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    Immunological failure in HIV-infected adults from 2003 to 2015 in Southwest Ethiopia: a retrospective cohort study
    (BMJ Publishing group, 2018-07-10) Gesesew, Hailay ; Ward, Paul Russell ; Woldemichael, Kifle ; Mwanri, Lillian
    Objective To assess the prevalence, trend and associated factors for immunological failure (IF), and the magnitude of antiretroviral therapy (ART) shift among adults infected with HIV in Southwest Ethiopia. Setting A retrospective cohort study was undertaken using the data from ART clinic at Jimma University Teaching Hospital from 21 June 2003 to 15 March 2015. Participants Retrospective analysis of 4900 HIV-infected adult patient records dating from June 2003 to March 2015 was conducted. Primary outcome measure The primary outcome was IF defined when cluster for differentiation 4 (CD4) count falls to the baseline (or below) or persistent CD4 levels below 100 cells/mm3 after 6 months of ART treatment. The analyses included descriptive and inferential statistics. Results 546 (19.5%) adults had developed clinical failure (CF), 775 (19.7%) adults had developed IF and 1231 (25.1%) had developed either CF or IF or both. The prevalence of IF was consistently high throughout the decade. Age 25 to ≤50 years adjusted OR (AOR 1.5, 9% CI 1.2 to 2.4), being female (AOR 1.8, 95% CI 1.3 to 1.9), late presenter for HIV care (AOR 2.2, 95% CI 1.6 to 2.7) and having baseline CD4 count below 200 cells/mm3 (AOR 5.5, 95% CI 4.1 to 7.4), and having no history of HIV testing before diagnosis (AOR 0.7, 95% CI 0.5 to 0.9) were the predictors for IF. Only 29 (0.9%) adults infected with HIV were shifted to second-line ART regimen. Conclusions The magnitude of CF or IF or both was found significant and consistently high throughout the calendar year although ART shift was found minimal. HIV-infected adult patients with IF were early age adults, females, late presenters for HIV care, and those who had low baseline CD4 counts and history of HIV testing before diagnosis.
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    The acceptability of participating in data linkage research: research with older Australians
    (Wiley, 2018-06-12) Harrison, Stephanie L ; Milte, Rachel ; Bradley, Clare Eileen ; Inacio, Maria C S ; Crotty, Maria
    Australians are increasingly concerned about the privacy of their data, but the biggest concerns relate to online services and identification fraud. Australians may be supportive of research that uses linked data; however, there have been conflicting findings as to whether formal consent from individuals should be sought, and the views of the older population have not been elicited specifically. A previous survey suggested half of Australians would expect consent to be sought for the use of de‐identified health information for research purposes, but the respondents were not specifically asked if they would expect an opt‐in or opt‐out approach to consent. The objectives of the current study were to determine if older Australians would find it acceptable to be part of the proposed registry and to explore different methods of consent.
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    Ecosystem-based translation of health research: expanding frameworks for environmental health
    (Wiley, 2018-08-08) McFarlane, Rosemary ; Butler, Colin David ; Maynard, Simone ; Cork, Steve ; Weinstein, Phillip
    The high capacity of science and health infrastructure in countries such as Australia has contributed to the relatively low public health impact of many environmental health hazards, including our endemic, wildlife‐origin zoonotic diseases. However, understanding how these and other health risks may be reduced within an ecosystem service framework will be increasingly valuable as climate change and pressures on natural environments intensify. Benefits could transcend national boundaries, especially if regional epicentres of ecological, political and social disintegration widen, creating milieux for potential pandemics. We are in a gainful position to progress research and translation of research into policy using the frameworks already available in Australia. This will be strengthened by promoting common language and metrics across disciplines and agencies, including costing that includes externalities and co‐benefits, and by supporting research into ecological linkage mechanisms and the broader ecosystem service ‘settings’ of health risks. Existing tools inclusive of stakeholder inputs can address ecosystem service trade‐offs. These can be used to identify or trial primordial preventative ‘eco‐social’ strategies. Aggregated, these have the potential to address GEC as health risk. We advocate concerted effort to refine these approaches and to promote a sense of urgency in their implementation.
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    Real-world use of fidaxomicin in a large UK tertiary hospital: how effective is it for treating recurrent disease?
    (Elsevier, 2018-05-07) Enoch, David A ; Santos, Reem ; Phillips, Cameron J ; Micallef, Christianne ; Murphy, Michael E ; Aliyu, Sani Hussein ; Massey, Dunecan C O ; Brown, Nicholas M
    All courses of fidaxomicin use in the study hospital were reviewed. It was used for first recurrence (six times), second recurrence (eight times) and one case of third recurrence. One patients received fidaxomicin as first-line treatment. Eight patients initially responded to therapy; of these, three patients were asymptomatic at 90 days, three patients remained asymptomatic at 30 days, and two patients had recurrences five and nine days after stopping therapy. Four patients failed to respond; of these, two patients required faecal transplantation and one patient required a colectomy. Two patients deteriorated and two patients died. Fidaxomicin was well tolerated. These findings suggest that the utility of fidaxomicin at this stage of infection is unclear.
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    Early mortality among children and adults in antiretroviral therapy programs in Southwest Ethiopia, 2003-15
    (Public Library of Science, 2018-06-18) Gesesew, Hailay ; Ward, Paul Russell ; Woldemichael, Kifle ; Mwanri, Lillian
    Background Several studies reported that the majority of deaths in HIV-infected people are documented in their early antiretroviral therapy (ART) follow-ups. Early mortality refers to death of people on ART for follow up period of below 24 months due to any cause. The current study assessed predictors of early HIV mortality in Southwest Ethiopia. Methods We have conducted a retrospective analysis of 5299 patient records dating from June 2003- March 2015. To estimate survival time and compare the time to event among the different groups of patients, we used a Kaplan Meir curve and log-rank test. To identify mortality predictors, we used a cox regression analysis. We used SPSS-20 for all analyses. Results A total of 326 patients died in the 12 years follow-up period contributing to 6.2% cumulative incidence and 21.7 deaths per 1000 person-year observations incidence rate. Eighty-nine percent of the total deaths were documented in the first two years follow up—an early-term ART follow up. Early HIV mortality rates among adults were 50% less in separated, divorced or widowed patients compared with never married patients, 1.6 times higher in patients with baseline CD4 count <200 cells/μL compared to baseline CD4 count ≥200 cells/μL, 1.5 times higher in patients with baseline WHO clinical stage 3 or 4 compared to baseline WHO clinical stage 1 or 2, 2.1 times higher in patients with immunologic failure compared with no immunologic failure, 60% less in patients with fair or poor compared with good adherence, 2.9 times higher in patients with bedridden functional status compared to working functional status, and 2.7 times higher with patients who had no history of HIV testing before diagnosis compared to those who had history of HIV testing. Most predictors of early mortality remained the same to the predictors of an overall HIV mortality. When discontinuation was assumed as an event, the predictors of an overall HIV mortality included age between 25–50 years, base line CD4 count, developing immunologic failure, bedridden functional status, and no history of HIV testing before diagnosis. Conclusions The great majority of deaths were documented in the first two years of ART, and several predictors of early HIV mortality were also for the overall mortality when discontinuation was assumed as event or censored. Considering the above population, interventions to improve HIV program in the first two years of ART follow up should be improved.
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    The health and wellbeing needs of veterans: a rapid review
    (BMC, 2017-12-29) Oster, Candice ; Morello, Andrea ; Venning, Anthony ; Redpath, Paula ; Lawn, Sharon Joy
    Background: For the majority of serving members, life in the military has a positive effect on wellbeing. However, the type, intensity and duration of service, along with the transition from fulltime military to civilian life, may have a negative effect on veterans’ wellbeing. Such negative consequences, alongside the growing veteran population, indicate the need for greater exploration of veterans’ physical, mental and social wellbeing. Methods: The current paper reports on the findings of a rapid review of the literature on the health and wellbeing needs of veterans, commissioned by the Australian Department of Veterans’ Affairs to inform future programs and services. The databases Embase, Medline, Cinahl, PubMed, Web of Science and Cochrane Database were searched for systematic reviews reporting on veterans’ physical, mental and social wellbeing published in English in peerreviewed journals. Results: A total of 21 systematic reviews were included. The reviews reported on a range of mental, physical and social health problems affecting veterans. While there was limited information on prevalence rates of physical, mental and social health problems in veterans compared to civilian populations, the reviews demonstrated the interconnection between these domains and the effect of demographic and military service factors. Conclusions: A key finding of the review is the interconnection of the mental, physical, and social health of veterans, highlighting the importance that an integrated approach to veterans’ wellbeing is adopted. It is suggested that understanding key factors, such as demographic factors and factors relating to military service, can support improved service provision for veterans.