Effect of antiretroviral therapy on patients' economic well being: five-year follow-up.
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ABSTRACT:
SUBMITTER: Rosen S
PROVIDER: S-EPMC3893293 | biostudies-other | 2014 Jan
REPOSITORIES: biostudies-other
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Effect of antiretroviral therapy on patients' economic well being: five-year follow-up.
Rosen Sydney S Larson Bruce B Rohr Julia J Sanne Ian I Mongwenyana Constance C Brennan Alana T AT Galárraga Omar O
AIDS (London, England) 20140101 3
<h4>Objective</h4>Evaluate the effect of antiretroviral therapy (ART) on South African HIV patients' economic well being, as indicated by symptoms, normal activities, employment, and external support, during the first 5 years on treatment.<h4>Methods</h4>Prospective cohort study of 879 adult patients at public or nongovernmental clinics enrolled before ART initiation or on ART less than 6 months and followed for 5.5 years or less. Patients were interviewed during routine clinic visits. Outcomes ...[more]
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Project description:ObjectiveTo compare community involvement of pediatricians exposed to enhanced residency training as part of the Dyson Community Pediatrics Training Initiative (CPTI) with involvement reported by a national sample of pediatricians.MethodsA cross-sectional analyses compared 2008-2010 mailed surveys of CPTI graduates 5 years after residency graduation with comparably aged respondents in a 2010 mailed national American Academy of Pediatrics survey of US pediatricians (CPTI: n = 234, response = 56.0%; national sample: n = 243; response = 59.9%). Respondents reported demographic characteristics, practice characteristics (setting, time spent in general pediatrics), involvement in community child health activities in past 12 months, use of ≥1 strategies to influence community child health (eg, educate legislators), and being moderately/very versus not at all/minimally skilled in 6 such activities (eg, identify community needs). χ(2) statistics assessed differences between groups; logistic regression modeled the independent association of CPTI with community involvement adjusting for personal and practice characteristics and perspectives regarding involvement.ResultsCompared with the national sample, more CPTI graduates reported involvement in community pediatrics (43.6% vs 31.1%, P < .01) and being moderately/very skilled in 4 of 6 community activities (P < .05). Comparable percentages used ≥1 strategies (52.2% vs 47.3%, P > .05). Differences in involvement remained in adjusted analyses with greater involvement by CPTI graduates (adjusted odds ratio 2.4, 95% confidence interval 1.5-3.7).ConclusionsFive years after residency, compared with their peers, more CPTI graduates report having skills and greater community pediatrics involvement. Enhanced residency training in community pediatrics may lead to a more engaged pediatrician workforce.
| S-EPMC4067634 | biostudies-literature
Project description:ImportanceEnsuring the well-being of the 73 million children in the United States is critical for improving the nation's health and influencing children's long-term outcomes as they grow into adults.ObjectiveTo examine recent trends in children's health-related measures, including significant changes between 2019 and 2020 that might be attributed to the COVID-19 pandemic.Design, setting, and participantsAnnual data were examined from the National Survey of Children's Health (2016-2020), a population-based, nationally representative survey of randomly selected children. Participants were children from birth to age 17 years living in noninstitution settings in all 50 states and the District of Columbia whose parent or caregiver responded to an address-based survey by mail or web. Weighted prevalence estimates account for probability of selection and nonresponse. Adjusted logistic regression models tested for significant trends over time.Main outcomes and measuresDiverse measures pertaining to children's current health conditions, positive health behaviors, health care access and utilization, and family well-being and stressors.ResultsA total of 174 551 children were included (annual range = 21 599 to 50 212). Between 2016 and 2020, there were increases in anxiety (7.1% [95% CI, 6.6-7.6] to 9.2% [95% CI, 8.6-9.8]; +29%; trend P < .001) and depression (3.1% [95% CI, 2.9-3.5] to 4.0% [95% CI, 3.6-4.5]; +27%; trend P < .001). There were also decreases in daily physical activity (24.2% [95% CI, 23.1-25.3] to 19.8% [95% CI, 18.9-20.8]; -18%; trend P < .001), parent or caregiver mental health (69.8% [95% CI, 68.9-70.8] to 66.3% [95% CI, 65.3-67.3]; -5%; trend P < .001), and coping with parenting demands (67.2% [95% CI, 66.3-68.1] to 59.9% [95% CI, 58.8-60.9]; -11%; trend P < .001). In addition, from 2019 to 2020, there were increases in behavior or conduct problems (6.7% [95% CI, 6.1-7.4] to 8.1% [95% CI, 7.5-8.8]; +21%; P = .001) and child care disruptions affecting parental employment (9.4% [95% CI, 8.0-10.9] to 12.6% [95% CI, 11.2-14.1]; +34%; trend P = .001) as well as decreases in preventive medical visits (81.0% [95% CI, 79.7-82.3] to 74.1% [95% CI, 72.9-75.3]; -9%; trend P < .001).Conclusions and relevanceRecent trends point to several areas of concern that can inform future research, clinical care, policy decision making, and programmatic investments to improve the health and well-being of children and their families. More analyses are needed to elucidate varying patterns within subpopulations of interest.
| S-EPMC8922203 | biostudies-literature
Project description:PurposeTo identify 5-year survival prognostic variables in patients with colorectal cancer (CRC) and to propose a survival prognostic score that also takes into account changes over time in the patient's health-related quality of life (HRQoL) status.MethodsProspective observational cohort study of CRC patients. We collected data from their diagnosis, intervention, and at 1, 2, 3, and 5 years following the index intervention, also collecting HRQoL data using the EuroQol-5D-5L (EQ-5D-5L), European Organization for Research and Treatment of Cancer's Quality of Life Questionnaire-Core 30 (EORTC-QLQ-C30), and Hospital Anxiety and Depression Scale (HADS) questionnaires. Multivariate Cox proportional models were used.ResultsWe found predictors of mortality over the 5-year follow-up to be being older; being male; having a higher TNM stage; having a higher lymph node ratio; having a result of CRC surgery classified as R1 or R2; invasion of neighboring organs; having a higher score on the Charlson comorbidity index; having an ASA IV; and having worse scores, worse quality of life, on the EORTC and EQ-5D questionnaires, as compared to those with higher scores in each of those questionnaires respectively.ConclusionsThese results allow preventive and controlling measures to be established on long-term follow-up of these patients, based on a few easily measurable variables.Implications for cancer survivorsPatients with colorectal cancer should be monitored more closely depending on the severity of their disease and comorbidities as well as the perceived health-related quality of life, and preventive measures should be established to prevent adverse outcomes and therefore to ensure that better treatment is received.Trial registrationClinicalTrials.gov identifier: NCT02488161.
| S-EPMC9998584 | biostudies-literature
Project description:PURPOSE: To assess longitudinal changes in parapapillary atrophy in the adult population of Greater Beijing. METHODS: The population-based Beijing Eye Study 2006 included 3251 subjects who had participated in the Beijing Eye Study 2001 and returned for re-examination. The mean age was 60.4 ± 10.1 years. Using optic disc photographs, we measured parapapillary atrophy which was divided into alpha zone and beta zone. RESULTS: Overall progression rate of alpha zone was seen in 0.6 ± 0.1% (95% confidence interval (CI):0.3,0.9) of the subjects and of beta zone in 8.2 ± 0.5% (95%CI:7.2,9.1) of the subjects. In binary regression analysis, rate of progression of alpha zone was significantly associated higher age (P = 0.04) and the co-progression of zone Beta (P<0.001). Rate of progression of beta zone was significantly associated with higher age (P<0.001; odds ratio (OR):1.11;95%CI:1.10,1.14), higher intraocular pressure (P<0.001;OR:1.10;95%CI:1.05,1.14), higher myopic refractive error (P<0.001;OR:0.71; 95%CI:0.67,0.75), rural region of habitation (P = 0.002;OR: 0.58; 95%CI:0.41,0.82), presence of glaucomatous optic nerve damage (P<0.001;OR:2.89; 95%CI:1.62,5.14), co-progression of alpha zone (P<0.001;OR:7.13;95%CI:2.43,20.9), absence of arterial hypertension (P = 0.03;OR: 0.70; 95%CI:0.51,0.96), and thicker central corneal thickness (P = 0.02;OR:1.01;95%CI:1.00,1.01). Subjects with a non-glaucomatous optic nerve damage (n = 22) as compared to the remaining subjects did not vary in the progression rate of alpha zone (0.0% versus 0.6 ± 0.1%; P = 1.0) and beta zone (8.2 ± 0.5% versus 6.3 ± 0.6%;P = 1.0). CONCLUSIONS: In adult Chinese in Greater Beijing, the 5-year progression rate of beta zone of parapapillary atrophy (seen in 8.2 ± 0.5% of subjects) was significantly correlated with higher age, rural region of habitation, absence of arterial hypertension, higher intraocular pressure, higher myopic refractive error, thicker central corneal thickness, and presence of glaucoma. It was not associated with non-glaucomatous optic nerve damage.
| S-EPMC3346821 | biostudies-other
Project description:ImportanceShort-term results support antibiotics as an alternative to surgery for treating uncomplicated acute appendicitis, but long-term outcomes are not known.ObjectiveTo determine the late recurrence rate of appendicitis after antibiotic therapy for the treatment of uncomplicated acute appendicitis.Design, setting, and participantsFive-year observational follow-up of patients in the Appendicitis Acuta (APPAC) multicenter randomized clinical trial comparing appendectomy with antibiotic therapy, in which 530 patients aged 18 to 60 years with computed tomography-confirmed uncomplicated acute appendicitis were randomized to undergo an appendectomy (n = 273) or receive antibiotic therapy (n = 257). The initial trial was conducted from November 2009 to June 2012 in Finland; last follow-up was September 6, 2017. This current analysis focused on assessing the 5-year outcomes for the group of patients treated with antibiotics alone.InterventionsOpen appendectomy vs antibiotic therapy with intravenous ertapenem for 3 days followed by 7 days of oral levofloxacin and metronidazole.Main outcomes and measuresIn this analysis, prespecified secondary end points reported at 5-year follow-up included late (after 1 year) appendicitis recurrence after antibiotic treatment, complications, length of hospital stay, and sick leave.ResultsOf the 530 patients (201 women; 329 men) enrolled in the trial, 273 patients (median age, 35 years [IQR, 27-46]) were randomized to undergo appendectomy, and 257 (median age, 33 years, [IQR, 26-47]) were randomized to receive antibiotic therapy. In addition to 70 patients who initially received antibiotics but underwent appendectomy within the first year (27.3% [95% CI, 22.0%-33.2%]; 70/256), 30 additional antibiotic-treated patients (16.1% [95% CI, 11.2%-22.2%]; 30/186) underwent appendectomy between 1 and 5 years. The cumulative incidence of appendicitis recurrence was 34.0% (95% CI, 28.2%-40.1%; 87/256) at 2 years, 35.2% (95% CI, 29.3%-41.4%; 90/256) at 3 years, 37.1% (95% CI, 31.2%-43.3%; 95/256) at 4 years, and 39.1% (95% CI, 33.1%-45.3%; 100/256) at 5 years. Of the 85 patients in the antibiotic group who subsequently underwent appendectomy for recurrent appendicitis, 76 had uncomplicated appendicitis, 2 had complicated appendicitis, and 7 did not have appendicitis. At 5 years, the overall complication rate (surgical site infections, incisional hernias, abdominal pain, and obstructive symptoms) was 24.4% (95% CI, 19.2%-30.3%) (n = 60/246) in the appendectomy group and 6.5% (95% CI, 3.8%-10.4%) (n = 16/246) in antibiotic group (P < .001), which calculates to 17.9 percentage points (95% CI, 11.7-24.1) higher after surgery. There was no difference between groups for length of hospital stay, but there was a significant difference in sick leave (11 days more for the appendectomy group).Conclusions and relevanceAmong patients who were initially treated with antibiotics for uncomplicated acute appendicitis, the likelihood of late recurrence within 5 years was 39.1%. This long-term follow-up supports the feasibility of antibiotic treatment alone as an alternative to surgery for uncomplicated acute appendicitis.Trial registrationClinicalTrials.gov Identifier: NCT01022567.
| S-EPMC6233612 | biostudies-literature
Project description:AimsThe long-term outcomes of the intracoronary delivery of autologous bone marrow-derived cells (BMCs) after acute myocardial infarction are not well established. Following the promising 1 year results of the REGENERATE-AMI trial (despite it not achieving its primary endpoint), this paper presents the analysis of the 5 year clinical outcomes of these acute myocardial infarction patients who were treated with an early intracoronary autologous BMC infusion or placebo.Methods and resultsA 5 year follow-up of major adverse cardiac events (defined as the composite of all-cause death, recurrent myocardial infarction, and all coronary revascularization) and of rehospitalization for heart failure was completed in 85 patients (BMC n = 46 and placebo n = 39). The incidence of major adverse cardiac events was similar between the BMC-treated patients and the placebo group (26.1% vs. 18.0%, P = 0.41). There were no cases of cardiac death in either group, but an increase in non-cardiac death was seen in the BMC group (6.5% vs. 0%, P = 0.11). The rates of recurrent myocardial infarction and repeat revascularization were similar between the two groups. There were no cases of rehospitalization for heart failure in either group.ConclusionThis 5 year follow-up analysis of the REGENERATE-AMI trial did not show an improvement in clinical outcomes for patients treated with cell therapy. This contrasts with the 1 year results which showed improvements in the surrogate outcome measures of ejection fraction and myocardial salvage index.
| S-EPMC8934988 | biostudies-literature
Project description:BackgroundPositive psychology indicators like well-being and life satisfaction may play a pivotal role in pain-related outcomes. In this study, we aimed to examine the prospective associations of positive well-being and life satisfaction with pain severity.Methods and subjectsThis longitudinal study, with a follow-up of 2 years, included 9361 participants (4266 males, 5095 females; mean age: 52.5 years; SD: 17.5) without and with chronic pain (CP) at baseline. All analyses were stratified by the two sub-cohorts-participants without CP (sub-cohort 1) and participants with CP (sub-cohort 2) at baseline. The predictive associations, assessed using ordinal regression in a Generalized Linear Model, were adjusted for baseline potential confounders and reported as odds ratios (ORs) with corresponding 95% confidence intervals (CIs).ResultsAfter adjustments, in sub-cohort 1 positive well-being at baseline was associated with lower severe pain at follow-up compared to participants with severe distress (OR: 0.64; 95% CI 0.49-0.84; p < 0.001). In sub-cohort 2, both positive well-being and life satisfaction at baseline were associated with lower severe pain at follow-up compared to participants with severe distress and not satisfied with life (OR: 0.80; 95% CI 0.65-0.98; p = 0.031 and OR: 0.82; 95% CI 0.69-0.96; p = 0.014, respectively).ConclusionsPositive well-being is predictive of lower pain severity both among participants without and with CP at baseline, whereas life satisfaction was found predictive of lower pain severity only for subjects with CP. Future research should emphasize implementing treatments associated with promoting and maintaining positive well-being and life satisfaction in patients who suffer from chronic pain and in risk populations.
| S-EPMC6543656 | biostudies-literature
Project description:ImportanceThere is a paucity of high-quality evidence about the long-term effects (ie, 3-5 years and beyond) of arthroscopic partial meniscectomy vs exercise-based physical therapy for patients with degenerative meniscal tears.ObjectivesTo compare the 5-year effectiveness of arthroscopic partial meniscectomy and exercise-based physical therapy on patient-reported knee function and progression of knee osteoarthritis in patients with a degenerative meniscal tear.Design, setting, and participantsA noninferiority, multicenter randomized clinical trial was conducted in the orthopedic departments of 9 hospitals in the Netherlands. A total of 321 patients aged 45 to 70 years with a degenerative meniscal tear participated. Data collection took place between July 12, 2013, and December 4, 2020.InterventionsPatients were randomly allocated to arthroscopic partial meniscectomy or 16 sessions of exercise-based physical therapy.Main outcomes and measuresThe primary outcome was patient-reported knee function (International Knee Documentation Committee Subjective Knee Form (range, 0 [worst] to 100 [best]) during 5 years of follow-up based on the intention-to-treat principle, with a noninferiority threshold of 11 points. The secondary outcome was progression in knee osteoarthritis shown on radiographic images in both treatment groups.ResultsOf 321 patients (mean [SD] age, 58 [6.6] years; 161 women [50.2%]), 278 patients (87.1%) completed the 5-year follow-up with a mean follow-up time of 61.8 months (range, 58.8-69.5 months). From baseline to 5-year follow-up, the mean (SD) improvement was 29.6 (18.7) points in the surgery group and 25.1 (17.8) points in the physical therapy group. The crude between-group difference was 3.5 points (95% CI, 0.7-6.3 points; P < .001 for noninferiority). The 95% CI did not exceed the noninferiority threshold of 11 points. Comparable rates of progression of radiographic-demonstrated knee osteoarthritis were noted between both treatments.Conclusions and relevanceIn this noninferiority randomized clinical trial after 5 years, exercise-based physical therapy remained noninferior to arthroscopic partial meniscectomy for patient-reported knee function. Physical therapy should therefore be the preferred treatment over surgery for degenerative meniscal tears. These results can assist in the development and updating of current guideline recommendations about treatment for patients with a degenerative meniscal tear.Trial registrationClinicalTrials.gov Identifier: NCT01850719.
| S-EPMC9270699 | biostudies-literature
Project description:Active surveillance (AS) is an important yet underutilized strategy to reduce prostate cancer (PCa) overtreatment.To examine the 5-yr outcomes of AS in a population-based setting.From the National Prostate Cancer Register of Sweden, we identified 11 726 men ?70 yr diagnosed with very low-risk to intermediate-risk PCa from 2003 to 2007 who completed 5 yr of follow-up. Of these men, 1729 (15%) chose AS for the primary management strategy.We calculated the probability of discontinuation of AS over time, and Cox proportional hazards models were used to determine factors associated with discontinuation. Reasons for discontinuation were assessed by data extraction from medical charts.By 5 yr, 64% of the men remained on AS. Predictors of discontinuation were younger age, fewer comorbidities, more education, higher prostate-specific antigen (PSA), and clinical stage T2 disease; marital status did not predict discontinuation. In a subset with data on the reason for discontinuation (86%), 20% of men discontinued because of patient preference, 52% because of PSA progression, 24% because of biopsy progression, and 3% for other reasons.In a population-based setting, the majority of men remained on AS at 5 yr. However, one-fifth of the men who discontinued AS did so for nonbiologic reasons. Thus, there is a need for support and counseling for men to continue AS in the absence of signs of progression to improve adherence to AS and decrease overtreatment.Active surveillance (AS) is an important option to delay or avoid treatment for men with favorable prostate cancer features. This study shows that at 5 yr, 64% of men across an entire population remained on AS. We concluded that AS is a durable option and that counseling may be useful to promote adherence for men without progression.
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Project description:In 2009, Mekele, the capital of the Tigray Region in Ethiopia, presented a mean prevalence of 44.7% of schistosomiasis (S. mansoni) in school children. Termed a public health problem, NALA, an international public health non-governmental organization, and their partners implemented a novel model of intervention, which aimed to compliment mass drug administration (MDA) campaigns with behavioral change (BC) and improved sanitation to achieve sustained elimination of schistosomiasis. The four-year intervention (2009-2012) covered 38 primary schools. The objective of this study was to examine factors associated with control or resurgence of the disease, and the association between the behavioral change program and disease prevalence, ten years after initiation. Eleven primary schools were selected for this follow-up study. All students provided a stool sample and filled in a knowledge, attitude and practice (KAP) questionnaire. In seven out of eleven schools (63.6%) the prevalence of schistosomiasis was maintained below 2% ten years after the initiation of the intervention. In four schools, prevalence returned to pre-intervention levels, defining them as persistent hot spots (PHS). Students from PHS schools scored lower on KAP questionnaires compared to students from responder schools; 3.9 ± 0.9 vs. 4.2 ± 0.9 (p-value < 0.001) for practice questions and 4.4 ± 1.4 vs. 4.6 ± 1.5 (p-value = 0.03) for attitude questions. The prevalence of schistosomiasis correlated positively with age, (p-value = 0.049), sex (relative risk = 1.7, p-value < 0.001), and location. Semi-urban locations (n = 382) had higher disease prevalence than urban locations (n = 242), (22.7% vs. 5.5%, p-value < 0.001). Students residing in semi-urban areas and close to a river (<500 m) were at higher risk of contracting schistosomiasis than those living in urban areas far from the river (RR = 5.95, p-value < 0.001). Finally, a correlation between prevalence and proximity of schools to rivers was found (semi-urban areas; RR = -0.91, p-value = 0.001 vs. urban areas; RR = -0.51, p-value = 0.001). Soil-transmitted-helminths prevalence in 2009 was 8.1% and declined during the intervention years to 0.5%. Prevalence in 2018 was found to be stable at 0.8%. These results demonstrate the long-term success of NALAs' comprehensive model of intervention for elimination of schistosomiasis in school children, combining behavioral change and improved sanitation with MDA.
| S-EPMC9501490 | biostudies-literature