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Kirkland Lake, Canada

Racine N.,Montreal Heart Institute | Hamet P.,University of Montreal | Sampalis J.S.,JSS Medical Research Inc. | Sampalis J.S.,McGill University | And 2 more authors.
Journal of Human Hypertension

The impact of an ARB, with or without hydrochlorothiazide (HCTZ), on glycaemic factors and the risk for developing diabetes in hypertensive patients with the metabolic syndrome have not been fully assessed. This was a 52-week multicentre, prospective, phase-IV, open-label, cohort study of losartan or losartan/HCTZ in hypertensive patients with metabolic syndrome. All subjects were treated initially with losartan 50 mg day-1. Those not achieving target blood pressure (BP <140/90 mm Hg) were titrated sequentially to losartan 100 mg, losartan 100 mg/HCTZ 12.5 mg, losartan 100 mg/HCTZ 25 mg and finally to losartan 100 mg/HCTZ 25 mg and calcium-channel blocker (CCB), as required. The primary glycaemic outcome measure was change in fasting blood glucose (FBG) and glycosylated haemoglobin A1c (HbA1c) at 52 weeks of treatment. Among the 1897 potentially eligible patients enrolled in the study, 1714 fulfilled the screening criteria. During the 52-week treatment period of the study, FBG and HbA1c did not change significantly. Clinically important and statistically significant changes were observed for both the systolic (SBP) and diastolic BP (DBP) during the study treatment period, with an overall mean decrease of 16.95 mm Hg in SBP (P=0.001) and 9.84 mm Hg in DBP (P=0.001). The majority of the patients (77.3%) achieved a target BP of <140/90 mm Hg. In conclusion, losartan, either alone or in combination with HCTZ, is effective in managing hypertension without inducing any change in glycaemic parameters or increasing the risk for developing diabetes in hypertensive patients with the metabolic syndrome. © 2010 Macmillan Publishers Limited All rights reserved. Source

Drolet M.,University of Quebec | Brisson M.,University of Quebec | Brisson M.,Laval University | Maunsell E.,University of Quebec | And 7 more authors.
Sexually Transmitted Diseases

Background: The burden of anogenital warts will be a determining factor when making decisions about the type of human papillomavirus (HPV) vaccine to be used (bivalent or quadrivalent) and whether to vaccinate males. We conducted a multicenter prospective study to (1) describe the impact of anogenital warts on quality of life and (2) estimate the quality-adjusted life-years (QALYs) lost due to anogenital warts. Methods: Between September 2006 and February 2008, 272 patients with a first or recurrent episode of anogenital warts were recruited from the clinical practices of 42 physicians across Canada. Quality of life was measured at recruitment, and 2 and 6 months later with the EuroQol, Short Form-12, short Spielberg State-Trait Anxiety Inventory, and HPV impact profile. The duration of an episode and QALYs lost due to anogenital warts were estimated among 51 incident cases recruited within 90 days of disease onset. RESULTS:: Anogenital warts had a significant impact on the quality of life. This negative impact was similar for first and recurrent episodes, and lasted as long as lesions persisted. Anogenital warts had the greatest negative impact on usual activities, pain/discomfort, and anxiety/depression, and on self-image, sexual activity, and partner issues and possible transmission. The median duration of a first anogenital wart episode amongst incident cases was 125 days and resulted in QALYs lost of 0.017 to 0.041, which is equivalent to 6 to 15 days of healthy life lost. Conclusions: The burden of anogenital warts is substantial and should be considered by physicians and public health officials when making recommendations about HPV vaccination. © 2011 American Sexually Transmitted Diseases Association All rights reserved. Source

Lima V.D.,British Columbia Center for Excellence in | Lima V.D.,University of British Columbia | Harrigan P.R.,British Columbia Center for Excellence in | Harrigan P.R.,University of British Columbia | And 7 more authors.
American Journal of Epidemiology

Given the recent evolution of therapeutic trends, the frequency and determinants of multiclass-resistant HIV infection in the modern combination highly active antiretroviral therapy (HAART) era are less well understood. In this study, the authors characterize the epidemiology of antiretroviral multiclass resistance among HAART-naïve patients enrolled in a province-wide HAART distribution program in British Columbia, Canada. HAART and resistance testing are free to eligible individuals in British Columbia. This study was based on patients who initiated naïve on HAART and were followed during January 1, 2000-June 30, 2007. Explanatory logistic and survival models were built to identify those factors most influential in the emergence of multiclass resistance. Among the 1,820 individuals in our study, 833 (46%) were tested for antiretroviral resistance at least once during their follow-up. Multiclass resistance was observed in 142 individuals (n = 833; 17%) during a median follow-up of 14 months (interquartile range, 3-34 months) (incidence rate, 0.8 cases/1,000 person-months). The authors found that initial nonnucleoside reverse transcriptase inhibitor-based HAART was the main determinant of multiclass resistance. Given that these inhibitors are still widely used, priority should be given to make resistance testing and viral load monitoring a standard part of human immunodeficiency virus care to maximize the long-term efficacy and efficiency of HAART. © 2010 The Author. Source

Drolet M.,Center Hospitalier Affilie | Drolet M.,Laval University | Brisson M.,Center Hospitalier Affilie | Brisson M.,Laval University | And 7 more authors.

Background Data on the impact of abnormal cervical smear results on health-related quality of life (HrQoL) are scarce. We aimed to (i) prospectively assess the HrQoL of women who were informed of an abnormal smear result; (ii) identify predictors of greater negative psychosocial impact of an abnormal result; and (iii) prospectively estimate the quality-adjusted life-years (QALYs) lost following an abnormal result. Methods Between 08/2006 and 08/2008, 492 women with an abnormal result and 460 women with a normal result, frequency matched for age and clinic, were recruited across Canada. HrQoL was measured at recruitment and 4 and 12 weeks later with the EuroQol, Short Form-12, short Spielberg State-Trait Anxiety Inventory (STAI) and HPV Impact Profile. Three blocks of potential predictors of higher psychosocial impact were tested by hierarchical modeling: (i) socio-demographics; (ii) sexual activity; and (iii) smear result severity, communication, and understanding. Results Receiving an abnormal result significantly increased anxiety (STAI mean difference between both groups = 8.3). Initial anxiety decreased over time for the majority of women. However, 35% of women had clinically meaningful anxiety at 12 weeks (i.e. STAI scores ≥0.5 standard deviation of the controls). These women reported a lower socio-economic level, did not completely understand the information about their result and perceived themselves at higher risk of cancer. QALY lost following an abnormal result were between 0.007 and 0.009. Conclusions Receiving an abnormal smear has a statistically significant and clinically meaningful negative impact on mental health. However, this negative impact subsides after 12 weeks for the majority of women. Copyright © 2011 John Wiley & Sons, Ltd. Copyright © 2011 John Wiley & Sons, Ltd. Source

Benbernou A.,University of Quebec | Benbernou A.,Laval University | Drolet M.,University of Quebec | Drolet M.,Laval University | And 9 more authors.
European Journal of Pain

Background: Herpes zoster results from the reactivation of the varicella-zoster virus, which is often accompanied by a prodrome of dermatomal pain. Little is known about the burden of prodromal pain. Objectives: (1) Describe the frequency, severity and duration of prodromal pain; (2) determine the relationship between prodromal pain and the characteristics of herpes zoster at recruitment and the utilization of health care resources. Methods: Between 10/2005 and 07/2006, 251 subjects ≥50 years old, seeking care for herpes zoster within 14 days of rash onset, were recruited across Canada. Severity and duration of prodromal pain were measured retrospectively using the Initial Zoster Impact Questionnaire. The burden of prodromal pain was obtained by the product of pain severity and duration. The severity of acute herpes zoster pain was measured using the Zoster Brief Pain Inventory. Results: The majority of participants reported prodromal pain (74%). Mean pain duration and severity were 4.7 days and 6/10, respectively. Subjects aged 61-70 years old were more likely to report prodromal pain (RR = 1.14, p-value = 0.02). The burden of prodromal pain was greater in subjects not working (p-value = 0.02) or immunosuppressed (p-value = 0.04). Prodromal pain was associated with more severe acute pain (6.2 vs. 4.3, p-value < 0.0001). Compared to subjects who did not report prodromal pain, those with this pain were more likely to receive antivirals (RR = 1.18, p-value = 0.04) and to visit the emergency room (RR = 2.56, p-value = 0.04). Conclusion: The burden of prodromal pain is significant and should be considered when evaluating the overall benefit of herpes zoster vaccination. © 2011 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved. Source

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