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Emerging Filoviral Disease in Uganda: Proposed Explanations and Research Directions
Get PDFOutbreaks of Ebola and Marburg virus diseases have recently increased in frequency in Uganda. This increase is probably caused by a combination of improved surveillance and laboratory capacity, increased contact between humans and the natural reservoir of the viruses, and fluctuations in viral load and prevalence in this reservoir. The roles of these proposed explanations must be investigated to guide appropriate responses to the changing epidemiological profile. Other African settings in which multiple filoviral outbreaks have occurred could also benefit from such information
CD4+ cell count at antiretroviral therapy initiation and economic restoration in rural Uganda
Get PDFTo determine whether earlier initiation of antiretroviral therapy (ART) is associated with better economic outcomes
Attacks on medical missions: overview of a polymorphous reality: the case of Médecins Sans Frontières
Get PDFThe aim of this article is to carry out a preliminary analysis of issues relating to the types of violence that are directed against humanitarian medical missions. Starting from the observation that violence can cause some degree of disruption for a medical organisation such as Médecins Sans Frontières, despite its wide experience which has brought it much wisdom and generated numerous and sporadic responses to such events, the article offers a more subtle analysis of terms and of situations of violence so as to contribute to the establishment of a research project and, in a second phase, to an awareness-raising campaign focusing on these complex phenomena
Assessing the quality of teleconsultations in a store-and-forward telemedicine network
Get PDFStore and forward telemedicine in resource-limited settings is becoming a relatively mature activity. However, there are few published reports about quality measurement in telemedicine, except in image-based specialties, and they mainly relate to high- and middle-income countries. In 2010, Medecins Sans Frontieres (MSF) began to use a store-and-forward telemedicine network to assist its field staff in obtaining specialist advice. To date, more than 1000 cases have been managed with the support of telemedicine, from a total of 40 different countries. We propose a method for assessing the overall quality of the teleconsultations provided in a store-and-forward telemedicine network. The assessment is performed at regular intervals by a panel of observers, who-independently-respond to a questionnaire relating to a randomly-chosen past case. The answers to the questionnaire allow two different dimensions of quality to be assessed: the quality of the process itself and the outcome, defined as the value of the response to three of the four parties concerned, i.e. the patient, the referring doctor and the organisation. It is not practicable to estimate the value to society by this technique. The feasibility of the method was demonstrated by using it in the MSF telemedicine network, where process-quality scores, and user-value scores, appeared to be stable over a nine-month trial period. This was confirmed by plotting the cusum of a portmanteau statistic (the sum of the four scores) over the study period. The proposed quality assessment method appears feasible in practice, and will form one element of a quality assurance programme for MSF's telemedicine network in future. The method is a generally applicable one, which can be used in many forms of medical interaction
Clinical features and management of a severe paradoxical reaction associated with combined treatment of Buruli ulcer and HIV co-infection
Get PDFIn West and Central Africa Buruli ulcer (BU) and HIV co-infection is increasingly recognised and management of these two diseases combined is an emerging challenge for which there is little published information. In this case we present a severe paradoxical reaction occurring after commencing antibiotic treatment for BU combined with antiretroviral therapy for HIV, and describe its clinical features and management. This includes to our knowledge the first reported use of prednisolone in Africa to manage a severe paradoxical reaction related to BU treatment
Vaccination in humanitarian crises: satisficing should no longer suffice
Get PDFThere are more possible vaccination interventions to mitigate the adverse health consequences of populations in crises than ever before, but recent reviews suggest delivering these vaccines has been fraught with difficulty. The decision to implement vaccination interventions in crises remains, more often than not, an exercise in satisficing. The sparse credible epidemiologic and effectiveness data in populations affected by crises contributes greatly to decision-making difficulty, as do the limits of vaccine presentations, formulations and storage. Political considerations and lack of decision-making guidance contribute further. Moving forward requires sound effectiveness studies to help ensure that decision-making is based to the degree possible on substance
An alternative classification to mixture modeling for longitudinal counts or binary measures
Get PDFClassifying patients according to longitudinal measures, or trajectory classification, has become frequent in clinical research. The k-means algorithm is increasingly used for this task in case of continuous variables with standard deviations that do not depend on the mean. One feature of count and binary data modeled by Poisson or logistic regression is that the variance depends on the mean; hence, the within-group variability changes from one group to another depending on the mean trajectory level. Mixture modeling could be used here for classification though its main purpose is to model the data. The results obtained may change according to the main objective. This article presents an extension of the k-means algorithm that takes into account the features of count and binary data by using the deviance as distance metric. This approach is justified by its analogy with the classification likelihood. Two applications are presented with binary and count data to show the differences between the classifications obtained with the usual Euclidean distance versus the deviance distance
