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Bruland D, Vetter N, Latteck ÄD. Health Literacy in people with intellectual disabilities – is there a need for an adapted concept? Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Health literacy (HL) is a crucial factor in terms of health and health-related outcomes. HL refers to personal and social resources as well as the abilities to access, understand, appraise and apply health information to make self-determined health decisions. Due to reduced resources including cognitive abilities it is assumed that HL in people with intellectual disabilities (PWID) is low. Up to 3% of the general population have an ID (IQ < 70).
Methods
Current state of the art is presented via a mixed-method literature review published in 2019. Against that, results from 5 target group orientated groups are presented (n = 50).
Results
Literature Review (12 studies incl.): HL does not go beyond a purely functional understanding. Studies assume that the HL level of PWID is very low, but fail to mention a reference source. Overall, studies are mainly from the health professionals' perspective and exceptions directly questioned or focused people with ID. People with ID still seems to be a 'hidden' population in HL research. Group discussions: An introducing quiz about health-related topics turns into a discussion within the group of PWID. Topics were physical activity, nutrition and health advices from health professionals like GPs. Instructions of physicians were discussed; a critical view of health advices were taken. Bassed on experiences own health decisions are described. Trained caregivers like nurses are stated as an own professional HL resource. Communicative and critical HL have been demonstrated.
Conclusions
There is only little knowledge about HL in PWID. Promoting HL could be highly beneficial for managing health information with a positive impact on PWID themselves (empowerment), their (family) caregivers, and the health care system (reducing health costs). A debate to conceptualize HL for PWID is mandatory. This must be based on valid data, consider the perspectives of PWID and have to respect the resources of PWID. Future directives will be discussed.
Key messages
People with ID communicative and critical health literacy is is available but not yet explored how it can be increased. A target-adapted health literacy of people with intellectual disabilities is beneficial, it it takes the perspectives of this target group into account.
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Affiliation(s)
- D Bruland
- Bielefeld University of Applied Sciences, Bielefeld, Germany
| | - N Vetter
- Bielefeld University of Applied Sciences, Bielefeld, Germany
| | - ÄD Latteck
- Bielefeld University of Applied Sciences, Bielefeld, Germany
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Yu T, Jia T, Zhu L, Desrivières S, Macare C, Bi Y, Bokde ALW, Quinlan EB, Heinz A, Ittermann B, Liu C, Ji L, Banaschewski T, Ren D, Du L, Hou B, Flor H, Frouin V, Garavan H, Gowland P, Martinot JL, Paillère Martinot ML, Nees F, Orfanos DP, Luo Q, Chu C, Paus T, Poustka L, Hohmann S, Millenet S, Smolka MN, Vetter NC, Mennigen E, Lei C, Walter H, Fröhner JH, Whelan R, He G, He L, Schumann G, Robert G, Artiges E, Schneider S, Bach C, Paus T, Barbot A, Barker G, Bokde A, Vetter N, Büchel C, Cattrell A, Constant P, Gowland P, Crombag H, Czech K, Dalley J, Decideur B, Spranger T, Ripley T, Heym N, Flor H, Sommer W, Fuchs B, Gallinat J, Garavan H, Spanagel R, Kaviani M, Heinrichs B, Heinz A, Subramaniam N, Jia T, Ihlenfeld A, Delosis JI, Ittermann B, Conrod P, Banaschewski T, Jones J, Klaassen A, Lalanne C, Lanzerath D, Lawrence C, Lemaitre H, Desrivieres S, Mallik C, Mann K, Mar A, Martinez-Medina L, Martinot JL, Mennigen E, de Carvahlo FM, Schwartz Y, Bruehl R, Müller K, Nees F, Nymberg C, Lathrop M, Robbins T, Pausova Z, Pentilla J, Biondo F, Poline JB, Hohmann S, Poustka L, Millenet S, Smolka M, Fröhner J, Struve M, Williams S, Hübner T, Bromberg U, Aydin S, Rogers J, Romanowski A, Schmäl C, Schmidt D, Ripke S, Arroyo M, Schubert F, Pena-Oliver Y, Fauth-Bühler M, Mignon X, Whelan R, Speiser C, Fadai T, Stephens D, Ströhle A, Paillere ML, Strache N, Theobald D, Jurk S, Vulser H, Miranda R, Yacubilin J, Frouin V, Genauck A, Parchetka C, Gemmeke I, Kruschwitz J, WeiB K, Walter H, Feng J, Papadopoulos D, Filippi I, Ing A, Ruggeri B, Xu B, Macare C, Chu C, Hanratty E, Quinlan EB, Robert G, Schumann G, Yu T, Ziesch V, Stedman A. Cannabis-Associated Psychotic-like Experiences Are Mediated by Developmental Changes in the Parahippocampal Gyrus. J Am Acad Child Adolesc Psychiatry 2020; 59:642-649. [PMID: 31326579 DOI: 10.1016/j.jaac.2019.05.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 05/15/2019] [Accepted: 07/15/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Cannabis consumption during adolescence has been reported as a risk factor for psychotic-like experiences (PLEs) and schizophrenia. However, brain developmental processes associated with cannabis-related PLEs are still poorly described. METHOD A total of 706 adolescents from the general population who were recruited by the IMAGEN consortium had structural magnetic resonance imaging scans at both 14 and 19 years of age. We used deformation-based morphometry to map voxelwise brain changes between the two time points, using the pairwise algorithm in SPM12b. We used an a priori region-of-interest approach focusing on the hippocampus/parahippocampus to perform voxelwise linear regressions. Lifetime cannabis consumption was assessed using the European School Survey Project on Alcohol and other Drugs (ESPAD), and PLEs were assessed with the Comprehensive Assessment Psychotic-like experiences (CAPE) tool. We first tested whether hippocampus/parahippocampus development was associated with PLEs. Then we formulated and tested an a priori simple mediation model in which uncus development mediates the association between lifetime cannabis consumption and PLEs. RESULTS We found that PLEs were associated with reduced expansion within a specific region of the right hippocampus/parahippocampus formation, the uncus (p = .002 at the cluster level, p = .018 at the peak level). The partial simple mediation model revealed a significant total effect from lifetime cannabis consumption to PLEs (b = 0.069, 95% CI = 0.04-0.1, p =2 × 10-16), as well as a small yet significant, indirect effect of right uncus development (0.004; 95% CI = 0.0004-0.01, p = .026). CONCLUSION We show here that the uncus development is involved in the cerebral basis of PLEs in a population-based sample of healthy adolescents.
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Affiliation(s)
- Tao Yu
- Bio-X Institutes, Shanghai Jiao Tong University, Shanghai, China; Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Shanghai Center for Women and Children's Health, China; Jining Medical University, Shandong, China
| | - Tianye Jia
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Institute of Science and Technology for Brain-Inspired Intelligence, MoE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Liping Zhu
- Shanghai Center for Women and Children's Health, China
| | - Sylvane Desrivières
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Christine Macare
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Yan Bi
- Bio-X Institutes, Shanghai Jiao Tong University, Shanghai, China
| | - Arun L W Bokde
- Discipline of Psychiatry, School of Medicine and Trinity College Institute of Neuroscience, Trinity College Dublin, College Green, Dublin, Ireland
| | - Erin Burke Quinlan
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Andreas Heinz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Charité Mitte, Berlin, Germany
| | - Bernd Ittermann
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Berlin, Germany
| | | | - Lei Ji
- Bio-X Institutes, Shanghai Jiao Tong University, Shanghai, China
| | - Tobias Banaschewski
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Decheng Ren
- Bio-X Institutes, Shanghai Jiao Tong University, Shanghai, China
| | - Li Du
- Shanghai Center for Women and Children's Health, China
| | - Binyin Hou
- Bio-X Institutes, Shanghai Jiao Tong University, Shanghai, China
| | - Herta Flor
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; School of Social Sciences, University of Mannheim, Germany
| | - Vincent Frouin
- NeuroSpin, Commissariat à l'Energie Atomique, CEA, Université Paris-Saclay, Gif-sur-Yvette, France
| | | | - Penny Gowland
- Sir Peter Mansfield Imaging Centre School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, UK
| | - Jean-Luc Martinot
- Institut National de la Santé et de la Recherche Médicale (INSERM), University Paris Sud, Orsay, France
| | | | - Frauke Nees
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Qiang Luo
- Institute of Science and Technology for Brain-Inspired Intelligence, MoE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Congying Chu
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Tomas Paus
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital and the University of Toronto, Ontario, Canada
| | - Luise Poustka
- University Medical Centre Göttingen, Göttingen, Germany
| | - Sarah Hohmann
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sabina Millenet
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | | | | | - Cai Lei
- Bio-X Institutes, Shanghai Jiao Tong University, Shanghai, China
| | - Henrik Walter
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Charité Mitte, Berlin, Germany
| | | | - Robert Whelan
- School of Psychology and Global Brain Health Institute, Trinity College Dublin, Ireland
| | - Guang He
- Bio-X Institutes, Shanghai Jiao Tong University, Shanghai, China
| | - Lin He
- Bio-X Institutes, Shanghai Jiao Tong University, Shanghai, China; Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Shanghai Center for Women and Children's Health, China; Baoan Maternal and Child Health Hospital, Jinan University, Shenzhen, China. IMAGEN consortium authors, affiliations, and acknowledgement are listed in the supplementary materials
| | - Gunter Schumann
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Gabriel Robert
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Behavior and Basal Ganglia Unit, Medical University of Rennes, France.
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Bartholdy S, O'Daly OG, Campbell IC, Banaschewski T, Barker G, Bokde ALW, Bromberg U, Büchel C, Quinlan EB, Desrivières S, Flor H, Frouin V, Garavan H, Gowland P, Heinz A, Ittermann B, Martinot JL, Paillère Martinot ML, Nees F, Orfanos DP, Poustka L, Hohmann S, Fröhner JH, Smolka MN, Walter H, Whelan R, Schumann G, Schmidt U, Artiges E, Schneider S, Bach C, Paus T, Barbot A, Gareth Barker, Bokde A, Vetter N, Büchel C, Cattrell A, Constant P, Gowland P, Crombag H, Czech K, Dalley J, Decideur B, Spranger T, Ripley T, Heym N, Flor H, Sommer W, Fuchs B, Gallinat J, Spanagel R, Kaviani M, Heinrichs B, Andreas Heinz, Subramaniam N, Jia T, Ihlenfeld A, Ireland J, Ittermann B, Conrod P, Banaschewski T, Jones J, Klaassen A, Lalanne C, Lanzerath D, Lawrence C, Lemaitre H, Desrivieres S, Mallik C, Karl Mann, Mar A, Martinez-Medina L, Jean-Luc Martinot, Mennigen E, Mesquita de Carvahlo F, Schwartz Y, Bruehl R, Müller K, Nees F, Nymberg C, Lathrop M, Trevor Robbins, Pausova Z, Jani Pentilla, Biondo F, Jean-Baptiste Poline, Hohmann S, Poustka L, Millenet S, Michael Smolka, Fröhner J, Struve M, Steve Williams, Hübner T, Bromberg U, Aydin S, Rogers J, Romanowski A, Schmäl C, Schmidt D, Ripke S, Arroyo M, Schubert F, Pena-Oliver Y, Fauth-Bühler M, Mignon X, Whelan R, Speiser C, Fadai T, Dai Stephens, Ströhle A, Paillere ML, Strache N, Theobald D, Jurk S, Vulser H, Miranda R, Yacubian J, Frouin V, Genauck A, Parchetka C, Gemmeke I, Kruschwitz J, Weiß K, Walter H, Feng J, Papadopoulos D, Filippi I, Ing A, Ruggeri B, Xu B, Macare C, Chu C, Hanratty E, Burke Quinlan E, Robert G, Schumann G, Yu T, Ziesch V, Stedman A. Neural Correlates of Failed Inhibitory Control as an Early Marker of Disordered Eating in Adolescents. Biol Psychiatry 2019; 85:956-965. [PMID: 31122340 DOI: 10.1016/j.biopsych.2019.01.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 01/23/2019] [Accepted: 01/24/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Binge eating and other forms of disordered eating behavior (DEB) are associated with failed inhibitory control. This study investigated the neural correlates of failed inhibitory control as a potential biomarker for DEB. METHODS The study used prospective longitudinal data from the European IMAGEN study adolescent cohort. Participants completed baseline assessments (questionnaires and a brain scan [functional magnetic resonance imaging]) at 14 years of age and a follow-up assessment (questionnaires) at 16 years of age. Self-reported binge eating and/or purging were used to indicate presence of DEB. Neural correlates of failed inhibition were assessed using the stop signal task. Participants were categorized as healthy control subjects (reported no DEB at both time points), maintainers (reported DEB at both time points), recoverers (reported DEB at baseline only), and developers (reported DEB at follow-up only). Forty-three individuals per group with complete scanning data were matched on gender, age, puberty, and intelligence (N = 172). RESULTS At baseline, despite similar task performance, incorrectly responding to stop signals (failed inhibitory control) was associated with greater recruitment of the medial prefrontal cortex and anterior cingulate cortex in the developers compared with healthy control subjects and recoverers. CONCLUSIONS Greater recruitment of the medial prefrontal and anterior cingulate regions during failed inhibition accords with abnormal evaluation of errors contributing to DEB development. As this precedes symptom onset and is evident despite normal task performance, neural responses during failed inhibition may be a useful biomarker of vulnerability for DEB. This study highlights the potential value of prospective neuroimaging studies for identifying markers of illness before the emergence of behavior changes.
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Affiliation(s)
- Savani Bartholdy
- Section of Eating Disorders, Department of Psychological Medicine, London, United Kingdom.
| | - Owen G O'Daly
- Centre for Neuroimaging Sciences, London, United Kingdom
| | - Iain C Campbell
- Section of Eating Disorders, Department of Psychological Medicine, London, United Kingdom
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Gareth Barker
- Centre for Neuroimaging Sciences, London, United Kingdom
| | - Arun L W Bokde
- Discipline of Psychiatry, School of Medicine and Trinity College Institute of Neuroscience, Dublin, Ireland
| | - Uli Bromberg
- University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Erin Burke Quinlan
- Medical Research Council Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Sylvane Desrivières
- Medical Research Council Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Herta Flor
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Vincent Frouin
- Neurospin, Commissariat à l'énergie atomique et aux énergies alternatives, Université Paris-Saclay, Gif-sur-Yvette, Paris, France
| | - Hugh Garavan
- Departments of Psychiatry and Psychology, University of Vermont, Burlington, Vermont
| | - Penny Gowland
- Sir Peter Mansfield Imaging Centre School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Ittermann
- Physikalisch-Technische Bundesanstalt, Braunschweig, Germany
| | - Jean-Luc Martinot
- Institut National de la Santé et de la Recherche Médicale, INSERM Unit 1000 "Neuroimaging & Psychiatry," University Paris Sud - Paris Saclay, University Paris Descartes, Paris, France
| | - Marie-Laure Paillère Martinot
- Institut National de la Santé et de la Recherche Médicale, INSERM Unit 1000 "Neuroimaging & Psychiatry," University Paris Sud - Paris Saclay, University Paris Descartes, Paris, France; Department of Adolescent Psychopathology and Medicine, Maison de Solenn, Cochin Hospital, Public Assistance Hospitals of Paris, Paris, France
| | - Frauke Nees
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Dimitri Papadopoulos Orfanos
- Neurospin, Commissariat à l'énergie atomique et aux énergies alternatives, Université Paris-Saclay, Gif-sur-Yvette, Paris, France
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Göttingen, Göttingen, Germany; Clinic for Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Sarah Hohmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Juliane H Fröhner
- Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - Michael N Smolka
- Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Whelan
- School of Psychology and Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Gunter Schumann
- Medical Research Council Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, London, United Kingdom; South London & Maudsley National Health Service Foundation Trust, London, United Kingdom
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Drees A, Vetter N, Rolf A, Seidl N, Latteck ÄD. Betreute Urlaube als Entlastungsangebot für pflegende Frauen und Männer – Erwartungen, Bedarfe und Einstellungen. Psychother Psychosom Med Psychol 2018. [DOI: 10.1055/s-0038-1667997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- A Drees
- Fachhochschule Bielefeld, Bielefeld, Deutschland
| | - N Vetter
- Institut für Bildungs- und Versorgungsforschung Im Gesundheitswesen (InBVG), Bielefeld, Deutschland
| | - A Rolf
- Institut für Bildungs- und Versorgungsforschung Im Gesundheitswesen (InBVG), Bielefeld, Deutschland
| | - N Seidl
- Institut für Bildungs- und Versorgungsforschung Im Gesundheitswesen (InBVG), Bielefeld, Deutschland
| | - ÄD Latteck
- Institut für Bildungs- und Versorgungsforschung Im Gesundheitswesen (InBVG), Bielefeld, Deutschland
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Ewald A, Becker S, Heinrich A, Banaschewski T, Poustka L, Bokde A, Büchel C, Bromberg U, Cattrell A, Conrod P, Desrivières S, Frouin V, Papadopoulos-Orfanos D, Gallinat J, Garavan H, Heinz A, Walter H, Ittermann B, Gowland P, Paus T, Martinot JL, Paillère Martinot ML, Smolka MN, Vetter N, Whelan R, Schumann G, Flor H, Nees F. The role of the cannabinoid receptor in adolescents' processing of facial expressions. Eur J Neurosci 2015; 43:98-105. [PMID: 26527537 DOI: 10.1111/ejn.13118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 10/26/2015] [Accepted: 10/27/2015] [Indexed: 01/22/2023]
Abstract
The processing of emotional faces is an important prerequisite for adequate social interactions in daily life, and might thus specifically be altered in adolescence, a period marked by significant changes in social emotional processing. Previous research has shown that the cannabinoid receptor CB1R is associated with longer gaze duration and increased brain responses in the striatum to happy faces in adults, yet, for adolescents, it is not clear whether an association between CBR1 and face processing exists. In the present study we investigated genetic effects of the two CB1R polymorphisms, rs1049353 and rs806377, on the processing of emotional faces in healthy adolescents. They participated in functional magnetic resonance imaging during a Faces Task, watching blocks of video clips with angry and neutral facial expressions, and completed a Morphed Faces Task in the laboratory where they looked at different facial expressions that switched from anger to fear or sadness or from happiness to fear or sadness, and labelled them according to these four emotional expressions. A-allele versus GG-carriers in rs1049353 displayed earlier recognition of facial expressions changing from anger to sadness or fear, but not for expressions changing from happiness to sadness or fear, and higher brain responses to angry, but not neutral, faces in the amygdala and insula. For rs806377 no significant effects emerged. This suggests that rs1049353 is involved in the processing of negative facial expressions with relation to anger in adolescence. These findings add to our understanding of social emotion-related mechanisms in this life period.
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Affiliation(s)
- Anais Ewald
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
| | - Susanne Becker
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
| | - Angela Heinrich
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Child and Adolescent Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Arun Bokde
- Discipline of Psychiatry, School of Medicine and Trinity College Institute of Neurosciences, Trinity College Dublin, Dublin 2, Ireland
| | | | - Uli Bromberg
- University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Cattrell
- Institute of Psychiatry, King's College London, London, UK.,Medical Research Council - Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Kings College London, London, UK
| | - Patricia Conrod
- Institute of Psychiatry, King's College London, London, UK.,Department of Psychiatry, Universite de Montreal, CHU Ste Justine Hospital, Montreal, QC, Canada
| | - Sylvane Desrivières
- Institute of Psychiatry, King's College London, London, UK.,Medical Research Council - Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Kings College London, London, UK
| | - Vincent Frouin
- Neurospin, Commissariat à l'Energie Atomique, CEA-Saclay Center, Paris, France
| | | | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hugh Garavan
- Departments of Psychiatry and Psychology, University of Vermont, Burlington, VT, USA
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Penny Gowland
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Tomáš Paus
- School of Psychology, University of Nottingham, Nottingham, UK.,Baycrest and Departments of Psychology and Psychiatry, Rotman Research Institute, University of Toronto, Toronto, ON, Canada
| | - Jean-Luc Martinot
- INSERM, UMR 1000, Research Unit Imaging and Psychiatry, CEA, DSV, I2BM-Service Hospitalier Frédéric Joliot, Orsay, France.,University Paris-Sud 11, Orsay, France.,University Paris Descartes, Sorbonne Paris Cité, Paris, France.,Psychiatry Department 91G16, Orsay Hospital, Orsay, France
| | - Marie-Laure Paillère Martinot
- INSERM, UMR 1000, Research Unit Imaging and Psychiatry, CEA, DSV, I2BM-Service Hospitalier Frédéric Joliot, Orsay, France.,University Paris-Sud 11, Orsay, France.,University Paris Descartes, Sorbonne Paris Cité, Paris, France.,AP-HP, Department of Adolescent Psychopathology and Medicine, Maison de Solenn, Cochin Hospital, Paris, France
| | - Michael N Smolka
- Department of Psychiatry and Psychotherapy, Faculty of Medicine Carl Gustav Carus, Section of Systems Neuroscience, Technische Universität Dresden, Dresden, Germany
| | - Nora Vetter
- Department of Psychiatry and Psychotherapy, Faculty of Medicine Carl Gustav Carus, Section of Systems Neuroscience, Technische Universität Dresden, Dresden, Germany
| | - Rob Whelan
- Discipline of Psychiatry, School of Medicine and Trinity College Institute of Neurosciences, Trinity College Dublin, Dublin 2, Ireland
| | - Gunter Schumann
- Institute of Psychiatry, King's College London, London, UK.,Medical Research Council - Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Kings College London, London, UK
| | - Herta Flor
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
| | - Frauke Nees
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
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6
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Arnoux E, Eraud C, Navarro N, Tougard C, Thomas A, Cavallo F, Vetter N, Faivre B, Garnier S. Morphology and genetics reveal an intriguing pattern of differentiation at a very small geographic scale in a bird species, the forest thrush Turdus lherminieri. Heredity (Edinb) 2014; 113:514-25. [PMID: 24984605 DOI: 10.1038/hdy.2014.56] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 04/11/2014] [Accepted: 05/06/2014] [Indexed: 11/09/2022] Open
Abstract
Mobile organisms are expected to show population differentiation only over fairly large geographical distances. However, there is growing evidence of discrepancy between dispersal potential and realized gene flow. Here we report an intriguing pattern of differentiation at a very small spatial scale in the forest thrush (Turdus lherminieri), a bird species endemic to the Lesser Antilles. Analysis of 331 individuals from 17 sampling sites distributed over three islands revealed a clear morphological and genetic differentiation between these islands isolated by 40-50 km. More surprisingly, we found that the phenotypic divergence between the two geographic zones of the island of Guadeloupe was associated with a very strong genetic differentiation (Fst from 0.073-0.153), making this pattern a remarkable case in birds given the very small spatial scale considered. Molecular data (mitochondrial control region sequences and microsatellite genotypes) suggest that this strong differentiation could have occurred in situ, although alternative hypotheses cannot be fully discarded. This study suggests that the ongoing habitat fragmentation, especially in tropical forests, may have a deeper impact than previously thought on avian populations.
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Affiliation(s)
- E Arnoux
- Biogéosciences, UMR CNRS 6282, Equipe BIOME, Université de Bourgogne, Dijon, France
| | - C Eraud
- Office National de la Chasse et de la Faune Sauvage, CNERA Avifaune Migratrice, Station Biologique de Chizé, Carrefour de la Canauderie, Villiers en Bois, France
| | - N Navarro
- 1] Biogéosciences, UMR CNRS 6282, Equipe BIOME, Université de Bourgogne, Dijon, France [2] Laboratoire EPHE PALEVO-Ecole Pratique des Hautes Etudes, Dijon, France
| | - C Tougard
- Institut des Sciences de l'Evolution de Montpellier, IMR CNRS 5554 and UMR IRD 226, Université de Montpellier II, Place Eugène Bataillon, CC065, Montpellier, France
| | - A Thomas
- Office National de la Chasse et de la Faune Sauvage, CNERA Avifaune Migratrice, Station Biologique de Chizé, Carrefour de la Canauderie, Villiers en Bois, France
| | - F Cavallo
- 1] Biogéosciences, UMR CNRS 6282, Equipe BIOME, Université de Bourgogne, Dijon, France [2] Office National de la Chasse et de la Faune Sauvage, CNERA Avifaune Migratrice, Station Biologique de Chizé, Carrefour de la Canauderie, Villiers en Bois, France
| | - N Vetter
- Biogéosciences, UMR CNRS 6282, Equipe BIOME, Université de Bourgogne, Dijon, France
| | - B Faivre
- Biogéosciences, UMR CNRS 6282, Equipe BIOME, Université de Bourgogne, Dijon, France
| | - S Garnier
- Biogéosciences, UMR CNRS 6282, Equipe BIOME, Université de Bourgogne, Dijon, France
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7
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Wiedermann U, Kletecka-Pulker M, Rommel A, Kollaritsch H, Cichoń P, Vetter N, Kautzky-Willer A, Novak-Zezula S, Trummer U, Binder-Fritz C, Akkaya-Kalayci T, Hanschitz AJ, Dachs P, Zehetgruber M, Habersack H, Allesch J, Leitner K, Parrag S. Migration – epidemiologische, soziokulturelle und medizinische Aspekte. Wien Klin Wochenschr 2014. [DOI: 10.1007/s00508-013-0462-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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8
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Geretti AM, Conibear T, Hill A, Johnson JA, Tambuyzer L, Thys K, Vingerhoets J, Van Delft Y, Rieger A, Vetter N, Greil R, Pedersen C, Storgaard M, Morlat P, Katlama C, Durant J, Cotte L, Duvivier C, Rey D, Esser S, Stellbrink C, Schmidt W, Stoll M, Stephan C, Fatkenheuer G, Stoehr A, Rockstroh J, Banhegyi D, Itzchak L, Shahar E, Maayan S, Turner D, Lazzarin A, Antinori A, Carosi G, Minoli L, di Perri G, Filice G, Andreoni M, Duiculescu D, Rugina S, Erscoiu S, Streinu A, Pronin A, Pokrovsky V, Gruzdev B, Yakovlev A, Voronin E, Clotet B, Gatell J, Arribas J, Podzamczer D, Domingo P, Alvarez CM, Quero JH, Furrer H, Feher J, Johnson M, Fox J, Nelson M, Fisher M, Orkin C. Sensitive testing of plasma HIV-1 RNA and Sanger sequencing of cellular HIV-1 DNA for the detection of drug resistance prior to starting first-line antiretroviral therapy with etravirine or efavirenz. J Antimicrob Chemother 2013; 69:1090-7. [DOI: 10.1093/jac/dkt474] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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9
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Mahy CEV, Vetter N, Kühn-Popp N, Löcher C, Krautschuk S, Kliegel M. The influence of inhibitory processes on affective theory of mind in young and old adults. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2013; 21:129-45. [PMID: 23597271 DOI: 10.1080/13825585.2013.789096] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The primary aim of this study was to examine the impact of an inhibition manipulation on the effect of age on theory of mind (ToM) in an ecologically valid, affective ToM task. Participants were 30 young and 30 old adults. The Cambridge Mindreading Face-Voice Battery was used to measure ToM; in addition, measures of fluid and crystallized intelligence were taken. Participants were subjected to three levels of inhibitory demand during ToM reasoning: emotional inhibition, non-emotional inhibition, and no inhibition. Old adults performed worse than young adults. The emotional and non-emotional inhibition conditions resulted in worse ToM performance compared to the no inhibition condition. There were no differences in the impact of the inhibition conditions on old and young adults. Regression analyses suggested that old adults' crystallized intelligence was a significant predictor of ToM performance, whereas it did not predict young adults' ToM performance. Results are discussed in terms of verbal ability as a possible compensatory mechanism in coping with verbal inhibitory load in ToM reasoning.
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Affiliation(s)
- Caitlin E V Mahy
- a Department of Psychology , University of Geneva , Geneva , Switzerland
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10
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Fatkenheuer G, Duvivier C, Rieger A, Durant J, Rey D, Schmidt W, Hill A, van Delft Y, Marks S, Rieger A, Vetter N, Greil R, Pedersen C, Storgaard M, Morlat P, Katlama C, Durant J, Cotte L, Duvvier C, Rey D, Esser S, Stellbrink C, Schmidt W, Stoll M, Stephan C, Fatkenheuer G, Stoehr A, Rockstroh J, Banhegyi D, Itzchak L, Shahar E, Maayan S, Turner D, Lazzarin A, Antinori A, Carosi G, Minoli L, di Perri G, Filice G, Andreoni M, Duiculescu D, Rugina S, Erscoiu S, Streinu A, Pronin A, Pokrovsky V, Gruzdev B, Yakovlev A, Voronin E, Clotet B, Gatell J, Arribas J, Podzamczer D, Domingo P, Miralles Alvarez C, Hernandez Quero J, Furrer H, Feher J, Johnson M, Fox J, Nelson M, Fisher M, Orkin C. Lipid profiles for etravirine versus efavirenz in treatment-naive patients in the randomized, double-blind SENSE trial. J Antimicrob Chemother 2011; 67:685-90. [DOI: 10.1093/jac/dkr533] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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11
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Fusco FM, Puro V, Baka A, Bannister B, Brodt HR, Brouqui P, Follin P, Gjorup IE, Gottschalk R, Hemmer R, Hoepelman IM, Jarhall B, Kutsar K, Lanini S, Lyytikainen O, Maltezou HC, Mansinho K, Marti MC, Ott K, Peleman R, Perronne C, Sheehan G, Siikamakii H, Skinhoj P, Trilla A, Vetter N, Ippolito G. Isolation rooms for highly infectious diseases: an inventory of capabilities in European countries. J Hosp Infect 2009; 73:15-23. [PMID: 19647337 PMCID: PMC7114849 DOI: 10.1016/j.jhin.2009.06.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Accepted: 06/10/2009] [Indexed: 01/23/2023]
Abstract
Isolation of patients with highly infectious diseases (HIDs) in hospital rooms with adequate technical facilities is essential to reduce the risk of spreading disease. The European Network for Infectious Diseases (EUNID), a project co-funded by European Commission and involving 16 European Union member states, performed an inventory of high level isolation rooms (HIRs, hospital rooms with negative pressure and anteroom). In participating countries, HIRs are available in at least 211 hospitals, with at least 1789 hospital beds. The adequacy of this number is not known and will depend on prevailing circumstances. Sporadic HID cases can be managed in the available HIRs. HIRs could also have a role in the initial phases of an influenza pandemic. However, large outbreaks due to natural or to bioterrorist events will need management strategies involving healthcare facilities other than HIRs.
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Affiliation(s)
- F M Fusco
- National Institution for Infectious Diseases 'Lazzaro Spallanzani', Rome, Italy.
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12
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Mocroft A, Kirk O, Aldins P, Chies A, Blaxhult A, Chentsova N, Vetter N, Dabis F, Gatell J, Lundgren JD. Loss to follow-up in an international, multicentre observational study. HIV Med 2008; 9:261-9. [DOI: 10.1111/j.1468-1293.2008.00557.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Greil R, Pfeifer W, Vetter N, Eckmayr J, Burghuber O, Hilbe W, Schmid T, Gastl G, Mohn-Stauder A. Multicenter phase II study evaluating docetaxel (D) and cisplatin (C) as an induction regimen prior to surgery or radiochemotherapy (RCT) with D, followed by adjuvant D in chemonaive patients with NSCLC: TAX-AT1–203. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7702 Background: This phase II study evaluated operable and unresectable patients (pts) treated with induction chemotherapy with DC to assess the response rate and conversion to resectability. Furthermore, the feasibility and efficacy of radiosensitizing with D was tested in unresectable pts undergoing RCT. The feasibility of adjuvant D was investigated in all patients. Study Design: Pts with stages II, IIIA and IIIB NSCLC were treated with 3 cycles of 3-wkly neoadjuvant D (75 mg/m2 d 1) and C (40 mg/m2 d1, 2). Within 4 wk after induction, pts were either resected or treated with RCT (2 Gy × 5d for 6 wk) and D 20 mg/m2 wkly × 6 cycles. Within 4–8 wk after definitive RCT or surgery, 3 cycles of adjuvant D 75 mg/m2 q3wk were initiated. Adjuvant RT was allowed in non-R0 resected cases. The primary endpoint was response rate to induction; secondary endpoints included resectability after induction, progression-free survival, overall survival, and safety. Results: 77 pts were included: age 60 yr [46–76 yr], males 78%, stages (II/IIIA/IIIB: 8%/39%/52%), primary resectability n=22 (29%), primary unresectability n=55 (71%). 59 patients were evaluable after induction chemotherapy, of whom 66% achieved a PR, 23% had stable disease, and 10% progressed. The PR rate was 73% in initially resectable and 63% in initially unresectable pts. 67 pts were evaluable for resectability. 28/39 (72%) of PR patients were resectable. As a result of induction therapy, 19 pts (25%) became resectable, 18 (24%) remained resectable, 27 (35%) remained unresectable, and 3 (4%) became unresectable. Treatment had to be stopped in 11 pts during induction. Three pts, primarily unresectable (4%) died of toxicity. 53% of patients had a grade 3 or 4 toxicity. In evaluable pts, the median PFS was 350 [80–1495] days vs 192 [21–989] days for resectable and unresectable pts after induction, respectively, and overall survival was 491 vs 303 days. Conclusions: DC induction chemotherapy resulted in a promising PR rate and rate of secondary resectability. The toxicity is substantial. Results of efficacy and toxicity of radiosensitizing and adjuvant D are pending. No significant financial relationships to disclose.
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Affiliation(s)
- R. Greil
- Hospital Salzburg Paracelsus University, Salzburg, Austria; AKH Linz, Linz, Austria; SMZ Baumgartner Höhe, Wien, Austria; Klinik Wels, Wels, Austria; University Hospital Innsbruck, Innsbruck, Austria
| | - W. Pfeifer
- Hospital Salzburg Paracelsus University, Salzburg, Austria; AKH Linz, Linz, Austria; SMZ Baumgartner Höhe, Wien, Austria; Klinik Wels, Wels, Austria; University Hospital Innsbruck, Innsbruck, Austria
| | - N. Vetter
- Hospital Salzburg Paracelsus University, Salzburg, Austria; AKH Linz, Linz, Austria; SMZ Baumgartner Höhe, Wien, Austria; Klinik Wels, Wels, Austria; University Hospital Innsbruck, Innsbruck, Austria
| | - J. Eckmayr
- Hospital Salzburg Paracelsus University, Salzburg, Austria; AKH Linz, Linz, Austria; SMZ Baumgartner Höhe, Wien, Austria; Klinik Wels, Wels, Austria; University Hospital Innsbruck, Innsbruck, Austria
| | - O. Burghuber
- Hospital Salzburg Paracelsus University, Salzburg, Austria; AKH Linz, Linz, Austria; SMZ Baumgartner Höhe, Wien, Austria; Klinik Wels, Wels, Austria; University Hospital Innsbruck, Innsbruck, Austria
| | - W. Hilbe
- Hospital Salzburg Paracelsus University, Salzburg, Austria; AKH Linz, Linz, Austria; SMZ Baumgartner Höhe, Wien, Austria; Klinik Wels, Wels, Austria; University Hospital Innsbruck, Innsbruck, Austria
| | - T. Schmid
- Hospital Salzburg Paracelsus University, Salzburg, Austria; AKH Linz, Linz, Austria; SMZ Baumgartner Höhe, Wien, Austria; Klinik Wels, Wels, Austria; University Hospital Innsbruck, Innsbruck, Austria
| | - G. Gastl
- Hospital Salzburg Paracelsus University, Salzburg, Austria; AKH Linz, Linz, Austria; SMZ Baumgartner Höhe, Wien, Austria; Klinik Wels, Wels, Austria; University Hospital Innsbruck, Innsbruck, Austria
| | - A. Mohn-Stauder
- Hospital Salzburg Paracelsus University, Salzburg, Austria; AKH Linz, Linz, Austria; SMZ Baumgartner Höhe, Wien, Austria; Klinik Wels, Wels, Austria; University Hospital Innsbruck, Innsbruck, Austria
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14
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Baka A, Fusco FM, Puro V, Vetter N, Skinhoj P, Ott K, Siikamaki H, Brodt HR, Gottschalk R, Follin P, Bannister B, De Carli G, Nisii C, Heptonstall J, Ippolito G. A curriculum for training healthcare workers in the management of highly infectious diseases. ACTA ACUST UNITED AC 2007; 12:E5-6. [PMID: 17991402 DOI: 10.2807/esm.12.06.00716-en] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The SARS epidemic, the threat of bioterrorism, and recent examples of imported highly infectious diseases (HID) in Europe have all highlighted the importance of competent clinical and public health management of infectious disease emergencies. Although the European Union of Medical Specialists in Europe and the Infectious Diseases Society of America have developed curricula for training in infectious disease medicine, neither of those mentions training in the management of HIDs. The European Network for Infectious Diseases (EUNID, http://www.eunid.com) is a European Commission co-funded network of experts in HID management, created to help improve the preparedness for HID emergencies within Europe. One of EUNID's agreed tasks is the development of a curriculum for such a training. Between April 2005 and September 2006, EUNID developed a curriculum and accompanying training course on the basis of a questionnaire that was sent to all country representatives and discussion, followed by amendment of drafts shared through the project website, and a final consensus meeting. The resulting curriculum consists of a two-module course covering the core knowledge and skills that healthcare workers need to safely treat a patient who has, or who may have, an HID. The first module introduces theoretical aspects of HID management, including disease-specific knowledge, infection control, and the public health response, through didactic teaching and class-based discussion. The second module involves a "skill station" and a clinical scenario, and equips trainees with relevant practical skills, including the use of specialised equipment and teamwork practice in patient management. Together, the curriculum and course contribute to the creation of a common framework for training healthcare professionals in Europe, and although they are designed primarily for clinicians that are directly involved in patient care, they are relevant also to public health professionals and others who may be involved in HID management and emergency response.
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Affiliation(s)
- A Baka
- Hellenic Center for Disease Control and Prevention, Athens, Greece
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15
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Mocroft A, Rockstroh J, Soriano V, Ledergerber B, Kirk O, Vinogradova E, Reiss P, Katlama C, Phillips AN, Lundgren JD, Losso M, Duran A, Vetter N, Karpov I, Vassilenko A, Clumeck N, De Wit S, Poll B, Machala L, Rozsypal H, Sedlacek D, Nielsen J, Lundgren J, Benfield T, Kirk O, Gerstoft J, Katzenstein T, Hansen ABE, Skinhøj P, Pedersen C, Zilmer K, Katlama C, Viard JP, Girard PM, Marc TS, Vanhems P, Pradier C, Dabis F, Dietrich M, Manegold C, Van Lunzen J, Stellbrink HJ, Staszewski S, Bickel M, Goebel FD, Fätkenheuer G, Rockstroh J, Schmidt R, Kosmidis J, Gargalianos P, Sambatakou H, Perdios J, Panos G, Banhegyi D, Mulcahy F, Yust I, Turner D, Burke M, Pollack S, Hassoun G, Sthoeger Z, Maayan S, Vella S, Chiesi A, Arici C, Pristerá R, Mazzotta F, Gabbuti A, Esposito R, Bedini A, Chirianni A, Montesarchio E, Vullo V, Santopadre P, Narciso P, Antinori A, Franci P, Zaccarelli M, Lazzarin A, Finazzi R, Monforte AD, Viksna L, Chaplinskas S, Hemmer R, Staub T, Reiss P, Bruun J, Maeland A, Ormaasen V, Knysz B, Gasiorowski J, Horban A, Prokopowicz D, Wiercinska-Drapalo A, Boron-Kaczmarska A, Pynka M, Beniowski M, Mularska E, Trocha H, Antunes F, Valadas E, Mansinho K, Matez F, Duiculescu D, Streinu-Cercel A, Vinogradova E, Rakhmanova A, Jevtovic D, Mokrás M, Staneková D, González-Lahoz J, Sánchez-Conde M, García-Benayas T, Martin-Carbonero L, Soriano V, Clotet B, Jou A, Conejero J, Tural C, Gatell JM, Miró JM, Blaxhult A, Karlsson A, Pehrson P, Ledergerber B, Weber R, Francioli P, Telenti A, Hirschel B, Soravia-Dunand V, Furrer H, Chentsova N, Barton S, Johnson AM, Mercey D, Phillips A, Johnson MA, Mocroft A, Murphy M, Weber J, Scullard G, Fisher M, Brettle R, Loveday C, Clotet B, Antunes F, Blaxhult A, Clumeck N, Gatell J, Horban A, Johnson A, Katlama C, Ledergerber B, Loveday C, Phillips A, Reiss P, Vella S, Lundgren J, Gjørup I, Kirk O, Friis-Moeller N, Mocroft A, Cozzi-Lepri A, Bannister W, Mollerup D, Podlevkareva D, Olsen CH, Kjær J. Are Specific Antiretrovirals associated with an Increased Risk of Discontinuation due to Toxicities or Patient/Physician Choice in patients with Hepatitis C Virus Coinfection? Antivir Ther 2005. [DOI: 10.1177/135965350501000704] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Liver damage associated with hepatitis C (HCV) may influence the likelihood of experiencing discontinuation due to toxicities or patient/physician choice (TOXPC) in patients taking combination antiretroviral therapy (cART). Little information to address this concern is available from clinical trials as patients with HCV are often excluded. Aims To compare incidence rates of discontinuation due to TOXPC associated with specific antiretrovial drugs in patients with or without HCV. Patients/methods A total of 4929 patients from EuroSIDA under follow-up from January 1999 on a specific nucleoside pair (zidovudine/lamivudine, didanosine/stavudine, stavudine/lamivudine, or other) with a third drug (abacavir, nelfinavir, indinavir, nevirapine, efavirenz, lopinavir/ ritonavir or other boosted-protease inhibitor (PI)-containing regimen) and with known HCV serostatus were studied for the incidence of discontinuation of any nucleoside pair or third drug due to TOXPC. Incidence rate ratios were derived from Poisson regression models. Results In total 1358 patients had HCV (27.5%). During 12 799 person-years of follow-up there were 2141 discontinuations due to TOXPC for nucleoside pairs and 2501 for third drugs. The incidence of discontinuation due to TOXPC was consistently higher in patients with HCV after stratification by nucleoside pair or third drug. After adjustment for CD4+ count, gender, exposure group, time on HAART, region and treatment regimen, there were few differences in the rate of discontinuation due to TOXPC in those with HCV compared with those without for any nucleoside pairs or third drugs. Similar results were seen when concentrating on discontinuation due to toxicities alone. Conclusions Although patients with HCV generally had higher rates of discontinuation due to TOXPC compared with patients without HCV, there was little evidence to suggest that this was associated with any specific nucleoside pair or third drug used as part of cART. Our results do not suggest that any specific component of cART is more poorly tolerated in patients with HCV or that the presence of HCV should influence the choice between antiretrovirals used as part of a cART regimen.
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Affiliation(s)
- Amanda Mocroft
- Royal Free Centre for HIV Medicine and Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK
| | | | | | | | - Ole Kirk
- Copenhagen HIV Program, Hvidovre Hospital, Copenhagen, Denmark
| | | | - Peter Reiss
- Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, the Netherlands
| | | | - Andrew N Phillips
- Royal Free Centre for HIV Medicine and Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK
| | - Jens D Lundgren
- Copenhagen HIV Program, Hvidovre Hospital, Copenhagen, Denmark
| | - M Losso
- Hospital JM Ramos Mejia, Buenos Aires
| | - A Duran
- Hospital JM Ramos Mejia, Buenos Aires
| | - N Vetter
- Pulmologisches Zentrum der Stadt Wien, Vienna
| | - I Karpov
- Belarus State Medical University, Minsk
| | | | - N Clumeck
- Saint-Pierre Hospital, Brussels; R Colebunders, Institute of Tropical Medicine, Antwerp
| | - S De Wit
- Saint-Pierre Hospital, Brussels; R Colebunders, Institute of Tropical Medicine, Antwerp
| | - B Poll
- Saint-Pierre Hospital, Brussels; R Colebunders, Institute of Tropical Medicine, Antwerp
| | | | | | | | | | | | | | - O Kirk
- Hvidovre Hospital, Copenhagen
| | | | | | | | | | | | - K Zilmer
- West-Tallinn Central Hospital, Tallinn
| | - C Katlama
- Hôpital de la Pitié-Salpétière, Paris
| | - J-P Viard
- Hôpital Necker-Enfants Malades, Paris
| | | | | | | | | | | | - M Dietrich
- Bernhard-Nocht-Institut for Tropical Medicine, Hamburg
| | - C Manegold
- Bernhard-Nocht-Institut for Tropical Medicine, Hamburg
| | | | | | | | - M Bickel
- JW Goethe University Hospital, Frankfurt
| | | | | | | | | | | | | | | | | | - G Panos
- A Filandras and E Karabatsaki, 1st IKA Hospital, Athens
| | | | | | - I Yust
- Ichilov Hospital, Tel Aviv
| | | | | | | | | | | | - S Maayan
- Hadassah University Hospital, Jerusalem
| | - S Vella
- Istituto Superiore di Sanita, Rome
| | - A Chiesi
- Istituto Superiore di Sanita, Rome
| | | | | | | | - A Gabbuti
- Ospedale S. Maria Annunziata, Florence
| | | | | | | | | | - V Vullo
- Università di Roma La Sapienza, Rome
| | | | | | | | | | | | | | | | | | - L Viksna
- Infectology Centre of Latvia, Riga
| | | | | | - T Staub
- Centre Hospitalier, Luxembourg
| | - P Reiss
- Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam
| | | | | | | | | | | | - A Horban
- Centrum Diagnostyki i Terapii AIDS, Warsaw
| | | | | | | | | | | | - E Mularska
- Osrodek Diagnostyki i Terapii AIDS, Chorzow
| | | | | | | | | | - F Matez
- Hospital Curry Cabral, Lisbon
| | - D Duiculescu
- Spitalul de Boli Infectioase si Tropicale: Dr. Victor Babes, Bucarest
| | | | | | | | - D Jevtovic
- The Institute for Infectious and Tropical Diseases, Belgrade
| | | | | | | | | | | | | | | | - B Clotet
- Hospital Germans Trias i Pujol, Badalona
| | - A Jou
- Hospital Germans Trias i Pujol, Badalona
| | - J Conejero
- Hospital Germans Trias i Pujol, Badalona
| | - C Tural
- Hospital Germans Trias i Pujol, Badalona
| | - JM Gatell
- Hospital Clinic i Provincial, Barcelona
| | - JM Miró
- Hospital Clinic i Provincial, Barcelona
| | | | - A Karlsson
- Karolinska University Hospital, Stockholm
| | - P Pehrson
- Karolinska University Hospital, Huddinge
| | | | | | - P Francioli
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - A Telenti
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - B Hirschel
- Hospital Cantonal Universitaire de Geneve, Geneve
| | | | | | | | - S Barton
- St. Stephen's Clinic, Chelsea and Westminster Hospital, London
| | - AM Johnson
- Royal Free and University College London Medical School, London (University College Campus)
| | - D Mercey
- Royal Free and University College London Medical School, London (University College Campus)
| | - A Phillips
- Royal Free and University College Medical School, London (Royal Free Campus)
| | - MA Johnson
- Royal Free and University College Medical School, London (Royal Free Campus)
| | - A Mocroft
- Royal Free and University College Medical School, London (Royal Free Campus)
| | - M Murphy
- Medical College of Saint Bartholomew's Hospital, London
| | - J Weber
- Imperial College School of Medicine at St. Mary's, London
| | - G Scullard
- Imperial College School of Medicine at St. Mary's, London
| | - M Fisher
- Royal Sussex County Hospital, Brighton
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Cozzi-Lepri A, Ruiz L, Loveday C, Phillips AN, Clotet B, Reiss P, Ledergerber B, Holkmann C, Staszewski S, Lundgren JD, Losso M, Duran A, Vetter N, Clumeck N, De Wit S, Poll B, Colebunders R, Machala L, Rozsypal H, Nielsen J, Lundgren J, Kirk O, Olsen CH, Gerstoft J, Katzenstein T, Hansen ABE, Skinhøj P, Pedersen C, Zilmer K, Rauka M, Katlama C, De Sa M, Viard JP, Marc TS, Vanhems P, Pradier C, Dietrich M, Manegold C, Van Lunzen J, Stellbrink HJ, Miller V, Staszewski S, Goebel FD, Salzberger B, Rockstroh J, Schmidt RE, Stoll M, Kosmidis J, Gargalianos P, Sambatakou H, Perdios J, Panos G, Banhegyi D, Mulcahy F, Yust I, Burke M, Pollack S, Hassoun J, Sthoeger Z, Maayan S, Vella S, Chiesi A, Arici C, Pristerá R, Mazzotta F, Gabbuti A, Esposito R, Bedini A, Chirianni A, Montesarchio E, Vullo V, Santopadre P, Narciso P, Antinori A, Franci P, Zaccarelli M, Lazzarin A, Castagna A, Monforte D, Viksna L, Rozentale B, Chaplinskas S, Hemmer R, Staub T, Reiss P, Bruun J, Maeland A, Ormaasen V, Knysz B, Gasiorowski J, Horban A, Prokopowicz D, Drapalo AW, Kaczmarska AB, Pynka M, Beniowski M, Trocha H, Smiatacz T, Antunes F, Mansinho K, Maltez F, Duiculescu D, Babes V, Cercel AS, Mokrás M, Staneková D, González-Lahoz J, Diaz B, García-Benayas T, Carbonero LM, Soriano V, Clotet B, Jou A, Conejero J, Tural C, Gatell JM, Miró JM, Zamora L, Blaxhult A, Karlsson A, Pehrson P, Ledergerber B, Weber R, Francioli P, Hirschel B, Schiffer V, Furrer H, Chentsova N, Barton S, Johnson AM, Mercey D, Youle M, Phillips A, Johnson MA, Mocroft A, Murphy M, Weber J, Scullard G, Fisher M, Brettle R, Loveday C, Clotet B, Ruiz L, Antunes F, Blaxhult A, Clumeck N, Gatell J, Horban A, Johnson A, Katlama C, Ledergerber B, Loveday C, Phillips A, Reiss P, Vella S, Lundgren J, Gjørup I, Kirk O, Moeller NF, Mocroft A, Lepri AC, Bannister W, Mollerup D, Nielsen M, Hansen A, Kristensen D, Kolte L, Hansen L, Kjær J. Thymidine Analogue Mutation Profiles: Factors Associated with Acquiring Specific Profiles and their Impact on the Virological Response to Therapy. Antivir Ther 2005. [DOI: 10.1177/135965350501000705] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Studies have suggested that HIV-1 may develop thymidine analogue mutations (TAMs) by one of two distinct pathways – the TAM1 pathway (including mutations 41L, 210W and 215Y) or the TAM2 pathway (including mutations 67N, 70R and 219E/Q) – under the pressure of a not fully suppressive thymidine-analogue-containing regimen. Methods Frozen plasma samples stored in the EuroSIDA repository were selected and sent to two central laboratories for genotypic analysis. We considered 733 patients with at least one genotypic test showing ≥1 TAMs (the first of these tests in chronological order was used). TAM1 and TAM2 genotypic profiles were defined in accordance with previous literature. Statistical modelling involved logistic regression and linear regression analysis for censored data. Results The observed frequencies of patterns classifiable as TAM1 or TAM2 profiles were markedly higher than the probabilities of falling into these classifications by chance alone. The chance of detecting a TAM2 profile increased by 25% per additional year of exposure to zidovudine. We found that mutations 67N and 184V were not associated with a particular TAM profile. In the presence of TAM2 profiles, the adjusted mean difference in the 6-month viral reduction was 0.96 log10 copies/ml (95% confidence interval: 0.20; 1.73) higher in patients who started stavudine-containing regimens instead of zidovudine-containing regimens. Conclusions This study provides evidence that the suggested TAM clustering is a real phenomenon and that it may be driven by which thymidine analogue the patients has used. In patients with TAM2-resistant viruses, stavudine appears to retain greater viral activity than zidovudine.
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Affiliation(s)
| | - Lidia Ruiz
- IrsiCaixa Foundation, Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Spain
| | - Clive Loveday
- International Clinical Virology Center (ICVC), High Wycombe, UK
| | | | - Bonaventura Clotet
- IrsiCaixa Foundation, Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Spain
| | - Peter Reiss
- Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, Switzerland
| | | | | | - Jens D Lundgren
- Copenhagen HIV Programme, Hvidovre University Hospital, Denmark
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Pohl WR, Vetter N, Zwick H, Hrubos W. Adjustable maintenance dosing with budesonide/formoterol or budesonide: double-blind study. Respir Med 2005; 100:551-60. [PMID: 16005623 DOI: 10.1016/j.rmed.2005.05.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2005] [Accepted: 05/24/2005] [Indexed: 11/25/2022]
Abstract
Adjustable maintenance dosing with either budesonide/formoterol or budesonide was compared in asthma patients. This double-blind trial randomized 133 patients (mean forced expiratory volume in 1s 66% predicted) to receive 2 inhalations twice daily of budesonide/formoterol 160/4.5 microg (640/18 microg/day) or budesonide 320 microg (1280 microg/day) for 4 weeks. The study drug was adjusted in both groups according to symptoms to 2-4 inhalations daily during Weeks 5-8 and 1-4 inhalations daily during Weeks 9-20. Asthma was well controlled in both groups, with minimal levels of treatment failure (5 budesonide/formoterol vs. 2 budesonide patients; P=NS) and minimal use of reliever therapy. Clinically important improvements in health-related quality of life (HRQL) occurred in the physical functioning and emotional role functioning domains (both P<0.05) for the budesonide/formoterol group compared with budesonide. Physician and patient treatment satisfaction favored budesonide/formoterol (both P<0.05). Budesonide/formoterol patients used fewer daily inhalations of study drug (P=0.024). The median average daily inhaled corticosteroid dose during the study was 448 microg with budesonide/formoterol and 1152 microg with budesonide. Adjustable maintenance dosing with budesonide/formoterol and budesonide resulted in high levels of asthma control. Adjustable budesonide/formoterol treatment achieved greater HRQL benefits and patient satisfaction, with lower overall drug use.
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Affiliation(s)
- W R Pohl
- Grimmenstein Hospital, Landesklinik Hochegg, Hocheggerstrasse 88, A-2840 Grimmenstein, Austria.
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18
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Cabrera C, Cozzi-Lepri A, Phillips AN, Loveday C, Kirk O, Ait-Khaled M, Reiss P, Kjær J, Ledergerber B, Lundgren JD, Clotet B, Ruiz L, Losso M, Duran A, Vetter N, Clumeck N, Hermans P, Sommereijns B, Colebunders R, Machala L, Rozsypal H, Nielsen J, Lundgren J, Benfield T, Kirk O, Gerstoft J, Katzenstein T, Røge B, Skinhøj P, Pedersen C, Zilmer K, Katlama C, De Sa M, Viard JP, Saint-Marc T, Vanhems P, Pradier C, Dietrich M, Manegold C, van Lunzen J, Stellbrink HJ, Miller V, Staszewski S, Goebel FD, Salzberger B, Rockstroh J, Kosmidis J, Gargalianos P, Sambatakou H, Perdios J, Panos G, Karydis I, Filandras A, Banhegyi D, Mulcahy F, Yust I, Burke M, Pollack S, Ben-Ishai Z, Bentwich Z, Maayan S, Vella S, Chiesi A, Arici C, Pristerá R, Mazzotta F, Gabbuti A, Esposito R, Bedini A, Chirianni A, Montesarchio E, Vullo V, Santopadre P, Narciso P, Antinori A, Franci P, Zaccarelli M, Lazzarin A, Finazzi R, D'Arminio Monforte A, Viksna L, Chaplinskas S, Hemmer R, Staub T, Reiss P, Bruun J, Maeland A, Ormaasen V, Knysz B, Gasiorowski J, Horban A, Prokopowicz D, Wiercinska-Drapalo A, Boron-Kaczmarska A, Pynka M, Beniowski M, Trocha H, Antunes F, Mansinho K, Proenca R, Duiculescu D, Streinu-Cercel A, Mikras M, González-Lahoz J, Diaz B, García-Benayas T, Martin-Carbonero L, Soriano V, Clotet B, Jou A, Conejero J, Tural C, Gatell JM, Miró JM, Blaxhult A, Karlsson A, Pehrson P, Ledergerber B, Weber R, Francioli P, Telenti A, Hirschel B, Soravia-Dunand V, Furrer H, Chentsova N, Barton S, Johnson AM, Mercey D, Phillips A, Loveday C, Johnson MA, Mocroft A, Pinching A, Parkin J, Weber J, Scullard G, Fisher M, Brettle R. Baseline Resistance and Virological Outcome in Patients with Virological Failure who Start a Regimen Containing Abacavir: Eurosida Study. Antivir Ther 2004. [DOI: 10.1177/135965350400900509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives To investigate the ability of several HIV-1 drug-resistance interpretation systems, as well as the number of pre-specified combinations of abacavir-related mutations, to predict virological response to abacavir-containing regimens in antiretroviral therapy-experienced, abacavir-naive patients starting an abacavir-containing regimen in the EuroSIDA cohort. Patients and methods A total of 100 HIV-infected patients with viral load (VL) >500 copies/ml who had a plasma sample available at the time of starting abacavir (baseline) were included. Resistance to abacavir was interpreted by using eight different commonly used systems that consisted of rules-based algorithms or tables of mutations. Correlation between baseline abacavir-resistance mutations and month 6 virological response was performed on this population using a multivariable linear regression model accounting for censored data. Results The baseline VL was 4.36 log10 RNA copies/ml [interquartile range (IQR): 3.65–4.99 log10 RNA copies/ml] and the median CD4 cell count was 210 cells/μl (IQR: 67–305 cells/μl). Our patients were pre-exposed to a median of seven antiretrovirals (2–12) before starting abacavir therapy. The median (range) number of abacavir mutations (according to the International AIDS Society-USA) detected at baseline was 3.5 (0–8). Overall, the Kaplan–Meier estimate of the median month 6 VL decline was 0.86 log10 RNA copies/ml [95% confidence intervals (95% CI): 0.45–1.24]. The VL in those patients ( n=31) who intensified treatment by adding only abacavir decreased by a median 0.20 log10 RNA copies/ml (95% CI: -0.18; +0.94). The proportion of patients who harboured viruses fully resistant to abacavir among the eight genotypic resistance interpretation algorithms ranged from 12% [Agence Nationale de Recherches sur le SIDA (ANRS)] to 79% [Stanford HIV RT and PR Sequence Database (HIVdb)]. Some interpretation systems showed statistically significant associations between the predicted resistance status and the virological response while others showed no consistent association. The number of active drugs in the regimen was associated with greater virological suppression (additional month 6 VL reduction per additional sensitive drug=0.51, 95% CI: 0.15–0.88, P=0.006); baseline VL was also weakly associated (additional month 6 VL reduction per log10 higher=0.30, 95% CI: -0.02; +0.62, P=0.06). In contrast, the number of drugs previously received was associated with diminished viral reduction (additional month 6 VL reduction per additional drug=-0.14, 95% CI: -0.28; 0.00, P=0.05). Conclusions Our results revealed a high degree of variability among several genotypic resistance interpretation algorithms currently in use for abacavir. Therefore, the interpretation of genotypic resistance for predicting response to regimens containing abacavir remains a major challenge.
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Affiliation(s)
| | - Cecilia Cabrera
- IrsiCaixa Foundation & Lluita contra la SIDA Foundation, Badalona, Spain
| | | | | | - Clive Loveday
- International Clinical Virology Centre (ICVC), Buckinghamshire, UK
| | - Ole Kirk
- EuroSIDA Coordinating Centre, Hvidovre University Hospital, Hvidovre, Denmark
| | | | - Peter Reiss
- Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, the Netherlands
| | - Jesper Kjær
- EuroSIDA Coordinating Centre, Hvidovre University Hospital, Hvidovre, Denmark
| | | | - Jens D Lundgren
- EuroSIDA Coordinating Centre, Hvidovre University Hospital, Hvidovre, Denmark
| | - Bonaventura Clotet
- IrsiCaixa Foundation & Lluita contra la SIDA Foundation, Badalona, Spain
| | - Lidia Ruiz
- IrsiCaixa Foundation & Lluita contra la SIDA Foundation, Badalona, Spain
| | - M Losso
- Hospital JM Ramos Mejia, Buenos Aires. Argentina
| | - A Duran
- Hospital JM Ramos Mejia, Buenos Aires. Argentina
| | - N Vetter
- Pulmologisches Zentrum der Stadt Wien, Vienna. Austria
| | - N Clumeck
- Saint-Pierre Hospital, Brussels; Belgium
| | - P Hermans
- Saint-Pierre Hospital, Brussels; Belgium
| | | | | | - L Machala
- Faculty Hospital Bulovka, Prague. Czech Republic
| | - H Rozsypal
- Faculty Hospital Bulovka, Prague. Czech Republic
| | - J Nielsen
- Hvidovre Hospital, Copenhagen; Denmark
| | | | | | - O Kirk
- Hvidovre Hospital, Copenhagen; Denmark
| | | | | | - B Røge
- Rigshospitalet, Copenhagen
| | | | | | - K Zilmer
- Tallinn Merimetsa Hospital, Tallinn. Estonia
| | - C Katlama
- Hôpital de la Pitié-Salpêtière, Paris; France
| | - M De Sa
- Hôpital de la Pitié-Salpêtière, Paris; France
| | - J-P Viard
- Hôpital Necker-Enfants Malades, Paris
| | | | | | | | - M Dietrich
- Bernhard-Nocht-Institut for Tropical Medicine, Hamburg; Germany
| | - C Manegold
- Bernhard-Nocht-Institut for Tropical Medicine, Hamburg; Germany
| | | | | | - V Miller
- JW Goethe University Hospital, Frankfurt
| | | | | | | | | | | | | | | | - J Perdios
- Athens General Hospital, Athens; Greece
| | | | | | | | | | - F Mulcahy
- St James's Hospital, Dublin. Ireland
| | - I Yust
- Ichilov Hospital, Tel Aviv; Israel
| | - M Burke
- Ichilov Hospital, Tel Aviv; Israel
| | | | | | | | - S Maayan
- Hadassah University Hospital, Jerusalem
| | - S Vella
- Istituto Superiore di Sanita, Rome; Italy
| | - A Chiesi
- Istituto Superiore di Sanita, Rome; Italy
| | | | | | | | - A Gabbuti
- Ospedale S Maria Annunziata, Florence
| | | | | | | | | | - V Vullo
- Università di Roma La Sapienza, Rome
| | | | | | | | | | | | | | | | | | - L Viksna
- Infectology Centre of Latvia, Riga. Latvia
| | | | - R Hemmer
- Centre Hospitalier, Luxembourg. Luxembourg
| | - T Staub
- Centre Hospitalier, Luxembourg. Luxembourg
| | - P Reiss
- Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam. Netherlands
| | - J Bruun
- Ullevål Hospital, Oslo. Norway
| | | | | | - B Knysz
- Medical University, Wroclaw; Poland
| | | | - A Horban
- Centrum Diagnostyki i Terapii AIDS, Warsaw
| | | | | | | | | | | | | | - F Antunes
- Hospital Santa Maria, Lisbon; Portugal
| | | | | | - D Duiculescu
- Spitalul de Boli Infectioase si Tropicale Dr Victor Babes, Bucharest; Romania
| | | | - M Mikras
- Derrer Hospital, Bratislava. Slovakia
| | | | - B Diaz
- Hospital Carlos III, Madrid; Spain
| | | | | | | | - B Clotet
- Hospital Germans Trias i Pujol, Barcelona
| | - A Jou
- Hospital Germans Trias i Pujol, Barcelona
| | - J Conejero
- Hospital Germans Trias i Pujol, Barcelona
| | - C Tural
- Hospital Germans Trias i Pujol, Barcelona
| | - JM Gatell
- Hospital Clinic i Provincial, Barcelona
| | - JM Miró
- Hospital Clinic i Provincial, Barcelona
| | | | | | | | | | | | - P Francioli
- Centre Hospitalier Universitaire Vaudois, Lausanne; Switzerland
| | - A Telenti
- Centre Hospitalier Universitaire Vaudois, Lausanne; Switzerland
| | - B Hirschel
- Hospital Cantonal Universitaire de Geneve, Geneve
| | | | | | | | - S Barton
- St Stephen's Clinic, Chelsea and Westminster Hospital, London; United Kingdom
| | - AM Johnson
- Royal Free and University College London Medical School, London University College Campus
| | - D Mercey
- Royal Free and University College London Medical School, London University College Campus
| | - A Phillips
- Royal Free and University College Medical School, London Royal Free Campus
| | - C Loveday
- Royal Free and University College Medical School, London Royal Free Campus
| | - MA Johnson
- Royal Free and University College Medical School, London Royal Free Campus
| | - A Mocroft
- Royal Free and University College Medical School, London Royal Free Campus
| | - A Pinching
- Medical College of Saint Bartholomew's Hospital, London
| | - J Parkin
- Medical College of Saint Bartholomew's Hospital, London
| | - J Weber
- Imperial College School of Medicine at St Mary's, London
| | - G Scullard
- Imperial College School of Medicine at St Mary's, London
| | - M Fisher
- Royal Sussex County Hospital, Brighton
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Abstract
OBJECTIVE To determine if low dose nalbuphine provides an adequate reduction in pain with minimal side effects. METHODS Prospective cohort of 115 patients given nalbuphine by paramedics in Wales and the English borders. OUTCOME MEASURES (1) Mean total dose of nalbuphine administered, change in pain score, time to adequate pain relief (score below four), and change in respiratory rate and systolic blood pressure; (2) proportion of patients continuing to suffer moderate to severe pain on arrival at hospital; (3) incidence of adverse events. RESULTS Full data were obtained for all patients. The mean total dose of nalbuphine administered was 6.09 mg (range 2.5 to 12.5 mg). This was significantly higher in trauma than ischaemic chest pain patients (7.03 versus 5.13 mg). The mean reduction in pain score was -3.97 (95% CI -4.38 to -3.57, p<0.001). The mean time to adequate pain relief (where this was achieved) was 15.7 minutes (95% CI 13.4 to 17.9 minutes). On arrival at hospital 60% of patients (n=69, 95% CI 50.9 to 68.5%) still met ambulance criteria for analgesia (70.7% of trauma patients and 49.1% with ischaemic chest pain). Systolic blood pressure fell by a mean of -3.67 (95% CI -6.76 to -0.58, p=0.02) and respiratory rate increased by a mean of 1.63 (95% CI 1.08 to 2.17, p<0.001). Two patients complained of nausea (1.74%, 95% CI 0.5 to 6.0%). No other adverse events were reported. CONCLUSION Low dose nalbuphine results in few adverse events, but offers poor pain control for a high proportion of patients.
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Affiliation(s)
- M Woollard
- Pre-hospital Emergency Research Unit, Welsh Ambulance Services NHS Trust/University of Wales College of Medicine, Cardiff, UK .
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21
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Vetter N. Dipilotomy: regulation as a barrier to best practice in the health service. J Public Health (Oxf) 2002; 24:75-6. [PMID: 12141588 DOI: 10.1093/pubmed/24.2.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Mocroft A, Phillips AN, Friis-Møller N, Colebunders R, Johnson AM, Hirschel B, Saint-Marc T, Staub T, Clotet B, Lundgren JD, Ledergerber B, Antunes F, Blaxhult A, Clumeck N, Gatell JM, Horban A, Johnson AM, Katlama C, Loveday C, Phillips A, Reiss P, Vella S, Vetter N, Clumeck N, Hermans P, Sommereijns B, Colebunders R, Machala L, Rozsypal H, Nielsen J, Lundgren J, Benfield T, Kirk O, Gerstoft J, Katzenstein T, Røge B, Skinhøj P, Pedersen C, Katlama C, Rivière C, Viard JP, Saint-Marc T, Vanhems P, Pradier C, Dietrich M, Manegold C, van Lunzen J, Miller V, Staszewski S, Goebel FD, Salzberger B, Rockstroh J, Kosmidis J, Gargalianos P, Sambatakou H, Perdios J, Panos G, Karydis I, Filandras A, Banhegyi D, Mulcahy F, Yust I, Turner D, Pollack S, Ben-Ishai Z, Bentwich Z, Maayan S, Vella S, Chiesi A, Arici C, Pristerá R, Mazzotta F, Gabbuti A, Esposito R, Bedini A, Chirianni A, Montesarchio E, Vullo V, Santopadre P, Narciso P, Antinori A, Franci P, Zaccarelli M, Lazzarin A, Finazzi R, Monforte AD, Hemmer R, Staub T, Reiss P, Bruun J, Maeland A, Ormaasen V, Knysz B, Gasiorowski J, Horban A, Prokopowicz D, Wiercinska-Drapalo A, Boron-Kaczmarska A, Pynka M, Beniowski M, Trocha H, Antunes F, Mansinho K, Proenca R, González-Lahoz J, Diaz B, García-Benayas T, Martin-Carbonero L, Soriano V, Clotet B, Jou A, Conejero J, Tural C, Gatell JM, Miró JM, Blaxhult A, Heidemann B, Pehrson P, Ledergerber B, Weber R, Francioli P, Telenti A, Hirschel B, Soravia-Dunand V, Barton S, Johnson AM, Mercey D, Phillips A, Loveday C, Johnson MA, Mocroft A, Pinching A, Parkin J, Weber J, Scullard G, Fisher M, Brettle R, Lundgren J, Gjørup I, Kirk O, Friis-Moeller N, Mocroft A, Cozzi-Lepri A, Mollerup D, Nielsen M, Hansen A, Kristensen D, Aabolt S, Cimposeu P, Hansen L, Kjær J. Response to Antiretroviral Therapy among Patients Exposed to Three Classes of Antiretrovirals: Results from the Eurosida Study. Antivir Ther 2002. [DOI: 10.1177/135965350200700103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is an increasing proportion of HIV-positive patients exposed to all licensed classes of antiretrovirals, and the response to salvage regimens may be poor. Among over 8500 patients in EuroSIDA, the proportion of treated patients exposed to nucleosides, protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitor (NNRTI) increased from 0% in 1996 to 47% in 2001. Four-hundred-and-thirteen patients, who had failed virologically two highly active antiretroviral therapy (HAART) regimens and experienced all three main drug classes, started a salvage regimen of at least three drugs, in which at least one new PI or NNRTI was included. Median viral load was 4.7 log copies/ml [Interquartile range (IQR) 4.2–5.2], CD4 lymphocyte count 150/mm3 (IQR 60–274/mm3) and follow-up 14 months. Of these patients, 283 (69%) subsequently experienced at least a 1 log decline in viral load and 202 (49%) achieved a viral load <500 copies/ml. Conversely, the CD4 count halved from the baseline value in 88 (21%), and 45 (11%) experienced a new AIDS-defining disease. In multivariable analyses, a 1 log viral load reduction was related to baseline viral load [relative hazard (RH) 1.27 per 1 log higher; P=0.008], a previous viral load of less than 500 copies/ml (RH 1.69; P=0.002), more recent initiation of the regimen (RH 1.36 per year more recent; P=0.02), number of new drugs in the regimen (RH 1.20 per drug; P=0.02), time since start of antiretroviral therapy (RH 0.94 per extra year; P=0.035) and time spent on HAART with viral load >1000 copies/ml (RH 0.96 per extra month; P=0.0001). Analysis of factors associated with CD4 count decline and new AIDS disease also indicated improved outcomes in more recent times and a tendency for a better response in those starting more new drugs, but no relationship with the total number of drugs. Outcomes in people starting salvage regimens appear to depend on the number of new drugs started but not on the total number of drugs being used.
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Affiliation(s)
- A Mocroft
- Royal Free Centre for HIV Medicine, Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK
| | - AN Phillips
- Royal Free Centre for HIV Medicine, Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK
| | - N Friis-Møller
- EuroSIDA Coordinating Centre, Hvidovre Hospital, Hvidovre, Denmark
| | | | - AM Johnson
- Royal Free Centre for HIV Medicine, Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK
| | - B Hirschel
- Hospital Cantonal Universitaire de Geneve, Geneva, Switzerland
| | | | - T Staub
- Centre Hospitalier, Luxembourg
| | - B Clotet
- Hospital Germans Trias I Pujol, Barcelona, Spain
| | - JD Lundgren
- EuroSIDA Coordinating Centre, Hvidovre Hospital, Hvidovre, Denmark
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- Pulmologisches Zentrum der Stadt Wien, Vienna
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- Hvidovre Hospital, Copenhagen
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- Rigshospitalet, Copenhagen
| | | | | | - C Katlama
- Hôpital de la Pitié-Salpétière, Paris
| | - C Rivière
- Hôpital de la Pitié-Salpétière, Paris
| | - J-P Viard
- Hôpital Necker-Enfants Malades, Paris
| | | | | | | | - M Dietrich
- Bernhard-Nocht-Institut for Tropical Medicine, Hamburg
| | - C Manegold
- Bernhard-Nocht-Institut for Tropical Medicine, Hamburg
| | | | - V Miller
- JW Goethe University Hospital, Frankfurt
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - I Yust
- Ichilov Hospital, Tel Aviv
| | | | | | | | | | - S Maayan
- Hadassah University Hospital, Jerusalem
| | - S Vella
- Istituto Superiore di Sanita, Rome
| | - A Chiesi
- Istituto Superiore di Sanita, Rome
| | | | | | | | - A Gabbuti
- Ospedale S. Maria Annunziata, Florence
| | | | | | | | | | - V Vullo
- Università di Roma La Sapienza, Rome
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- Centre Hospitalier, Luxembourg
| | - P Reiss
- Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam
| | | | | | | | | | | | - A Horban
- Centrum Diagnostyki i Terapii AIDS, Warsaw
| | | | | | | | - M Pynka
- Medical University, Szczecin
| | | | | | | | | | | | | | - B Diaz
- Hospital Carlos III, Madrid
| | | | | | | | - B Clotet
- Hospital Germans Trias i Pujol, Badalona
| | - A Jou
- Hospital Germans Trias i Pujol, Badalona
| | - J Conejero
- Hospital Germans Trias i Pujol, Badalona
| | - C Tural
- Hospital Germans Trias i Pujol, Badalona
| | - JM Gatell
- Hospital Clinic i Provincial, Barcelona
| | - JM Miró
- Hospital Clinic i Provincial, Barcelona
| | | | | | | | | | | | - P Francioli
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - A Telenti
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - B Hirschel
- Hospital Cantonal Universitaire de Geneve, Geneve
| | | | - S Barton
- St Stephen's Clinic, Chelsea and Westminster Hospital, London
| | - AM Johnson
- Royal Free and University College London Medical School, London (University College Campus)
| | - D Mercey
- Royal Free and University College London Medical School, London (University College Campus)
| | - A Phillips
- Royal Free and University College Medical School, London (Royal Free Campus)
| | - C Loveday
- Royal Free and University College Medical School, London (Royal Free Campus)
| | - MA Johnson
- Royal Free and University College Medical School, London (Royal Free Campus)
| | - A Mocroft
- Royal Free and University College Medical School, London (Royal Free Campus)
| | - A Pinching
- Medical College of St Bartholomew's Hospital, London
| | - J Parkin
- Medical College of St Bartholomew's Hospital, London
| | - J Weber
- Imperial College School of Medicine at St Mary's, London
| | - G Scullard
- Imperial College School of Medicine at St Mary's, London
| | - M Fisher
- Royal Sussex County Hospital, Brighton
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Vetter N. Informed consent from the community? J Public Health Med 2001; 23:171-2. [PMID: 11585187 DOI: 10.1093/pubmed/23.3.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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24
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Gsur A, Haidinger G, Hollaus P, Herbacek I, Madersbacher S, Trieb K, Pridun N, Mohn-Staudner A, Vetter N, Vutuc C, Micksche M. Genetic polymorphisms of CYP1A1 and GSTM1 and lung cancer risk. Anticancer Res 2001; 21:2237-42. [PMID: 11501853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Susceptibility to lung cancer may, in part, be determined by interindividual differences in the cytochrome P450-catalysed bioactivation and the glutathione S-transferase-catalysed detoxification of procarcinogens. Therefore a lung cancer case-control study was set up to investigate the association of three polymorphisms of the CYP1A1 gene (CYP1A1*2A, CYP1A1*2B, CYP1A1*4) and GSTM1*0 genotype with lung cancer risk in Austrian Caucasians. Genomic DNA was isolated from the peripheral blood lymphocytes of 134 male lung cancer patients and 134 age-matched controls with nonmalignant conditions and PCR-based analyses were performed. There was no significant difference in risk between cases and controls, either for the CYP1A1*2A (OR=1.09, 95%CI=0.46-2.58), CYP1A1*2B (OR=1.09, 95%CL=0.46-2.58) or for the CYP1A1*4 polymorphism (OR=0.49, 95%CL=0.20-1.16). The prevalence of the GSTM1*0 genotype in the lung cancer group (47.8%) was comparable to that found in the control group (49.3%) and also had no effect on lung cancer risk (OR=0.94, 95%CL=0.54-1.57). Further, in a subgroup of male ever-smokers (n=126), no significant influence on the relative risk was found for these polymorphisms. Our results suggest that these investigated polymorphisms can not be considered as genetic susceptibility markers for lung cancer within the Austrian Caucasian population.
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Affiliation(s)
- A Gsur
- Division of Applied and Experimental Oncology, Institute of Cancer Research, University of Vienna, Austria.
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25
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Aberle SW, Kletzmayr J, Watschinger B, Schmied B, Vetter N, Puchhammer-Stöckl E. Comparison of sequence analysis and the INNO-LiPA HBV DR line probe assay for detection of lamivudine-resistant hepatitis B virus strains in patients under various clinical conditions. J Clin Microbiol 2001; 39:1972-4. [PMID: 11326026 PMCID: PMC88061 DOI: 10.1128/jcm.39.5.1972-1974.2001] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A line probe assay (INNO-LiPA HBV DR) detecting drug-resistant hepatitis B virus (HBV) strains was evaluated. Results concordant with sequence analysis were obtained with 48 of 56 serum samples from HBV-infected patients undergoing lamivudine therapy. In eight cases, additional minor subpopulations could be identified by the line probe assay.
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Affiliation(s)
- S W Aberle
- Institute of Virology, University of Vienna, Kinderspitalgasse 15, A-1095 Vienna, Austria.
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26
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Viard JP, Mocroft A, Chiesi A, Kirk O, Røge B, Panos G, Vetter N, Bruun JN, Johnson M, Lundgren JD. Influence of age on CD4 cell recovery in human immunodeficiency virus-infected patients receiving highly active antiretroviral therapy: evidence from the EuroSIDA study. J Infect Dis 2001; 183:1290-4. [PMID: 11262215 DOI: 10.1086/319678] [Citation(s) in RCA: 183] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2000] [Revised: 01/18/2001] [Indexed: 11/03/2022] Open
Abstract
Influence of age on the CD4 cell response to highly active antiretroviral therapy (HAART) was examined in 1956 patients (median age, 37.2 years) in the EuroSIDA study. Median initial CD4 cell count was 192x106 cells/L, follow-up was 31 months, and time to maximum CD4 cell response was 20 months. Age groups were not different for baseline CD4 cell count, baseline human immunodeficiency virus RNA load, or treatment history. CD4 cell increase, stratified by age quartiles, differed during months 3-36 of HAART (P=.023). Maximum CD4 cell increase from start of HAART differed by age group (P=.0003), as did maximum CD4 cell count (P<10-4). Multivariate analysis confirmed the inverse relationship between age and maximum CD4 cell response (P=.023). Time to a CD4 increase of >200x106 cells/L was shorter for patients in the younger age groups (P=.0026), as confirmed by multivariate analysis (P<10-4). Younger age may favor CD4 cell restoration because of preserved thymic function.
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Affiliation(s)
- J P Viard
- Service d'Immunologie Clinique, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75743 Paris Cedex 15, Paris, France.
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Affiliation(s)
- I Jacobs
- University of Western Australia, Nedlands, Australia.
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28
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29
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Stephens D, Lewis P, Davis A, Gianopoulos I, Vetter N. Hearing aid possession in the population: lessons from a small country. Audiology 2001; 40:104-11. [PMID: 11409762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
The results of several studies on hearing aid use in the Welsh population were considered to investigate some general principles on determinants of such use within the general populations of developed countries. Overall hearing aid possession and use were not found to have changed significantly over the past 18 years, remaining at 4 per cent having obtained hearing aids and 3 per cent using them. The possession figures were consistent across all methodologies used. Higher hearing aid use in the post-industrial valleys (in which the traditional industries of coal mining and steel production had disappeared) was explained entirely by a higher level of reported hearing difficulties there. In all populations, less than 20 per cent of those reporting difficulties possessed hearing aids. Whether a hearing aid had been obtained free of charge from the National Health Service or purchased privately did not influence whether it was still used. It was concluded that an effort to improve the acceptability of hearing aids and reduce their stigma is required.
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Affiliation(s)
- D Stephens
- Welsh Hearing Institute, University Hospital of Wales, Heath Park, Cardiff
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30
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Joly V, Moroni M, Concia E, Lazzarin A, Hirschel B, Jost J, Chiodo F, Bentwich Z, Love WC, Hawkins DA, Wilkins EG, Gatell AJ, Vetter N, Greenwald C, Freimuth WW, de Cian W. Delavirdine in combination with zidovudine in treatment of human immunodeficiency virus type 1-infected patients: evaluation of efficacy and emergence of viral resistance in a randomized, comparative phase III trial. The M/3331/0013B Study Group. Antimicrob Agents Chemother 2000; 44:3155-7. [PMID: 11036040 PMCID: PMC101620 DOI: 10.1128/aac.44.11.3155-3157.2000] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We compared the activity of delavirdine (DLV) plus zidovudine (AZT) (n = 300) with that of AZT (n = 297) against human immunodeficiency virus type 1 in a randomized, double-blind, placebo-controlled trial. DLV exerted a transient antiviral effect, and mutations for resistance to DLV were found in more than 90% of subjects at week 12. The K103N mutation, which confers nonnucleoside reverse transcriptase inhibitor cross-resistance, was found in 85% of the patients.
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Affiliation(s)
- V Joly
- Department of Internal Medicine, Hôpital Bichat, Paris, France.
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31
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Baldaszti E, Wimmer-Puchinger B, Vetter N. [HIV/AIDS in gynecology. On the treatment readiness of established gynecologists for HIV positive women]. Z Geburtshilfe Neonatol 2000; 204:210-7. [PMID: 11199149 DOI: 10.1055/s-2000-9580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Decreasing vertical transmission rates of HIV due to highly active antiretroviral therapy regimens faciliate the choice for childbearing in HIV positive women. Recent trends in epidemiology of HIV show increasing incidence of HIV-related gynecologic diseases. These facts implicate the question about the role of gynecologists in primary care of HIV-infected women and furthermore about the use of health services by HIV-infected women. MATERIALS AND METHODS 143 of the total of 298 office-based gynecologists practicing in Vienna (41%) completed a questionnaire to assess their knowledge, attitudes, and practice with respect to HIV-infection and AIDS. In addition, personal interviews with 30 HIV-positive women were conducted. RESULTS Although about 75% of the gynecologists are willing to care for HIV-positive women in their private practice, only about a third of them already care and 17.9% refuse to care for these patients. More than two thirds of the gynecologists refuse to care for intravenous drug users and patients with manifestations of AIDS. Barriers to care are the fear to be confronted with the psychosocial problems of patients, the fear to need more time to care for these patients and the fear of a lack in knowledge about HIV/AIDS. HIV-positive women are highly satisfied with care, although the majority of the women reported about a lack of confidentiality and therefore did not inform their gynecologist about their HIV-infection. CONCLUSIONS The physician-patient relationship of gynecologists and HIV-positive women is characterized by gynecologist's barriers to care on the one hand, on the other hand HIV-positive women report about a lack of confidentiality, which often is associated with a delay in seeking medical care. DISCUSSION A strategy to overcome gynecologist's barriers in care for HIV-positive women is medical education. The improvement of the physician-patient relationship will enhance the effects of HIV/STD risk assessment as well as the quality of care.
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Affiliation(s)
- E Baldaszti
- Ludwig Boltzmann Institut für Frauengesundheitsforschung, Semmelweis-Frauenklinik Wien.
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32
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Vetter N. [On the way to a tuberculosis-free Central Europe?]. Wien Klin Wochenschr 2000; 112:783-4. [PMID: 11072665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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33
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Vetter N. Doctors and nurses. Sex difference? Is there one? BMJ 2000; 321:699. [PMID: 10987787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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34
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Vetter N. Are Primary Care Trusts an opportunity or a threat to the specialty of public health medicine? J Public Health Med 2000; 22:251-2. [PMID: 11077893 DOI: 10.1093/pubmed/22.3.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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O'Connor C, Vetter N. Comeback kids. Cost control tool spurs hospital turnaround. Mater Manag Health Care 1999; 8:28-31. [PMID: 11067219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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37
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Shah PM, Maesen FP, Dolmann A, Vetter N, Fiss E, Wesch R. Levofloxacin versus cefuroxime axetil in the treatment of acute exacerbation of chronic bronchitis: results of a randomized, double-blind study. J Antimicrob Chemother 1999; 43:529-39. [PMID: 10350383 DOI: 10.1093/jac/43.4.529] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A randomized, double-blind, double-dummy, three-arm parallel design, multicentre study was conducted among adult patients with acute exacerbation of chronic bronchitis (AECB) in order to compare the efficacy and safety of two different doses of levofloxacin with cefuroxime axetil. A total of 832 patients were randomized to receive oral levofloxacin (250 mg od or 500 mg od) or oral cefuroxime axetil (250 mg bd) for 7-10 days. The primary efficacy analysis was based on the clinical response in patients with bacteriologically confirmed AECB, determined 5-14 days after the end of therapy (per-protocol population). Of 839 patients enrolled (at 71 centres in 14 countries), seven were not treated, giving an intention-to-treat (ITT) population of 832. In total, 281 patients received levofloxacin 250 mg, 280 received levofloxacin 500 mg and 271 received cefuroxime axetil. The cure rates in the ITT population were: levofloxacin 250 mg, 70% (196/281); levofloxacin 500 mg, 70% (195/280); cefuroxime axetil, 61% (166/271); those in the per-protocol population were: 78% (121/156), 79% (108/137) and 66% (88/134), respectively. Both doses of levofloxacin were at least as effective as cefuroxime axetil and were active against the main pathogens of clinical relevance (Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis). All three treatment regimens were equally well tolerated. In conclusion, the results show that levofloxacin (250 mg and 500 mg) od is effective and well tolerated in the treatment of AECB in adult patients.
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Affiliation(s)
- P M Shah
- Klinikum der Johann Wolfgang Goethe-Universitaet, Zentrum der Inneren Medizin, Medizinische Klinik III, Schwerpunkt Infektiologie, Frankfurt, Germany.
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38
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Abstract
The identification of HIV strains that are resistant to antiretroviral drugs, which emerge during a patient's therapy or are already present in infected individuals prior to treatment, is of increasing importance for the clinical management of HIV-infected persons. Two different methods were compared for the genotypic detection of resistance development in the HIV-1 reverse transcriptase (RT) gene, the commonly used sequence analysis, and the commercially available RT-line immunoprobe assay (LIPA), which can detect mutations at six separate codons of the RT gene, which are known to confer resistance to certain nucleoside inhibitors. Eighty serum samples from HIV-1-infected persons, some of whom were receiving antiretroviral therapy, were investigated in parallel by sequencing as well as by LIPA. LIPA results agreed with sequence data in the vast majority of the cases. However, in 40% of the samples, LIPA failed to yield evaluable results for one or more of the codon positions. In particular, LIPA detection rate was low at codon 41 (75%), whereas at codons 69/70, 74, 184, and 215 results were obtained from 90%-95% of the samples. A number of mutations in the vicinity of the respective codons were detected by sequencing, and these may have been responsible for the LIPA hybridization failure. There remained a number of samples, however, where no explanation for the lack of hybridization could be derived from sequence data. Our results indicate that the use of the LIPA does not eliminate the need for sequence analysis for detection of drug-resistant HIV strains.
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39
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Norrby SR, Petermann W, Willcox PA, Vetter N, Salewski E. A comparative study of levofloxacin and ceftriaxone in the treatment of hospitalized patients with pneumonia. Scand J Infect Dis 1998; 30:397-404. [PMID: 9817522 DOI: 10.1080/00365549850160710] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A multinational, multicentre, open, randomised study in hospitalised patients with pneumonia compared levofloxacin 500 mg twice daily with ceftriaxone 4 g i.v. once daily. Levofloxacin patients started on i.v. treatment and switched to oral on d 3-5 of therapy if signs and symptoms had improved. The minimum treatment duration was 5 d, except for treatment failure, and the median 8 d. The primary efficacy analysis was based on the per-protocol assessment of the clinical cure rate determined 2-5 d after the end of treatment in the per-protocol (PP) population (levofloxacin 127, ceftriaxone 139). Of 625 patients enrolled and randomized, 6 received no treatment, giving an intention-to-treat (ITT) population of 619 (levofloxacin 314, ceftriaxone 305). At the clinical endpoint, 2-5 d after the end of treatment, the cure rates for levofloxacin and ceftriaxone were similar in both the ITT (76% and 75%, respectively) and PP (87% and 86%, respectively) populations. Both drugs were well tolerated. Twice-daily levofloxacin 500 mg, either i.v. or as sequential i.v./oral therapy, was as effective as i.v. once-daily ceftriaxone 4 g in the treatment of hospitalized patients with pneumonia and offers the advantage of sequential therapy.
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Affiliation(s)
- S R Norrby
- Department of Infectious Disease, University of Lund, Sweden
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40
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Nell H, Buxbaum A, Czedron A, Vetter N. Fatal complication of paraffin plombage after half a century. Wien Klin Wochenschr 1998; 110:729-31. [PMID: 9857432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Complications following thoracic plombage for treatment of tuberculosis can be observed more than 50 years after placement of the filling. The management of these late complications is challenging and frequently requires surgical intervention. We report a patient who received a plombage in 1947. She was admitted to hospital with subfebrile temperature and hoarseness. A computed tomography scan of the chest revealed transthoracic penetration of the paraffin plombage with intrusion into the overlying soft tissue. The patient underwent excision and debridement of the paraffin wax mass followed by thoracoplasty. She then developed septicaemia and died due to multiple organ failure 23 days after the surgical intervention. Early ablation of plombage should be considered in order to prevent late complications.
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Affiliation(s)
- H Nell
- II. Interne Abteilung, Pulmologisches Zentrum der Stadt Wien
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Hollaus P, Pridun N, Vetter N. [Oleothorax: the "bomb" from the past is still ticking]. Wien Klin Wochenschr 1998; 110:697-8. [PMID: 9857425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Ukena D, Harnest U, Sakalauskas R, Magyar P, Vetter N, Steffen H, Leichtl S, Rathgeb F, Keller A, Steinijans VW. [Comparison of addition of theophylline to inhaled steroid with doubling of the dose of inhaled steroid in asthma]. Pneumologie 1998; 52:377-84. [PMID: 9738388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The anti-asthmatic effect of theophylline may supplement those of inhaled steroids in asthma. The aim of the present trial was to study how the addition of theophylline compares to doubling the dose of inhaled steroid in asthmatics who remain symptomatic on beclomethasone dipropionate (BDP) 400 micrograms/day. The trial was designed as a randomized, double-blind, parallel-group study in several European countries. 69 patients were treated for 6 weeks with theophylline plus BDP 400 micrograms/day, compared to 64 patients treated with BDP 800 micrograms/day. The mean +/- SD serum theophylline concentration was 10.1 +/- 4.2 mg/l. Lung function measurements were made throughout the study and patients kept daily records of peak expiratory flow rate (PEF), symptoms and salbutamol usage. Forced expiratory volume in one second and PEF at week 6 were significantly increased by both treatments (p < 0.01). PEF variability was reduced by about 30% in both groups. There were significant improvements in asthma symptoms and rescue medication use (p < 0.001). There were no significant differences between the treatment groups. The study demonstrated clinical equivalence of theophylline plus beclomethasone dipropionate 400 micrograms/day and beclomethasone dipropionate 800 micrograms/day in patients whose asthma is not controlled on beclomethasone dipropionate 400 micrograms/d. The results support the use of theophylline as steroid-sparing agent. The combination of low-dose inhaled steroid plus theophylline is a suitable treatment for moderate asthma.
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Affiliation(s)
- D Ukena
- Medizinische Universitätsklinik, Homburg
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Ukena D, Harnest U, Sakalauskas R, Magyar P, Vetter N, Steffen H, Leichtl S, Rathgeb F, Keller A, Steinijans VW. Comparison of addition of theophylline to inhaled steroid with doubling of the dose of inhaled steroid in asthma. Eur Respir J 1997; 10:2754-60. [PMID: 9493656 DOI: 10.1183/09031936.97.10122754] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The anti-asthmatic effects of theophylline may supplement those of inhaled steroids in asthma. The aim of the present trial was to study how the addition of theophylline compares to doubling the dose of inhaled steroid in asthmatics who remain symptomatic on beclomethasone dipropionate (BDP) 400 microg x day(-1). The trial was designed as a randomized, double-blind, parallel-group study in several European countries. Sixty nine patients were treated for 6 weeks with theophylline plus BDP 400 microg x day(-1), compared to 64 patients treated with BDP 800 micro x day(-1). The mean+/-SD serum theophylline concentration was 10.1+/-4.2 mg x L(-1). Lung function measurements were made throughout the study and patients kept daily records of peak expiratory flow (PEF), symptoms and salbutamol usage. Forced expiratory volume in one second and PEF at week 6 were significantly increased by both treatments (p<0.01). PEF variability was reduced by about 30% in both groups. There were significant improvements in asthma symptoms and rescue medication use (p<0.001). There were no significant differences between the treatment groups. The study demonstrated clinical equivalence of theophylline plus beclomethasone dipropionate 400 microg x day(-1) and beclomethasone dipropionate 800 microg x day(-1) in patients whose asthma is not controlled on beclomethasone dipropionate 400 microg x day(-1). The results support the use of theophylline as a steroid-sparing agent. The combination of low-dose inhaled steroid plus theophylline is a suitable treatment for moderate asthma.
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Affiliation(s)
- D Ukena
- Medizinische Universitätsklinik, Homburg, Germany
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Vetter N, Stamler D, OʼNeill S, Rafferty P, Praz G, Cantolla JD, Pongratz-Roger M, Aigner K, Bolitschek J, Puig JG, Afilalo M, Small D, Winter J. Clarithromycin vs Combined Cefuroxime and Erythromycin in the Treatment of Hospitalised Community-Acquired Pneumonia Patients - Intravenous Followed by Oral Therapy. Clin Drug Investig 1997. [DOI: 10.2165/00044011-199714060-00001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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45
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Vetter N, George M, Lewis P. A district-wide examination of 75-year olds suggests discrimination in the provision of services. Aging (Milano) 1996; 8:205-10. [PMID: 8862196 DOI: 10.1007/bf03339678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The aim of this study was to assess the adequacy of existing services across a whole health district for those aged 75 years, in an attempt to detect shortfalls and biases in the provision of services. This study was carried out as a cross-sectional survey using community based nurses in the county of South Glamorgan. 1376 people in their 75th year who were registered with a general practitioner were visited, and their problems assessed by community based nurses. There was a marked difference in the results of the assessment for different services. It was estimated that 76% of the 75-year olds would benefit from additional health services, and 37% from social services. There was a striking difference between the services in the proportion of people whose problems were satisfactorily solved, according to the criteria used by the community nurses. The proportion of problems that were solved varied according to the degree of dependency of the individuals, and the service involved. Some services showed a clear trend to care more for dependent people; services with a relatively undeveloped home delivery system seemed likely to discriminate against people who were dependent.
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Affiliation(s)
- N Vetter
- Department of Epidemiology and Community Medicine, University of Wales College of Medicine, Cardiff, United Kingdom
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Armbruster C, Schalleschak J, Vetter N, Pokieser L. Pleural effusions in human immunodeficiency virus-infected patients. Correlation with concomitant pulmonary diseases. Acta Cytol 1995; 39:698-700. [PMID: 7631543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The objective of our study was to evaluate the prevalence of pleural effusions in patients with the acquired immunodeficiency syndrome, to correlate these effusions with any concomitant pulmonary diseases and to evaluate the role of cytologic examination in the diagnosis of the effusions. Twenty-eight of 389 (7.2%) human immunodeficiency virus-infected patients had pleural effusions and 27 of the 28 were suffering from concomitant pulmonary diseases. Those diseases were bacterial pneumonia (9), mycobacterial infection (7), non-Hodgkin's lymphoma (4) and Kaposi's sarcoma (2). Pneumocystis carinii pneumonia was diagnosed in two patients, and cytomegalovirus pneumonitis and pulmonary aspergillosis and small cell carcinoma in one patient each. Cytologic examination of pleural effusions provided conclusive diagnoses of mycobacterial infection in 2 of the 7 patients, of non-Hodgkin's lymphoma in 4 and of P carinii infection in 2.
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Affiliation(s)
- C Armbruster
- IInd Medical Department, Pulmologisches Zentrum Vienna, Austria
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Affiliation(s)
- J P Lehrner
- Department of Psychology, University of Vienna, Austria
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Roberts C, Crosby D, Dunn R, Evans K, Grundy P, Hopkins R, Jones JH, Lewis P, Vetter N, Walker P. Rationing is a desperate measure. Health Serv J 1995; 105:15. [PMID: 10140480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- C Roberts
- University of Wales College of Medicine
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Cooper C, Crome P, Lewis P, Vetter N, Dunn R, McAlpine CH, Rein J, Milnes JP, Smith I, Easton PM, Oliphant JB. Effect of NHS and Community Care Act Problem with interpretation. BMJ 1994. [DOI: 10.1136/bmj.309.6954.605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wettengel R, Vetter N, Waardenburg FA. Clarithromycin versus cefaclor for the treatment of mild-to-moderate acute bacterial bronchitis. J Antimicrob Chemother 1993; 31:963-72. [PMID: 8360133 DOI: 10.1093/jac/31.6.963] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Four hundred and eight outpatients with the clinical signs and symptoms of mild-to-moderate acute bronchitis of bacterial aetiology were enrolled in a multicentre, double-blind, randomized clinical trial comparing the efficacy and safety of clarithromycin and cefaclor, both administered orally. Two hundred and seven patients received clarithromycin 250 mg bd and 201 patients received cefaclor 500 mg tds for a maximum of seven days. Clinical and bacteriological evaluations were performed before treatment was initiated, during the course of treatment, and within 72 h of completing therapy; all adverse events were recorded. Two hundred and three patients in the clarithromycin group and 195 in the cefaclor group were evaluable for clinical response and 129 and 124 patients in the clarithromycin and cefaclor groups, respectively, were evaluable for bacteriological response. The clinical response rates three to five days after starting treatment and at the post-treatment assessment were 97% (193/199) and 99.5% (202/203), respectively, for the clarithromycin group and 97.4% (187/192) and 97.9% (191/195), respectively, for the cefaclor group. The bacteriological cure rates were 94.6% (122/129) for the clarithromycin group and 90.3% (112/124) for the cefaclor group. None of the differences between the groups was statistically significant. Adverse events, which were generally mild and predominantly related to the gastrointestinal tract, were reported by 5.8% of clarithromycin-treated patients and 10.4% of cefaclor-treated patients. Adverse reactions caused one patient in the clarithromycin group and three in the cefaclor group to discontinue treatment prematurely. The results of this study indicate that clarithromycin and cefaclor are comparable with respect to efficacy and safety when used as treatment for patients with mild-to-moderate acute bacterial bronchitis.
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Affiliation(s)
- R Wettengel
- Karl-Hansen-Klinik, Bad Lippspringe, Germany
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