Dissertations / Theses: 'Cohorts Treatment'

1

Davies, Mary-Ann. "Outcomes and effectiveness of antiretroviral therapy for HIV-infected children in South African treatment cohorts." Doctoral thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/9382.

Full text

Abstract:

Includes abstract.
Includes bibliographical references.
Since 2004, increasing numbers of children in sub-Saharan Africa have commenced antiretroviral therapy (ART). This thesis reviews the outcomes of published studies of paediatric ART cohorts in Africa, describes outcomes for children receiving ART in South Africa and examines determinants of mortality and generalizability across the Southern African region. Temporal trends in characteristics at ART initiation are also examined. The measurement of treatment success in resource-limited settings is reviewed, by examining virological failure, and assessing the diagnostic accuracy of immunological criteria for identifying virological failure.The results chapter is presented in the form of published or submitted papers based on data from the International epidemiologic Databases to Evaluate AIDS-Southern Africa (IeDEASA) collaboration. The first paper reviews paediatric ART studies from Africa published before 2008. Together with the literature review in chapter 1, it provides the background to this thesis. The second paper reports on mortality (8%) and retention in care (81%) by 3 years after ART start for > 6,000 children who initiated ART in South Africa. The generalizable prognostic models in the third paper suggest that mortality during the first year on ART ranges from <2% to >45%, with the majority of children being in the group with the best prognosis. The fourth paper reports that 1 in 5 children meet criteria for confirmed virological failure by 3 years on ART. The risk is greater with triple ART containing nevirapine or unboosted ritonavir (in comparison with lopinavir/ritonavir or efavirenz). The fifth and sixth papers demonstrate that immunological criteria have low sensitivity and positive predictive value for virological failure. Targeted viral load measurement reduces the number of false positive virological failure diagnoses. The final paper shows that increasing numbers of children have initiated ART with a decline in disease severity at therapy start from 2005-2010. However, even in 2010 a substantial number of children started ART with advanced disease. The thesis concludes that access to ART for children has increased, with good outcomes. HIV cohort research is important in evaluating the safety and effectiveness of different models of care, treatment and monitoring strategies.

APA, Harvard, Vancouver, ISO, and other styles

2

Seleke, Rachel. "A comparison of treatment response in two cohorts of once daily HAART and twice daily HAART in a sample population in Gaborone, Botswana." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/80462.

Full text

Abstract:

Thesis (MFamMed) -- Stellenbosch University, 2012.
ENGLISH ABSTRACT: Background Sub-Saharan Africa has been hard hit by the HIV/AIDS epidemic with an estimated 22.9 million adults infected in 2010. The advent of antiretroviral therapy (ART) has seen significant reduction in mortality from AIDS related illnesses. With the reduction of mortality and the indisputable positive results seen from the use of Anti-retroviral Treatment (ART), the demand both from people living with HIV and health care providers to phase in less toxic ARVs while maintaining simplified fixed-dose combinations has increased considerably. Botswana like most low-resource countries has adapted the WHO recommendation of daily ART as opposed to the previous twice daily HAART. No evidence from resource limited settings has been found that clearly indicates the superiority of regimens based on AZT, d4T or TDF. Aim The primary aim was to compare treatment response between two cohorts. The secondary aim was to compare any association of regimen to age or gender. Objectives To comparatively determine treatment response at 3 months based on immunological response (shown by an increase in CD4 above pre-therapy levels) and viral load response. Methods The study is a retrospective comparative cohort study. Three ART sites were selected from a total of 6 sites. A sample size of 263 was required to achieve a 90% effect power. An equal number of patient records were reviewed per site and each arm had an equal number of reviewed records. A total of 286 patient record files which fit the inclusion criteria were retrospectively analysed and data entered in Excel before being analysed using Statistica Version 10. A p <0.05 represents statistical significance whilst a 95% confidence interval was used for estimation of unknown variables. Results n=263. The overall sample was predominantly male (75.19%). An overwhelming majority (95.88%) of patients in both arms had undetectable viral loads (VL<400). A significant association was found between the regimen and viral load (p=0.0315-Pearson Chi Test). The difference in CD4 between the two arms was not statistically significant (p=0.655890-ANOVA). A positive association was found between the regimen and gender (p=0.03190-Pearson Chi Test). This was possibly owing to the high numbers of males and no statistical adjustment to gender made. No association was found in the difference in CD4 cell counts for regimen and gender (p=0.612191-Anova). Conclusion Treatment response at 3 months post initiation between once daily and twice daily HAART in Gaborone Botswana by use of virologic and immunologic response has been shown to be comparable. The use of one regimen over the other as first line as recommended by WHO and the subsequent adoption of the current first line regimen by the Botswana Ministry of Health may be justified. This study has therefore reinforced the applicability of previous findings in other settings of this recommendation. As part of the targeted audience and indeed as a partner in the care and management of HIV, the responsibility to ensure applicability of the recommendations set out for resource limited areas has been achieved through this study. However, bigger randomized trials in resource limited settings are needed to justify and accredit these findings as well as add to the evidence obtained in developed countries.

APA, Harvard, Vancouver, ISO, and other styles

3

Groah, Joseph S. "Treatment of fourth class midshipmen : hazing and its impact on academic and military performance and psychological and physical health /." Thesis, access online version, 2005. http://www.usna.edu/IR/htmls/lead/database/cohort8/c08%5Foakes.pdf.

Full text

APA, Harvard, Vancouver, ISO, and other styles

4

Langwenya, Nontokozo. "Adherence to antiretroviral treatment (ART) among HIV-infected pregnant women starting treatment immediately vs delayed: a cohort study." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/22899.

Full text

Abstract:

Introduction: Use of highly effective antiretroviral drugs to eliminate new paediatric HIV infections is the keystone of all prevention of mother-to-child transmission (PMTCT) programmes. Time on antiretroviral treatment (ART) before delivery reduces maternal viral load and decreases the risk of transmission in utero, during labour and whilst breastfeeding. Currently, many PMTCT programmes across Africa initiate HIV-infected pregnant women on lifelong antiretroviral therapy (ART) on the first day of antenatal care ("same-day" initiation). However concerns have been raised regarding patient readiness and whether same-day initiation in pregnancy may contribute to subsequent ART non-adherence. Methods: As part of a larger study of ART in pregnancy, consecutive ART-eligible pregnant women making their first antenatal care (ANC) visit at a primary care facility in Cape Town, South Africa were enrolled into a prospective cohort between March 2013 and June 2014. Before July 2013, eligibility was based on CD4 cell count ≤350 cells/μL ("Option A"), with a 1-2 week delay from the first ANC visit to ART initiation; thereafter all women were eligible regardless of CD4 cell count ("Option B+") and typically offered ART on the same day as first ANC visit. All women received standardized counselling before starting a fixed-dose regimen. Study interviews were conducted separately from the ART service through one week postpartum with self-reported adherence from 30- day recall. Results: Among 625 consecutive ART-eligible women (median age, 28 years; median gestation, 21 weeks; 55% newly diagnosed with HIV), 72% of women started ART same-day; this proportion was higher under "Option B+" versus "Option A" (p< 0.001). Of those with adherence assessments data available (n=618), 29% reported at least one missed ART dose during pregnancy. Missed doses were reported more frequently among women with previous use of PMTCT (p=0.014), of younger age (p=0.029) and starting ART under Option B+ (p=0.019). In women initiating ART same-day, 31% reported a missed dose compared to 23% among women who delayed ART start following first ANC visit (odds ratio, 1.07; 95% CI: 0.61 – 1.88). This finding did not vary after adjustment for demographic and clinical measures, and was consistent when restricted to women with CD4 cell counts ≤350 cells/μL. Conclusions: These results suggest same-day ART initiation in pregnant women is not associated with increased non-adherence during the antenatal period. While these results are reassuring for ART programmes implementing "Option B+", further research is required to examine adherence over time, particularly postpartum.

APA, Harvard, Vancouver, ISO, and other styles

5

Olson, Karen. "Comparison of two treatments for fingertip amputation : a retrospective cohort study." [Tampa, Fla.] : University of South Florida, 2007. http://purl.fcla.edu/usf/dc/et/SFE0002164.

Full text

APA, Harvard, Vancouver, ISO, and other styles

6

Pan, Yi-Ju. "Economic evaluations of antidepressant treatments : a national cohort study in Taiwan." Thesis, King's College London (University of London), 2014. https://kclpure.kcl.ac.uk/portal/en/theses/economic-evaluations-of-antidepressant-treatments(306d9beb-b8d9-4aa6-b41d-d11e570d41f9).html.

Full text

Abstract:

Given the marked personal, social and economic impacts, depressive disorder creates significant demands on individuals, health service providers and society as a whole. Antidepressant drugs remain the mainstay of treatment for depression for most people in contact with healthcare services and the last 20 years have seen dramatic changes in antidepressant prescription patterns. Initially, there was an increase in the use of the selective serotonin reuptake inhibitors (SSRIs) and subsequently, other novel antidepressant agents with different pharmacological mechanisms entered the market. Given the range of choices, clinicians must decide about which is the most appropriate intervention for their patients. To this end, knowledge regarding the relative cost-effectiveness and cost-utility of individual antidepressants is important. Therefore, in this thesis, a systematic review was first conducted to assess methodological approaches in economic evaluations of pharmacological treatments using database analyses. Based on the National Health Insurance Research Database in Taiwan, a cost analysis was conducted to identify which demographic and clinical characteristics are associated with healthcare costs of patients with depression. Compared to patients prescribed SSRIs, those prescribed older antidepressants had lower total and psychiatric costs, while patients prescribed serotonin norepinephrine reuptake inhibitors (SNRIs), and other newer antidepressants had higher total and psychiatric costs. The baseline comorbidities of cardiovascular diseases (CVD) and headache were also associated with healthcare costs over the 12-month period. To further assess the longer-term economic impacts, a set of database outcome statuses (sustained treatment-free status, continuous treatment, and late re-contact) were then applied to explore factors associated with outcome status following initial treatments and to examine healthcare costs over the following three years by outcome status. Theresults showed the initial outcome status could exert an impact on total healthcarecosts in the second and third years after commencing treatments. Finally, cost-effectiveness and cost-utility were compared between different categories of antidepressant treatments and also to test whether and how the presence of CVD, the most prevalent comorbid physical illness in this cohort, affects these results. The results showed that SSRIs are more cost-effective than tricyclic antidepressants and SNRIs regardless of comorbid CVD. There are various limitations to be considered in these analyses, including the limited scope of costs, the lack of clinical information, and the adoption of utility scores from previous studies. Further efforts to elucidate the relationship between depression treatments, costs and outcomes for longer period of follow up are warranted.

APA, Harvard, Vancouver, ISO, and other styles

7

McNeil, Alexander John. "Statistical methods in AIDS progression studies with an analysis of the Edinburgh City Hospital Cohort." Thesis, University of Cambridge, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.307053.

Full text

APA, Harvard, Vancouver, ISO, and other styles

8

Feng, Lili. "Cocaine use among drug users in Methadone treatment: results from the Amsterdam cohort study." The Ohio State University, 2001. http://rave.ohiolink.edu/etdc/view?acc_num=osu1406728675.

Full text

APA, Harvard, Vancouver, ISO, and other styles

9

Akin, Faith W., Kristal M. Riska, Laura Williams, Stephanie B. Rouse, and Owen D. Murnane. "Characteristics and Treatment Outcomes of Benign Paroxysmal Positional Vertigo in a Cohort of Veterans." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/1780.

Full text

Abstract:

Background: The Mountain Home Veterans Affairs (VA) Medical Center has been diagnosing and treating veterans with benign paroxysmal positional vertigo (BPPV) for almost 2 decades. The clinic protocol includes a 2-week follow-up visit to determine the treatment outcome of the canalith repositioning treatment (CRT). To date, the characteristics of BPPV and treatment efficacy have not been reported in a cohort of veterans with BPPV. Purpose: To determine the prevalence and characteristics of veterans diagnosed with BPPV in a Veterans Affairs Medical Center Audiology Clinic and to examine treatment outcomes. Research Design: Retrospective chart review. Study Sample: A total of 102 veterans who tested positive for BPPV in the Vestibular Clinic at the Mountain Home VA Medical Center from March 2010 to August 2011. Results: In 102 veterans who were diagnosed with BPPV, the posterior semicircular canal was most often involved (75%), motion-provoked vertigo was the most common symptom (84%), and the majority (43%) were diagnosed with BPPV in their sixth decade. The prevalence of BPPV in the Audiology Vestibular Clinic was 15.6%. Forty-one percent of veterans reported a symptom onset within 12 months of treatment for BPPV; however, 36% reported their symptoms began > 36 months prior to treatment. CRT was effective (negative Dix–Hallpike/roll test) in most veterans (86%) following 1 treatment appointment (M = 1.6), but more than half reported incomplete symptom resolution (residual dizziness) at the follow-up appointment. Eighteen percent of veterans experienced a recurrence (M = 1.8 years; SD = 1.7 years). Conclusions: The characteristics and treatment outcomes of BPPV in our veteran cohort was similar to what has been reported in the general population. Future work should focus on improving the timeliness of evaluation and treatment of BPPV and examining the time course and management of residual dizziness.

APA, Harvard, Vancouver, ISO, and other styles

10

Gilmore, Annette. "Feasibility and utility of a sickle cell disease registry for research and patient management." Thesis, Brunel University, 2009. http://bura.brunel.ac.uk/handle/2438/4445.

Full text

Abstract:

This thesis aimed to evaluate the feasibility and utility of a sickle cell disease registry for clinical patient management and research. Five hospitals out of nine in the North West London health region participated in the registry, with 78 percent coverage of the sickle cell disease population. There was 80% case ascertainment in participating hospitals. Aggregated anonymised demographic and diagnostic data was collected for all haemoglobinopathy patients. This provided the core dataset for quantifying prevalence of sickle cell and thalassaemia and mapping local hospital workloads and service requirements. Thirteen percent of HbSS adult patients were taking hydroxycarbamide. The cohort of patients treated with hydroxycarbamide was evaluated. Sixty two of the 80 patients started on treatment were included. Follow-up was censored after 9 years, totalling 249 person-years of data with a median follow-up of three years (IQR, 1-6). Results showed that haematological benefits were maintained in the long-term with treatment, but evidence of long-term clinical effectiveness was less strong. This appeared to be due to the patterns of clinical management in everyday practice. Patients tend to be treated with modest doses of hydroxycarbamide due to intolerance or inability to attain or maintain maximum tolerated dose. For example maximum tolerated dose was the aim of treatment for 91% of patients but it was achieved for 65% of participants. Non- compliance with treatment and monitoring schedule was the main reason for non- attainment. Results suggest that it is sensible to strive for maximum tolerated dose to ensure therapy remains effective, but with more realistic expectations of the dose patients can attain and maintain. Doses in adult patients average 20mg/kg/day and 25mg/kg/day in children. Adult patients may be able to achieve a higher dose, if there was more stringent monitoring and improved management of non-compliance. The North West London HU Sub-Registry proved useful for measuring long-term effectiveness and tolerability of hydroxycarbamide. Routinely collected data was utilized for both clinical management and research purposes. The novelty lay in examination of the nuances of routine clinical practice. An electronic patient record was developed as a clinical management tool. It is the first study reporting long-term outcomes for UK sickle cell disease patients on hydroxycarbamide. Findings should help clinicians devise effective treatment protocols and strategies for managing patients commenced on this therapy. Interventions need to be targeted at increasing utilisation, patient adherence and persistence with treatment. The electronic patient record could be used to maximise treatment benefit and improve adherence. More effective involvement of the multidisciplinary team and primary care colleagues in patient education and management should improve usage. Patients and carers need up to date and easy to assimilate information to make informed decisions about treatment options. Maintaining a SCD registry is challenging. Models which operate as clinical information systems provide an incentive for participation. These enable active involvement of local care providers in registry management and the ability to keep and utilize their own data. Clinicians require accurate and current data for patient management and to enable them to benchmark their local outcomes against national outcomes and care standards.

APA, Harvard, Vancouver, ISO, and other styles

11

Zimmer, Andrea, Michael Coslovsky, Ivo Abraham, and Bernhard F. Décard. "Adherence to fingolimod in multiple sclerosis: an investigator-initiated, prospective, observational, single-center cohort study." DOVE MEDICAL PRESS LTD, 2017. http://hdl.handle.net/10150/626094.

Full text

Abstract:

Objectives: Adherence to multiple sclerosis (MS) treatment is essential to optimize the likelihood of full treatment effect. This prospective, observational, single-center cohort study investigated adherence to fingolimod over the 2 years following treatment initiation. Two facets of adherence - implementation and persistence - were examined and compared between new and experienced users of disease-modifying treatments (DMTs). Materials and methods: Implementation rates were based on the proportion of days covered and calculated as percentages per half-yearly visits and over 2 years, captured through refill data, pill count, and self-report. Nonadherence was defined as taking less than 85.8% of prescribed pills. Implementation rates were classified as nonadherent (< 85.8%), suboptimally adherent (>= 85.8% but. 96.2%), and optimally adherent (>= 96.2%), including perfectly adherent (100%). Persistence, ie, time until discontinuation, was analyzed by Kaplan-Meier analysis. Reasons for discontinuation were recorded. Results: The cohort included 98 patients with relapsing MS, all of whom received a dedicated education session about their medication. Of these 80% were women, 31.6% had fingolimod as first DMT, and 68.4% had switched from other DMTs. The mean implementation rate over 2 years was 98.6% (IQR(1-3) 98.51%-98.7%) and did not change significantly over time; 89% of measurements were in the optimally adherent category, 45.6% in the perfectly adherent category. There was one single occurrence of nonadherence. New users of DMTs were 1.29 times more likely to be adherent than experienced users (OR 1.29, 95% CI 1.11-1.51; P < 0.001), but not more persistent. Nineteen of 98 patients discontinued fingolimod. Conclusion: The very high implementation rates displayed in this sample of MS patients suggest that facilitation by health care professionals in preserving adherence behavior may be sufficient for the majority of patients. Targeted interventions should focus on patients who are nonadherent or who stop treatment without intention to reinitiate.

APA, Harvard, Vancouver, ISO, and other styles

12

Harvard, Stephanie. "Economic evaluations in the context of treatment recommendations in spondyloarthritis : analyses from the DESIR cohort." Thesis, University of British Columbia, 2017. http://hdl.handle.net/2429/63323.

Full text

Abstract:

Spondyloarthritis (SpA) is an inflammatory disease comprising both ankylosing spondylitis and non-radiographic axial SpA. This thesis conducted four studies using data from DESIR, a longitudinal cohort of 708 French SpA patients, focusing on economic questions in the context of SpA treatment recommendations. The objectives of study 1 were to value health resource use and productivity loss among DESIR patients and identify factors associated with costs. Cost valuation was done using public data and factors associated with costs were identified in multivariate regression models. This study showed that anti-TNF agents were the greatest cost driver in DESIR and generated the cost outcomes necessary to perform economic evaluations using DESIR data. The objective of study 2 was to collaborate with rheumatologists to develop measurable definitions of adherence to SpA treatment recommendations. A Delphi survey was conducted with 15 rheumatologists, who developed measurable definitions for 6/11 recommendations. The study uncovered differences of opinion between rheumatologists and generated the classification system necessary to explore adherence to recommendations among DESIR patients. The objective of study 3 was to examine the effect of adherence to anti-TNF use recommendations on outcomes in DESIR. Employing alternate definitions of adherence, patients were classed as adherent anti-TNF users, non-adherent anti-TNF users, adherent non-users, and non-adherent non-users. Following one potential definition, non-adherent anti-TNF users had significantly increased non-biologic costs compared to adherent users, while non-adherent non-users had significantly worse health outcomes than adherent anti-TNF users. This study showed that the impact of adherence to anti-TNF recommendations is sensitive to the definition of adherence and highlighted the need to validate methods to measure adherence. The objective of study 4 was to explore whether the French anti-TNF access restrictions are the most cost-effective in that setting relative to other potential restrictions. Five separate datasets were created comprising DESIR patients satisfying different sets of anti-TNF access criteria. Incremental cost-effectiveness ratios (ICERs) associated with anti-TNF use were calculated in each subset in basecase and sensitivity analyses. A sensitivity analysis simulating a 24-week stopping rule among anti-TNF non-responders demonstrated the effect of non-response on anti-TNF cost-effectiveness. The study underscored the need for evidence-informed anti-TNF access restrictions.
Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate

APA, Harvard, Vancouver, ISO, and other styles

13

Viney, Kerri. "Universal or selective directly observed treatment? : a clinical audit of directly observed treatment and tuberculosis in a North-East London (United Kingdom) cohort /." St. Lucia, Qld, 2003. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe17920.pdf.

Full text

APA, Harvard, Vancouver, ISO, and other styles

14

Moeketsi, Ntshebo Mirriam. "Treatment and regimen change in a cohort of HIV positive patients in anti-retroviral treatment at Tshepang Wellness Clinic, Dr George Mukhari Hospital." Thesis, University of Limpopo ( Medunsa Campus ), 2010. http://hdl.handle.net/10386/218.

Full text

Abstract:

Thesis (MPH)--University of Limpopo, 2010.
Background: Antiretroviral therapy led to a revolution in care of patients with HIV/AIDS in a developed world. Treatment is not a cure but it also presented with new challenges of side effects, drug resistance and it also dramatically reduces rate of mortality and morbidity and it also improves quality of life to people living with HIV/AIDS, and it also now considered as manageable chronic diseases. Aim: Aim of the study is to establish and describe reasons for treatment and regimen change in a cohort of HIV positive patients on ART enrolled in the pharmaco-epidemiological survey at Tshepang wellness clinic. Objectives: is to determine reasons for treatment and regimen change, types of treatment and regimen change among patients on ART who are enrolled in pharmacoepidemiological survey at Tshepang wellness clinic. Design and Methods: Study is a retrospective cohort study, and sample size of 301 medical records of a cohort of HIV positive patients on ARVs enrolled in a longitudinal pharmaco-epidemiological survey from November 2006-May 2007 reviewed. Data extraction tool used to collect data and software called SPSS 17.0 used to analyze data and relevant themes were extracted to determine distribution of variables. Results: Results of this study indicated that 91 (85%) were males and (87.8%) 191 were females. Age was grouped as teenagers (15-25yrs), young adults (26-49yrs) and adults (50- 70yrs). Results also shows reasons of treatment and regimen change of which majority of patients 134(44.8%) changed due toxicity followed by 16 (5.4%) who changed because of pregnancy, and the other 4(1.3%) changed because of resistance, and the last 2(0.7%) which are regarded as minorities change because of T.B. Conclusion and Recommendations: Results shows that majority of pharmacovigilance patients were initiated Regimen 1 compared to other regimens. Toxicity appear as the main reason of treatment and regimen change on this study as 140(46.4%) reported toxicities (peripheral neuropathy, lactic acidosis, lipodystrophy and lipoatrophy). Implementation of monitoring of adherence needed for prevention of resistance and virological failure.

APA, Harvard, Vancouver, ISO, and other styles

15

Haerle, Darin R. "Recidivism Outcomes among a Cohort of Violent Institutionalized Juvenile Offenders." Thesis, University of North Texas, 2008. https://digital.library.unt.edu/ark:/67531/metadc9098/.

Full text

Abstract:

Serious and violent juvenile offenders cause a disproportionate amount of harm to society, yet this population receives very little attention within the realm of empirical research. This research study examined the recidivism outcomes of 296 serious and violent offenders previously exposed to rehabilitative treatment in the Capital and Serious Violent Offender Program provided by the Texas Youth Commission. This group of juveniles was followed for three years following their release from institutionalization. This analysis revealed that 52% of those released were rearrested at least once during the follow-up period for any offense, while 48% of those released desisted from crime altogether. Of those 296 released, 34% were rearrested for at least one new felony offense. The analyses indicate that those involved in various forms of institutional misconduct during institutionalization were significantly more likely to recidivate. African-American race and institutional misconduct in the form of rule infractions emerged as the most consistent predictors of recidivism for this sample. This study concludes with a discussion of policy implications and risk assessment related to the decisions that are made to release this population of violent juvenile offenders.

APA, Harvard, Vancouver, ISO, and other styles

16

Takuva, Simbarashe G. "A retrospective cohort analysis of antiretroviral treatment modifications at the referral HIV clinic in Mbabane, Swaziland." Diss., University of Pretoria, 2010. http://hdl.handle.net/2263/30684.

Full text

Abstract:

Background: Optimizing initial antiretroviral therapy (ART) regimens is of paramount importance in improving the durability of treatment efficacy and patient prognosis. We evaluated the reasons for and risk factors relating to ART modifications in an outpatient cohort in Mbabane, Swaziland. Methods: Retrospective cohort analysis of data for 782 patients who started first-line ART between 1 March 2006 and 31 March 2008. Multivariate piecewise Cox regression models were used to identify potential predictors of treatment modification. Results: Over a median follow-up period of 21 months, 17.5% of patients modified their regimen. Drug toxicity was the commonest reason (77 %) while drug contra-indications, namely tuberculosis (13.1%) and pregnancy (6.6%) accounted for 20% of the modifications. In the adjusted multivariate Cox piecewise regression model; after 11 months on ART, baseline CD4 cell count < 200cells/mm3 (HR = 4.42; 95% CI: 1.62 – 12.1), having Stavudine (d4T) in the initial regimen (HR = 2.64; 95% CI: 1.56 – 4.46) and baseline weight > 60kg (HR = 2.40; 95% CI: 1.43 – 4.04) significantly increased the hazards for modification. Conclusions: Initiating HAART at higher CD4 counts, avoiding drugs with poor safety profiles, such as Stavudine (d4T), and identifying individuals who may require therapy for tuberculosis or who may become pregnant could reduce modification rates.
Dissertation (MSc)--University of Pretoria, 2010.
Clinical Epidemiology
Unrestricted

APA, Harvard, Vancouver, ISO, and other styles

17

Kantojärvi, L. (Liisa). "Personality disorders in the Northern Finland 1966 Birth Cohort Study." Doctoral thesis, University of Oulu, 2008. http://urn.fi/urn:isbn:9789514288487.

Full text

Abstract:

Abstract Personality disorders (PDs) are relatively common mental disorders associating with other psychiatric disorders and disability. The aim of the study was to determine the occurrence of PDs in a general population subsample and psychiatric hospital patients, the associations of PDs with childhood family structure, the co-occurrence of PD with common psychiatric disorders, and the associations between PDs and temperament. The study is part of the Northern Finland 1966 Birth Cohort Project (NFBC 1966), consisting of cohort members living in Oulu (N = 1,609) on 1st January 1997 (the Oulu Study). The study consisted of a two-stage psychiatric field survey with questionnaires and a structured clinical interview and analysis of the patient records in public outpatient care. Information concerning psychiatric illness of all cohort members (N = 12,058) was gathered from the Finnish Hospital Discharge register (FHDR). The best-estimate procedure was used for the assessment of psychiatric morbidity including PDs. Childhood family structure and other sociodemographic variables were drawn from questionnaires of the field study conducted during earlier follow-up studies. In this study PDs were classified into three clusters: Cluster A (paranoid, schizoid and schizotypal PD), Cluster B (antisocial, borderline, histrionic, and narcissistic PD), and Cluster C (avoidant, dependent, obsessive-compulsive, and passive-aggressive PD). The most common PDs in the Oulu Study sample were Cluster C PDs, whereas Cluster B PDs were most common in the hospital-treated sample. PDs were highly associated with mood, anxiety and substance use disorders. Single-parent family type in childhood was associated with PDs, especially Cluster B PDs in adulthood. PD clusters were associated with different profiles of temperament, but the temperament dimensions could not distinguish different PDs very well. These results indicated that it is important to recognize PDs and their comorbid psychiatric disorders. This will have implications in both general outpatient care and psychiatry. These results indicate the importance of recognition of childhood risk factors for PDs for the prevention of severe PDs. The results suggest a need for more studies about the aetiology and development of PDs
Tiivistelmä Persoonallisuushäiriöt ovat yleisiä mielenterveyden ongelmia, joihin liittyy usein psykiatrista oheissairastavuutta ja toimintakyvyn laskua. Tämän tutkimuksen tarkoituksena oli arvioida persoonallisuushäiriöiden yleisyyttä nuorilla aikuisilla. tehtävänä oli arvoida yhteyksiä lapsuuden perherakenteeseen ja yleisimpiin psykiatrisiin häiriöihin sekä arvioida persoonallisuushäiriöiden yhteyksiä temperamenttitekijöihin. Tutkimus on osa Pohjois-Suomen vuoden 1966 syntymäkohortin psykiatrista osaprojektia, Oulu Studyä. Tutkimusaineiston muodostivat Oulu Studyn otokseen kuuluvat kaikki 1. tammikuuta 1997 Oulussa asuneet kohortin jäsenet (N = 1 609) sekä sairaalahoidossa olleiden persoonallisuushäiriö- diagnoosin saaneiden osalta koko alkuperäisen syntymäkohortin (N = 12 058) jäsenet. Tutkimus koostui kaksivaiheisesta psykiatrisesta kenttätutkimuksesta, jossa tietoja tutkittavilta kerättiin sekä kyselylomakkeiden ja haastattelututkimuksen avulla. Lisäksi tutkittavilta kerättiin tiedot heidän elinaikanaan toteutuneesta julkisten psykiatristen sairaala- ja avohoitopalvelujen käytöstä sairauskertomustietojen perusteella. Niin kutsutun best-estimated -menetelmän avulla arvioitiin tutkittavien psykiatrista sairastavuutta mukaan lukien persoonallisuushäiriöt. Tutkittavien lapsuuden perherakennetta ja sosiodemografisia tekijöitä arvioitiin aiempien seurantatutkimusten tietojen avulla. Tutkimuksessa persoonallisuushäiriöt luokiteltiin DSM-III-R-diagnoosiluokituksen mukaisesti kolmeen eri pääryhmään ja niiden mukaisiin alaryhmiin: Ryhmä A (epävakaa, eristäytyvä ja psykoosipiirteinen persoonallisuus), ryhmä B (epäsosiaalinen, epävakaa, huomionhakuinen ja narsistinen persoonallisuus) ja ryhmä C (estynyt, riippuvainen, pakko-oireinen ja passiivis-aggressiivinen persoonallisuus). Oulu Studyn väestöotoksessa yleisimpiä näistä olivat ns. C-ryhmän persoonallisuushäiriöt, kun taas sairaalahoidetuilla henkilöillä B-ryhmän persoonallisuushäiriöt olivat yleisimpiä. Persoonallisuushäiriöiden todettiin liittyvän yleisesti masennus- ja ahdistuneisuushäiriöihin sekä päihteiden käyttöön. Vanhemman yksinhuoltajuuden todettiin liittyvän persoonallisuushäiriöihin, etenkin B-ryhmän persoonallisuushäiriöihin. Persoonallisuushäiriöryhmät erosivat toisistaan temperamenttiprofiilien perusteella. Eri persoonallisuushäiriöistä kärsivillä tutkittavilla ei todettu tyypillisiä temperamenttiprofiileja. Johtopäätöksenä voidaan todeta, että persoonallisuushäiriöiden ja niihin yleisesti liittyvän psykiatrisen oheissairastavuuden tunnistaminen on tärkeää. Havainnot korostavat perusterveydenhuollon ja erikoissairaanhoidon yhteistyön merkitystä persoonallisuushäiriöistä ja psykiatrisista häiriöistä kärsivien henkilöiden tutkimuksessa ja hoidossa. Persoonallisuushäiriöille altistavien lapsuuden tekijöiden tunnistaminen on tärkeää vaikeiden persoonallisuushäiriöiden ehkäisemiseksi. Persoonallisuushäiriöiden etiologian ja kehittymisen selvittämiseksi tarvitaan uusia tutkimuksia

APA, Harvard, Vancouver, ISO, and other styles

18

Abdelrahman, Tamer. "Quasispecies dynamics and treatment outcome during early hepatitis C infection in a cohort of HIV-infected men." Thesis, University of Glasgow, 2015. http://theses.gla.ac.uk/7402/.

Full text

Abstract:

Hepatitis C virus (HCV) is emerging as one of the leading causes of morbidity and mortality in individuals infected with HIV and has overtaken AIDS-defining illnesses as a cause of death in HIV patient populations who have access to highly active antiretroviral therapy. For many years, the clonal analysis was the reference method for investigating viral diversity. In this thesis, a next generation sequencing (NGS) approach was developed using 454 pyrosequencing and Illumina-based technology. A sequencing pipeline was developed using two different NGS approaches, nested PCR, and metagenomics. The pipeline was used to study the viral populations in the sera of HCV-infected patients from a unique cohort of 160 HIV-positive patients with early HCV infection. These pipelines resulted in an improved understanding of HCV quasispecies dynamics, especially regarding studying response to treatment. Low viral diversity at baseline correlated with sustained virological response (SVR) while high viral diversity at baseline was associated with treatment failure. The emergence of new viral strains following treatment failure was most commonly associated with emerging dominance of pre-existing minority variants rather than re-infection. In the new era of direct-acting antivirals, next generation sequencing technologies are the most promising tool for identifying minority variants present in the HCV quasispecies populations at baseline. In this cohort, several mutations conferring resistance were detected in genotype 1a treatment-naïve patients. Further research into the impact of baseline HCV variants on SVR rates should be carried out in this population. A clearer understanding of the properties of viral quasispecies would enable clinicians to make improved treatment choices for their patients.

APA, Harvard, Vancouver, ISO, and other styles

19

Drogemoller, Britt Ingrid. "Investigation of genetic variation contributing to antipsychotic treatment response in a South African first episode schizophrenia cohort." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/95473.

Full text

Abstract:

Thesis (PhD)--Stellenbosch University, 2013.
ENGLISH ABSTRACT: Schizophrenia is a debilitating disorder that occurs the world over. Although antipsychotics are largely effective in treating the positive symptoms of schizophrenia, the outcomes are non-optimal in many patients. As antipsychotic treatment response has been shown to be heritable, it is expected that the implementation of antipsychotic pharmacogenomics should aid in the optimization of antipsychotic treatments, however to date clinically applicable results are limited. Therefore this study utilized exome sequencing in a cohort of well characterized first episode schizophrenia patients to identify the genetic factors contributing to antipsychotic treatment response. The utility of exome sequencing for antipsychotic pharmacogenomic applications in the African context was assessed through examination of the literature and publically available data. Thereafter, a cohort of 104 well characterized South African first episode schizophrenia patients who were treated with flupenthixol decanoate for twelve months was collected. From this cohort, subsets of patients on extreme ends of the treatment response spectrum were identified for exome sequencing. Thereafter a bioinformatics pipeline was used to call and annotate variants. These variants and those that have previously been associated with antipsychotic response, along with a panel of ancestry informative markers, were prioritized for genotyping in the entire cohort of patients. After genotyping of the 393 variants, statistical analyses were performed to identify associations with treatment response outcomes. Examination of the literature revealed a need for exome sequencing in Africa. However, critical analyses of next generation sequencing data demonstrated that complex regions of the genome may not be well suited to these technologies. Thus, it may be necessary to combine exome sequencing with knowledge obtained from past research, as was done in this study to identify the genetic factors contributing to antipsychotic treatment response. Using this strategy, the current study highlighted the potential role that rare variants play in antipsychotic treatment response and additionally detected 11 variants that were significantly associated with antipsychotic treatment response outcomes (P=2.19x10-5). Nine of these variants were predicted to alter the function of the genes in which they occurred; of which eight were novel with regards to antipsychotic treatment response. The remaining two variants have been associated with antipsychotic treatment outcomes in previous GWAS. Examination of the function of the genes in which the variants occurred revealed that the variants associated with (i) positive symptom improvement were involved in the folate metabolism pathway and (ii) negative and general pathological symptoms improvement had potential links to neuronal development and migration. To our knowledge this study is the first to utilize exome sequencing for antipsychotic pharmacogenomic purposes. The ability of this study to identify significant associations, even after correction for multiple testing, has highlighted the importance of combining genomic technologies with well characterized cohorts. The results generated from this study have served both to replicate results from previous antipsychotic pharmacogenetic studies and to identify novel genes and pathways involved in antipsychotic response. These results should aid in improving our understanding of the biological underpinnings of antipsychotic treatment response and may ultimately aid in the optimization of these treatments.
AFRIKAANSE OPSOMMING: Skisofrenie is ‘n siekte wat wêreldwyd voorkom en lei tot erge funksionele inkorting. Alhoewel antipsigotiese medikasie redelik effektief is in die behandeling van die positiewe simptome van skisofrenie, is die funksionele uitkomste in baie pasiënte nie optimaal nie. Die reaksie op antipsigotiese behandeling blyk oorerflik te wees. Die verwagting is dus dat die implementering van antipsigotiese farmakogenomika met die optimalisering van antipsigotiese behandeling sal help. Tot dusver het die resultate van farmakogenomika studies egter beperkte kliniese toepassings opgelewer. Hierdie studie het dus eksoomvolgordebepaling in 'n groep van goed-karakteriseerde eerste-episode skisofrenie pasiënte gebruik om die genetiese faktore wat bydra tot die antipsigotiese behandelings-reaksies te identifiseer. Die gebruik van eksoom-volgordebepaling vir antipsigotiese farmakogenomika in die Afrikakonteks is deur die ondersoek van literatuur en openbaar-beskikbare data geëvalueer. Daarna is 'n groep van 104 goed-gekarakteriseerde Suid-Afrikaanse eerste-episode skisofrenie pasiënte, wat met flupenthixol dekanoaat vir twaalf maande behandel is, versamel. Uit hierdie groep is subgroepe van pasiënte op die teenoorgestelde eindpunte van die behandelings-reaksiespektrum vir eksoom-volgordebepaling geïdentifiseer. Hierna is 'n bioinformatika pyplyn gebruik om variante te identifiseer en te annoteer. Hierdie variante, asook variante wat voorheen met antipsigotiese reaksie geassosieer is, is saam met 'n paneel van afkoms-informatiewe merkers vir genotipering in die hele groep pasiënte geprioritiseer vir genotipering. Na genotipering van die 393 variante, is statistiese analises uitgevoer om assosiasies met behandelings-reaksie uitkomste te identifiseer. ‘n Ondersoek van die literatuur het getoon dat daar 'n behoefte vir eksoomvolgordebepaling in Afrika is. ‘n Kritiese analise van volgende-generasie volgordebepalings data het egter getoon dat komplekse dele van die genoom nie geskik is vir die gebruik van hierdie tegnologie nie. Om die genetiese faktore wat bydra tot suksesvolle antipsigotiese behandeling te identifiseer, mag dit nodig wees om eksoom-volgordebepaling te kombineer met bevindings verkry uit vorige navorsing, soos gedoen in hierdie studie. In die huidige studie het die gebruik van hierdie strategie die potensiële rol van skaars variante in antipsigotiese behandelings-reaksies beklemtoon en ‘n bykomende 11 variante is geïdentifiseer wat beduidend met antipsigotiese behandelingsrespons geassosieer is (P=2.19x10-5). Daar is voorspel dat nege van hierdie variante die funksie van die gene waarin hulle voorkom sal verander en agt van hierdie variante is vir die eerste keer met antipsigotiese behandelingsrespons geassosieer. Die oorblywende twee variante is met antipsigotiese behandelingsrespons in vorige GWAS geassosieer. ‘n Ondersoek na die funksie van die gene waarin die variasies voorgekom het, toon dat die variante wat geassosieer is met (i) verbetering van positiewe simptome ‘n rol speel in folaatmetabolisme, terwyl variante wat geassosieer is met (ii) die verbetering in negatiewe en algemene patologiese simptome potensiële skakels met neuron ontwikkeling en migrasie het. Na ons wete is hierdie die eerste studie wat eksoom-volgordebepaling vir antipsigotiese farmakogenomika doeleindes gebruik. Die vermoë van hierdie studie om beduidende assosiasies te identifiseer, selfs na korreksie vir veelvoudige toetse, onderstreep die belangrikheid van die kombinering van genomiese tegnologie met goed-gekarakteriseerde pasiënte. Die bevindinge van hierdie studie het nie net die resultate van vorige antipsigotiese farmakogenetiese studies bevestig nie, maar ook nuwe gene en variante wat betrokke is in antipsigotiese reaksie geïdentifiseer. Hierdie resultate sal hopelik ons begrip van die onderliggende biologiese faktore wat antipsigotiese behandelingsrespons beïnvloed verbeter en uiteindelik ook met die optimalisering van behandeling help.

APA, Harvard, Vancouver, ISO, and other styles

20

Leoo, Malin. "Childhood obesity treatment during the first wave of the Covid-19 pandemic : – a retrospective controlled cohort study." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-91059.

Full text

Abstract:

Abstract Introduction: Obesity amongst children is a major health problem. At the outpatient paediatric clinic at Södertälje hospital in Region Stockholm, there is a large and well-established treatment model against childhood obesity. During spring 2020 all elective care in Region Stockholm, including visits to the obesity team, was cancelled for 3 months due to relocation of health care professionals because of the Covid-19 pandemic. Aim: To investigate whether the first wave of the Covid-19 pandemic affected the outcome of childhood obesity treatment at one outpatient paediatric clinic in Region Stockholm. Methods: A retrospective controlled cohort study comparing two groups regarding results of first year of obesity treatment for children. One group had their first year of treatment during the first wave of the Covid-19 pandemic and the control group before the pandemic. Data was retrieved from BORIS and complemented by a review of medical records. Results: Mean change in BMI SDS after one year of treatment in the Covid group was -0.10 units and in the control group -0.11 (ns). In the Covid group more patients quit the treatment programme and had a smaller number of visits to a nurse compared to controls. Conclusion: This study showed no difference in outcome regarding change in BMI SDS. However, it seems that the cancellation of visits might have affected the number of children lost to follow-up. Therefore, clinics should consider “digi-physical” care (e.g., via telephone, videocalls or other media) to secure the child and parents motivation and participation in the obesity treatment programme.

APA, Harvard, Vancouver, ISO, and other styles

21

Manentsa, Mmatsie. "Stavudine-associated toxicity in patients on low-dose versus high-dose Stavudine in an HIV treatment cohort." Diss., University of Pretoria, 2015. http://hdl.handle.net/2263/53058.

Full text

Abstract:

Background Stavudine (d4T) is an antiretroviral drug used in developing countries for the management of HIV due to its efficacy and low cost. Concerns over its toxic side effects has led the WHO to recommend that it be phased out. The study aim was to ascertain whether a low, yet efficacious dose of d4T (20 mg twice daily) would lead to fewer incidences of toxicity. Objectives This study compared incidence of toxicity in patients on low dose d4T (20 mg) versus the higher doses (30 mg /40 mg). Methods A retrospective analysis using STATA 12 was conducted on 1086 patients in a South African HIV treatment cohort. They were stratified into 3 d4T dose groups; 20 mg (n=43); 30 mg (n=707); and 40 mg (n=336). Time to onset of toxicity was assessed using survival analysis. Toxicity incidence rates were estimated using Poisson regression. Cox models were used to determine risk factors. Results Median time to onset of toxicity was 217, 137 and 55 weeks for the d4T 20 mg, d4T 30 mg and d4T 40 mg groups, respectively. Toxicity incidence rates per 100 person-years were 43 (95%CI 25 - 76), 67 (95%CI 54 - 83) and 174 (95%CI 143 - 211), respectively. Patients on d4T 20 mg were less likely to develop toxicity compared to the other doses, hazard ratio 0.36 (95%CI 0.20 - 0.65). Female sex was a risk factor for toxicity, hazard ratio 1.58 (95%CI 1.25 2.00). Other identified risk factors included the presence of renal dysfunction as well as BMI. Conclusion d4T 20 mg twice daily led to fewer incidences of toxicity. Further clinical trials are needed to compare this drug dose to other antiretrovirals.
Dissertation (MSc)--University of Pretoria, 2015.
School of Health Systems and Public Health (SHSPH)
MSc
Unrestricted

APA, Harvard, Vancouver, ISO, and other styles

22

Bwalya, Clement Mudala. "Retention in HIV care among female sex workers on antiretroviral treatment in Lusaka, Zambia: A retrospective cohort study." University of the Western Cape, 2020. http://hdl.handle.net/11394/8045.

Full text

Abstract:

Master of Public Health - MPH
Background: HIV/AIDS remains a major public health issue that is affecting all population groups and communities in Zambia. Among the most affected groups are key populations (KPs) such as female sex workers. KPs are considered at high risk of contracting HIV but have limited access to HIV services and retention in care due to internalized stigma, discrimination, criminalization, and negative attitudes towards HIV treatment. Under the USAID Open Doors project in Zambia, KPs access comprehensive HIV prevention, care and treatment services. The test and treat strategy is implemented by the project in support of the UNAIDS 90-90-90 targets by 2020 to diagnose 90% of people living with HIV, put 90% of them on treatment, and for 90% of them to have suppressed viral load. Aim: This study aimed to determine retention in care among female sex workers (FSWs) in the first six months after ART initiation using the HIV care cascade. Methodology: A retrospective cohort study was conducted of all new HIV positive female sex workers (FSWs) initiated on ART between October 2018 and June 2019 (9 months period) based on the electronic records. Data were extracted from SmartCare, an electronic health record system used by the ART clinic. Microsoft Excel and Epi-Info 7 software were used for data entry and analysis. Kaplan–Meier survival analysis was conducted to examine differences in retention rates. Results: A total of 205 FSWs were initiated on ART, out of which 180 were active on ART (36 youths and 144 adults) and 25 were lost to follow-up (four youths and 21 adults) during the 9 months study period. Of the 180 FSWs active on ART, 36 were FSWs aged 18 – 24 years (youths) representing 90% retained in care while 144 were FSWs aged 25 – 42 years (adults) with 87% being retained on ART treatment. Retention in ART care was not significantly different in the survival curves between the age groups of FSW youths and FSW adults during the study period (p-value = 0.637). Retention in ART care was not statistically significant for education (p-value = 0.481), marital status (p-value = 0.545), and occupation (p-value = 0.169). Conclusion: Retention in ART care among FSWs was 88%. However, there were no significant differences by age group identified in this study. While this study shows 88% retention rate among FSWs, it will be used as a baseline in meeting the UNAIDS 90-90-90 goals.

APA, Harvard, Vancouver, ISO, and other styles

23

Smith, Sean. "Trocantheric Femoral Fractures - a retrospective cohort study comparing reoperation rates before and after implementation of new treatment protocol." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-86763.

Full text

Abstract:

Introduction: Hip fractures are very common in Sweden. Keeping reoperation rates as low as possible is critical. One factor correlated to mechanical complications and thereby reoperation rates is the tip-apex distance. In April of 2017 the Orthopedic clinic at Karlstad’s Central Hospital in Sweden implemented new routines for the choice of treatment method of pertrocantheric and subtrocantheric femoral fractures. Aim: The primary aim of this study was to compare reoperation rates of pertrocantheric and subtrocantheric femoral fractures before and after implementation of new routines. Secondly, we wanted to study the association between the tip-apex distance and reoperation rates for pertrocantheric femoral fractures treated at Karlstad’s Central Hospital. Method: This was an internal quality control designed as a retrospective cohort study. Data on patients treated for pertrocantheric or subtrocantheric femoral fractures were retrieved from the Swedish Fracture Registry. Tip-apex distances were measured on patients’ radiographic images. P-values for comparison of the two study periods were created using the chi2 test. Association between the tip-apex distance and reoperation rate was presented as odds ratio. Result: The reoperation rates were the same for both time periods. The reoperation rates of unstable fractures were lower for the study period after implementation of new routines. Neither of these results were statistically significant. There was also no statistically significant association between the tip-apex distance and reoperation rates. Conclusion: No statistically significant decrease in reoperation rates was seen after implementation of new routines. There was no association between the tip-apex distance and reoperation rates.

APA, Harvard, Vancouver, ISO, and other styles

24

Bogefeldt, Johan. "Low back pain with special reference to prevalence, diagnosis, treatment and prognosis /." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl.[distributör], 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-108070.

Full text

APA, Harvard, Vancouver, ISO, and other styles

25

Wyl, Viktor von. "HIV-1 drug resistance in the Swiss HIV Cohort study : epidemiology and impact on treatment of HIV-infected patients /." Zürich : ETH, 2008. http://e-collection.ethbib.ethz.ch/show?type=diss&nr=17726.

Full text

APA, Harvard, Vancouver, ISO, and other styles

26

Zhao, Ying. "Improved treatment outcomes with bedaquiline when substituted for second-line injectable agents in multidrug-resistant tuberculosis: A retrospective cohort study." Master's thesis, Faculty of Health Sciences, 2019. https://hdl.handle.net/11427/31777.

Full text

Abstract:

Background Bedaquiline is used as a substitute for second-line injectable (SLI) intolerance in the treatment of multidrug-resistant tuberculosis (MDR-TB), but the efficacy and safety of this strategy is unknown. Methods We performed a retrospective cohort study to evaluate treatment outcomes for MDR-TB patients who substituted bedaquiline for SLIs. Adults receiving bedaquiline substitution for MDR-TB therapy, plus a matched control group who did not receive bedaquiline, were identified from the electronic TB register in the Western Cape Province, South Africa. The primary outcome measure was the proportion of patients with death, loss to follow up, or failure to achieve sustained culture conversion at 12 months of treatment. Results Data from 162 patients who received bedaquiline substitution and 168 controls were analyzed; 70.6% were HIV-infected. Unfavorable outcomes occurred in 35/146 (23.9%) patients in the bedaquiline group versus 51/141 (36.2%) in the control group (relative risk, 0.66; 95% confidence interval [CI], 0.46 to 0.95). The number of patients with culture reversion was lower in those receiving bedaquiline (1 patient, 0.8%) compared to controls (12 patients, 10.3%; P = 0.001). Delayed initiation of bedaquiline was independently associated with failure to achieve sustained culture conversion (adjusted odds ratio, 1.5; 95% CI, 1.1 – 1.9, for every 30-day delay). Mortality was similar at 12 months (11 deaths in each group; P = 0.973). Conclusions Substituting bedaquiline for SLIs in MDR-TB treatment resulted in improved outcomes at 12 months compared with patients who remained on SLIs, supporting the use of bedaquiline for MDR-TB treatment in programmatic settings.

APA, Harvard, Vancouver, ISO, and other styles

27

Ishida, Yoshihiro. "Killer immunoglobulin-like receptor genotype did not correlate with response to anti-PD-1 antibody treatment in a Japanese cohort." Kyoto University, 2020. http://hdl.handle.net/2433/253207.

Full text

APA, Harvard, Vancouver, ISO, and other styles

28

Baquerizo, Pamela, Camila Carbone, and Monica Giacchetti. "Abandono de la terapia nutricional y pérdida de peso en pacientes bariátricos: Cohorte retrospectiva en Lima-Perú." Bachelor's thesis, Universidad Peruana de Ciencias Aplicadas (UPC), 2015. http://hdl.handle.net/10757/621812.

Full text

Abstract:

Objetivos: Determinar la proporción de pacientes que cumplen los criterios internacionales de gastrectomía en manga así como estimar la asociación entre el porcentaje de pérdida de peso en el primer, tercer y sexto mes del tratamiento nutricional con la tasa de abandono del mismo. Materiales y métodos: Estudio de tipo cohorte retrospectivo realizado con historias clínicas de pacientes con gastrectomía en manga laparoscópica operados desde el 2008 hasta marzo 2014 en una clínica privada. Dos fueron las variables resultado de interés: la elegibilidad para cirugía bariátrica según criterios internacionales (IMC ≥40 kg/m2o ≥ 35 kg/m2 con comorbilidades) y el abandono antes o durante (inasistencia por más de 60 días desde la consulta previa sin haber sido dado de alta (IMC < 25)) el tratamiento nutricional. La exposición fue el porcentaje de peso perdido en las primeras cincos semanas después de la cirugía (< 10% vs. ≥ 10%). Se utilizaron modelos de regresión de Poisson y se calcularon riesgos relativos y sus respectivos intervalos de confianza al 95% (IC95%). Resultados: La muestra estuvo compuesta por datos de 423 historias clínicas de pacientes bariátricos, 294 (69.5%) fueron mujeres, edad media 39.2 (DE: 12.3) años. Solo 117 (27.7%) pacientes cumplieron con los requisitos establecidos para la cirugía, y 48 de esos 117 (41%) abandonaron el tratamiento nutricional antes de iniciarlo. Controlando por sexo y edad y tomando como referencia aquellos que perdieron <10% de peso, los que perdieron ≥10% del peso inicial redujeron el riesgo de abandonar el tratamiento nutricional (RR = 0.10; IC95% 0.01–0.68) en el primer mes. Conclusión: A pesar de las recomendaciones internacionales, una gran proporción de los pacientes de cirugía bariátrica no cumple los requisitos. La incidencia de abandono antes y durante el tratamiento nutricional es alta. Los resultados resaltan la necesidad de tener guías para el manejo de cirugía bariátrica en nuestro contexto.
bjectives: To determine the proportion of patients who meet international recommendations for bariatric surgery and to assess the impact of weight loss in the first, third and sixth month of nutritional treatment on it’s abandonment. Methods: A retrospective cohort study was performed using data from clinical records of patients who underwent sleeve gastrectomy in a private clinic of Lima, Peru. Two outcomes were evaluated, eligibility for bariatric surgery according to international recommendations (BMI ≥40 kg/m2 or ≥35 kg/m2 with comorbidities) and abandonment before and after starting nutritional management (no nutritional assessment after 60 days from the previous visit without achieving ideal BMI). The exposure was the percentage of weight lost in the first five weeks after surgery split into <10% and ≥10%. Poisson regression was used and relative risks and 95% confidence intervals (95%CI) were calculated. Results: Data from 423 medical records of bariatric patients, mean age 39.2 years (SD 12.3), 294 (69.5%) women, were analyzed. Only 117 (27.7%) patients met international recommendations for bariatric surgery. Before starting nutritional management, 48/117 (41%) abandoned treatment, whereas an additional 29/69 (42.0%) abandoned before six months of nutritional management. In multivariable model, a weight loss ≥10% in the first five weeks reduced the risk of abandoning nutritional management (RR = 0.10, 95% CI 0.01-0.68) in the first month. Conclusions: Despite of international recommendations, a great proportion of patients undergoing bariatric surgery did not meet the criteria. Rates of abandonment before and after starting nutritional management are high. Results highlight the urgency of having appropriate guidelines for managing bariatric surgery in our context.

APA, Harvard, Vancouver, ISO, and other styles

29

Herdman, Susan J., Courtney D. Hall, and Lisa Heusel Gillig. "Factors Associated with Rehabilitation Outcomes in Patients with Unilateral Vestibular Hypofunction: A Prospective Cohort Study." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/etsu-works/7778.

Full text

Abstract:

Objective:The purpose of this study was to determine factors associated with rehabilitation outcomes following vestibular rehabilitation (VR). Methods:In this prospective cohort study, 116 patients who completed at least 2 supervised sessions participated. Patient characteristics and comorbidities were recorded. Initial and discharge measures included symptom intensity, balance confidence, quality of life, time symptoms interfere with life, perceived benefits of VR, gait speed, fall risk, visual acuity during head movement, and anxiety/depression. Intention-to-treat analyses were performed to determine outcomes at discharge. Bivariate correlations between independent (group characteristics and baseline measures) and dependent (discharge measures) variables were determined. Logistic regressions were performed to identify factors associated with whether a patient would have a normal score or meaningful change at discharge. Results:There was a large effect of VR with significant improvement for the group as a whole on each outcome measure. For each outcome measure most patients improved. Based on preliminary logistic regression, 2 patient characteristics were associated with outcome: number of therapy visits predicted meaningful improvement in gait speed and falls after the onset of the UVH predicted meaningful change in the percent of time symptoms interfered with life. Initial Activities-based Balance Confidence (ABC) scale and Dynamic Gait Index (DGI) scores predicted normal ABC scores at discharge, and initial ABC scores predicted recovery of DGI scores. Preliminary prediction models were generated for balance confidence, impact of dizziness on life, dynamic visual acuity, gait speed, and fall risk. Conclusions:Therapists may use these findings for patient education or the need for adjunct therapy such as counseling. Impact:Not all people with UVH improve following VR, but there is little research examining why. This study looked at multiple factors and identified number of visits and falls after onset of UVH as patient characteristics associated with outcomes following VR, which will help therapists create better predictive models.

APA, Harvard, Vancouver, ISO, and other styles

30

Frick, Ulrich, Jürgen Rehm, Daniele Zullino, Manrique Fernando, Gerhard Wiesbeck, Jeannine Ammann, and Ambros Uchtenhagen. "Long-Term Follow-Up of Orally Administered Diacetylmorphine Substitution Treatment." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-133129.

Full text

Abstract:

Background: To assess the long-term course of the feasibility and safety of orally administered heroin [diacetylmorphine (DAM)] tablets in substitution treatment of severely addicted opioid users. Design: Open-label, prospective cohort study with 2 non-randomly assigned treatment arms: DAM tablets only (n = 128) or DAM tablets combined with injected DAM and/or other opioids (n = 237). The average duration of the observation period was 62 months. Study endpoints were the time to discharge from treatment and the number of serious adverse events. Results: Both patient groups had a higher than 70% retention rate after the first 48 months of treatment, with similar long-term retention rates (after 8 years both groups had retention over 50%). The physician-verified rate of serious adverse events was 0.01 events per application year among the exclusively oral substitution group (intention-to-treat analysis) during the last year of observation, and 0.005 events per application year in the other group. Conclusions: Because of their feasibility and safety over years, DAM tablets may be a valuable long-term therapeutic alternative
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich

APA, Harvard, Vancouver, ISO, and other styles

31

Relton, Clare. "A new design for pragmatic randomised controlled trials : a 'Patient Cohort' RCT of treatment by a homeopath for menopausal hot flushes." Thesis, University of Sheffield, 2009. http://etheses.whiterose.ac.uk/6644/.

Full text

Abstract:

There is debate regarding the effectiveness of homeopathy and its continuing provision in the NHS, and despite 150+ clinical trials there are conflicting opinions as to what can be concluded from these trials. This thesis addresses the question: “What type of clinical trial design can provide the information needed to make decisions about the provision of homeopathy in a publicly funded healthcare system?” A critique of the methods used in existing clinical trial designs was undertaken which identified twelve key criteria for appropriate clinical trial design; methods from existing standard and alternative clinical trial designs were adapted in order to derive a new clinical trial design that has the potential to meet all twelve key criteria (the ‘Patient Cohort’ RCT design). A current clinical question was identified: ‘What is the clinical & cost effectiveness of treatment by a homeopath for women with menopausal hot flushes?” and a population based survey confirmed the importance of this question. The ‘Patient Cohort’ RCT design was piloted in an NHS setting in order to address this current clinical question. Seventy ‘with need’ women were recruited to the Hot Flush Cohort of whom forty-eight were eligible for the treatment, a proportion of whom were randomly selected to be offered the treatment. 70.8% of those offered treatment accepted the offer and completion of outcome measures was high (93.7%). The results indicate that a full trial of this treatment for this condition may be worthwhile conducting. A full RCT using this design would be an appropriate clinical trial design to provide answers as to the provision of homeopathy and other clinician delivered interventions in publicly funded healthcare system such as the NHS. The ‘Patient Cohort’ RCT design can be usefully applied to clinical questions that require very pragmatic approaches yet need the scientific rigour of randomisation.

APA, Harvard, Vancouver, ISO, and other styles

32

Frick, Ulrich, Jürgen Rehm, Daniele Zullino, Manrique Fernando, Gerhard Wiesbeck, Jeannine Ammann, and Ambros Uchtenhagen. "Long-Term Follow-Up of Orally Administered Diacetylmorphine Substitution Treatment." Karger, 2010. https://tud.qucosa.de/id/qucosa%3A27490.

Full text

Abstract:

Background: To assess the long-term course of the feasibility and safety of orally administered heroin [diacetylmorphine (DAM)] tablets in substitution treatment of severely addicted opioid users. Design: Open-label, prospective cohort study with 2 non-randomly assigned treatment arms: DAM tablets only (n = 128) or DAM tablets combined with injected DAM and/or other opioids (n = 237). The average duration of the observation period was 62 months. Study endpoints were the time to discharge from treatment and the number of serious adverse events. Results: Both patient groups had a higher than 70% retention rate after the first 48 months of treatment, with similar long-term retention rates (after 8 years both groups had retention over 50%). The physician-verified rate of serious adverse events was 0.01 events per application year among the exclusively oral substitution group (intention-to-treat analysis) during the last year of observation, and 0.005 events per application year in the other group. Conclusions: Because of their feasibility and safety over years, DAM tablets may be a valuable long-term therapeutic alternative.
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

APA, Harvard, Vancouver, ISO, and other styles

33

Sá, Edmundo José Bragança de. "How effective are brief interventions in smoking cessation: project of a cohort study in a family health care unit." Master's thesis, Faculdade de Ciências Médicas. UNL, 2012. http://hdl.handle.net/10362/9253.

Full text

Abstract:

ABSTRACT: Tobacco use remains the most significant modifiable cause of disability, death and illness1. In Portugal, 19,6% of the population aged ten years or more smoke3. A Cochrane review of 20087 concluded that a brief advice intervention (compared to usual care) can increase the likelihood of a smoker to quit and remain nonsmoker 12 months later by a further 1 to 3 %. Several studies have shown that Primary Care Physicians can play a key role in these interventions8,9,10. However we did not find studies about the effectiveness of brief interventions in routine consultations of Family Doctors in Portugal. For this reason we designed a Cohort Study to make an exploratory study about the effectiveness of brief interventions of less than three minutes in comparison with usual care in routine consultations. The study will be implemented in a Family Healthcare Unit in Beja, during six months. Family Doctors of the intervention group should be submitted for an educational and training program before the study begin. Quit smoking sustained rates will be estimated one year after the first intervention in each smoker. If, as we expect, quit smoking rates will be higher in the intervention group than in the control group, this may change Portuguese Family Doctors attitudes and increase the provision of brief interventions in routine consultations in Primary Healthcare Centers.

APA, Harvard, Vancouver, ISO, and other styles

34

Oliveira, Natasha van Schalkwyk Pimenta de. "Mental health care assessed based on structure, process and outcome : a retrospective cohort study." Master's thesis, Faculdade de Ciências Médicas, 2013. http://hdl.handle.net/10362/11455.

Full text

Abstract:

RESUMO: As doenças mentais são comuns, universais e associadas a uma significativa sobrecarga pessoal, familiar, social e económica. Os Serviços de Saúde Mental devem abordar de forma adequada as necessidades dos pacientes e familiares tanto ao nível clínico como também ao nível social. O presente estudo foi realizado num período de grande transformação nos sistemas de saúde primário e de saúde mental em Portugal, num Departamento de Psiquiatria desenvolvido com base nos princípios da OMS. Os objectivos incluem a caracterização: 1) das Unidades Funcionais do Departamento; 2) dos pacientes internados pela primeira vez no internamento de agudos; 3) da utilização dos serviços nas equipas comunitárias após a alta; e 4) da avaliação de alguns dos indicadores de qualidade do departamento, com recurso ao modelo de Donabedian sobre a articulação entre a Estrutura-Processo-Resultados. Metodologia: Foi escolhido um estudo de coorte retrospectivo. Todos os pacientes internados pela primeira vez entre 2008 e 2010 foram incluídos no estudo. Os seus processos clínicos e a base de dados do hospital onde são registados todos os contactos que estes tiveram com os profissionais de saúde mental foram revistos de forma a obter dados sociodemográficos e clínicos, durante o período do estudo e após a alta. Os instrumentos utilizados foram o WHO-ICMHC (Classificação Internacional de Cuidados de Saúde Mental), para caracterizar o Departamento, o AIESMP (Avaliação Inicial de Enfermagem em Saúde Mental e Psiquiatria) para recolha dos dados sociodemográficos, e o VSSS (Escala de Satisfação com os Serviços de Verona) de forma a avaliar a satisfação dos pacientes em relação aos cuidados recebidos. A análise estatística incluiu a análise descritiva, quantitativa e qualitativa dos dados. Resultados: As Unidades Funcionais do Departamento revelaram níveis elevados de articulação e consistência com as necessidades de cuidados psiquiátricos e reabilitação psicossocial dos pacientes. Os 543 pacientes admitidos pela primeira vez eram maioritariamente (56.9%) mulheres, caucasianas (81.2%), com diagnóstico de perturbações do humor (66.3%), internadas voluntariamente (59.7%), e uma idade média de 45.1 anos. Estas eram significativamente mais velhas, mais frequentemente empregadas, casadas/coabitar e tinham uma prevalência mais elevada de perturbações do humor, comparativamente aos homens. O internamento compulsivo era mais significativo nos homens (54.7%). A taxa de abandono no pós-alta (4.2%) e a taxa de reinternamentos (2.9%) na quinzena após a alta revelaram-se inferiores aos padrões na literatura internacional. De forma global, a satisfação dos pacientes com os cuidados de saúde mental foi positiva. Conclusões: Os cuidados prestados mostraram-se eficazes, adaptados e baseados nas necessidades e problemas específicos dos pacientes. A continuidade e a abrangência de cuidados foram difundidos e mantidos ao longo do processo de cuidados. Este Departamento pode ser considerado um exemplo de como proporcionar tratamento digno e eficiente, e uma referência para futuros serviços de psiquiatria.-------------- ABSTRACT: Mental health disorders are common, universal, and associated with heavy personal, family, social and economic burden. Mental health services should be aimed at adequately addressing patients’ and families’ needs at clinical and social level. The current study was carried out at a time of great transformation in the health and mental health systems in Portugal, in a Psychiatric Department developed taking in consideration the WHO principles. The objectives included characterizing: 1) the Psychiatric Department’s different units; 2) the patients admitted for the first time to the inpatient unit; 3) their use of community mental health services after discharge; and 4) assessing some of the department’s quality indicators, with resource to Donabedian’s Structure-Process-Outcome model. Methodology: A retrospective cohort design was chosen. All the firstly admitted patients in the period between 2008 and 2010 were included in the study. Their clinical records and the hospital’s database which registers all of the contacts the patients had with the mental health professionals during the study period, were reviewed to retrieve sociodemographic and clinical data and information on follow-up. The instruments used were the WHO International Classification of Mental Health Care (ICMHC) to characterize the department, the Initial Nurses’ Assessment in Mental Health and Psychiatry (AIESMP) for patients’ sociodemographic data, and the Verona Service Satisfaction Scale (VSSS) to assess patients’ satisfaction with care received. Statistical analysis included descriptive, quantitative and qualitative analysis of the data. Results: The Department’s Functional units revealed high levels of articulation, and were consistent with patients’ needs for psychiatric care and psychosocial rehabilitation. The 543 patients firstly admitted were mainly (56.9%) female, Caucasian (81.2%), diagnosed with mood disorders (66.3%), voluntarily admitted (59.7%), and with a mean age of 45.1 years. Female patients were significantly older, more frequently employed, married/cohabiting and had a higher prevalence of mood disorders when compared to males. Involuntary admission was more significant in males (54.7%). Dropout rates during follow-up (4.2%) and readmission rates (2.9%) in the fortnight following discharge were lower than standards in international literature. Overall patients’ satisfaction with mental health care was positive. Conclusions: The care delivered was effective, adapted and based on the patients’ specific needs and problems. Continuity and comprehensiveness of care was endorsed and maintained throughout the care process. This department may be considered an example of both humane and effective treatment, and a reference for future psychiatric care.

APA, Harvard, Vancouver, ISO, and other styles

35

Dartois, Laureen. "Facteurs comportementaux et non-comportementaux associés au risque de cancer et de mortalité à partir des données de la cohorte de femmes françaises E3N." Thesis, Paris 11, 2014. http://www.theses.fr/2014PA11T081/document.

Full text

Abstract:

Contexte : Le cancer est la seconde cause de mortalité chez la femme en France, et la première chez les femmes âgées de 35 à 84 ans. Le cancer du sein est le cancer le plus fréquemment diagnostiqué, représentant 35 % des cas chez les femmes en France en 2012. De multiples facteurs, comportementaux et non-Comportementaux, augmentant le risque de cancer, tant en incidence qu’en mortalité, ont été identifiés dans la littérature, tandis que leur influence conjointe est très peu évaluée. Dans le cas du cancer du sein, certains facteurs diffèrent selon le statut ménopausique des femmes, suggérant une étiologie différente entre les cancers du sein diagnostiqués avant et après la ménopause. Objectif : Les données de la cohorte prospective française E3N ont été utilisées pour évaluer l’influence des facteurs comportementaux et non-Comportementaux sur le risque de cancer et de mortalité chez les femmes avant et après la ménopause. Nous avons également cherché à estimer leur impact relatif sur la population et à identifier les facteurs à forts pouvoirs prédictifs.Résultats : Nos résultats suggèrent que le mode de vie a une influence modeste sur le risque de cancer et de mortalité lors de l’adhésion à une seule recommandation de santé publique. En revanche, elle est conséquente lors d’une adhésion conjointe à plusieurs recommandations. Les facteurs comportementaux jouent ainsi un rôle non négligeable dans la survenue de cancer et sur le risque de décès prématuré. Dans le cas du cancer du sein, ces facteurs influencent particulièrement le risque après la ménopause, tandis qu’avant la ménopause leur impact est plus faible que les facteurs qui ne relèvent pas du mode de vie ou de choix personnels. Ces observations sont retrouvées lorsque l’on cherche à prédire le risque de cancer du sein avant et après la ménopause. En effet, la prédiction du risque de cancer du sein en préménopause s’établit principalement à partir de facteurs non-Comportementaux, alors que la prédiction du risque en postménopause est également déterminée par des facteurs comportementaux.Conclusion : Nous avons montré que l’étiologie du cancer du sein diffère selon la nature de la tumeur, et en particulier selon le statut ménopausique des femmes. À tout âge, le mode de vie a une influence sur le risque de cancer et de mortalité prématurée, particulièrement après la ménopause lorsque leur impact est supérieur à celui des facteurs non-Comportementaux. Ces résultats demandent, cependant, à être reproduits dans des études prospectives portant sur des femmes plus jeunes
Background: Cancer is the second leading cause of mortality among women in France, and the leading cause of mortality among women aged between 35 and 84. Breast cancer is the most frequently diagnosed cancer, with 35% of cases among women in France in 2012. Multiple behavioural and non-Behavioural factors have been associated with increases in cancer incidence and mortality. However, the literature about their combined impact is scarce. Regarding breast cancer, some risk factors differed according to the menopausal status, suggesting a different etiology between premenopausal and postmenopausal breast cancers.Objectives: Data from the E3N prospective cohort of French women were used to evaluate the influence of behavioural and non-Behavioural factors on cancer risk before and after the menopause and on mortality. In addition, we aimed at estimating their relative impact on the population and identifying factors with the highest predictive power.Results: Our results suggest a modest influence of the lifestyle on cancer risk and mortality when adhering to only one public health recommendation. However, the influence is substantial with a combined adherence to several recommendations. Behavioural factors play a key role in the occurrence of cancer and mortality risk. Regarding breast cancer, these factors influence particularly the risk after the menopause, while before, their impact is lower than non-Behavioural factors. These observations were retrieved when aiming at predicting breast cancer risk according to menopausal status. Prediction was established by non-Behavioural factors in premenopause, while the prediction in postmenopause was driven by behavioural factors.Conclusion: We have shown that the etiology of breast cancer differs according to the nature of the tumour, and particularly according to the menopausal status of women. Whatever the age, lifestyle influence the risk of cancer and mortality, especially after the menopause when their impact is higher than the non-Behavioural factors’ one. New results from prospective study on younger women are warranted to confirm the results

APA, Harvard, Vancouver, ISO, and other styles

36

Theunissen, Helene Cornelia. "Early infant breastfeeding practices, and predictors of breastfeeding cessation, in HIV-uninfected and HIV-infected mothers on antiretroviral treatment: a prospective cohort study." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33051.

Full text

Abstract:

Background: Optimal breastfeeding promotes child health and survival globally. Pro-breastfeeding HIV infant feeding policy changes in 2010, and the roll-out of universal maternal anti-retroviral therapy (ART) since 2013, have created an opportunity for re-establishment of breastfeeding among HIV exposed infants in resource-limited settings. Yet data are limited on breastfeeding practices under these policies. This study aimed to evaluate breastfeeding practices and predictors of breastfeeding cessation among women living with HIV (WLHIV) receiving universal ART, and a comparator group of HIV-negative (HIV-) women in Cape Town, South Africa. Methodology: This secondary data analysis used deidentified data from two parallel, prospective cohort studies conducted at the Gugulethu Midwife and Obstetric Unit between 2013 and 2017; the unit is certified as Baby-Friendly. Utilizing the same research staff, measurement tools and procedures, the studies followed pregnant women (HIV-; and WLHIV initiating universal ART) through delivery. HIVexposed infants received nevirapine and co-trimoxazole prophylaxis. At the early neonatal visit (± 7 days), breastfeeding mother-infant pairs were eligible to continue follow-up (visits at 6 weeks; 3, 6, 9, 12 months). At each study visit, trained field workers administered 24-hour recall questionnaires to assess infant feeding and asked about changes in feeding practices since the preceding visit. Exclusive breastfeeding (EBF) was defined as feeding infants no other food or drink other than breastmilk, except for medicines, vitamins and minerals. Breast feeding (BF) was censored at last visit with reported BF. We used Cox proportional hazards regression to assess factors associated with cessation of exclusive and all breastfeeding among HIV-negative children of both groups of women (HIV-exposed uninfected, HEU and HIV-unexposed, HU children), expressed as crude (HR) or adjusted hazard ratios (aHR). Results: Overall, 872 breastfeeding mother-infant pairs (HEU, n=461; HU, n=411) contributed 925 person-years of follow-up. All WLHIV initiated ART in pregnancy (at ART initiation, median HIV viral load 3.97 log10 copies/mL; median CD4 cell count, 354 cells/uL); 352/461 (76%) of WLHIV had viral load < 1 hour; overall, 788/867, 91%) was more common among HU than HEU infants (95% vs 87%, p<0.0001). Among infants who ever received EBF (754/872, 86%), median EBF duration was 1.4 (0.2-3.1) months. HEU vs HU infants were more likely to ever EBF (91% vs 81%, p <0.0001), with longer durations of EBF (median 1.5 vs 1.4 months, p=0.01; HR for EBF cessation, 0.78 [95% CI 0.67-0.9]). The overall median duration of any breastfeeding was 6.0 (IQR 1.5-12.0) months, with earlier cessation among HEU (median 3.9 months) than HU infants (median 9.0 months); HR for BF cessation 1.87 (95% CI 1.56-2.24). Lactation issues (for example cracked nipples or engorgement) were common in the first 6 weeks postpartum (reported by 143 of 872, 16%), with greater risk among WLHIV than HIV- women (20% vs 12%, p=0.003). Lactation problems (vs none reported) were associated with increased relative hazard for EBF cessation among both HEU (HR 1.48, 95% CI 1.13- 1.96) and HU infants (HR 1.63, 95% CI 1.17-2.26); and for BF cessation among HEU infants (HR 2.45, 95% CI 1.85-3.24). Study limitations include reliance on maternal recall, and inability to assess exact date of breastfeeding cessation. Conclusion: Breastfeeding practices remain poor among both WLHIV and HIV- women, despite probreastfeeding HIV policy changes. An alarmingly high proportion of WLHIV reported lactation problems including cracked nipples. These data highlight an urgent need for lactation support among peri-urban women in our setting, especially those living with HIV, both to improve overall breastfeeding practices to maximize child health and to prevent breastmilk-associated transmission of HIV.

APA, Harvard, Vancouver, ISO, and other styles

37

Reichmuth, Kirsten Leah. "Virologic outcomes of HIV-infected children undergoing a single-class drug substitution from Lopinavir/Ritonavir- to Efavirenz-based antiretroviral treatment: A retrospective cohort study." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/14257.

Full text

Abstract:

Major advances have been made in preventing mother to child transmission of HIV (PMTCT), as well as in decreasing morbidity and mortality amongst HIV-infected infants and children. However, maintenance of excellent adherence to combination antiretroviral therapy (cART) lifelong is required to achieve optimal benefits. In addition, treatment options for children are limited by potential drug-resistance following PMTCT exposure, availability of appropriate and palatable formulations, long-term toxicity concerns and drug-interactions - notably with co-treatment for tuberculosis. Given these challenges, drug simplification strategies for children remains an important area of research. The World Health Organisation (WHO) recommends lopinavir/ritonavir-based (LPV/r) cART as first-line for children <36 months old with the option to substitute LPV/r with a non-nucleoside reverse transcriptase inhibitor if virologic suppression is maintained. This simplification strategy is potentially cost-saving, regimen-sparing and more tolerable, with a better long-term side-effect profile. Consequently, benefits should also exist in terms of adherence. The main evidence in support of this strategy has come from trials conducted by the Nevirapine Resistance Studies (NEVEREST) group. In particular, the NEVEREST 3 trial showed that substituting LPV/r for efavirenz (EFV) in children aged 36-60 months virologically suppressed on LPV/r-based cART was protective against viral rebound and had no effect on virological failure compared with remaining on LPV/r. To our knowledge, no studies to date have examined the virologic outcomes of children changed to an EFV-based regimen after initiating a LPV/r based regimen in routine, resource-constrained settings where selection of patients as eligible for EFV substitution and subsequent monitoring practices may be less rigorous than in a trial setting. At the International Epidemiologic Database to Evaluate AIDS - Southern Africa collaboration's (IeDEA-SA) South African sites LPV/r has been used for first-line cART in children <36 months of age irrespective of PMTCT antiretroviral exposure. At many of these sites clinicians have, at their discretion, elected to substitute LPV/r with EFV when children reach 36 months of age. This has provided the opportunity to conduct an observational study to investigate this practice in a routine-care setting â€“ comparing outcomes in children virologically suppressed and â‰¥36 months old who underwent a substitution of LPV/r to EFV (substitution group) to those who remained on their initial LPV/r-based regimen (stay group).

APA, Harvard, Vancouver, ISO, and other styles

38

Sinclair, Michael. "A qualitative exploration of coping and adhering with hepatitis C treatment amongst a cohort of gay men in London co-infected with HIV and hepatitis C." Thesis, University of Essex, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.435559.

Full text

APA, Harvard, Vancouver, ISO, and other styles

39

Montvida, Olga. "Evaluation of cardio-metabolic effects of treatment with incretin-based therapies in patients with type 2 diabetes." Thesis, Queensland University of Technology, 2018. https://eprints.qut.edu.au/122920/1/Olga_Montvida_Thesis.pdf.

Full text

Abstract:

This dissertation provides a detailed exploration and valuable insights of type 2 diabetes management in the real-world setting. Incretin-based therapies and thiazolidinedione were found to provide higher chances of sustainable glycaemic and cardiovascular risk factor control, compared to older anti-diabetic treatment options. The project highlights alarming rates of the existing cardio-metabolic burden at the population level. Proper control in terms of timely intensification with anti-hyperglycaemic, anti-hypertensive, and anti-dyslipidemic therapies when needed, remains a key aspect to improve long-term outcomes in patients with type 2 diabetes.

APA, Harvard, Vancouver, ISO, and other styles

40

Travers, Andrew H. "Intravenous ß¦2-agonists in the treatment of patients who present to the Emergency Department with severe acute asthma, a meta analysis and prospective observational cohort study." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape8/PQDD_0026/MQ40119.pdf.

Full text

APA, Harvard, Vancouver, ISO, and other styles

41

Workman, Lesley. "Does helminth treatment reduce the risk of active tuberculosis in a cohort of children from high tuberculosis risk population who have been vaccinated with BCG at birth?" Master's thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/9315.

Full text

Abstract:

Includes bibliographical references.
[Background] Research in adults and older children has shown an association between Mycobacterium tuberculosis and helminth infection, with those infected with helminths at greater risk of tuberculosis. This association is believed to be on the basis that chronic helminth infection can result in a functional impairment of the immune response that is necessary to clear or control infection by Mycobacterium tuberculosis (Elias et al. 2001; Rook et al. 2006; Fincham 2001). It is thus possible that the introduction of regular deworming programmes in a vulnerable population of children under the age of five years could assist their immune systems to ward off tuberculosis infection and reduce the risk of tuberculosis disease in such a population. A randomised controlled trial to compare two methods of administering bacille Camlette-Guerin (BCG) vaccination to newborns from a high tuberculosis risk population provided an opportunity to test this hypothesis in a sub-study. [Objective] The objective of this study is to determine if young children in a high-risk tuberculosis population who have been vaccinated with BCG at birth and have been treated for helminth infection are at lower risk of tuberculosis disease than children who have been vaccinated with BCG at birth but not treated for helminth infection. [Method] A case control study nested within a cohort recruited for a separate randomised control trial to compare two methods of administering BCG vaccination was carried out. Children who presented to their local clinic or hospital with symptoms of tuberculosis or a history of exposure to tuberculosis were admitted to a case verification (CV) ward for investigation of tuberculosis. Investigation of tuberculosis included a detailed history, including past helminth treatment, physical examination, tuberculin skin test, chest radiograph, gastric washing and induced sputum for culture of tuberculosis and clinical examination. A diagnostic algorithm was developed by specialist physicians and biostatisticians to classify the children into one of five tuberculosis categories. A total of 510 children (median age 18.13 months) were included in the primary analysis of this case control study. Those defined as cases were the 328 classified as "definite or probable TB" and 182, classified as "not TB", comprised the control group. Those classified as "possible TB" or "unlikely TB" were excluded. A secondary analysis was performed that included the 337 children who had been classified as "unlikely TB" with the controls resulting in a total of 847 children (median age 18.37 months). The 328 children classified as "definite or probable TB" were defined as cases and the 519 classified as "unlikely or not TB" comprised the control group. Univariate analysis was used to explore a possible relationship between tuberculosis and helminth treatment using all the variables in the sub-study (n=510 primary analysis; n=847 secondary analysis). For both the primary and secondary analysis a multivariate logistic regression model was built using a reduced sample that had a complete set of data for all the variables: primary analysis (n=435); secondary analysis (n=724). This final model was then fitted on a more complete sample as the final variables selected had fewer missing data for the observations: primary analysis (n=493); secondary analysis (n=822). [Result] A total of 35.69% of the study sample in the primary analysis had been treated for helminth infection. The proportion of children who had been treated for helminth infection was similar in the cases and controls (35.98% and 35.16% respectively). Univariate logistic regression showed no association between tuberculosis and treatment for helminth infection: [odds ratio (OR) 1.04; 95% confidence interval (CI) 0.71 - 1.51]. Multivariate analysis adjusted for the effect of nutritional status, recorded as height for age z score (haz), number of occupants sharing the same dwelling as the child, gender and birth site showed a similar result: (OR 1.03; 95% CI 0.69 " 1.53). The OR is very close to 1 with a 95% CI that includes 1, which indicates that there is not a statistically significant association between tuberculosis and helminth treatment. In the secondary analysis, a total of 38.61% of the study sample had been treated for helminth infection. In this analysis the proportion of children who had been treated for helminth infection showed a difference between the cases and controls (35.98% and 40.27% respectively). Univariate logistic regression showed a 17% relative reduction in tuberculosis odds but this was not a statistically significant result: (OR 0.83; 95% CI 0.63 " 1.11). Multivariate analysis adjusted for the effect of haz, number of children sharing the same dwelling as the child and gender, showed a similar result: (OR 0.85; 95% CI 0.63 " 1.15). [Conclusion] The primary analysis of this observational study does not support the hypothesis that helminth treatment reduces the risk of tuberculosis disease in young children in a high-risk tuberculosis population. Although the secondary analysis showed a 15% relative reduction in tuberculosis odds after adjusting for the effect of haz, number of occupants sharing the same dwelling as the child and gender, this was not a statistically significant result. [Final Conclusion] This study does not support the hypothesis that helminth treatment reduces the risk of tuberculosis disease in young children in a high-risk tuberculosis population.

APA, Harvard, Vancouver, ISO, and other styles

42

Härkin, P. (Pia). "Closure of patent ductus arteriosus in very preterm infants:potential role of paracetamol and consequences of current treatments." Doctoral thesis, Oulun yliopisto, 2018. http://urn.fi/urn:isbn:9789526220253.

Full text

Abstract:

Abstract The ductus arteriosus connects the pulmonary artery and the descending aorta in the foetus. In normal neonatal transition, the ductus closes soon after birth. If the duct remains significantly open after birth, it may complicate the recovery of a very preterm infant. Present treatments of patent ductus arteriosus (PDA) are either medical (ibuprofen or indomethacin) or surgical (ligation). However, these treatments can have serious side effects, especially in the most immature infants. This doctoral thesis studied the potential role of intravenous paracetamol for PDA treatment in very preterm infants born before 32 weeks of gestation. Consequences of the PDA treatments in an epidemiological birth cohort were also studied. In retrospective Study I stated that treatments of PDA decreased after the introduction of IV paracetamol for early pain management in preterm infants. Study II showed in a randomised clinical trial for the first time that paracetamol has a biological effect on the ductus arteriosus in preterm infants soon after birth. The ductus closed significantly earlier in the paracetamol group than in the placebo group. The epidemiological cohort Study III showed evidence that both medical and surgical treatment of PDA associated with severe bronchopulmonary dysplasia in infants born very preterm. Additionally, surgical PDA ligation was associated with increased risk of necrotising enterocolitis and intraventricular haemorrhage. Study IV showed that treatment of PDA was not associated with increased mortality, even in the most immature preterm infants born before 28 weeks of gestation
Tiivistelmä Valtimotiehyt on sikiöaikana avoimena oleva suoni, joka yhdistää keuhkovaltimon laskevaan aorttaan ja ohjaa vähähappisen veren istukkaan. Yhdessä soikean aukon kanssa suoni takaa sikiön verenkierron normaalin toiminnan ennen keuhkojen avautumista. Mikäli valtimotiehyt jää syntymän jälkeen pitkittyneesti auki, muuttaa se keskosen verenkiertoa siten, että osa aortan verenkiertoa ohjautuu keuhkoverenkiertoon vaikeuttaen pienen keskosen toipumista. Nykyhoitoina käytetään joko lääkkeellistä (ibuprofeeni tai indometasiini) tai kirurgista sulkua. Lääkkeellinen hoito ei ole kovin tehokas kaikista epäkypsimmillä keskosilla ja hoitoihin liittyy vakaviakin sivuvaikutuksia. Väitöskirjassa tutkittiin parasetamolilääkityksen vaikutusta hyvin pienen keskosen avoimen valtimotiehyen sulkeutumiseen. Epidemiologisessa osiossa tutkittiin nykyhoitojen sivuvaikutuksia hyvin pienillä keskosilla. Osatyössä I todettiin, että avoimen valtimotiehyen hoidon tarve väheni merkittävästi sen jälkeen kun parasetamoli oli otettu käyttöön kivun hoidossa vastasyntyneiden teholla. Osatyö II oli satunnaistettu ja sokkoutettu hoitotutkimus, jossa todettiin alkuperäishavaintona, että parasetamolilla on biologinen vaikutus keskosen avoimeen valtimotiehyeen. Parasetamolia saaneilla keskosilla valtimotiehyt sulkeutui aikaisemmin kuin verrokeilla. Hoidolla ei todettu merkittäviä sivuvaikutuksia. Osatöissä III ja IV tutkittiin kaikkien vuosina 2005−2013 Suomessa syntyneiden hyvin pienten keskosten avoimen valtimotiehyen hoitoja. Lääkehoidolla (ibuprofeeni ja indometasiini) ja kirurgisella hoidolla todettiin olevan yhteys keskosen kroonisen keuhkotaudin (BPD) vaikeimpaan muotoon. Kirurgisella hoidolla oli yhteys keskosen vaikeaan suolitulehdukseen ja vaikeaan aivoverenvuotoon. Kuolleisuuden riskin ei kuitenkaan todettu lisääntyneen valtimotiehyen hoitoihin liittyen

APA, Harvard, Vancouver, ISO, and other styles

43

Pillay, Vashini. "Short-term treatment outcomes of children starting ART in the ICU, general medical wards and outpatient HIV clinics at Red Cross War Memorial Children’s Hospital (RCWMCH): a retrospective cohort study." Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/13245.

Full text

Abstract:

Includes bibliographical references.
Short-term treatment outcomes of children starting ART in the ICU, general medical wards and outpatient HIV clinics at Red Cross War Memorial Children’s Hospital (RCWMCH): A Retrospective Cohort Study. Background: Antiretroviral therapy (ART) has proven to decrease morbidity and mortality in HIV-infected children and improve immunologic, virologic and clinical outcomes. As clinical management policies evolved, an emphasis on early infant testing was adopted resulting in an increasing number of children being diagnosed and commenced on therapy before the onset of severe disease progression. However, a fair proportion still remain untested and subsequently present to hospital with advanced immunosuppression and severe disease. Since the advent of the 2013 national Standard Treatment Guidelines which encourage expedited initiation of ART within 7 days of HIV diagnosis in all children under the age of 12 months and in those with advanced immunosuppression, it is likely that many HIV-infected children are being initiated on ART during hospitalisation in South Africa. No local published data on these outcomes exist. We assessed the short-term outcomes of children initiated on ART in the intensive care unit (ICU), general medical wards (GMWs) and outpatient HIV clinics (OHCs) at RCWMCH. Methods: Structured Literature Review A Pubmed search looking at outcomes of treatment naïve HIV-infected children and adolescents up to 19 years of age living in South Africa commenced on 1st line ART regimens in accordance to the national guidelines presiding at the time, over a 10 year period was performed. This served to identify gaps in knowledge around paediatric ART in a South African context warranting further research. Retrospective Cohort Study We conducted a retrospective cohort study of HIV-infected children <13 years of age, commenced on first line ART between January 2008 and December 2011 at RCWMCH. Outcome measures included death, virologic suppression and changes in CD4 count and percentage. Kaplan-Meier estimates, multivariate Cox proportional hazard ratios and logistic regression were used to estimate outcomes 6 months after ART initiation. Results: Structured Literature Review This review identified several knowledge gaps. One of these gaps, the treatment outcomes of children started on ART at different service levels within tertiary health care settings was addressed in our retrospective cohort study and described in section C of this dissertation Retrospective Cohort Study Seven hundred and forty-nine children were included: 106 were commenced on ART in the ICU, 509 in the GMWs and 127 in the OHCs. Four hundred and ninety-two (65.7%) children were <12 months old. Children in the ICU and GMW cohorts were significantly younger than the OHC cohort (median ages: 3 and 5 months respectively vs. 22 months) and had lower WAZ scores (-2.48 and -2.33 respectively vs -1.14). Three hundred and eighty-five (51.4%) children qualified for rapid ART initiation within 7 days of HIV diagnosis or hospitalisation, based on CD4 criteria in the 2013 national Standard Treatment Guidelines. Overall mortality was 6.4% (CI: 4.9 - 8.4). Mortality was significantly higher in the ICU cohort i.e. 14 (13.2%) deaths compared to 28 (5.5%) and 5 (3.9%) deaths in the GMWs and OHCs cohorts, logrank p=0.004. Predictors of mortality included being moderately underweight HR 2.4 (CI: 1.1 – 5.2; p=0.02), severely underweight HR 3.2 (CI: 1.6 – 6.5; p=0.001), absence of caregiver counselling sessions HR 2.9 (CI: 1.4 – 6.0; p=0.005) and ART initiation in ICU HR 2.6 (CI: 1.4 – 4.9; p=0.003). Conclusion: The findings of our retrospective cohort study serve as a basis for understanding the implications of ART initiation in children during hospitalisation.

APA, Harvard, Vancouver, ISO, and other styles

44

Bao, Yan [Verfasser], and Gerhard [Akademischer Betreuer] Jahn. "Dynamic and kinetic of HCV viral load under the new treatment with direct acting antivirals in a patient cohort of the University Clinic Tuebingen 2014-2017 / Yan Bao ; Betreuer: Gerhard Jahn." Tübingen : Universitätsbibliothek Tübingen, 2018. http://d-nb.info/1198972793/34.

Full text

APA, Harvard, Vancouver, ISO, and other styles

45

Abdel-Gadir, A. "B cell lipid presentation controls the homeostasis and immunoregulatory function of iNKT cells in healthy controls but not in SLE patients : analysis of a cohort of patients before and after rituximab treatment." Thesis, University College London (University of London), 2011. http://discovery.ucl.ac.uk/1322445/.

Full text

Abstract:

B cells are characteristically the main ,er0tagonists in the pathogenesis of systemic lupus erythematosus (SLE) and its clinical manifestations. It is known that iNKT cells may interact with B cells to steer the production of autoantibodies in SLE, whether CD1 d-mediated lipidantigen presentation by B cells maintains invariant natural killer T (iNKT) cells in vivo remains unclear. I demonstrate that B cells are crucial for iNKT cell expansion in healthy individuals. SLE patients have reduced iNKT cell numbers, fail to expand and produce TH1like cytokines. We use confocal microscopy to visualise increased CD1 d aggregation in SLE B cells compared to healthy B cells. Thus, "healthy"antigen-presenting B cells are pivotal for the physiological maintenance of iNKT cells.

APA, Harvard, Vancouver, ISO, and other styles

46

Atanga, Pascal Nji [Verfasser], and Michael [Akademischer Betreuer] Hölscher. "Retention-in-care, adherence and treatment outcomes in a cohort of HIVpositive pregnant and breastfeeding women enrolled in a pilot project implementing “Option B+” in Cameroon / Pascal Nji Atanga ; Betreuer: Michael Hölscher." München : Universitätsbibliothek der Ludwig-Maximilians-Universität, 2017. http://d-nb.info/113104035X/34.

Full text

APA, Harvard, Vancouver, ISO, and other styles

47

Eze, Chukwuka [Verfasser], and Claus [Akademischer Betreuer] Belka. "Treatment response and prophylactic cranial irradiation are prognostic factors in a real-life limited-disease small-cell lung cancer patient cohort comprehensively staged with cranial magnetic resonance imaging / Chukwuka Eze ; Betreuer: Claus Belka." München : Universitätsbibliothek der Ludwig-Maximilians-Universität, 2019. http://d-nb.info/1178323811/34.

Full text

APA, Harvard, Vancouver, ISO, and other styles

48

Spivey, Justin, Heather Sirek, Robert Wood, Kalpit Devani, Billy Brooks, and Jonathan Moorman. "Retrospective Cohort Study of the Efficacy of Azithromycin Vs. Doxycycline as Part of Combination Therapy in Non-Intensive Care Unit Veterans Hospitalized with Community-Acquired Pneumonia." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/3177.

Full text

Abstract:

The IDSA Community-Acquired Pneumonia (CAP) Guideline recommends ceftriaxone in combination with doxycycline as an alternative to combination therapy with ceftriaxone and azithromycin for non-intensive care unit (ICU) patients hospitalized with CAP. This is an attractive alternative regimen due to recent concerns of increased cardiovascular risk associated with azithromycin. The objective of this study was to compare the clinical outcomes of azithromycin and doxycycline each in combination with ceftriaxone for non-ICU Veterans hospitalized with CAP.

APA, Harvard, Vancouver, ISO, and other styles

49

Krastinova, Evguenia. "Prise en charge du VIH au stade de la primo-infection." Thesis, Paris 11, 2015. http://www.theses.fr/2015PA11T013/document.

Full text

Abstract:

Depuis 2013, le traitement « universel » est recommandé en France. Le moment de l’initiation thérapeutique est une question qui reste cependant d’actualité pour les patients se présentant en primo-infection. Cette thèse s’attache à étudier la prise en charge thérapeutique du VIH au stade de la primo-infection (PIV) sous différents angles :1) le suivi par les cliniciens des recommandations d’initiation des traitements antirétroviraux depuis 1996 en fonction de l’évolution de ces recommandations; 2) l’impact d’un traitement ARV transitoire en PIV sur la réponse immuno-virologique lors de la reprise du traitement et 3) l’identification de nouveaux biomarqueurs comme facteurs pronostiques de progression de l’infection VIH. La majorité des travaux présentés dans cette thèse repose sur les données de la cohorte ANRS PRIMO qui comporte environ 1 500 patients infectés par le VIH inclus en PIV entre juin 1996 et décembre 2013, dans 94 hôpitaux français. Tous les patients étaient naïfs de traitement antirétroviral à l'inclusion.La première partie de la thèse analyse la mise en œuvre des recommandations d’initiation du traitement ARV entre 1996 et 2010 par les médecins en France, dans deux situations distinctes : au stade chronique et lors de la primo-infection par le VIH-1. Nous avons montré que les recommandations d’initiation du traitement ARV étaient largement suivies. Néanmoins, il existe un effet d’inertie dans leurs applications lors des changements de recommandation. Il reste à améliorer le délai de mise sous traitement lorsque le taux de CD4 atteint le seuil recommandé. Au stade chronique, le traitement était plus fréquemment initié chez les patients présentant un critère d’initiation dès le diagnostic d’infection par le VIH (96%), que chez les patients qui atteignaient un critère d’initiation au cours du suivi (78%, p<0.001). Nous avons identifié comme facteurs de risque de ne pas être traité en phase chronique malgré une indication de traitement : une charge virale < 5log (versus >5), un plus faible niveau d’éducation et des conditions de vie précaires.L’impact de l’interruption d’un traitement antirétroviral initié en PIV sur la restauration des CD4 après reprise du traitement a été exploré en modélisant l’évolution des CD4 avec des modèles linéaires à effets mixtes avec intercept et pente aléatoires. Les patients qui avaient initié un traitement ARV pendant la phase chronique avaient une meilleure réponse immunologique que les patients reprenant un 2ème traitement après un traitement transitoire en PIV : à 36 mois, les gains en √CD4 cellules/mm3 et en pourcentage de CD4 étaient significativement plus élevés. Cependant, il s’agissait de différences modestes en termes cliniques, qui ne conduisent pas à recommander d’arrêter la recherche clinique sur les arrêts de traitement cherchant à induire des contrôleurs post traitement. Après un état des lieux des mécanismes complexes d’activation/inflammation du système immunitaire pendant la primo-infection nous avons cherché à identifier de nouveaux biomarqueurs prédictifs de l’évolution de l’infection. Le taux de sCD14 (marqueur d’activation monocyte/macrophage et marqueur indirect de translocation microbienne) au moment de la PIV a été identifié comme marqueur potentiel de prédiction du déclin des CD4 et du risque de mortalité d’origine cardio-vasculaire. En conclusion, bien que des progrès considérables aient été réalisés dans la prise en charge du VIH, d'autres études sont nécessaires pour optimiser et adapter le traitement au profil du patient dès les premiers stades de l’infection VIH
In France, since 2013, HIV treatment has been recommended for all HIV-infected patients independently of their CD4 count. However, when to start anti-retroviral (ARV) treatment is still an issue. This thesis aims to explore the therapeutic management of HIV at the stage of PHI in different aspects: 1) we explored how physicians in France have applied the evolving guidelines for ART initiation since 1996 2) the impact of a transient ARV treatment at PHI on immuno-virological response during 2nd treatment and 3) identification of new biomarkers prognostic of HIV progression.Most of the work presented in this thesis is based on data from the ongoing ANRS PRIMO cohort that enrolled more than 1 500 HIV infected patients enrolled at PHI since June 1996 in 94 French hospitals. All patients were antiretroviral therapy naive at baseline.The first part of the thesis analyzes the implementation of the recommendations of ARV treatment initiation between 1996 and 2010 by physicians in France, in two distinct situations: in the chronic HIV-1 infection and during primary HIV-1 infection. We have shown that the recommendations of ARV treatment initiation were widely followed. Nevertheless, there was inertia in guidelines application when changes in the recommendations took place. The time to treatment when CD4 cell counts reach the threshold to treat can be improved. 96% of the patients initiated ART when they had a CD4 cell count below the threshold to treat at entry, while treatment was less timely initiated when the CD4 threshold was reached during active follow-up (78%, p <0.001).We identified as risk factors for not being timely treated in chronic phase despite an indication for treatment: a viral load <5log (versus> 5), a lower education level and poor living conditions.The impact of ARV interruption after a first treatment initiated at PHI on the CD4 count restoration after resumption was explored by modeling the evolution of CD4 cells with linear mixed effects models with random intercept and slope. Patients who initiated ARV treatment during the chronic phase had a better immune response than patients who initiated a second course treatment after a transient ART at PHI: at 36 months, the gains in √CD4 cells / mm3 and CD4 percentage were significantly higher. However, this difference was clinically modest and further research on treatment interruptions seeking to induce post-treatment controllers is still an issue but only in research settings and under close medical surveillance. After an overview of the complex mechanisms of activation / inflammation of the immune system during primary infection we sought to identify new predictive biomarkers of disease progression. The level of sCD14 (marker of monocyte/macrophage activation and an indirect marker of microbial translocation) at the time of PHI was identified as predictive marker of CD4 decline and of risk of cardio-vascular mortality. In conclusion, although considerable progress has been made in the management of HIV, further studies are needed to optimize and adapt the treatment to the patient profile in the early stages of HIV infection

APA, Harvard, Vancouver, ISO, and other styles

50

Novelli, Sophie. "Pronostic à long terme des personnes diagnostiquées en primo-infection VIH-1." Thesis, université Paris-Saclay, 2020. http://www.theses.fr/2020UPASS079.

Full text

Abstract:

Les personnes vivant avec le VIH développent souvent des comorbidités sévères, en partie attribuables à la persistance d’une inflammation chronique, y compris sous traitement antirétroviral. Cette thèse portait sur le suivi à long terme des personnes diagnostiquées en primo-infection VIH-1 et sur l’impact du traitement immédiat préconisé par les recommandations internationales sur cette inflammation chronique. Elle a été menée à partir des données de la cohorte française ANRS CO6 PRIMO. Avec un suivi médian de 7 ans, nos résultats confirmaient l’intérêt certain du traitement en primo-infection pour accélérer la restauration immunitaire et réduire la taille du réservoir viral. En revanche, nous ne mettions pas en évidence de bénéfice du traitement en primo-infection par rapport à un traitement différé en infection chronique sur les niveaux d’activation immunitaire, d’inflammation et de réplication virale résiduelle atteints sous traitement à long terme. De plus, comparés à deux groupes contrôles non infectés par le VIH, présentant respectivement une fréquence faible et élevée de comportements de santé dits « à risque », les individus en succès virologique prolongé maintenaient des niveaux élevés pour des marqueurs spécifiques des composantes mono-macrophagique et lymphocytaire de l’inflammation et de l’activité de l’épithélium intestinal, y compris après prise en compte de cofacteurs d’inflammation non liés au VIH. Enfin, les femmes, qui à l’initiation du traitement avaient déjà des caractéristiques immunovirologiques plus favorables que les hommes, présentaient une meilleure réponse virologique et immunologique que leurs homologues masculins, dont les répercussions cliniques restent toutefois à préciser.Ces travaux centrés sur les paramètres immunovirologiques seront poursuivis et complétés par une meilleure caractérisation de l’état de santé des personnes vivant avec le VIH en France par rapport à la population générale
This thesis focused on the long-term follow-up of individuals diagnosed with primary HIV-1 infection and the impact of early antiretroviral therapy (ART) initiation, particularly on chronic inflammation, which has been linked to the development of severe co-morbidities in people aging with HIV. Data came from the French ANRS CO6 PRIMO cohort. First, we confirmed the benefit of immediate ART initiation during primary infection, as recommended by international guidelines, to enhance the immune recovery and achieve long-term reduction of HIV reservoir size. However, we did not observe any effect of ART initiation in primary infection versus deferred in chronic infection on the levels of inflammation, nor immune activation or residual viral replication, after nearly 7 years of effective ART. Moreover, compared to two non HIV infected control groups, with respectively low and high frequency of health risk behaviours, HIV participants under long-term suppressive ART showed increased levels of markers associated with the mono-macrophagic and lymphocytic components of inflammation and intestinal mucosal integrity, even after taking into account major non-HIV related cofactors of inflammation. Besides, women, who already had more favourable immunovirological characteristics than men in primary infection, showed a better virological and immunological response than men following ART initiation in primary infection. However, the clinical benefit of these immunological advantages remains to be determined.This work focused on immunovirological parameters and will be continued with a better characterization of the health status of people living with HIV in France on common health parameters, compared to the general population

APA, Harvard, Vancouver, ISO, and other styles

Dissertations / Theses on the topic 'Cohorts Treatment'

Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles