Mar Pujades-rodriguez | University of Leeds (original) (raw)

Papers by Mar Pujades-rodriguez

Research paper thumbnail of Gender Differences in Immune Reconstitution: A Multicentric Cohort Analysis in Sub-Saharan Africa

PLoS ONE, 2012

Background: In sub-Saharan Africa, men living with HIV often start ART at more advanced stages of... more Background: In sub-Saharan Africa, men living with HIV often start ART at more advanced stages of disease and have higher early mortality than women. We investigated gender difference in long-term immune reconstitution.

Research paper thumbnail of Immunovirological response to combined antiretroviral therapy and drug resistance patterns in children: 1- and 2-year outcomes in rural Uganda

Little is known about immunovirological treatment outcomes and adherence in HIV/AIDS patients on ... more Little is known about immunovirological treatment outcomes and adherence in HIV/AIDS patients on antiretroviral therapy (ART) treated using a simplified management approach in rural areas of developing countries, or about the main factors influencing those outcomes in clinical practice.

Research paper thumbnail of Toxicity Associated with Stavudine Dose Reduction from 40 to 30 mg in First-Line Antiretroviral Therapy

PLoS ONE, 2011

Background: To compare the incidence and timing of toxicity associated with the use of a reduced ... more Background: To compare the incidence and timing of toxicity associated with the use of a reduced dose of stavudine from 40 to 30 mg in first-line antiretroviral therapy (ART) for HIV treatment and to investigate associated risk factors.

Research paper thumbnail of Comparing asthma prevalence estimates in Recife

Jornal de Pediatria, 2005

Research paper thumbnail of Evaluation of Three Sampling Methods to Monitor Outcomes of Antiretroviral Treatment Programmes in Low- and Middle-Income Countries

PLoS ONE, 2010

Background: Retention of patients on antiretroviral therapy (ART) over time is a proxy for qualit... more Background: Retention of patients on antiretroviral therapy (ART) over time is a proxy for quality of care and an outcome indicator to monitor ART programs. Using existing databases (Antiretroviral in Lower Income Countries of the International Databases to Evaluate AIDS and Médecins Sans Frontières), we evaluated three sampling approaches to simplify the generation of outcome indicators.

Research paper thumbnail of Comparison of Methods to Correct Survival Estimates and Survival Regression Analysis on a Large HIV African Cohort

PLoS ONE, 2012

Objective: The evaluation of HIV treatment programs is generally based on an estimation of surviv... more Objective: The evaluation of HIV treatment programs is generally based on an estimation of survival among patients receiving antiretroviral treatment (ART). In large HIV programs, loss to follow-up (LFU) rates remain high despite active patient tracing, which is likely to bias survival estimates and survival regression analyses.

Research paper thumbnail of Timeliness of Clinic Attendance Is a Good Predictor of Virological Response and Resistance to Antiretroviral Drugs in HIV-Infected Patients

PLoS ONE, 2012

Background: Ensuring long-term adherence to therapy is essential for the success of HIV treatment... more Background: Ensuring long-term adherence to therapy is essential for the success of HIV treatment. As access to viral load monitoring and genotyping is poor in resource-limited settings, a simple tool to monitor adherence is needed. We assessed the relationship between an indicator based on timeliness of clinic attendance and virological response and HIV drug resistance.

Research paper thumbnail of Antiretroviral Therapy Outcomes in Resource-Limited Settings for HIV-Infected Children <5 Years of Age

PEDIATRICS, 2010

WHAT'S KNOWN ON THIS SUBJECT: ART for children with HIV/ AIDS in resource-limited settings has be... more WHAT'S KNOWN ON THIS SUBJECT: ART for children with HIV/ AIDS in resource-limited settings has been shown to be feasible, but few data exist on ART outcomes in children Ͻ5 years of age.

Research paper thumbnail of Evaluation of a 5-year Programme to Prevent Mother-to-child Transmission of HIV Infection in Northern Uganda

Journal of Tropical Pediatrics, 2010

Prevention of mother-to-child transmission (PMTCT) is essential in HIV/AIDS control. We analysed ... more Prevention of mother-to-child transmission (PMTCT) is essential in HIV/AIDS control. We analysed 2000-05 data from mother-infant pairs in our PMTCT programme in rural Uganda, examining programme utilization and outcomes, HIV transmission rates and predictors of death or loss to followup (LFU). Out of 19 017 women, 1 037 (5.5%) attending antenatal care services tested HIV positive. Of these, 517 (50%) enrolled in the PMTCT programme and gave birth to 567 infants. Before tracing, 303 (53%) mother-infant pairs were LFU. Reasons for dropout were infant death and lack of understanding of importance of follow-up. Risk of death or LFU was higher among infants with no or incomplete intrapartum prophylaxis (OR ¼ 1.90, 95% CI 1.07-3.36) and of weaning age <6 months (OR 2.55, 95% CI 1.42-4.58), and lower in infants with diagnosed acute illness (OR 0.30, 95% CI 0.16-0.55). Mother-to-child HIV cumulative transmission rate was 8.3%, and 15.5% when HIV-related deaths were considered. Improved tracking of HIV-exposed infants is needed in PMTCT programmes where access to early infant diagnosis is still limited.

Research paper thumbnail of Nutrition outcomes of HIV-infected malnourished adults treated with ready-to-use therapeutic food in sub-Saharan Africa: a longitudinal study

Journal of the International AIDS Society, 2011

Background: Among people living with HIV/AIDS, nutritional support is increasingly recognized as ... more Background: Among people living with HIV/AIDS, nutritional support is increasingly recognized as a critical part of the essential package of care, especially for patients in sub-Saharan Africa. The objectives of the study were to evaluate the outcomes of HIV-positive malnourished adults treated with ready-to-use therapeutic food and to identify factors associated with nutrition programme failure. Methods: We present results from a retrospective cohort analysis of patients aged 15 years or older with a body mass index of less than 17 kg/m 2 enrolled in three HIV/AIDS care programmes in Africa between March 2006 and August 2008. Factors associated with nutrition programme failure (patients discharged uncured after six or more months of nutritional care, defaulting from nutritional care, remaining in nutritional care for six or more months, or dead) were investigated using multiple logistic regression.

Research paper thumbnail of Treatment Failure and Mortality Factors in Patients Receiving Second-Line HIV Therapy in Resource-Limited Countries

JAMA, 2010

Context Long-term antiretroviral therapy (ART) use in resource-limited countries leads to increas... more Context Long-term antiretroviral therapy (ART) use in resource-limited countries leads to increasing numbers of patients with HIV taking second-line therapy. Limited access to further therapeutic options makes essential the evaluation of second-line regimen efficacy in these settings.

Research paper thumbnail of Adults Receiving HIV Care Before the Start of Antiretroviral Therapy in Sub-Saharan Africa

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2013

Background: Gaining understanding of the period before antiretroviral therapy (ART) is needed to ... more Background: Gaining understanding of the period before antiretroviral therapy (ART) is needed to improve treatment outcomes and to reduce HIV transmission. This study describes the cascade of enrollment in HIV care, pre-ART follow-up, and predictors of mortality and lost to follow-up (LTFU) before ART initiation.

Research paper thumbnail of Risk factors for virological failure and subtherapeutic antiretroviral drug concentrations in HIV-positive adults treated in rural northwestern Uganda

BMC Infectious Diseases, 2009

Little is known about immunovirological treatment outcomes and adherence in HIV/AIDS patients on ... more Little is known about immunovirological treatment outcomes and adherence in HIV/AIDS patients on antiretroviral therapy (ART) treated using a simplified management approach in rural areas of developing countries, or about the main factors influencing those outcomes in clinical practice.

Research paper thumbnail of Second-line antiretroviral therapy in resource-limited settings: the experience of Médecins Sans Frontières

AIDS, 2008

Objectives: To describe the use of second-line protease-inhibitor regimens in Médecins Sans Front... more Objectives: To describe the use of second-line protease-inhibitor regimens in Médecins Sans Frontières HIV programmes, and determine switch rates, clinical outcomes, and factors associated with survival.

Research paper thumbnail of Effect of living close to a main road on asthma, allergy, lung function and chronic obstructive pulmonary disease

Occupational and Environmental Medicine, 2009

A number of epidemiological studies suggest that the risk of asthma is increased among those livi... more A number of epidemiological studies suggest that the risk of asthma is increased among those living in close proximity to major roads. However, the evidence is inconsistent, and effects on asthma and related respiratory and allergic conditions using objective measures such as lung function and allergic sensitisation have not been widely investigated. In 1995, 1996 and 2001 data on respiratory and allergic disease, along with demographic and lifestyle factors, were collected in 59 285 children (aged 2-16 years) and adults as part of the Health Survey for England, a nationally representative annual survey. Using Geographical Information System software, we mapped the location of each participant&#39;s home and computed distance to the nearest major road. We estimated the effect of distance on self-reported wheezing in the past year, asthma, eczema and hay fever in 50 994 participants, and on 1-second forced expiratory volume (FEV(1)), immunoglobulin E and spirometry-defined chronic obstructive pulmonary disease (COPD) in subgroups of those aged 7+, 11+ and 16+ years, respectively. Living within 150 m from a major road was not significantly associated with an increased risk of any of the outcome variables in any age group (adjusted odds ratios ranged from 0.85 to 1.05). Furthermore there was little evidence that risk increased with increasing proximity across the 0-150 m range where contrasts in traffic-related pollutant concentrations are greatest. Our analysis of a large and nationally representative population sample did not provide evidence of an adverse effect of living in close proximity to main roads on the risk of asthma, COPD or allergic disease in England.

Research paper thumbnail of Socioeconomic deprivation and the incidence of 12 cardiovascular diseases in 1.9 million women and men: implications for risk prediction and prevention

Background: Recent experimental evidence suggests that socioeconomic characteristics of neighbour... more Background: Recent experimental evidence suggests that socioeconomic characteristics of neighbourhoods influence cardiovascular health, but observational studies which examine deprivation across a wide range of cardiovascular diseases (CVDs) are lacking.

Research paper thumbnail of Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1·25 million people

Lancet, Jan 31, 2014

The associations of blood pressure with the different manifestations of incident cardiovascular d... more The associations of blood pressure with the different manifestations of incident cardiovascular disease in a contemporary population have not been compared. In this study, we aimed to analyse the associations of blood pressure with 12 different presentations of cardiovascular disease. We used linked electronic health records from 1997 to 2010 in the CALIBER (CArdiovascular research using LInked Bespoke studies and Electronic health Records) programme to assemble a cohort of 1·25 million patients, 30 years of age or older and initially free from cardiovascular disease, a fifth of whom received blood pressure-lowering treatments. We studied the heterogeneity in the age-specific associations of clinically measured blood pressure with 12 acute and chronic cardiovascular diseases, and estimated the lifetime risks (up to 95 years of age) and cardiovascular disease-free life-years lost adjusted for other risk factors at index ages 30, 60, and 80 years. This study is registered at ClinicalT...

Research paper thumbnail of Inhaled corticosteroids and the risk of fracture in chronic obstructive pulmonary disease

Qjm-an International Journal of Medicine, 2007

Background: Inhaled corticosteroids are used increasingly to treat people with COPD, but the exte... more Background: Inhaled corticosteroids are used increasingly to treat people with COPD, but the extent to which these drugs increase the risk of fracture is unclear. Aim: To quantify the dose-response relationship between fracture risk and inhaled corticosteroids in people with COPD, independent of the effects of percent predicted FEV 1 and oral corticosteroids. Design: Nested case-control study. Methods: Cases and controls were COPD patients aged 540 years or more at diagnosis, with a FEV 1 measurement recorded in The Health Improvement Network database, up to 5 July 2005. Cases (people with a fracture event after 1 January 1998, n ¼ 1235) were assigned up to four controls (n ¼ 4598), matched by gender and general practice. Results: Mean FEV 1 was 57.5% in cases, and 58.5% in controls. Inhaled corticosteroids had been prescribed in 69% of cases (median dose 269 mcg/day) and 66% (226 mcg/day) of controls. Oral corticosteroids had been prescribed in 60% of cases (median annual prescription rate 0.6) and 56% of controls (also 0.6 per year). Risk of fracture increased with increasing mean daily doses of inhaled corticosteroid (p for trend 0.007), and was most marked in those whose daily dose was 51600 mcg (OR 1.80, 95% CI 1.04-3.11). This effect was virtually unchanged by adjustment for mean percent predicted FEV 1 and annual prescription rate for oral corticosteroids (OR for highest dose exposure 1.74, 95% CI 1.00-3.01). Discussion: Our findings add to the evidence that the use of inhaled corticosteroids is associated with a small increase in fracture risk, particularly at higher doses.

Research paper thumbnail of Vital status of pre-ART and ART patients defaulting from care in rural Malawi

Tropical Medicine & International Health, 2010

objectives To ascertain the outcome of pre-Antiretroviral therapy (ART) and ART patients defaulti... more objectives To ascertain the outcome of pre-Antiretroviral therapy (ART) and ART patients defaulting from care and investigate reasons for defaulting.

Research paper thumbnail of Mortality of Patients Lost to Follow-Up in Antiretroviral Treatment Programmes in Resource-Limited Settings: Systematic Review and Meta-Analysis

PLoS ONE, 2009

Background: The retention of patients in antiretroviral therapy (ART) programmes is an important ... more Background: The retention of patients in antiretroviral therapy (ART) programmes is an important issue in resource-limited settings. Loss to follow up can be substantial, but it is unclear what the outcomes are in patients who are lost to programmes.

Research paper thumbnail of Gender Differences in Immune Reconstitution: A Multicentric Cohort Analysis in Sub-Saharan Africa

PLoS ONE, 2012

Background: In sub-Saharan Africa, men living with HIV often start ART at more advanced stages of... more Background: In sub-Saharan Africa, men living with HIV often start ART at more advanced stages of disease and have higher early mortality than women. We investigated gender difference in long-term immune reconstitution.

Research paper thumbnail of Immunovirological response to combined antiretroviral therapy and drug resistance patterns in children: 1- and 2-year outcomes in rural Uganda

Little is known about immunovirological treatment outcomes and adherence in HIV/AIDS patients on ... more Little is known about immunovirological treatment outcomes and adherence in HIV/AIDS patients on antiretroviral therapy (ART) treated using a simplified management approach in rural areas of developing countries, or about the main factors influencing those outcomes in clinical practice.

Research paper thumbnail of Toxicity Associated with Stavudine Dose Reduction from 40 to 30 mg in First-Line Antiretroviral Therapy

PLoS ONE, 2011

Background: To compare the incidence and timing of toxicity associated with the use of a reduced ... more Background: To compare the incidence and timing of toxicity associated with the use of a reduced dose of stavudine from 40 to 30 mg in first-line antiretroviral therapy (ART) for HIV treatment and to investigate associated risk factors.

Research paper thumbnail of Comparing asthma prevalence estimates in Recife

Jornal de Pediatria, 2005

Research paper thumbnail of Evaluation of Three Sampling Methods to Monitor Outcomes of Antiretroviral Treatment Programmes in Low- and Middle-Income Countries

PLoS ONE, 2010

Background: Retention of patients on antiretroviral therapy (ART) over time is a proxy for qualit... more Background: Retention of patients on antiretroviral therapy (ART) over time is a proxy for quality of care and an outcome indicator to monitor ART programs. Using existing databases (Antiretroviral in Lower Income Countries of the International Databases to Evaluate AIDS and Médecins Sans Frontières), we evaluated three sampling approaches to simplify the generation of outcome indicators.

Research paper thumbnail of Comparison of Methods to Correct Survival Estimates and Survival Regression Analysis on a Large HIV African Cohort

PLoS ONE, 2012

Objective: The evaluation of HIV treatment programs is generally based on an estimation of surviv... more Objective: The evaluation of HIV treatment programs is generally based on an estimation of survival among patients receiving antiretroviral treatment (ART). In large HIV programs, loss to follow-up (LFU) rates remain high despite active patient tracing, which is likely to bias survival estimates and survival regression analyses.

Research paper thumbnail of Timeliness of Clinic Attendance Is a Good Predictor of Virological Response and Resistance to Antiretroviral Drugs in HIV-Infected Patients

PLoS ONE, 2012

Background: Ensuring long-term adherence to therapy is essential for the success of HIV treatment... more Background: Ensuring long-term adherence to therapy is essential for the success of HIV treatment. As access to viral load monitoring and genotyping is poor in resource-limited settings, a simple tool to monitor adherence is needed. We assessed the relationship between an indicator based on timeliness of clinic attendance and virological response and HIV drug resistance.

Research paper thumbnail of Antiretroviral Therapy Outcomes in Resource-Limited Settings for HIV-Infected Children <5 Years of Age

PEDIATRICS, 2010

WHAT'S KNOWN ON THIS SUBJECT: ART for children with HIV/ AIDS in resource-limited settings has be... more WHAT'S KNOWN ON THIS SUBJECT: ART for children with HIV/ AIDS in resource-limited settings has been shown to be feasible, but few data exist on ART outcomes in children Ͻ5 years of age.

Research paper thumbnail of Evaluation of a 5-year Programme to Prevent Mother-to-child Transmission of HIV Infection in Northern Uganda

Journal of Tropical Pediatrics, 2010

Prevention of mother-to-child transmission (PMTCT) is essential in HIV/AIDS control. We analysed ... more Prevention of mother-to-child transmission (PMTCT) is essential in HIV/AIDS control. We analysed 2000-05 data from mother-infant pairs in our PMTCT programme in rural Uganda, examining programme utilization and outcomes, HIV transmission rates and predictors of death or loss to followup (LFU). Out of 19 017 women, 1 037 (5.5%) attending antenatal care services tested HIV positive. Of these, 517 (50%) enrolled in the PMTCT programme and gave birth to 567 infants. Before tracing, 303 (53%) mother-infant pairs were LFU. Reasons for dropout were infant death and lack of understanding of importance of follow-up. Risk of death or LFU was higher among infants with no or incomplete intrapartum prophylaxis (OR ¼ 1.90, 95% CI 1.07-3.36) and of weaning age <6 months (OR 2.55, 95% CI 1.42-4.58), and lower in infants with diagnosed acute illness (OR 0.30, 95% CI 0.16-0.55). Mother-to-child HIV cumulative transmission rate was 8.3%, and 15.5% when HIV-related deaths were considered. Improved tracking of HIV-exposed infants is needed in PMTCT programmes where access to early infant diagnosis is still limited.

Research paper thumbnail of Nutrition outcomes of HIV-infected malnourished adults treated with ready-to-use therapeutic food in sub-Saharan Africa: a longitudinal study

Journal of the International AIDS Society, 2011

Background: Among people living with HIV/AIDS, nutritional support is increasingly recognized as ... more Background: Among people living with HIV/AIDS, nutritional support is increasingly recognized as a critical part of the essential package of care, especially for patients in sub-Saharan Africa. The objectives of the study were to evaluate the outcomes of HIV-positive malnourished adults treated with ready-to-use therapeutic food and to identify factors associated with nutrition programme failure. Methods: We present results from a retrospective cohort analysis of patients aged 15 years or older with a body mass index of less than 17 kg/m 2 enrolled in three HIV/AIDS care programmes in Africa between March 2006 and August 2008. Factors associated with nutrition programme failure (patients discharged uncured after six or more months of nutritional care, defaulting from nutritional care, remaining in nutritional care for six or more months, or dead) were investigated using multiple logistic regression.

Research paper thumbnail of Treatment Failure and Mortality Factors in Patients Receiving Second-Line HIV Therapy in Resource-Limited Countries

JAMA, 2010

Context Long-term antiretroviral therapy (ART) use in resource-limited countries leads to increas... more Context Long-term antiretroviral therapy (ART) use in resource-limited countries leads to increasing numbers of patients with HIV taking second-line therapy. Limited access to further therapeutic options makes essential the evaluation of second-line regimen efficacy in these settings.

Research paper thumbnail of Adults Receiving HIV Care Before the Start of Antiretroviral Therapy in Sub-Saharan Africa

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2013

Background: Gaining understanding of the period before antiretroviral therapy (ART) is needed to ... more Background: Gaining understanding of the period before antiretroviral therapy (ART) is needed to improve treatment outcomes and to reduce HIV transmission. This study describes the cascade of enrollment in HIV care, pre-ART follow-up, and predictors of mortality and lost to follow-up (LTFU) before ART initiation.

Research paper thumbnail of Risk factors for virological failure and subtherapeutic antiretroviral drug concentrations in HIV-positive adults treated in rural northwestern Uganda

BMC Infectious Diseases, 2009

Little is known about immunovirological treatment outcomes and adherence in HIV/AIDS patients on ... more Little is known about immunovirological treatment outcomes and adherence in HIV/AIDS patients on antiretroviral therapy (ART) treated using a simplified management approach in rural areas of developing countries, or about the main factors influencing those outcomes in clinical practice.

Research paper thumbnail of Second-line antiretroviral therapy in resource-limited settings: the experience of Médecins Sans Frontières

AIDS, 2008

Objectives: To describe the use of second-line protease-inhibitor regimens in Médecins Sans Front... more Objectives: To describe the use of second-line protease-inhibitor regimens in Médecins Sans Frontières HIV programmes, and determine switch rates, clinical outcomes, and factors associated with survival.

Research paper thumbnail of Effect of living close to a main road on asthma, allergy, lung function and chronic obstructive pulmonary disease

Occupational and Environmental Medicine, 2009

A number of epidemiological studies suggest that the risk of asthma is increased among those livi... more A number of epidemiological studies suggest that the risk of asthma is increased among those living in close proximity to major roads. However, the evidence is inconsistent, and effects on asthma and related respiratory and allergic conditions using objective measures such as lung function and allergic sensitisation have not been widely investigated. In 1995, 1996 and 2001 data on respiratory and allergic disease, along with demographic and lifestyle factors, were collected in 59 285 children (aged 2-16 years) and adults as part of the Health Survey for England, a nationally representative annual survey. Using Geographical Information System software, we mapped the location of each participant&#39;s home and computed distance to the nearest major road. We estimated the effect of distance on self-reported wheezing in the past year, asthma, eczema and hay fever in 50 994 participants, and on 1-second forced expiratory volume (FEV(1)), immunoglobulin E and spirometry-defined chronic obstructive pulmonary disease (COPD) in subgroups of those aged 7+, 11+ and 16+ years, respectively. Living within 150 m from a major road was not significantly associated with an increased risk of any of the outcome variables in any age group (adjusted odds ratios ranged from 0.85 to 1.05). Furthermore there was little evidence that risk increased with increasing proximity across the 0-150 m range where contrasts in traffic-related pollutant concentrations are greatest. Our analysis of a large and nationally representative population sample did not provide evidence of an adverse effect of living in close proximity to main roads on the risk of asthma, COPD or allergic disease in England.

Research paper thumbnail of Socioeconomic deprivation and the incidence of 12 cardiovascular diseases in 1.9 million women and men: implications for risk prediction and prevention

Background: Recent experimental evidence suggests that socioeconomic characteristics of neighbour... more Background: Recent experimental evidence suggests that socioeconomic characteristics of neighbourhoods influence cardiovascular health, but observational studies which examine deprivation across a wide range of cardiovascular diseases (CVDs) are lacking.

Research paper thumbnail of Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1·25 million people

Lancet, Jan 31, 2014

The associations of blood pressure with the different manifestations of incident cardiovascular d... more The associations of blood pressure with the different manifestations of incident cardiovascular disease in a contemporary population have not been compared. In this study, we aimed to analyse the associations of blood pressure with 12 different presentations of cardiovascular disease. We used linked electronic health records from 1997 to 2010 in the CALIBER (CArdiovascular research using LInked Bespoke studies and Electronic health Records) programme to assemble a cohort of 1·25 million patients, 30 years of age or older and initially free from cardiovascular disease, a fifth of whom received blood pressure-lowering treatments. We studied the heterogeneity in the age-specific associations of clinically measured blood pressure with 12 acute and chronic cardiovascular diseases, and estimated the lifetime risks (up to 95 years of age) and cardiovascular disease-free life-years lost adjusted for other risk factors at index ages 30, 60, and 80 years. This study is registered at ClinicalT...

Research paper thumbnail of Inhaled corticosteroids and the risk of fracture in chronic obstructive pulmonary disease

Qjm-an International Journal of Medicine, 2007

Background: Inhaled corticosteroids are used increasingly to treat people with COPD, but the exte... more Background: Inhaled corticosteroids are used increasingly to treat people with COPD, but the extent to which these drugs increase the risk of fracture is unclear. Aim: To quantify the dose-response relationship between fracture risk and inhaled corticosteroids in people with COPD, independent of the effects of percent predicted FEV 1 and oral corticosteroids. Design: Nested case-control study. Methods: Cases and controls were COPD patients aged 540 years or more at diagnosis, with a FEV 1 measurement recorded in The Health Improvement Network database, up to 5 July 2005. Cases (people with a fracture event after 1 January 1998, n ¼ 1235) were assigned up to four controls (n ¼ 4598), matched by gender and general practice. Results: Mean FEV 1 was 57.5% in cases, and 58.5% in controls. Inhaled corticosteroids had been prescribed in 69% of cases (median dose 269 mcg/day) and 66% (226 mcg/day) of controls. Oral corticosteroids had been prescribed in 60% of cases (median annual prescription rate 0.6) and 56% of controls (also 0.6 per year). Risk of fracture increased with increasing mean daily doses of inhaled corticosteroid (p for trend 0.007), and was most marked in those whose daily dose was 51600 mcg (OR 1.80, 95% CI 1.04-3.11). This effect was virtually unchanged by adjustment for mean percent predicted FEV 1 and annual prescription rate for oral corticosteroids (OR for highest dose exposure 1.74, 95% CI 1.00-3.01). Discussion: Our findings add to the evidence that the use of inhaled corticosteroids is associated with a small increase in fracture risk, particularly at higher doses.

Research paper thumbnail of Vital status of pre-ART and ART patients defaulting from care in rural Malawi

Tropical Medicine & International Health, 2010

objectives To ascertain the outcome of pre-Antiretroviral therapy (ART) and ART patients defaulti... more objectives To ascertain the outcome of pre-Antiretroviral therapy (ART) and ART patients defaulting from care and investigate reasons for defaulting.

Research paper thumbnail of Mortality of Patients Lost to Follow-Up in Antiretroviral Treatment Programmes in Resource-Limited Settings: Systematic Review and Meta-Analysis

PLoS ONE, 2009

Background: The retention of patients in antiretroviral therapy (ART) programmes is an important ... more Background: The retention of patients in antiretroviral therapy (ART) programmes is an important issue in resource-limited settings. Loss to follow up can be substantial, but it is unclear what the outcomes are in patients who are lost to programmes.