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Lawrence, MA, United States

Ockene I.S.,University of Massachusetts Medical School | Tellez T.L.,Greater Lawrence Family Health Center | Rosal M.C.,University of Massachusetts Amherst | Reed G.W.,University of Massachusetts Amherst | And 6 more authors.
American Journal of Public Health | Year: 2012

Objectives. We tested the effectiveness of a community-based, literacysensitive, and culturally tailored lifestyle intervention on weight loss and diabetes risk reduction among low-income, Spanish-speaking Latinos at increased diabetes risk. Methods. Three hundred twelve participants from Lawrence, Massachusetts, were randomly assigned to lifestyle intervention care (IC) or usual care (UC) between 2004 and 2007. The intervention was implemented by trained Spanishspeaking individuals from the community. Each participant was followed for 1 year. Results. The participants' mean age was 52 years; 59% had less than a high school education. The 1-year retention rate was 94%. Compared with the UC group, the IC group had a modest but significant weight reduction (-2.5 vs 0.63 lb; P=.04) and a clinically meaningful reduction in hemoglobin A1c (-0.10% vs -0.04%; P=.009). Likewise, insulin resistance improved significantly in the IC compared with the UC group. The IC group also had greater reductions in percentage of calories from total and saturated fat. Conclusions. We developed an inexpensive, culturally sensitive diabetes prevention program that resulted in weight loss, improved HbA1c, and improved insulin resistance in a high-risk Latino population.

van Dijk J.H.,Macha Research Trust | van Dijk J.H.,Erasmus University Rotterdam | Sutcliffe C.G.,Johns Hopkins University | Hamangaba F.,Macha Research Trust | And 3 more authors.
PLoS ONE | Year: 2013

Background: Antiretroviral treatment (ART) options for young children co-infected with HIV and tuberculosis are limited in resource-poor settings due to limited data on the use of efavirenz (EFV). Using available pharmacokinetic data, an EFV dosing schedule was developed for young co-infected children and implemented as the standard of care at Macha Hospital in Southern Province, Zambia. Treatment outcomes inchildren younger than 3 years of age or weighing less than 10 kg receiving either EFV-based ART plus anti-tuberculous treatment or nevirapine-based (NVP) ART were compared. Methods: Treatment outcomes were measured in a cohort of HIV-infected children seeking care at Macha Hospital in rural Zambia from 2007 to 2010. Informationon the diagnosis and treatment of tuberculosis was abstracted from medical records. Results: Forty-five children treated for tuberculosis initiated an EFV-based regimen and 69 children initiated a NVP-based regimen, 7 of whom also were treated for tuberculosis. Children receiving both regimens were comparable in age, but children receiving EFV started ART with a lower CD4+ T-cell percentage and weight-for-age z-score. Children receiving EFV experienced increases in both CD4+ T-cell percentage and weight-for-age z-score during follow-up, such that levels were comparable to children receiving NVP after two years of ART. Cumulative survival after 12 months of ART did not differ between groups (NVP:87%;EFV:80%;p = 0.25). Eleven children experienced virologic failure during follow-up.The adjusted hazard ratio of virologic failure comparing EFV to NVP was 0.25 (95% CI:0.05,1.24) and 0.13 (95% CI:0.03,0.62) using thresholds of 5000 and 400 copies/mL, respectively.Five children receiving EFV were reported to have had convulsions after ART initiation compared to only one child receiving NVP (p = 0.04). Conclusions: Despite poorer health at ART initiation, children treated for tuberculosis and receiving EFV-based regimens showed significant improvements comparable to children receiving NVP-based regimens. EFV-based regimens should be considered for young HIV-infected children co-infected with tuberculosis in resource-limited settings. © 2013 van Dijk et al.

McKersie R.C.,Greater Lawrence Family Health Center
Annals of family medicine | Year: 2010

On January 12, 2010, a 7.0 magnitude earthquake struck Haiti. All told, more than 240,000 perished; another 200,000 were injured; and one-half of the city's 2,000,000 residents were left homeless. In March I volunteered with Medishare to help with the relief effort. Being a family physician, broadly trained in all aspects of medicine, I knew many of my skills would be needed. In the 7 days I was in Haiti, I worked excruciatingly long hours, witnessed the sorrow of death and joy of birth, and was continually confronted with the challenge of giving adequate and meaningful health care in a broken country. I learned that the physical and emotional toll on those who provide care in a crisis like Haiti is immense and unrelenting. But most importantly, I left Haiti with a renewed belief in what humans are able to accomplish when we all work together for a common purpose.

Krolikowski A.M.,Greater Lawrence Family Health Center | Koyfman A.,Illinois College
African Journal of Emergency Medicine | Year: 2014

Methamphetamine and MDMA have been called safe drugs of abuse. Worldwide there is an increased consumption of these drugs, which has become a focus of research in South Africa. As the number of methamphetamine users has increased in many African countries, it is essential that emergency care practitioners are able to diagnose and manage intoxication with methamphetamine, MDMA, and other derivatives. The most common presentations include restlessness, agitation, hypertension, tachycardia, and headache while hyperthermia, hyponatraemia, and rhabdomyolysis are among the most common serious complications. Most deaths are secondary to hyperthermia complicated by multiple organ failure. A number of laboratory analyses should be obtained if locally available. We provide a review of the current recommended general and specific management approaches. Benzodiazepines are the first line therapy for hyperthermia, agitation, critical hypertension, and seizures. Patients with serious complications are best managed in an intensive care unit if available. Emergency centres should create protocols and/or further train staff in the recognition and management of intoxication with these 'not so safe' drugs. © 2013 Production and hosting by Elsevier on behalf of African Federation for Emergency Medicine.

Barr W.B.,Greater Lawrence Family Health Center | Aslam S.,Lake Erie College | Levin M.,Yeshiva University
Family Medicine | Year: 2011

BACKGROUND: There is a growing trend within family medicine residency training programs to implement group prenatal care programs. While the clinical benefits of group prenatal care have been well documented, there have been no published studies to date evaluating the educational impact of using group prenatal care in residency training programs. METHODS: A retrospective cohort study of both patient care performance and outcome measures over a 4-year time span in a pre- and post-intervention design in a single family medicine training program was used. RESULTS: A total of 184 women were cared for by residents educated under the old curriculum, and 195 women were cared for under the new curriculum. Patients cared for by residents under the new curriculum had significantly fewer cesarean sections compared to patients cared for under the old curriculum (17.53% versus 26.92%) and also trended toward having a lower rate of preterm births (4.15% versus 8.33%) that reached significance when controlled for parity and insurance status. CONCLUSIONS: The ultimate measure of how well we train our residents is how well they care for their patients. Our evaluation of teaching residents maternity care through group prenatal visits and the IMPLICIT quality improvement initiative found that we improved not only several processes of care outcomes but most importantly the key maternity care outcomes of cesarean section and preterm birth rates.

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