Duchenne muscular dystrophy (DMD) is a serious degenerative muscular disease affecting males. Diagnosis usually occurs in childhood and is confirmed through genetic testing and/or muscle biopsy. Accompanying the disease are several nutrition-related concerns: growth, body composition, energy and protein requirements, constipation, swallowing difficulties, bone health, and complementary medicine. This review article addresses the nutrition aspects of DMD.
BackgroundThis study reports the outcomes of the Strong Hearts pilot project to integrate screening for Trypanosoma cruzi into a primary care setting and facilitate referral for treatment at East Boston Neighborhood Health Center.MethodsContinuing education about Chagas disease was offered to healthcare providers, and community-based outreach was provided. One-time screening for all patients ≤50 years old who lived in Mexico, South or Central America for ≥6 months was recommended. The initial screening test was an ELISA performed by a commercial laboratory and confirmatory testing was performed at the US CDC. Confirmed positives were defined as positive on both the screening and confirmatory tests. Confirmed positive patients were referred to the Pediatric and Adult Infectious Disease clinics at Boston Medical Center for further evaluation and treatment. We compared the proportion of confirmed positives by sex, age, and self-reported national origin using chi-squared tests. We then used multivariable logistic regression to examine predictors of (1) confirmed positive or (2) discordant screening and confirmatory testing.ResultsA total of 2,183 screening tests were sent; 84 (3.8%) were positive, 2,082 (95.4%) negative, and 17 (0.8%) indeterminate. Among 73 tests with confirmatory results available, 19 (26%) were positive and 54 (74%) negative. All indeterminate tests were confirmed negative. The proportion of confirmed positives increased with increasing age (P = 0.014) (Table 1), but there were no significant differences by sex (M: 8/757, F: 11/1,413, P = 0.51) or national origin (P = 0.79). Nineteen confirmed positives have been evaluated and six initiated benznidazole to date. Three confirmed positives were pregnant. In multivariable models, there were no significant predictors of confirmed positive or discordant testing.ConclusionThis pilot shows that integration of screening for Chagas disease is feasible in primary care. Although the prevalence of T. cruzi infection was higher in older age groups, there were no clear demographic predictors of a confirmed positive or discordant test. We also found a high false-positive rate of the screening test, highlighting the need for improved serologic testing options.Table 1.Age Group (Years)Positive Cases (#)*Total Screened (#)Prevalence (%)≤1901010.020–2937420.430–3978200.940–4953921.3≥5041153.5Disclosures All authors: No reported disclosures.
BackgroundOver 300,000 people in the United States are infected with Trypanosoma cruzi, the parasite that causes Chagas disease. Less than 1% of those people have received antitrypanosomal therapy. We report findings of an ongoing project to address Chagas disease in East Boston, including the epidemiology and cascade of care for this disease.MethodsProviders at the East Boston Neighborhood Health Center were offered continuing medical education sessions on Chagas disease by the Strong Hearts project. One-time screening for Chagas disease is recommended for all patients <50 years old who had lived in Mexico, South or Central America for ≥6 months at the provider’s discretion. Screening is performed by a commercial laboratory using the Hemagen ELISA; confirmatory testing is performed at CDC. Patients with confirmed positive serology are referred to the Center for Infectious Diseases (ID) at Boston Medical Center for evaluation and treatment. We compared the prevalence of Chagas disease by age, sex and national origin. We then used a conditional numerator and fixed denominator to construct the cascade of care, with the stages defined as referred to ID care, evaluation in ID, initiation of treatment and completion of antitrypanosomal therapy. We used chi-squared tests to compare proportions.ResultsFrom March 21, 2017 to April 17, 2019, 5,125 patients were screened. 50 (0.97%) were confirmed to have T. cruzi infection, among them 3 pregnant women. There were no differences in the prevalence of T. cruzi infection by sex (M = 22/1870 [1.18%], F = 28/3305 [0.85%], P = 0.245) but prevalence increased from 0/190 (0%) in those <20 years old to 11/1083 (1.02%) in 40–49 year olds (P = 0.001). The 3 infants of infected mothers were screened. The cascade of care for Strong Hearts is displayed in Figure 1.ConclusionChagas disease prevalence in at-risk communities in Boston is substantial. 20% of patients with T. cruzi infection identified in this program have completed treatment to date. Most infected patients were referred for evaluation, but substantial drop-off occurred at each of the next 3 steps of the cascade. Confronting barriers at each of these steps is a crucial component of efforts to address this neglected disease. Disclosures All authors: No reported disclosures.
Background More than 300,000 people in the United States may be infected with Trypanosoma cruzi. This study describes the results of the Strong Hearts pilot project to integrate screening and facilitate referral for treatment for T. cruzi infection into primary care settings serving patients at high risk in Massachusetts.Methods We partnered with the Medicine, Pediatrics, Obstetrics, and Family Medicine divisions at the East Boston Neighborhood Health Center. Continuing education about Chagas disease was offered to healthcare providers, and community outreach to educate at-risk individuals and families was initiated. One-time screening for all patients under 50 years of age who lived in Mexico, South or Central America for at least 6 months was recommended. The initial screening test was an ELISA performed by a commercial laboratory. Confirmatory testing was performed at the Centers for Disease Control and Prevention (CDC) using serum saved at the health center laboratory. Patients with two positive tests were referred to the Infectious Disease Department of a partner institution for further evaluation and treatment.ResultsThree screening tests were ordered at the health center in the 3 months before the pilot. During the first 6 weeks of the pilot, participating providers ordered 203 screening tests. The patients screened included 90 (44%) women and 113 (56%) men; 90 (44%) were from El Salvador and 46 (23%) from Colombia. Thus far, results are available for 123 tests, among which 118 are negative and five are positive (one confirmed positive, one confirmed negative, and three pending). Two patients have been referred and seen by the partnering ID clinic, both within 6 weeks of the initial screening test.Conclusion The burden of Chagas disease may be underappreciated even in facilities that serve high-risk patients. Our preliminary findings suggest that primary care-based screening for Chagas disease is feasible and embraced by providers and patients, in the context of appropriate education and a seamless system for referral and treatment.Disclosures All authors: No reported disclosures.
Background Chagas disease is a potentially life-threatening neglected disease of poverty that is endemic in continental Latin America. Caused by Trypanosoma cruzi (T. cruzi), it is one of six parasitic diseases in the United States targeted by the Centers for Disease Control as a public health problem in need of action. An estimated 300,000 people are infected with T. cruzi in the United States (US). Although its morbidity, mortality and economic burden are high, awareness of Chagas disease is lacking among many healthcare providers in the US. The purpose of this analysis is to determine if the number of diagnostic tests performed at a community health center serving an at-risk population for Chagas disease increased after information sessions. A secondary aim was to determine if there was a difference by provider type, i.e., nurse practitioner vs. physician, or by specialty in the number of patients screened. Methodology/Principal findings We conducted a retrospective data analysis of the number of Chagas serology tests performed at a community health center before and after information sessions for clinicians. A time series analysis was conducted focusing on the Adult and Family Medicine Departments at East Boston Neighborhood Health Center (EBNHC). Across all departments there were 1,957 T. cruzi tests performed before the sessions vs. 2,623 after the sessions. Interrupted time series analysis across departments indicated that testing volume was stable over time prior to the sessions (pre-period slope = +4.1 per month; p = 0.12), followed by an immediate shift after the session (+51.6; p = 0.03), while testing volume remained stable over time after the session (post-period slope = -6.0 per month; p = 0.11). Conclusion/Significance In this study, Chagas testing increased after information sessions. Clinicians who began testing their patients for Chagas disease after learning of the importance of this intervention added an extra, potentially time-consuming task to their already busy workdays without external incentives or recognition.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.