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1.
Burns ; 2024 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-38724347

RESUMO

BACKGROUND: Negative-pressure-wound-therapy (NPWT) has become a widely used tool for the coverage and active treatment of complex wounds, including burns. This study aimed to evaluate the effectiveness of NPWT in acute burns of upper and lower extremities and to compare results to the standard-of-care (SOC) at our institution. METHODS: Patients that were admitted to our institution between May 2019 and November 2021 with burns on extremities between 0.5 % and 10 % of the total body surface area (%TBSA) were included and randomized to either NPWT or SOC (polyhexanide gel, fatty gauze, and cotton wool). Treatment was performed until complete wound healing. Patients that required skin grafts, received additional NPWT after grafting independent on the initial group allocation. RESULTS: Sixty-five patients suffering from burn injury between May 2019 and November 2021 were randomized into treatment with NPWT (n = 33) or SOC (n = 32); of these, 33 patients (NPWT) and 28 patients (SOC) had complete data sets and were included in the analysis. Both groups were similar regarding age (39.8 ± 13.7 vs. 44.8 ± 16.2 years,p = 0.192), total burn size (3.1 ± 2.3 vs. 3.4 ± 2.8 %TBSA,p = 0.721) and treated wound size (1.9 ± 1.2 vs. 1.5 ± 0.8 %TBSA,p = 0.138). We found no differences regarding healing time (11.0 ± 4.9 vs. 8.6 ± 3.8,p = 0.074, and significant differences in a number of dressing changes throughout the study (2.4 ± 1.5 vs 4.2 ± 1.9,p < 0.001). The Kaplan-Meier time-to-event analysis exhibited no statistically significant difference in the time to healing or skin grafting (p = 0.085) in NPWT group compared with SOC group. The median time to healing or skin grafting was 10(8-11) days for NPWT and 9(7-11) days for SOC. The hazard ratio for healing or skin graft was HR= 0.64(0.38-1.08). The results of the time-to-event analysis as well as the Kaplan-Meier curve on the PPS confirmed this result. We found no differences in secondary surgical operations 15.2 vs 21.4 % pain or functional outcomes. CONCLUSIONS: In this study, we found no significant difference between the two groups in terms of time to detect wound healing. We also found no difference regarding further operations for wound closure, pain and/or scarring. However, dressing changes were significantly less frequent for patients that were treated with NPWT, which may be a psychological and logistical advantage.

3.
HIV Med ; 18(3): 171-180, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27625109

RESUMO

OBJECTIVES: The aim of the study was to determine the time to, and risk factors for, triple-class virological failure (TCVF) across age groups for children and adolescents with perinatally acquired HIV infection and older adolescents and adults with heterosexually acquired HIV infection. METHODS: We analysed individual patient data from cohorts in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE). A total of 5972 participants starting antiretroviral therapy (ART) from 1998, aged < 20 years at the start of ART for those with perinatal infection and 15-29 years for those with heterosexual infection, with ART containing at least two nucleoside reverse transcriptase inhibitors (NRTIs) and a nonnucleoside reverse transcriptase inhibitor (NNRTI) or a boosted protease inhibitor (bPI), were followed from ART initiation until the most recent viral load (VL) measurement. Virological failure of a drug was defined as VL > 500 HIV-1 RNA copies/mL despite ≥ 4 months of use. TCVF was defined as cumulative failure of two NRTIs, an NNRTI and a bPI. RESULTS: The median number of weeks between diagnosis and the start of ART was higher in participants with perinatal HIV infection compared with participants with heterosexually acquired HIV infection overall [17 (interquartile range (IQR) 4-111) vs. 8 (IQR 2-38) weeks, respectively], and highest in perinatally infected participants aged 10-14 years [49 (IQR 9-267) weeks]. The cumulative proportion with TCVF 5 years after starting ART was 9.6% [95% confidence interval (CI) 7.0-12.3%] in participants with perinatally acquired infection and 4.7% (95% CI 3.9-5.5%) in participants with heterosexually acquired infection, and highest in perinatally infected participants aged 10-14 years when starting ART (27.7%; 95% CI 13.2-42.1%). Across all participants, significant predictors of TCVF were those with perinatal HIV aged 10-14 years, African origin, pre-ART AIDS, NNRTI-based initial regimens, higher pre-ART viral load and lower pre-ART CD4. CONCLUSIONS: The results suggest a beneficial effect of starting ART before adolescence, and starting young people on boosted PIs, to maximize treatment response during this transitional stage of development.


Assuntos
Antirretrovirais/uso terapêutico , Farmacorresistência Viral , Infecções por HIV/tratamento farmacológico , Grupos Populacionais , Adolescente , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Europa (Continente) , Feminino , Humanos , Lactente , Masculino , Fatores de Tempo , Falha de Tratamento , Adulto Jovem
4.
Clin Genet ; 89(5): 608-13, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-26848058

RESUMO

Premature ovarian insufficiency (POI) affects approximately 1% of women before the age of 40. Genetic contribution is a significant component of POI. In this context, heterozygous mutations in NOBOX, BMP15 and GDF9 have been reported. The objective of our study was to evaluate the prevalence of these genes mutations in 125 unrelated Tunisian patients diagnosed with POI. The screening of NOBOX gene revealed three missense mutations (p.Arg117Trp; p.Gly91Trp and p.Pro619Leu) in eight patients. These mutations were not found in a 200 ethnically matched women without fertility problem. The sequencing of BMP15 and GDF9 gene revealed only previously reported variants. In contrast to previous studies, the prevalence of BMP15 variations is not higher than in the control population. Conversely, 6.4% of the cases present a NOBOX mutations; this high prevalence strengthens the consideration of NOBOX gene as strong autosomal candidate for POI.


Assuntos
Predisposição Genética para Doença/genética , Proteínas de Homeodomínio/genética , Mutação de Sentido Incorreto , Insuficiência Ovariana Primária/genética , Fatores de Transcrição/genética , Adulto , Alelos , Análise Mutacional de DNA , Feminino , Frequência do Gene , Testes Genéticos/métodos , Testes Genéticos/estatística & dados numéricos , Genótipo , Humanos , Prevalência , Insuficiência Ovariana Primária/diagnóstico , Insuficiência Ovariana Primária/epidemiologia , Tunísia/epidemiologia
5.
Rev Epidemiol Sante Publique ; 62(5): 283-90, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25444835

RESUMO

BACKGROUND: Since 1994, French population-based knowledge, attitudes, beliefs and practices surveys have enabled researchers to estimate trends in sexual behavioural indicators. METHODS: We estimated trends and prevalence of self-reported sexually transmitted infections during the previous 5 years among 16,095 sexually active adults aged 18-54 through five cross-sectional telephone surveys between 1994 and 2010. We then studied the factors associated with participants' most recent sexually transmitted infections other than genital candidiasis. RESULTS: Overall, 2.5% (95% confidence interval: 2.2%-2.9%) of women reported sexually transmitted infections within the previous 5 years, increases being continuously reported between 1998 and 2010. In contrast, men reported lower prevalence of sexually transmitted infections (1.4%; 95% confidence interval: 1.1%-1.7%), which remained stable over time. General practitioners and gynaecologists managed most sexually transmitted infections. Men notified their stable partners about infection less often than women (66% vs. 84%). Self-reported sexually transmitted infections were associated with younger age, multiple sexual partnerships and fear of sexually transmitted infections in both genders, with exclusively homosexual practices in men, and with a high educational level and recent HIV testing in women. CONCLUSION: Self-reported sexually transmitted infections clearly reflect risky sexual behaviours. The lower prevalence of self-reported sexually transmitted infections among men than among women may reflect less access to screening activities for sexually transmitted infections in men.


Assuntos
Autorrelato , Infecções Sexualmente Transmissíveis/epidemiologia , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , França/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores de Tempo , Adulto Jovem
6.
Artigo em Inglês | MEDLINE | ID: mdl-25049210

RESUMO

Lopinavir is an HIV protease inhibitor with high protein binding (98-99%) in human plasma. This study was designed to develop an ultrafiltration method to measure the unbound concentrations of lopinavir overcoming the non-specific binding issue. A liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the determination of total concentrations of lopinavir in plasma was developed and validated, and an adaptation was also optimized and validated for the determination of unbound concentrations. The chromatographic separation was performed with a C18 column (100 mm × 2.1mm i.d., 5 µm particle size) using a mobile phase containing deionized water with formic acid, and acetonitrile, with gradient elution at a flow-rate of 350 µL min(-1). Identification of the compounds was performed by multiple reaction monitoring, using electrospray ionization in positive ion mode. The method was validated over a clinical range of 0.01-1 µg/mL for human plasma ultrafiltrate and 0.1-15 µg/mL in human plasma. The inter and intra-assay accuracies and precisions were between 0.23% and 11.37% for total lopinavir concentrations, and between 3.50% and 13.30% for plasma ultrafiltrate (unbound concentration). The ultrafiltration method described allows an accurate separation of the unbound fraction of lopinavir, circumscribing the loss of drug by nonspecific binding (NSB), and the validated LC-MS/MS methodology proposed is suitable for the determination of total and unbound concentrations of lopinavir in clinical practice.


Assuntos
Cromatografia Líquida de Alta Pressão/métodos , Lopinavir/sangue , Espectrometria de Massas em Tandem/métodos , Ultrafiltração/métodos , Ensaios Clínicos Fase II como Assunto , Ensaios Clínicos Fase III como Assunto , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Humanos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Lopinavir/química , Lopinavir/isolamento & purificação , Gravidez , Complicações Infecciosas na Gravidez/sangue , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/virologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
7.
J Gynecol Obstet Biol Reprod (Paris) ; 43(7): 534-48, 2014 Sep.
Artigo em Francês | MEDLINE | ID: mdl-24947850

RESUMO

With effective antiretroviral therapy, the risk of mother to child transmission (MTCT) is now under 1%. The 2013 French guidelines emphasize early antiretroviral lifelong antiretroviral therapy. Thus, the current trend for women living with HIV is to take antiretroviral therapy before, during and after their pregnancies. A major issue today is the choice of antiretroviral drugs, to maximize the benefits and minimize the risks of fetal exposure. This requires interdisciplinary care. The use of effective therapies permits gradual but profound changes in obstetric practice. When maternal plasma viral load is controlled (<50 copies/ml), obstetrical care can be more similar to standards in HIV-negative women. Prophylactic cesarean section is recommended when the viral load in late pregnancy is above 400 copies/mL. Intravenous zidovudine during labor is recommended only if the last maternal viral load is>400 copies/mL or in case of complications such as preterm delivery, bleeding or chorio-amnionitis during labor. In case of premature rupture of membranes before 34 weeks, a multidisciplinary decision should be made, based on gestational age and control of maternal viral load; if the woman is under antiretroviral therapy and especially if her viral load is undetectable, steroids and antibiotics should be offered and pregnancy can be continued except in case of signs or symptoms of chorio-amnionitis. Breastfeeding is not recommended in women living with HIV in France, as in industrialized countries. Prophylaxis in the newborn is usually zidovudine for 1 month. In case of significant exposure to HIV perinatally, in particular when, maternal viral load is>1000 copies/mL, prophylactic combination therapy is recommended. Monitoring of the child is necessary to determine whether or not it is free of HIV infection and to monitor possible adverse effects of perinatal exposure to antiretroviral drugs.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Feminino , Infecções por HIV/complicações , Humanos , Gravidez
8.
Clin Infect Dis ; 57(7): 1038-47, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23921881

RESUMO

BACKGROUND: Few studies consider the incidence of individual AIDS-defining illnesses (ADIs) at higher CD4 counts, relevant on a population level for monitoring and resource allocation. METHODS: Individuals from the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) aged ≥14 years with ≥1 CD4 count of ≥200 µL between 1998 and 2010 were included. Incidence rates (per 1000 person-years of follow-up [PYFU]) were calculated for each ADI within different CD4 strata; Poisson regression, using generalized estimating equations and robust standard errors, was used to model rates of ADIs with current CD4 ≥500/µL. RESULTS: A total of 12 135 ADIs occurred at a CD4 count of ≥200 cells/µL among 207 539 persons with 1 154 803 PYFU. Incidence rates declined from 20.5 per 1000 PYFU (95% confidence interval [CI], 20.0-21.1 per 1000 PYFU) with current CD4 200-349 cells/µL to 4.1 per 1000 PYFU (95% CI, 3.6-4.6 per 1000 PYFU) with current CD4 ≥ 1000 cells/µL. Persons with a current CD4 of 500-749 cells/µL had a significantly higher rate of ADIs (adjusted incidence rate ratio [aIRR], 1.20; 95% CI, 1.10-1.32), whereas those with a current CD4 of ≥1000 cells/µL had a similar rate (aIRR, 0.92; 95% CI, .79-1.07), compared to a current CD4 of 750-999 cells/µL. Results were consistent in persons with high or low viral load. Findings were stronger for malignant ADIs (aIRR, 1.52; 95% CI, 1.25-1.86) than for nonmalignant ADIs (aIRR, 1.12; 95% CI, 1.01-1.25), comparing persons with a current CD4 of 500-749 cells/µL to 750-999 cells/µL. DISCUSSION: The incidence of ADIs was higher in individuals with a current CD4 count of 500-749 cells/µL compared to those with a CD4 count of 750-999 cells/µL, but did not decrease further at higher CD4 counts. Results were similar in patients virologically suppressed on combination antiretroviral therapy, suggesting that immune reconstitution is not complete until the CD4 increases to >750 cells/µL.


Assuntos
Antirretrovirais/administração & dosagem , Linfócitos T CD4-Positivos/imunologia , Infecções por HIV/epidemiologia , Infecções por HIV/imunologia , Adulto , Contagem de Linfócito CD4/estatística & dados numéricos , Estudos de Coortes , Europa (Continente)/epidemiologia , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Incidência , Masculino , Distribuição de Poisson
9.
Arch Pediatr ; 20(8): 890-6, 2013 Aug.
Artigo em Francês | MEDLINE | ID: mdl-23850051

RESUMO

Thirty years after the first descriptions of AIDS in children in May 1983, the risk of viral transmission from mother to child has been reduced to almost zero and the disease in infected children has become an asymptomatic condition, stable in the long-term, thanks to antiretroviral drugs. Unbelievable though it may have seemed until the mid-1990s, children infected during the perinatal period are now growing up to be adults in a chronic, stable, asymptomatic medical condition with often satisfactory personal, family, and social lives. The French perinatal epidemiological cohort, which was set up in 1984 and has included more than 18,000 mother-child pairs to date, traces the steps in this extraordinary revolution in the prevention and treatment of HIV-1 infection in children.


Assuntos
Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Síndrome da Imunodeficiência Adquirida/transmissão , Antirretrovirais/uso terapêutico , Criança , Estudos de Coortes , Estudos Epidemiológicos , Feminino , França/epidemiologia , Sobreviventes de Longo Prazo ao HIV/estatística & dados numéricos , Nível de Saúde , Humanos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Gravidez , Efeitos Tardios da Exposição Pré-Natal , Fatores de Risco
10.
AIDS Behav ; 17(2): 488-97, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22130651

RESUMO

Our objective was to study relations between non-disclosure of HIV to partner, socio demographics and prevention of HIV mother-to-child transmission (PMTCT), among HIV-infected pregnant women enrolled in the French Perinatal Cohort (ANRS-EPF-CO1) from 2005 to 2009 (N = 2,952). Fifteen percent of the women did not disclose their HIV status to their partner. Non-disclosure was more frequent in women diagnosed with HIV infection late in pregnancy, originating from Sub-Saharan Africa or living alone, as well as when the partner was not tested for HIV. Non-disclosure was independently associated with non optimal PMTCT: late initiation of antiretroviral therapy, detectable viral load at delivery and lack of neonatal prophylaxis. Nonetheless, the rate of transmission did not differ according to disclosure status. Factors associated with non-disclosure reflect vulnerability and its association with non optimal PMTCT is a cause for concern although the impact on transmission was limited in this context of universal free access to care.


Assuntos
Aconselhamento , Soropositividade para HIV/transmissão , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Mães , Complicações Infecciosas na Gravidez/prevenção & controle , Parceiros Sexuais , Revelação da Verdade , Adulto , Fármacos Anti-HIV/administração & dosagem , Terapia Antirretroviral de Alta Atividade , Escolaridade , Feminino , França/epidemiologia , Soropositividade para HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Masculino , Mães/psicologia , Aceitação pelo Paciente de Cuidados de Saúde , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/psicologia , Cuidado Pré-Natal/estatística & dados numéricos , Parceiros Sexuais/psicologia , Cônjuges , Inquéritos e Questionários , Carga Viral
11.
Rev Epidemiol Sante Publique ; 59(2): 91-6, 2011 Apr.
Artigo em Francês | MEDLINE | ID: mdl-21397420

RESUMO

BACKGROUND: Survey non-response rates are important quality indicators. Refusal rates can induce non-response bias in health survey estimates. However, comparisons across surveys highlight inconsistencies in the use of survey outcome categories and in the calculation of response rates. In this paper we discuss the relevance of these indicators and suggest other survey quality indicators. METHODS: Outcome rates from two French random-digit dialing (RDD) telephone surveys are compared : the Nicolle survey on infectious diseases of 4112 individuals conducted in 2006, and the HIV knowledge, attitude, belief and practices (KABP) survey of 5071 individuals in 2004. Based on the same protocol, we describe in details the way the two RDD samples were drawn and how non-response rates were estimated. RESULTS: Non-response rates were different: 36% in Nicolle survey and 18% in KABP survey. However, the quantity of telephone numbers required to obtain one interview was higher in the KABP survey: 2.8 telephone numbers versus 2.1 in the Nicolle survey. The participation rates, aggregating together refusals, break-off and non-reachable numbers, were equivalent for the two surveys. This result occurred because of a greater proportion of unreached calls in the KABP surveys, which is not integrated into the non-response rates commonly used. CONCLUSION: Survey non-response rate is insufficient to estimate the quality of a survey. The need for other indicators has been previously stressed in the literature, notably with the adoption and utilization of the American Association for Public Opinion Research (AAPOR) standard definitions of four indicators. But these indicators are quite complex for evaluating non-response bias between surveys. In addition to the classical refusal rate, two other indicators are proposed in this paper: participation rate (number of complete interviews divided by the number of eligible and of unknown eligibility units) and a liking contact rate (number of unreachable units because of a long absence, break-off or non-answer divided by the number of eligible and of unknown eligibility units). The sum of these three indicators is equal to 100% and thus easier to manipulate when comparing surveys.


Assuntos
Doenças Transmissíveis/epidemiologia , Inquéritos Epidemiológicos , Participação do Paciente/estatística & dados numéricos , Telefone , Adolescente , Adulto , Idoso , Doenças Transmissíveis/transmissão , Interpretação Estatística de Dados , França/epidemiologia , Infecções por HIV/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos/normas , Humanos , Pessoa de Meia-Idade , Distribuição Aleatória , Recusa de Participação/estatística & dados numéricos , Estudos de Amostragem , Viés de Seleção , Inquéritos e Questionários
12.
Clin Infect Dis ; 51(7): 833-43, 2010 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-20804413

RESUMO

BACKGROUND: Management of pregnant women with human immunodeficiency virus (HIV) type 2 infection remains unclear because of its low prevalence and important differences from HIV-1. METHODS: Pregnant women monoinfected with HIV-2 or HIV-1 and their infants enrolled in the prospective, national, multicenter French Perinatal Cohort between 1986 and 2007. RESULTS: Overall, 2.6% (223/8660) of mothers were infected with HIV-2, and they accounted for 3.1% (367/ 11841) of the total births. Most were born in sub-Saharan Africa. A higher proportion of HIV-2-infected mothers than HIV-1-infected mothers had no symptoms, had received no antiretroviral therapy at conception (85.9% vs 66.7%), and had received no antiretroviral therapy during pregnancy (42.8% vs 19.9%), particularly highly active antiretroviral therapy (HAART) (79.7% vs 46.1%), and they had higher CD4 cell counts near delivery (median, 574 vs 452 cells/mm3; P < .01). If antiretroviral therapy was used, it was started at a later gestational age for HIV- 2-infected mothers (median, 28 vs 25 weeks; P < .01). HIV-2-infected mothers were more likely to deliver vaginally (67.9% vs 49.3%) and to breastfeed (3.6% vs 0.6%; P < .01), and their infants less frequently received postexposure prophylaxis. In the period 2000-2007, the proportion with viral load <100 copies/mL at delivery was 90.5% of HIV-2-infected mothers, compared with 76.2% of HIV-1-infected mothers (P=.1). There were 2 cases of transmission: 1 case in 1993 occurred following maternal primary infection, and the other case occurred postnatally in 2002 and involved a mother with severe immune deficiency. The mother-to-child transmission rate for HIV-2 was 0.6% (95% confidence interval, 0.07%-2.2%). CONCLUSIONS: Care for HIV-2-infected pregnant women rests on expert opinion. The mother-to-child transmission residual rate (0.07%-2.2%) argues for systematic treatment: protease inhibitor-based HAART for women requiring antiretrov


Assuntos
Infecções por HIV/transmissão , Infecções por HIV/virologia , HIV-2/isolamento & purificação , Transmissão Vertical de Doenças Infecciosas , Complicações Infecciosas na Gravidez/virologia , Adulto , Estudos de Coortes , Feminino , França , Humanos , Gravidez
13.
Sex Transm Infect ; 86(4): 263-70, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20660590

RESUMO

BACKGROUND: Few studies have estimated Chlamydia trachomatis (CT) prevalence in the general population, most prevalence studies being based on people already attending healthcare settings. OBJECTIVES: To estimate the prevalence of CT in France, assess the feasibility of home sampling without any face-to-face intervention and identify risk factors associated with CT infection using data from the Contexte de la Sexualité (CSF) survey on sexual behaviour; a national population-based survey, carried out by telephone in 2006. METHODS: A random subsample of sexually experienced people aged 18-44 (N=4957) were invited to participate in a CT home-sampling study (NatChla study). Participants' samples were tested for CT by PCR. Percentages were weighted for unequal selection probabilities and post-stratified based on French population census data. Independent risk factors were identified by logistic regression. RESULTS: CT prevalence in people aged 18-44 was estimated at 1.4% (95% CI 0.8% to 2.6%) for men, and 1.6% (95% CI 1.0% to 2.5%) for women. Increased rates were found in subjects aged 18-29: 2.5% (95% CI 1.2% to 5.0%) for men and 3.2% (95% CI 2.0% to 5.3%) for women. CT infection was associated, for both genders, with having their last sexual intercourse with a casual partner. Other risk factors were for men, having last intercourse with a new partner, living in the Paris area, and for women, multiple partners during the previous year, same sex partners and a low level of education. CONCLUSIONS: CT prevalence in France is similar to that in other developed countries. Home sampling proved feasible and useful to reach members of the population with limited access to traditional care.


Assuntos
Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis , Adolescente , Adulto , Idoso , Preservativos/estatística & dados numéricos , Estudos de Viabilidade , Feminino , França/epidemiologia , Inquéritos Epidemiológicos , Serviços de Assistência Domiciliar , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Vigilância da População , Prevalência , Fatores de Risco , Parceiros Sexuais , Sexo sem Proteção/estatística & dados numéricos , Adulto Jovem
14.
Clin Infect Dis ; 51(2): 214-24, 2010 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-20536367

RESUMO

BACKGROUND. Increasing numbers of children perinatally infected with human immunodeficiency virus (HIV) are reaching adolescence, largely because of advances in treatment over the past 10 years, but little is known about their current health status. We describe here the living conditions and clinical and immunovirologic outcomes at last evaluation among this pioneering generation of adolescents who were born before the introduction of prophylaxis for vertical transmission and whose infections were diagnosed at a time when treatment options were limited. METHODS. The eligible population consisted of HIV-1-infected children who were born before December 1993 and who were included at birth in the prospective national French Perinatal Cohort (EPF/ANRS CO10). RESULTS. Of the 348 eligible children, 210 (60%; median age, 15 years) were still alive and regularly followed up. Current treatment was highly active antiretroviral therapy (HAART) in 77% and 2 nucleoside analogues in 5.0%; 16% had stopped treatment, and 2% had never been treated. The median CD4 cell count was 557 cells/microL, and 200 cells/microL was exceeded in 94% of patients. The median viral load was 200 copies/mL. Viral load was undetectable in 43% of the adolescents and in 54.5% of those receiving HAART. Median height, weight, and body mass index were similar to French reference values for age, and school achievement was similar to nationwide statistics. Better immunologic status was associated with being younger and with having begun HAART earlier. Undetectable viral load was associated with maternal geographic origin and current HAART. CONCLUSIONS. Given the limited therapeutic options available during the early years of these patients' lives and the challenge presented by treatment adherence during adolescence, the long-term outcomes among this population are encouraging.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade/métodos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/transmissão , HIV-1/isolamento & purificação , Adolescente , Contagem de Linfócito CD4 , Criança , Pré-Escolar , Estudos de Coortes , Feminino , França , Infecções por HIV/patologia , Infecções por HIV/virologia , Humanos , Lactente , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas , Estudos Longitudinais , Masculino , Gravidez , Complicações Infecciosas na Gravidez , Resultado do Tratamento , Carga Viral
15.
Rev Epidemiol Sante Publique ; 57(3): 191-203, 2009 Jun.
Artigo em Francês | MEDLINE | ID: mdl-19398285

RESUMO

BACKGROUND: Reading impairment is the major learning disability in children. While research on illiteracy has mainly been conducted from a sociological perspective, research on dyslexia has typically been studied from a cognitive-linguistic perspective. Studies that jointly investigate sociological, behavioral and cognitive factors in predicting reading outcome are rare and limited to English-speaking populations. The goal of the present study was to screen second grade children with reading impairment in French urban elementary schools and to pin down the factors that explain the various facets of reading failure and success. METHODS: A total of 1062 children from 20 different schools in the city of Paris participated in the study. Different aspects of reading were assessed individually for children with a suspected impairment in reading acquisition. Subsequently, 131 poor readers and 50 typically developing readers were matched for sex, age, and school. For these children, medical, cognitive, behavioral and individual socioeconomic data were obtained. Group differences were examined and multiple regression analyses were conducted to examine how much variance in reading was explained by the various variables. RESULTS: The prevalence of poor reading skills in grade 2 was highly influenced by neighborhood socioeconomic status (SES) (ranging from 3.3% in high SES to 20.5% in low SES areas). Among the SES variables, employment of the father was a significant predictor of poor reading. Among the cognitive variables, phonological awareness and rapid naming were the most significant factors, much more than verbal or nonverbal intelligence. Among the behavioral variables, attention was an important factor but not externalized symptoms. Multiple regression analyses showed that reading outcome was best predicted by phonological awareness skills and attention deficits. CONCLUSION: The majority of children with reading disability come from low SES areas. As in the English literature, the most robust predictor for reading impairment is phonological awareness, even when SES is taken into account. In addition, attention deficits seemed to aggravate reading impairments for children with weak phonological awareness skills. Successful early prevention should focus on reinforcing phonological awareness, recoding and attention skills.


Assuntos
Comportamento , Cognição , Dislexia/epidemiologia , Pobreza/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Criança , Estudos de Coortes , Dislexia/complicações , Dislexia/diagnóstico , Feminino , Humanos , Testes de Linguagem/estatística & dados numéricos , Masculino , Paris/epidemiologia , Prevalência , Análise de Regressão , Características de Residência , Estudos de Amostragem , Instituições Acadêmicas/estatística & dados numéricos , Fatores Socioeconômicos
16.
Arch Pediatr ; 15(6): 1058-67, 2008 Jun.
Artigo em Francês | MEDLINE | ID: mdl-18456475

RESUMO

OBJECTIVE: From an original large sample of 1062 7 to 8-year-old children, reading skills were assessed and found to be highly linked with socioeconomic status (SES). The purpose of the present study was to further determine underlying medical, sociocultural, cognitive and behavioural factors explaining the diversity of reading skills and the influence of SES. METHOD: Individual testing among low-SES children identified 100 poor readers, 50 typical readers and 31 children with intermediate reading scores. All 3 groups underwent a thorough assessment, including a medical evaluation, a full cognitive battery, a structured parental interview and behavioural questionnaire. Logistic regression was used to demonstrate the variables predicting reading score outcome. RESULTS: None of the medical factors studied was statistically related to reading scores. Due to the methodology buffering the impact of SES sociocultural variables, such as parental levels of education, parental occupation, as well as familial income were weak, but statistically significant predictors. The strongest variables were phonological abilities and symptoms of attention disorders. In a final regression model, phonological awareness, level of mother's education and attention explained the differences in reading skills. CONCLUSIONS: These results, which are unique in France, are similar to existing data in the literature. They support the need to conceptualize an early screening programme to detect reading difficulties and to promote an intervention based on phonological processing and decoding in low-SES environments.


Assuntos
Dislexia/etiologia , Testes de Aptidão , Transtornos da Articulação/complicações , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Criança , Estudos Transversais , Escolaridade , Feminino , Humanos , Masculino , Análise Multivariada , Inquéritos e Questionários
17.
Arch Pediatr ; 15(6): 1049-57, 2008 Jun.
Artigo em Francês | MEDLINE | ID: mdl-18424086

RESUMO

OBJECTIVE: Socioeconomic status (SES) has a known influence on academic achievement. Most studies, however, were conducted in English-speaking countries. Because recent cross-linguistic studies suggest that reading English is much harder to learn than reading other languages, an epidemiological study was conducted in French investigating the impact of socioeconomic background on early reading development. DESIGN: One thousand and twenty second-grade children (476 girls and 544 boys) from 20 different schools participated in the study. Approximately 1/3 of the children lived and were schooled in a high SES area, 1/3 in an intermediate SES area, and one final third in a very low SES area. Assessment of reading, writing and mathematical skills was conducted initially in small groups. Children with suspected learning difficulties were further tested individually. Forty-two children of equivalent age who repeated the first grade received similar individual testing. RESULTS: Average reading scores were in accordance with chronological age, without gender differences. Children from low SES schools had academic performances significantly lower than their peers. Boys exhibited superior arithmetic skills than girls. A significant reading delay was observed in 12.7% of children. The prevalence of poor reading was highly correlated with the area of schooling, varying from 3.3% in the high SES area to 24.2% in low SES area. CONCLUSION: The high rate of children from our sample with a significant delay in reading depended on general socioeconomic environment. An understanding of the origin of such differences is mandatory for defining and coordinating preventive actions and appropriate interventions.


Assuntos
Dislexia/epidemiologia , Criança , Avaliação Educacional , Feminino , França/epidemiologia , Humanos , Masculino , Prevalência , Fatores Socioeconômicos
18.
Arch Pediatr ; 14(3): 298-302, 2007 Mar.
Artigo em Francês | MEDLINE | ID: mdl-17287114

RESUMO

Limit of antiretroviral treatment success is the emergence of drug-resistant virus. As reported in adult population, prevalence of resistance was high in treated HIV-infected children with detectable HIV viral load. Resistance increased with number of prior antiretroviral treatments, particularly with protease inhibitors. Adolescent boys seem at greater risk to harbor multi-classes resistant virus. In HIV-infected newborns, prevalence of resistance was 20%. Most of resistance mutations detected were in accord to perinatal antiretroviral exposition. Principal mechanism of resistance acquisition in newborns was transmission of resistant viruses from mother to child with early archive in cellular reservoir and long term persistence with or without treatment. Consequences of long term therapeutic strategies in children are major.


Assuntos
Antirretrovirais/uso terapêutico , Farmacorresistência Viral , Infecções por HIV/tratamento farmacológico , HIV-1 , Adolescente , Criança , Pré-Escolar , França , Humanos , Lactente , Recém-Nascido
19.
Arch Pediatr ; 13(1): 23-31, 2006 Jan.
Artigo em Francês | MEDLINE | ID: mdl-16271450

RESUMO

INTRODUCTION: The BREV battery (Battery for rapid evaluation of cognitive functions) is a tool which can be used for the rapid neuropsychological evaluation of children aged between 4 and 9 years. OBJECTIVES: After standardization (700 unaffected children) and validation by comparison with a reference battery (202 children with epilepsy), the aim of this study was further validation in 173 children with learning disorders. POPULATION AND METHODS: The study protocol included administration of the BREV, precise neuropsychological examination and evaluation of oral and written language. Statistical analysis was used to compare the findings of the BREV with those of the reference method, and the recommendations indicated by the BREV with the final diagnoses, and to define the sensitivity and the specificity of the BREV battery. RESULTS: All the correlations between BREV tests and reference tests were significant. Recommendations after the BREV were in agreement with the conclusions of the reference evaluation in 168/172 children for language, 145/173 for the psychometric evaluation. For only 4 chidren, the results of the BREV were false negative. Diagnoses corresponded in 168/173 children for oral language, in 102/110 for written language, 166/173 for praxis disorders and 157/173 for intellectual deficit. The most predictive subtests of the BREV and sensitivity and specificity of verbal and non-verbal scores were calculated. CONCLUSION: The BREV is a reliable examination, in learning disorders, to determine the most complementary investigations both in terms of language disorders and for non-verbal or global learning disabilities.


Assuntos
Deficiências da Aprendizagem/diagnóstico , Testes Neuropsicológicos/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Psicometria , Valores de Referência , Sensibilidade e Especificidade
20.
J Pediatr ; 147(5): 669-73, 2005 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16291361

RESUMO

OBJECTIVES: To study the frequency and risk factors of growth retardation (GR) in patients with Diamond-Blackfan anemia. STUDY DESIGN: A cross-sectional survey including the 95 patients followed by hematologists affiliated with the French Society of Pediatric Hematology and Immunology for whom growth data were available; 43 patients were transfusion dependent, 32 were steroid dependent, and 20 patients were off treatment. GR was defined as height below 2 SD. RESULTS: Growth retardation was observed in 29.5% (28) patients. The proportion of GR increased significantly with age (16% <10, 32% among 10 to 16, 47.6% among 17 to 25, 41.7% among >16 years) and was higher in on-treatment than in off-treatment patients (35% among transfusion-dependent, 37% among steroid-dependent vs 5% among off-treatment). GR was significantly linked to associated malformations (OR, 2.3 [1.1 to 8.0]; P = .02) and intrauterine growth retardation (OR, 6.0 [1.1 to 11.6]; P = .021). GR remained independently associated with age, malformations, and treatment in a logistic regression. CONCLUSIONS: Our study showed that the risk of GR increases with age and is associated with treatment dependence. This result addresses the question of the respective part, in the pathogenesis of GR, of the disease severity, illustrated by treatment dependence on the one hand and of the deleterious effects of long-term treatments on the other hand.


Assuntos
Anemia de Diamond-Blackfan/epidemiologia , Transtornos do Crescimento/epidemiologia , Adolescente , Adulto , Anemia de Diamond-Blackfan/terapia , Criança , Estudos Transversais , Feminino , França/epidemiologia , Humanos , Modelos Logísticos , Masculino , Análise Multivariada , Fatores de Risco
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