Predictors of retention in the prospective HIV prevention OKAPI cohort in Kinshasa.

Retention is a key element in HIV prevention programs. In Sub-Saharan Africa most data on retention come from HIV clinical trials or people living with HIV attending HIV treatment and control programs. Data from observational cohorts are less frequent. Retention at 6-/12-month follow-up and its predictors were analyzed in OKAPI prospective cohort. From April 2016 to April 2018, 797 participants aged 15-59 years attending HIV Voluntary Counseling and Testing in Kinshasa were interviewed about HIV-related knowledge and behaviors at baseline and at 6- and 12-month follow-ups. Retention rates were 57% and 27% at 6- and 12-month follow up; 22% of participants attended both visits. Retention at 6-month was significantly associated with 12-month retention. Retention was associated with low economic status, being studying, daily/weekly Internet access, previous HIV tests and aiming to share HIV test with partner. Contrarily, perceiving a good health, living far from an antiretroviral center, daily/weekly alcohol consumption and perceiving frequent HIV information were inversely associated with retention. In conclusion, a high attrition was found among people attending HIV testing participating in a prospective cohort in Kinshasa. Considering the low retention rates and the predictors found in this study, more HIV cohort studies in Kinshasa need to be evaluated to identify local factors and strategies that could improve retention if needed.

Primer aislamiento de Salmonella Javiana con portación de KPC-2 en Paraguay / First isolation of Salmonella Javiana with KPC-2 in Paraguay

Varios mecanismos de resistencia a diversos agentes antimicrobianos que se han incorporado al arsenal terapéutico, han emergido en los últimos años, destacando la aparición de carbapenemasas en enterobacterias, siendo Klebsiella pneumoniae carbapenemasa (KPC) una de las más importantes, identificada originalmente en los Estados Unidos en 1996. En Paraguay, los primeros aislamientos de cepas portadoras de carbapenemasa tipo KPC se obtuvieron en septiembre del año 2009, a partir del cual se confirmaron la presencia en varias especies de enterobacterias, siendo Klebsiella pneumoniae la de mayor prevalencia entre ellas. Según datos del centro de referencia, Salmonella entérica serotipo Typhimurium es el serovar más común identificado en muestras de heces hasta la fecha, y el serotipo Javiana el cuarto. En este informe se describe el primer aislamiento resistente a carbapenemes por carbapenemasa del tipo KPC-2 en Salmonella entérica serotipo Javiana aislado en febrero de 2015 de una muestra fecal. Además, en muestras de la misma paciente, fueron aisladas las especies Klebsiella pneumoniae resistente a carbapenemes por presencia de la misma enzima (KPC-2) en secreción orotraqueal y Enterococcus faecalis resistente a vancomicina en muestra fecal. Este hallazgo, confirma la portación del gen que codifica para la carbapenemasa tipo KPC-2 por cepa de Salmonella entérica, y que el mismo ocurre en un serotipo poco frecuente (serotipo Javiana). Además, la recuperación en otra muestra de la paciente de K. pneumoniae productora de carbapenemasa tipo KPC- 2 evidencia la diseminación de este mecanismo de resistencia entre las enterobacterias. Palabras claves: Salmonella, KPC, carbapenemasas, enterobacterias.

At the global level have emerged over the years, microorganisms resistant to various antimicrobial agents that have been incorporated to the therapeutic arsenal. Several mechanisms of resistance have emerged in recent years, highlighting the emergence of carbapenemases in enterobacterias, entity which Klebsiella pneumoniae carbapenemasa (KPC), being one of the most important, originally identified in the United States in 1996. In Paraguay, the first isolates of KPC carbapenemasecarrying strains were obtained in september 2009, from which the presence of several Enterobacteria species was confirmed, with Klebsiella pneumoniae being the most prevalent among them. According to data from the reference center, Salmonella enterica serotype Typhimurium is the most common serovar identified in stool samples to date, and the Javiana serotype the fourth. This report describes the first KPC-2 carbapenemase isolate in Salmonella enterica serovar Javiana isolated in February 2015 from a fecal sample. In addition, in samples from the same patient, Klebsiella pneumoniae species resistant to carbapenems were isolated by the presence of the same enzyme (KPC-2) in orotracheal secretion and vancomycin-resistant Enterococcus faecalis in fecal samples. Key words: Salmonella, KPC, carbapenemases, enterobacterias.

Caracterización molecular de caso fatal por Streptococcus pyogenes

Streptococcus pyogenes es ampliamente conocido como uno de los patógenos bacterianos más importantes en seres humanos. Este caso reporta a una paciente femenina de 3 años de edad, procedente de Lambaré, sin patología de base conocida, consultó en el Servicio de Urgencias del Instituto de Medicina Tropical por una lesión en cara externa de pierna derecha de 3 días de evolución que se extendió progresivamente, agregándose tumefacción y flictenas violáceas. Además vómitos 24 hs antes del ingreso en varias ocasiones. La paciente presentó cultivo de lesión por punción infiltrativa de zona afecta del miembro inferior derecho positivo a Streptococcus pyogenes multisensible que fue derivado al Departamento de Biología Molecular y Biotecnología del Instituto de Investigaciones en Ciencias de la Salud para caracterización molecular en el que se detectó la portación de los factores de virulencia speA, speB y speC.

Abstract Streptococcus pyogenes is widely known as one of the most important bacterial pathogens in humans. This case report of a female patient age 3, from Lambaré, no known pathology base, consulted in the emergency department of the Institute of Tropical Medicine with an injured right leg outer face of 3 days of evolution that progressively expanded, adding purple swelling and blisters. In addition vomiting 24 hours before admission several times. The patient developed culture of lesion infiltration puncture affected area of the right leg positive for Streptococcus pyogenes multisusceptible which was referred to the Department of Molecular Biology and Biotechnology Research Institute in Health Sciences for molecular characterization in which the bearing was detected virulence factors speA, speB and speC.

Adherence to the Mediterranean diet and quality of life in the SUN Project.

BACKGROUND/OBJECTIVES: Mediterranean diet has been related with reduced morbidity and better well-being. The aim of this study was to assess whether the adherence to the Mediterranean diet were associated with mental and physical health related to quality of life. SUBJECTS/METHODS: This analysis included 11 015 participants with 4 years of follow-up in the SUN Project (a multipurpose cohort study based on university graduates from Spain). A validated 136-item food frequency questionnaire was used to assess the adherence to the Mediterranean diet at baseline, according to a nine-point score, presented in four categories (low, low-moderate, moderate-high and high). Health-related quality of life (HRQL) was measured after 4 years of follow-up with the Spanish version of the SF-36 Health Survey. Generalized Linear Models were fitted to assess adjusted mean scores, the regression coefficients (ß) and their 95% confidence intervals (95% CIs) for the SF-36 domains according to categories of adherence to Mediterranean diet. RESULTS: Multivariate-adjusted models revealed a significant direct association between adherence to Mediterranean diet and all the physical and most mental health domains (vitality, social functioning and role emotional). Vitality (ß=0.50, 95% CI=0.32-0.68) and general health (ß=0.45, 95% CI=0.26-0.62) showed the highest coefficients. Mean values for physical functioning, role physical, bodily pain, general health and vitality domains were significantly better with increasing adherence to the Mediterranean diet. Those having improved their initial high diet scores have better scores in physical functioning, general health and vitality. CONCLUSIONS: Adherence to the Mediterranean diet seems to be a factor importantly associated with a better HRQL.

Analysis of content about sexuality and human reproduction in school textbooks in Spain.

OBJECTIVES: The spread of sexually transmitted infections (STIs) inadolescents and teenage pregnancy rates are increasing. A decrease in the average age of youth's first sexual experience has also been noted. Sexual education programmes in schools have an important role to play in addressing these issues. The objective of this study was to analyse the content of textbooks in the areas of sexuality and human reproduction in order to evaluate the extent to which these textbooks promote healthy reproductive lifestyles, as well as avoidance of risk behaviour among adolescent students. STUDY DESIGN: Descriptive study of the content of school textbooks. METHODS: The study sample consisted of 12 textbooks (approximately 80% of all the textbooks used in Spanish secondary schools) which were edited in 2002. Content analysis evaluated the extent to which these books demonstrated reliable scientific information about: (a) condom effectiveness; (b) consequences, prevention and treatment of STIs; (c) family planning methods; (d) assisted reproductive technologies; and (e) the promotion of healthy reproductive lifestyles. RESULTS: All textbooks presented inaccurate information in the areas studied. One hundred and fifty one quotes were identified that facilitated incomplete perception of sexuality or risky behaviour. On average, 12.6 incorrect messages were identified in each textbook. CONCLUSIONS: The textbooks examined are neither appropriate nor sufficiently comprehensive for adolescent education on issues of sexuality. Results suggest a need for alternative textbooks based on better scientific evidence. It is essential that textbooks empower adolescents to make healthy decisions through the promotion of useful life skills that provide a more integrated concept of sexuality. There is a need for approaches to sexual education to integrate values commonly held by parents of the youth that use such texts.

[Prognostic factors for cancer patients in the postanesthetic recovery unit]. / Pronóstico de los pacientes oncológicos médicos ingresados en Reanimación.

OBJECTIVE: To assess the prognosis of cancer patients in an intensive care unit (ICU), to compare the capabilities of severity scoring systems to predict hospital death, and to improve prediction by adding new variables. PATIENTS AND METHODS: Cohort study in a medical-surgical ICU of a university hospital. Demographic and oncologic characteristics were collected along with death records for all nonsurgical cancer patients admitted between January 1995 and June 2000. Severity scores and risk of death were calculated. RESULTS: In the cohort of 250 patients studied, the hospital mortality rate was 58% and the ICU mortality rate was 38.8%. The best predictions were made with the third version of the Acute Physiology and Chronic Health Evaluation (APACHE III), the total maximum Sequential Organ Failure Assessment (SOFA) score, and the total maximum Multiple Organ Dysfunction Score (MODS). The APACHE II and the Simplified Acute Physiology Score (SAPS), version II, were good predictors, whereas the systems of the International Council on Mining and Metals overestimated hospital mortality and the Modality Prediction Model at 0 and 24 hours (MPM0 and MPM24) and the Logistic Organ Dysfunction System underestimated it. The total maximum SOFA and MODS scores had the greatest discriminating capability and the SOFA0, the MODS0, MPM0, and MPM24 had the poorest. All assessment systems except the APACHE III improved when we added new mortality-associated variables: prior functional status, diabetes, radiographic lung infiltrates, mechanical ventilation, and vasoactive support. CONCLUSIONS: Medical oncology patients should not all be denied intensive care. None of the systems assessed offer clinically relevant advantages for predicting hospital mortality in nonsurgical oncology patients in the ICU, although we recommend the SAPS II because it includes oncologic variables, is easy to score, and has good prognostic capability.

Olive oil consumption and weight change: the SUN prospective cohort study.

The aim of this dynamic prospective follow-up study was to assess the association between olive oil consumption and the likelihood of weight gain or the incidence of overweight or obesity in a large Mediterranean cohort of 7,368 male and female Spanish university graduates (the SUN Project) who were followed for a median period of 28.5 mon. A validated Food Frequency Questionnaire was administered at baseline, and respondents also completed a follow-up questionnaire after 28.5 mon. Changes in participants' consumption of olive oil and their weight were assessed during follow-up. A higher baseline consumption of olive oil was associated with a lower likelihood of weight gain, although the differences were not statistically significant. The adjusted difference in weight gain (kg) was -0.16 [95% confidence interval (CI): -0.42 to +0.11] for participants in the upper quintile of olive oil consumption (median: 46 g/d) compared with those in the lowest quintile (median: 6 g/d). For participants with a high baseline consumption of olive oil whose olive oil consumption also increased during follow-up, we found a slightly increased but nonsignificant risk of incidence of overweight or obesity (adjusted odds ratio = 1.19, 95% CI: 0.73 to 1.95). Our study, carried out in a sample of free-living people, shows that a high amount of olive oil consumption is not associated with higher weight gain or a significantly higher risk of developing overweight or obesity in the context of the Mediterranean food pattern.

Employee's perceived exposure to environmental tobacco smoke, passive smoking risk beliefs and attitudes towards smoking: a case study in a university setting.

Despite the growing literature on workplace smoking policies, few studies have focused on the implementation of such policies in university settings. Smoking in the workplace is still very common in many countries, including Spain. While the law is about to change and more non-smoking policies are to be implemented, it is not clear what kind of restrictions Spanish workers would find acceptable. This study investigated perceived exposure to environmental tobacco smoke (ETS), passive smoking risks beliefs and attitudes towards smoking at the University of Navarra (Spain). A questionnaire was sent by E-mail to 641 randomly selected employees and a response rate of 70.4% was obtained. The survey results suggest that 27.3% of the university employees were smokers and 26.6% were exposed to ETS on a daily basis. The majority of respondents (81.7%) supported a restrictive non-smoking policy. Acceptance among active smokers was significantly lower (59.2 versus 89.3%). Smoking prohibition with the provision of smoking areas was the most favored option (46.9%). Results suggest that employees are ready to restrict smoking in the university, but there was not enough support for a total ban. Employers considering adopting a ban on smoking should be encouraged to conduct a similar survey to identify potential barriers to policy implementation.

Determinants of the adherence to an "a priori" defined Mediterranean dietary pattern.

BACKGROUND: A prospective cohort study with university level participants was initiated to study the effect of Mediterranean diet on health. AIMS: The objective of this study was to identify possible lifestyle and socioeconomic variables associated with the consumption of a Mediterranean dietary pattern (MDP). METHOD: This analysis includes 1587 males and 2260 females. MDP was defined "a priori" by summing the standardized residuals of nutrients and foods after adjusting a regression model using total energy intake as the independent variable. Multiple regression and non-parametric locally weighted regression models were adjusted with the relative adherence to the MDP as the dependent variable in males and females. RESULTS: Women were more compliant than men with the MDP (Coefficient regression (b) = 4.1; Confidence Interval (CI) 95 % = 3.2 to 4.9). The compliance with the MDP was significantly poorer among younger participants both in men and women (p < 0.001 in men and in women). Participants who were more physically active were more likely to fulfill the traditional MDP (p = 0.01 in men and p < 0.001 in women). CONCLUSIONS: Our findings provide evidence supporting the progressive departure from the traditional MDP in younger and highly educated subjects of the Mediterranean area. A more active life-style is associated with a better compliance with the MDP.

Mediterranean diet and stroke: objectives and design of the SUN project. Seguimiento Universidad de Navarra.

PURPOSE: The Mediterranean diet has been postulated as a protective factor against different diseases including stroke. Thus, an epidemiological study in a Mediterranean country, such as Spain, focused on diet may offer new insights of the potential benefits of this nutritional pattern to prevent the onset of cerebrovascular diseases. METHODS: The SUN ("Seguimiento Universidad de Navarra") project is a prospective study among Spanish university alumni, aimed to identify the dietary determinants of stroke, coronary disease and other disorders. Two pilot studies have been developed. The first pilot study was focused on the understanding of the questionnaire. The second study used a random sample to assess the response proportion and the feasibility of using a mailing system for following-up the cohort. The first informative results are expected to be available after the first four years of following-up the cohort (2005). Here, we report the description of the baseline diet of the first participants in the cohort using data from 1,587 men and 2,260 women. RESULTS: The outcome of our pilot studies ensure the feasibility of a mail-based cohort. In the baseline assessment, we found a high consumption of olive oil (18.5 g/person/day), red wine (28.8 g/person/day), legumes (102.5 g/person/day), vegetables (507.8 g/person/ day) and fruits (316.7 g/person/day), with a great between-subject variability. Also, the values for cereals (170.4g/person/day), dairy products (239.3 g/person/day) and meat and meat products consumption (186 g/person/ day) in this cohort were estimated. The coefficients of variation ranged in women from 56 (for vegetables) to 240% (for red wine) and in men from 62 to 180% (for these same two items), reflecting a wide heterogeneity in the diet of participants. CONCLUSIONS: Although the participation was not high (22% according to the estimates of the pilot study), it was comparable to the proportion found in large previous cohorts such as the Nurses-II Health Study (24%). The sharp contrast in dietary habits between the US and Spain together with the high between-subjects variability we have found in our Spanish cohort provides an exceptional opportunity to assess the aspects of the Mediterranean diet, which may be protective against stroke and other neurological disorders.

[The Mediterranean diet and cardiovascular disease: results of a pilot study from the SUN project (University of Navarre Follow-Up Study)]. / Dieta mediterránea y enfermedad cardiovascular: resultados del estudio piloto del proyecto SUN.

BACKGROUND: The Mediterranean diet has been postulated as a model for the prevention of coronary heart disease. The SUN project ("Seguimiento Universidad de Navarra") is an epidemiological prospective cohort study of University of Navarre alumni started in 2000 with the main objective of identifying dietary and non-dietary determinants of these disorders. The feasibility of the project was verified in a two-phase pilot study. METHOD: Volunteers participated in the first phase of the pilot study. Dietary and non-dietary exposures were measured using self-administered questionnaires and interview. A random sample of 600 graduates was selected for the second phase of the pilot study. The selected alumni received a questionnaire by mail. The 10th, 25th, 50th, 75th and 90th percentiles were calculated for the consumption of each food item or nutrient to estimate the inter-subject variability. RESULTS: The participants understood and answered the questionnaires properly. The mean time spent in completing the questionnaire was 55 minutes (95% CI: 50.7-59.3). A wide inter-subject variability was found in the consumption of food items considered as more representative of the Mediterranean diet (olive oil, fruits, vegetables and wine) with major differences between the 10th and 90th percentile. A Mediterranean diet pattern was found with a wide inter-subject variability. CONCLUSIONS: The response rate was acceptable. This finding is likely to ensure the identification of associations between the consumption of given food items and the occurrence of the main outcomes we are targeting.

Fixed higher dose schedule of suramin plus hydrocortisone in patients with hormone refractory prostate carcinoma a multicenter Phase II study.

BACKGROUND: Using a fixed higher-dose schedule, the efficacy and toxicity of suramin plus hydrocortisone were assessed in patients with metastatic hormone-refractory prostate carcinoma (HRPC). METHODS: Fifty consecutive patients with HRPC (including those in whom hormonotherapy was withdrawn) and an Eastern Cooperative Oncology Group performance status of 0-2 were recruited. Treatment was comprised of a bolus intravenous infusion of 200 mg of suramin followed by suramin (500 mg/m(2) intravenously [i.v.] over 24 hours) given daily over 5 days as a loading course, followed by suramin (350 mg/m(2) i.v. over 2 hours) administered weekly for 12 weeks. This 12-week course was repeated at 6-month intervals. All patients received concomitant hydrocortisone. RESULTS: Five hundred fifty weekly doses of therapy were delivered over the course of the entire study. A partial response, based on a > 50% decrease in the prostate specific antigen (PSA) level, was achieved in 27 patients (54%; 95% confidence interval [95% CI], 44.7-65.0%), 16 of whom (32%; 95%CI, 23.9-43.2%) had a > 75% decrease in their PSA levels. The measurable disease objective response rate was 18% (95% CI, 2.3-51.8%). Of the 37 patients with bone pain requiring analgesia, 27 patients (73%; 95% CI, 55.9-86.2%) reduced their medication consumption to a lower level on the World Health Organization analgesic ladder. The median duration of response was 15.5 weeks (range, 6-70 weeks), the median time to disease progression was 13 weeks, and the median overall survival time was 11 months. Treatment generally was well tolerated. Fatigue and severe lymphopenia were the most commonly reported significant toxicities. In addition, there was 1 septic toxic death reported, and 10% of the patients were found to have NCI Grade 3-4 neurotoxicity. CONCLUSIONS: The results of the current study demonstrated that the fixed-dose suramin regimen administered herein showed high, although short-lived, activity and a good tolerance profile in HRPC patients.

Prevalence of physical activity during leisure time in the European Union.

PURPOSE: To estimate the prevalence of physical activity during leisure time in adults from the 15 member states of the European Union and the relationship with sociodemographic variables. METHODS: A representative sample, with approximately 1000 adults, aged 15 and upward, was selected from each member state to complete a questionnaire on attitudes to physical activity, body weight, and health by a face-to-face interview, summing a total of 15,239 subjects. The amount of leisure-time physical activity was quantified by assigning metabolic equivalents (METs) to each activity. Multiple linear regression models with MET-h.wk(-1) as the dependent variable were fitted. RESULTS: Northern European countries showed higher levels of physical activity than southern ones. The highest prevalence (91.9%) was found in Finland, and the lowest (40.7%) in Portugal. A higher percentage of men practiced any leisure-time physical activity and also showed higher mean of MET-h.wk(-1). In both genders, the multivariate models showed a significant trend to higher leisure time activity in participants with higher educational levels and in nonsmokers. Also, an inverse association between body mass index and leisure-time physical activity was found. CONCLUSION: The prevalence of any physical activity during leisure time in the adult European population was similar to the U.S. estimates. Nevertheless, the amount of activity is low, and a wide disparity between countries exists. To our knowledge, this is the first study determining the prevalence and amount of leisure-time physical activity, which is the first step to define strategies to persuade populations to increase their physical activity.

Perception of body image as indicator of weight status in the European union.

OBJECTIVE: To identify the factors associated with an adequate perception of body image in relation to body weight. MATERIAL AND METHODS: An observational, cross-sectional study was conducted in a representative sample of the European Union (7,155 men and 8,077 women). Body Mass Index (BMI) was grouped into four categories, perceived body image was assessed using the nine silhouettes drawing scheme. A multivariable logistic regression model for each sex was used to adjust for potentially confounding variables. RESULTS: Underweight men and women classified themselves better than other groups (92.9% of correct answers among men and 79.3% among women). Overall, women classified themselves better than men (57.6% vs. 32.7%). DISCUSSION: Perceived body image as a method of assessment for body weight has different validity depending on sociodemographic or attitudinal categories. Perceived body image as an estimate of the nutritional status has a limited individualized application. Thus, perhaps it could be applied as a proxy measure of adiposity among slim males and among slim and overweight females, but not among the other groups.