Prospective Cohort Study Of Persons Research Articles

Influence of dietary pattern on anti-tuberculosis treatment outcomes in persons with dysglycemia: a Peruvian prospective cohort study.

Dietary patterns (DPs) are associated with overall nutritional status and may alter the clinical prognosis of tuberculosis. This interaction can be further intricated by dysglycemia (i.e., diabetes or prediabetes). Here, we identified DPs that are more common with tuberculosis-dysglycemia and depicted their association with tuberculosis treatment outcomes. A prospective cohort study of persons with tuberculosis and their contacts was conducted in Peru. A food frequency questionnaire and a multidimensional systems biology-based analytical approach were employed to identify DPs associated with these clinical groups. Potential independent associations between clinical features and DPs were analyzed. Three major DPs were identified. TB-dysglycemia cases more often had a high intake of carbohydrates (DP1). Furthermore, DP1 was found to be associated with an increased risk of unfavorable TB outcomes independent of other factors, including dysglycemia. Our findings suggest that the evaluation of nutritional status through DPs in comorbidities such as dysglycemia is a fundamental action to predict TB treatment outcomes. The mechanisms underlying the association between high intake of carbohydrates, dysglycemia, and unfavorable tuberculosis treatment outcomes warrant further investigation.

Impact of adverse drug reactions on the outcomes of tuberculosis treatment.

Adverse drug reactions (ADR) challenge successful anti-tuberculosis treatment (ATT). The aim of this study was to evaluate the impact of ATT-associated ADR and related factors on ATT outcomes. A prospective cohort study of persons with tuberculosis (TB) at a referral center in Rio de Janeiro, Brazil, from 2010 to 2016. Baseline information: race, sex, schooling, economic status, tobacco, drugs and alcohol abuse, HIV-infection status and comorbidities were captured during TB screening and diagnosis. Laboratory exams were performed to confirm TB diagnosis and monitor ADRs, favorable (cure and treatment completion) and unfavorable (death, loss to follow up and failure) outcomes were prospectively captured. The Kaplan-Meier curve was used to estimate the probability of ADR-free time. A logistic regression analysis (backward elimination) was performed to identify independent associations with unfavorable outcomes. 550 patients were enrolled, 35.1% were people living with HIV (PLHIV) and ADR occurred in 78.6% of all participants. Smoking (OR: 2.32; 95% CI:1.34-3.99) and illicit-drug use (OR:2.02; 95% CI:1.15-3.55) were independent risk factors for unfavorable outcomes. In PLHIV, alcohol abuse and previous ART use were associated with unfavorable outcomes. In contrast, ADR increased the odds of favorable outcomes in the overall population. PLHIV more frequently experienced grade 3/4-ADR (18.36%), especially "liver and biliary system disorders". Lower CD4 counts (<100 cells/uL) were associated with hepatotoxicity (p = 0.03). ART-naïve participants presented a higher incidence of ADR in comparison with ART-experienced patients. Substance use was associated with unfavorable outcomes, highlighting the need for better strategies to reduce this habit. In contrast, ADRs were associated with favorable outcomes. Attention to the occurrence of ADR in PLHIV is essential, especially regarding hepatotoxicity in those with high immunosuppression.

Infections averted by a comprehensive HIV prevention intervention and its cost-effectiveness: a prospective cohort study of persons who inject drugs in Delhi, India

ABSTRACT This paper presents the cost-effectiveness of a WHO-recommended harm-reduction programme implemented among a cohort of persons who inject drugs in Delhi, India. We estimate the number of infections averted using Bernoulli process model and calculate cost-effectiveness ratio as the total programme cost per infection averted. The intervention averted 996 HIV infections over 36 months, with a cost-effectiveness ratio of INR 24,763 (US$ 476) per infection averted per year. The first phase, when HIV testing and counselling were initiated, was more cost-effective than the second phase when full intervention package, including needle-syringe exchange, condom distribution, harm-reduction education, etc., was implemented.

Longitudinal Median Nerve Ultrasound Changes in Individuals With Spinal Cord Injury and an Age- and Sex-Matched Nondisabled Cohort.

To assess the natural history for development of carpal tunnel syndrome (CTS) in persons with acute spinal cord injury (SCI) at 1 year postdischarge from initial rehabilitation and to assess baseline median nerve (MN) cross-sectional area (CSA) above/below 10 mm2 correlates with any longitudinal changes in quantitative ultrasound (US) of the MN. A prospective cohort study of persons with acute SCI evaluated for CTS using quantitative US and compared to a group without SCI (non-SCI). Academic medical center. N=69 total (N=34 SCI, N=35 non-SCI). The average age in both groups was 28 and the SCI group included 30 males and 2 females and the non-SCI group included 30 males and 3 females. Not applicable. The primary outcome was the change in quantitative US parameters of the MN, including CSA and grayscale, from baseline to 1-year follow-up in those with SCI and those without SCI. CTS symptomatology and physical exam sum score and US measures for dominant and nondominant arms were considered secondary outcomes. The SCI had darker nerves at baseline (P=.036, nondominant), greater CTS symptoms at follow-up (P≤.036, bilateral), and no differences in all change scores (all P≥.056). Individuals with smaller nerves at baseline had larger increases in nerve size (P=.029, nondominant) vs those with larger nerves. Change in CTS symptoms CSA (nondominant) and nerve echogenicity (dominant) were inversely associated with their respective baseline values (all P≤.045). We observed few differences between the SCI group and the non-SCI control group and between those with smaller vs larger MN. In general, MN pathology changes (CTS symptoms and US variables) over 1 year were more common in the nondominant arm and appear to be a function of MN pathology at enrollment. Individuals with SCI may experience increased CTS symptoms as soon as 1 year after injury.

Design and implementation of a prospective cohort study of persons living with and without HIV infection who are initiating medication treatment for opioid use disorder

BackgroundOpioid use disorder (OUD) negatively impacts the HIV continuum of care for persons living with HIV. Medication treatment for OUD (MOUD) may have differential biological effects in individuals with HIV and OUD. To address the question of modulation of immune responses by MOUDs, we describe state of the art systems biology approaches to carry out the first prospective, longitudinal study of persons with and without HIV infection with OUD initiating MOUD. MethodsA prospective cohort study of persons with DSM-5 diagnosed OUD who are living with and without HIV infection and initiating treatment with methadone or buprenorphine is underway to assess biological effects of these medications on immunobiological outcomes. ResultsWe describe the recruitment, laboratory, and statistical methods of this study as well as the protocol details. Of those screened for enrollment into the study, 468 (36%) were eligible and 135 were enrolled thus far. Retention through month 6 has been high at 80%. ConclusionsThis study will use state of the art systems biology approaches to carry out the first prospective, longitudinal studies of persons living with and without HIV with DSM-5 OUD initiating treatment with MOUD.

Recent incarceration and risk of first-time injection initiation assistance: A prospective cohort study of persons who inject drugs

BackgroundGiven the prevalence and harms of incarceration among persons who inject drugs (PWID) and their role in injection drug use initiation, we aimed to investigate whether recent incarceration influences the likelihood PWID assist others in their first-ever injection. MethodsProspective cohort study of PWID in Vancouver, Canada who had their PReventing Injecting by Modifying Existing Responses (PRIMER) baseline visit between December 2014 and May 2017, reported never providing injection initiation assistance previously, and had ≥1 follow-up visit. The primary outcome, provision of injection initiation assistance, was defined via self-report as helping anybody inject for the first time in the past six months. The primary exposure was recent incarceration, i.e., self-report of being jailed, imprisoned or detained in the past six months. Participants were assessed biannually until November 2017, drop-out, or their first report of the primary outcome. Results1,199 PWID (62.1% male; mean (SD) age, 44.4 (12.3) years) were included in our study. Across 4,171 follow-up visits, 67 participants (5.6%) reported providing injection initiation assistance. The proportion of participants reporting recent incarceration varied between 2.4% to 5.1% per follow-up visit. Based on a multivariable discrete-time proportional hazards regression analysis, recent incarceration was associated with an increased risk of providing injection initiation assistance during the same six-month period (adjusted hazard ratio, 2.64; 95% CI, 1.19 to 5.86). ConclusionsThe observed association between recent incarceration and risk of providing injection initiation assistance suggests that incarceration could be contributing to the expansion of injection drug use practices within vulnerable populations over time.

Prevalence, Incidence, and Clearance of Human Papillomavirus Types Covered by Current Vaccines in Men With Human Immunodeficiency Virus in the SUN Study.

High-risk anal human papillomavirus (HPV) infection is prevalent among men living with human immunodeficiency virus (HIV); the association between 9-valent (9v) high-risk HPV (HR-HPV) vaccine types and abnormal cytology has not been well characterized. We followed a prospective cohort study of persons with HIV at 7 HIV clinics in 4 US cities from March 2004 through June 2012. Annually, providers collected separate anal swabs for HPV detection and cytopathologic examination. Among men, we examined prevalence, incidence, and clearance of 9v HR-HPV vaccine types, compared with other HR types, and associations with abnormal cytology to assess potential vaccine impact. Baseline prevalence of any anal 9v HR-HPV type among men who have sex with men (MSM) and men who have sex with women (MSW) was 74% and 25% (P < .001), respectively. Among 299 MSM, abnormal cytology was detected in 161 (54%) MSM and was associated with the presence of any 9v HR-HPV (relative risk [RR], 1.8 [95% confidence interval {CI}, 1.3-2.6]; P < .001). Among 61 MSW, abnormal anal cytology was detected in 12 (20%) and was associated with the presence of any 9v HR-HPV (RR, 4.3 [95% CI, 1.6-11.5]; P < .001). Among men with HIV, the prevalence of the 7 HR-HPV types in the 9v vaccine was high and was associated with abnormal cytology. These findings indicate that men with HIV could benefit from prophylactic administration of the 9v HPV vaccine.

Home care aides' observations and machine learning algorithms for the prediction of visits to emergency departments by older community-dwelling individuals receiving home care assistance: A proof of concept study.

BackgroundOlder individuals receiving home assistance are at high risk for emergency visits and unplanned hospitalization. Anticipating their health difficulties could prevent these events. This study investigated the effectiveness of an at-home monitoring method using social workers’ observations to predict risk for 7- and 14-day emergency department (ED) visits.MethodsThis was a prospective cohort study of persons ≥75 years, living at home and receiving assistance from home care aides (HCA) at 6 French facilities. After each home visit, HCAs reported on participants’ functional status using a smartphone application that recorded 27 functional items about each participant (e.g., ability to stand, move, eat, mood, loneliness). We recorded ED visits. Finally, we used machine learning techniques (i.e., leveraging random forest predictors) to develop a 7- and 14-day predictive algorithm for the risk of ED visit.ResultsThe study included 301 participants, and the HCA made 9,987 observations. Over the mean 10-month follow-up, 97 participants (32%) had at least one ED visit. Modeling techniques identified 9 contributory factors from the longitudinal records of the HCA and developed a predictive algorithm for the risk of ED visit. The predictive performance (i.e., the area under the ROC curve) was 0.70 at 7 days and 0.67 at 14 days.InterpretationFor frail elders receiving in-home care, information on functional status collected by HCA helps predict the risk of ED visits 7 to 14 days in advance. A survey system for real-time identification of risks could be developed using this exploratory work.

The Beijing Desheng Diabetic Eye Study: rationale, design, methodology and baseline data.

To present the rationale, design, methodology, and the baseline data of the Beijing Desheng Diabetic Eye Study (BDDES), and to determine the prevalence of diabetic retinopathy (DR) and possible risk factors in patients with type 2 diabetes mellitus (T2DM) in an urban community of Beijing, China. Community-based prospective cohort study of persons diagnosed with T2DM aged 30y or older. The main variables of interest are the presence and progression of DR as determined by the standardized ETDRS grading of seven fields fundus photographs. The presence and severity of DR were analyzed for possible correlations to non-genetic and genetic dispositions. A total of 1438 participants with data available for analysis, the prevalence of any DR was 35.4%. The prevalence of mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR, and proliferative diabetic retinopathy was 27.7%, 2.6%, 0.5% and 4.5%, respectively. By multiple logistic regression analysis, risk factors for the presence of any DR included male (P=0.031), lower income level (P=0.011), lower education background (P=0.022), longer duration of diabetes (P=0.001), younger age at diabetic onset (P=0.001), higher systolic blood pressure (P=0.007), higher glycosylated hemoglobin A1c levels (P=0.001), high albuminuria (P=0.03), and use of insulin (P<0.001). For vision-threatening DR, four factors were significant: younger age at diabetic onset (P<0.001), higher systolic blood pressure (P=0.042), high albuminuria (P<0.001), and use of insulin (P<0.001). The BDDES is the first large-scale ongoing cohort study of a Chinese urban population of persons with type 2 diabetes. Using standardized grading system comparable to large cohort studies from western populations, our baseline data shows that the prevalence of DR and major risk factors in this Chinese ethnic population are comparable to that found in the western population studies.

Briefer activation time is associated with better outcomes after out-of-hospital cardiac arrest

BackgroundTreatment of out-of-hospital cardiac arrest (OHCA) requires prompt intervention. Better outcomes are associated with briefer time from dispatch of emergency medical services (EMS) providers to arrival on scene, application of a defibrillator or insertion of an advanced airway. We assessed whether time from receipt of a call by a telecommunicator to dispatch of EMS providers was associated with outcomes. MethodsThis was a retrospective analysis of a prospective cohort study of persons who had OHCA treated by EMS providers in Seattle, WA. Activation interval was defined as time from call pick up by telecommunicator to notification of EMS providers to respond to the call. Response interval was defined as the time from notification of EMS providers to their arrival at patient side. We determined the association between time intervals and outcomes of sustained restoration of spontaneous circulation (ROSC), survival to hospital discharge and neurologically favorable survival using multiple logistic regression. Secondary analyses assessed the relative contribution of activation versus response interval, and adjusted for post-treatment patient and EMS characteristics. ResultsAmong 2,687 patients, activation interval was mean 1.2±0.6min. Response interval was mean 6.1±2.4min. 1,232 (45.9%) achieved ROSC; 475 (17.7%) survived to discharge; and 428 (15.9%) had favorable neurologic status at discharge. Compared to an activation interval of at least 1.5min, patients with briefer intervals were more likely to survive to discharge (adjusted odds ratio (OR) for <1min, 1.69 (95% confidence interval (CI), 1.26, 2.28); adjusted odds ratio for 1 to 1.49min, 1.54 (95% CI, 1.14, 2.08); p value=0.002). With baseline survival of 10%, the absolute increase in survival associated with a 30s decrease in activation interval was 0.7% and for a 30s decrease in response interval was 0.4%. ConclusionsBriefer activation interval was independently associated with greater survival. Further research is needed to assess whether reduction of the activation interval improves outcome after OHCA.

Changes in life satisfaction in persons with spinal cord injury during and after inpatient rehabilitation: adaptation or measurement bias?

PurposeTo analyze changes in life satisfaction (LS) scores over time in persons with spinal cord injury (SCI) and to interpret what these changes mean.MethodsMulticenter, prospective cohort study of persons with SCI (n = 96) classified into 3 life satisfaction trajectories identified earlier. Assessment took place 6 times from the start of active rehabilitation up to 5 years after discharge. Three LS scores were compared: (1) LS ‘now’ score, (2) ‘comparison’ score between LS ‘now’ and LS ‘before the SCI’, and (3) retrospective score of LS ‘before the SCI’.ResultsPersons in the low LS trajectory showed increase in the LS ‘now’ score, but not in the LS ‘comparison’ score and retrospective score. Persons in the recovery trajectory showed increase in the LS ‘now’ and LS ‘comparison’ scores, but not in the retrospective score. Persons in the high LS trajectory showed increase in the ‘comparison’ LS score and decrease in the retrospective score, but no change in the LS ‘now’ score.ConclusionsDiverging patterns of change were found and that were interpreted as adaptation or scale recalibration. Recalibration could also be considered healthy rebalancing after SCI. Being able to compare different LS ratings can facilitate the interpretation of change in and stability of LS.

Predicting tooth loss during a population-based study: role of attachment level in the presence of other dental conditions.

Our objectives were to quantify: 1) the association between incident tooth loss and prior periodontal attachment level; and 2) the contribution to tooth loss made by non-periodontal conditions in increasingly periodontally involved teeth. The Florida Dental Care Study was a prospective cohort study of persons who at baseline had at least 1 tooth and were 45 years or older. In-person interviews and clinical examinations were conducted at baseline, and at 24 and 48 months, with telephone interviews at 6-month intervals in between. A regression model was used to simultaneously quantify tooth-specific predictors of tooth loss, with person-level factors taken into account. Of the 687 persons who participated for a 48-month clinical examination, 36% lost 1 or more teeth during follow-up, and 5.0% of all teeth were lost. Attachment level up to 2 years before tooth loss was strongly predictive of incident tooth loss, with increases in risk for each millimeter in attachment loss. Certain other tooth-specific conditions (tooth mobility, bulk restoration fracture, decayed surfaces, filled surfaces, tooth type and arch location, root fragment) were strongly and independently associated with increased risk for tooth loss, while others were not (prosthetic crown coverage, cusp fracture, root surface defect). Propensity to choose extraction over other treatment alternatives, as reported by participants at baseline, was also strongly predictive of tooth loss. Increasingly severe attachment level was consistently associated with an increased risk for tooth loss in this sociodemographically diverse sample, with or without other tooth-specific conditions taken into account.