling. In this paper we develop a theory of inference for ERNMs when only part of the network is observed, as well as specific methodology for partially observed networks, including non-ignorable mechanisms for network-based sampling designs. In particular, we consider data collected via contact tracing, of considerable importance to infectious disease epidemiology and public health.

3.
Lancet HIV ; 10(6): e375-e384, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-37119825

RESUMO

BACKGROUND: Despite high HIV prevalence in transgender women in sub-Saharan Africa, to our knowledge no study presents data across the HIV care continuum for this population in the region. The aim of this study was to estimate HIV prevalence and present data to develop the HIV care continuum indicators for transgender women in three South African metropolitan municipalities. METHODS: Biobehavioural survey data were collected among sexually active transgender women in the metropolitan municipalities of Johannesburg, Buffalo City, and Cape Town, South Africa. Transgender women (aged ≥18 years, self-reporting consensual sex with a man in the 6 months before the survey) were recruited using respondent-driven sampling (RDS). An interviewer-administered questionnaire was used to determine awareness of HIV status; blood specimens were collected on dried blood spots to test for HIV antibodies, antiretroviral treatment (ART) exposure, and viral load suppression. Population-based estimates of HIV 95-95-95 cascade indicators were derived by use of individualised RDS weights with RDS Analyst software. Multivariate stepwise backward logistic regression modelling was used to determine factors associated with each cascade indicator. All eligible participants were included in the final analysis. FINDINGS: Between July 26, 2018, and March 15, 2019, we enrolled 887 sexually active transgender women: 323 in Johannesburg, 305 in Buffalo City, and 259 in Cape Town. HIV prevalence was highest in Johannesburg where 229 (74·1%) of 309 tests were positive (weighted prevalence estimate 63·3%, 95% CI 55·5-70·5), followed by Buffalo City where 121 (43·7%) of 277 were positive (46·1%, 38·7-53·6), and then Cape Town where 122 (48·4%) of 252 were positive (45·6%, 36·7-54·7). In Johannesburg, an estimated 54·2% (95% CI 45·8-62·4) of transgender women with HIV knew their positive status, in Cape Town this was 24·2% (15·4-35·8), and in Buffalo City this was 39·5% (27·1-53·4). Among those who knew their status, 82·1% (73·3-88·5) in Johannesburg, 78·2% (57·9-90·3) in Cape Town, and 64·7% (45·2-80·2) in Buffalo City were on ART. Of those on ART, 34·4% (27·2-42·4) in Johannesburg, 41·2% (30·7-52·6) in Cape Town, and 55·0% (40·7-68·4) in Buffalo City were virally suppressed. INTERPRETATION: Innovative strategies are needed to inform efforts to diagnose and to treat transgender women living with HIV promptly to achieve viral load suppression. Differentiated HIV services tailored to transgender women of race groups other than Black South African, and those with low education attainment and low outreach exposure, innovative testing, and adherence strategies should be developed to improve the HIV cascade for South African transgender women. FUNDING: The US President's Emergency Plan For AIDS Relief and US Centers for Disease Control and Prevention.


Assuntos
Infecções por HIV , HIV-1 , Pessoas Transgênero , Humanos , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , África do Sul/epidemiologia , Cidades/epidemiologia , Inquéritos e Questionários , Antirretrovirais/uso terapêutico , Continuidade da Assistência ao Paciente
4.
Epidemiology ; 34(3): 353-364, 2023 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-36863062

RESUMO

BACKGROUND: Estimating HIV-1 incidence using biomarker assays in cross-sectional surveys is important for understanding the HIV pandemic. However, the utility of these estimates has been limited by uncertainty about what input parameters to use for false recency rate (FRR) and mean duration of recent infection (MDRI) after applying a recent infection testing algorithm (RITA). METHODS: This article shows how testing and diagnosis reduce both FRR and mean duration of recent infection compared to a treatment-naive population. A new method is proposed for calculating appropriate context-specific estimates of FRR and mean duration of recent infection. The result of this is a new formula for incidence that depends only on reference FRR and mean duration of recent infection parameters derived in an undiagnosed, treatment-naive, nonelite controller, non-AIDS-progressed population. RESULTS: Applying the methodology to eleven cross-sectional surveys in Africa results in good agreement with previous incidence estimates, except in 2 countries with very high reported testing rates. CONCLUSIONS: Incidence estimation equations can be adapted to account for the dynamics of treatment and recent infection testing algorithms. This provides a rigorous mathematical foundation for the application of HIV recency assays in cross-sectional surveys.


Assuntos
Biomarcadores , Infecções por HIV , Biomarcadores/análise , Infecções por HIV/diagnóstico , Infecções por HIV/metabolismo , Infecções por HIV/terapia , Incidência , Algoritmos , Estudos Transversais , Humanos , Masculino , Feminino
5.
J Acquir Immune Defic Syndr ; 92(3): 189-196, 2023 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-36730779

RESUMO

BACKGROUND: Estimating HIV incidence is essential to monitoring progress in sub-Saharan African nations toward global epidemic control. One method for incidence estimation is to test nationally representative samples using laboratory-based incidence assays. An alternative method based on reported HIV testing history and the proportion of undiagnosed infections has recently been described. METHODS: We applied an HIV incidence estimation method which uses history of testing to nationally representative cross-sectional survey data from 12 sub-Saharan African nations with varying country-specific HIV prevalence. We compared these estimates with those derived from laboratory-based incidence assays. Participants were tested for HIV using the national rapid test algorithm and asked about prior HIV testing, date and result of their most recent test, and date of antiretroviral therapy initiation. RESULTS: The testing history-based method consistently produced results that are comparable and strongly correlated with estimates produced using a laboratory-based HIV incidence assay (ρ = 0.85). The testing history-based method produced incidence estimates that were more precise compared with the biomarker-based method. The testing history-based method identified sex-, age-, and geographic location-specific differences in incidence that were not detected using the biomarker-based method. CONCLUSIONS: The testing history-based method estimates are more precise and can produce age-specific and sex-specific incidence estimates that are informative for programmatic decisions. The method also allows for comparisons of the HIV transmission rate and other components of HIV incidence among and within countries. The testing history-based method is a useful tool for estimating and validating HIV incidence from cross-sectional survey data.


Assuntos
Infecções por HIV , Soropositividade para HIV , HIV-1 , Masculino , Feminino , Humanos , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , HIV-1/genética , Incidência , Estudos Transversais , Biomarcadores
6.
Emerg Infect Dis ; 28(13): S69-S75, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36502429

RESUMO

We conducted 4,863 mobile phone and 1,715 face-to-face interviews of adults >18 years residing in Pakistan during June 2021-January 2022 that focused on opinions and practices related to COVID-19. Of those surveyed, 26.3% thought COVID-19 was inevitable, and 16.8% had tested for COVID-19. Survey participants who considered COVID-19 an inevitability shared such traits as urban residency, concerns about COVID-19, and belief that the virus is a serious medical threat. Survey respondents who had undergone COVID-19 testing shared similarities regarding employment status, education, mental health screening, and the consideration of COVID-19 as an inevitable disease. From this survey, we modeled suspected and confirmed COVID-19 cases and found nearly 3 times as many suspected and confirmed COVID-19 cases than had been reported. Our research also suggested undertesting for COVID-19 even in the presence of COVID-19 symptoms. Further research might help uncover the reasons behind undertesting and underreporting of COVID-19 in Pakistan.


Assuntos
COVID-19 , Telefone Celular , Adulto , Humanos , Teste para COVID-19 , COVID-19/diagnóstico , COVID-19/epidemiologia , Paquistão/epidemiologia , Fenótipo
7.
Proc Natl Acad Sci U S A ; 119(21): e2116169119, 2022 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-35576463

RESUMO

SignificanceSeveral negative effects of forced displacement have been well documented, yet we lack reliable measurement of eviction risk in the national perspective. This prevents accurate estimations of the scope and geography of the problem as well as evaluations of policies to reduce housing loss. We construct a nationwide database of eviction filings in the United States. Doing so reveals that 2.7 million households, on average, are threatened with eviction each year; that the highest eviction filing rates are not concentrated solely in high-cost urban areas; and that state-level housing policies are strongly associated with county-level eviction filing risk. These data facilitate an expanded research agenda on the causes and consequences of eviction lawsuits in the United States.

8.
JMIR Public Health Surveill ; 8(4): e32645, 2022 04 26.
Artigo em Inglês | MEDLINE | ID: mdl-35471234

RESUMO

BACKGROUND: Population size estimates (PSE) provide critical information in determining resource allocation for HIV services geared toward those at high risk of HIV, including female sex workers, men who have sex with men, and people who inject drugs. Capture-recapture (CRC) is often used to estimate the size of these often-hidden populations. Compared with the commonly used 2-source CRC, CRC relying on 3 (or more) samples (3S-CRC) can provide more robust PSE but involve far more complex statistical analysis. OBJECTIVE: This study aims to design and describe the Shiny application (shinyrecap), a user-friendly interface that can be used by field epidemiologists to produce PSE. METHODS: shinyrecap is built on the Shiny web application framework for R. This allows it to seamlessly integrate with the sophisticated CRC statistical packages (eg, Rcapture, dga, LCMCR). Additionally, the application may be accessed online or run locally on the user's machine. RESULTS: The application enables users to engage in sample size calculation based on a simulation framework. It assists in the proper formatting of collected data by providing a tool to convert commonly used formats to that used by the analysis software. A wide variety of methodologies are supported by the analysis tool, including log-linear, Bayesian model averaging, and Bayesian latent class models. For each methodology, diagnostics and model checking interfaces are provided. CONCLUSIONS: Through a use case, we demonstrated the broad utility of this powerful tool with 3S-CRC data to produce PSE for female sex workers in a subnational unit of a country in sub-Saharan Africa.


Assuntos
Infecções por HIV , Profissionais do Sexo , Minorias Sexuais e de Gênero , Teorema de Bayes , Feminino , Infecções por HIV/epidemiologia , Homossexualidade Masculina , Humanos , Internet , Masculino , Densidade Demográfica
9.
J Surv Stat Methodol ; 10(2): 377-396, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35449603

RESUMO

Respondent-driven sampling (RDS) is a popular method of conducting surveys in hard to reach populations where strong assumptions are required in order to make valid statistical inferences. In this paper we investigate the assumption that network degrees are measured accurately by the RDS survey and find that there is likely significant measurement error present in typical studies. We prove that most RDS estimators remain consistent under an imperfect measurement model with little to no added bias, though the variance of the estimators does increase.

10.
J Int AIDS Soc ; 24 Suppl 5: e25788, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34546657

RESUMO

INTRODUCTION: HIV planning requires granular estimates for the number of people living with HIV (PLHIV), antiretroviral treatment (ART) coverage and unmet need, and new HIV infections by district, or equivalent subnational administrative level. We developed a Bayesian small-area estimation model, called Naomi, to estimate these quantities stratified by subnational administrative units, sex, and five-year age groups. METHODS: Small-area regressions for HIV prevalence, ART coverage and HIV incidence were jointly calibrated using subnational household survey data on all three indicators, routine antenatal service delivery data on HIV prevalence and ART coverage among pregnant women, and service delivery data on the number of PLHIV receiving ART. Incidence was modelled by district-level HIV prevalence and ART coverage. Model outputs of counts and rates for each indicator were aggregated to multiple geographic and demographic stratifications of interest. The model was estimated in an empirical Bayes framework, furnishing probabilistic uncertainty ranges for all output indicators. Example results were presented using data from Malawi during 2016-2018. RESULTS: Adult HIV prevalence in September 2018 ranged from 3.2% to 17.1% across Malawi's districts and was higher in southern districts and in metropolitan areas. ART coverage was more homogenous, ranging from 75% to 82%. The largest number of PLHIV was among ages 35 to 39 for both women and men, while the most untreated PLHIV were among ages 25 to 29 for women and 30 to 34 for men. Relative uncertainty was larger for the untreated PLHIV than the number on ART or total PLHIV. Among clients receiving ART at facilities in Lilongwe city, an estimated 71% (95% CI, 61% to 79%) resided in Lilongwe city, 20% (14% to 27%) in Lilongwe district outside the metropolis, and 9% (6% to 12%) in neighbouring Dowa district. Thirty-eight percent (26% to 50%) of Lilongwe rural residents and 39% (27% to 50%) of Dowa residents received treatment at facilities in Lilongwe city. CONCLUSIONS: The Naomi model synthesizes multiple subnational data sources to furnish estimates of key indicators for HIV programme planning, resource allocation, and target setting. Further model development to meet evolving HIV policy priorities and programme need should be accompanied by continued strengthening and understanding of routine health system data.


Assuntos
Epidemias , Infecções por HIV , Adulto , Antirretrovirais/uso terapêutico , Teorema de Bayes , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Malaui/epidemiologia , Masculino , Gravidez , Prevalência
11.
BMC Urol ; 21(1): 23, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33579261

RESUMO

BACKGROUND: Voluntary medical male circumcision (VMMC) is an HIV prevention strategy recommended to partially protect men from heterosexually acquired HIV. From 2015 to 2019, the President's Emergency Plan for AIDS Relief (PEPFAR) has supported approximately 14.9 million VMMCs in 15 African countries. Urethrocutaneous fistulas, abnormal openings between the urethra and penile skin through which urine can escape, are rare, severe adverse events (AEs) that can occur with VMMC. This analysis describes fistula cases, identifies possible risks and mechanisms of injury, and offers mitigation actions. METHODS: Demographic and clinical program data were reviewed from all reported fistula cases during 2015 to 2019, descriptive analyses were performed, and an odds ratio was calculated by patient age group. RESULTS: In total, 41 fistula cases were reported. Median patient age for fistula cases was 11 years and 40/41 (98%) occurred in patients aged < 15 years. Fistulas were more often reported among patients < 15 compared to ≥ 15 years old (0.61 vs. 0.01 fistulas per 100,000 VMMCs, odds ratio 50.9 (95% confidence interval [CI] = 8.6-2060.0)). Median time from VMMC surgery to appearance of fistula was 20 days (interquartile range (IQR) 14-27). CONCLUSIONS: Urethral fistulas were significantly more common in patients under age 15 years. Thinner tissue overlying the urethra in immature genitalia may predispose boys to injury. The delay between procedure and symptom onset of 2-3 weeks indicates partial thickness injury or suture violation of the urethral wall as more likely mechanisms of injury than intra-operative urethral transection. This analysis helped to inform PEPFAR's recent decision to change VMMC eligibility policy in 2020, raising the minimum age to 15 years.


Assuntos
Circuncisão Masculina/efeitos adversos , Fístula Cutânea/etiologia , Complicações Pós-Operatórias/etiologia , Doenças Uretrais/etiologia , Fístula Urinária/etiologia , Adolescente , África , Criança , Fístula Cutânea/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Tempo , Doenças Uretrais/epidemiologia , Fístula Urinária/epidemiologia
12.
PLoS One ; 15(8): e0237221, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32785257

RESUMO

Estimating incidence from cross-sectional data sources is both important to the understanding of the HIV epidemic and challenging from a methodological standpoint. We develop a new incidence estimator that measures the size of the undiagnosed population and the amount of time spent undiagnosed in order to infer incidence and transmission rates. The estimator is calculated using commonly collected information on testing history and HIV status and, thus, can be deployed in many HIV surveys without additional cost. If ART biomarker status and/or viral load information is available, the estimator can be adjusted for biases in self-reported testing history. The performance of the estimator is explored in two large surveys in Kenya, where we find our point estimates to be consistent with assay-derived estimates, with much smaller standard errors.


Assuntos
Infecções por HIV/epidemiologia , Estudos Transversais , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/transmissão , Inquéritos Epidemiológicos , Humanos , Incidência , Quênia/epidemiologia , Masculino , Carga Viral
13.
Stat Med ; 38(1): 131-150, 2019 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-30259528

RESUMO

Respondent-Driven Sampling (RDS) is a popular method for surveying hard-to-reach populations, especially in the public health domain. Adjusting for the complex sampling mechanism of the RDS procedure is challenging. We propose a new model for the RDS mechanism motivated by a graph model, which we call the Homophily Configuration Graph. Under this model, we develop a new estimator for population proportions that is robust to seed bias, differential activity, differential recruitment and short recruitment chains. We also connect it to existing RDS theory by showing that, if the sample fraction is small, our estimator limits to the popular Salganik-Heckathorn estimator. We perform simulation studies on both empirically observed networks and networks with known statistical properties, suggesting that this new estimator has less bias than currently recommended estimators.


Assuntos
Viés , Modelos Estatísticos , Estudos de Amostragem , Humanos , Cadeias de Markov , Informática em Saúde Pública , Inquéritos e Questionários
15.
PLoS One ; 13(4): e0195959, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29698493

RESUMO

Size estimation is particularly important for populations whose members experience disproportionate health issues or pose elevated health risks to the ambient social structures in which they are embedded. Efforts to derive size estimates are often frustrated when the population is hidden or hard-to-reach in ways that preclude conventional survey strategies, as is the case when social stigma is associated with group membership or when group members are involved in illegal activities. This paper extends prior research on the problem of network population size estimation, building on established survey/sampling methodologies commonly used with hard-to-reach groups. Three novel one-step, network-based population size estimators are presented, for use in the context of uniform random sampling, respondent-driven sampling, and when networks exhibit significant clustering effects. We give provably sufficient conditions for the consistency of these estimators in large configuration networks. Simulation experiments across a wide range of synthetic network topologies validate the performance of the estimators, which also perform well on a real-world location-based social networking data set with significant clustering. Finally, the proposed schemes are extended to allow them to be used in settings where participant anonymity is required. Systematic experiments show favorable tradeoffs between anonymity guarantees and estimator performance. Taken together, we demonstrate that reasonable population size estimates are derived from anonymous respondent driven samples of 250-750 individuals, within ambient populations of 5,000-40,000. The method thus represents a novel and cost-effective means for health planners and those agencies concerned with health and disease surveillance to estimate the size of hidden populations. We discuss limitations and future work in the concluding section.


Assuntos
Modelos Teóricos , Análise por Conglomerados , Humanos , Cadeias de Markov , Densidade Demográfica
17.
PLoS One ; 10(7): e0129551, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26196132

RESUMO

We develop a new approach for estimating the undiagnosed fraction of HIV cases, the first step in the HIV Care Cascade. The goal is to address a critical blindspot in HIV prevention and treatment planning, with an approach that simplifies data requirements and can be implemented with open-source software. The primary data required is HIV testing history information on newly diagnosed cases. Two methods are presented and compared. The first is a general methodology based on simplified back-calculation that can be used to assess changes in the undiagnosed fraction over time. The second makes an assumption of constant incidence, allowing the estimate to be expressed as a simple closed formula calculation. We demonstrate the methods with an application to HIV diagnoses among men who have sex with men (MSM) from Seattle/King County. The estimates suggest that 6% of HIV-infected MSM in King County are undiagnosed, about one-third of the comparable national estimate. A sensitivity analysis on the key distributional assumption gives an upper bound of 11%. The undiagnosed fraction varies by race/ethnicity, with estimates of 4.9% among white, 8.6% of African American, and 9.3% of Hispanic HIV-infected MSM being undiagnosed.


Assuntos
Infecções por HIV/epidemiologia , Homossexualidade Masculina , Modelos Estatísticos , Negro ou Afro-Americano/estatística & dados numéricos , Infecções por HIV/etnologia , Hispânico ou Latino/estatística & dados numéricos , Homossexualidade Masculina/etnologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Programas de Rastreamento , Washington/epidemiologia , Washington/etnologia , População Branca/estatística & dados numéricos
18.
BMJ Case Rep ; 20142014 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-24414180

RESUMO

The introduction of proton pump inhibitors (PPIs) in the late 1980s optimised the medical treatment of acid-related disorders. They are potent medications and have a good safety profile. However, long-term therapy with PPIs may carry undesired side effects, one of which is hypomagnesaemia. This entity is likely to be under-reported. We present a clinical case which illustrates this important clinical problem. We present the case of a 73-year-old woman who was admitted to the hospital with supraventricular tachycardia due to hypomagnesaemia while using lansoprazole, followed by the literature review on this subject. In our patient after the intravenous magnesium replenishment, her arrhythmia resolved. After stopping her PPI her serum magnesium remained within reference values without oral supplementation. We believe that more attention towards this underdiagnosed side effect is required. Serum magnesium concentration should be checked in patients on PPIs if they are unwell or present with arrythmia.


Assuntos
Lansoprazol/efeitos adversos , Deficiência de Magnésio/induzido quimicamente , Magnésio/uso terapêutico , Inibidores da Bomba de Prótons/efeitos adversos , Idoso , Feminino , Humanos , Hipocalcemia/induzido quimicamente , Deficiência de Magnésio/complicações , Taquicardia Supraventricular/etiologia , Suspensão de Tratamento
19.
Indian J Psychiatry ; 55(2): 144-8, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23825848

RESUMO

OBJECTIVES: It remains unclear how augmenting anti-psychotic medications with anti-depressants impacts primary positive and negative symptoms of schizophrenia. In this study, we used data collected from a randomized trial comparing citalopram to placebo for management of subsyndromal depression (SSD) in schizophrenia and schizoaffective disorder, to assess the effects of antidepressant augmentation on positive and negative symptoms. MATERIALS AND METHODS: Participants in this study conducted at the University of California, San Diego and the University of Cincinnati, were persons with schizophrenia or schizoaffective disorder aged 40 or older and who met study criteria for SSD. Patients were randomly assigned to flexible-dose treatment with citalopram or placebo augmentation of their current anti-psychotic medication. Analysis of covariance was used to compare changes in positive and negative syndrome scale (PANSS) scores between treatment groups. We also assessed mediating effects of improvement in depression and moderating effects of multiple factors on positive and negative symptoms. RESULTS: There was significant improvement in PANSS negative symptoms scores in the citalopram group, which was partially mediated by improvement in depressive symptoms. There was no effect on PANSS positive scores. CONCLUSIONS: In patients with schizophrenia/schizoaffective disorder, treating depressive symptoms with citalopram appears to carry the added benefit of improving negative symptoms.

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