While tremendous progress has been made on attaining HIV treatment goals (95-95-95), children’s v... more While tremendous progress has been made on attaining HIV treatment goals (95-95-95), children’s viral load suppression remains a challenge particularly among the orphans and vulnerable groups. In Sub Saharan Africa, there is limited evidence of specific interventions in orphans and vulnerable children (OVC) programs to support children and adolescents living with HIV (CALHIV) to attain durable viral load suppression. Through a large OVC cohort, the study sought to identify correlates of optimal viral load suppression among CALHIV in the Kenya OVC program. This cross-sectional study utilized data on CALHIV below the age of 18 years who were enrolled in the OVC program and actively receiving HIV care and treatment services from ART clinics across Kenya and with documented VL results between October 2019 and September 2020. To obtain a nationally representative sample, data was retrieved from USAID implementing partners’ databases across the country. Association between selected variables and VL suppression (outcome of interest) were assessed using a multivariate mixed effect logistic regression model, using glmer function in the LME4 package in R. Factors associated with VL suppression included child’s education status (aOR = 1.33; 95% CI: 1.07, 1.65), membership of a psychosocial support group (aOR = 1.258; 95% CI: 1.15, 1.38), and membership of a voluntary savings and lending association (VSLA) (aOR = 1.226; 95% CI: 1.129, 1.33). In addition, child’s sex (aOR = 0.88; 95% CI: 0.83, 0.94), caregiver sex (aOR = 0.909; 95% CI: 0.839, 0.997) and “high” status for caregiver household vulnerability (aOR = 0.81; 95% CI: 0.71, 0.924), had an inverse relationship with VL suppression. CALHIV characteristics including child’s sex, child’s education status (whether currently active in school or inactive) and child’s membership in a psychosocial support group were key determinants of VL suppression. Similarly, caregiver sex and membership in a voluntary savings and lending association also influence VL suppression.
To cite: Maina BW, Juma K, Igonya EK, et al. Effectiveness of school-based interventions in delay... more To cite: Maina BW, Juma K, Igonya EK, et al. Effectiveness of school-based interventions in delaying sexual debut among adolescents in sub-Saharan Africa: a protocol for a systematic review and meta-analysis. BMJ Open 2021;11:e044398.
Abstract 2055 Background: Erythropoiesis stimulating agents (ESAs) are commonly used to treat che... more Abstract 2055 Background: Erythropoiesis stimulating agents (ESAs) are commonly used to treat chemotherapy-induced anemia (CIA) in cancer patients. However, numerous clinical trials indicate that about half of the patients fail to show an increase in hemoglobin (Hb) levels or a reduction in red blood cell (RBC) transfusions following treatment. This may be attributed to functional iron deficiency (FID) experienced by these patients. Iron is often used to supplement ESAs to correct the FID. However, no systematic review has been conducted that tackles the role of iron supplementation. This is the first systematic review and meta-analysis that addresses the efficacy and safety of iron supplementation to ESAs in the management of CIA. Methods: Literature search of PubMed, Cochrane databases and meetings abstracts from American Society of Clinical Oncology, American Society of Hematology and European Hematology Association was undertaken to identify phase III RCTs published until June 2010. No limits were used in the search. We extracted data on hematopoietic response rate, time to hematopoietic response, RBC transfusions, mean change in Hb level, quality of life (QOL), overall survival (OS), and grade III-IV treatment related harms. We conducted subgroup analyses based on type and route of administration of iron. Time to event data, dichotomous data, and ratio level data were pooled as hazard ratios, risk ratios (RR), and mean difference (MD), respectively, under the random effects model. Results: Seven RCTs (5 full papers and 2 meeting abstracts) were included enrolling 1,777 patients. For the outcome of hematopoietic response, there was a beneficial effect of iron supplementation to ESAs compared with ESAs alone (RR= 0.65, 95% CI: 0.53 – 0.79). However, for this outcome, RCTs which used intravenous iron favored ESAs and iron (RR= 0.57, 95% CI: 0.44 – 0.74), whereas no differences were found in RCTs using oral iron (RR= 0.81, 95% CI: 0.64 – 1.03) (test of interaction: p= 0.02). No differences were found in the median time to hematopoietic response between patients receiving ESAs and iron versus those receiving ESAs alone. Significantly fewer patients treated with ESAs and iron required RBC transfusions compared to the number treated with ESAs alone (RR= 0.67, 95% CI: 0.52 – 0.86) (Table 1). There were no differences in RBC transfusions based on the route of iron administration. Although mean change in Hb level data was reported in 71% of studies (5/7), data were extractable for meta-analysis from only 43% of RCTs (3/7). The mean change in Hb level was significantly greater in patients receiving ESAs and iron (MD = 0.77, 95%CI: 0.27–1.28) compared with ESAs alone. QOL was reported in three studies, but due to variation in the scales used (FACT-F and LASA) we were unable to provide a pooled estimate. In trial by Bastit et al., no differences in the QOL were found between patients treated with ESA and iron versus those treated with ESAs alone. In the trial by Auerbach et al., patients receiving ESAs and iron had statistically significant better QOL than those receiving ESAs alone. None of the included RCTs reported OS estimates. No differences were found related to risk of grade III-IV thromboembolic events between patients receiving ESAs and iron versus patients receiving ESAs alone (RR= 1.09, 95% CI: 0.55 – 2.18, p= 0.807, 3 RCTs, 614 patients). Type of iron used (gluconate vs. dextran vs. sucrose vs. sulphate) had no impact on any outcome. Conclusion: Compared with ESA alone/placebo, iron supplementation to ESAs significantly increases hematopoietic response rates and reduces number of RBC transfusions in patients with CIA. Intravenous iron appears to be superior to oral iron in achieving hematopoietic response. Both treatments are well tolerated with no significant differences in adverse events. Note: RR=Risk Ratio; CI=Confidence Interval; NNT=Number Needed to Treat Disclosures: No relevant conflicts of interest to declare.
Background: Lung cancer is considered a terminal illness with a five-year survival rate of about ... more Background: Lung cancer is considered a terminal illness with a five-year survival rate of about 16%. Informed decision-making related to the management of a disease requires accurate prognosis of the disease with or without treatment. Despite the significance of disease prognosis in clinical decision-making, systematic assessment of prognosis in patients with lung cancer without treatment has not been performed. We conducted a systematic review and meta-analysis of the natural history of patients with confirmed diagnosis of lung cancer without active treatment, to provide evidence-based recommendations for practitioners on management decisions related to the disease. Specifically, we estimated overall survival when no anticancer therapy is provided. Methods: Relevant studies were identified by search of electronic databases and abstract proceedings, review of bibliographies of included articles, and contacting experts in the field. All prospective or retrospective studies assessing prognosis of lung cancer patients without treatment were eligible for inclusion. Data on mortality was extracted from all included studies. Pooled proportion of mortality was calculated as a back-transform of the weighted mean of the transformed proportions using the random-effects model. To perform meta-analysis of median survival, published methods were used to pool the estimates as mean and standard error under the random-effects model. Methodological quality of the studies was examined. Results: Seven cohort studies (4,418 patients) and 15 randomized controlled trials (1,031 patients) were included in the meta-analysis. All studies assessed mortality without treatment in patients with non-small cell lung cancer (NSCLC). The pooled proportion of mortality without treatment in cohort studies was 0.97 (95% CI: 0.96 to 0.99) and 0.96 in randomized controlled trials (95% CI: 0.94 to 0.98) over median study periods of eight and three years, respectively. When data from cohort and randomized controlled trials were combined, the pooled proportion of mortality was 0.97 (95% CI: 0.96 to 0.98). Test of interaction showed a statistically non-significant difference between subgroups of cohort and randomized controlled trials. The pooled mean survival for patients without anticancer treatment in cohort studies was 11.94 months (95% CI: 10.07 to 13.8) and 5.03 months (95% CI: 4.17 to 5.89) in RCTs. For the combined data (cohort studies and RCTs), the pooled mean survival was 7.15 months (95% CI: 5.87 to 8.42), with a statistically significant difference between the two designs. Overall, the studies were of moderate methodological quality.
Background A North–South (N–S) research collaboration is one way through which research capacity ... more Background A North–South (N–S) research collaboration is one way through which research capacity of developing countries can be strengthened. Whereas N–S collaboration in HIV/AIDS area may result in research capacity strengthening of Southern partners, it is not clear what factors are associated with this type of collaboration. The study aims to characterize N–S research collaboration focusing on HIV/AIDS and to determine factors associated with such N–S research collaborations. Methods Clinical trial data on HIV/AIDS-related studies conducted between 2000 and 2019 were obtained from ClinicalTrials.gov. Using these data, we characterized N–S collaborative studies focusing on HIV/AIDS and summarized them using frequencies and percentages. To determine factors associated with these studies, we used logistic regression and reported results as adjusted odds ratios with Wald 95% confidence intervals. Results and discussion Of the 4,832 HIV/AIDS-related studies retrieved from the registry...
ObjectivesThis review aimed at identifying the elements of integrated care models for cardiometab... more ObjectivesThis review aimed at identifying the elements of integrated care models for cardiometabolic multimorbidity in sub-Saharan Africa (SSA) and their effects on clinical or mental health outcomes including systolic blood pressure (SBP), blood sugar, depression scores and other patient-reported outcomes such as quality of life and medication adherence.DesignSystematic review and meta-analysis using the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach.Data sourcesWe systematically searched PubMed, Embase, Scopus, Web of Science, Global Health CINAHL, African Journals Online, Informit, PsycINFO, ClinicalTrials.gov, Pan African Clinical Trials Registry and grey literature from OpenSIGLE for studies published between 1999 and 2022.Eligibility criteria for selecting studiesWe included randomised controlled trial studies featuring integrated care models with two or more elements of Wagner’s chronic care model.Data extraction and synthesisTwo independe...
Viral load (VL) near delivery is a determinant of mother-to-child transmission (MTCT) of HIV. To ... more Viral load (VL) near delivery is a determinant of mother-to-child transmission (MTCT) of HIV. To evaluate factors associated with an undetectable VL near delivery in HIV-infected pregnant women receiving highly active antiretroviral therapy (HAART) and non-HAART regimens, HIV-infected pregnant women with a detectable VL at entry and having used antiretrovirals for ≥4 weeks before delivery were selected. Multivariate analysis was employed using binary logistic unconditional models; the dependent variable was having a VL <400 copies/mL near delivery. VL suppression was achieved in 403/707 women (57%): 65.4% in the HAART group, but only 26% in the non-HAART group P = 0.001. Duration of HAART was correlated with VL suppression, with maximum benefit seen after ≥12 weeks of therapy (odds ratio [OR]: 2.51; 95% confidence interval [CI]: 1.72–3.65). CD4+ cell count near delivery (OR: 1.53; 95% CI: 1.06–2.20) and baseline VL (OR: 0.74; 95% CI: 0.58–0.94) were also independently associated ...
Background Women and under-represented minority (URM) students continue to be under-represented i... more Background Women and under-represented minority (URM) students continue to be under-represented in STEM and earn the lowest proportion of undergraduate engineering degrees. We employed a mixed methods research approach grounded in social capital theory to investigate when they first consider pursuing engineering as a college degree major, who influences this decision, and how the influence occurs. First, we surveyed 2186 first-year undergraduate students entering engineering programs at 11 universities in the U.S. during the fall of 2014. Next, we interviewed a subsample of 55 women and URM students. Results Survey findings indicated that women were more likely than men to consider pursuing engineering while in high school, before admission into college, or while in college rather than considering it earlier in their education. Black and Latinx students were more likely than white students to consider pursuing engineering after high school. In addition, Black and Latinx students wer...
IntroductionIn Africa, the prevalence of mental health problems is higher among university studen... more IntroductionIn Africa, the prevalence of mental health problems is higher among university students than in the general population. A number of systematic reviews and recent prevalence studies have focused on prevalence of mental health issues among college. This mixed-methods systematic review, including meta-analysis and meta-synthesis, will explore: what mental health services are available to university students; the extent to which students access available services and factors associated with service access; and the degree to which students activate (use) accessible services and factors associated with service activation.Methods and analysisWe will conduct electronic literature search of the following databases: PubMed, Cochrane Library, Semantic Scholar, ERIC, Trip Database, Medline and PsycINFO. Disagreement, if any, will be resolved by a third reviewer. Two reviewers will independently assess the methodological quality of included studies using relevant tools. For cross-sec...
Studies in graduate and postdoctoral education, Apr 19, 2022
Purpose-This study aims to understand master's students' experiences of service-learning, followi... more Purpose-This study aims to understand master's students' experiences of service-learning, following their participation in a workshop with local social innovators whose activities had contributed to combating poverty in East Africa and to determine how this participation affected work on the students' theses. The authors also explored possible gender differences in this context. Design/methodology/approach-The study was based on pretest-posttest mixed methods research design. Data were collected from master's students within the social sciences and science, technology, engineering and mathematics (STEM) disciplines, respectively, in Kenya and Uganda, via surveys and interviews before the workshop, immediately afterwards and six months later.
Research writing confidence and organizational support toward research activities are two essenti... more Research writing confidence and organizational support toward research activities are two essential factors that may affect research productivity among higher educational institutions. This study investigated the possible relationships of these two factors to research productivity among faculty members of the College of Dentistry at Lyceum of the Philippines University-Batangas. The study used descriptive survey using percentage, weighted mean and Chi square to test the relationship of the selected variables. The findings indicate that Dentistry faculty members have low research productivity as evidenced by its research production, with only five of them having completed a research paper as main author and only one as co-author (but, not the main author) from SY 2008-2009 to 2012-2013. Respondents agreed that, in average, institutional support is higher than the departmental support for conducting research paper. Meanwhile, respondents are most confident with the technical part in research writing, but least confident in writing the methodology. Organizational support given by the university itself and the Department of College of Dentistry towards research activities and faculty members' confidence in writing the paper particularly the technical and major parts were not indicators associated with research productivity. However, they are confident with the other parts of the research process including writing the abstract and references as associated with developing research findings.
In comparison to work on women and historically excluded racial/ethnic minority students in scien... more In comparison to work on women and historically excluded racial/ethnic minority students in science, technology, engineering, and math (STEM), research on sexual and gender minority (SGM) students in STEM is somewhat incipient. There is little scholarship available on SGM-focused STEM organizations (e.g., oSTEM). Building on the previous literature, we examine how SGM-focused STEM organizations provide social capital, both expressive (e.g., emotional support) and instrumental (e.g., academic resources), that helps students feel they fit in STEM and ultimately persist. We report findings from a large online survey with 477 SGM STEM undergraduates, 463 of whom participate in STEM organizations, which offers one of if not the largest study on the topic to date. We compare three types of identity-focused organizations, SGM-focused, women-focused, and race/ethnicity-focused, finding that they each provide expressive capital to SGM students. The organizations helped students cultivate sup...
College students engage in strategic gender and sexuality expression, making attire and interacti... more College students engage in strategic gender and sexuality expression, making attire and interactional decisions that can seem mundane. However, STEM undergraduate academic cultures tend to be hetero-and cisnormative and can be unwelcoming of other gender identities and sexualities (e.g., faculty resistance to trans students&#39; pronouns). Our analysis of interviews with 29 LGBTQPIA+ STEM undergraduates suggests that while some students chose behaviors and clothing reflective of hetero/cis norms to avoid attention and/or conflict (e.g., not wearing Pride buttons, nail polish, dresses), others challenged these norms. We explore how STEM programs can be more inclusive of LGBTQPIA+ students&#39; gender and sexual identities and expressions.
Women and underrepresented minority (URM) undergraduates declare and complete science, technology... more Women and underrepresented minority (URM) undergraduates declare and complete science, technology, engineering, and mathematics majors at different rates in comparison to majority groups. Explanations of these differences have long been deficit oriented, focusing on aptitude or similar characteristics, but more recent work focuses on institutional contexts, such as academic climate and feelings of belonging (fit). This study examines the experiences of women and URM students in engineering undergraduate programs, focusing on how they fit, experiential factors affecting fit, and how fit is mitigated by social relationships from their networks and organizations in which they participate (i.e., social capital). Thematic analysis of 55 women and URM interviewee responses shows that students who fit well were those with majority characteristics, including race (i.e., White, White-passing) and gender (i.e., men, masculine appearance), and those in groups well represented in their programs numerically (i.e., men, Asian). In contrast, women and Black students encountered threats to their fit due to stereotyping from bias and differential treatment from others (i.e., being excluded from group work). However, students received advice from their social networks (i.e., family, professors) in which they were warned to expect discrimination, or through organizations in which they participated (i.e., National Association of Black Engineers) where their sense of community was expanded. The advice and resources provided through this network-based and participatory social capital mitigated fit for women and Black students, albeit in different ways, helping to preserve their feelings of belonging and promote their persistence in engineering. We offer suggestions to enact university policies to increase access to social capital with homophilious alters and educational opportunities for majority groups.
Undergraduates with sexual and/or gender minority (SGM) identities, including lesbian, gay, bisex... more Undergraduates with sexual and/or gender minority (SGM) identities, including lesbian, gay, bisexual, transgender, queer/questioning, pansexual, intersexual, asexual, or additional positionalities, often face an unwelcoming STEM microclimate. The STEM microclimate includes the places students experience, such as classrooms or labs, and the people, such as peers or professors, with whom they discuss their STEM program. While previous work offers a framework of microaggressions faced by SGM people, and the behavioral, cognitive, and emotional strategies they use to react to them, little is known about the strategies SGM students use to persist in the STEM microclimate. We analyze interviews with 29 SGM STEM undergraduates to uncover how they fit in STEM, their experiences that affect fit, how social capital in the form of influential others affects fit, and the strategies used to deal with microaggressions and cultivate a supportive network. Using thematic analysis, we find that stude...
In comparison to work on women and historically excluded racial/ethnic minority students in scien... more In comparison to work on women and historically excluded racial/ethnic minority students in science, technology, engineering, and math (STEM), research on sexual and gender minority (SGM) students in STEM is somewhat incipient. There is little scholarship available on SGM-focused STEM organizations (e.g., oSTEM). Building on the previous literature, we examine how SGM-focused STEM organizations provide social capital, both expressive (e.g., emotional support) and instrumental (e.g., academic resources), that helps students feel they fit in STEM and ultimately persist. We report findings from a large online survey with 477 SGM STEM undergraduates, 463 of whom participate in STEM organizations, which offers one of if not the largest study on the topic to date. We compare three types of identity-focused organizations, SGM-focused, women-focused, and race/ethnicity-focused, finding that they each provide expressive capital to SGM students. The organizations helped students cultivate supportive networks of peers like themselves who then help them feel they fit in STEM through similar but not identical mechanisms. For SGM-focused organizations, their assistance in helping students reconcile their SGM identities with their STEM identity was an important nuance tailored to SGM students' needs. However, students described how SGM-focused organizations provided instrumental capital far less, which we posit may take a back seat to SGM STEM students' expressive needs. Unfortunately, women-focused organizations were not always welcoming to SGM students, an issue not documented in race/ethnicity-focused societies. However, some identity-focused organizations established partnerships with other identity-focused organizations, highlighting the possible role of such collaboration in better serving SGM students, particularly those with minoritized ethnic/racial identities. Implications for research and practice are included.
While tremendous progress has been made on attaining HIV treatment goals (95-95-95), children’s v... more While tremendous progress has been made on attaining HIV treatment goals (95-95-95), children’s viral load suppression remains a challenge particularly among the orphans and vulnerable groups. In Sub Saharan Africa, there is limited evidence of specific interventions in orphans and vulnerable children (OVC) programs to support children and adolescents living with HIV (CALHIV) to attain durable viral load suppression. Through a large OVC cohort, the study sought to identify correlates of optimal viral load suppression among CALHIV in the Kenya OVC program. This cross-sectional study utilized data on CALHIV below the age of 18 years who were enrolled in the OVC program and actively receiving HIV care and treatment services from ART clinics across Kenya and with documented VL results between October 2019 and September 2020. To obtain a nationally representative sample, data was retrieved from USAID implementing partners’ databases across the country. Association between selected variables and VL suppression (outcome of interest) were assessed using a multivariate mixed effect logistic regression model, using glmer function in the LME4 package in R. Factors associated with VL suppression included child’s education status (aOR = 1.33; 95% CI: 1.07, 1.65), membership of a psychosocial support group (aOR = 1.258; 95% CI: 1.15, 1.38), and membership of a voluntary savings and lending association (VSLA) (aOR = 1.226; 95% CI: 1.129, 1.33). In addition, child’s sex (aOR = 0.88; 95% CI: 0.83, 0.94), caregiver sex (aOR = 0.909; 95% CI: 0.839, 0.997) and “high” status for caregiver household vulnerability (aOR = 0.81; 95% CI: 0.71, 0.924), had an inverse relationship with VL suppression. CALHIV characteristics including child’s sex, child’s education status (whether currently active in school or inactive) and child’s membership in a psychosocial support group were key determinants of VL suppression. Similarly, caregiver sex and membership in a voluntary savings and lending association also influence VL suppression.
To cite: Maina BW, Juma K, Igonya EK, et al. Effectiveness of school-based interventions in delay... more To cite: Maina BW, Juma K, Igonya EK, et al. Effectiveness of school-based interventions in delaying sexual debut among adolescents in sub-Saharan Africa: a protocol for a systematic review and meta-analysis. BMJ Open 2021;11:e044398.
Abstract 2055 Background: Erythropoiesis stimulating agents (ESAs) are commonly used to treat che... more Abstract 2055 Background: Erythropoiesis stimulating agents (ESAs) are commonly used to treat chemotherapy-induced anemia (CIA) in cancer patients. However, numerous clinical trials indicate that about half of the patients fail to show an increase in hemoglobin (Hb) levels or a reduction in red blood cell (RBC) transfusions following treatment. This may be attributed to functional iron deficiency (FID) experienced by these patients. Iron is often used to supplement ESAs to correct the FID. However, no systematic review has been conducted that tackles the role of iron supplementation. This is the first systematic review and meta-analysis that addresses the efficacy and safety of iron supplementation to ESAs in the management of CIA. Methods: Literature search of PubMed, Cochrane databases and meetings abstracts from American Society of Clinical Oncology, American Society of Hematology and European Hematology Association was undertaken to identify phase III RCTs published until June 2010. No limits were used in the search. We extracted data on hematopoietic response rate, time to hematopoietic response, RBC transfusions, mean change in Hb level, quality of life (QOL), overall survival (OS), and grade III-IV treatment related harms. We conducted subgroup analyses based on type and route of administration of iron. Time to event data, dichotomous data, and ratio level data were pooled as hazard ratios, risk ratios (RR), and mean difference (MD), respectively, under the random effects model. Results: Seven RCTs (5 full papers and 2 meeting abstracts) were included enrolling 1,777 patients. For the outcome of hematopoietic response, there was a beneficial effect of iron supplementation to ESAs compared with ESAs alone (RR= 0.65, 95% CI: 0.53 – 0.79). However, for this outcome, RCTs which used intravenous iron favored ESAs and iron (RR= 0.57, 95% CI: 0.44 – 0.74), whereas no differences were found in RCTs using oral iron (RR= 0.81, 95% CI: 0.64 – 1.03) (test of interaction: p= 0.02). No differences were found in the median time to hematopoietic response between patients receiving ESAs and iron versus those receiving ESAs alone. Significantly fewer patients treated with ESAs and iron required RBC transfusions compared to the number treated with ESAs alone (RR= 0.67, 95% CI: 0.52 – 0.86) (Table 1). There were no differences in RBC transfusions based on the route of iron administration. Although mean change in Hb level data was reported in 71% of studies (5/7), data were extractable for meta-analysis from only 43% of RCTs (3/7). The mean change in Hb level was significantly greater in patients receiving ESAs and iron (MD = 0.77, 95%CI: 0.27–1.28) compared with ESAs alone. QOL was reported in three studies, but due to variation in the scales used (FACT-F and LASA) we were unable to provide a pooled estimate. In trial by Bastit et al., no differences in the QOL were found between patients treated with ESA and iron versus those treated with ESAs alone. In the trial by Auerbach et al., patients receiving ESAs and iron had statistically significant better QOL than those receiving ESAs alone. None of the included RCTs reported OS estimates. No differences were found related to risk of grade III-IV thromboembolic events between patients receiving ESAs and iron versus patients receiving ESAs alone (RR= 1.09, 95% CI: 0.55 – 2.18, p= 0.807, 3 RCTs, 614 patients). Type of iron used (gluconate vs. dextran vs. sucrose vs. sulphate) had no impact on any outcome. Conclusion: Compared with ESA alone/placebo, iron supplementation to ESAs significantly increases hematopoietic response rates and reduces number of RBC transfusions in patients with CIA. Intravenous iron appears to be superior to oral iron in achieving hematopoietic response. Both treatments are well tolerated with no significant differences in adverse events. Note: RR=Risk Ratio; CI=Confidence Interval; NNT=Number Needed to Treat Disclosures: No relevant conflicts of interest to declare.
Background: Lung cancer is considered a terminal illness with a five-year survival rate of about ... more Background: Lung cancer is considered a terminal illness with a five-year survival rate of about 16%. Informed decision-making related to the management of a disease requires accurate prognosis of the disease with or without treatment. Despite the significance of disease prognosis in clinical decision-making, systematic assessment of prognosis in patients with lung cancer without treatment has not been performed. We conducted a systematic review and meta-analysis of the natural history of patients with confirmed diagnosis of lung cancer without active treatment, to provide evidence-based recommendations for practitioners on management decisions related to the disease. Specifically, we estimated overall survival when no anticancer therapy is provided. Methods: Relevant studies were identified by search of electronic databases and abstract proceedings, review of bibliographies of included articles, and contacting experts in the field. All prospective or retrospective studies assessing prognosis of lung cancer patients without treatment were eligible for inclusion. Data on mortality was extracted from all included studies. Pooled proportion of mortality was calculated as a back-transform of the weighted mean of the transformed proportions using the random-effects model. To perform meta-analysis of median survival, published methods were used to pool the estimates as mean and standard error under the random-effects model. Methodological quality of the studies was examined. Results: Seven cohort studies (4,418 patients) and 15 randomized controlled trials (1,031 patients) were included in the meta-analysis. All studies assessed mortality without treatment in patients with non-small cell lung cancer (NSCLC). The pooled proportion of mortality without treatment in cohort studies was 0.97 (95% CI: 0.96 to 0.99) and 0.96 in randomized controlled trials (95% CI: 0.94 to 0.98) over median study periods of eight and three years, respectively. When data from cohort and randomized controlled trials were combined, the pooled proportion of mortality was 0.97 (95% CI: 0.96 to 0.98). Test of interaction showed a statistically non-significant difference between subgroups of cohort and randomized controlled trials. The pooled mean survival for patients without anticancer treatment in cohort studies was 11.94 months (95% CI: 10.07 to 13.8) and 5.03 months (95% CI: 4.17 to 5.89) in RCTs. For the combined data (cohort studies and RCTs), the pooled mean survival was 7.15 months (95% CI: 5.87 to 8.42), with a statistically significant difference between the two designs. Overall, the studies were of moderate methodological quality.
Background A North–South (N–S) research collaboration is one way through which research capacity ... more Background A North–South (N–S) research collaboration is one way through which research capacity of developing countries can be strengthened. Whereas N–S collaboration in HIV/AIDS area may result in research capacity strengthening of Southern partners, it is not clear what factors are associated with this type of collaboration. The study aims to characterize N–S research collaboration focusing on HIV/AIDS and to determine factors associated with such N–S research collaborations. Methods Clinical trial data on HIV/AIDS-related studies conducted between 2000 and 2019 were obtained from ClinicalTrials.gov. Using these data, we characterized N–S collaborative studies focusing on HIV/AIDS and summarized them using frequencies and percentages. To determine factors associated with these studies, we used logistic regression and reported results as adjusted odds ratios with Wald 95% confidence intervals. Results and discussion Of the 4,832 HIV/AIDS-related studies retrieved from the registry...
ObjectivesThis review aimed at identifying the elements of integrated care models for cardiometab... more ObjectivesThis review aimed at identifying the elements of integrated care models for cardiometabolic multimorbidity in sub-Saharan Africa (SSA) and their effects on clinical or mental health outcomes including systolic blood pressure (SBP), blood sugar, depression scores and other patient-reported outcomes such as quality of life and medication adherence.DesignSystematic review and meta-analysis using the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach.Data sourcesWe systematically searched PubMed, Embase, Scopus, Web of Science, Global Health CINAHL, African Journals Online, Informit, PsycINFO, ClinicalTrials.gov, Pan African Clinical Trials Registry and grey literature from OpenSIGLE for studies published between 1999 and 2022.Eligibility criteria for selecting studiesWe included randomised controlled trial studies featuring integrated care models with two or more elements of Wagner’s chronic care model.Data extraction and synthesisTwo independe...
Viral load (VL) near delivery is a determinant of mother-to-child transmission (MTCT) of HIV. To ... more Viral load (VL) near delivery is a determinant of mother-to-child transmission (MTCT) of HIV. To evaluate factors associated with an undetectable VL near delivery in HIV-infected pregnant women receiving highly active antiretroviral therapy (HAART) and non-HAART regimens, HIV-infected pregnant women with a detectable VL at entry and having used antiretrovirals for ≥4 weeks before delivery were selected. Multivariate analysis was employed using binary logistic unconditional models; the dependent variable was having a VL <400 copies/mL near delivery. VL suppression was achieved in 403/707 women (57%): 65.4% in the HAART group, but only 26% in the non-HAART group P = 0.001. Duration of HAART was correlated with VL suppression, with maximum benefit seen after ≥12 weeks of therapy (odds ratio [OR]: 2.51; 95% confidence interval [CI]: 1.72–3.65). CD4+ cell count near delivery (OR: 1.53; 95% CI: 1.06–2.20) and baseline VL (OR: 0.74; 95% CI: 0.58–0.94) were also independently associated ...
Background Women and under-represented minority (URM) students continue to be under-represented i... more Background Women and under-represented minority (URM) students continue to be under-represented in STEM and earn the lowest proportion of undergraduate engineering degrees. We employed a mixed methods research approach grounded in social capital theory to investigate when they first consider pursuing engineering as a college degree major, who influences this decision, and how the influence occurs. First, we surveyed 2186 first-year undergraduate students entering engineering programs at 11 universities in the U.S. during the fall of 2014. Next, we interviewed a subsample of 55 women and URM students. Results Survey findings indicated that women were more likely than men to consider pursuing engineering while in high school, before admission into college, or while in college rather than considering it earlier in their education. Black and Latinx students were more likely than white students to consider pursuing engineering after high school. In addition, Black and Latinx students wer...
IntroductionIn Africa, the prevalence of mental health problems is higher among university studen... more IntroductionIn Africa, the prevalence of mental health problems is higher among university students than in the general population. A number of systematic reviews and recent prevalence studies have focused on prevalence of mental health issues among college. This mixed-methods systematic review, including meta-analysis and meta-synthesis, will explore: what mental health services are available to university students; the extent to which students access available services and factors associated with service access; and the degree to which students activate (use) accessible services and factors associated with service activation.Methods and analysisWe will conduct electronic literature search of the following databases: PubMed, Cochrane Library, Semantic Scholar, ERIC, Trip Database, Medline and PsycINFO. Disagreement, if any, will be resolved by a third reviewer. Two reviewers will independently assess the methodological quality of included studies using relevant tools. For cross-sec...
Studies in graduate and postdoctoral education, Apr 19, 2022
Purpose-This study aims to understand master's students' experiences of service-learning, followi... more Purpose-This study aims to understand master's students' experiences of service-learning, following their participation in a workshop with local social innovators whose activities had contributed to combating poverty in East Africa and to determine how this participation affected work on the students' theses. The authors also explored possible gender differences in this context. Design/methodology/approach-The study was based on pretest-posttest mixed methods research design. Data were collected from master's students within the social sciences and science, technology, engineering and mathematics (STEM) disciplines, respectively, in Kenya and Uganda, via surveys and interviews before the workshop, immediately afterwards and six months later.
Research writing confidence and organizational support toward research activities are two essenti... more Research writing confidence and organizational support toward research activities are two essential factors that may affect research productivity among higher educational institutions. This study investigated the possible relationships of these two factors to research productivity among faculty members of the College of Dentistry at Lyceum of the Philippines University-Batangas. The study used descriptive survey using percentage, weighted mean and Chi square to test the relationship of the selected variables. The findings indicate that Dentistry faculty members have low research productivity as evidenced by its research production, with only five of them having completed a research paper as main author and only one as co-author (but, not the main author) from SY 2008-2009 to 2012-2013. Respondents agreed that, in average, institutional support is higher than the departmental support for conducting research paper. Meanwhile, respondents are most confident with the technical part in research writing, but least confident in writing the methodology. Organizational support given by the university itself and the Department of College of Dentistry towards research activities and faculty members' confidence in writing the paper particularly the technical and major parts were not indicators associated with research productivity. However, they are confident with the other parts of the research process including writing the abstract and references as associated with developing research findings.
In comparison to work on women and historically excluded racial/ethnic minority students in scien... more In comparison to work on women and historically excluded racial/ethnic minority students in science, technology, engineering, and math (STEM), research on sexual and gender minority (SGM) students in STEM is somewhat incipient. There is little scholarship available on SGM-focused STEM organizations (e.g., oSTEM). Building on the previous literature, we examine how SGM-focused STEM organizations provide social capital, both expressive (e.g., emotional support) and instrumental (e.g., academic resources), that helps students feel they fit in STEM and ultimately persist. We report findings from a large online survey with 477 SGM STEM undergraduates, 463 of whom participate in STEM organizations, which offers one of if not the largest study on the topic to date. We compare three types of identity-focused organizations, SGM-focused, women-focused, and race/ethnicity-focused, finding that they each provide expressive capital to SGM students. The organizations helped students cultivate sup...
College students engage in strategic gender and sexuality expression, making attire and interacti... more College students engage in strategic gender and sexuality expression, making attire and interactional decisions that can seem mundane. However, STEM undergraduate academic cultures tend to be hetero-and cisnormative and can be unwelcoming of other gender identities and sexualities (e.g., faculty resistance to trans students&#39; pronouns). Our analysis of interviews with 29 LGBTQPIA+ STEM undergraduates suggests that while some students chose behaviors and clothing reflective of hetero/cis norms to avoid attention and/or conflict (e.g., not wearing Pride buttons, nail polish, dresses), others challenged these norms. We explore how STEM programs can be more inclusive of LGBTQPIA+ students&#39; gender and sexual identities and expressions.
Women and underrepresented minority (URM) undergraduates declare and complete science, technology... more Women and underrepresented minority (URM) undergraduates declare and complete science, technology, engineering, and mathematics majors at different rates in comparison to majority groups. Explanations of these differences have long been deficit oriented, focusing on aptitude or similar characteristics, but more recent work focuses on institutional contexts, such as academic climate and feelings of belonging (fit). This study examines the experiences of women and URM students in engineering undergraduate programs, focusing on how they fit, experiential factors affecting fit, and how fit is mitigated by social relationships from their networks and organizations in which they participate (i.e., social capital). Thematic analysis of 55 women and URM interviewee responses shows that students who fit well were those with majority characteristics, including race (i.e., White, White-passing) and gender (i.e., men, masculine appearance), and those in groups well represented in their programs numerically (i.e., men, Asian). In contrast, women and Black students encountered threats to their fit due to stereotyping from bias and differential treatment from others (i.e., being excluded from group work). However, students received advice from their social networks (i.e., family, professors) in which they were warned to expect discrimination, or through organizations in which they participated (i.e., National Association of Black Engineers) where their sense of community was expanded. The advice and resources provided through this network-based and participatory social capital mitigated fit for women and Black students, albeit in different ways, helping to preserve their feelings of belonging and promote their persistence in engineering. We offer suggestions to enact university policies to increase access to social capital with homophilious alters and educational opportunities for majority groups.
Undergraduates with sexual and/or gender minority (SGM) identities, including lesbian, gay, bisex... more Undergraduates with sexual and/or gender minority (SGM) identities, including lesbian, gay, bisexual, transgender, queer/questioning, pansexual, intersexual, asexual, or additional positionalities, often face an unwelcoming STEM microclimate. The STEM microclimate includes the places students experience, such as classrooms or labs, and the people, such as peers or professors, with whom they discuss their STEM program. While previous work offers a framework of microaggressions faced by SGM people, and the behavioral, cognitive, and emotional strategies they use to react to them, little is known about the strategies SGM students use to persist in the STEM microclimate. We analyze interviews with 29 SGM STEM undergraduates to uncover how they fit in STEM, their experiences that affect fit, how social capital in the form of influential others affects fit, and the strategies used to deal with microaggressions and cultivate a supportive network. Using thematic analysis, we find that stude...
In comparison to work on women and historically excluded racial/ethnic minority students in scien... more In comparison to work on women and historically excluded racial/ethnic minority students in science, technology, engineering, and math (STEM), research on sexual and gender minority (SGM) students in STEM is somewhat incipient. There is little scholarship available on SGM-focused STEM organizations (e.g., oSTEM). Building on the previous literature, we examine how SGM-focused STEM organizations provide social capital, both expressive (e.g., emotional support) and instrumental (e.g., academic resources), that helps students feel they fit in STEM and ultimately persist. We report findings from a large online survey with 477 SGM STEM undergraduates, 463 of whom participate in STEM organizations, which offers one of if not the largest study on the topic to date. We compare three types of identity-focused organizations, SGM-focused, women-focused, and race/ethnicity-focused, finding that they each provide expressive capital to SGM students. The organizations helped students cultivate supportive networks of peers like themselves who then help them feel they fit in STEM through similar but not identical mechanisms. For SGM-focused organizations, their assistance in helping students reconcile their SGM identities with their STEM identity was an important nuance tailored to SGM students' needs. However, students described how SGM-focused organizations provided instrumental capital far less, which we posit may take a back seat to SGM STEM students' expressive needs. Unfortunately, women-focused organizations were not always welcoming to SGM students, an issue not documented in race/ethnicity-focused societies. However, some identity-focused organizations established partnerships with other identity-focused organizations, highlighting the possible role of such collaboration in better serving SGM students, particularly those with minoritized ethnic/racial identities. Implications for research and practice are included.
Society for Applied Anthropology Annual Meeting Poster, 2019
College students engage in strategic gender and sexuality expression, making attire and interacti... more College students engage in strategic gender and sexuality expression, making attire and interactional decisions that can seem mundane. However, STEM undergraduate academic cultures tend to be hetero-and cisnormative and can be unwelcoming of other gender identities and sexualities (e.g., faculty resistance to trans students' pronouns). Our analysis of interviews with 29 LGBTQPIA+ STEM undergraduates suggests that while some students chose behaviors and clothing reflective of hetero/cis norms to avoid attention and/or conflict (e.g., not wearing Pride buttons, nail polish, dresses), others challenged these norms. We explore how STEM programs can be more inclusive of LGBTQPIA+ students' gender and sexual identities and expressions.
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