ABSTRACT
OBJECTIVE: The purpose of this study was to investigate the effect of HTLVI infection on survival in AIDS patients in French Guiana. PATIENTS AND METHODS: A cohort of 151 adult patients with AIDS were followed from January 1992 through June 1996. Kaplan-Meier survival curves were established. Using the Cox model, multivariate analysis was performed to examine different factors affecting survival. RESULTS: The incidence of HTLVI infection in this cohort was 11.9% and 57.6% of the patients died during the study period. Multivariate analysis disclosed that older age at diagnosis of AIDS (over 45 years) and low CD4 count (< 100/mm3) were predictors of poor survival. HIV-HTLVI co-infection was strongly correlated with reduced survival (p = 0.02; RR = 2.2; CI = 1.1-4.5). CONCLUSION: In our region, all patients with HIV infection should be screened for HTLVI infection. In case of co-infection, early care should included adapted antiretroviral regimens.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , HTLV-I Infections/complications , Acquired Immunodeficiency Syndrome/mortality , Adult , CD4 Lymphocyte Count , Cohort Studies , Comorbidity , Female , French Guiana/epidemiology , HTLV-I Infections/mortality , Humans , Male , Middle Aged , Prognosis , Survival RateABSTRACT
OBJECTIVE: Much proof has been accumulated over the last decade demonstrating that depression is a major public health issue. Use of psychotropics and more precisely antidepressants is considered to be excessive. It is however paradoxical that prescribing antidepressants has become commonplace. The aim of this study was to better assess the process of prescribing antidepressants in the hospital setting. METHODS: An epidemiological study was carried out to examine prescribing practices used by psychiatrists and non psychiatrists working in the Rennes University Hospital. The psychiatrist population was used as the reference population for univariate and multivariate analysis designed to ascertain differences concerning prescription practices. RESULTS: Duration of the clinical examination (shortest for non-psychiatric physicians, p = 0.0001), use of a diagnostic scale (more frequently for psychiatrists, p = 0.0008), reasons for choosing an antidepressant (pharmacological considerations more frequent among psychiatrists, p = 0.0009), and co-therapies (neuroleptic association more frequent among psychiatrists, p = 0.0001) were found to be different between the two prescribing populations. CONCLUSION: All patients with signs of depression are not necessarily given optimal care. Errors in assessing antidepressants is probably a common problem.
Subject(s)
Antidepressive Agents/therapeutic use , Depression/drug therapy , Drug Prescriptions/statistics & numerical data , Medical Staff, Hospital , Psychiatry , Adult , Analysis of Variance , Depression/diagnosis , Epidemiologic Methods , Female , France , Hospitals, University , Humans , Internship and Residency , Male , Multivariate Analysis , Regression AnalysisABSTRACT
In this paper, we present an overview of the CARDIOLAB environment where the heart's electrical activity is modeled at distinct space and time scales. CARDIOLAB uses three models, two of which are based on cellular automata, and the third on qualitative simulation. They are combined around a blackboard for multi-scale quantitative and qualitative modeling of cardiac electrical activity. A general account on how spatio-temporal representation and reasoning methods are applied to produce heuristic associations is also presented.
Subject(s)
Computer Simulation , Heart/physiology , Models, Cardiovascular , Electrophysiology , Humans , SoftwareABSTRACT
Cellular Automata (CA) models offer a good compromise between computational complexity and biological plausibility while qualitative models have expressive power for explicitly describing dynamic processes. In this paper we present a 2D CA model and its coupling with a qualitative model. The CA model includes elements characterizing muscle, nodal tissue, and bypass conduction. Each element exhibits adaptive properties to cycle length and to the prematurity of incoming impulses. A crude electrocardiogram is also simulated via an equivalent source formulation. Arrhythmias such as the Wenckebach phenomenon, atrial flutter, or extrasystole-triggered tachyarrhythmias can be simulated using relatively simple models when they incorporate the fast conduction system with muscle tissue and when the model elements exhibit adaptive properties. We then illustrate how a CA model can be coupled to a qualitative model to produce a system that combines the fine grained description of CA models with the high level interpretative role of qualitative models.
