Boucekine M.,Jean Moulin University Lyon 3 |
Loundou A.,Jean Moulin University Lyon 3 |
Baumstarck K.,Jean Moulin University Lyon 3 |
Minaya-Flores P.,Jean Moulin University Lyon 3 |
And 3 more authors.
BMC Medical Research Methodology
Background: Multiple sclerosis (MS), a common neurodegenerative disease, has well-described associations with quality of life (QoL) impairment. QoL changes found in longitudinal studies are difficult to interpret due to the potential response shift (RS) corresponding to respondents' changing standards, values, and conceptualization of QoL. This study proposes to test the capacity of Random Forest (RF) for detecting RS reprioritization as the relative importance of QoL domains' changes over time. Methods. This was a longitudinal observational study. The main inclusion criteria were patients 18 years old or more with relapsing-remitting multiple sclerosis. Every 6 months up to month 24, QoL was recorded using generic and MS-specific questionnaires (MusiQoL and SF-36). At 24 months, individuals were divided into two 'disability change' groups: worsened and not-worsened patients. The RF method was performed based on Breiman's description. Analyses were performed to determine which QoL scores of SF-36 predicted the MusiQoL index. The average variable importance (AVI) was estimated. Results: A total of 417 (79.6%) patients were defined as not-worsened and 107 (20.4%) as worsened. A clear RS was identified in worsened patients. While the mental score AVI was almost one third higher than the physical score AVI at 12 months, it was 1.5 times lower at 24 months. Conclusion: This work confirms that the RF method offers a useful statistical approach for RS detection. How to integrate the RS in the interpretation of QoL scores remains a challenge for future research. Trial registration. ClinicalTrials.gov identifier: NCT00702065. © 2013 Boucekine et al.; licensee BioMed Central Ltd. Source
Dassa D.,Conception University Hospital |
Boyer L.,Timone University Hospital |
Benoit M.,Nice University Hospital Center |
Bourcet S.,Chalucet Hospital |
And 2 more authors.
Australian and New Zealand Journal of Psychiatry
Objective: To quantify the factors associated with non-adherence to medication among stable patients suffering from schizophrenia in the context of universal access to care. Methods: This naturalistic, multicentric study was conducted in 15 French public hospitals in a region of south-eastern France during a 1 week period in 2008. All consecutive outpatients with stable schizophrenia were recruited. Adherence was assessed with the 10-item Drug Attitude Inventory (DAI). Measures included socio-demographic characteristics, clinical characteristics, insight using the Scale to assess Unawareness of Mental Disease (SUMD), and therapeutic alliance using the Patient Session Questionnaire (PSQ). Regression models were used to identify the risk factors associated with non-adherence. Results: The study included 291 patients, 30% of whom were considered to be non-adherent. Non-adherence increased with duration of untreated psychosis (DUP) (OR=1.12, 95%CI=1.03-1.22), lack of insight only for the dimension 'effect of medication' (OR=3.23, 95%CI=1.05-9.89), and a low level of therapeutic alliance (OR=0.45, 95%CI 0.32-0.64). Individuals prescribed atypical antipsychotic drugs were more likely to be adherent than those prescribed typical antipsychotics (OR=0.37, 95%CI=0.13-1.0). Conclusions: DUP, prescription of typical antipsychotics, therapeutic alliance and insight were the most important features associated with non-adherence. This study also suggests that economic factors such as the service delivery system should not be neglected in public strategies aimed at addressing problems of non-adherence in non-universal coverage health systems. © 2010 The Royal Australian and New Zealand College of Psychiatrists. Source
Chenaitia H.,Timone University Hospital
The American journal of emergency medicine
Pulmonary embolism (PE) is a common cause of sudden death; the use of prehospital thrombolysis is currently a last-resort option and requires a prolonged cardiopulmonary resuscitation (CPR). Novel mechanical devices have recently been introduced that provides automatic mechanical chest compression (AMCC) according to the guidelines and continually without decrease efficiency throughout prolonged resuscitation. A 54 year-old woman with a history of breast cancer experienced sudden chest pain and severe dyspnea. A mobile intensive care unit was dispatched to her home. During physical examination, she suddenly collapsed with pulseless electrical activity as the initial rhythm. Prehospital thrombolysis during CPR combined with use of AMCC was performed based on a strongly suspected diagnosis of massive PE. After 75 minutes of effective CPR, return of spontaneous circulation was attained. After admission to an intensive care unit, computed tomographic scan confirmed bilateral PE. The patient was discharged 3 weeks after CPR in good neurologic condition. To our knowledge, this is the first case describing combined use of thrombolysis and AMCC in out-ofhospital cardiac arrest. However, for the time being, prehospital thrombolysis in CPR continues to be a measure that should only be performed on a case-by-case basis based on informed decision. Further studies are needed to evaluate the efficacy and safety of AMCC with thrombolysis and thus prolonged CPR. Source
Tamalet C.,French National Center for Scientific Research |
Obry-Roguet V.,French Institute of Health and Medical Research |
Ressiot E.,French Institute of Health and Medical Research |
Bregigeon S.,French Institute of Health and Medical Research |
And 2 more authors.
Journal of Medical Virology
Natural history of anal intraepithelial neoplasia and anal cancer is not fully understood. Factors associated with cytological abnormalities and predictors of progression to high-grade anal intraepithelial neoplasia still deserve investigation. The aim of this cross-sectional study was to assess the prevalence of HPV types, the relationship between HPV genotypes, HPV 16/18 viral load and cytological abnormalities in male and female HIV-infected patients. One hundred and twenty-two (72.6%) patients were infected with HPV, 75 (61%) had multiple HPV infection, and 94 (77%) had high-risk HPV infection. The most frequently identified HPV types were HPV 16 (64%), HPV 6 (39%), HPV 18 (31%), HPV 53 (14.7%), HPV 33 (10.6%), HPV 11 (8.2%), HPV 70 (5.7%), and HPV 61 (4.9%). The HPV types which were most frequently found in combination were HPV 6+16 (9.8%), 6+16+18 (8.2%), 16+18 (6.6%), 6+18 (4.9%), 16+33 (3.3%), 16+53 (3.3%). Median HPV16 and 18 viral loads were 6.1log10copies/106cells [IQR 5.0-7.3] and 6.1log10copies/106cells [IQR 5.7-6.0], respectively. Male gender (P=0.03, OR: 1.2 [1.0-1.4]) and homo/bisexual transmission routes (P=0.044, OR: 1.4 [1.0-1.9]) were associated with HPV 16 infection. An HPV 16 viral load cut-off ≥5.3log10copies/106cells and a CD4+ cell count ≤200/μl were independent factors associated with abnormal cytology. In the absence of national consensus guidelines, a strict regular follow-up at shorter intervals is recommended for HIV-infected patients with abnormal cytology, especially low grade squamous intraepithelial lesions, an HPV 16 viral load ≥5.3log/106cells and a CD4+ cell count ≤200/μl. J. Med. Virol. 86:419-425, 2014. © 2013 Wiley Periodicals, Inc. Source
Baumstarck K.,Nord University Hospital |
Pelletier J.,Timone University Hospital |
Aghababian V.,Aix - Marseille University |
Reuter F.,Timone University Hospital |
And 4 more authors.
Background: Cognitive impairment occurs in about 50% of multiple sclerosis (MS) patients, and the use of self-reported outcomes for evaluating treatment and managing care among subjects with cognitive dysfunction has been questioned. The aim of this study was to provide new evidence about the suitability of self-reported outcomes for use in this specific population by exploring the internal structure, reliability and external validity of a specific quality of life (QoL) instrument, the Multiple Sclerosis International Quality of Life questionnaire (MusiQoL). Methods: Design: cross-sectional study. Inclusion criteria: MS patients of any disease subtype. Data collection: sociodemographic (age, gender, marital status, education level, and occupational activity) and clinical data (MS subtype, Expanded Disability Status Scale, disease duration); QoL (MusiQoL and SF36); and neuropsychological performance (Stroop color-word test). Statistical analysis: confirmatory factor analysis, item-dimension correlations, Cronbach's alpha coefficients, Rasch statistics, relationships between MusiQoL dimensions and other parameters. Principal Findings: One hundred and twenty-four consecutive patients were enrolled. QoL scores did not differ between the 69 cognitively non-impaired patients and the 55 cognitively impaired patients, except for the symptoms dimension. The confirmatory factor analysis performed among the impaired subjects showed that the structure of the questionnaire matched with the initial structure of the MusiQoL. The unidimensionality of the MusiQoL dimensions was preserved, and the internal validity indices were satisfactory and close to those of the reference population. Conclusions/Significance: Our study suggests that executive dysfunction did not compromise the reliability and the validity of the self-reported QoL questionnaires. © 2012 Baumstarck et al. Source