Publications by authors named "Makeda J Williams"

20 Publications

  • Page 1 of 1

Scaling Up Science-Based Care for Depression and Unhealthy Alcohol Use in Colombia: An Implementation Science Project.

Psychiatr Serv 2021 Aug 4:appips202000041. Epub 2021 Aug 4.

Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams).

Background: Mental disorders are a major cause of the global burden of disease and significantly contribute to disability and death. This challenge is particularly evident in low- and middle-income countries (LMICs), where >85% of the world's population live. Latin America is one region comprising LMICs where the burden of mental disorders is high and the availability of mental health services is low. This is particularly evident in Colombia, a country with a long-standing history of violence and associated mental health problems.

Methods: This article describes the design of a multisite implementation science project, "Scaling Up Science-Based Mental Health Interventions in Latin America" (also known as the DIADA project), that is being conducted in six primary care systems in Colombia. This project, funded via a cooperative agreement from the National Institute of Mental Health, seeks to implement and assess the impact of a new model for promoting widespread access to mental health care for depression and unhealthy alcohol use within primary care settings and building an infrastructure to support research capacity and sustainability of the new service delivery model in Colombia. This care model centrally harnesses mobile health technology to increase the reach of science-based mental health care for depression and unhealthy alcohol use.

Results: This initiative offers great promise to increase capacity for providing and sustaining evidence-based treatment for depression and unhealthy alcohol use in Colombia.

Next Steps: This project may inform models of care that can extend to other regions of Latin America or other LMICs.
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http://dx.doi.org/10.1176/appi.ps.202000041DOI Listing
August 2021

Barriers and facilitators to the diagnosis and treatment of depression in primary care in Colombia: Perspectives of providers, healthcare administrators, patients and community representatives.

Rev Colomb Psiquiatr (Engl Ed) 2021 Jul 17;50 Suppl 1:64-72. Epub 2021 Jul 17.

Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA.

Introduction: Depression represents a major disease burden in Colombia. To better understand opportunities to improve access to mental healthcare in Colombia, a research team at Javeriana University conducted formative qualitative research to explore stakeholders' experiences with the integration of mental healthcare into the primary care system.

Methods: The research team conducted 16 focus groups and 4 in-depth interviews with patients, providers, health administrators and representatives of community organisations at five primary care clinics in Colombia, and used thematic analysis to study the data.

Results: Themes were organised into barriers and facilitators at the level of patients, providers, organisations and facilities. Barriers to the treatment of depression included stigma, lack of mental health literacy at the patient and provider level, weak links between care levels, and continued need for mental health prioritization at the national level. Facilitators to the management of depression in primary care included patient support systems, strong patient-provider relationships, the targeting of depression interventions and national depression guidelines.

Discussion: This study elucidates the barriers to depression care in Colombia, and highlights action items for further integrating depression care into the primary care setting.
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http://dx.doi.org/10.1016/j.rcpeng.2021.01.001DOI Listing
July 2021

Addressing harmful alcohol use in primary care in Colombia: Understanding the sociocultural context.

Rev Colomb Psiquiatr (Engl Ed) 2021 Jul 16;50 Suppl 1:73-82. Epub 2021 Jul 16.

Center for Technology and Behavioral Health, Department of Psychiatry, Geisel School of Medicine at Dartmouth College.

Harmful alcohol use is a public health problem worldwide, contributing to an estimated 5.1% of the global burden of illness. Screening and addressing at-risk drinking in primary care settings is an empirically supported health care intervention strategy to help reduce the burden of alcohol-use problems. In preparation for introducing screening and treatment for at-risk drinking in primary care clinics in Colombia, we conducted interviews with clinicians, clinic administrators, patients, and participants in Alcoholics Anonymous. Interviews were conducted within the framework of the Detección y Atención Integral de Depresión y Abuso de Alcohol en Atención Primaria (DIADA, [Detection and Integrated Care for Depression and Alcohol Use in Primary Care] www.project-diada.org) research project, and its qualitative phase that consisted of the collection of data from 15 focus groups, 6 interviews and field observations in 5 regional settings. All participants provided informed consent to participate in this research. Findings revealed the association of harmful alcohol use with a culture of consumption, within which it is learned and socially accepted practice. Recognition of harmful alcohol consumption includes a social context that influences its screening, diagnosis and prevention. The discussion highlights how, despite the existence of institutional strategies in healthcare settings and the awareness of the importance of at-risk drinking among health personnel, the recognition of the harmful use of alcohol as a pathology should be embedded in an understanding of historical, social and cultural dimensions that may affect different identification and care scenarios.
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http://dx.doi.org/10.1016/j.rcpeng.2020.11.004DOI Listing
July 2021

Patterns of digital information and communication technology use among patients at primary health care centres in Colombia: Phase I of the DIADA project.

Rev Colomb Psiquiatr (Engl Ed) 2021 Jul 10;50 Suppl 1:116-132. Epub 2021 Jul 10.

Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, USA.

Objective: Assess the prevalence and types of digital technology use, as well as the extent to which patients use the internet and mobile devises. Evaluate the socioeconomic characteristics of patients and the possible relation to patterns of technology use in Colombia. Understand the nature of patient technology use in primary care for finding medical information.

Methods: A survey was applied to adult patients who attended primary health care centers systems in 6 Colombian cities. The survey inquired about demographic characteristics, insurance, access to services, cell phone use, internet access, and the use of such technology to access health-related services and information. Data was collected and managed using REDCap. Summary statistics on each survey item were calculated and the differences between discrete variables were analyzed using chi-square. Multivariate analyses were performed using logistic regression analysis for binary dependent variables.

Results: A total of 1580 patients were surveyed across the six study sites. 93% of the patients reported they have a cell phone. Patients from urban healthcare centers showed a higher use of the Internet on their phone than less urban settings. Around half of the surveyed patients reported Internet use (49.7%). Among Internet users, 65% of participants use the Internet looking for health care information. Around one-third of patients use cellphones to arrange clinic visits. Around 24% of participants answered positively for both Whooley's questions. Of those who screened positive on the Whooley questions, 43% reported being moderately anxious, 47% reported being very anxious. 51% reported having moderate pain; 52% reported having severe pain.

Conclusions: The patterns of technology use identified in this study are essential for developing future health interventions based on ICT. The design of ICT clinical interventions must take into account the cellphone payment plans, availability of internet connection, advantages, and disadvantages of messenger services, including SMS as a possible alternative to people who do not have smartphones.
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http://dx.doi.org/10.1016/j.rcpeng.2021.06.003DOI Listing
July 2021

A characterisation of social media users within the primary care system in Colombia and predictors of their social media use to understand their health.

Rev Colomb Psiquiatr (Engl Ed) 2021 Jul 7;50 Suppl 1:42-51. Epub 2021 Jul 7.

Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, United States.

Introduction: Social media use is growing in Latin America and is increasingly being used in innovative ways. This study sought to characterise the profile of social media users, among primary care patients in Colombia, and to assess predictors of their use of social media to search for health and mental health information (searching behaviour).

Methods: As part of a larger scale-up study, we surveyed 1580 patients across six primary care sites in Colombia about their social media use. We used chi-square and Student's t-tests to assess associations between demographic variables, social media use and searching behaviour, and a Chi-square Automatic Interaction Detector (CHAID) analysis to determine predictors of searching behaviour.

Results: In total, 44.4% of respondents reported that they were social media users. Of these, 35.7% used social media to search for health-related information and 6.6% used it to search for mental health-related information. While the profile of individuals who used social media to search for health-related information was similar to that of general social media users (the highest use was among women living in urban areas), the presence of mental health symptoms was a more important predictor of using social media to search for mental health-related information than demographic variables. Individuals with moderate-severe symptoms of anxiety reported a significantly higher percentage of searching than individuals without symptoms (12.5% vs. 5.2%).

Conclusions: Given that some individuals with mental health disorders turn to social media to understand their illness, social media could be a successful medium for delivering mental health interventions in Colombia.
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http://dx.doi.org/10.1016/j.rcpeng.2021.06.002DOI Listing
July 2021

Barriers and facilitators to the diagnosis and treatment of depression in Primary Care in Colombia: Perspectives of providers, healthcare administrators, patients and community representatives.

Rev Colomb Psiquiatr 2021 Jun 23;50 Suppl 1:67-76. Epub 2021 Mar 23.

Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, Estados Unidos.

Introduction: Depression represents a major disease burden in Colombia. To better understand opportunities to improve access to mental healthcare in Colombia, a research team at Javeriana University conducted formative qualitative research to explore stakeholders' experiences with the integration of mental healthcare into the primary care system.

Methods: The research team conducted 16 focus groups and 4 in-depth interviews with patients, providers, health administrators and representatives of community organisations at 5 primary care clinics in Colombia, and used thematic analysis to study the data.

Results: Themes were organised into barriers and facilitators at the level of patients, providers, organisations and facilities. Barriers to the treatment of depression included stigma, lack of mental health literacy at the patient and provider level, weak links between care levels, and continued need for mental health prioritisation at the national level. Facilitators to the management of depression in primary care included patient support systems, strong patient-provider relationships, the targeting of depression interventions and national depression guidelines.

Discussion: This study elucidates the barriers to depression care in Colombia, and highlights action items for further integrating depression care into the primary care setting.
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http://dx.doi.org/10.1016/j.rcp.2021.01.001DOI Listing
June 2021

A characterisation of social media users within the Primary Care System in Colombia and predictors of their social media use to understand their health.

Rev Colomb Psiquiatr 2021 Jun 19;50 Suppl 1:44-54. Epub 2021 Mar 19.

Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, Estados Unidos.

Introduction: Social media use is growing in Latin America and is increasingly being used in innovative ways. This study sought to characterise the profile of social media users, among primary care patients in Colombia, and to assess predictors of their use of social media to search for health and mental health information (searching behaviour).

Methods: As part of a larger scale-up study, we surveyed 1,580 patients across six primary care sites in Colombia about their social media use. We used chi-square and Student's t-tests to assess associations between demographic variables, social media use and searching behaviour, and a Chi-square Automatic Interaction Detector (CHAID) analysis to determine predictors of searching behaviour.

Results: In total, 44.4% of respondents reported that they were social media users. Of these, 35.7% used social media to search for health-related information and 6.6% used it to search for mental health-related information. While the profile of individuals who used social media to search for health-related information was similar to that of general social media users (the highest use was among women living in urban areas), the presence of mental health symptoms was a more important predictor of using social media to search for mental health-related information than demographic variables. Individuals with moderate-severe symptoms of anxiety reported a significantly higher percentage of searching than individuals without symptoms (12.5% vs. 5.2%).

Conclusions: Given that some individuals with mental health disorders turn to social media to understand their illness, social media could be a successful medium for delivering mental health interventions in Colombia.
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http://dx.doi.org/10.1016/j.rcp.2020.12.010DOI Listing
June 2021

Childhood obesity prevention across borders: A National Institutes of Health commentary.

Obes Rev 2021 06 19;22 Suppl 3:e13243. Epub 2021 Mar 19.

Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA.

In response to the increasing rates of childhood obesity, the United States and countries across Latin America have invested in research that tests innovative strategies and interventions. Despite this, progress has been slow, uneven, and sporadic, calling for increased knowledge exchange and research collaboration that accelerate the adaptation and implementation of promising childhood obesity interventions. To share research results, challenges, and proven intervention strategies among Latin American and US researchers, particularly those working with Latino and Latin American populations, the National Institutes of Health (NIH) convened researchers from the United States and Latin America to highlight synergies between research conducted in Latin America and among Latino populations in the United States with the goal of catalyzing new relationships and identifying common research questions and strategies. This article highlights the NIH's research and priorities in childhood obesity prevention as well as areas for future direction, including overarching NIH plans and NIH institutes, centers, and offices investments in specific areas related to childhood obesity prevention in Latin America and/or among Latino populations in the United States.
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http://dx.doi.org/10.1111/obr.13243DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8365634PMC
June 2021

Addressing harmful alcohol use in Primary Care in Colombia: Understanding the sociocultural context.

Rev Colomb Psiquiatr 2021 Jun 25;50 Suppl 1:77-86. Epub 2021 Feb 25.

Center for Technology and Behavioral Health, Dartmouth College, Hanover, New Hampshire, United States.

Harmful alcohol use is a public health problem worldwide, contributing to an estimated 5.1% of the global burden of illness. Screening and addressing at-risk drinking in primary care settings is an empirically supported health care intervention strategy to help reduce the burden of alcohol-use problems. In preparation for introducing screening and treatment for at-risk drinking in primary care clinics in Colombia, we conducted interviews with clinicians, clinic administrators, patients, and participants in Alcoholics Anonymous. Interviews were conducted within the framework of the Detección y Atención Integral de Depresión y Abuso de Alcohol en Atención Primaria (DIADA [Detection and Integrated Care for Depression and Alcohol Use in Primary Care] www.project-diada.org) research project, and its qualitative phase that consisted of the collection of data from 15 focus groups, 6 interviews and field observations in 5 regional settings. All participants provided informed consent to participate in this research. Findings revealed the association of harmful alcohol use with a culture of consumption, within which it is learned and socially accepted practice. Recognition of harmful alcohol consumption includes a social context that influences its screening, diagnosis and prevention. The discussion highlights how, despite the existence of institutional strategies in healthcare settings and the awareness of the importance of at-risk drinking among health personnel, the recognition of the harmful use of alcohol as a pathology should be embedded in an understanding of historical, social and cultural dimensions that may affect different identification and care scenarios.
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http://dx.doi.org/10.1016/j.rcp.2020.11.016DOI Listing
June 2021

Youth Functioning and Organizational Success for West African Regional Development (Youth FORWARD): Study Protocol.

Psychiatr Serv 2021 05 9;72(5):563-570. Epub 2020 Dec 9.

School of Social Work, Boston College, Chestnut Hill, Massachusetts (Betancourt, Farrar, Borg, Desrosiers, Antonaccio, Brennan); College of Public Health, University of Georgia, Athens (Hansen, Callands); National Institute of Mental Health (NIMH) and National Heart, Lung, and Blood Institute (NHLBI), Bethesda, Maryland (Williams); Caritas Freetown, Freetown, Sierra Leone (Bangura); Women's Study Research Center, Brandeis University, Waltham, Massachusetts (Brennan).

Background: This article describes the incorporation of an evidence-based mental health intervention, the Youth Readiness Intervention (YRI), into a youth entrepreneurship training program in Sierra Leone. A collaborative team approach (CTA) was used as the implementation strategy to address the human resource shortage and related challenges associated with capacity and access to care.

Methods: A cluster randomized quasi-experimental pilot trial (N=175) was conducted in one rural district of Sierra Leone. Pilot data assessed implementation feasibility and clinical effectiveness when using a CTA. A larger hybrid type-2 effectiveness-implementation cluster randomized trial is underway (N=1,151) in three rural districts. Findings on feasibility and fidelity, barriers and facilitators influencing the integration of the YRI into the entrepreneurship program, and clinical effectiveness of the YRI are of interest.

Results: Findings from the pilot study indicated that the YRI can be implemented within a youth entrepreneurship program and provide mental health benefits to youths at high risk of emotion dysregulation and interpersonal deficits. Pilot findings informed the ongoing, larger hybrid type-2 trial to understand barriers and facilitators of the CTA and clinical effectiveness of the YRI within youth employment programming.

Next Steps: In fragile postconflict settings, innovative approaches are needed to address the mental health treatment gap. Findings from this study will support efforts by the government of Sierra Leone and its partners to address human resource challenges and increase access to evidence-based mental health services.
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http://dx.doi.org/10.1176/appi.ps.202000009DOI Listing
May 2021

The effectiveness and cost-effectiveness of integrating mental health services in primary care in low- and middle-income countries: systematic review.

BJPsych Bull 2021 Feb;45(1):40-52

Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, USA.

Aims And Method: This systematic review examines the effectiveness and cost-effectiveness of behavioural health integration into primary healthcare in the management of depression and unhealthy alcohol use in low- and middle-income countries. Following PRISMA guidelines, this review included research that studied patients aged ≥18 years with unhealthy alcohol use and/or depression of any clinical severity. An exploration of the models of integration was used to characterise a typology of behavioural health integration specific for low- and middle-income countries.

Results: Fifty-eight articles met inclusion criteria. Studies evidenced increased effectiveness of integrated care over treatment as usual for both conditions. The economic evaluations found increased direct health costs but cost-effective estimates. The included studies used six distinct behavioural health integration models.

Clinical Implications: Behavioural health integration may yield improved health outcomes, although it may require additional resources. The proposed typology can assist decision-makers to advance the implementation of integrated models.
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http://dx.doi.org/10.1192/bjb.2020.35DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8058938PMC
February 2021

Perspectives, Experiences, and Practices in the Use of Digital Information Technologies in the Management of Depression and Alcohol Use Disorder in Health Care Systems in Colombia.

Qual Health Res 2020 05 13;30(6):906-916. Epub 2020 Feb 13.

Department of Epidemiology and Biostatistics, School of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia.

Digital information technologies are increasingly used in the treatment of mental health disorders. Through this qualitative study, researchers illuminated perspectives, experiences, and practices among diverse stakeholders in the use of digital information technologies in the management of depression and alcohol use disorders in Colombia. In-depth interviews and focus groups were conducted in five primary care institutions across Colombia. Thematic analysis was used to analyze the data. The use of technology in the treatment of mental health disorders can facilitate the , and , as well as Potential barriers to the use of technology in this setting include challenges of , and This study can inform the implementation of digital information technologies in the care of depression and problematic alcohol use within health care systems in Colombia.
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http://dx.doi.org/10.1177/1049732320902460DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265234PMC
May 2020

Assessing the Integration of Behavioral Health Services in Primary Care in Colombia.

Adm Policy Ment Health 2020 05;47(3):435-442

Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia.

Integration of behavioral health care into primary care can improve health and economic outcomes. This study adapted the Behavioral Health Integration in Medical Care (BHIMC) index to the Colombian context and assessed the baseline level of behavioral health integration in a sample of primary care organizations. The BHIMC was able to detect the capacity to provide integrated behavioral care in Colombian settings. Results indicate a minimal to partial integration level across all sites, and that it is possible to measure the degree of integrated care capacity and identify improvement areas for better behavioral health care provision.
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http://dx.doi.org/10.1007/s10488-019-01002-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7159997PMC
May 2020

Subsequent Cancer Prevention and Control Activities Among Low- and Middle-Income Country Participants in the US National Cancer Institute's Summer Curriculum in Cancer Prevention.

J Glob Oncol 2019 10;5:1-9

Center for Global Mental Health Research, National Institute of Mental Health, National Institutes of Health, Bethesda, MD.

Purpose: A dramatic shift in the burden of cancer from high-income countries to low- and middle-income countries (LMICs) is predicted to occur over the next few decades. An effective response requires a range of approaches to capacity building in cancer prevention and control in LMICs, including training of cancer prevention and control professionals. Toward this end, the US National Cancer Institute includes LMIC-based participants in its Summer Curriculum in Cancer Prevention, which is an annual, short-term in-person training program.

Methods: In 2015 and 2016, the US National Cancer Institute fielded a survey to all Summer Curriculum alumni who were based in LMICs when they participated in the program, between 1998 and 2015. Its aims were to learn about subsequent engagement in cancer prevention and control in LMICs and attribution of activities/accomplishments to participation in the Summer Curriculum in Cancer Prevention.

Results: Respondents (N = 138) worked in academia/research (n = 61), health care (n = 41), and health policy/Ministries of Health (n = 36) in all six world regions. Most respondents (90.6%) worked in the same LMIC as when they participated in the Summer Curriculum in Cancer Prevention. When asked about activities/accomplishments completed as a result of participation, 92.8% reported at least one cancer prevention and control practice activity/accomplishment, 81.2% reported at least one cancer research activity/accomplishment, and 44.2% reported authoring one or more peer-reviewed publications. Reported ways that the Summer Curriculum in Cancer Prevention contributed to these activities/accomplishments were emphasizing a public health approach; focusing on research priorities, methods, and scientific writing; and highlighting the importance of research and publications. Finally, 79.7% of respondents reported using Summer Curriculum in Cancer Prevention materials to train others.

Conclusion: These findings have implications for the design of future training initiatives for LMIC-based cancer prevention and control professionals.
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http://dx.doi.org/10.1200/JGO.19.00231DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6825253PMC
October 2019

Joining Forces to Overcome Cancer: The Kenya Cancer Research and Control Stakeholder Program.

J Cancer Policy 2016 Mar;7:36-41

U.S. National Cancer Institute, Center for Global Health.

Background: Cancer is the third leading cause of mortality in Kenya, accounting for 7% of annual deaths. The Kenyan Ministry of Health (MOH) is committed to reducing cancer mortality, as evidenced by policies such as the National Cancer Control Strategy (2011-2016). There are many Kenyan and international organizations devoted to this task; however, coordination is lacking among stakeholders, resulting in inefficient and overlapping expenditure of resources.

Methods: The MOH and the NCI Center for Global Health collaboratively executed a two day workshop to improve coordination among government, NGO, and private organizations. Over 80 stakeholders participated from leading cancer research and control institutions in Kenya and the international sphere.

Findings: Actionable recommendations include: establishment of a nationally representative population-based cancer registry; enhanced training for community health workers, nurses, researchers, pathologists, and oncology specialists; a reconfigured referral process, including leveraging of existing resources to improve access to cancer care; and coordinated community outreach and education. The MOH is in the process of forming a Technical Working Group (TWG) and has elected a Board of Directors for the newly established Kenyan National Cancer Institute (KNCI), with both entities committed to advancing the cancer control work of the MOH.

Interpretation: This stakeholder meeting enhanced in-country networks, identified priority needs and developed actionable proposals for coordinated improvement of cancer research and control. Active, persistent follow-up by the TWG, KNCI, and other partners will be needed to turn proposals into reality and ensure that partners' investments are integrated into larger cancer control efforts prioritized by MOH.
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http://dx.doi.org/10.1016/j.jcpo.2015.12.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4770827PMC
March 2016

Launching an Interactive Cancer Projects Map: A Collaborative Approach to Global Cancer Research and Program Development.

J Glob Oncol 2015 Oct 23;1(1):7-10. Epub 2015 Sep 23.

, National Cancer Institute, Center for Global Health, Bethesda, MD; , Global Oncology, Boston, MA, and University of Hawaii, Honolulu, HI; , Global Oncology, Boston, MA, and Dana-Farber Cancer Institute, Boston, MA; , National Cancer Institute, Center for Global Health, Bethesda, MD; , Global Oncology, Boston, MA, and Broad Institute of MIT and Harvard, Cambridge, MA; , Global Oncology, Boston, MA; , Global Oncology, Boston, MA; , Global Oncology, Boston, MA; , National Cancer Institute, Center for Global Health, Bethesda, MD; , National Cancer Institute, Center for Global Heatlh, Bethesda, MD; , Global Oncology, Boston, MA; , National Cancer Institute, Center for Global Health, Bethesda, MD; , Global Oncology, Boston, MA, and Dana-Farber Cancer Institute, Boston, MA; , Global Oncology, Boston, MA, and Stanford University, Stanford, CA.

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http://dx.doi.org/10.1200/JGO.2015.000034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5551646PMC
October 2015

Building capacity for sustainable research programmes for cancer in Africa.

Nat Rev Clin Oncol 2014 May 11;11(5):251-9. Epub 2014 Mar 11.

University of Oxford, UK.

Cancer research in Africa will have a pivotal role in cancer control planning in this continent. However, environments (such as those in academic or clinical settings) with limited research infrastructure (laboratories, biorespositories, databases) coupled with inadequate funding and other resources have hampered African scientists from carrying out rigorous research. In September 2012, over 100 scientists with expertise in cancer research in Africa met in London to discuss the challenges in performing high-quality research, and to formulate the next steps for building sustainable, comprehensive and multi-disciplinary programmes relevant to Africa. This was the first meeting among five major organizations: the African Organisation for Research and Training in Africa (AORTIC), the Africa Oxford Cancer Foundation (AfrOx), and the National Cancer Institutes (NCI) of Brazil, France and the USA. This article summarizes the discussions and recommendations of this meeting, including the next steps required to create sustainable and impactful research programmes that will enable evidenced-based cancer control approaches and planning at the local, regional and national levels.
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http://dx.doi.org/10.1038/nrclinonc.2014.37DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4403794PMC
May 2014

Evaluation of the impact of NCI's Summer Curriculum on Cancer Prevention on participants from low- and middle-income countries.

J Cancer Educ 2013 Mar;28(1):27-32

National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA,

The National Cancer Institute (NCI) Summer Curriculum on Cancer Prevention provides scientists and health care professionals training in principles and practices of cancer prevention and control, and molecular biology and genetics of cancer. Originally intended for US scientists, the curriculum's enrollment of international scientists has increased steadily. The objective of the current study was to evaluate the curriculum's impact on knowledge, skills, and career accomplishments of the international participants from low- and middle-income countries. International participants from 1998 to 2009 completed questionnaires regarding knowledge, overall experience, and accomplishments directly associated with the curriculum. Almost all respondents agreed that the curriculum enhanced their knowledge and skills, prepared them to contribute to cancer control activities in their home countries, and addressed specific needs and achieve research goals. The NCI Summer Curriculum on Cancer Prevention gives international participants a unique opportunity to enhance their knowledge and effectively contribute to cancer control activities in their home country.
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http://dx.doi.org/10.1007/s13187-013-0455-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3610778PMC
March 2013

Depressive symptoms and interpersonal victimization among African American women attending an urban STD clinic.

Womens Health Issues 2008 Sep-Oct;18(5):375-80

National Cancer Institute, Bethesda, Maryland 20892, USA.

Objectives: This study evaluated the association of depressive symptom levels and interpersonal victimization. The sample was comprised of 455 African American women attending an urban sexually transmitted disease clinic. Interpersonal victimization was defined as whether a woman was forced to have sexual intercourse and whether a woman was ever hit, slap or physically hurt by a boyfriend, girlfriend, or spouse in the past 12 months.

Methods: Using audio computer-assisted self-interviewing (ACASI), women responded to questions regarding interpersonal victimization and depressive symptom levels (e.g., depression, sadness, loneliness and crying in the past week).

Results: Results indicated that women with a history of interpersonal victimization were more likely to experience higher levels of depressive symptoms when compared with women who did not. Statistically significant differences were found for being forced to have sexual intercourse (all p's <0.0001) and ever being hit, slap or physically hurt by a boyfriend, girlfriend, or spouse in the past 12 months (p's range from 0.012 to 0.0003) with regard to each depressive symptom item.

Conclusion: Behavioral women-focused interventions need to address mental health issues associated with risky sexual behaviors in order to be more efficacious.
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http://dx.doi.org/10.1016/j.whi.2008.06.004DOI Listing
December 2008

Perinatal mortality in the normal siblings of anomalous triplets.

Obstet Gynecol 2005 Jun;105(6):1419-23

Department of Maternal and Child Health, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.

Objective: To estimate the risk of survival of unaffected cofetuses of anomalous triplets.

Methods: Retrospective cohort study of triplets delivered in the United States from 1995 through 1998. Four triplet clusters were identified: cluster A (all members anomaly-free); cluster B (1 anomalous member); cluster C (2 anomalous members), and cluster D (all 3 members anomalous). We compared the risk for stillbirth and infant mortality among nonanomalous fetuses in clusters A, B, and C after adjusting for intracluster correlations.

Results: A total of 7,560 triplet clusters (98.9%) were analyzed after excluding cluster D (1.1%). The total stillbirth rate was 20.9 (cluster A), 61.0 (cluster B), and 81.1 (cluster C) per 1,000 (P for trend < .001), and infant mortality rate was 56.4 (cluster A), 108.8 (cluster B), and 196.1 (cluster C) per 1,000 (P for trend < .001). Using cluster A as the referent category, the risk for stillbirth among anomaly-free clustermates climbed with increase in the number of siblings with anomalies in a dose-response pattern (adjusted odds ratio, 95% confidence interval 1.5, 0.7-3.1, for cluster B; and 5.2, 1.4-18.8, for cluster C; P for trend = .03). For infant mortality, the only rise in risk was in cluster C (3.3, 1.6-6.7), whereas cluster B showed comparable risk with the referent category (0.8, 0.5-1.4; P for trend > .05).

Conclusion: The presence of anomalous fetuses compromises the survival of normal cotriplets. These findings could prove useful for counseling affected parents and highlight the need for follow-up of normal coinfants of anomalous fetuses.
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http://dx.doi.org/10.1097/01.AOG.0000161374.70882.22DOI Listing
June 2005
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