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Biomedical subjects

R Salamon

Publications and source records attributed to R Salamon.

At least 73 records · Page 4Linked to original sources
PubMed1998

Effect of gender, age, transmission category, and antiretroviral therapy on the progression of human immunodeficiency virus infection using multistate Markov models. Groupe d'Epidémiologie Clinique du SIDA en Aquitaine.

This article illustrates the use of time-homogeneous Markov models with covariates to estimate the AIDS incubation period distribution from prevalent cohorts and to evaluate the effect of factors such as gender, age, human immunodeficiency virus (HIV) transmission category, and antiretroviral therapy on disease progression. We applied this methodology to the analysis of data from a cohort of 3,027 patients enrolled from a hospital-based surveillance system of HIV infection in the Bordeaux University Hospital and four secondary public hospitals in southwestern France. A total of 998 individuals (33%) progressed to AIDS during a median follow-up period of 34 months. Based on a progressive three-state Markov model, the estimated mean and median incubation periods were 9.1 years [95% confidence interval (CI) = 8.7-9.6] and 7.5 years (95% CI = 7.2-7.9), respectively. Our analyses showed a similar disease progression in men and women; we observed a more rapid progression for older subjects compared with younger ones and for homosexual men compared with heterosexuals, intravenous drug users, and transfusion recipients, who had similar disease progression rates after adjusting for age. The use of antiretroviral therapy appeared to slow disease progression. Moreover, the results indicated that a combination therapy of zidovudine with another antiretroviral drug may be more efficient than zidovudine monotherapy.

Acquired Immunodeficiency Syndrome↗
PubMed1998

[Major statistical software usable in epidemiology].

Quality assurance of biostatistical data analysis is becoming mandatory. The aim of this review of statistical software was to guide uses who are faced with the increasing number of these tools. A list of softwares was obtained from statisticians and computer scientists, computerized databases, computer science lay press, and commercial documents. The softwares were described and their possibilities measured. The following functions were studied: functions considered as essential (descriptive analysis, Student's t, Mann-Whitney or Wilcoxon, ANOVA, Kruskall-Wallis, Pearson's chi 2, Fisher's exact test, Pearson's r), survival and multivariate analysis (logistic regression, proportional hazards modelling, times series). User-friendliness and quality of graphs were also studied. Among the 220 listed softwares, 26 could be considered as general softwares and were extensively analyzed. Statistical softwares may be classified into four categories: easy-to-use general public softwares with limited functions, such as EPI INFO; simple reference softwares with satisfactory user-friendliness and performing most of the statistical analyses, such as PCSM, STATISTICA or STATA; complex reference softwares intended for statisticians (EPILOG PLUS, SAS); specific cases such as EGRET performing only multivariate analysis or SUPERANOVA performing only analysis of variance. Such a review should be regularly updated.

Analysis of Variance↗
PubMed1997

Survival after AIDS-defining events in patients with < 200 lymphocytes CD4+ x 10(6)/L who are toxoplasmosis antibody positive. ANRS 005/ACTG 154 Trial Group.

The objective of this study was to assess whether patients with CD4+ cell counts <200 x 10(6)/L have a decreased survival after the occurrence of any AIDS-defining event; 187 patients from the placebo arm of a clinical trial of toxoplasmosis prophylaxis (ANRS005-ACTG154) were included. For this analysis, patients were HIV infected without any AIDS-defining event, had a CD4+ lymphocyte count < 200 x 10(6)/L, had a positive serology for Toxoplasma gondii, and had no severe liver, renal, or hematologic abnormalities. We used proportional hazards regression to study the relationships between baseline variables. AIDS-defining events as time-dependent variables, and survival. The risk of dying was increased by 1.9 for a 10-year increase in age and by 1.3 when CD4+ decreased by 50 x 10(6)/L; after the occurrence of a pneumocystosis, a cytomegalovirus infection, or a toxoplasmosis, the risk of dying was multiplied, respectively, by 10.9 (3.0-40.2), 10.0 (2.8-35.4), and 10.0 (4.5-22.2). None of the other AIDS-defining events was associated with an increased risk of dying, but the power to detect such an association was limited. We conclude that the occurrence of pneumocystosis, cytomegalovirus infection, or toxoplasmosis; age; and CD4+ cell count are important determinants of survival for HIV1-infected patients with CD4+ counts < 200 x 10(6)/L who are toxoplasmosis antibody positive.

AIDS-Related Opportunistic Infections↗
PubMed1997

Progression of human immunodeficiency virus infection in patients with tuberculosis disease. A cohort study in Bordeaux, France, 1988-1994. The Groupe d'Epidémiologie Clinique du Sida en Aquitaine (GECSA).

To assess the role of Mycobacterium tuberculosis disease in human immunodeficiency virus (HIV) infection, the authors compared survival of tuberculosis patients and controls matched on year of HIV diagnosis and CD4+ lymphocyte count. Patients were selected in the Aquitaine Cohort, which follows, since 1985, all patients infected with HIV, aged more than 13 years, in five hospitals. Time of inclusion of controls was the date of diagnosis of tuberculosis for the corresponding tuberculosis patient. Patients who had received primary prophylaxis against mycobacteria other than tuberculosis were excluded. As of June 30, 1994, 104 tuberculosis patients and 620 controls were selected; they were similar, except for history of intravenous drug use (tuberculosis patients, 51%, vs. controls, 31%) and AIDS-defining opportunistic infection (40 vs. 29%). Survival was shorter in tuberculosis patients than in controls (risk ratio 1.5, 95% confidence interval 1.2-2.1) even after controlling for differences at entry. The risk of AIDS-defining opportunistic infection or a decrease to fewer than 50 CD4+ cells/mm3 was slightly but not statistically greater in tuberculosis patients than in controls. Tuberculosis disease affected survival but not occurrence of subsequent opportunistic infections or rate of CD4+ count decline. Tuberculosis may be a marker of advanced HIV and may accelerate its course of infection.

AIDS-Related Opportunistic Infections↗
PubMed1997

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.

Humans↗
PubMed1997

[Prevalence of clinical manifestations of allergic reactions in HIV infection. Cross sectional study of 115 subjects].

A cross sectional survey was set up to study the relation between the prevalence of allergic-type reactions during HIV infection course. For each patient, a standardized interview about recent allergic-type manifestations (RATM), skin prick-tests to six common airborne allergens, IgE serum level were done. Among the 115 included patients, the mean CD4 lymphocyte count (CD4) was 214.7/mm3 (range: 0-1328/mm3). RATM were found in 8.8% of patients with CD4 < 50, in 30% of patients with CD4 between 51 and 200, in 36% of patients with CD4 between 201 and 350 and in 11.5% of patients with CD4 < 350 (p = 0.03). The risk of presenting RATM was 4.8 times (95% confidence interval = 1.7-13.5) higher in patients with CD4 between 51 and 350 than in other patients (p = 0.003). The proportion of positive prick-tests did not significantly vary according to the level of CD4. The increased frequency of RATM in patients with CD4 between 51 and 350/mm3 could be due to an allergic predisposition acquired during the course of HIV infection. The mechanisms explaining the reduced frequency of allergic manifestations when immunodeficiency is profound (CD4 < 50/mm3) remain to be explained.

Adult↗
PubMed1997

Increased risk of toxoplasmic encephalitis in human immunodeficiency virus-infected patients with pyrimethamine-related rash. ANRS 005-ACTG 154 Trial Group. Agence Nationale de Recherche sur le SIDA (ANRS-INSERM) and the NIAID-AIDS Clinical Trials Group.

Although drug-induced rash is frequent in human immunodeficiency virus (HIV)-infected patients, rash due to pyrimethamine has not been described previously. In a randomized, double-blind, placebo-controlled study of pyrimethamine as primary prophylaxis for toxoplasmic encephalitis, the incidence of rash (per hundred patient-years) was 8.1 in the pyrimethamine group versus 1.5 in the placebo group (P < .0002). The 1-year incidence of toxoplasmic encephalitis after occurrence of rash was 37%, as compared with 9.6% in the pyrimethamine group without rash, with a 3.7 times higher risk for patients with pyrimethamine-induced rash (P = .001); the incidence was 13% in the placebo group. At the time of toxoplasmic encephalitis, pyrimethamine was successfully readministered to 80% of patients who discontinued it because of rash. Thus, pyrimethamine, when used for prophylaxis, does induce rash in HIV-infected patients. These patients are at higher risk for toxoplasmic encephalitis and should be carefully monitored for it.

AIDS-Related Opportunistic Infections↗
PubMed1997

Regional experience of evaluation of professional practice and quality assurance implementation in Aquitaine.

We report the establishment of a voluntary programme for developing the assessment of professional practice and quality assurance conducted since 1989 in the Aquitaine region of south-west France. This experience, in a region where there are 14,000 hospital beds in about a hundred institutions, has aimed at two objectives: (1) the adoption by the region's health professionals of medical guidelines for good practice and methods for measuring quality and outcomes obtained, by means of university training in evaluation and the conducting of several surveys of professional practice and clinical audits; (2) similar adoption by the regional political, administrative and medical directors of quality assurance procedures defined by an organizational audit concerning the prescription of preoperative tests in the university hospital and in the main public hospitals of the region. The critical impetus that this experience has created, together with other factors related to the political decision-makers and health managers of the region, has led to an operational regional structure for developing clinical evaluation and quality in Aquitaine.

Decision Making, Organizational↗
PubMed1997

Cognitive predictors of dementia in elderly community residents.

Detection of subjects with a high risk of developing dementia is a major goal of epidemiological research. Among the potential predictors, minor cognitive impairments detected by psychometric methods could be important precursors. A total of 2,726 elderly nondemented subjects, aged 65 and over, randomly selected from the general population of Gironde (south-western France) were followed up for 3 years. During this time, 84 developed an incident dementia, diagnosed as Alzheimer's disease (AD) in 59. The relationships between cognitive performance (Mini Mental State Examination, Benton Visual Retention Test and Isaacs Set Test) measured at the baseline screening of the cohort and the risk of dementia or AD were studied with a discrete Cox proportional hazard model. After adjustment for age and educational level, the three test scores remained strongly related to the risk of dementia or AD. Psychometric performance can be used to screen subjects at risk of developing dementia or AD and allow pharmacological intervention at an early stage.

Activities of Daily Living↗
PubMed1997

Health informatics: handle with caution.

The increased use of computers is a response to the considerable growth in information in all fields of activities. Related to this, in the field of medicine a new component appeared about 40 years ago: Medical Informatics. Its goals are to assist health care professionals in the choice of data to manage and in the choice of applications of such data. These possibilities for data management must be well understood and, related to this, two major dangers must be emphasized. One concerns data security, and the other concerns the processing of these data. This paper discusses these items and warns of the inappropriate use of medical informatics.

Computer Security↗
PubMed1997

Wine consumption and dementia in the elderly: a prospective community study in the Bordeaux area.

Alcoholism is a possible cause of dementia, mainly through associated nutritional deficiencies and, rarely, through acute direct toxicity. However alcohol consumption was not found to be a risk factor in previous epidemiologic studies. We prospectively studied 3,777 community residents aged 65 and over, in the districts of Gironde and Dordogne. Average daily alcoholic consumption was recorded at baseline. Incident cases of dementia and Alzheimer's disease were screened at follow-up with explicit criteria. At 3 years, 2,273 subjects not demented at baseline were still available for follow-up. Wine was the only alcoholic beverage reported by more than 95 p. 100 of regular drinkers. In the 318 subjects drinking 3 to 4 standard glasses per day (> 250 and up to 500 ml), categorized as moderate drinkers, the crude odds ratio (OR) was 0.18 for incident dementia (p < 0.01) and 0.25 for Alzheimer's disease (p < 0.03), as compared to the 971 non-drinkers. After adjusting for age, sex, education, occupation, baseline MMSE and other possible confounders, the ORs were respectively 0.19 (p < 0.01) and 0.28 (p < 0.05). In the 922 mild drinkers (< 1 to 2 glasses per day) there was a negative association only with AD, after adjustment (OR = 0.55; p < 0.05). The inverse relationship between moderate wine drinking and incident dementia was explained neither by known predictors of dementia nor by medical, psychological or socio-familial factors. Considering also the well documented negative associations between moderate wine consumption and cardiovascular morbidity and mortality in this age group, it seems that there is no medical rationale to advise people over 65 to quit drinking wine moderately, as this habit carries no specific risk and may even be of some benefit for their health. Advising all elderly people to drink wine regularly for prevention of dementia would be however premature at this stage.

Aged↗
PubMed1997

[Epidemiologic aspects of respiratory aging: contribution of the PAQUID survey].

BACKGROUND: Respiratory ageing raises for the epidemiologists many questions still unsolved by clinical and physiological approaches: prevalence of chronic respiratory diseases, consequences on autonomy, risk factors. This paper aims to provide some responses based on a wide sample of elderly people: the PAQUID cohort. METHOD: PAQUID is a cohort of 3777 dwellers representative of the population aged 65 and over in two administrative areas of south-western France. The study is based on general variables as well as specific variables identifying dyspnea, asthma, chronic bronchitis and their risk factors. Disability was measured using specific scales. Mortality is registered during the follow-up. RESULTS: Twenty-five percent of subjects had a dyspnea for minor efforts (level 3 and over). There was a significant relationship between dyspnea and disability levels for basic and instrumental activities of daily living. Mortality rate was significantly associated to dyspnea level of the subjects at inclusion in the cohort, especially in men, even taking into account other mortality related risk factors (sex, smoking, occupation). 6.1% of the subjects reported symptoms of asthma. But only 2.5% reported symptoms in the twelve last months. The follow-up has shown new asthma cases among symptom-free subjects at the beginning of the survey. Previous occupation especially agricultural (pesticides exposition), and industrial activity, smoking and allergy may be considered as the main respiratory risk factors. CONCLUSION: These data provide more knowledge of some aspects of respiratory ageing. The results allowed to evaluate associated morbidity, to determine risk factors and to measure its impact on disability and mortality. Such information may be useful for prevention of respiratory related disability.

Age Factors↗
PubMed1996

Prevalence of self-reported asthma symptoms in a French elderly sample.

The aim of this study was to estimate the prevalence of reported asthma symptoms in French elderly people according to age, sex and principal lifetime occupation. PAQUID (Personnes Agées QUID) is a cohort of 3777 subjects, aged 65 years and over, living at home in the south-west of France. The aim of PAQUID is to study factors of cerebral and functional ageing. This cross-sectional study took place during the third year of the PAQUID follow-up, and concerned 2406 subjects (63.7% of the initial sample). Two questions were introduced into the PAQUID general questionnaire: "have you ever had asthma?' (cumulative asthma), and "did you have at least one asthma attack in the last 12 months?' (current asthma). Of 2355 subjects, 144 (6.1%) reported asthma history at some point in their life. For 58 (40.3%) subjects, it was in the previous 12 months. In men, the prevalence rate was 7.3% for cumulative asthma and 2.8% for current asthma. In women, rates were 5.2% and 2.2%, respectively. The rates were lower at advanced ages (> 85 years) for both males and females. They were particularly high in former farm workers; 13% reported cumulative asthma and 11% reported at least one asthma attack in the previous 12 months. Farmers appear to have a higher risk of both cumulative [odds ratio (OR): 2.30; 95% confidence interval (CI): 1.00-5.47] and current asthma (OR: 5.35; 95% CI: 1.33-21.50) compared to white collar workers, despite adjustments on age, sex and smoking history. The risk was also significant for manual workers, but only for cumulative asthma.

Age Factors↗
PubMed1996

Pyrimethamine for primary prophylaxis of toxoplasmic encephalitis in patients with human immunodeficiency virus infection: a double-blind, randomized trial. ANRS 005-ACTG 154 Group Members. Agence Nationale de Recherche sur le SIDA. AIDS Clinical Trial Group.

Pyrimethamine (50 mg) with folinic acid (15 mg) given three times weekly was assessed as primary prophylaxis for toxoplasmic encephalitis (TE) in 554 human immunodeficiency virus-infected patients seropositive for Toxoplasma gondii and with < 200 CD4 cells/mm3. At 1 year, the incidence of TE was similar in pyrimethamine, 12%, and placebo, 13%, groups (relative risk [RR], 0.9; 95% confidence interval [CI], 0.6-1.4), and the survival rate was also similar, 85% and 80%, respectively (RR, 0.9; 95% CI, 0.7-1.2). Rash was the only adverse event that appeared significantly more frequently in the pyrimethamine arm (7% vs. 1%). In the on-treatment analysis, the incidence of TE was lower in the pyrimethamine arm, 4%, than in the placebo arm, 12% (P < .006). Thus, pyrimethamine cannot be recommended as a first-line regimen for primary prophylaxis of TE if the patient can take cotrimoxazole. However, it should be considered for patients who are intolerant to cotrimoxazole, especially in high-risk patients with < 100 CD4 cells/mm3.

AIDS-Related Opportunistic Infections↗
PubMed1996

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.

AIDS-Related Opportunistic Infections↗