Social Work Commons^™

Two Clinical Prediction Tools To Improve Tuberculosis Contact Investigation, Ruoran Li, Francesco Nordio, Chuan-Chin Huang, Carmen Contreras, Roger Calderon, Rosa Yataco, Jerome Galea, Zibiao Zhang, Mercedes C. Becerra, Leonid Lecca, Megan B. Murray

Social Work Faculty Publications

Background: Efficient contact investigation strategies are needed for the early diagnosis of TB disease and treatment of latent TB infections.

Methods: Between September 2009 and August 2012, we conducted a prospective cohort study in Lima, Peru in which we enrolled and followed 14,044 household contacts of adult pulmonary TB patients. We used information from a subset of this cohort to derive two clinical prediction tools that identify contacts of TB patients at elevated risk of progressing to active disease by training multivariable models that predict (1) co-prevalent TB among all household contacts and (2) one-year incident TB among adult contacts. …

Tuberculosis Clinical Presentation And Treatment Outcomes In Pregnancy: A Prospective Cohort Study, Brittney J. Van De Water, Meredith B. Brooks, Chuan-Chin Huang, Letizia Trevisi, Leonid Lecca, Carmen Contreras, Jerome Galea, Roger Calderon, Rosa Yataco, Megan Murray, Mercedes C. Becerra

Social Work Faculty Publications

Background: There is limited research to guide TB treatment specifically in pregnant women and few studies have described the presentation of TB in pregnant women. We aimed to understand TB presentation and treatment outcomes in pregnant women in a low HIV burden setting. We describe a cohort of women of childbearing age treated for TB disease in Lima, Peru, and compare clinical presentation and treatment outcomes among pregnant and non-pregnant women between 2009 and 2012, including 36 pregnant women.

Methods: This is a prospective cohort study. Subjects were recruited from across 106 public health centers in Lima, Peru. Baseline demographic, …

Uncovering Reasons For Treatment Initiation Delays Among Children With Tb In Lima, Peru, J. Coit, M. Wong, J. T. Galea, M. Mendoza, H. Marin, M. Tovar, S. S. Chiang, L. Lecca, M. F. Franke

Social Work Faculty Publications

Background: Timely diagnosis and treatment of pediatric tuberculosis (TB) is critical to reducing mortality but remains challenging in the absence of adequate diagnostic tools. Even once a TB diagnosis is made, delays in treatment initiation are common, but for reasons that are not well understood.

Methods: To examine reasons for delay post-diagnosis, we conducted semi-structured interviews with Ministry of Health (MoH) physicians and field workers affiliated with a pediatric TB diagnostic study, and caregivers of children aged 0–14 years who were diagnosed with pulmonary TB in Lima, Peru. Interviews were analyzed using systematic comparative and descriptive content analysis.

Results: We …

Impact Of Mental Disorders On Active Tb Treatment Outcomes: A Systematic Review And Meta-Analysis, G. Lee, J. Scuffell, J. T. Galea, S. S. Shin, E. Magill, E. Jaramillo, A. C. Sweetland

Social Work Faculty Publications

Background: Comorbid mental disorders in patients with TB may exacerbate TB treatment outcomes. We systematically reviewed current evidence on the association between mental disorders and TB outcomes.

Methods: We searched eight databases for studies published from 1990 to 2018 that compared TB treatment outcomes among patients with and without mental disorders. We excluded studies that did not systematically assess mental disorders and studies limited to substance use. We extracted study and patient characteristics and effect measures and performed a meta-analysis using random-effects models to calculate summary odds ratios (ORs) with 95% confidence intervals (CIs).

Results: Of 7687 studies identified, 10 …

Mycobacterium Tuberculosis Beijing Lineage And Risk For Tuberculosis In Child Household Contacts, Peru, Chuan-Chin Huang, Alexander L. Chu, Mercedes C. Becerra, Jerome T. Galea, Roger Calderón, Carmen Contreras, Rosa Yataco, Zibiao Zhang, Leonid Lecca, Megan B. Murray

Social Work Faculty Publications

Few studies have prospectively compared the relative transmissibility and propensity to cause disease of Mycobacterium tuberculosis Beijing strains with other human-adapted strains of the M. tuberculosis complex. We assessed the effect of Beijing strains on the risk for M. tuberculosis infection and disease progression in 9,151 household contacts of 2,223 culture-positive pulmonary tuberculosis (TB) patients in Lima, Peru. Child contacts exposed to Beijing strains were more likely than child contacts exposed to non-Beijing strains to be infected at baseline, by 12 months of follow-up, and during follow-up. We noted an increased but nonsignificant tendency for child contacts to develop TB. …

A Positively Selected Fbn1 Missense Variant Reduces Height In Peruvian Individuals, Samira Asgari, Yang Luo, Ali Akbari, Gillian M. Belbin, Xinyi Li, Daniel N. Harris, Martin Selig, Eric Bartell, Roger Calderon, Kamil Slowikowski, Carmen Contreras, Rosa Yataco, Jerome T. Galea, Judith Jimenez, Julia M. Coit, Chandel Farroñay, Rosalynn M. Nazarian, Timothy D. O’Connor, Harry C. Dietz, Joel N. Hirschhorn, Heinner Guio, Leonid Lecca, Eimear E. Kenny, Esther E. Freeman, Megan B. Murray, Soumya Raychaudhuri

Social Work Faculty Publications

On average, Peruvian individuals are among the shortest in the world1. Here we show that Native American ancestry is associated with reduced height in an ethnically diverse group of Peruvian individuals, and identify a population-specific, missense variant in the FBN1 gene (E1297G) that is significantly associated with lower height. Each copy of the minor allele (frequency of 4.7%) reduces height by 2.2 cm (4.4 cm in homozygous individuals). To our knowledge, this is the largest effect size known for a common height-associated variant. FBN1 encodes the extracellular matrix protein fibrillin 1, which is a major structural component of microfibrils. We …

Parent-Led, Stepped-Care Cognitive-Behavioral Therapy For Youth With Autism And Co-Occurring Anxiety: Study Rationale And Method, Ana C. Ramirez, Stacey C. Grebe, Morgan M. Mcneel, Danica L. Limon, Sophie C. Schneider, Leandra N. Berry, Robin P. Goin-Kochel, Sandra L. Cepeda, Robert G. Voigt, Alison Salloum, Eric A. Storch

Social Work Faculty Publications

Anxiety disorders affect up to 50% of individuals with autism spectrum disorder (ASD) and are significantly impairing to the person affected, as well as to their loved ones. Cognitive-behavioral therapy (CBT) has been established as the gold-standard treatment for anxiety disorders among typically developing youth and adults, and demonstrates similar efficacy among youth with high-functioning autism (HFA). Many CBT interventions utilize a “full-package” treatment approach to treat co-occurring anxiety in youth with ASD. However, these service delivery systems are often therapist-intensive, costly, and impractical, thereby compromising full engagement and treatment adherence. This paper describes the design, rationale, and methodology of …

A Qualitative Exploration Of Racial And Ethnic Differences In Cost Of Care Conversations Among Older Adults, Kyaien Oquinn Conner, Jaqueline Wiltshire, Edlin Colato Garcia, Barbara Langland-Orban, Erica Anderson, Iraida Carrion, Amber Goodman, Ashley Goodman

Social Work Faculty Publications

Background: The rapidly growing racially diverse, aging population in the United States is presenting unique challenges for our social, economic, and healthcare systems. Rising health care costs, increased patient cost-sharing, and limited financial resources make this generation of older Americans susceptible to large medical bills or debt which disproportionally impacts older racial/ethnic minorities. Cost-of-care (CoC) conversations between patients and doctors is one recommended approach to containing health care costs and alleviating patients’ financial burden of care.

Methods: The current study used focus group methodology to qualitatively explore the contextual factors that influence CoC conversations in a diverse sample of older …