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4. The 2022 symposium on dementia and brain aging in low‐ and middle‐income countries: Highlights on research, diagnosis, care, and impact

Author

Kalaria, Raj, Maestre, Gladys, Mahinrad, Simin, Acosta, Daisy M, Akinyemi, Rufus Olusola, Alladi, Suvarna, Allegri, Ricardo F, Arshad, Faheem, Babalola, David Oluwasayo, Baiyewu, Olusegun, Bak, Thomas H, Bellaj, Tarek, Brodie‐Mends, David K, Carrillo, Maria C, Celestin, Kaputu‐Kalala‐Malu, Damasceno, Albertino, de Silva, Ranil Karunamuni, de Silva, Rohan, Djibuti, Mamuka, Dreyer, Anna Jane, Ellajosyula, Ratnavalli, Farombi, Temitope H, Friedland, Robert P, Garza, Noe, Gbessemehlan, Antoine, Georgiou, Eliza Eleni‐Zacharoula, Govia, Ishtar, Grinberg, Lea T, Guerchet, Maëlenn, Gugssa, Seid Ali, Gumikiriza‐Onoria, Joy Louise, Hogervorst, Eef, Hornberger, Michael, Ibanez, Agustin, Ihara, Masafumi, Issac, Thomas Gregor, Jönsson, Linus, Karanja, Wambui M, Lee, Joseph H, Leroi, Iracema, Livingston, Gill, Manes, Facundo Francisco, Mbakile‐Mahlanza, Lingani, Miller, Bruce L, Musyimi, Christine Wayua, Mutiso, Victoria N, Nakasujja, Noeline, Ndetei, David M, Nightingale, Sam, Novotni, Gabriela, Nyamayaro, Primrose, Nyame, Solomon, Ogeng'o, Julius A, Ogunniyi, Adesola, de Oliveira, Maira Okada, Okubadejo, Njideka U, Orrell, Martin, Paddick, Stella‐Maria, Pericak‐Vance, Margaret A, Pirtosek, Zvezdan, Potocnik, Felix Claude Victor, Raman, Rema, Rizig, Mie, Rosselli, Mónica, Salokhiddinov, Marufjon, Satizabal, Claudia L, Sepulveda‐Falla, Diego, Seshadri, Sudha, Sexton, Claire E, Skoog, Ingmar, St George‐Hyslop, Peter H, Suemoto, Claudia Kimie, Thapa, Prekshy, Udeh‐Momoh, Chinedu Theresa, Valcour, Victor, Vance, Jeffery M, Varghese, Mathew, Vera, Jaime H, Walker, Richard W, Zetterberg, Henrik, Zewde, Yared Z, and Ismail, Ozama

Subjects
Biomedical and Clinical Sciences, Biological Psychology, Clinical Sciences, Neurosciences, Psychology, Brain Disorders, Dementia, Aging, Neurodegenerative, Prevention, Acquired Cognitive Impairment, Neurological, Good Health and Well Being, Humans, Developing Countries, Brain, Congresses as Topic, Biomedical Research, Alzheimer's disease, dementia, diversity, high‐income countries, low‐ and middle‐income countries, risk factors, vascular dementia, Geriatrics, Clinical sciences, Biological psychology
Abstract

Two of every three persons living with dementia reside in low- and middle-income countries (LMICs). The projected increase in global dementia rates is expected to affect LMICs disproportionately. However, the majority of global dementia care costs occur in high-income countries (HICs), with dementia research predominantly focusing on HICs. This imbalance necessitates LMIC-focused research to ensure that characterization of dementia accurately reflects the involvement and specificities of diverse populations. Development of effective preventive, diagnostic, and therapeutic approaches for dementia in LMICs requires targeted, personalized, and harmonized efforts. Our article represents timely discussions at the 2022 Symposium on Dementia and Brain Aging in LMICs that identified the foremost opportunities to advance dementia research, differential diagnosis, use of neuropsychometric tools, awareness, and treatment options. We highlight key topics discussed at the meeting and provide future recommendations to foster a more equitable landscape for dementia prevention, diagnosis, care, policy, and management in LMICs. HIGHLIGHTS: Two-thirds of persons with dementia live in LMICs, yet research and costs are skewed toward HICs. LMICs expect dementia prevalence to more than double, accompanied by socioeconomic disparities. The 2022 Symposium on Dementia in LMICs addressed advances in research, diagnosis, prevention, and policy. The Nairobi Declaration urges global action to enhance dementia outcomes in LMICs.

Published
2024

10. HIV, Social Networks, and Loneliness among Older Adults in Uganda

Author

Quach, Lien T., Ritchie, Christine S., Reynolds, Zahra, Paul, Robert, Seeley, Janet, Tong, Yao, Hoeppner, Susanne, Okello, Samson, Nakasujja, Noeline, Olivieri-Mui, Brianne, Saylor, Deanna, Greene, Meredith, Asiimwe, Stephen, Tindimwebwa, Edna, Atwiine, Flavia, Sentongo, Ruth, Siedner, Mark J., and Tsai, Alexander C.

Published
2024
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11. The benefits of care: treated HIV infection and health-related quality of life among older-aged people in Uganda.

Author

Quach, Lien, Ritchie, Christine, Tsai, Alexander, Reynolds, Zahra, Paul, Robert, Seeley, Janet, Tong, Yao, Hoeppner, Susanne, Okello, Samson, Nakasujja, Noeline, Olivieri-Mui, Brianne, Saylor, Deanna, Greene, Meredith, Asiimwe, Stephen, and Siedner, Mark

Subjects
HIV, Uganda, anxiety and trauma related disorders, depression , mood disorders, epidemiology (mental health), health service use, health-related quality of life, older people, quality of life/wellbeing, psychosocial and cultural aspects
Abstract

OBJECTIVES: The objective of this study is to explore how HIV care affects health-related quality of life (HRQoL) among older people in Uganda. METHODS: We enrolled older-aged (≥49 years) people with HIV receiving HIV care and treatment, along with age- and sex-similar people without HIV. We measured health-related quality of life using the EQ-5D-3L scale. RESULTS: People with HIV (n = 298) and people without HIV (n = 302) were similar in median age (58.4 vs. 58.5 years), gender, and number of comorbidities. People with HIV had higher self-reported health status (b = 7.0; 95% confidence interval [CI], 4.2-9.7), higher EQ-5D utility index (b = 0.05; 95% CI, 0.02-0.07), and were more likely to report no problems with self-care (adjusted odds ratio [AOR], 2.0; 95% CI, 1.2-3.3) or pain/discomfort (AOR = 1.8, 95% CI, 1.3-2.8). Relationships between HIV serostatus and health-related quality of life differed by gender, but not age. CONCLUSIONS: Older people with HIV receiving care and treatment reported higher health-related quality of life than people without HIV in Uganda. Access to primary care through HIV programs and/or social network mobilization may explain this difference, but further research is needed to elucidate the mechanisms.

Published
2023

12. Associations of the COVID-19 pandemic with quality of life: A cross-sectional study of older-age people with and without HIV in rural Uganda

Author

Olivieri-Mui, Brianne, Hoeppner, Susanne S, Tong, Yao, Kohrt, Emma, Quach, Lien T, Saylor, Deanna, Seeley, Janet, Tsai, Alexander C, Reynolds, Zahra, Okello, Samson, Asiimwe, Stephen, Flavia, Atwiine, Sentongo, Ruth, Tindimwebwa, Edna, Meyer, Ana-Claire, Nakasujja, Noeline, Paul, Robert, Ritchie, Christine, Greene, Meredith, and Siedner, Mark J

Subjects
Health Services and Systems, Public Health, Health Sciences, HIV/AIDS, Behavioral and Social Science, Clinical Research, Infectious Diseases, Aging, Infection, Good Health and Well Being, Humans, Female, Aged, Middle Aged, Male, Quality of Life, HIV, Cross-Sectional Studies, Uganda, Pandemics, HIV Infections, COVID-19, Communicable Disease Control, Public Health and Health Services, Public health
Abstract

BackgroundCOVID-19-related lockdowns and other public health measures may have differentially affected the quality of life (QOL) of older people with and without human immunodeficiency virus (HIV) in rural Uganda.MethodsThe Quality of Life and Aging with HIV in Rural Uganda study enrolled people with and without HIV aged over 49 from October 2020 to October 2021. We collected data on COVID-19-related stressors (behavior changes, concerns, interruptions in health care, income, and food) and the participants' QOL. We used linear regression to estimate the associations between COVID-19-related stressors and QOL, adjusting for demographic characteristics, mental and physical health, and time before vs after the lockdown during the second COVID-19 wave in Uganda. Interaction between HIV and COVID-19-related stressors evaluated effect modification.ResultsWe analyzed complete data from 562 participants. Mean age was 58 (standard deviation (SD) = 7); 265 (47%) participants were female, 386 (69%) were married, 279 (50%) had HIV, and 400 (71%) were farmers. Those making ≥5 COVID-19-related behavior changes compared to those making ≤2 had worse general QOL (estimated linear regression coefficient (b) = - 4.77; 95% confidence interval (CI) = -6.61, -2.94) and health-related QOL (b = -4.60; 95% CI = -8.69, -0.51). Having access to sufficient food after the start of the COVID-19 pandemic (b = 3.10, 95% CI = 1.54, 4.66) and being interviewed after the start of the second lockdown (b = 2.79, 95% CI = 1.30, 4.28) were associated with better general QOL. Having HIV was associated with better health-related QOL (b = 5.67, 95% CI = 2.91,8.42). HIV was not associated with, nor did it modify the association of COVID-19-related stressors with general QOL.ConclusionsIn the context of the COVID-19 pandemic in an HIV-endemic, low-resource setting, there was reduced QOL among older Ugandans making multiple COVID-19 related behavioral changes. Nonetheless, good QOL during the second COVID-19 wave may suggest resilience among older Ugandans.

Published
2023

13. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission

Author

Livingston, Gill, Huntley, Jonathan, Liu, Kathy Y, Costafreda, Sergi G, Selbæk, Geir, Alladi, Suvarna, Ames, David, Banerjee, Sube, Burns, Alistair, Brayne, Carol, Fox, Nick C, Ferri, Cleusa P, Gitlin, Laura N, Howard, Robert, Kales, Helen C, Kivimäki, Mika, Larson, Eric B, Nakasujja, Noeline, Rockwood, Kenneth, Samus, Quincy, Shirai, Kokoro, Singh-Manoux, Archana, Schneider, Lon S, Walsh, Sebastian, Yao, Yao, Sommerlad, Andrew, and Mukadam, Naaheed

Published
2024
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16. Reply to ‘Cognitive criteria in HIV: greater consensus is needed’

Author

Nightingale, Sam, Cinque, Paola, Dravid, Ameet, Dreyer, Anna J., Gisslén, Magnus, Joska, John A., Kwasa, Judith, Meyer, Ana-Claire, Mpongo, Nombeko, Nakasujja, Noeline, Pebody, Roger, Pozniak, Anton, Price, Richard W., Saylor, Deanna, Thomas, Kevin G. F., Underwood, Jonathan, Vera, Jaime H., and Winston, Alan

Published
2024
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18. Feasibility and outcomes of using DIALOG+ in primary care to improve quality of life and mental distress of patients with long-term physical conditions: an exploratory non-controlled study in Bosnia and Herzegovina, Colombia and Uganda

Author

van Loggerenberg, Francois, Akena, Dickens, Alinaitwe, Racheal, Birabwa-Oketcho, Harriet, Méndez, Camilo Andrés Cabarique, Gómez-Restrepo, Carlos, Kulenović, Alma Džubur, Selak, Nejra, Kiseljaković, Meliha, Musisi, Seggane, Nakasujja, Noeline, Sewankambo, Nelson K., and Priebe, Stefan

Published
2023
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30. A cross-sectional mixed methods protocol to describe correlates and explanations for a long duration of untreated psychosis among patients with first episode psychosis in Uganda

Author

Mwesiga, Emmanuel Kiiza, Nakasujja, Noeline, Ongeri, Linnet, Semeere, Aggrey, Loewy, Rachel, and Meffert, Susan

Subjects
Biological Psychology, Biomedical and Clinical Sciences, Psychology, Serious Mental Illness, Clinical Research, Mental Health, Schizophrenia, Brain Disorders, HIV/AIDS, Mental health, Infection, Good Health and Well Being, Adolescent, Adult, Antipsychotic Agents, Complementary Therapies, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Psychotic Disorders, Time-to-Treatment, Uganda, Young Adult, alternative and complimentary therapies, duration of untreated psychosis, first episode psychosis, Clinical Sciences, Public Health and Health Services, Other Medical and Health Sciences, Biomedical and clinical sciences, Health sciences
Abstract

IntroductionAmong patients with psychotic disorders, the 'duration of untreated psychosis' (DUP) is a predictor of key outcomes such as symptom remission and quality of life. In sub-Saharan Africa, DUP is up to five times longer than in high-income countries, with many patients going without antipsychotic medication for 5 years or longer. One contributor to this high DUP may relate to cultural norms that drive use of alternative and complementary therapies (ACTs) as first-line treatment strategies, rather than biomedical care with antipsychotic medicine. We aim to1 determine the prevalence and factors associated with DUP and ACT use in Uganda, and2 Identify factors that drive patient and family choices to use ACT as a first-line treatment strategy.Methods and analysisWe will leverage on an ongoing cohort study at the national psychiatric and teaching hospital in Uganda. The parent study is an observational cohort design following antipsychotic naïve adults with a first episode of psychosis without substance use, HIV/AIDS or syphilis. The embedded study will use a mixed methods design including quantitative assessment of parent study participants with the Nottingham Onset Schedule-DUP to determine the DUP. Qualitative assessment will focus on patient and caregiver perceptions and use of ACT and its impact on DUP among patients with psychosis using in-depth interviews.Ethics and disseminationThe study has received ethical approval from the school of medicine research and ethics committee of the college of health sciences at Makerere University. It has also received institutional support to perform the study from the Infectious Diseases Institute and Butabika hospital. Besides publication of the work in reputable peer-reviewed journals, we hope that this work will lead to evidence-based discussions on the need for early interventions to reduce DUP in Uganda.

Published
2019

39. Sex-specific associations between cerebrospinal fluid inflammatory marker levels and cognitive function in antiretroviral treated people living with HIV in rural Uganda

Author

Vecchio, Alyssa C., Williams, Dionna W., Xu, Yanxun, Yu, Danyang, Saylor, Deanna, Lofgren, Sarah, O'Toole, Riley, Boulware, David R., Nakasujja, Noeline, Nakigozi, Gertrude, Kisakye, Alice, Batte, James, Mayanja, Richard, Anok, Aggrey, Reynolds, Steven J., Quinn, Thomas C., Gray, Ronald H., Wawer, Maria J., Sacktor, Ned, and Rubin, Leah H.

Published
2021
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42. Barriers to biomedical care for people with epilepsy in Uganda: A cross-sectional study

Author

Kaddumukasa, Martin N., Kaddumukasa, Mark, Kajumba, Mayanja, Smith, Patrick J., Bobholz, Samuel, Kakooza-Mwesige, Angelina, Sinha, Drishti D., Almojuela, Alysa, Chakraborty, Payal, Nakasujja, Noeline, Nakku, Juliet, Gualtieri, Alex, Onuoha, Erica, Kolls, Brad J., Muhumuza, Christine, Smith, Caleigh E., Sanchez, Nadine, Fuller, Anthony T., Haglund, Michael M., and Koltai, Deborah C.

Published
2021
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43. Pluralistic and singular causal attributions for epilepsy in Uganda

Author

Smith, Caleigh E., Kajumba, Mayanja, Bobholz, Samuel, Smith, Patrick J., Kaddumukasa, Mark, Kakooza-Mwesige, Angelina, Chakraborty, Payal, Sinha, Drishti D., Kaddumukasa, Martin N., Gualtieri, Alex, Nakasujja, Noeline, Onuoha, Erica, Nakku, Juliet, Muhumuza, Christine, Sanchez, Nadine, Fuller, Anthony T., Haglund, Michael M., and Koltai, Deborah C.

Published
2021
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48. Prevalence and Factors Associated with Anxiety Disorders Among Pregnant Women at Mulago National Referral Hospital, Uganda

Author

Nabwire,Mariam, Nakimuli,Annettee, Nakasujja,Noeline, Migisha,Richard, Kiggundu,Charles, Nabwire,Mariam, Nakimuli,Annettee, Nakasujja,Noeline, Migisha,Richard, and Kiggundu,Charles

Abstract

Mariam Nabwire,1 Annettee Nakimuli,1 Noeline Nakasujja,2 Richard Migisha,3,4 Charles Kiggundu1, †1Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; 2Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; 3Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda; 4Department of Physiology, Mbarara University of Science and Technology, Mbarara, Uganda†Charles Kiggundu passed away on 29th December 2020Correspondence: Mariam Nabwire, Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda, Tel +256 756600593 ; +256 775834405, Email nabwirem@yahoo.comBackground: Anxiety disorders in pregnancy are common and represent a global concern. However, data regarding the magnitude of anxiety among pregnant women in Uganda are limited, and yet, these data could pave way for implementing effective mitigation measures. We determined the prevalence of anxiety disorders and associated factors among pregnant women at Mulago Hospital Uganda.Methods: A cross-sectional study was conducted among pregnant women attending antenatal care clinic at Mulago Hospital between September and November 2015. Systematic sampling was used to enroll eligible women. An interviewer-administered demographic questionnaire and the Hamilton Anxiety Rating Scale for Antenatal Anxiety (HAMA-A) scale were used to assess demographic features and anxiety, respectively. Women with HAMA-A score ≥ 17 were considered to have anxiety disorder. Factors associated with anxiety disorders were determined using multivariate logistic regression.Results: A total of 501 pregnant women were enrolled into the study; the prevalence of anxiety disorders was 13% (n=65; 95% CI: 9.8– 15.7%). Factors that were significantly associated with anxiety disorders were low income of the partic

Published
2024

50. Using Grounded Theory to Develop a Substantive Theory for Grandparent-Caregiving in Uganda: The GRACE Model.

Author

Matovu, Schola N., Watt, Melissa, Young, Heather M., Nakasujja, Noeline, and Ellington, Lee

Subjects
RESEARCH funding, INTERVIEWING, GRANDPARENTS, GRANDCHILDREN, MATHEMATICAL models, RESEARCH methodology, CONCEPTUAL structures, RESEARCH, MEDICAL coding, PSYCHOLOGY of caregivers, THEORY, GROUNDED theory, PSYCHOSOCIAL factors, WELL-being
Abstract

Introduction: Few studies have focused on developing theories to explain caregiving as performed by grandparents who provide care for their grandchildren in any setting. Theory development that is grounded in the experiences and cultural context of those being studied is needed to inform research, subsequent care, and overall well-being, especially of populations that are understudied. Methods: This manuscript was informed by Constructivist Grounded Theory, semi-structured in-depth and individual interviews. Also, three methodological phases were followed: (a) concurrent data collection and analysis procedures, (b) developing categories and relationships among them, and (c) defining the core category and building the substantive theory. Results: The methodological steps involved in generating a substantive theory, the GRAndparent-CarEgiving (GRACE) model, are reported. Discussion: Research, and subsequently the well-being and health care of grandparent-caregivers, needs to be informed by culturally congruent theories that are founded in the experiences and cultural context of the individuals being investigated. [ABSTRACT FROM AUTHOR]

Published
2024
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