Lawrence, MA, United States
Lawrence, MA, United States

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PubMed | Greater Lawrence Family Health Center and University of Massachusetts Amherst
Type: Journal Article | Journal: Childhood obesity (Print) | Year: 2015

This is a retrospective cohort study to evaluate a novel group medical visit (GMV) program using an empowerment curriculum as treatment for pediatric obesity in a federally qualified community health center.Biometric and self-reported data were reviewed from 417 overweight or obese children ages 5-18 attending the pediatric obesity empowerment model GMV program (POEM-GMV) at least twice during a 3-year period. Variables were evaluated using paired means t-test. Pearsons correlation test was used to evaluate variables and the BMI z-score. Subanalysis by gender was performed.The average participant was 10.482.53 years old and participated for 301287 days. BMI z-score reduced from 2.990.96 to 2.880.88 (p<0.0001). Overall, 62.6% of participants had improved weight outcome. Statistically significant improvement was noted in stress, exercise, beverage consumption, fast food intake, television viewing, and bedtime. Stress and beverage consumption had the highest correlation with BMI z-score. By sex, 71.4% of boys (n=196; p<0.0001) and 54.8% (n=221; p<0.014) of girls realized a reduction in BMI z-score, 61.2% (p<0.001) of boys and 47.1% (p=0.097) of girls had a reduction in their percent overweight.POEM-GMV may be a useful approach in the treatment of pediatric obesity in an underserved community. There were statistically significantly improved outcomes in obesity, especially for boys. Significant improvement was observed in many lifestyle factors associated with obesity. Weight loss most closely correlated with reduced stress levels and sugary beverage consumption. Additional studies are needed to further evaluate the efficacy of POEM-GMV.

News Article | December 21, 2016

Barriers to diagnosis and lack of access to modern medications have combined to place caregivers and HIV-positive patients in sub-Saharan Africa between a rock and a hard place. A new study shows that physicians are often forced to choose between controlling seizures, which can occur if the disease goes undiagnosed for too long, or treating the underlying HIV infection. The study was led by Gretchen Birbeck, M.D., M.P.H., the Edward A. and Alma Vollertson Rykenboer Professor in Neurology at University of Rochester Medical Center (URMC). Birbeck also serves as director of the Epilepsy Care Team at Chikankata Hospital in rural Zambia and is an honorary lecturer at the University of Zambia. While the study, which appears in the journal Neurology, was undertaken for the purpose of identifying risk factors for seizures in HIV-positive patients and thereby providing physicians with a blueprint for care, it has instead highlighted the difficult decisions that providers and patients must confront. Seizures are a common symptom in individuals with advanced stage HIV. At least 11 percent of people with the infection will have a seizure at some point if the disease is undiagnosed and not treated. In many parts of Africa there are still significant social and economic barriers that prevent people from being tested for HIV. Consequently, for some individuals the first time there are diagnosed with the disease is after they have been brought to the hospital following a seizure. Once this occurs, caregivers are forced into a no-win situation. Because the HIV infection is often advanced, the appropriate course of action is to aggressively start a treatment of combined antiretroviral therapy (cART). However, at the same time there is a sense of pressure and urgency to treat the seizures as well, which represent a significant health risk if left unaddressed. The dilemma exists due to limited treatment options. Most African regions with high rates of HIV infection continue to rely largely on older, enzyme-inducing antiepileptic drugs (AED) for seizure management. Unlike newer anti-seizure treatments, these AEDs are known to interfere with cART, making the HIV treatment less effective. Not only does this interaction place the patients at greater risk from death from the disease - a third of the patients were dead within a year of their first visit to the hospital - but it could also give rise to drug-resistant strains of HIV. While the long term solution is to increase access to newer anti-seizure drugs, the authors believe that the priority should be to reconstitute the immune system by getting patients on cART as soon as possible. They acknowledge that a treatment approach that omits AEDs leaves patients vulnerable to a reoccurrence of seizures, but believe that the HIV infection poses the far greater health risk in the long term. Additional co-authors include Omar Siddiqi and Igor Koralnik with Beth Israel Deaconess Medical Center, Melissa Elafros with Michigan State University, Christopher Bositis with the Greater Lawrence Family Health Center, William Theodore with the National Institutes of Health, Jason Okulicz with the San Antonio Military Medical Center, Lisa Kalungwana with the University of Zambia, Izukanji Sikazwe with the Centre for Infectious Disease Research in Zambia, and Michael Potchen with URMC Department of Imaging Sciences. The study was supported with grants from the Fogarty International Center and the National Institute of Neurological Disorders and Stroke.

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 Hospital | van Dijk J.H.,Erasmus University Rotterdam | Sutcliffe C.G.,Johns Hopkins University | Hamangaba F.,Macha Hospital | 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.

Catic A.G.,Baylor College of Medicine | Mattison M.L.P.,Beth Israel Deaconess Medical Center | Bakaev I.,Lawrence General Hospital | Bakaev I.,Greater Lawrence Family Health Center | And 4 more authors.
Journal of the American Medical Directors Association | Year: 2014

Objectives: To design, implement, and assess the pilot phase of an innovative, remote case-based video-consultation program called ECHO-AGE that links experts in the management of behavior disorders in patients with dementia to nursing home care providers. Design: Pilot study involving surveying of participating long-term care sites regarding utility of recommendations and resident outcomes. Setting: Eleven long-term care sites in Massachusetts and Maine. Participants: An interprofessional specialty team at a tertiary care center and staff from 11 long-term care sites. Intervention: Long-term care sites presented challenging cases regarding residents with dementia and/or delirium related behavioral issues to specialists via video-conferencing. Methods: Baseline resident characteristics and follow-up data regarding compliance with ECHO-AGE recommendations, resident improvement, hospitalization, and mortality were collected from the long-term care sites. Results: Forty-seven residents, with a mean age of 82years, were presented during the ECHO-AGE pilot period. Eighty-three percent of residents had a history of dementia and 44% were taking antipsychotic medications. The most common reasons for presentation were agitation, intrusiveness, and paranoia. Behavioral plans were recommended in 72.3% of patients. Suggestions for medication adjustments were also frequent. ECHO-AGE recommendations were completely or partially followed in 88.6% of residents. When recommendations were followed, sites were much more likely to report clinical improvement (74% vs 20%, P<.03). Hospitalization was also less common among residents for whom recommendations were followed. Conclusions: The results suggest that a case-based video-consultation program can be successful in improving the care of elders with dementia and/or delirium related behavioral issues by linking specialists with long-term care providers. © 2014.

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.

Geller J.S.,Greater Lawrence Family Health Center | Orkaby A.,Boston Medical Center | Cleghorn G.D.,Greater Lawrence Family Health Center
Explore: The Journal of Science and Healing | Year: 2011

Context: Movement toward the Medical Home and group medical visits (GMV). Objective: To investigate the impact of a GMV program in an underserved Latino community. Design: Year-long observational community-based research pilot study evaluating the impact of twice weekly GMVs on quality of life, depression, and loneliness in Latinos with diabetes and other risk factors for heart disease. Setting: The Greater Lawrence Family Health Center in Lawrence, MA. Approved by the Tufts University review committee on human subjects as part of the CDC funded Latino Health 2010 initiative to evaluate and eliminate health disparities in minority populations. IRB # 5243. Patients: Fifty-seven Latino adults with diabetes and heart disease risk factors. Interventions: Participants had two intervention opportunities weekly, including the GMV. Main Outcome Measures: Despite a high dropout rate, and baseline differences between groups, we found reduced depression and loneliness and improved quality-of-life indicators for participants with high attendance to GMVs during one year compared to those with low attendance. Mean depression scores in high attendees, measured by the Zung Depression Scale, improved from 46.83 to 38.85 (p < .001). Mean loneliness scores for high attendees, measured by the UCLA Loneliness Questionnaire, improved from 49.61 to 37.6 (P < .001). Quality-of-life indicators, measured by SF 36, showed statistically significant improvement in general health, vitality, bodily pain, mental health, and role-emotional (P < .05). High attendees also maintained constant weight with the average decreasing slightly during the year-long intervention. Results: Attending GMVs regularly was associated with improved health-related quality of life, decreased loneliness, decreased depression, and no weight gain. Despite a high dropout rate there were many participants mainly female. More research is needed. © 2011 Elsevier Inc.

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.

PubMed | Greater Lawrence Family Health Center, University of Rochester, Michigan State University, Health-U and 4 more.
Type: Journal Article | Journal: HIV medicine | Year: 2016

The aim of the study was to describe patient characteristics and outcomes among HIV-positive adults presenting to a Zambian tertiary care hospital with new-onset seizures.From July 2011 to June 2013, adults with seizures and a known or probable diagnosis of HIV infection were screened for a cohort study. Demographic and clinical data were obtained, including information on engagement in HIV services and in-patient mortality. Analyses were conducted to identify characteristics associated with poor engagement in care and death.A total of 320 of 351 screened adults were HIV-positive, with 268 of 320 experiencing new-onset seizures. Of these, 114 of 268 (42.5%) were female, and their mean age was 36.8 years. Seventy-nine of the 268 patients (29.5%) were diagnosed with HIV infection during the index illness. Among those who were aware of their HIV-positive status, 59 of 156 (37.8%) had disengaged from care. Significant functional impairment (Karnofsky score <50) was evident in 44.0% of patients. Cerebrospinal fluid was not obtained in 108 of 268 (40.3%). In-patient mortality outcomes were available for 214 patients, and 47 of these 214 (22.0%) died during hospitalization. Patients with significant functional impairment were more likely to undergo lumbar puncture (P=0.046). Women and the functionally impaired were more likely to die (P=0.04 and <0.001, respectively).Despite the availability of care, less than half of HIV-infected people with new-onset seizures were actively engaged in care and in-patient mortality rates were high. In the absence of clinical contraindication, lumbar puncture should be performed to diagnose treatable conditions and reduce morbidity and mortality. Continued efforts are needed to expand community-based testing and improve HIV care retention rates. Qualitative studies are needed to elucidate factors contributing to lumbar puncture usage in this population.

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