<p>Many studies have reported low cure rates for multidrug-resistant tuberculosis (MDRTB) patients and MDR-TB patients co-infected with human immunodeficiency virus (HIV). However, little is&nbsp / known about the effect of HIV infection and antiretroviral therapy on the treatment outcomes of MDR-TB in South Africa. Therefore, the objectives of the study are: to find out whether HIV infection&nbsp / and interactions between ARVs and second line anti-TB drugs have an impact on the following MDR-TB treatment outcomes: cure rate and treatment failure at Brewelskloof Hospital. MDR-TB&nbsp / patients were treated for 18-24 months. The study was designed as a case-control retrospective study comparing MDR-TB treatment outcomes between HIV positive (cases) and HIV negative&nbsp / patients (controls). Patients were included in the study only if they complied with the following criteria: sensitivity to second line anti-TB drugs, MDR-TB infection, co-infection with HIV (for some&nbsp / of them), male and female patients, completion of treatment between 1 January 2006 and 31 December 2008. Any patients that presented with extreme drug-resistant tuberculosis (XDR-TB)&nbsp / were excluded from the study. Data were retrospectively collected from each patient&rsquo / s medical records. There were a total of 336 patients of which 242 (72%) were MDR-TB patients and 94&nbsp / (27.9%) MDRTB co-infected with HIV patients. Out of the 242 MDR-TB patients, 167 (69.2%) were males and 75 (30.7%) were females. Of the 94 patients with MDR-TB co-infected with HIV, 51&nbsp / (54.2%) males and 43 (45.7%) females. Patients with multidrug-resistant tuberculosis co-infected with HIV who qualify for antiretroviral therapy were treated with stavudine, lamivudine and&nbsp / efavirenz while all MDR-TB patients were given kanamycin, ethionamide, ofloxacin, cycloserine and pyrazinamide. The cure rate of MDR-TB in HIV (+) patients and in HIV (-) patients is 34.5%&nbsp / and 30 % respectively. There is no significant difference between both artes (pvalue = 0.80). The MDR-TB cure rate in HIV (+) patients taking antiretroviral drugs and in HIV (+) patients without&nbsp / antiretroviral therapy is 35% and 33% respectively. The difference between both rates is not statistically significant. The study shows that 65 (28.0%) patients completed MDR-TB treatment but&nbsp / could not be classified as cured or failure, 29 (12.5%) patients failed, 76 (32.7%) defaulted, 18 (7.7%) were transferred out and 44 (18.9%) died. As far as treatment completed and defaulted is concerned,&nbsp / there is no significant statistical difference between HIV (+) and HIV (-) The number of patients who failed the MDR-TB treatment and who were transferred out is significantly higher in the HIV (-)&nbsp / group than in the HIV (+) group. Finally the number of MDR-TB patients who died is significantly higher in the HIV (+) group). The median (range) duration of antiretroviral therapy before starting&nbsp / anti-tuberculosis drugs is 10.5 (1-60) months. According to this study results, the MDR-TB treatment cure rate at Brewelkloof hospital is similar to the cure rate at the national level. The study also&nbsp / hows that HIV infection and antiretroviral drugs do not influence any influence on MDR-TB treatment outcomes.</p>

<p>Many studies have reported low cure rates for multidrug-resistant tuberculosis (MDRTB) patients and MDR-TB patients co-infected with human immunodeficiency virus (HIV). However, little is&nbsp / known about the effect of HIV infection and antiretroviral therapy on the treatment outcomes of MDR-TB in South Africa. Therefore, the objectives of the study are: to find out whether HIV infection&nbsp / and interactions between ARVs and second line anti-TB drugs have an impact on the following MDR-TB treatment outcomes: cure rate and treatment failure at Brewelskloof Hospital. MDR-TB&nbsp / patients were treated for 18-24 months. The study was designed as a case-control retrospective study comparing MDR-TB treatment outcomes between HIV positive (cases) and HIV negative&nbsp / patients (controls). Patients were included in the study only if they complied with the following criteria: sensitivity to second line anti-TB drugs, MDR-TB infection, co-infection with HIV (for some&nbsp / of them), male and female patients, completion of treatment between 1 January 2006 and 31 December 2008. Any patients that presented with extreme drug-resistant tuberculosis (XDR-TB)&nbsp / were excluded from the study. Data were retrospectively collected from each patient&rsquo / s medical records. There were a total of 336 patients of which 242 (72%) were MDR-TB patients and 94&nbsp / (27.9%) MDRTB co-infected with HIV patients. Out of the 242 MDR-TB patients, 167 (69.2%) were males and 75 (30.7%) were females. Of the 94 patients with MDR-TB co-infected with HIV, 51&nbsp / (54.2%) males and 43 (45.7%) females. Patients with multidrug-resistant tuberculosis co-infected with HIV who qualify for antiretroviral therapy were treated with stavudine, lamivudine and&nbsp / efavirenz while all MDR-TB patients were given kanamycin, ethionamide, ofloxacin, cycloserine and pyrazinamide. The cure rate of MDR-TB in HIV (+) patients and in HIV (-) patients is 34.5%&nbsp / and 30 % respectively. There is no significant difference between both artes (pvalue = 0.80). The MDR-TB cure rate in HIV (+) patients taking antiretroviral drugs and in HIV (+) patients without&nbsp / antiretroviral therapy is 35% and 33% respectively. The difference between both rates is not statistically significant. The study shows that 65 (28.0%) patients completed MDR-TB treatment but&nbsp / could not be classified as cured or failure, 29 (12.5%) patients failed, 76 (32.7%) defaulted, 18 (7.7%) were transferred out and 44 (18.9%) died. As far as treatment completed and defaulted is concerned,&nbsp / there is no significant statistical difference between HIV (+) and HIV (-) The number of patients who failed the MDR-TB treatment and who were transferred out is significantly higher in the HIV (-)&nbsp / group than in the HIV (+) group. Finally the number of MDR-TB patients who died is significantly higher in the HIV (+) group). The median (range) duration of antiretroviral therapy before starting&nbsp / anti-tuberculosis drugs is 10.5 (1-60) months. According to this study results, the MDR-TB treatment cure rate at Brewelkloof hospital is similar to the cure rate at the national level. The study also&nbsp / hows that HIV infection and antiretroviral drugs do not influence any influence on MDR-TB treatment outcomes.</p>

Psychotherapy is sought for diverse problems, and trust in its efficacy has led to increasing parity in insurance coverage for psychological services. But about half of those who begin therapy drop out prematurely, and only about half of those who complete therapy experience significant improvements. Here issues of efficacy measurement and the potential role of personality differences to better guide and assess treatment are explored. It is hoped this knowledge could lead to increased success rates. In terms of outcome measurement, the use and psychometric properties of the Outcome Questionnaire-45 (OQ-45), a popular, brief measure of psychological functioning and change, are assessed. Factor structure is tested in clinical (Study 1) and student (Study 2) samples. Alternative scoring models test whether dimensions of personality drive responses. Using bi-level models, including a total score factor, fit of the intended structure and three- and four-factor personality models was similar. A seven-factor problems model provided the best fit. About half the variance in OQ scores was accounted for by a Big Six personality inventory. The best items for assessing personality attributes in OQ-45 data are noted. Secondly, the relation between personality attributes and clinical presentation and outcomes is explored. Self-report scores on personality attributes predict virtually every life outcome and are highly associated with clinical presentation. Such attributes surely also play a role in treatment, but this association has not been widely studied. In Study 3 the relation of personality attributes to presentation, usage, and outcome is tested in a Couples and Family Therapy clinic sample (N = 222). Neuroticism was strongly associated with initial OQ-45 score, as were other scales (except Openness) to a lesser degree. Being older, more educated, and married predicted attending more sessions, and being older, female, and higher income predicted termination success. Personality scales did not play a role in either outcome. Honesty/Propriety and Neuroticism were, however, associated with steeper decrease in OQ-45 scores over time. / 2015-10-10

Magister Pharmaceuticae - MPharm / Many studies have reported low cure rates for multidrug-resistant tuberculosis (MDRTB) patients and MDR-TB patients co-infected with human immunodeficiency virus (HIV). However, little is known about the effect of HIV infection and antiretroviral therapy on the treatment outcomes of MDR-TB in South Africa. Therefore, the objectives of the study are: to find out whether HIV infection and interactions between ARVs and second line anti-TB drugs have an impact on the following MDR-TB treatment outcomes: cure rate and treatment failure at Brewelskloof Hospital. MDR-TB patients were treated for 18-24 months. The study was designed as a case-control retrospective study comparing MDR-TB treatment outcomes between HIV positive (cases) and HIV negative patients (controls). Patients were included in the study only if they complied with the following criteria: sensitivity to second line anti-TB drugs, MDR-TB infection, co-infection with HIV (for some of them), male and female patients, completion of treatment between 1 January 2006 and 31 December 2008. Any patients that presented with extreme drug-resistant tuberculosis (XDR-TB) were excluded from the study. Data were retrospectively collected from each patient’s medical records. There were a total of 336 patients of which 242 (72%) were MDR-TB patients and 94 (27.9%) MDRTB co-infected with HIV patients. Out of the 242 MDR-TB patients, 167 (69.2%) were males and 75 (30.7%) were females. Of the 94 patients with MDR-TB co-infected with HIV, 51 (54.2%) males and 43 (45.7%) females. Patients with multidrug-resistant tuberculosis co-infected with HIV who qualify for antiretroviral therapy were treated with stavudine, lamivudine and efavirenz while all MDR-TB patients were given kanamycin, ethionamide, ofloxacin, cycloserine and pyrazinamide. The cure rate of MDR-TB in HIV (+) patients and in HIV (-) patients is 34.5% and 30 % respectively. There is no significant difference between both artes (pvalue = 0.80). The MDR-TB cure rate in HIV (+) patients taking antiretroviral drugs and in HIV (+) patients without antiretroviral therapy is 35% and 33% respectively. The difference between both rates is not statistically significant. The study shows that 65 (28.0%) patients completed MDR-TB treatment but could not be classified as cured or failure, 29 (12.5%) patients failed, 76 (32.7%) defaulted, 18 (7.7%) were transferred out and 44 (18.9%) died. As far as treatment completed and defaulted is concerned, there is no significant statistical difference between HIV (+) and HIV (-) The number of patients who failed the MDR-TB treatment and who were transferred out is significantly higher in the HIV (-) group than in the HIV (+) group. Finally the number of MDR-TB patients who died is significantly higher in the HIV (+) group). The median (range) duration of antiretroviral therapy before starting anti-tuberculosis drugs is 10.5 (1-60) months. According to this study results, the MDR-TB treatment cure rate at Brewelkloof hospital is similar to the cure rate at the national level. The study also hows that HIV infection and antiretroviral drugs do not influence any influence on MDR-TB treatment outcomes. / South Africa

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第22119号 / 医博第4532号 / 新制||医||1039(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 大森 孝一, 教授 Shohab YOUSSEFIAN, 教授 山下 潤 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

A current body of research is finding significant connection between biological, psychological, social, and spiritual factors in health and wellbeing. Some studies have found significant improvements in treatment outcomes for patients who received medical treatment in collaboration with psychosocial therapeutic treatment. In this study, I sought to observe the impact collaborative treatment had on patients with diabetes who were treated at a community health center. I compared the treatment outcomes of a group of patients who received a collaborative treatment, looking to see if their overall health (measured by A1c, a diabetes severity marker) and medical utilization (or their number of doctors’ visits). I found no significant difference in the improvements in health outcomes (A1c) made by my treatment group who received collaborative treatment in addition to standard medical treatment for diabetes management when compared to my control group who received only medical treatment. I did find that collaborative treatment was associated with increases in medical utilization as were increases in age and initial A1c levels. Clinical implications include the need for therapists to be aware of how biological factors, such as age and severity of symptoms, may affect psychosocial-spiritual factors commonly addressed in therapy when working with patients who have chronic illnesses like diabetes. I hope that these findings will lead future research into the association of collaboration and medical utilization in order to find if there are any clinical benefits to recommending increased utilization for patients who are older or begin treatment with higher A1c levels.

A thesis submitted to the College of Dental Medicine of Nova Southeastern University of the degree of Master of Science in Dentistry. Objectives: The purpose of this study was to evaluate clinical outcomes based on the American Board of Orthodontics Objective Grading System (ABO-OGS) in a 30-month postgraduate orthodontic residency and to determine what factors affected these treatment outcomes. Methods: Consecutively debonded cases from July 1, 2010 to June 30, 2011 treated by residents in the Orthodontics Department at Nova Southeastern University were graded using the ABO-OGS. The age and sex of the patient, the treatment time, the missed appointments and the number of providers were documented. Discrepancy indices were calculated for each patient. These variables were assessed and their associations with the obtained treatment outcome scores were evaluated. Results: The average OGS score of the debonded cases was 33.87. There was no significant correlation between total OGS score and the demographic or explanatory variables. There were significant correlations found between the discrepancy index (DI) and the treatment time, the number of providers, but not the OGS. Significant correlations were also identified between treatment time and the number of failed appointments and the number of providers. Extraction cases were shown to have a significantly longer treatment time. Out of the eight objective measurements of the OGS, occlusal contacts, marginal ridges, buccolingual inclination and alignment/rotations scored the highest points in our evaluation with an average of 7.81, 6.37, 5.04, and 5.01 respectively. Conclusions: This study indicated the Nova Southeastern University Orthodontic Department average OGS score is about 6 points higher than the ABO clinical exam passing score. The initial complexity of a case was not a pre-determined factor for the final treatment results. This study identified several aspects of treatment outcomes that need improvement including, occlusal contacts, marginal ridges, correcting buccolingual inclination and improving the alignment.

Bakgrund   I samhällen där andelen äldre människor ökar i förhållande till andra åldersgrupper, blir det åldersrelaterade sjukdomstillståndet sarkopeni mer och mer aktuellt. Definitionen av sarkopeni innehåller oftast en ökad förlust av muskelmassa och tillståndet har ett tydligt samband med fysiska handikapp, skörhet, längre vårdtider, ökad fallrisk, frakturer, lägre livskvalitet, dödlighet och därmed lidande. Behandling och prevention av sarkopeni innehåller nutritionsrelaterade åtgärder, ofta i form av kosttillskott. För att kunna utföra omvårdnadsåtgärder på ett säkert sätt tillsammans med patienten, är det viktigt att vårdpersonalen har god kunskap som är evidensbaserad. Syfte Syftet var att beskriva effekter av kosttillskott på äldre patienter med sarkopeni. Metod Designen som valdes var en litteraturöversikt. Sexton artiklar hittades genom databassökning och analyserades för att hitta likheter och olikheter mellan dem. Ett resultat sammanställdes genom en integrerad analys. Resultat  Effekterna av kosttillskott på äldre patienter med sarkopeni som hittades kunde delas in i nio olika kategorier: förändring i muskelmassa, kroppsvikt, fysisk kapacitet, fettmassa, fettfri massa, nutritionsstatus, biokemiska parametrar, förekomsten av sarkopeni, samt aktiviteter i det dagliga livet (ADL) och livskvalitet.  Slutsats Effektparametrarna som studerades visade sig ha samband med fenomen som livskvalitet, ADL, fallrisk, vårdtider och dödlighet. Kosttillskottens förmåga att positivt påverka dessa fenomen, kan på det viset spela en betydande roll i lindrande och prevention av lidande bland äldre människor med sarkopeni. / Background Age-related conditions such as sarcopenia are becoming more common in societies where age-distribution is increasingly tilting towards older generations. Sarcopenia, involving increased loss of muscle mass, is significantly associated with physical handicap, frailty, need of medical care, falls, fractures, decreasing quality of life, mortality and suffering. Amongst the methods for treating and preventing sarcopenia are nutrition related interventions such as nutritional supplementation. For nursing and health care to be safe and satisfactory, medical personnel needs to have evidence based knowledge on the applied methods and interventions. Aim The aim was to describe effects of nutritional supplements on elderly patients with sarcopenia. Method The design chosen for this study was a literature review of scientific articles. Sixteen articles were found using databases and analysed with the aim to find similarities and differences. Results The found effects of nutritional supplements on elderly with sarcopenia could be categorized as change in muscle mass, physical capacity, body weight, fat mass, lean body mass, nutritional status, biochemical parameters, the prevalence of sarcopenia as well as activities of daily living (ADL) and quality of life.  Conclusions  The effect parameters defined in the result of this study were shown to be associated with quality of life, ADL, risk for falls, extended need of medical care and mortality. The positive effects of nutritional supplements on these phenomena can therefore play an important role in easing and preventing suffering amongst elderly patients with sarcopenia.

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