Sexual risk-taking during travel abroad - a cross-sectional survey among youth in Sweden.

BACKGROUND: The aim was to assess sexual risk-taking behaviour in a sample of Swedish youth who were sexually active while travelling abroad and to examine possible associations with sexual risk-taking behaviour during such travel. METHODS: From a population-based sample of 2189 Swedes 18-29 years, 768 who were sexually active while abroad, were assessed by a questionnaire concerning socio-demographic background, life-style, travel duration, sexuality, mental health, heavy episodic drinking (HED) and drug-use. RESULTS: Approximately 1/4 reported intercourse with a casual partner abroad. Casual sex was associated with HED, 18-24 years, and drug use in both sexes, and for women, also with ≥one month of travel. Among youth with casual partners, 48% reported non-condom use. Non-condom use with a casual partner was associated with 18-24 years, ≥one month of travel for women, and poor self-rated mental health for men. About 10% had ≥2 partners abroad. Having ≥2 partners abroad was associated with ≥one month of travel, and for men also with HED. CONCLUSION: Male sex, 18-24 years of age, ≥1 month of travel, HED, and drug use were significantly associated with sexual risk-taking during travel abroad. Poor self-rated mental health and foreign-born parentage might also constitute risk factors for men.

Use of a T cell interferon gamma release assay in the investigation for suspected active tuberculosis in a low prevalence area.

BACKGROUND: In settings with low background prevalence of tuberculosis (TB) infection, interferon-gamma release assays (IGRA) could be useful for diagnosing active TB. This study aims to evaluate the performance of QuantiFERON-TB Gold (QFT-G) in the investigation for suspected active TB, with particular attention to patients originating in high-incidence countries. Furthermore, factors associated with QFT-G results in patients with active TB were assessed. METHODS: From patients investigated for clinically suspected active TB, blood was obtained for QFT-G testing, in addition to routine investigations. Positive (PPV) and negative (NPV) predictive values for QFT-G were calculated, comparing patients with confirmed TB and those with other final diagnoses. QFT-G results in TB patients originating from countries with intermediate or high TB incidence were compared with QFT-G results from a control group of recently arrived asymptomatic immigrants from high-incidence countries. Factors associated with QFT-G outcome in patients with confirmed TB were assessed. RESULTS: Among 141 patients, 41/70 (58.6%) with confirmed TB had a positive QFT-G test, compared to 16/71 (22.6%) patients with other final diagnoses, resulting in overall PPV of 71.9% and NPV of 67.6%. For patients with pulmonary disease, PPV and NPV were 61.1% and 67.7%, respectively, and 90.5% and 66.7% for subjects with extrapulmonary manifestations. Comparing patients from high-incidence countries with controls yielded a PPV for active TB of 76.7%, and a NPV of 82.7%. Patients with confirmed TB and positive QFT-G results were characterized by a lower median peripheral white blood cell count (5.9 x 10(9)/L vs. 8.8 x 10(9)/L; P < 0.001) and a higher median body mass index (22.7 vs. 20.7; P = 0.043) as compared to QFT-G-negative TB patients. CONCLUSION: The overall PPV and NPV of QFT-G for identifying active TB were unsatisfactory, especially for pulmonary disease. Thus, the usefulness of QFT-G for this purpose is questionable. However, a high PPV was observed for extrapulmonary TB and QFT-G might be considered in the diagnostic process in this situation. The PPV and NPV for identifying active TB among persons originating from regions with high-and intermediate TB incidence was similar to that observed in subjects originating in the low-incidence region.

Demographics of tuberculosis in an emerging EU region in southern Scandinavia.

To describe demographics of tuberculosis (TB) in the Øresund region, southern Scandinavia, a retrospective analysis of epidemiological data from TB registers and population databases, from 1995 to 2002, was performed. A total of 2678 TB cases were reported with an overall incidence of 6.3 per 100,000 person-y of observation. There were major differences in notification rates among immigrants depending on their country of origin and their residence in the Øresund region. In the Danish part, 37% of all cases among immigrants came from the Horn of Africa compared to 28% in the Swedish areas. Older age and residence in Denmark were independent risk factors for TB. Comparisons of TB rates within the group of immigrants from the Horn of Africa showed higher rates in the Danish areas compared to the Swedish areas. The discrepancies in notification rates could be explained by different socioeconomic circumstances in the 2 countries or by a greater immigration from highly endemic countries into Denmark during the study period; however, ongoing transmission in specific population groups at high risk of tuberculosis cannot be excluded. This highlights the need for continued and improved surveillance for TB, especially among newly arrived immigrants from highly endemic countries.

Direct colorimetric assay for rapid detection of rifampin-resistant Mycobacterium tuberculosis.

The colorimetric 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay was standardized for direct detection of rifampin-resistant Mycobacterium tuberculosis in sputum samples. The sensitivity and specificity of the direct MTT assay matched those of the standard indirect susceptibility assay on 7H10 medium, and interpretable results were obtained for 98.5% of the samples within 2 weeks. Traditional methods of in vitro drug susceptibility testing are time consuming and laborious. Susceptibility tests on clinical isolates require 6 to 9 weeks, and tests conducted directly on smear-positive samples take about 3 weeks (International Union Against Tuberculosis and Lung Disease, The public health service national tuberculosis reference laboratory and the national laboratory network. Minimum requirements, role and operation in a low-income country, Paris, France, 1998, and P. T. Kent and G. P. Kubica, Public health mycobacteriology. A guide for the level III laboratory, Centers for Disease Control and Prevention, Atlanta, Ga., 1985). More-rapid methods are available but are very expensive for routine use under program conditions in countries with high levels of tuberculosis endemicity.

Incidence and clinical significance of non-tuberculous mycobacteria isolated from clinical specimens during a 2-y nationwide survey.

A 2-y nationwide survey of patients in Denmark with non-tuberculous mycobacteria (NTM) cultures was undertaken. Patients were identified by means of records held at the International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Denmark. The objectives were to identify isolated NTM to species level, to describe the incidence of the various species and to evaluate the clinical significance of pulmonary NTM isolates other than M. avium complex (MAC) and M. gordonae. Identification was performed by means of hybridization or sequencing of 16S rDNA. The clinical significance of pulmonary NTM isolates was evaluated by means of questionnaires concerning patients (was sent to the clinicians!) patients who had NTM isolated for the first time using bacteriologic, radiographic and clinical criteria. A total of 1110 specimens (2.1%) from 525 patients grew NTM. After MAC (n = 198) and M. gordonae (n = 168), most patients had M. abscessus (n = 21), M. malmoense (n = 20) and M. xenopi (n = 17) isolated. Of the pulmonary patients, 50.6% met bacteriologic criteria, 75.3% radiographic criteria and 53.4% clinical criteria for significant infection. Almost half of the pulmonary patients met all the criteria for significant NTM infection that could be evaluated. Clinically significant infection was associated with underlying disease in most patients.