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  1. Article ; Online: Fever and Neck Pain in an Adolescent: A Case Report.

    Starnes, Lauren S / Starnes, Joseph R / Ghafuri, Djamila / Charnogursky, Cara / Duffus, Sara / Fritz, Cristin

    Clinical pediatrics

    2023  Volume 63, Issue 4, Page(s) 560–563

    MeSH term(s) Humans ; Adolescent ; Neck Pain/etiology ; Fever/etiology ; Fever/diagnosis ; Diagnosis, Differential ; Neck/diagnostic imaging
    Language English
    Publishing date 2023-05-30
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 207678-0
    ISSN 1938-2707 ; 0009-9228
    ISSN (online) 1938-2707
    ISSN 0009-9228
    DOI 10.1177/00099228231176704
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Feasibility of focused cardiac ultrasound training for non-cardiologists in a resource-limited setting using a handheld ultrasound machine.

    Acheampong, Benjamin / Starnes, Joseph R / Awuku, Yaw A / Parra, David / Aliyu, Muktar H / Soslow, Jonathan

    Cardiovascular journal of Africa

    2022  Volume 33, Page(s) 1–5

    Abstract: Background: Heart disease remains a leading cause of morbidity and mortality, particularly in low- and middle-income countries. Access to diagnostic modalities is limited in these settings. Limited echocardiographic studies performed by non- ... ...

    Abstract Background: Heart disease remains a leading cause of morbidity and mortality, particularly in low- and middle-income countries. Access to diagnostic modalities is limited in these settings. Limited echocardiographic studies performed by non-cardiologists can increase access, improve diagnosis and allow for earlier medical therapy.
    Methods: Two internal medicine residents at a tertiary-level hospital in Ghana were trained to perform limited echocardiographic studies. Each trainee performed 50 echocardiograms and interpreted 20 studies across three predetermined timepoints. Interpretation was compared to expert interpretation.
    Results: Agreement improved over time. At the final evaluation, there was high agreement across all aspects: left ventricular structure (70%, kappa 0.52,
    Conclusions: Non-cardiologists can be trained in focused echocardiography using handheld machines. Such training can increase access to diagnostic capabilities in resource-limited settings.
    Language English
    Publishing date 2022-12-14
    Publishing country South Africa
    Document type Journal Article
    ZDB-ID 2383233-2
    ISSN 1680-0745 ; 1996-3467 ; 1015-9657 ; 1995-1892
    ISSN (online) 1680-0745 ; 1996-3467
    ISSN 1015-9657 ; 1995-1892
    DOI 10.5830/CVJA-2022-057
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Training and experience outperform literacy and formal education as predictors of community health worker knowledge and performance, results from Rongo sub-county, Kenya.

    Rogers, Ash / Goore, Lou L / Wamae, Jane / Starnes, Joseph R / Okong'o, Stephen O / Okoth, Vincent / Mudhune, Sandra

    Frontiers in public health

    2023  Volume 11, Page(s) 1120922

    Abstract: Introduction: There is a growing recognition that Community Health Workers are effective at improving health outcomes and expanding health access. However, the design elements that lead to high-quality Community Health Worker programing are relatively ... ...

    Abstract Introduction: There is a growing recognition that Community Health Workers are effective at improving health outcomes and expanding health access. However, the design elements that lead to high-quality Community Health Worker programing are relatively understudied. We looked at the predictors of Community Health Worker knowledge of obstetric and early infant danger signs as well as performance in achieving antenatal care and immunization uptake among their clients.
    Methods: The study takes place in the context of an intervention implemented jointly by Lwala Community Alliance and the Kenya Ministry of Health which sought to professionalize Community Health Worker cadres through enhanced training, payment, and supervision. There were four cohorts included in the study. Two cohorts started receiving the intervention prior to the baseline, one cohort received the intervention between the baseline and endline, and a final cohort did not receive the intervention. Data on Community Health Worker demographics, knowledge tests, and key performance indicators were collected for 234 Community Health Workers. Regression analyses were used to explore education, literacy, experience, training, and gender as potential predictors of CHW performance.
    Results: We found that clients of Community Health Workers trained through the intervention were 15% more likely to be fully immunized and 14% more likely to have completed four or more antenatal care visits. Additionally, recency of training and experience caring for pregnant women were associated with increased Community Health Worker knowledge. Finally, we found no association between gender and CHW competency and tenuous associations between education/literacy and Community Health Worker competency.
    Discussion: We conclude that the intervention was predictive of increased Community Health Worker performance and that recency of training and experience were predictive of increased knowledge. Though education and literacy are often used in the selection processes of Community Health Workers globally, the link between these characteristics and Community Health Worker knowledge and performance are mixed. Thus, we encourage further research into the predictive value of common Community Health Worker screening and selection tools. Further, we encourage policymakers and practitioners to reconsider the use of education and literacy as means of Community Health Worker selection.
    MeSH term(s) Infant ; Female ; Humans ; Pregnancy ; Community Health Workers ; Literacy ; Kenya ; Pregnant Women ; Prenatal Care
    Language English
    Publishing date 2023-04-27
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2711781-9
    ISSN 2296-2565 ; 2296-2565
    ISSN (online) 2296-2565
    ISSN 2296-2565
    DOI 10.3389/fpubh.2023.1120922
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Novel Cardiac Imaging Risk Score for Mortality Prediction in Duchenne Muscular Dystrophy.

    Starnes, Joseph R / Crum, Kimberly / George-Durrett, Kristen / Godown, Justin / Parra, David A / Markham, Larry W / Soslow, Jonathan H

    Pediatric cardiology

    2022  

    Abstract: Cardiovascular disease is the leading cause of death in patients with Duchenne Muscular Dystrophy (DMD), but there is significant cardiomyopathy phenotypic variability. Some patients demonstrate rapidly progressive disease and die at a young age while ... ...

    Abstract Cardiovascular disease is the leading cause of death in patients with Duchenne Muscular Dystrophy (DMD), but there is significant cardiomyopathy phenotypic variability. Some patients demonstrate rapidly progressive disease and die at a young age while others survive into the fourth decade. Criteria to identify DMD subjects at greatest risk for early mortality could allow for increased monitoring and more intensive therapy. A risk score was created describing the onset and progression of left ventricular dysfunction and late gadolinium enhancement in subjects with DMD. DMD subjects prospectively enrolled in ongoing observational studies (which included cardiac magnetic resonance [CMR]) were used to validate the risk score. A total of 69 subjects had calculable scores. During the study period, 12 (17%) died from complications of DMD. The median risk score was 3 (IQR [2,5]; range [0,9]). The overall risk score applied at the most recent imaging age was associated with mortality at a median age of 17 years (IQR [16,20]) (HR 2.028, p < 0.001). There were no deaths in subjects with a score of less than two. Scores were stable over time. An imaging-based risk score allows risk stratification of subjects with DMD. This can be quickly calculated during a clinic visit to identify subjects at greatest risk of early death.
    Language English
    Publishing date 2022-11-02
    Publishing country United States
    Document type Journal Article
    ZDB-ID 800857-7
    ISSN 1432-1971 ; 0172-0643
    ISSN (online) 1432-1971
    ISSN 0172-0643
    DOI 10.1007/s00246-022-03040-6
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Clinical prediction model: Multisystem inflammatory syndrome in children versus Kawasaki disease.

    Starnes, Lauren S / Starnes, Joseph R / Stopczynski, Tess / Amarin, Justin Z / Charnogursky, Cara / Hayek, Haya / Talj, Rana / Parra, David A / Clark, Daniel E / Patrick, Anna E / Katz, Sophie E / Howard, Leigh M / Peetluk, Lauren / Rankin, Danielle / Spieker, Andrew J / Halasa, Natasha B

    Journal of hospital medicine

    2024  Volume 19, Issue 3, Page(s) 175–184

    Abstract: Background: Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious complication of severe acute respiratory syndrome coronavirus 2 infection. Features of MIS-C overlap with those of Kawasaki disease (KD).: Objective: The study ... ...

    Abstract Background: Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious complication of severe acute respiratory syndrome coronavirus 2 infection. Features of MIS-C overlap with those of Kawasaki disease (KD).
    Objective: The study objective was to develop a prediction model to assist with this diagnostic dilemma.
    Methods: Data from a retrospective cohort of children hospitalized with KD before the coronavirus disease 2019 pandemic were compared to a prospective cohort of children hospitalized with MIS-C. A bootstrapped backwards selection process was used to develop a logistic regression model predicting the probability of MIS-C diagnosis. A nomogram was created for application to individual patients.
    Results: Compared to children with incomplete and complete KD (N = 602), children with MIS-C (N = 105) were older and had longer hospitalizations; more frequent intensive care unit admissions and vasopressor use; lower white blood cell count, lymphocyte count, erythrocyte sedimentation rate, platelet count, sodium, and alanine aminotransferase; and higher hemoglobin and C-reactive protein (CRP) at admission. Left ventricular dysfunction was more frequent in patients with MIS-C, whereas coronary abnormalities were more common in those with KD. The final prediction model included age, sodium, platelet count, alanine aminotransferase, reduction in left ventricular ejection fraction, and CRP. The model exhibited good discrimination with AUC 0.96 (95% confidence interval: [0.94-0.98]) and was well calibrated (optimism-corrected intercept of -0.020 and slope of 0.99).
    Conclusions: A diagnostic prediction model utilizing admission information provides excellent discrimination between MIS-C and KD. This model may be useful for diagnosis of MIS-C but requires external validation.
    MeSH term(s) Child ; Humans ; Alanine Transaminase ; Mucocutaneous Lymph Node Syndrome/complications ; Mucocutaneous Lymph Node Syndrome/diagnosis ; Prospective Studies ; Retrospective Studies ; Stroke Volume ; Ventricular Function, Left ; COVID-19/complications ; Sodium ; Systemic Inflammatory Response Syndrome
    Chemical Substances Alanine Transaminase (EC 2.6.1.2) ; Sodium (9NEZ333N27)
    Language English
    Publishing date 2024-01-28
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2233783-0
    ISSN 1553-5606 ; 1553-5592
    ISSN (online) 1553-5606
    ISSN 1553-5592
    DOI 10.1002/jhm.13290
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Rate of Change in Cardiac Magnetic Resonance Imaging Measures Is Associated With Death in Duchenne Muscular Dystrophy.

    Starnes, Joseph R / Xu, Meng / George-Durrett, Kristen / Crum, Kimberly / Raucci, Frank J / Spurney, Christopher F / Hor, Kan N / Cripe, Linda H / Husain, Nazia / Buddhe, Sujatha / Gambetta, Katheryn / Tamaroff, Jaclyn / Slaughter, James C / Markham, Larry W / Soslow, Jonathan H

    Journal of the American Heart Association

    2024  Volume 13, Issue 9, Page(s) e032960

    Abstract: Background: Cardiovascular disease is the leading cause of death among patients with Duchenne muscular dystrophy (DMD). Identifying patients at risk of early death could allow for increased monitoring and more intensive therapy. Measures that associate ... ...

    Abstract Background: Cardiovascular disease is the leading cause of death among patients with Duchenne muscular dystrophy (DMD). Identifying patients at risk of early death could allow for increased monitoring and more intensive therapy. Measures that associate with death could serve as surrogate outcomes in clinical trials.
    Methods and results: Duchenne muscular dystrophy subjects prospectively enrolled in observational studies were included. Models using generalized least squares were used to assess the difference of cardiac magnetic resonance measurements between deceased and alive subjects. A total of 63 participants underwent multiple cardiac magnetic resonance imaging and were included in the analyses. Twelve subjects (19.1%) died over a median follow-up of 5 years (interquartile range, 3.1-7.0). Rate of decline in left ventricular ejection fraction was faster in deceased than alive subjects (
    Conclusions: Duchenne muscular dystrophy death is associated with the rate of change in left ventricular ejection fraction, midcircumferential strain, and ventricular volumes. Aggressive medical therapy to decrease the rate of progression may improve the mortality rate in this population. A decrease in the rate of progression may serve as a valid surrogate outcome for therapeutic trials.
    MeSH term(s) Humans ; Muscular Dystrophy, Duchenne/mortality ; Muscular Dystrophy, Duchenne/physiopathology ; Muscular Dystrophy, Duchenne/diagnostic imaging ; Muscular Dystrophy, Duchenne/complications ; Stroke Volume/physiology ; Male ; Ventricular Function, Left ; Adolescent ; Child ; Prospective Studies ; Magnetic Resonance Imaging, Cine/methods ; Disease Progression ; Magnetic Resonance Imaging ; Young Adult ; Predictive Value of Tests ; Risk Factors ; Time Factors ; Prognosis
    Language English
    Publishing date 2024-04-30
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Observational Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 2653953-6
    ISSN 2047-9980 ; 2047-9980
    ISSN (online) 2047-9980
    ISSN 2047-9980
    DOI 10.1161/JAHA.123.032960
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article: Prevalence and determinants of contraception utilization over time in Migori County, Kenya: Repeated cross-sectional household surveys.

    Li, Andria N / Starnes, Joseph R / Omondi, Alyn / Were, Vincent / Vill, Beffy / Were, Lawrence P O / Oyugi, Samuel / Edelquinn, Mumma / Mudhune, Sandra / Mbeya, Julius / Rogers, Ash / Wamai, Richard / Moon, Troy D

    African journal of reproductive health

    2023  Volume 27, Issue 6, Page(s) 17–26

    Abstract: Contraception use and family planning have been shown to save lives and benefit women, their families, and their communities. We conducted a cross-sectional study analyzing data from a 2021 survey that was conducted across eight different regions in ... ...

    Abstract Contraception use and family planning have been shown to save lives and benefit women, their families, and their communities. We conducted a cross-sectional study analyzing data from a 2021 survey that was conducted across eight different regions in Migori County, Kenya to examine the potential role that different factors play in meeting family planning targets. Comparisons are made to data collected in 2018/2019 in order to estimate the change over time of contraception uptake. Descriptive statistics were calculated, the Cochran-Mantel-Haenszel test was used to compare contraception use over time, and multivariable logistic regression was used to model determinants of contraceptive use. Sixty-four percent of respondents in 2021 reported that they currently use some form of contraception, and implants are the most popular contraceptive method. Factors associated with higher contraception usage were region, ages 25-34 years, and marital status. Contraception uptake increased significantly in East Kamagambo following a community-driven sexual and reproductive health intervention by the Lwala Community Alliance, suggesting that increased investment in family planning may be influential. We recommend targeted outreach to population groups with low uptake of contraception and investment in both demand- and supply-side interventions to increase contraceptive uptake. Additional research, especially for populations under 18, is needed to further inform effective investment and policy.
    MeSH term(s) Female ; Humans ; Cross-Sectional Studies ; Kenya ; Prevalence ; Contraception ; Contraceptive Agents
    Chemical Substances Contraceptive Agents
    Language English
    Publishing date 2023-07-31
    Publishing country Nigeria
    Document type Journal Article
    ZDB-ID 2111906-5
    ISSN 1118-4841
    ISSN 1118-4841
    DOI 10.29063/ajrh2023/v27i6.2
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  8. Article: Incidence and types of congenital heart disease at a referral hospital in Jordan: retrospective study from a tertiary center.

    Hasan, Abeer A / Abu Lehyah, Naser Aldain A / Al Tarawneh, Moath K / Abbad, Mahmoud Y / Fraijat, Areen G / Al-Jammal, Razan A / Moamar, Dania M / Shersheer, Qasem A / Guthrie, Scott O / Starnes, Joseph R

    Frontiers in pediatrics

    2023  Volume 11, Page(s) 1261130

    Abstract: Background: Congenital heart disease (CHD) is the most common birth defect and accounts for significant global morbidity and mortality. Relatively little is known about the epidemiology of CHD in Jordan or the manner in which CHD is identified.: ... ...

    Abstract Background: Congenital heart disease (CHD) is the most common birth defect and accounts for significant global morbidity and mortality. Relatively little is known about the epidemiology of CHD in Jordan or the manner in which CHD is identified.
    Methods: A retrospective medical record review was conducted for all neonates who had an abnormal echocardiogram performed at a tertiary referral hospital. All included neonates had echocardiography performed by the same pediatric cardiologist at the discretion of the treatment team. Descriptive statistics were used to describe CHD incidence, types of CHD identified, and mechanism of identification.
    Results: The incidence of congenital heart disease was 17.8 per 1,000 live births. This rose to 24.6 per 1,000 if patent ductus arteriosus in preterm infants was included. The most common identified abnormalities were PDA, atrial septal defects, persistent pulmonary hypertension, septal hypertrophy, and ventricular septal defects. Most children were evaluated either for a murmur heard on exam or as a part of screening due to other comorbidities or risk factors. Less than 1% of children had a prenatal diagnosis. There was a higher rate of persistent pulmonary hypertension during the COVID-19 pandemic than before (
    Conclusions: There is a high incidence of CHD in Jordan. Increased prenatal and perinatal screening for CHD may allow for earlier detection.
    Language English
    Publishing date 2023-09-15
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2711999-3
    ISSN 2296-2360
    ISSN 2296-2360
    DOI 10.3389/fped.2023.1261130
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  9. Article ; Online: Childhood mortality and associated factors in Migori County, Kenya: evidence from a cross-sectional survey.

    Starnes, Joseph R / Rogers, Ash / Wamae, Jane / Okoth, Vincent / Mudhune, Sandra A / Omondi, Alyn / Were, Vincent / Baraza Awino, Doreen / Lefebvre, Christina Hope / Yap, Samantha / Otieno Odhong, Tom / Vill, Beffy / Were, Lawrence / Wamai, Richard

    BMJ open

    2023  Volume 13, Issue 8, Page(s) e074056

    Abstract: Objectives: The under-five mortality (U5M) rate in Kenya (41 per 1000 live births) remains significantly above international goals (25 per 1000 live births). This is further exacerbated by regional inequalities in mortality. We aimed to describe U5M in ... ...

    Abstract Objectives: The under-five mortality (U5M) rate in Kenya (41 per 1000 live births) remains significantly above international goals (25 per 1000 live births). This is further exacerbated by regional inequalities in mortality. We aimed to describe U5M in Migori County, Kenya, and identify associated factors that can serve as programming targets.
    Design: Cross-sectional observational survey.
    Setting: Areas served by the Lwala Community Alliance and control areas in Migori County, Kenya.
    Participants: This study included 15 199 children born to respondents during the 18 years preceding the survey.
    Primary and secondary outcome measures: The primary outcome was mortality in the first 5 years of life. The survey was powered to detect a 10% change in various health metrics over time with 80% power.
    Results: A total of 15 199 children were included in the primary analyses, and 230 (1.5%) were deceased before the fifth birthday. The U5M rate from 2016 to 2021 was 32.2 per 1000 live births. Factors associated with U5M included year of birth (HR 0.926, p<0.001), female sex (HR 0.702, p=0.01), parental marriage (HR 0.642, p=0.036), multiple gestation pregnancy (HR 2.776, p<0.001), birth spacing less than 18 months (HR 1.894, p=0.005), indoor smoke exposure (HR 1.916, p=0.027) and previous familial contribution to the National Hospital Insurance Fund (HR 0.553, p=0.009). The most common cause of death was malaria.
    Conclusions: We describe factors associated with childhood mortality in a Kenyan community using survival analyses of complete birth histories. Mortality rates will serve as the baseline for future programme evaluation as a part of a 10-year study design. This provides both the hyperlocal information needed to improve programming and generalisable conclusions for other organisations working in similar environments.
    MeSH term(s) Child ; Female ; Humans ; Pregnancy ; Birth Intervals ; Child Mortality ; Cross-Sectional Studies ; Kenya/epidemiology
    Chemical Substances HR 916
    Language English
    Publishing date 2023-08-22
    Publishing country England
    Document type Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2023-074056
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  10. Article ; Online: Characterizing multidimensional poverty in Migori County, Kenya and its association with depression.

    Starnes, Joseph R / Di Gravio, Chiara / Irlmeier, Rebecca / Moore, Ryan / Okoth, Vincent / Rogers, Ash / Ressler, Daniele J / Moon, Troy D

    PloS one

    2021  Volume 16, Issue 11, Page(s) e0259848

    Abstract: Introduction: Narrow, unidimensional measures of poverty often fail to measure true poverty and inadequately capture its drivers. Multidimensional indices of poverty more accurately capture the diversity of poverty. There is little research regarding ... ...

    Abstract Introduction: Narrow, unidimensional measures of poverty often fail to measure true poverty and inadequately capture its drivers. Multidimensional indices of poverty more accurately capture the diversity of poverty. There is little research regarding the association between multidimensional poverty and depression.
    Methods: A cross-sectional survey was administered in five sub-locations in Migori County, Kenya. A total of 4,765 heads of household were surveyed. Multidimensional poverty indices were used to determine the association of poverty with depression using the Patient Health Questionnaire (PHQ-8) depression screening tool.
    Results: Across the geographic areas surveyed, the overall prevalence of household poverty (deprivation headcount) was 19.4%, ranging from a low of 13.6% in Central Kamagambo to a high of 24.6% in North Kamagambo. Overall multidimensional poverty index varied from 0.053 in Central Kamagambo to 0.098 in North Kamagambo. Of the 3,939 participants with depression data available, 481 (12.2%) met the criteria for depression based on a PHQ-8 depression score ≥10. Poverty showed a dose-response association with depression.
    Conclusions: Multidimensional poverty indices can be used to accurately capture poverty in rural Kenya and to characterize differences in poverty across areas. There is a clear association between multidimensional poverty and depressive symptoms, including a dose effect with increasing poverty intensity. This supports the importance of multifaceted poverty policies and interventions to improve wellbeing and reduce depression.
    MeSH term(s) Adult ; Cross-Sectional Studies ; Depression/epidemiology ; Female ; Humans ; Kenya ; Male ; Poverty/statistics & numerical data ; Prevalence
    Language English
    Publishing date 2021-11-16
    Publishing country United States
    Document type Journal Article ; Multicenter Study
    ISSN 1932-6203
    ISSN (online) 1932-6203
    DOI 10.1371/journal.pone.0259848
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