Abstract The aims of this study were to evaluate the treatment need of fixed bridges according to the distribution of pontics in dentition in different age groups, and to investigate the primary and late complications and survival of the conventional fixed metal ceramic prostheses, as well as patients' satisfaction with the prosthetic treatment. The whole material consisted of the patients treated with fixed metal ceramic prostheses by undergraduate students at the Institute of Dentistry during the years 1984 - 1996. There were altogether 772 patients, 460 women (60 %) and 312 men (40 %). Their mean age was 47 years (23 - 81 years). Altogether 944 single metal ceramic crowns and 543 fixed bridges (1374 abutments and 807 pontics) were prepared. It can be concluded that the fixed bridges are most often prepared to replace upper first premolars and lower first molars also in the future. The most usual primary complications related to fixed bridges occurred during preprosthetic endodontic treatment of abutment teeth and during the preparation of the root canals. Previous restoration of the prepared tooth does not have any marked effect on the prognosis of single crowns with dowels, although anatomically complicated upper lateral incisors and upper first premolars need special attention in the treatment planning. Patients were satisfied with aesthetics and function of the fixed metal ceramic prostheses. Late complications found in clinical examinations were few, and the survival rate for the fixed metal ceramic bridge prostheses was calculated to be 84 % after 10 years, long fixed bridges having a lower survival than the shorter ones. The treatment need for conventional fixed bridges seems to be highest among patients over 50 years of age in the future. Age does not influence the longevity of the fixed prostheses, but basic circumstances of the mouth, especially low secretion of saliva affected by diseases and/or medications and high scores of lactobacilli and streptococcus mutans of the saliva seem to decrease the survival.

Approximately 10–25% of children and youth suffer from mental health problems, such as depression, emotional difficulties, and disruptive behaviors. The evidence base of the effectiveness of preventive interventions targeting youth mental health currently delivered in regular care is weak. Also, little is known about what is needed for continued delivery of preventive programs in regular care. Hence, there is an evident need of effectiveness evaluations of preventive interventions and their implementation in regular care. In childhood, parenting is an important risk or protective factor for child development, and many programs to improve parents’ parenting has been developed used as preventive interventions. Using an ecological approach to prevention and the prevention research cycle as the theoretical framework this dissertation aim to investigate: 1) the long-term effectiveness of four parenting programs (Cope, Comet, Connect, and the Incredible Years); 2) whether the programs work better for some compared to others; 3) if it matters where parents attend the programs; 4) the field of implementation research regarding group based parenting programs ; and 5) implementation challenges specifically related to such parenting programs. Overall, the long-term results reveal that there are no significant difference in effectiveness across the programs over time. Also, the programs does not seem work better for some compared to others, and neither does it seem as if program effectiveness is much influenced by the sectors delivering the programs (child and adolescent psychiatry, social care, or school). Concerning the implementation of preventive interventions the research base is small, and conclusive evidence concerning implementation aspects of group based parenting programs are non-existing. Thus, it was not possible to draw firm conclusions about their implementation. Nonetheless, existing research clearly suggest that program specific challenges can influence the implementation of group based parenting programs. Implications for practice and research are discussed, for instance, adaptations to the prevention research cycle.

Objectifs : Cette recherche étudie la variabilité de la qualité de vie de femmes atteintes de cancer du sein à l’aide de l’évaluation de facteurs biopsychosociaux, de la mise en évidence du rôle de la surveillance alternée mise en place à l’institut-Du-Sein (Drôme-Ardèche) et de l’étude du lien entre ces facteurs et le vécu de la surveillance post-thérapeutique. Méthode : Population : 30 femmes atteintes d’un cancer du sein non métastasé en rémission âgées de 36 à 78 ans et actuellement sous surveillance à l’Institut Du Sein (Drôme, Ardèche) ont participé à l’étude. Outils : cinq outils ont été utilisés : 1) Un entretien semi-directif abordant les thèmes suivants : la condition de malade et son contexte, l’installation du cancer et dans la maladie et les attentes relatives au suivi ; 2) Le test de l’arbre (Fernandez, 2005, 2010) pour évaluer à partir de constellations de tracés les facteurs psychologiques associées à la maladie ; 3) Le questionnaire d’anxiété et de dépression (HAD) (Zigmund et Snaith, 1983) évaluant la symptomatologie anxieuse et dépressive et sa sévérité ; 4) Le questionnaire d’image corporelle (QIC) (Bruchon-Schweitzer, 1981) afin d’évaluer la satisfaction de l’image corporelle ; 5) Le questionnaire de coping (WCC) (Vitalino et al., 1985 ; Cousson et al., 1996) évaluant les stratégies d’ajustement face au cancer ; 6) Le questionnaire de soutien social spécifique au cancer (QSSS-c) (Segrestan, 2008) qui estime le soutien social perçu ; 7) Le questionnaire de qualité de vie (FACT-B) (Brady et al., 1997) pour évaluer la qualité de vie globale, des symptômes physiques spécifiques et généraux du cancer du sein. Résultats : En s’appuyant sur le modèle transactionnel-intégratif-multifactoriel (TIM) de Bruchon-Schweitzer et Boujut (2014), on retrouve que certains antécédents (niveau d’étude, âge jeune, présence d’enfant à charge, mastectomie et présence d’hormonothérapie dans le traitement) ainsi que les facteurs liés à l’adaptation psychologique (coping, soutien social perçu) et facteurs psychologiques (anxiété, dépression, image corporelle) ont des effets directs sur la QdV et ses dimensions. Aucun effet médiateurs des facteurs transactionnels n’a été retrouvé entre les antécédents et les issus. Conclusion : Le modèle TIM est adapté et prometteur : des liens ont été mis en évidence entre les différents facteurs et le vécu par les patientes de la surveillance post-thérapeutique. L’évaluation de l’anxiété, de la dépression et de l’image corporelle des patientes à chaque étape de la maladie (au diagnostic, à la fin des traitements et en rémission) doit être rendue systématique. Des réajustements de la surveillance alternée mise en place à l’Institut-Du-Sein sont nécessaires. / Objectives: This research deals with the variability of the quality of life of women suffering from a breast cancer, thanks to the assessment of biological, psychological and social factors, of the emphasis of the role of alternative follow-up installed by the Institut Du Sein (Drôme-Ardèche) and the study of the link between these factors, let alone the experience of the post medical supervision. Method: Population: 30 women in remission suffering from a non metastatic breast cancer, aged from 36 to 78 and currently under medical control at the Institut Du Sein were involved in this survey. Tools: 1) A semi guided interview broaching the following themes: the sick person’s condition and her background, the development of cancer as for the illness and the expectations in relation with the aftercare ; 2) The Test de l’arbre (Fernandez, 2005, 2010) to assess the psychological factors associated to the illness due to regrouping of drawing ; 3) The hospital anxiety and depression scale (HAD) (Zigmund et Snaith, 1983) assessing the symptomatic issue and its seriousness ; 4) The body image questionnaire (QIC) (Bruchon-Schweitzer, 1981) so as to assess the satisfaction of the body image ; 5) The way of coping checklist (WCC) (Vitalino et al., 1985 ; Cousson et al., 1996) assessing the adjustment strategies facing cancer ; 6) The cancer specific and social support questionnaire (QSSS-c) (Segrestan, 2008) which takes the social support received into consideration ; 7) The quality of life questionnaire (FACT-B) (Brady et al., 1997) to assess the general quality of life, all the general, physical and specific symptoms of breast cancer. Results: Using the transactionnel-integratif-multifactoriel (TIM) patterns of Bruchon-Schweitzer et Boujut (2014), it seems that certain medical history (educational standards, young age, dependent children, mastectomy and hormonotherapy in the treatment) and factors linked to the psychological adaptability (coping, perceived social support) adding psychological factors linked (anxiety, physical, body image) have direct consequences on the quality of life and its impacts. No mediator effect of the transactional factors was to be found between antecedent and quality of life. Conclusion: The TIM pattern is both adapted and promising: some links between the different factors and how the patients experienced the post medical aftercare were brought into the fore. The assessment of anxiety, depression and body image of the patients at each step of the illness (at the time of the diagnosis, at the end of the treatment and during the remission period) must be automatically done. Some adjustments of the alternative follow-up might be necessary at the Institut Du Sein.

Aujourd’hui, au moins 5 millions d’enfants à travers le monde, sont nés suite au recours de leurs parents à l’AMP. Les traitements de l’infertilité ont significativement évolué, le plus souvent cela a eu lieu en dehors des protocoles expérimentaux classiques. L’exemple le plus marquant a été l’introduction de la FIV avec micro-injection intracytoplasmique d’un spermatozoïde (ICSI). Le manque d’évaluation de la santé des enfants nés de ces techniques reste la faiblesse de cette spécialité. Nous avons mis en place un suivi longitudinal d’une cohorte mono-centrique au sein de l’hôpital Saint-Joseph (Marseille). Le recueil a été fait par la collecte des photocopies des pages du carnet de santé des enfants et de questionnaires remplis par les parents. Notre étude est une des rares études françaises présentant un suivi à long terme, pouvant aller jusqu’à 5 ans, sur une cohorte à grande échelle. L’étude de l’IMC jusqu’à l’âge de 5 ans, n’a pas révélé d’effet de la FIV, comme cela a pu être pressenti dans la littérature. D’autres investigations méritent d’être conduites. Il est important de construire un système d’information cohérent autour de la santé des enfants nés après FIV à cause de l’apparition constante des nouvelles techniques dans cette spécialité, toutes étant potentiellement responsables de risques sur la santé future de l’enfant. La faisabilité de la collecte de données couvrant à la fois l’environnement maternel, conceptionnel et les indicateurs de santé de l’enfant doit être pensée à l’échelle nationale. A cette fin le développement des méthodes de liaison entre les différents registres existants en France serait une des solutions les plus opportunes. / Today, at least 5 million children worldwide were born following the enrollment of their parents in ART program. Infertility treatments have changed significantly; most often these changes took place outside traditional experimental protocols. The most striking event was when IVF with intracytoplasmic sperm injection (ICSI) was introduced in ART practices in 1995. The lack assessment of the health of children born after this technique remains the major weak in this discipline. We established a longitudinal monocentric follow-up study in Saint-Joseph Hospital (Marseille). The data were collected by asking parents to send copies of child health records and questionnaires filled out by them. This investigation is one of the few French studies involving a long-term follow- up to 5 years, in a large scale cohort. The study of BMI up to age 5 years didn’t show the suspected epigenetic influence of IVF reported in literature. Further investigations need to be conducted. It is important to build a coherent information system around the health of children born after IVF. The feasibility of collecting a series of data covering both maternal and conceptional environment, and child health indicators should be considered at the national level through the development of connection methods between different registers developed in France.

Les progrès thérapeutiques réguliers ont transformé le pronostic des enfants atteints de leucémie aiguë, posant avec une grande acuité le problème des effets secondaires tardifs, de l'insertion sociale mais aussi de la qualité de vie des patients et de leur entourage, ainsi que des déterminants mis en jeu. L'ensemble des acteurs du système de soins ont la responsabilité de l'étude de ces effets secondaires tardifs et de leur prise en compte. En 2004, le projet LEA (Leucémie de l'Enfant et de l'Adolescent) a débuté avec pour objectif d'évaluer l'état de santé et la qualité de vie à moyen et long terme de patients traités pour une leucémie aiguë de l'enfance après 1980. La volonté était de mettre en oeuvre un système pouvant produire de la connaissance dans une démarche de recherche traditionnelle, mais aussi de s'inscrire rapidement dans une démarche pragmatique de production d'informations susceptibles de modifier les pratiques de prise en charge et de suivi. L'objectif général de ce travail cherche à démontrer l'utilité de dispositifs lourds comme la mise en oeuvre d'une cohorte, dans la double logique de fournir une information d'une part directement utile à la décision clinique, et d'autre part susceptible d'éclairer la décision publique. Les travaux scientifiques s'articulent autour de : 1. La visibilité de la cohorte LEA au regard des autres dispositifs existants au niveau international ; 2. Les conséquences à distance des traitements lourds reçus par les patients ; 3. La qualité de vie de l'entourage à distance de l'épisode aigu de la maladie ; 4. L'utilité d'un suivi systématisé dans la diminution des inégalités d'accès au système de santé entre les classes sociales. / Regular advances in cancer treatment have dramatically improved the prognosis of children with acute leukemia, raising with a great acuity the problem of the late physical side effects, social integration, quality of life of the patients and their family as well as identification of the determinants of these outcomes. It is the responsibility of all the care system actors to consider these objective and subjective late effects. The LEA project (Leucémie de l'Enfant et de l'Adolescent - childhood and adolescent leukemia) was initiated in 2004 with the aim of studying the long-term health status and quality of life of children treated for leukemia after January 1980. As soon as the project began, the aim was to implement a system that can produce knowledge in a traditional research approach, but also to rapidly become a pragmatic approach of producing information that could affect both care and monitoring practices. The general objective of this manuscript seeks to demonstrate the utility of heavy plan such as the implementation of a cohort, in the double approach of providing information on the one hand directly relevant to clinical decision, and on the other hand likely to enlighten public decision. The present scientific works are based on: 1. The visibility of LEA in relation to other cohorts of childhood cancer survivors existing internationally; 2. The long-term impact of the heavy modalities of treatment, as the hematopoietic stem cell transplantation or irradiation; 3. The quality of life of the family long after the completion of cancer therapy; 4. The usefulness of a systematic follow-up in reducing inequalities in access to health care among social classes.

A aterosclerose é um processo inflamatório crônico e sistêmico, responsável pelo surgimento de eventos cardiovasculares, uma alteração precoce na aterosclerose é a disfunção endotelial. Fatores de risco clássicos, em geral, associam-se a aterosclerose. Porém, cerca de 35% dos coronariopatas não apresentam estes fatores. Estudos têm relacionado concentrações baixas de HDL-C com coronariopatia e disfunção endotelial. Sabe-se também que a lipemia pós-prandial está relacionada alterações na cinética de quilomícrons (QM) e associa-se à doença coronária. Nossa hipótese foi que concentrações baixas de HDL-C, isoladamente, estariam associadas a disfunção endotelial e a diminuição da remoção de remanescentes de quilomícrons; e que o tratamento com niacina de liberação lenta poderia reverter estes efeitos. Estudamos 30 pacientes com HDL-C inferior a 40 mg/dl e 11 controles. Avaliamos a função endotelial por ultra-sonografia de alta resolução da artéria braquial aferindo a dilatação mediada pelo fluxo (DMF) e pela dilatação mediada pelo nitrato (DMN). Avaliamos também a cinética de quilomícrons utilizando a técnica de clearence de quilomícrons artificiais. Idade e altura foram similares em ambos os grupos, porém os pacientes do grupo HDL-C Baixo apresentavam maior peso, IMC e circunferência abdominal. Os pacientes do grupo HDL-C Baixo apresentaram concentrações mais baixas de HDL-C (34,3 +/- 4,6 vs. 50,6 +/- 11,7 mg/dl), p < 0,001. As concentrações de Colesterol Total e LDL-C foram semelhantes em ambos os grupos porém, as concentrações basais de triglicérides e glicemia foram mais elevadas no grupo HDL-C Baixo (113,1 +/- 43,9 vs. 78,9 +/- 35,1; e 96,2 +/- 8,6 vs. 89,9 +/- 7,8), p<0,02 e <0,05 respectivamente. A DMF e a taxa de remoção fracional de colesterol éster (TRF-CE) foram menores no grupo HDL-C Baixo (7,4 +/- 4,1 vs. 12,8 +/- 4,6%; e 0,0036 +/- 0,0051 vs. 0,0122 +/- 0,0084 0,0036 +/- 0,0051min-1), p < 0,001 e < 0,008 respectivamente; a DMN e a taxa de remoção fracional de triglicérides (TRF-TG) foram similares. Os 22 pacientes apresentaram DMF diminuída (< 8 %) e foram divididos aleatoriamente em 2 grupos de 11 indivíduos. Um grupo recebeu 1,5 g/dia de niacina de liberação lenta e o outro placebo. Após 3 meses de tratamento os pacientes do grupo niacina apresentou normalização da DMF que aumentou de 5,44 +/- 1,89% para 11,13 +/-3,4%, p <0,01. Os demais parâmetros não se alteraram em ambos os grupos. Baixas concentrações de HDL-C associaram-se a disfunção endotelial, pela menor DMF, e a menor TRF-CE, ou seja maior permanência de RQM. A niacina corrigiu a disfunção endotelial sem agir nas concentrações lipídicas ou na cinética de lípides / Atherosclerosis is a chronic and systemic inflammatory process that causes the cardiovascular disease. Classical risk factors are, in general, associated to atherosclerosis; however about 35% of the patients do not have those factors. Low HDL-C has been associated to coronary artery disease (CAD) and endothelial dysfunction. Postprandial lipemia is related to changes in chylomicron kinetics and are also related to CAD. Our hypothesis were that low HDL-C would be associated to endothelial dysfunction and slower clearence of chylomicron and remnants; and that treatment with slow release niacin could revert those abnormalities. We studied 30 men with 40 mg/dl or less of HDL-C and 11 controls. We used high resolution ultrasonography on the brachial artery to evaluate flow-mediated dilation (FMD) and nitrate-mediated dilation (NMD) to estimate the flow independent dilation. We also assessed chylomicron kinetics trough the chylomicron-like emulsion clearence technique. Both groups were comparable regarding age, height and total cholesterol and LDL-C concentrations. The low HDL-C group had higher weight, body mass index, abdominal circumference and triglycerides and glucose concentrations (113.1 +/- 43.9 vs. 78.9 +/- 35.1; and 96.2 +/- 8.6 vs. 89.9 +/- 7.8), p<0.02 and <0.05 respectively. This group also had lower concentrtions of HDL-C (34.3 +/- 4.6 vs. 50.6 +/- 11.7 mg/dl, p < 0.001) as expected. The FMD and the cholesterol ester fractional clearence (CEFC) were reduced in the low HDL-C group (7.4 +/- 4.1 vs. 12.8 +/- 4.6%; and 0.0036 +/- 0.0051 vs. 0.0122 +/- 0.0084 vs. 0.0036 +/- 0.0051min-1, p < 0.001 and < 0,008 respectively). The NMD and the triglycerides fractional clearence were similar in both groups. Twenty two low HDL-C patients had a reduced FMD (< 8%) and were randomized in 2 groups of eleven. 1.5 g/day of niacin were given to the first group while the other received placebo. After 3 months the niacin treated patients showed a normalization of FMD (from 5.44 +/- 1.89 to 11.13 +/-3.4%, p <0,01) while the placebo group had no changes (from 5.21 +/- 2.07 vs. 5.69 +/- 2%) . The other variables remained unmodified. In conclusion, low concentrations of HDL-C were associated with endothelial dysfunction and slower chylomicron clearence. Niacin corrected the endothelial dysfunction without affecting the lipids concentration or chylomicron kinetics

Estudo descritivo, correlacional, de delineamento longitudinal, com 78 pacientes que iniciaram anticoagulante oral (ACO) entre abril de 2008 a junho de 2009 em três serviços de saúde de um município do oeste do Paraná. Os objetivos foram avaliar a adesão medicamentosa e comparar a qualidade de vida relacionada à saúde (QVRS) e o estado global de saúde no início e com seis meses de tratamento. Os dados foram coletados por entrevistas individuais com instrumentos específicos para adesão farmacológica (Medida de Adesão ao Tratamento), QVRS (Medical Outomes Survey Short form - SF-36; Duke Anticoagulation Satisfaction Scale DASS), todos validados para o uso no Brasil, e o estado global de saúde (Escala Visual analógica EVA). Foram realizados testes de comparação de médias (Teste t de Student pareado e para amostras independentes), de correlação (coeficiente de correlação de Pearson) e de regressão linear múltipla. O nível de significância foi 0,05. Entre os sujeitos, 53,8% eram mulheres, com idade média de 56,8 anos, casados (71,8%), com baixa escolaridade e 48,7% não desempenhavam atividades remuneradas. As principais indicações para o uso do ACO foram fibrilação atrial (34,6%) e prótese cardíaca mecânica (26,9%) e o ACO mais usado foi a varfarina sódica (91%). Os resultados apontaram que após seis meses, apenas dois participantes foram classificados como não aderentes ao tratamento com ACO e que, no geral, houve melhora na QVRS avaliada por ambos os instrumentos. A avaliação pelo SF-36 mostrou que as diferenças entre os oito domínios foram estatisticamente significantes, exceto para saúde mental. Entretanto, as comparações das médias dos domínios do DASS foram estatisticamente significantes apenas para os domínios Impacto psicológico negativo e Impacto psicológico positivo. O estado global de saúde avaliado pela EVA apresentou valores médios que aumentaram da primeira para segunda avaliação, de 74 para 83, respectivamente, em um intervalo possível de zero a 100. Considerando como variável resposta a medida do DASS total, um modelo de regressão linear multivariada composto pelas variáveis idade, escolaridade, número de medicamentos em uso, indicação para o ACO, dosagem semanal do ACO, Saúde mental (domínio do SF-36), Vitalidade (domínio do SF-36) e intervalo terapêutico explicaram 39,3% da variância da medida da QVRS. Neste modelo, as variáveis com maiores valores de coeficiente beta () e estatisticamente significantes foram: idade (= - 0,317; p=0,017), número de medicamentos usados pelo indivíduo (= -0,353; p=0,005) e saúde mental (= -0,364; p=0,032). Um segundo modelo de regressão linear multivariada foi feito tendo como variável resposta a medida do estado global de saúde. As variáveis explanatórias foram: escolaridade, número de medicamentos em uso, Vitalidade, Saúde mental, Aspectos emocionais e intervalo terapêutico que explicaram 40,4% da variância desta medida. Os resultados obtidos podem subsidiar a prática dos profissionais da saúde na prevenção de fatores que possam afetar à adesão ao medicamento e a qualidade de vida dos usuários de ACO. / A descriptive, correlational design of longitudinal, with 78 patients who initiated oral anticoagulant taking (OAC) within the months of April, 2008 and June, 2009 in three health care services from a municipality of the state of Parana. The aims of this study were to evaluate the medication adherence and compare the health-related quality of life (HRQL) and the global health status in its beginning and within six months of treatment. The datas were all collected through individual interviews making use of specific instruments for pharmacological adherence (Means of Adherence to Treatment), QVRS (Medical Outcomes Survey Short form - SF-36; Duke Anticoagulation Satisfaction Scale DASS), which ones are validated to use in Brazil, and the global health status (Visual Analog Scale VAS).Comparison of average tests were applied (Students test t for paired and independent samples), of correlation (Pearsons correlation test) and of multiple linear regression. The significance level was set at 0,05. Among the subjects, 53,8% were women, at the average age of 56.8, married (71.8%), with low education and 48,7% did not performed any paid job. The main indications to the use of OAC were atrial fibrillation (34,6%) and mechanical cardiac prosthesis (26,9%) and the most used OAC was the warfarin sodium (91%). The results pointed out that after six months, only two participants were classified as not-adherent to treatment with OAC and that, by and large, there was improvement in the HRQL evaluated by both instruments. The evaluation with SF-36 showed that the differences among the eight domains were statistically significant, except for mental health. However, the average comparisons of domains of the DASS were statistically significant only to the negative psychological impact and positive psychological impact domains.The global health status evaluated by VAS presented average score increase from the first to the second evaluation, from 74 to 83, respectively, in a possible interval from zero to 100. Considering it as a variable response to the measurement of the total DASS, a model of linear regression multivariate made up by age variables, education, number of chemicals in use, indication to the OAC, weekly dose of OAC, mental health (domain of SF-36), Vitality (domain of SF-36) and interval therapy explained 39,3% of the variability of the measurement of HRQL. In this model, the variables with higher beta () coefficient scores and statistically significant, were: age (= -0,317; p=0,017), number of chemicals taken by the individual (= -0,353; p=0,005) and mental health (= -0,364; p=0,032).A second model of linear multivariate regression was done, taking into account as a variable response to the measurement of global state of health. The explanatory variables were: education, number of chemicals in use, Vitality, Mental health, Emotional functioning and interval therapy explained 40,4% of the variability of this measurement. The results obtained may subside the practice of healthcare professionals in the prevention of factors that may affect the adherence to the medication and the health-related quality of life of OAC users.

I denna studie undersöktes det om drönare är ett användbart hjälpmedel vid slutavverkningsuppföljning. Uppföljningar gjorda med drönare jämfördes med traditionella fältinventeringar för att se om resultaten skiljde sig åt. De parametrar som har undersökts i studien är högstubbar, naturvårdsträd och körskador. Studien är genomförd på tjugo olika objekt utspritt i delar av Kronoberg, Jönköping och Kalmar län. Utifrån resultaten bedömdes det möjligt att använda drönaren till slutavverkningsuppföljning.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a novel pathogen that emerged in December of 2019 and has since infected people of all ages around the world. Children with acute SARS-CoV-2 infection are largely spared of the severe disease seen in adults. However, a life-threatening, post-viral inflammatory condition known as Multisystem Inflammatory Syndrome – Children (MIS-C) develops in a small fraction of children four to six weeks after either past SARS-CoV-2 infection or exposure and is characterized by high fevers, significant gastrointestinal symptoms and severe cardiac complications. Little is known about the lasting immune profiles of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in children, let alone the long-term effects of the disease in this population. This study presents clinical features and serologic immune profiles of forty-nine pediatric patients (ages 12.4 ± 6.7 years) enrolled in the Massachusetts General Hospital Pediatric COVID-19 Biorepository with previous diagnoses of SARS-CoV-2 infection or the COVID-19-related MIS-C. Thirty-two children ages 0-22 years completed a questionnaire which captured lingering clinical symptoms of COVID-19 and MIS-C at the follow-up timepoint. This questionnaire study revealed significant on-going symptoms in both cohorts, including respiratory, gastrointestinal, neurologic and cardiovascular symptoms. To characterize lasting immune responses following the acute presentation, serum antibodies to S, RBD and N proteins of SARS-CoV-2 were quantified at the follow-up timepoint in forty-nine pediatric patients with past COVID-19 or MIS-C at a mean follow-up timepoint of 6.56 ± 1.75 months. Serologic signatures against SARS-CoV-2 in COVID-19 and severe MIS-C patients were compared at acute illness and at follow-up timepoints. Anti-SARS-CoV-2 antibodies remained elevated over time showing adequate seroconversion. Interestingly, anti-SARS-CoV-2 IgA remained elevated in the vast majority of individuals at follow-up, suggesting continued antigen exposure and mucosal inflammation. This research elucidates whether children maintain antibody levels to SARS-CoV-2 over time and speaks to the differences in antibody recovery to baseline in COVID-19 and MIS-C patients. It also highlights the lingering symptoms in both the COVID-19 and MIS-C cohorts, and suggests the need for significant long-term follow-up in children months, or even years after resolution of acute illness or disease. In total, this study addresses the substantial gap in understanding of the recovery of the adaptive immune system after SARS-CoV-2 infection in children. / 2023-11-09T00:00:00Z

HIV and AIDS pandemic have been declining in South Africa. HIV and AIDS affect individuals, families, organizations and the communities at large. While the roll out of the antiretroviral treatment (ART) has brought much excitement and hope to both patients and the health practitioners, it has also brought challenges (Maskew, Macphail, Menez & Rubel, 2007:853). In order for ART to be effective patients need to adhere to antiretroviral treatment, thus adherence is a critical component of ART. Patients who discontinue treatment are at high risk of illness and death because of AIDS related diseases or developing drug resistant virus. With a better understanding of the reasons for defaulting antiretroviral treatment interventions can be designed to improve adherence to antiretroviral treatment. Thus the purpose of this study was to explore the reasons why HIV and AIDS infected patients default antiretroviral treatment because adherence to ART is of utmost important. Within the context of qualitative and applied research the researcher utilized the collective case study design. Semi structured interviewing was used as data collection method to elicit qualitative information on the reasons why patients default ART. The main research question that was put forward to all participants was: What are your reasons for defaulting ART? The participants in this study were patients who have default their ART during 2012. By using systematic sampling fourteen participants from Thekganang ARV Clinic in Seshego District Hospital, Limpopo province, were selected to form a sample for this study. Some conclusions based on the findings were that: The participants were knowledgeable about the basic facts of HIV and AIDS and they had a good understanding about the importance of adherence even though they defaulted their antiretroviral treatment. The use of ART may also be challenging to individuals. The findings of this study were that not all participants in the study experienced challenges with taking ART. Those who experienced challenges included fear of disclosing HIV status, fear of stigmatization and physical challenges due to ill health. Regarding the reasons for defaulting ART, participants’ reasons for defaulting antiretroviral treatment were similar although some of the reasons applied to only one participant. Participants’ reasons for treatment default were classified into socio-economic factors, patient related, psychological related and medication related factors. Socio- economic factors included shortage of food in the household and lack of money for transport to attend clinic appointments. Patient related factors included substance abuse, lost appointment cards, participants were too busy with personal issues and relocation to another area of residence. Psychological factors that contributed to non-adherence to treatment were depression and denial. Medical related factor voiced was that participant was too confused about the drug regimen. Most participants were satisfied with the services in Thekganang ARV clinic although some participants raised concerns about staff attitudes and long queue. The findings will assist the hospital management and the clinic staff to make informed decisions about the management of defaulters in the clinic. The study was concluded with the relevant recommendations to the ART facilities. The recommendations included implementation of the multi-disciplinary centred approach, establishing patient education programmes and on-going support services to patients who fail to adhere to treatment. Future research studies should determine the prevalence of drug resistant HIV patients in the ART facilities and the development of a systematic method of capturing ‘‘lost to follow up’’ patients who pass away within hospitals. / Dissertation (MA)--University of Pretoria, 2014. / lk2014 / Social Work and Criminology / MA / Unrestricted