Papers by Catherine Marimoutou
Circulation: Genomic and Precision Medicine, 2022
Background: Lp(a) (lipoprotein [a]) is a highly atherogenic lipoprotein strongly associated with ... more Background: Lp(a) (lipoprotein [a]) is a highly atherogenic lipoprotein strongly associated with coronary artery disease (CAD). Lp(a) concentrations are chiefly determined genetically. Investigation of large pedigrees with extreme Lp(a) using modern whole-genome approaches may unravel the genetic determinants underpinning this pathological phenotype. Methods: A large family characterized by high Lp(a) and increased CAD incidence was recruited by cascade screening. Plasma lipids, lipoproteins, and apolipoproteins concentrations, as well as the size of apo(a) isoforms, were determined enzymatically by high-resolution mass spectrometry and Western blot, respectively. Whole-exome sequencing was performed to search for rare defects in modifier genes. Genetic risk scores (GRS) for Lp(a) and CAD were calculated and their discriminative power was assessed. Results: Seventeen individuals displayed extreme Lp(a) levels including 6 with CAD. Whole-exome sequencing showed no hint for genetic de...
BMJ Open
IntroductionAdolescence and early adulthood are often critical periods of sexual development. The... more IntroductionAdolescence and early adulthood are often critical periods of sexual development. The discovery of sexual intercourse can lead to sexual risk-taking which may impact the incidence of sexually transmitted infections (STIs) and unwanted pregnancies. Despite available sexual health services on Reunion Island, sexual health indicators for adolescents are very poor showing a high number of teenage pregnancies and abortions, low use of contraception and an upsurge of STIs. In contrast, this French region is equipped with many services and resources that enable young adults to make informed sexual health choices. This study protocol describes the methodology to describe adolescent experiences of using sexual health services on Reunion Island.Methods and analysisA monocentric descriptive qualitative study using a phenomenological approach will be conducted from December 2022 to August 2023 and will be based on face-to-face semistructured interviews with participants aged 15–19 y...
Medecine Et Maladies Infectieuses, Jun 1, 2016
Revue D Epidemiologie Et De Sante Publique, Aug 1, 2022
The Lancet, 2000
Background We used data from Europe, North America, and Australia to assess the effect of exposur... more Background We used data from Europe, North America, and Australia to assess the effect of exposure category on the AIDS incubation period and HIV-1 survival and whether the effect of age at seroconversion varies with exposure category and with time since seroconversion. Methods 38 studies of HIV-1-infected individuals whose dates of seroconversion could be reliably estimated were included in the analysis. Individual data on 13 030 HIV-1infected individuals from 15 countries were collated, checked, and analysed centrally. We calculated estimates of mortality and AIDS incidence rates and estimated the proportions of individuals surviving and developing AIDS at each year after seroconversion from the numbers of observed deaths or cases of AIDS and the corresponding person-years at risk. Analyses were adjusted for age at seroconversion, time since seroconversion, and other factors as appropriate. Findings Mortality and AIDS incidence increased strongly with time since seroconversion and age at seroconversion. Median survival varied from 12•5 years (95% CI 12•1-12•9) for those aged 15-24 years at seroconversion to 7•9 years (7•4-8•5) for those aged 45-54 years at seroconversion, whereas for development of AIDS the corresponding values were 11•0 years (10•7-11•7) and 7•7 years (7•1-8•6). There was no appreciable effect of exposure category on survival. For AIDS incidence, the exposure category effect that we noted was explained by the high incidence of Kaposi's sarcoma in those infected through sex between men. We estimated that among people aged 25-29 years at seroconversion 90% (89-91) and 60% (57-62) survived to 5 years and 10 years, respectively, after seroconversion, whereas 13% (12-15) and 46% (44-49), respectively, developed AIDS (excluding Kaposi's sarcoma). Interpretation Before widespread use of highly-active antiretroviral therapy (before 1996), time since seroconversion and age at seroconversion were the major determinants of survival and development of AIDS in Europe, North America, and Australia.
AIDS, 2000
Objective: To compare estimates of changes in HIV survival over time derived from seroconverter a... more Objective: To compare estimates of changes in HIV survival over time derived from seroconverter and prevalent cohorts. Design and methods: Using pooled data from 19 seroconverter cohorts (CASCADE), the relative risk of death from HIV seroconversion by calendar time at risk from 1 January 1991 was examined. The analyses were repeated, ignoring knowledge of the time of seroconversion, but adjusting for the CD4 cell count at the time the participant came under observation, thus mimicking a prevalent cohort. Estimates from thè prevalent' cohort approach were compared with those obtained from the seroconverter cohort. Results: Of 5428 subjects at risk on 1 January 1991 or later, 1312 (24.2%) had died. In the analysis based on time from seroconversion, estimates of the effect of calendar year showed marked reductions in mortality in 1997±1999 only, with no evidence of a linear trend over the period 1991±1996 (P-trend 0.85). Using the prevalent cohort approach a decrease in the relative risk of death was observed from 1991 to 1998± 1999, with a statistically signi®cant trend of a decrease in risk from 1991 to 1996 (Ptrend 0.002). Similar ®ndings were observed when the analyses was repeated taking the start date of the cohort as 1 January 1988. Conclusion: Lack of knowledge of HIV infection duration may lead to biased and exaggerated estimates of survival improvements over time. The adjustment for duration of infection in prevalent HIV cohorts through laboratory markers may compensate inadequately for this.
European Journal of Public Health, Oct 1, 2015
L’enquete menee en 2001 par l’INSERM aupres des personnes atteintes de l’infection a VIH/Sida sui... more L’enquete menee en 2001 par l’INSERM aupres des personnes atteintes de l’infection a VIH/Sida suivies a l’hopital en Ile-de-France et en Provence-Alpes-Cote d’Azur
Frontiers of neurology and neuroscience, Apr 1, 2016
During the 20th century, the management of war-related psychological trauma shifted from neurolog... more During the 20th century, the management of war-related psychological trauma shifted from neurology to psychiatry. After September 11, 2001, the French forces participated in a multinational force deployed in Afghanistan to fight against terrorism. Post-traumatic stress disorder (PTSD) became a priority. We report the daily work of the psychiatrists involved in this mission and the organization developed to psychologically support wounded military personnel. The doctrine of early intervention psychiatrization and the technique of collective debriefing are the key points of this procedure. The psychiatrist is also responsible for the healthcare community, particularly vulnerable when confronted with severe ballistic injuries. One aim of this organization is also to screen PTSD in soldiers returning from Afghanistan. The military general practitioner is a pivotal point of this procedure built to detect PTSD, anxiety, depressive reaction and behavioral problems. The French health service has developed a genuine care strategy aimed at identifying patients, accompanying them in the formalities for recognition and compensation, and offering them treatment locally by arranging clinical psychology consultations near their home.
BMC Infectious Diseases, May 1, 2014
International Journal of Epidemiology, Dec 1, 1998
Nouts a and Francois Dabis b for the Groupe d'Epidemiologie Clinique du SIDA en Aquitaine (GECSA)... more Nouts a and Francois Dabis b for the Groupe d'Epidemiologie Clinique du SIDA en Aquitaine (GECSA) a ' b Objective To assess secular trends of the incidence of Kaposi's sarcoma (KS) between 1988 and 1996 in the Aquitaine Cohort of human immunodeficiency virus type 1 (HTV1)-infected subjects (southwestern France). Methods Adults of both sexes of all HTV-transmission categories were included. We distinguished between incident and prevalent KS and in case of multiple acquired immunodeficiency syndrome (AIDS) defining illnesses between initial or subsequent KS. Only incident KS were considered for annual incidence rate calculation. Results Overall, 21.2% (356/1678) of homosexuals and 1.9% (58/3030) of the other patients were diagnosed with KS over time. Although there was a sharp decrease in 1996 for initial KS, the annual incidence rate of KS was stable over time in the overall cohort as well as in homosexuals (4.3% per year on the average for KS as an initial AJDS-defining illness and 2.1% per year for subsequent KS in homosexuals). The median CD4+ cell count at the time of diagnosis of KS was 56 per mm 3 (78 for initial KS, 14 for subsequent KS), with no significant variation over time. Conclusion In the Aquitaine Cohort, the annual incidence of KS has remained stable between 1988 and 1995 with a recent decline in 1996, only for initial KS, while case management of HIV-infected subjects changed drastically.
PubMed, May 3, 1997
Objectives: To describe the hospital-based information system developed by the GESCA (Clinical ep... more Objectives: To describe the hospital-based information system developed by the GESCA (Clinical epidemiology group on AIDS in Aquitaine) and evaluate the main results obtained over the last 10 years, specifically data related to epidemiological monitoring, medico-economic analysis and clinical research in HIV infection. Methods: Inclusion criteria were HIV-1 seropositivity confirmed by Western blot, age over 13 years, consultation or hospitalization is one of the 18 participating units. Follow-up data were collected at each hospital visit. Results: On December 31, 1995, 4268 subjects had been registered in the GECSA system, including 25.7% women. Contamination categories were homosexuals 33.4%, intravenous drug abusers 32.8%, heterosexuals 13.9%. A clear drop in the number of new cases in intravenous drug abusers and an increase in the number with heterosexual transmission was observed after 1988. The medico-economic analysis showed that patients followed in the system were in a more advanced stage at registry since 1992. More than half of the subjects are now taking antiretroviral therapy and prophylaxis for opportunistic infections. Clinically, after adjusting data for the major known prognosis factors, the risk of progression to AIDS is higher in homosexuals and intravenous drug abusers than in heterosexuals. Transmission route does not however have any significant effect on survival after development of AIDS. There is no significant difference in outcome of HIV infection between men and women and pregnancy is not associated with poorer outcome. Conclusion: This regional registry provides valuable data for epidemiological monitoring, medico-economic analysis, hospital management and clinical research.
Infectious diseases now, Mar 1, 2023
Clinical Nutrition Supplements, 2008
Increased length of hospital stay is one of many reported consequences of malnutrition. However, ... more Increased length of hospital stay is one of many reported consequences of malnutrition. However, this relation is often biased by selecting the population and not taking into account disease and its severity. The main goal of this study was to assess the influence of nutritional risk on the length of stay in a nonselected general hospital population, taking into account the disease and its severity by a classification into homogeneous disease groups thanks to diagnostic coding. Methods: We analysed all medical diagnostic codes and nutritional assessment reports over a 45-month period in 9 wards of a 300-bed hospital. Malnutrition and its risk were assessed with BMI, albumin levels and by the Geriatric Nutritional Risk Index (GNRI, cutoffs at 92 for mild malnutrition and 82 for severe malnutrition). The delta length of stay (DLS, actual length of stay minus national standardized length of stay for each homogeneous disease group) was the main endpoint. Age, sex, medical vs. surgical stay were also recorded. The influence of these variables on DLS was assessed by ANOVA. Results: 1198 patients were included (599 M, 599 W, aged 71±18 years [M±SD]), totalling 1310 hospital stays (86% medical, 14% surgical). Malnutrition was absent/ mild/severe in 53/27/20% of patients (GNRI), 37/31/32% (albumin) and 73/17/10% (BMI), with a good correlation between GNRI and albumin (kappa = 0.51), GNRI and BMI (kappa = 0.37), but a low correlation between albumin and BMI (kappa = 0.05). GNRI was therefore used. It was assessed after 4.0±6.8 hospital days in non-malnourished, 5.0±6.9 days in mildly malnourished and 5.7±7.6 days in severely malnourished patients (P = 0.002 between non-malnourished and severely malnourished). 73 patients died during their stay; OR for death was 4.4 [95%CI = 2.2 9.3] in mild malnutrition and 8.7 [95%CI = 4.4 18.3] in severe malnutrition. DLS was 2.1±9.8 days in non-malnourished, 3.5±12.9 days in mildly malnourished and 3.9±14.2 days in severely malnourished patients (P = 0.05 between each group). In multivariate analysis, malnutrition was independently associated with DLS. Conclusion: The risk of malnutrition, assessed by the GNRI, influences mortality and hospital length of stay independently from age, sex, disease and its severity. This confirms the medico-economic consequences of malnutrition. Even though GNRI was calculated later in severely malnourished patients, these findings are solid in mildly malnourished patients.
Pathogens, Aug 21, 2021
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
European journal of public health, Oct 1, 2014
HAL (Le Centre pour la Communication Scientifique Directe), 2018
67th Annual Meeting of the American-Society-of-Tropical-Medicine-and-Hygiene (ASTHM), New Orleans... more 67th Annual Meeting of the American-Society-of-Tropical-Medicine-and-Hygiene (ASTHM), New Orleans, LA, OCT 28-NOV 01, 201
Revue D Epidemiologie Et De Sante Publique, Jun 1, 2021
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Papers by Catherine Marimoutou