Post-stroke pathway analysis and link with one year sequelae in a French cohort of stroke patients: the PAPASePA protocol study.

BACKGROUND: Stroke is a health problem with serious consequences, both in terms of mortality, and after-effects affecting patient quality of life. Stroke requires both urgent and chronic management involving the entire health care system. Although large variability in the management of stroke patients have been noticed, knowledge of the diversity and the scalability of post-stroke pathways, whether it is the care pathway or the life pathway, is currently not sufficient. Moreover the link between post-stroke pathways and patients sequelae have not been yet clearly defined. All this information would be useful to better target the needs to improve stroke patient management. The purposes are to identify the post-stroke life pathways components associated with sequelae (activity limitations - main purpose, cognitive disorders, anxio-depressive disorders, fatigue, participation restrictions) at 3 months and 1 year post-stroke, to define a typology of life pathways of patients during the post-stroke year and to analyze the social and geographical inequalities in the management of stroke. METHODS: Design: a prospective multicenter comparative cohort study with a follow up to 1 year after the acute episode. Participant centers: 13 hospitals in the Aquitaine region (France). STUDY POPULATION: patients diagnosed with a confirmed ischemic or hemorrhagic stroke included in the Aquitaine Observatory of Stroke (ObA2) cohort and voluntary to participate. Data sources are existing databases (ObA2 database and the French National Health Data System - SNDS) to collect information about care pathways, patient characteristics and stroke characteristics and Ad hoc surveys to collect information about life pathways and post-stroke sequelae. The endpoints of the study are post-stroke activity limitations evaluated by the modified Rankin score, other post-stroke sequelae (Cognitive disorders, anxio-depressive disorders, fatigue, restriction of participation) assessed by standardized and validated scales and Clusters of patients responding to pathways with common or similar characteristics.; DISCUSSION: By integrating a longitudinal dimension and relying on a large cohort, the project will make it possible to identify the sources of disturbances and the factors favorable to the outcome of the life pathways, important for the planning of the offer and the management of the public policies concerning stroke pathways. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT03865173 , March 6th, 2019.

[The role of a hospital-based registry of a regional cancer center for a population-based cancer registry]. / Intérêt des données du registre hospitalier (Enquête permanente cancer) d'un centre régional de lutte contre le cancer pour un registre de cancer en population.

BACKGROUND: Hospital-based cancer registries (HBR) of Comprehensive cancer centers (CCC) named "Enquête permanente cancer (EPC)" could represent an important information source of data for a population-based cancer registry (PBR). The main purpose of this study was to evaluate the concordance between data from HBR of the CCC for regions of Bordeaux and South-Western France and data from PBR of the General cancer registry of Gironde and the completeness for the year 2005, in order to explore the possibility for immediate integration of data collected by the HBR in the database of the PBR and to reduce the systematic consultation of medical records for cancer cases notified by the HBR. METHODS: We estimated the proportion of concordant cases between the HBR and the PBR and the unweighted and weighted Cohen's Kappa coefficient for certain variables. RESULTS: Among 1151 cases notified by the HBR, 1095 (positive predictive value of HBR: 95%) were included in the PBR database. For these admissible cases, sex, birth date and place for residence postal code at diagnosis were concordant in more than 94%. Concordance of cancer incidence date was 50% but difference between two dates was lower than 1 month in 91% of cases. Concordance of cancer topography and morphology was respectively 72% and 78%. Cancer progression, estimated by TNM classification was concordant in 96% of cases. The Kappa coefficient was 0.95 for pT, and respectively 0.92 for pN and M. CONCLUSION: Automatic data integration from the HBR database to the PBR database without consulting medical record will be possible in Gironde. But, topography and morphology will be systematically recoded using pathologist records. And, if cancer progression (coded by TNM classification) is missing in the HBR database, medical records will be consulted in order to complete this data in the PBR database.

[Needs and expectations of Alzheimer's disease family caregivers]. / Attentes et besoins des aidants de personnes souffrant de maladie d'Alzheimer.

BACKGROUND: Family members of people suffering from Alzheimer's disease play a major role in providing daily life care for their relatives. Compared to non-caregivers, they present increased risks of mortality as well as psychological and physical co-morbidity. Altered relationships between caregivers and medical staff and dissatisfaction with the quality of help provided tend to increase the risk of depression and anxiety disorders among caregivers. The present study aimed at exploring the needs and expectations of family caregivers of patients with Alzheimer's disease who request medical assistance for their relatives. METHODS: The present analysis is an ancillary study of a large multicentric controlled randomized study designed to assess the efficacy of three non-pharmacological treatments in Alzheimer's disease, in which 645 mild-to-moderate Alzheimer patients were enrolled. Needs and expectations of the caregivers were assessed with a French scale of patient expectations for medical consultation, the échelle d'attentes en matière de consultations (EAC), completed by caregivers during the inclusion visit. This scale consists in a self-administered 28-item questionnaire concerning four main needs: learning skills to improve daily life management of their relatives; information regarding the disease; improving caregivers' self-confidence; support to improve communication with their relatives. RESULTS: The ten items for which more than 40% of caregivers reported high or very high expectations referred to two main needs: information regarding the disease (treatment, prognosis…) and learning skills in order to improve daily life management of their relative. The predominance of such needs was observed whatever the relationship between the caregiver and the cared relative but seemed to be more pronounced in female spouses and children of patients with Alzheimer's disease. CONCLUSIONS: Needs and expectations of Alzheimer's disease family caregivers involve two major aspects: first, information regarding the disease (treatment, prognosis…) and second, learning skills for improving daily life management of their relative. These results suggest that among the various available family caregivers support programs, programs providing information, education, and practical advice to improve daily life assistance seem to be adequate.

[Performance evaluation of hospital claims database for the identification of incident central nervous system tumors compared with a cancer registry in Gironde, France, 2004]. / Évaluation des performances du PMSI pour l'identification des tumeurs incidentes du système nerveux central par rapport à un registre spécialisé en Gironde, France, en 2004.

BACKGROUND: Cancer registries cover 18% of the French population. A national surveillance might be warranted for some potentially environment-related cancers such as tumors of the central nervous system (CNS) to detect abnormal incidence variations. The PMSI database provides an interesting source of comprehensive, standardized and mandatory data collected from all health facilities. The aim of this work was to develop methods to identify incident CNS tumors using the PMSI database. METHODS: A selection of patients living in Gironde was made in the 2004 PMSI database of the hospital of Bordeaux, using the CNS tumors codification. Cases were validated via the CNS primary tumor registry of Gironde taken as the reference, or medical records. Various combinations of criteria were defined and tested. RESULTS: The first selection based on diagnoses identified patients with a sensitivity of 84% and a positive predictive value (PPV) of 34%. Patients wrongly identified by the PMSI were non-incident cases (49%) or patients without a CNS tumor (45%). Patients with a tumor not identified by the PMSI had been hospitalized in 2005 (44%) or had no code for CNS tumor (42%). According to the algorithms, the sensitivity ranged from 64% to 84%, and the PPV from 34% to 69%. The best combination had a sensitivity of 67% and a PPV of 69% and was obtained with codes for CNS tumor in 2004 associated with a diagnostic or therapeutic code for persons under 70 years without code for CNS tumor in previous years or code for metastasis in 2004. CONCLUSION: According to these results, the PMSI database cannot be used alone to calculate the incidence of these complex tumors. However the PMSI database plays an important role in cancer surveillance, in combination with other information sources and the expertise of cancer registries. This role could increase with further reflection and improvement of data quality.

Prevalence of hypertension and associated risk factors in Benin.

BACKGROUND: Hypertension is one of the main risk factors of cardiovascular diseases. There has been a lack of data on this risk factor in the general population in Benin. The aim of this study was to determine the prevalence of hypertension and identify the associated risk factors in Benin. METHODS: A cross-sectional study was conducted from July to August 2008 in Benin's 12 departments. The questionnaire and anthropometric measurements of the World Health Organization STEPWISE survey were used. The sample included 6853 subjects 25-64 years of age, randomly selected by five-stage random sampling. Blood pressure was measured using standard procedures. Data was processed and analyzed using EPI DATA and STATA 9.2 software. Prevalence levels were compared using Pearson's chi(2) and means with the Student t-test. Univariate and multivariate regression analysis, taking the sampling method into account, was used to identify risk factors. RESULTS: The sample comprised 49.5% females, the 25- to 34-year-old age group was the largest, and the mean age was 42.7±12.4 years. The prevalence of hypertension was 27.9% [95% CI: 26.3-29.5%], 77.5% of the subjects were unaware of their high blood pressure, and 81.6% had not taken their drugs two weeks before the survey. Prevalence of known hypertension was 6.9%, prevalence of treated hypertension 4.8%, and prevalence of controlled hypertension 1.9%. Age and obesity were significantly associated with hypertension. Department and profession were not associated with hypertension. CONCLUSION: This study showed a high prevalence of hypertension in the general population in Benin. Better management of this risk factor will contribute to reducing morbidity and mortality due to cardiovascular diseases.

Survey of European programmes for the epidemiological surveillance of congenital toxoplasmosis.

The objective of this investigation was to describe systems for the epidemiological surveillance of congenital toxoplasmosis implemented in European countries. In September 2004, a questionnaire, adapted from the evaluation criteria published by the United States Centers for Disease Control and Prevention, was sent to a panel of national correspondents in 35 countries in the European geographical area with knowledge of the epidemiological surveillance systems implemented in their countries. Where necessary, we updated the information until July 2007. Responses were received from 28 countries. Some 16 countries reported routine surveillance for toxoplasmosis. In 12 countries (Bulgaria, Cyprus, Czech Republic, England and Wales, Estonia, Ireland, Latvia, Lithuania, Malta, Poland, Scotland and Slovakia), surveillance was designed to detect only symptomatic toxoplasmosis, whether congenital or not. Four countries reported surveillance of congenital toxoplasmosis, on a regional basis in Italy and on a national basis in Denmark, France and Germany. In conclusion, epidemiological surveillance of congenital toxoplasmosis needs to be improved in order to determine the true burden of disease and to assess the effectiveness of and the need for existing prevention programmes.

Stress, attention deficit hyperactivity disorder (ADHD) symptoms and tobacco smoking: The i-Share study.

BACKGROUND: The contribution of mental health to the risk of smoking is increasingly acknowledged but still insufficiently studied during the key period of student life. In particular, the simultaneous action of stress and Attention Deficit Hyperactivity Disorder (ADHD) symptoms on the risk of smoking remains poorly understood. AIMS: To assess the effects of stress and ADHD symptoms on tobacco smoking. METHOD: Multivariate modeling was conducted on the French i-Share study (n=8110, median age 20.3 years, 74.8% females, 32.9% regular/occasional smokers) to evaluate the associations between stress, ADHD symptoms and tobacco smoking, adjusting for potential family/socio-demographic confounders. RESULTS: Students with high levels of stress were more likely to smoke>10 cigarettes/day (adjusted odds ratio (aOR): 1.48, 95% CI: 1.12-1.96) than those with low levels of stress. Students with high levels of ADHD symptoms were more likely to smoke>10 cigarettes/day (aOR: 2.08, 95% CI: 1.58-2.75) than those with low levels of ADHD symptoms. CONCLUSIONS: Stress and ADHD contribute independently to the risk of smoking. Interventions targeting each condition are likely to reduce the burden of tobacco use in students.

Health consequences of the first Persian Gulf War on French troops.

Since 1993, many studies on the health of Persian Gulf War Veterans (PGWV) have been undertaken. These studies have concluded that there has been an increased mortality due to external causes, no excess of recognized diseases, and no effect on PGWV children. When compared with the non-deployed, PGWV have reported a higher frequency of infertility as well as different symptoms, but a specific Gulf War syndrome was not identified. In October 2000, the French government asked an independent working group to analyse the scientific literature on PGWV health. The group concluded that an exhaustive study of French PGWV was to be undertaken. The objectives of this study were to describe the exposures of PGWV in the operations theatre, to report on the symptoms and diseases that occurred in PGWV and their children during and after the military campaign, and to explore the possibility of a Gulf War syndrome. This exhaustive cross-sectional study, which included all civilians and troops who served in the Gulf from August 1990 to July 1991, began in January 2002. Data were collected by postal self-administered questionnaires. A standardized clinical evaluation was performed by 27 clinics of occupational diseases and nine military hospitals. Symptoms and diseases which appeared after the campaign are described. To date, among 20,261 PGWV, 5,666 participated in the study (28%). The most frequent symptoms described since the return from the Gulf were headaches (83%), neurological or psychological symptoms, and back pain. Apart from well-known symptoms associations (respiratory, neurocognitive, psychological and musculo-skeletal syndromes), no other cluster was highlighted by our analysis.

mTORC1 directly phosphorylates and activates ERα upon estrogen stimulation.

Breast cancer is the leading cause of cancer-related deaths among women. Approximately 75% of breast cancers are estrogen receptor-α (ERα) positive, underscoring the dependence of cancer cells on estrogen for growth and survival. Patients treated with endocrine therapy often develop resistance, either de novo or acquired, which in some cases is caused by aberrations within the growth factor signaling pathways. The mechanistic target of rapamycin complex 1 (mTORC1) has emerged as a critical node in estrogenic signaling. We have previously shown that mTORC1 can phosphorylate and activate ERα on S167 via its effector-the 40S ribosomal S6 kinase 1 (S6K1). Presently, we have uncovered a direct link between mTORC1 and ERα. We found that ERα binds to regulatory-associated protein of mTOR (Raptor) and causes it to translocate to the nucleus upon estrogen stimulation. In addition, we identified mTOR as the kinase that phosphorylates ERα on S104/106 and activates transcription of ER target genes. Our findings show a direct link between mTORC1 and ERα, which further implicates mTORC1 signaling in the pathogenesis of ER-positive breast cancer and provides rationale for FDA-approved use of mTORC1 inhibitors in combination with endocrine agents for treatment of this disease.

Balneotherapy Together with a Psychoeducation Program for Benzodiazepine Withdrawal: A Feasibility Study.

Benzodiazepines should be prescribed on a short-term basis, but a significant proportion of patients (%) use them for more than 6 months, constituting a serious public health issue. Indeed, few strategies are effective in helping patients to discontinue long-term benzodiazepine treatments. The aim of this study was to assess the feasibility and the impact of a program including cognitive behavioural therapy, psychoeducation, and balneotherapy in a spa resort to facilitate long-term discontinuation of benzodiazepines. We conducted a prospective multicentre cohort study. Patients with long-term benzodiazepine use were recruited with the aim of anxiolytic withdrawal by means of a psychoeducational program and daily balneotherapy during 3 weeks. The primary efficacy outcome measure was benzodiazepine use 6 months after the program, compared to use at baseline. A total of 70 subjects were enrolled. At 6 months, overall benzodiazepine intake had decreased by 75.3%, with 41.4% of patients completely stopping benzodiazepine use. The results also suggest a significantly greater improvement in anxiety and depression symptoms among patients who discontinued benzodiazepines compared to patients who only reduced their use. Our findings suggest that balneotherapy in association with a psychoeducative program is efficient in subjects with benzodiazepine addiction.

Wine, beer, and mortality in middle-aged men from eastern France.

OBJECTIVE: To evaluate prospectively the health risk of wine and beer drinking in middle-aged men in the area of Nancy, France. DESIGN: Prospective cohort study. SUBJECTS: A total of 36 250 healthy men who underwent comprehensive health appraisals in a center of preventive medicine between January 1, 1978, and December 31, 1983. MAIN OUTCOME MEASURES: Education, professional and leisure activities, and smoking and drinking habits were evaluated using a questionnaire. Blood pressure and mean corpuscular volume and gamma-glutamyltransferase, glucose, and serum cholesterol levels were routinely measured, and electrocardiography was routinely performed. We recorded mortality from all causes and specific causes during a 12- to 18-year follow-up across categories of baseline alcohol consumption. RESULTS: Of the subjects, 28% drank beer, 61% drank wine but no beer, and 11% were abstainers; there was not much difference between social classes. During the follow-up, 3617 subjects died. The relative risk of death was estimated by the Cox proportional hazards model using nondrinkers as the reference and adjusting for 4 or 5 covariables. Moderate intake of both wine and beer was associated with lower relative risk for cardiovascular diseases; the risk was more significant with the intake of wine. For all-cause mortality, only daily wine intake (22-32 g of alcohol) was associated with a lower risk (0.67; 95% confidence interval, 0.58-0.77; P<.001) due to a lower incidence of cardiovascular diseases, cancers, violent deaths, and other causes. CONCLUSION: In eastern France, moderately drinking only wine was associated with a lower all-cause mortality, although drinking both wine and beer reduced the risk of cardiovascular death.

[Prenatal screening of cytomegalovirus in France: an increasing frequency practices of screening from 2000 to 2003 despite no recommendation in favor]. / Dépistage prénatal du cytomégalovirus en France: une augmentation des pratiques de prescription de 2000 à 2003 malgré l'absence de recommandation favorable.

BACKGROUND: Screening cytomegalovirus infection in pregnant women is still controversial in 2004 in France. In this context, we evaluated the interest of such a screening in 2004 in France. This paper was designed to describe trends in CMV prenatal screening practices in 2000-2003 in France. METHODS: This retrospective study, describes the prescription of CMV screening in HIV-negative pregnant women giving birth in the private care sector, according to their occupational category and geographical area. Data were provided by the "Caisse d'Assurance-maladie des Travailleurs Indépendants" (independent workers health insurance fund). RESULTS: The study included 34.347 women, delivering in 2001-2004 (beginning of pregnancy in 2000-2003). The number of pregnant women screened for CMV increased significantly between 2000 (5.8%, 301/5.177), 2001 (11.1%, 1.130/10.139) and 2002 (22.1%, 2.701/12.223), (p<0.001), then was stable in 2003 (22.0%, 1.496/6.808). The percentage of women screened for CMV, at least once during pregnancy, doubled between 2001 and 2002 (p<0.001) in each occupational category and geographical area. It was significantly different between occupational categories (p<0.01), with a higher percentage of women in the self-employed and commercial agent occupational categories than in the craftsman category. There was also a significant difference between geographical areas (p<0.001), with a higher rate in Paris. CONCLUSION: This study providing baseline information on CMV practices showed: 1- a significant increase in the frequency of CMV screening among pregnant women over the period 2000-2002 with a stabilization in 2003; 2- a similar trend observed in each occupation category and geographical area but with a markedly higher frequency of screening practices in the Paris area and among self-employed women. A study measuring the effect of the 2004 ANAES recommendation suggesting not to screen for CMV during pregnancy should be conducted.

[Profile of HIV infected patients among blood donors in Abidjan, Côte d'Ivoire (1992-1999)]. / Profil des patients infectés par le VIH, dépistés au Centre national de transfusion sanguine d'Abidjan, Côte d'Ivoire, 1992-1999.

The FonSIDA is a private clinic created in 1992 within the premises of the National Blood Transfusion Center of Abidjan (CNTS), the largest city in Côte d'Ivoire. It provides medical and psychological follow-up for blood donors which are diagnosed as HIV-infected. This Centre provides blood for transfusions in Abidjan and the surrounding area, which from 1992 to 1999 collected 263,398 blood units. In this period, 5574 subjects were detected HIV-positive. Among those, 1766 (32%) HIV infected blood donors came back to be tested for confirmation of HIV diagnosis. Since then, only 9% of the 5574 donors have been seen at least twice a year for medical and psychological follow-up. Women were more compliant than men in the FonSIDA Clinic: they constituted 62% of the 409 patients who were followed-up (p < 0.001). 53% of men had sex with prostitutes the year before HIV diagnosis. 67% of women stated voluntary abortion at least once. In the same period the systematic use of condoms was reported by only 7% of women and 5% of men. 22% of women and 28% of men reported having two or more sexual partners in the year before HIV diagnosis. The main aim of every blood center is to improve blood safety, particularly in developing countries. The appropriate counseling towards blood donors and especially those detected HIV positive can contribute to reduce new HIV infections in high HIV prevalence cities. Rate of compliance of HIV-infected patients to follow-up has risen to 11% in 1992-1994 to 60% in 1997-1999 and will contribute to reach this aim.

Preventing mother-to-child transmission of HIV-1 in Africa in the year 2000.

OBJECTIVES: Various approaches to preventing mother-to-child transmission (MTCT) of HIV have recently been, or are being, evaluated in developing countries, especially in Africa. New findings from these trials are now becoming available, the implications of which, for population-based intervention programmes, need urgent consideration. METHOD: A critical review of 18 randomized trials and other relevant studies from developing and industrialized countries. RESULTS: Most African results relate to trials of antiretroviral agents (ARV). They demonstrate efficacy in reducing transmission in the first 6 months of life with short regimens of zidovudine (ZDV), with or without lamivudine (3TC), and nevirapine (NVP) alone. Preliminary results suggest the long-term efficacy of zidovudine. Antiseptic and nutritional interventions have been shown to reduce maternal and infant mortality and morbidity but not MTCT of HIV. HIV confidential voluntary counselling and testing for pregnant women, a short regimen of peripartum ARV with alternatives to breastfeeding such as early weaning or breast milk substitutes from birth currently represent the best option to reduce MTCTof HIV in Africa. However, the prevention of postnatal transmission requires further research, particularly in view of the consequences of different feeding options and the possibility of post-perinatal exposure prophylaxis of newborns with ARV. Issues relating to the implementation of currently validated strategies are discussed.

Seroincidence of HIV-1 infection in African women of reproductive age: a prospective cohort study in Kigali, Rwanda, 1988-1992.

OBJECTIVE: To estimate the seroincidence of HIV-1 infection among women of reproductive age in Kigali, Rwanda. DESIGN: Fixed prospective cohort followed for 36 months between November 1988 and June 1992, as part of an ongoing study of mother-to-child transmission of HIV-1. SETTING: Centre Hospitalier, Kigali, Rwanda. SUBJECTS: A total of 216 HIV-seronegative women were enrolled at delivery between November 1988 and June 1989. METHODS: A blood sample was obtained at delivery to test for HIV antibodies (by enzyme-linked immunosorbent assay and Western blot). Serum was tested every 3 months during follow-up. Incidence density rates of HIV seroconversion were estimated. RESULTS: The follow-up rate after 3 years was 89%, assessed by the maximum person-years method. The seroincidence density rate was 3.5 per 100 women-years (95% confidence interval, 1.9-5.0). It decreased linearly from 7.6 during the first 6-months postpartum to 2.5 per 100 women-years during the last 6 months of the third year of follow-up. Maternal age did not affect HIV incidence rates. We examined the role of the cohort, counselling, and the first 6-month postpartum effects on this estimate. CONCLUSION: This fixed cohort provided an overall estimation of the HIV infection incidence rate and its dynamics. These figures could be used for programming future HIV preventive vaccine efficacy trials in Rwanda.

PIP: The objective was to estimate the seroincidence of HIV-1 infection among women of reproductive age in Kigali, Rwanda. A fixed prospective cohort followed a total of 216 HIV-seronegative women for 36 months between November 1988 and June 1992 at Centre Hospitalier, Kigali, Rwanda. A study of mother-to-child transmission of HIV-1 has been going on at the Centre Hospitalier de Kigali since November 1988. A group of HIV-seronegative women matched by maternal age and parity was consecutively selected as a comparison group. The mean maternal age was 25.1 years (SD, 4.5 years), and the total number of pregnancies was 2.7 (SD, 1.8). A blood sample was obtained at delivery to test for HIV antibodies (by enzyme-linked immunosorbent assay and Western blot). Serum was tested every 3 months during follow-up. The follow-up rate after 3 years was 89.2% (577/646.75), assessed by the maximum person-years method. 20 seroconversions were documented during the first 36 months of follow-up among the 216 women seronegative at inclusion, yielding a cumulative incidence of 11.2%. The largest number of seroconversions (8/20; 40%) was observed in the first 6 months of the postpartum period. The seroincidence density rate was 3.5/100 women-years (95% confidence interval, 1.9-5.0). It decreased linearly from 7.6 during the first 6-months postpartum to 2.5 per 100 women-years during the last 6 months of the third year of follow-up (P = 0.01). Maternal age did not affect HIV incidence rates. We examined the role of the cohort, counseling, and the first 6-month postpartum effects on this estimate. The study confirms that pregnant women may represent a population in which the HIV seroincidence is high and concentrated in the immediate postpartum period. Pregnant women should become a potential target group for future large scale vaccination trials and programs with adequate follow-up. These figures could be used for programming future HIV preventive vaccine efficacy trials in Rwanda.

Effect of early chemoprophylaxis with co-trimoxazole on nutritional status evolution in HIV-1-infected adults in Abidjan, Côte d'Ivoire.

BACKGROUND: In sub-Saharan Africa, malnutrition is a major complication of HIV disease. Measuring accurately the nutritional benefits of a therapeutic intervention could be an easy-to-monitor secondary outcome. METHODS: Anthropometric data were analysed from patients participating in a placebo-controlled trial of co-trimoxazole prophylaxis in adults recruited at early stages of HIV-1 infection in Côte d'Ivoire (COTRIMO-CI ANRS 059 trial). Body mass index (BMI), arm muscle circumference (AMC) and percentage of fat mass (FM) were measured at baseline and quarterly during the follow up. Percentage of variation from the baseline value was compared between treatment groups and within the groups using Student t-test. RESULTS: An improvement of all anthropometric indicators was observed in the first 3 months of follow up in both treatment groups, significant in the co-trimoxazole group (P < or = 0.0006) but not in the placebo group (P > or = 0.06). In the co-trimoxazole group, this improvement was maintained for up to 24 months for BMI (P = 0.007), 21 months for AMC (P = 0.02) and only up to 12 months for FM (P = 0.04). The placebo group had a stable anthropometric status up to the end of the trial. Differences between treatment groups were significant for up to 15 months for BMI and AMC and 12 months for FM. CONCLUSION: As co-trimoxazole prophylaxis is now recommended in Africa as part of a minimum package of care for HIV-infected symptomatic subjects, the short-term improvement of these anthropometric indicators in adults who start co-trimoxazole prophylaxis should be considered as an effective clinical outcome.

Predictive value of Toxoplasma gondii antibody titres on the occurrence of toxoplasmic encephalitis in HIV-infected patients. ANRS 005/ACTG 154 Trial Group.

OBJECTIVE: To study the predictive value of anti-Toxoplasma gondii antibody titres for the occurrence of toxoplasmic encephalitis (TE) in HIV-infected patients. METHODS: Data from the placebo arm of a trial of primary prophylaxis for TE (ANRS 005/ACTG 154) were analysed. Patients included had CD4+ cell counts < 200 x 10(6)/l and a positive Toxoplasma serology. Immunoglobulin (Ig) G and IgM Toxoplasma antibody titres at entry were retrospectively determined by enzyme-linked immunosorbent assay and agglutination on serum samples in a single laboratory. Incidence of TE was estimated by Kaplan-Meier method and a Cox model was used to study the predictive value of antibody titres, adjusted for other covariates. RESULTS: All 164 patients studied were positive for IgG antibodies and one had IgM antibodies. After a mean follow-up of 16 months, 31 cases of TE were documented. One-year incidence of TE was significantly higher in patients with IgG titres > or = 150 IU/ml (23.7%) than in patients with titres < 150 IU/ml (7.7%; relative risk, 3.1; P < 0.003). IgG titres remained significantly associated with the occurrence of TE (relative risk, 3.3; P < 0.005) in the Cox model. Predictive value of IgG titres did not differ according to baseline CD4+ cell counts. CONCLUSIONS: In patients with CD4+ cell counts < 200 x 10(6)/l, IgG anti-Toxoplasma antibody titre is a prognostic factor of occurrence of TE, with a higher risk for titres > or = 150 IU/ml. This finding should reinforce the recommendation of specific prophylaxis in these patients.

Prevention of human immunodeficiency virus-related opportunistic infections in France: a cost-effectiveness analysis.

A simulation model of human immunodeficiency virus (HIV) disease, which incorporated French data on the progression of HIV disease in the absence of antiretroviral therapy and on cost, was used to determine the clinical impact and cost-effectiveness of different strategies for the prevention of opportunistic infections in French patients who receive highly active antiretroviral therapy (HAART). Compared with use of no prophylaxis, use of trimethoprim-sulfamethoxazole (TMP-SMZ) increased per-person lifetime costs from euro 185,600 to euro 187,900 and quality-adjusted life expectancy from 112.2 to 113.7 months, for an incremental cost-effectiveness ratio of euro 18,700 per quality-adjusted life-year (euro/QALY) gained. Compared with use of TMP-SMZ alone, use of TMP-SMZ plus azithromycin cost euro 23,900/QALY gained; adding fluconazole cost an additional euro 54,500/QALY gained. All strategies that included oral ganciclovir had cost-effectiveness ratios that exceeded euro 100,000/QALY gained. In the era of HAART, on the basis of French data, prophylaxis against Pneumocystis carinii pneumonia, toxoplasmic encephalitis, and Mycobacterium avium complex bacteremia is cost-effective. Prophylaxis against fungal and cytomegalovirus infections is less cost-effective than are other therapeutic options for HIV disease and should remain of lower priority.

Patient information about radiation therapy: a survey in Europe.

BACKGROUND AND PURPOSE: We performed a survey to evaluate the present status and means of information given to patients treated by radiotherapy. A short questionnaire was sent, with the help of ESTRO, to 746 European heads of department with a request to send specific documents used for informing the patient. Within 2 months (March and April 1996) we received 290 answers (39%) and 97 centres sent documents. MATERIALS AND METHODS: Analysis of the questionnaire and the documents was performed quantitatively with usual statistical methods and qualitatively with a socio-anthropological method of content analysis. RESULTS: Analysis of the questionnaire shows the major role of the radiation oncologist in giving information and writing documents. The 298 different samples sent from 97 centres represent a wide panel with a booklet of general information (59 booklets/57 centres), practical advice and specific explanations (177 documents/49 centres) and informed consent (36 documents/28 centres). The anthropological study was centred on the way information was given, evaluation of the patient's understanding and analysis of documents sent. CONCLUSION: This preliminary survey needs to be completed by a study, including the patient's point of view and needs, about the information given.