RESUMO
OBJECTIVE: We aimed to retrieve the vital status of patients lost to follow-up (LFU), with no further visits for at least 12 months, for the 34,835 patients in the Agence Nationale de Recherche sur le SIDA CO4 French Hospital Database on HIV (ANRS CO4 FHDH) seen in 1999 and to examine how loss to follow-up might influence estimates of survival and the impact of delayed access to care (DAC) on survival. METHODS: The status of LFU patients was established by using the mid-2006 update of the FHDH in which their status 12 months after loss to follow-up was added when available and by matching with the Mortalité 2000-Epidemiological Centre for Medical Causes of Death (CépiDc) database, which included HIV-infected patients dying in 2000. We compared Kaplan-Meier and hazard ratio (HR) estimates before and after correction for the status of LFU patients. RESULTS: In the mid-2006 updated FHDH, of the patients seen in 1999, 7.5% were LFU: of these, 2.1% later returned for follow-up, with a median time without follow-up in an FHDH centre of 3.5 years, and 5.4% had no further FHDH visits whatsoever, of whom 29.8% died according to Mortalité 2000-CépiDc. After correction, the estimated 1-year survival rates following enrolment in 1999 differed between the original and updated analyses (97.1 vs. 95.9%, respectively; P=0.017); the estimates of mortality HRs associated with DAC did not differ during the first 6 months, but did differ for the 6-18-month period. CONCLUSIONS: Among LFU patients, 28.1% returned to follow-up after several years and at least 21.4% died, which led to a slight overestimation of both survival and the impact of DAC on survival.
Assuntos
Bases de Dados Factuais/estatística & dados numéricos , Atestado de Óbito , Infecções por HIV/mortalidade , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Adulto , África Subsaariana/etnologia , Viés , Causas de Morte , Estudos de Coortes , Feminino , França/epidemiologia , Guiana Francesa/epidemiologia , Infecções por HIV/etnologia , Hospitais/estatística & dados numéricos , Humanos , Estimativa de Kaplan-Meier , Masculino , Gravidez , Complicações Infecciosas na Gravidez/mortalidade , Modelos de Riscos Proporcionais , Índias Ocidentais/epidemiologiaRESUMO
This study was designed to estimate the prevalence of hypertension in Guadeloupe, the French West Indies, and to evaluate the risk factors associated with hypertension in the largest ethnic group, that of African origin. Households were randomly selected using a two-stage systematic sample of districts and then of houses; all adults aged 18 years in the household were included. In total, 1043 men and women were studied. Blood pressure, plasma glucose concentrations and gamma-glutamyl transferase activity were measured, hypertensive treatment and lifestyle factors recorded. The prevalence of hypertension, age-standardized to the Guadeloupe population was 21% and 26% in men and women of African origin, 28% and 22% in those of Indian-origin and 18% and 16% for other origins. The vast majority of subjects were unaware of their hypertension (90% of men, 74% of women). After adjustment for age, factors associated with high blood pressure in the 826 adults of African origin were: obesity, hyperglycemia, low educational level and family history of hypertension and of stroke. Additional factors in women were alcohol consumption, gamma-glutamyl transferase activity, physical inactivity, occupational category and a retired status, even after adjustment for age. Measures must be taken to diagnose hypertension early, particularly in individuals of African and Indian origin. An effective education program is needed, with an emphasis on life-style factors associated with obesity: diet and physical activity.
Assuntos
População Negra , Negro ou Afro-Americano , Hipertensão/etnologia , Hipertensão/genética , Adolescente , Adulto , África/etnologia , Feminino , Guadalupe/epidemiologia , Humanos , Hipertensão/prevenção & controle , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Vigilância da População , Prevalência , Fatores de Risco , Estudos de AmostragemRESUMO
BACKGROUND: Screening for human T-lymphotropic virus type I (HTLV-I) infection became systematic in 1989 in the French West Indies for blood from all donors and in France for blood from natives of endemic areas; in 1990, it was extended to blood from donors with at-risk sex partners and in July 1991 to blood from all donors. STUDY DESIGN AND METHODS: The epidemiologic characteristics of individuals found through the screening of donated blood to be HTLV-I infected were compared for an endemic region (Guadeloupe, French West Indies) and a nonendemic region (Paris area) over a 3-year period (1989 through 1991). RESULTS: In Guadeloupe, 131 HTLV-I-infected individuals were detected in the screening of 28,801 units; in the Paris area, 38 HTLV-I-infected donors were detected in the screening of 109,824 units. All Guadeloupean HTLV-I-infected donors were natives of endemic areas. Among the 38 Parisian HTLV-I-infected donors, 21 were natives of endemic areas, 10 were natives of endemic areas and had received transfusions, 2 were whites who had received transfusions, and 5 were whites who had had heterosexual contact with natives of endemic areas. The percentage of HTLV-I-infected individuals whose blood would have been excluded because of positivity for one or more markers for other viruses did not significantly change over the study period and did not significantly differ between regions (41%). Among the eight Parisian HTLV-I-infected blood donors detected after July 1991, six would not have been detected without the biologic screening. CONCLUSION: The generalization of biologic screening of HTLV-I-infected donated blood in France was useful for the prevention of HTLV-I and HTLV type II infections through transfusion.
Assuntos
Doadores de Sangue , Infecções por HTLV-I/epidemiologia , Adulto , Feminino , França , Anticorpos Anti-HTLV-I/sangue , Infecções por HTLV-I/diagnóstico , Anticorpos Anti-HTLV-II/sangue , Humanos , Masculino , Fatores de Risco , Parceiros Sexuais , Índias OcidentaisRESUMO
2'3'-Dideoxyinosine (didanosine) is a nucleoside analog active in vitro against human immunodeficiency virus. Few data are available regarding its use for the treatment of children. In a single-center, randomized, open-label trial, we compared two dosages of didanosine (120 vs 270 mg/m2 per day) for at least 6 months in 34 children infected with human immunodeficiency virus who had become resistant to or were intolerant of zidovudine. Serum levels of didanosine 1 hour after administration were significantly different in the two groups and remained stable with time. There was a significant reduction in human immunodeficiency virus-p24 antigenemia and quantitative cellular viremia with time but no difference between the two groups. The intensity of the biologic response, however, was significantly higher in the patients who had more than 50 CD4+ cells 10(6)/L at inclusion. No pancreatic or neurologic toxic effects were observed. In five children, liver function abnormalities developed that are unusual in this setting, and the death of one child from unexplained hepatocellular failure suggests that didanosine may be hepatotoxic. Three of these five children had preexisting liver disease. Although no definite conclusion can be made as to the optimal dose, there were no major differences between the two administration schedules in terms of biologic effects and tolerability.
Assuntos
Didanosina/administração & dosagem , Infecções por HIV/tratamento farmacológico , Adolescente , Criança , Pré-Escolar , Feminino , HIV/isolamento & purificação , Proteína do Núcleo p24 do HIV/análise , Infecções por HIV/microbiologia , Humanos , Lactente , Masculino , ViremiaRESUMO
A study was conducted between January 1984 and March 1985 to determine the prevalence of diabetes in the adult population of Guadeloupe (18 years of age and over). A two-step sampling frame, using a sampling fraction of 0.46%, where the primary units were composed of districts and where sub-units were households, was used. The household refusal rate was 22%. Subjects were classified as 'diabetic' when they were either already known or when their fasting plasma glucose was above 8.0 mmol/l. The total age and sex standardized prevalence of diabetes among the adult population of Guadeloupe can be estimated at 6.6%. The high prevalence rate appears to be related to obesity (strongly in women), a genetic susceptibility (22.5% of age standardized prevalence among subjects of Asian Indian origin for both sexes), and, possibly, in men of African origin only, to a maternal history of diabetes.