HIV infections in sub-Saharan Africa not explained by sexual or vertical transmission

Gisselquist, David; Rothenberg, Richard; Potterat, John J.; Drucker, Ernest

doi:10.1258/095646202760326390

Cited by 102 publications

(77 citation statements)

References 79 publications

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“…Most of the reports are anecdotal, yet evidence points to a large potential transmission effect due to interactions with the health system. 15,16 The first Global Patient Safety Challenge addressed the issue of hand washing as a means of transmitting infections to patients in the hospital setting. 17 The work from this challenge resulted in guidelines aimed at improving practices of hospital staff responsible for patient care.…”

Section: Clean Surgery -Antisepsis and Control Of Contaminationmentioning

confidence: 99%

Patterns in neurosurgical adverse events: intracranial neoplasm surgery

Wong¹,

Panchmatia

Ziewacz

et al. 2012

FOC

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Object Neurosurgery is a high-risk specialty currently undertaking the pursuit of systematic approaches to measuring and improving outcomes. As part of a project to devise evidence-based safety interventions for specialty surgery, the authors sought to review current evidence in cranial tumor resection concerning the frequency of adverse events in practice, their patterns, and current methods of reducing the occurrence of these events. This review represents part of a series of papers written to consolidate information about these events and preventive measures as part of an ongoing effort to ascertain the utility of devising system-wide policies and safety tools to improve neurosurgical practice. Methods The authors performed a PubMed search using search terms “intracranial neoplasm,” “cerebral tumor,” “cerebral meningioma,” “glioma,” and “complications” or “adverse events.” Only papers that specifically discussed the relevant complication rates were included. Papers were chosen to maximize the range of rates of occurrence for the reported adverse events. Results Review of the tumor neurosurgery literature showed that documented overall complication rates ranged from 9% to 40%, with overall mortality rates of 1.5%–16%. There was a wide range of types of adverse events overall. Deep venous thromboembolism (DVT) was the most common adverse event, with a reported incidence of 3%–26%. The presence of new or worsened neurological deficit was the second most common adverse event found in this review, with reported rates ranging from 0% for the series of meningioma cases with the lowest reported rate to 20% as the highest reported rate for treatment of eloquent glioma. Benign tumor recurrence was found to be a commonly reported adverse event following surgery for intracranial neoplasms. Rates varied depending on tumor type, tumor location, patient demographics, surgical technique, the surgeon's level of experience, degree of specialization, and changes in technology, but these effects remain unmeasured. The incidence on our review ranged from 2% for convexity meningiomas to 36% for basal meningiomas. Other relatively common complications were dural closure–related complications (1%–24%), postoperative peritumoral edema (2%–10%), early postoperative seizure (1%–12%), medical complications (6%–7%), wound infection (0%–4%), surgery-related hematoma (1%–2%), and wrong-site surgery. Strategies to minimize risk of these events were evaluated. Prophylactic techniques for DVT have been widely demonstrated and confirmed, but adherence remains unstudied. The use of image guidance, intraoperative functional mapping, and real-time intraoperative MRI guidance can allow surgeons to maximize resection while preserving neurological function. Whether the extent of resection significantly correlates with improved overall outcomes remains controversial. Discussion A significant proportion of adverse events in intracranial neoplasm surgery may be avoidable by use of practices to encourage use of standardized protocols for DVT, seizure, and infection prophylaxis; intraoperative navigation among other steps; improved teamwork and communication; and concentrated volume and specialization. Systematic efforts to bundle such strategies may significantly improve patient outcomes.

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Section: Clean Surgery -Antisepsis and Control Of Contaminationmentioning

confidence: 99%

Patterns in neurosurgical adverse events: intracranial neoplasm surgery

Wong¹,

Panchmatia

Ziewacz

et al. 2012

FOC

View full text Add to dashboard Cite

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“…Based on the findings of various studies, Gisselquist and colleagues 4 calculate the PAFs (causal fractions) associated with injections and conclude that, "Many studies show 20%-40% of HIV infections in African adults associated with injections (though direction of causation is unknown)". Furthermore, in analyses of data from the 1980s, Gisselquist and co-workers 3 report that, "Overall, crude PAFs from general population studies through 1988 suggest that medical exposures were responsible for more African HIV than sexual exposures".…”

Section: Population Attributable Fractions (Pafs)mentioning

confidence: 99%

Transmission of HIV-1 infection in sub-Saharan Africa and effect of elimination of unsafe injections

et al. 2004

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“…3,4 Recently, Gisselquist and his colleagues 5 expressed skepticism that heterosexual transmission alone can explain the magnitude of sub-Saharan Africa's HIV/ AIDS pandemic. Contrary to prevailing opinions, they estimated that only 25-29% of the sub-Saharan HIV infections in women and 30-35% in men result from sexual transmission and suggested that needle exposures to HIV during health-care encounters may account for more HIV infections in sub-Saharan Africa than do sexual exposures.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with HIV prevalence in a pre-partum cohort of Zambian women

et al. 2006

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An ongoing study of mother-to-child human herpes virus-8 (HHV-8) transmission in Zambian women (n = 3160) allowed us to examine the association of medical injections with HIV serostatus while simultaneously accounting for other factors known to be correlated with HIV prevalence. Multi-method data collection included structured interviews, medical record abstraction, clinical examinations, and biological measures. Medically administered intramuscular or intravenous injections in the past five years (but not blood transfusions) were overwhelmingly correlated with HIV prevalence, exceeding the contribution of sexual behaviours in a multivariable logistic regression. Statistically significant associations with HIV also were found for some demographic variables, sexual behaviours, alcohol use, and sexually transmitted diseases (STD). The results confirmed that iatrogenic needle exposure, sexual behaviour, demographic factors, substance use, and STD history are all implicated in Zambian women's HIV+ status. However, the disproportionate association of medical injection history with HIV highlights the need to investigate further and prospectively the role of health-care injection in sub-Saharan Africa's HIV epidemic.

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HIV infections in sub-Saharan Africa not explained by sexual or vertical transmission

Cited by 102 publications

References 79 publications

Patterns in neurosurgical adverse events: intracranial neoplasm surgery

Patterns in neurosurgical adverse events: intracranial neoplasm surgery

Transmission of HIV-1 infection in sub-Saharan Africa and effect of elimination of unsafe injections

Factors associated with HIV prevalence in a pre-partum cohort of Zambian women

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