Papers by Olugbenga Obasanjo
Archives of internal medicine, Oct 8, 2001
... JAMA & Archives Select Journal or Resource ... Transmission of Mycobacter... more ... JAMA & Archives Select Journal or Resource ... Transmission of Mycobacteriumtuberculosis Through Casual Contact With an Infectious Case ...
We studied factors associated with loss-to-follow-up (LTFU) of reported cases of tuberculosis (TB... more We studied factors associated with loss-to-follow-up (LTFU) of reported cases of tuberculosis (TB) in Baltimore City from 1971 through 1995 to identify patterns in LTFU among individuals treated for TB in the city during this time. We also analyzed the spatial clustering of LTFUs to those who completed treatment. Demographic characteristics of individuals with confirmed TB were extracted from the records of the Baltimore City Health Dept. (BCHD) for every third year starting from 1971. Information on age, sex, race, ethnicity, place of birth, occupation, clinical status and place of residence were recorded. LTFUs represented a significantly higher proportion of individuals with TB prior to DOT (10.9%) than after DOT (4.7%) (p<0.0001). However, there were no differences in any of the demographic characteristics in LTFUs when compared to those who completed therapy for any of the years analyzed, except in 1992 when LTFUs were significantly younger. There were also no temporal patterns among LTFs. There was also no spatial clustering of the residences of LTFU relative to those completing therapy. We conclude that in Baltimore, DOT has successfully reduced the number of TB cases and has not resulted in an increase in or clustering of LTFU among any risk groups or geographical areas. In this study, we investigated factors associated with loss-to-follow-up (LTFU) of reported cases of TB in Baltimore City from 1971 to 1995. We wanted to determine if there were identifiable patterns of LTFU in people identified as TB cases in the city during this time. We primarily wanted to determine if the introduction of DOT in 1978 altered the pattern of LTFU individuals. We examined whether LTFU individuals differed from those who completed therapy demographically or geographically, we also examined if LTFUs identified prior to DOT (pre-DOT) differed from those following introduction of DOT (post-DOT) by these same parameters. Methods The Baltimore city TB control program is administered by the Baltimore City Health Department. It has an efficient multi-tier case identification program which is also involved in contact tracing and identification iv. The program also maintains confidential medical records for every case of TB identified in the city since 1956.
Human Immunology, Jun 1, 2007
Dengue virus infection has emerged as one of the most important arthropod-borne diseases. In some... more Dengue virus infection has emerged as one of the most important arthropod-borne diseases. In some dengue-infected individual, the disease progresses to its severe, life-threatening form, dengue hemorrhagic fever (DHF). Host genetic factors may be relevant and predispose some individuals to the severe dengue disease. The unique history of dengue outbreaks in Cuba is extremely advantageous for genetic studies of dengue disease resistance or susceptibility. Consequently, samples collected from 120 healthy individuals that developed dengue fever (DF) and DHF during the 1997 dengue 2 outbreak in the Santiago de Cuba municipality were HLA genotyped using polymerase chain reaction-sequence-specific primers. Polymorphism at the human leukocyte antigen (HLA) class I loci was significantly associated with DHF disease susceptibility, but polymorphism in the HLA-DRB1 was associated with protection. Amino acid peptides present in the poly-protein of the dengue 2 Jamaica strain, which are able to bind to the HLA class I and class II allotypes associated with susceptibility to or protection against the dengue clinical disease, respectively, were predicted using the BIMAS and SYFPEITHI predictive algorithms of peptide/MHC interaction.
Journal of Clinical Oncology, May 20, 2016
e13053Background: Public health (PH) clinics are in the process of optimizing genetic referrals f... more e13053Background: Public health (PH) clinics are in the process of optimizing genetic referrals from primary care settings. Adherence to breast cancer genetic screening guidelines depend on patient- and provider-related factors, including knowledge about breast cancer genetics. The objective of this study was to assess factors associated with knowledge about Breast Cancer (BC) genetics among female patients & PH employees across a rural health district. Methods: Cross-sectional study with mixed sampling (convenience & intra stratum systematic randomization) of adult female patients and female PH employees across 12 health clinics in Georgia. Respondents completed a modified, validated BC Genetic Questionnaire (developed from NIH Cancer Genetic Studies Consortium) that assessed socio-demographics, knowledge about BC, interest in genetic screening and Health Belief Model constructs. Factorial analysis of variance and multivariate regression were used compare means & elucidate associations with knowledge sco...
Infection Control and Hospital Epidemiology, 2001
Objective:To investigate an outbreak of scabies in an inner-city teaching hospital, identify path... more Objective:To investigate an outbreak of scabies in an inner-city teaching hospital, identify pathways of transmission, institute effective control measures to end the outbreak, and prevent future occurrences.Design:Outbreak investigation, case-control study, and chart review.Setting:Large tertiary acute-care hospital.Results:A patient with unrecognized Norwegian (crusted) scabies was admitted to the acquired immunodeficiency syndrome (AIDS) service of a 940-bed acute-care hospital. Over 4 months, 773 healthcare workers (HCWs) and 204 patients were exposed to scabies. Of the exposed HCWs, 147 (19%) worked on the AIDS service. Risk factors for being infested with scabies among HCWs included working on the AIDS service (odds ratio [OR], 5.3; 95% confidence interval [CI95], 2.17-13.15) and being a nurse, physical therapist, or HCW with extensive physical contact with infected patients (OR, 4.5; CI95, 1.26-17.45). Aggressive infection control precautions beyond Centers for Disease Control and Prevention barrier and isolation recommendations were instituted, including the following: (1) early identification of infected patients; (2) prophylactic treatment with topical applications for all exposed HCWs; (3) use of two treatments 1 week apart for all cases of Norwegian scabies; (4) maintaining isolation for 8 days and barrier precautions for 24 hours after completing second treatment for a diagnosis of Norwegian scabies; and (5) oral ivermectin for treatment of patients who failed conventional therapy.Conclusions:HCWs with the most patient contact are at highest risk of acquiring scabies. Because HCWs who used traditionally accepted barriers while caring for patients with Norwegian scabies continued to develop scabies, we found additional measures were required in the acute-care hospital. HCWs with skin exposure to patients with scabies should receive prophylactic treatment. We recommend (1) using heightened barrier precautions for care of patients with scabies and (2) extending the isolation period for 8 days or 24 hours after the second treatment with a scabicide for those patients with Norwegian scabies. Oral ivermectin was well tolerated for treating patients and HCWs who failed conventional treatment. Finally, we developed a surveillance system that provides a “barometric measure” of the infection rate in the community. If scabies increases in the community, a tiered triage system is activated to protect against transmission among HCWs or hospital patients.
JAMA, Aug 12, 1998
and the International AIDS Society-USA recently published recommendations for antiretroviral ther... more and the International AIDS Society-USA recently published recommendations for antiretroviral therapy (ART) for persons infected with human immunodeficiency virus (HIV); however, anecdotal evidence suggests that HIV-infected injection drug users (IDUs) may not be receiving optimal care as defined by the recommendations. Objective.-To assess ART use in HIV-infected IDUs. Design.-A cross-sectional survey of self-reported ART use between July 1996 and June 1997 in IDUs.
Southern Medical Journal, Jul 1, 2003
The prevalence of congestive heart failure (CHF) in the United States is approximately 4 million,... more The prevalence of congestive heart failure (CHF) in the United States is approximately 4 million, with associated annual health care expenditures exceeding dollar 8 billion. Clinical pathways for CHF have been developed, but they have not been rigorously evaluated regarding efficacy and improvement in the quality of care. We sought to evaluate the effect of a CHF clinical pathway on hospital charges, length of stay, and use of angiotensin-converting enzyme (ACE) inhibitors in patients with CHF in a retrospective cohort study. We studied 371 patients (age range, 44-92 yr) with discharge diagnoses of CHF in a 376-bed community hospital between July 1996 and December 1997. We conducted chart reviews to determine length of stay, hospital charges, and use of ACE inhibitors. Of the 371 patients, 174 were assigned to the clinical pathway and 197 were not. Baseline characteristics of the two groups were similar. The benchmark of less than 4 days&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; in-hospital stay was achieved in 65% of patients on the pathway and 42% who were not on the pathway (odds ratio, 2.6; 95% confidence interval, 1.67-4.05; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The median hospital charges were lower in the group on the clinical pathway (dollar 3,000 versus dollar 5,500, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). In addition, 81% of the patients on the clinical pathway were administered ACE inhibitors, compared with 48% of equally eligible patients from the nonpathway group (odds ratio, 4.68; 95% confidence interval, 2.85-7.72; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The clinical pathway for CHF was associated with increased use of ACE inhibitors as well as reduced length of stay and hospital charges.
We studied factors associated with loss-to-follow-up (LTFU) of reported cases of tuberculosis (TB... more We studied factors associated with loss-to-follow-up (LTFU) of reported cases of tuberculosis (TB) in Baltimore City from 1971 through 1995 to identify patterns in LTFU among individuals treated for TB in the city during this time. We also analyzed the spatial clustering of LTFUs to those who completed treatment. Demographic characteristics of individuals with confirmed TB were extracted from the records of the Baltimore City Health Dept. (BCHD) for every third year starting from 1971. Information on age, sex, race, ethnicity, place of birth, occupation, clinical status and place of residence were recorded. LTFUs represented a significantly higher proportion of individuals with TB prior to DOT (10.9%) than after DOT (4.7%) (p<0.0001). However, there were no differences in any of the demographic characteristics in LTFUs when compared to those who completed therapy for any of the years analyzed, except in 1992 when LTFUs were significantly younger. There were also no temporal patte...
Journal of Clinical Oncology, 2016
e13053Background: Public health (PH) clinics are in the process of optimizing genetic referrals f... more e13053Background: Public health (PH) clinics are in the process of optimizing genetic referrals from primary care settings. Adherence to breast cancer genetic screening guidelines depend on patient- and provider-related factors, including knowledge about breast cancer genetics. The objective of this study was to assess factors associated with knowledge about Breast Cancer (BC) genetics among female patients & PH employees across a rural health district. Methods: Cross-sectional study with mixed sampling (convenience & intra stratum systematic randomization) of adult female patients and female PH employees across 12 health clinics in Georgia. Respondents completed a modified, validated BC Genetic Questionnaire (developed from NIH Cancer Genetic Studies Consortium) that assessed socio-demographics, knowledge about BC, interest in genetic screening and Health Belief Model constructs. Factorial analysis of variance and multivariate regression were used compare means & elucidate associations with knowledge sco...
Current clinical topics in infectious diseases, 2001
... 9l. For example, the Medieare and Medieaid programs reimhurse hospitals set fees hased on the... more ... 9l. For example, the Medieare and Medieaid programs reimhurse hospitals set fees hased on the patient diagnosis t9l. Ejeh diagnosis is elassified into a partieular eategory ealled a diagnosis-related group tDRGl. Rarely will ...
Given the reemergence of Tuberculosis (TB) in the United States (U.S.) in the 1980s and 1990s, se... more Given the reemergence of Tuberculosis (TB) in the United States (U.S.) in the 1980s and 1990s, several strategies have emerged to combat the disease. A successful tool has been Directly Observed Therapy (DOT). Chaulk, et al. showed that DOT was responsible for the maintaining the decline in TB rates in Baltimore through the corresponding period of an upswing in rates
JAMA, 1998
and the International AIDS Society-USA recently published recommendations for antiretroviral ther... more and the International AIDS Society-USA recently published recommendations for antiretroviral therapy (ART) for persons infected with human immunodeficiency virus (HIV); however, anecdotal evidence suggests that HIV-infected injection drug users (IDUs) may not be receiving optimal care as defined by the recommendations. Objective.-To assess ART use in HIV-infected IDUs. Design.-A cross-sectional survey of self-reported ART use between July 1996 and June 1997 in IDUs.
Infection Control & Hospital Epidemiology, 2001
Objective:To investigate an outbreak of scabies in an inner-city teaching hospital, identify path... more Objective:To investigate an outbreak of scabies in an inner-city teaching hospital, identify pathways of transmission, institute effective control measures to end the outbreak, and prevent future occurrences.Design:Outbreak investigation, case-control study, and chart review.Setting:Large tertiary acute-care hospital.Results:A patient with unrecognized Norwegian (crusted) scabies was admitted to the acquired immunodeficiency syndrome (AIDS) service of a 940-bed acute-care hospital. Over 4 months, 773 healthcare workers (HCWs) and 204 patients were exposed to scabies. Of the exposed HCWs, 147 (19%) worked on the AIDS service. Risk factors for being infested with scabies among HCWs included working on the AIDS service (odds ratio [OR], 5.3; 95% confidence interval [CI95], 2.17-13.15) and being a nurse, physical therapist, or HCW with extensive physical contact with infected patients (OR, 4.5; CI95, 1.26-17.45). Aggressive infection control precautions beyond Centers for Disease Contro...
Human Immunology, 2007
Dengue virus infection has emerged as one of the most important arthropod-borne diseases. In some... more Dengue virus infection has emerged as one of the most important arthropod-borne diseases. In some dengue-infected individual, the disease progresses to its severe, life-threatening form, dengue hemorrhagic fever (DHF). Host genetic factors may be relevant and predispose some individuals to the severe dengue disease. The unique history of dengue outbreaks in Cuba is extremely advantageous for genetic studies of dengue disease resistance or susceptibility. Consequently, samples collected from 120 healthy individuals that developed dengue fever (DF) and DHF during the 1997 dengue 2 outbreak in the Santiago de Cuba municipality were HLA genotyped using polymerase chain reaction-sequence-specific primers. Polymorphism at the human leukocyte antigen (HLA) class I loci was significantly associated with DHF disease susceptibility, but polymorphism in the HLA-DRB1 was associated with protection. Amino acid peptides present in the poly-protein of the dengue 2 Jamaica strain, which are able to bind to the HLA class I and class II allotypes associated with susceptibility to or protection against the dengue clinical disease, respectively, were predicted using the BIMAS and SYFPEITHI predictive algorithms of peptide/MHC interaction.
East African Medical Journal, 2010
Background: Longitudinal studies face power reduction due to loss to follow up (LTFU). Bias may a... more Background: Longitudinal studies face power reduction due to loss to follow up (LTFU). Bias may also arise because of differences between those who stay in the study and those who are LTFU We studied factors associated with LTFU in a cohort of HIV seronegative and sera-positive mothers in urban Malawi. Objective: To bridge the existing gaps by examining the factors associated with attrition. Design: Longitudinal study. Setting: Queen Elizabeth Central Hospital (QECH) and the Kamuzu Central Hospital in Blantyre, Malawi. Subjects: One thousand three hundred and fifty three women who attended the prenatal clinic, between October 1989 and October 1990 were recruited as part of a study to determine rates and risk factors of sero-prevalence and sera-conversion of HIV-1 among this cohort. Results: In this cohort study, 1353 women were enrolled at delivery and 1188 (88%) returned for the first follow-up visit at three months post-partum. Of those who returned, 177 (15%) were subsequently lost during the remaining months of followup. The main predictors of L TFU were younger maternal age, lower educational level of the father, HIV infection of the mother, lower birth weight of the index child and mother not being married. Conclusions: Researchers planning studies in developing countries should consider the impact of lower education and poorer infant health on study retention in developing countries.
Clinical Infectious Diseases, 2001
Chest, 2000
Background: Incomplete or incorrect antibiotic therapy, especially in the initial phase of antitu... more Background: Incomplete or incorrect antibiotic therapy, especially in the initial phase of antituberculosis (anti-TB) treatment, is a major cause of acquired drug resistance and treatment failure. We determined the extent of errors in anti-TB treatment regimens by way of nonadherence to recommended treatment protocols among patients with TB in Baltimore, MD, a city with declining rates of disease. An error was defined as using too few drugs or the wrong drugs, giving inadequate doses of drugs, or prescribing an inadequate duration of treatment. Methods: We reviewed the records of all patients with culture-positive, pulmonary TB reported in the city of Baltimore from January 1, 1994, to December 31, 1995. We determined demographic information, initial anti-TB regimen, doses and duration of therapy, history or presence of resistance to anti-TB drugs, injecting-drug or alcohol abuse, HIV status, and whether treatment was given by a private physician or by the Tuberculosis Clinic of the Baltimore City Health Department (BCHD). Results: Of the 110 cases of active pulmonary TB, 17 cases (15.4%) had errors in treatment for control of their current disease. Thirteen of 34 privately treated patients (38%) had some error in their initial anti-TB regimen, compared with 4 of 76 patients (5.2%) treated by the Tuberculosis Clinic of the BCHD (p < 0.0001). Patients were otherwise similar as determined by age, sex, HIV status, drug-resistance characteristics, and injecting-drug use, regardless of whether they had erroneous anti-TB regimens. Conclusion: In a low-prevalence area, private physicians make frequent errors in prescribing anti-TB therapy. Additional educational resources for physicians and increased use of expert consultation may contribute to improved TB control.
American Journal of Respiratory and Critical Care Medicine, 1996
Several studies have shown that funeral directors have an increased risk of tuberculosis (TB). Al... more Several studies have shown that funeral directors have an increased risk of tuberculosis (TB). Although there is indirect evidence of transmission of TB from cadavers to mortuary workers, there is only one recently documented case in the literature. We report here another case of occupationally acquired TB in a funeral director, which was confirmed by conventional epidemiology and genotyping. This case illustrates the risk of TB transmission to mortuary workers from routine embalming of deceased TB patients with active disease.
American Journal of Infection Control, 1999
Southern Medical Journal, 2003
The prevalence of congestive heart failure (CHF) in the United States is approximately 4 million,... more The prevalence of congestive heart failure (CHF) in the United States is approximately 4 million, with associated annual health care expenditures exceeding dollar 8 billion. Clinical pathways for CHF have been developed, but they have not been rigorously evaluated regarding efficacy and improvement in the quality of care. We sought to evaluate the effect of a CHF clinical pathway on hospital charges, length of stay, and use of angiotensin-converting enzyme (ACE) inhibitors in patients with CHF in a retrospective cohort study. We studied 371 patients (age range, 44-92 yr) with discharge diagnoses of CHF in a 376-bed community hospital between July 1996 and December 1997. We conducted chart reviews to determine length of stay, hospital charges, and use of ACE inhibitors. Of the 371 patients, 174 were assigned to the clinical pathway and 197 were not. Baseline characteristics of the two groups were similar. The benchmark of less than 4 days&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; in-hospital stay was achieved in 65% of patients on the pathway and 42% who were not on the pathway (odds ratio, 2.6; 95% confidence interval, 1.67-4.05; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The median hospital charges were lower in the group on the clinical pathway (dollar 3,000 versus dollar 5,500, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). In addition, 81% of the patients on the clinical pathway were administered ACE inhibitors, compared with 48% of equally eligible patients from the nonpathway group (odds ratio, 4.68; 95% confidence interval, 2.85-7.72; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The clinical pathway for CHF was associated with increased use of ACE inhibitors as well as reduced length of stay and hospital charges.
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Papers by Olugbenga Obasanjo