评估一种用于在乌干达农村识别神经障碍的筛查工具。
Evaluation of a screening tool for the identification of neurological disorders in rural Uganda.
机构信息
University of Iowa Carver College of Medicine, Iowa City, IA, USA.
Department of Neurology, Columbia University, New York City, NY, USA.
出版信息
J Neurol Sci. 2021 Feb 15;421:117273. doi: 10.1016/j.jns.2020.117273. Epub 2020 Dec 24.
BACKGROUND
Neurological disorders are common in sub-Saharan African, but accurate neuroepidemiologic data are lacking from the region. We assessed a neuroepidemiological screening tool in a rural Ugandan cohort with high HIV prevalence.
METHODS
Participants were recruited from the Rakai Neurology Study in rural Rakai District, Uganda. A nurse administered the tool and a sociodemographic survey. 100 participants returned for validation examinations by a neurologist (validation cohort). The diagnostic utility and validity of the instrument were calculated and characteristics of those with and without neurological disorders compared.
RESULTS
The tool was administered to 392 participants, 48% female, 33% people with HIV, average age 35.1 ± 8.5 years. 33% of the study cohort screened positive for neurologic disorders. These participants were older [mean (SD): 38.3 (9.7) vs. 33.5 (7.1) years, p < 0.001], had a lower Karnofsky score [89.8 (8.4) vs. 93.9 (7.5), p < 0.001] and had a lower body mass index [21.8 (3.3) vs. 22.8 (3.7), p = 0.007] than those who screened negative. Amongst the validation cohort, 54% had a neurological abnormality of which 46% were symptomatic. The tool was 57% sensitive and 74% specific for detecting any neurological abnormality and 80% sensitive and 69% specific for symptomatic abnormalities.
CONCLUSIONS
We found a lower sensitivity and similar specificity for the screening tool compared with two previous studies. The lower validity in this study was likely due in part to the high percentage of asymptomatic neurological abnormalities detected. This screening tool will require further refinement and cultural contextualization before it can be widely implemented across new populations.
背景
在撒哈拉以南非洲地区，神经障碍较为常见，但该地区缺乏准确的神经流行病学数据。我们评估了一种在艾滋病毒流行率较高的乌干达农村队列中使用的神经流行病学筛查工具。
方法
参与者从乌干达农村地区 Rakai 区的 Rakai 神经病学研究中招募。一名护士管理该工具和社会人口学调查。100 名参与者由一名神经科医生进行验证检查（验证队列）。计算了该仪器的诊断效用和有效性，并比较了有和无神经障碍者的特征。
结果
该工具在 392 名参与者中进行了管理，48%为女性，33%为艾滋病毒感染者，平均年龄为 35.1 ± 8.5 岁。研究队列中有 33%的人筛查出有神经障碍。这些参与者年龄较大[平均（标准差）：38.3（9.7）比 33.5（7.1）岁，p < 0.001]，Karnofsky 评分较低[89.8（8.4）比 93.9（7.5），p < 0.001]，体重指数较低[21.8（3.3）比 22.8（3.7），p = 0.007]，比筛查阴性者低。在验证队列中，54%有神经异常，其中 46%为有症状的异常。该工具检测任何神经异常的敏感性为 57%，特异性为 74%，检测有症状异常的敏感性为 80%，特异性为 69%。
结论
与之前的两项研究相比，我们发现该筛查工具的敏感性较低，特异性相似。该研究中较低的有效性可能部分归因于检测到的无症状神经异常比例较高。在广泛应用于新人群之前，该筛查工具需要进一步改进和文化调整。
Zotero 插件