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2.
Epidemiol Psychiatr Sci ; 29: e92, 2020 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-31928567

RESUMEN

AIMS: Research from high-income countries has implicated travel distance to mental health services as an important factor influencing treatment-seeking for mental disorders. This study aimed to test the extent to which travel distance to the nearest depression treatment provider is associated with treatment-seeking for depression in rural India. METHODS: We used data from a population-based survey of adults with probable depression (n = 568), and calculated travel distance from households to the nearest public depression treatment provider with network analysis using Geographic Information Systems (GIS). We tested the association between travel distance to the nearest public depression treatment provider and 12 month self-reported use of services for depression. RESULTS: We found no association between travel distance and the probability of seeking treatment for depression (OR 1.00, 95% CI 0.98-1.02, p = 0.78). Those living in the immediate vicinity of public depression treatment providers were just as unlikely to seek treatment as those living 20 km or more away by road. There was evidence of interaction effects by caste, employment status and perceived need for health care, but these effect sizes were generally small. CONCLUSIONS: Geographic accessibility - as measured by travel distance - is not the primary barrier to seeking treatment for depression in rural India. Reducing travel distance to public mental health services will not of itself reduce the depression treatment gap for depression, at least in this setting, and decisions about the best platform to deliver mental health services should not be made on this basis.


Asunto(s)
Depresión/terapia , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Conducta de Búsqueda de Ayuda , Servicios de Salud Mental/estadística & datos numéricos , Aceptación de la Atención de Salud , Población Rural/estadística & datos numéricos , Viaje/estadística & datos numéricos , Adulto , Estudios Transversales , Depresión/diagnóstico , Depresión/psicología , Femenino , Sistemas de Información Geográfica , Encuestas de Atención de la Salud , Investigación sobre Servicios de Salud , Humanos , India , Masculino , Vigilancia de la Población , Factores de Tiempo
3.
J Insect Sci ; 20(1)2020 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-31916580

RESUMEN

The western tree hole mosquito, Aedes sierrensis (Ludlow), is a common nuisance mosquito and vector of Dirofilaria immitis (Leidy), the etiologic agent of dog heartworm, in western North America. Here, we compare weekly mosquito collections made with Mosquito Magnet (MM) traps, Biogents Sentinel (BGS) traps, and Biogents Bowl (BGS Bowl) traps set in Salt Lake City, UT, from the start of June to mid-August 2017. We found the number of mosquitoes decreased with rainfall and temperature independently of trap type. The highest number of mosquitoes were caught by BGS traps baited with carbon dioxide (CO2) and BG lure, which collected 62% (n = 422) of all mosquitoes, followed by the MM at 31% (n = 213), and both the BGS and BG Bowl with BG lure had 3.5% (n = 24) each. Aedes sierrensis females were caught weekly at similar densities (mean ±â€…SD) in BGS with CO2 and lure (1.17 ±â€…2.93) and the MM (1.17 ±â€…2.66) traps during the study period. Given that BGS with CO2 and lure traps have several operational advantages over MM traps, including a quicker setup, smaller size, and lower cost, we consider BGS with CO2 and lure traps as the best suited surveillance tool to detect and remove Ae. sierrensis in the western United States and similar settings throughout North America.


Asunto(s)
Aedes , Control de Mosquitos/métodos , Mosquitos Vectores , Vigilancia de la Población/métodos , Animales , Dirofilaria immitis , Femenino , Masculino , Mosquitos Vectores/fisiología , Dinámica Poblacional , Utah
4.
MMWR Morb Mortal Wkly Rep ; 69(3): 67-71, 2020 Jan 24.
Artículo en Inglés | MEDLINE | ID: mdl-31971935

RESUMEN

Zika virus infection during pregnancy can cause congenital brain and eye abnormalities and is associated with neurodevelopmental abnormalities (1-3). In areas of the United States that experienced local Zika virus transmission, the prevalence of birth defects potentially related to Zika virus infection during pregnancy increased in the second half of 2016 compared with the first half (4). To update the previous report, CDC analyzed population-based surveillance data from 22 states and territories to estimate the prevalence of birth defects potentially related to Zika virus infection, regardless of laboratory evidence of or exposure to Zika virus, among pregnancies completed during January 1, 2016-June 30, 2017. Jurisdictions were categorized as those 1) with widespread local transmission of Zika virus; 2) with limited local transmission of Zika virus; and 3) without local transmission of Zika virus. Among 2,004,630 live births, 3,359 infants and fetuses with birth defects potentially related to Zika virus infection during pregnancy were identified (1.7 per 1,000 live births, 95% confidence interval [CI] = 1.6-1.7). In areas with widespread local Zika virus transmission, the prevalence of birth defects potentially related to Zika virus infection during pregnancy was significantly higher during the quarters comprising July 2016-March 2017 (July-September 2016 = 3.0; October-December 2016 = 4.0; and January-March 2017 = 5.6 per 1,000 live births) compared with the reference period (January-March 2016) (1.3 per 1,000). These findings suggest a fourfold increase (prevalence ratio [PR] = 4.1, 95% CI = 2.1-8.4) in birth defects potentially related to Zika virus in widespread local transmission areas during January-March 2017 compared with that during January-March 2016, with the highest prevalence (7.0 per 1,000 live births) in February 2017. Population-based birth defects surveillance is critical for identifying infants and fetuses with birth defects potentially related to Zika virus regardless of whether Zika virus testing was conducted, especially given the high prevalence of asymptomatic disease. These data can be used to inform follow-up care and services as well as strengthen surveillance.


Asunto(s)
Anomalías Congénitas/epidemiología , Anomalías Congénitas/virología , Vigilancia de la Población , Complicaciones Infecciosas del Embarazo/virología , Infección por el Virus Zika/complicaciones , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Embarazo , Prevalencia , Puerto Rico/epidemiología , Estados Unidos/epidemiología , Islas Virgenes de los Estados Unidos/epidemiología
5.
Gut ; 69(2): 201-223, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31776230

RESUMEN

These consensus guidelines were jointly commissioned by the British Society of Gastroenterology (BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and Public Health England (PHE). They provide an evidence-based framework for the use of surveillance colonoscopy and non-colonoscopic colorectal imaging in people aged 18 years and over. They are the first guidelines that take into account the introduction of national bowel cancer screening. For the first time, they also incorporate surveillance of patients following resection of either adenomatous or serrated polyps and also post-colorectal cancer resection. They are primarily aimed at healthcare professionals, and aim to address:Which patients should commence surveillance post-polypectomy and post-cancer resection?What is the appropriate surveillance interval?When can surveillance be stopped? two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); or five or more premalignant polyps The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument provided a methodological framework for the guidelines. The BSG's guideline development process was used, which is National Institute for Health and Care Excellence (NICE) compliant.two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); or five or more premalignant polyps The key recommendations are that the high-risk criteria for future colorectal cancer (CRC) following polypectomy comprise either:two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); or five or more premalignant polyps This cohort should undergo a one-off surveillance colonoscopy at 3 years. Post-CRC resection patients should undergo a 1 year clearance colonoscopy, then a surveillance colonoscopy after 3 more years.


Asunto(s)
Pólipos del Colon/cirugía , Neoplasias Colorrectales/cirugía , Vigilancia de la Población/métodos , Colonoscopía/normas , Medicina Basada en la Evidencia/métodos , Humanos , Cuidados a Largo Plazo/métodos , Cuidados a Largo Plazo/normas , Recurrencia Local de Neoplasia/diagnóstico , Selección de Paciente , Periodo Posoperatorio
6.
Rev Esp Cardiol (Engl Ed) ; 73(1): 43-52, 2020 Jan.
Artículo en Inglés, Español | MEDLINE | ID: mdl-31521574

RESUMEN

INTRODUCTION AND OBJECTIVES: To describe, for the first time, reference values for the cardio-ankle vascular index (CAVI), brachial-ankle pulse wave velocity (BA-PWV), carotid-femoral pulse wave velocity (CF-PWV), and the central augmentation index and to establish their association with cardiovascular risk factors in the Spanish adult population aged 35 to 75 years without cardiovascular disease. METHODS: We conducted a cross-sectional study. Through random sampling stratified by age and sex, we included 501 participants without cardiovascular disease. The mean age was 55.9 years and 50.3% were women. The measurements were taken using the SphigmoCor and Vasera VS-1500 devices. RESULTS: Values for all measures, except those for the central augmentation index, were higher in men and increased with age and blood pressure. The mean values were as follows: CAVI, 8.01±1.44; BA-PWV, 12.93±2.68m/s; CF-PWV, 6.53±2.03 m/s, and central augmentation index, 26.84±12.79. On multiple regression analysis, mean blood pressure was associated with the 4 measures, glycated hemoglobin was associated with all measures except the central augmentation index, and body mass index showed an inverse association with CAVI. The explanatory capacity of age, sex, and mean blood pressure was 62% for BA-PWV, 49% for CF-PWV 49%, 54% for the CAVI, and 38% for the central augmentation index. On logistic regression, hypertension was associated with the CAVI (OR=3.45), VOP-BT (OR=3.44), VOP-CF (OR=3.38) and with the central augmentation index (OR=3.73). CONCLUSIONS: All arterial stiffness measures increased with age. The CAVI and CF-PWV were higher in men and the central augmentation index was higher in women, with no differences in BA-PWV. This study is registered at ClinicalTrials.gov. Identifier NCT02623894.


Asunto(s)
Enfermedades Cardiovasculares/fisiopatología , Vigilancia de la Población , Rigidez Vascular/fisiología , Adulto , Anciano , Índice Tobillo Braquial , Índice de Masa Corporal , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Grosor Intima-Media Carotídeo , Estudios Transversales , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Análisis de la Onda del Pulso , Valores de Referencia , Factores de Riesgo , España/epidemiología
7.
J Urol ; 203(1): 115-119, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31502940

RESUMEN

PURPOSE: The following is a summary of discussion at a United States FDA (Food and Drug Administration) public workshop reviewing potential trial designs and end points to develop therapies to treat localized prostate cancer. MATERIALS AND METHODS: The workshop focused on the challenge that drug and device development to treat localized prostate cancer has been limited by the large trial sizes and lengthy timelines required to demonstrate an improvement in overall or metastasis-free survival and by the lack of agreed on alternative end points. Additionally, evolving treatment paradigms in the management of localized prostate cancer include the widespread use of active surveillance of patients with low and some intermediate risk prostate cancer, and the availability of advances in imaging and genomics. RESULTS: The workshop addressed issues related to trial design in this setting. Attendees discussed several potential novel end points such as a delay of morbidity due to radiation or prostatectomy and pathological end points such as Gleason Grade Group upgrade. CONCLUSIONS: The workshop provided an open forum for multiple stakeholder engagement to advance the development of effective treatment options for men with localized prostate cancer.


Asunto(s)
Ensayos Clínicos como Asunto , Neoplasias de la Próstata/terapia , Proyectos de Investigación , United States Food and Drug Administration , Diagnóstico por Imagen , Educación , Determinación de Punto Final , Genómica , Humanos , Masculino , Vigilancia de la Población , Estados Unidos , Espera Vigilante
8.
Gut ; 69(1): 7-17, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31672839

RESUMEN

BACKGROUND AND AIM: The International Cancer of the Pancreas Screening Consortium met in 2018 to update its consensus recommendations for the management of individuals with increased risk of pancreatic cancer based on family history or germline mutation status (high-risk individuals). METHODS: A modified Delphi approach was employed to reach consensus among a multidisciplinary group of experts who voted on consensus statements. Consensus was considered reached if ≥75% agreed or disagreed. RESULTS: Consensus was reached on 55 statements. The main goals of surveillance (to identify high-grade dysplastic precursor lesions and T1N0M0 pancreatic cancer) remained unchanged. Experts agreed that for those with familial risk, surveillance should start no earlier than age 50 or 10 years earlier than the youngest relative with pancreatic cancer, but were split on whether to start at age 50 or 55. Germline ATM mutation carriers with one affected first-degree relative are now considered eligible for surveillance. Experts agreed that preferred surveillance tests are endoscopic ultrasound and MRI/magnetic retrograde cholangiopancreatography, but no consensus was reached on how to alternate these modalities. Annual surveillance is recommended in the absence of concerning lesions. Main areas of disagreement included if and how surveillance should be performed for hereditary pancreatitis, and the management of indeterminate lesions. CONCLUSIONS: Pancreatic surveillance is recommended for selected high-risk individuals to detect early pancreatic cancer and its high-grade precursors, but should be performed in a research setting by multidisciplinary teams in centres with appropriate expertise. Until more evidence supporting these recommendations is available, the benefits, risks and costs of surveillance of pancreatic surveillance need additional evaluation.


Asunto(s)
Carcinoma/diagnóstico , Detección Precóz del Cáncer/métodos , Neoplasias Pancreáticas/diagnóstico , Factores de Edad , Investigación Biomédica/métodos , Carcinoma/genética , Predisposición Genética a la Enfermedad , Mutación de Línea Germinal , Humanos , Tamizaje Masivo/métodos , Neoplasias Pancreáticas/genética , Vigilancia de la Población/métodos , Factores de Riesgo
9.
Gut ; 69(1): 112-121, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-30981990

RESUMEN

BACKGROUND AND AIMS: Serrated polyposis syndrome (SPS) is associated with an increased risk of colorectal cancer (CRC). International guidelines recommend surveillance intervals of 1-2 years. However, yearly surveillance likely leads to overtreatment for many. We prospectively assessed a surveillance protocol aiming to safely reduce the burden of colonoscopies. METHODS: Between 2013 and 2018, we enrolled SPS patients from nine Dutch and Spanish hospitals. Patients were surveilled using a protocol appointing either a 1-year or 2-year interval after each surveillance colonoscopy, based on polyp burden. Primary endpoint was the 5-year cumulative incidence of CRC and advanced neoplasia (AN) during surveillance. RESULTS: We followed 271 SPS patients for a median of 3.6 years. During surveillance, two patients developed CRC (cumulative 5-year incidence 1.3%[95% CI 0% to 3.2%]). The 5-year AN incidence was 44% (95% CI 37% to 52%), and was lower for patients with SPS type III (26%) than for patients diagnosed with type I (53%) or type I and III (59%, p<0.001). Most patients were recommended a 2-year interval, and those recommended a 2-year interval were not at increased risk of AN: AN incidence after a 2-year recommendation was 15.6% compared with 24.4% after a 1-year recommendation (OR 0.57, p=0.08). CONCLUSION: Risk stratification substantially reduced colonoscopy burden while achieving CRC incidence similar to previous studies. AN incidence is considerable in SPS patients, but extension of surveillance intervals was not associated with increased AN in those identified as low-risk by the protocol. We identified SPS type III patients as low-risk group that might benefit from even less frequent surveillance. TRIAL REGISTRATION NUMBER: The study was registered on http://www.trialregister.nl; trial-ID NTR4609.


Asunto(s)
Poliposis Adenomatosa del Colon/diagnóstico , Neoplasias Colorrectales/diagnóstico , Poliposis Adenomatosa del Colon/epidemiología , Poliposis Adenomatosa del Colon/cirugía , Anciano , Estudios de Cohortes , Colonoscopía/métodos , Colonoscopía/estadística & datos numéricos , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/cirugía , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Uso Excesivo de los Servicios de Salud/prevención & control , Uso Excesivo de los Servicios de Salud/estadística & datos numéricos , Persona de Mediana Edad , Países Bajos/epidemiología , Vigilancia de la Población/métodos , Prevalencia , Estudios Prospectivos , Factores de Riesgo , España/epidemiología
10.
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi ; 37(11): 842-845, 2019 Nov 20.
Artículo en Chino | MEDLINE | ID: mdl-31826551

RESUMEN

Objective: Analyzes of the monitoring results of silicosis in key occupational disease monitoring in Tianjin in 2017, providing reference for continuous monitoring, and prevention and control work of silicosis. Methods: Monitor and analyze the current state of silica dust hazard enterprises, the health status of silica dust workers, and the characteristics of newly developed silicosis cases in accordance with the national 2017 work plan for key occupational disease monitoring and occupational health risk assessment. Results: In 2017, 210 enterprises have silica dust hazard in Tianjin, silica dust workplaces exceed the standard rate is 34.73%, 5 695 workers' health examination who contact with silica dust were collected. 2 were detected occupational contraindication, the abnormal detection rate of chest examination is 3.60%, the abnormal index of lung function mainly is FVC, the abnormal rate is 15.8%. The abnormal rate increases with working years. In 2017, 193 new cases of silicosis were reported most cases were developed after years of decontamination. Most enterprises with cases had already out of market, only 7 were still producing. Conclusion: The key prevention and control in Tianjin was enterprises with silica dust excess of standard, as well as older and longer working years workers, adopting effective measures to reduce the concentration of silica dust in workplace is a fundamental measure to reduce the risk of silicosis.


Asunto(s)
Enfermedades Profesionales , Exposición Profesional , Salud Laboral , Silicosis , China/epidemiología , Polvo/análisis , Humanos , Enfermedades Profesionales/epidemiología , Exposición Profesional/estadística & datos numéricos , Vigilancia de la Población , Dióxido de Silicio/análisis , Silicosis/epidemiología
11.
BMC Infect Dis ; 19(1): 1019, 2019 Dec 02.
Artículo en Inglés | MEDLINE | ID: mdl-31791253

RESUMEN

BACKGROUND: Chronic hepatitis C is a major public health burden. With new interferon-free direct-acting agents (showing sustained viral response rates of more than 98%), elimination of HCV seems feasible for the first time. However, as HCV infection often remains undiagnosed, screening is crucial for improving health outcomes of HCV-patients. Our aim was to assess the long-term cost-effectiveness of a nationwide screening strategy in Germany. METHODS: We used a Markov cohort model to simulate disease progression and examine long-term population outcomes, HCV associated costs and cost-effectiveness of HCV screening. The model divides the total population into three subpopulations: general population (GEP), people who inject drugs (PWID) and HIV-infected men who have sex with men (MSM), with total infection numbers being highest in GEP, but new infections occurring only in PWIDs and MSM. The model compares four alternative screening strategies (no/basic/advanced/total screening) differing in participation and treatment rates. RESULTS: Total number of HCV-infected patients declined from 275,000 in 2015 to between 125,000 (no screening) and 14,000 (total screening) in 2040. Similarly, lost quality adjusted life years (QALYs) were 320,000 QALYs lower, while costs were 2.4 billion EUR higher in total screening compared to no screening. While incremental cost-effectiveness ratio (ICER) increased sharply in GEP and MSM with more comprehensive strategies (30,000 EUR per QALY for total vs. advanced screening), ICER decreased in PWIDs (30 EUR per QALY for total vs. advanced screening). CONCLUSIONS: Screening is key to have an efficient decline of the HCV-infected population in Germany. Recommendation for an overall population screening is to screen the total PWID subpopulation, and to apply less comprehensive advanced screening for MSM and GEP.


Asunto(s)
Erradicación de la Enfermedad , Hepatitis C/prevención & control , Tamizaje Masivo/economía , Tamizaje Masivo/métodos , Adulto , Antivirales/economía , Antivirales/uso terapéutico , Estudios de Cohortes , Análisis Costo-Beneficio , Pruebas Diagnósticas de Rutina/economía , Pruebas Diagnósticas de Rutina/estadística & datos numéricos , Erradicación de la Enfermedad/economía , Erradicación de la Enfermedad/métodos , Erradicación de la Enfermedad/estadística & datos numéricos , Consumidores de Drogas/estadística & datos numéricos , Femenino , Alemania/epidemiología , Infecciones por VIH/diagnóstico , Infecciones por VIH/economía , Infecciones por VIH/epidemiología , Costos de la Atención en Salud , Hepacivirus/genética , Hepacivirus/aislamiento & purificación , Hepatitis C/diagnóstico , Hepatitis C/economía , Hepatitis C/epidemiología , Hepatitis C Crónica/diagnóstico , Hepatitis C Crónica/economía , Hepatitis C Crónica/epidemiología , Hepatitis C Crónica/prevención & control , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Masculino , Tamizaje Masivo/estadística & datos numéricos , Persona de Mediana Edad , Vigilancia de la Población/métodos , Años de Vida Ajustados por Calidad de Vida , Minorías Sexuales y de Género/estadística & datos numéricos
12.
BMC Infect Dis ; 19(1): 1022, 2019 Dec 02.
Artículo en Inglés | MEDLINE | ID: mdl-31791273

RESUMEN

BACKGROUND: Few countries in sub-Saharan Africa know the magnitude of their HIV epidemic among people who inject drugs (PWID). This was the first study in Mozambique to measure prevalence of HIV, HBV, and HCV, and to assess demographic characteristics and risk behaviors in this key population. METHODS: We used respondent-driven sampling (RDS) to conduct a cross-sectional behavioral surveillance survey of PWID in two cities of Mozambique lasting six months. Participants were persons who had ever injected drugs without a prescription. Participants completed a behavioral questionnaire and provided blood specimens for HIV, hepatitis B surface antigen (HBsAg) and hepatitis C virus antibody (anti-HCV) testing. We performed RDS-adjusted analysis in R 3.2 using RDSAT 7.1 weights. RESULTS: We enrolled 353 PWID in Maputo and 139 in Nampula/Nacala; approximately 95% of participants were men. Disease prevalence in Maputo and Nampula/Nacala, respectively, was 50.1 and 19.9% for HIV, 32.1 and 36.4% for HBsAg positivity, and 44.6 and 7.0% for anti-HCV positivity. Additionally, 8% (Maputo) and 28.6% (Nampula/Nacala) of PWID reported having a genital sore or ulcer in the 12 months preceding the survey. Among PWID who injected drugs in the last month, 50.3% (Maputo) and 49.6% (Nampula/Nacala) shared a needle at least once that month. Condomless sex in the last 12 months was reported by 52.4% of PWID in Maputo and 29.1% in Nampula/Nacala. Among PWID, 31.6% (Maputo) and 41.0% (Nampula/Nacala) had never tested for HIV. In multivariable analysis, PWID who used heroin had 4.3 (Maputo; 95% confidence interval [CI]: 1.2, 18.2) and 2.3 (Nampula/Nacala; 95% CI: 1.2, 4.9) greater odds of having HIV. CONCLUSION: Unsafe sexual behaviors and injection practices are frequent among PWID in Mozambique, and likely contribute to the disproportionate burden of disease we found. Intensified efforts in prevention, care, and treatment specific for PWID have the potential to limit disease transmission.


Asunto(s)
Consumidores de Drogas/estadística & datos numéricos , Infecciones por VIH/epidemiología , Hepatitis B/epidemiología , Hepatitis C/epidemiología , Abuso de Sustancias por Vía Intravenosa/epidemiología , Adolescente , Adulto , Anciano , Ciudades/epidemiología , Estudios Transversales , Epidemias , Femenino , Infecciones por VIH/sangre , Seropositividad para VIH/epidemiología , Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/análisis , Antígenos de Superficie de la Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/inmunología , Hepatitis C/sangre , Humanos , Masculino , Persona de Mediana Edad , Mozambique/epidemiología , Vigilancia de la Población/métodos , Prevalencia , Asunción de Riesgos , Estudios Seroepidemiológicos , Conducta Sexual/estadística & datos numéricos , Encuestas y Cuestionarios/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Adulto Joven
13.
BMC Infect Dis ; 19(1): 1023, 2019 Dec 02.
Artículo en Inglés | MEDLINE | ID: mdl-31791276

RESUMEN

BACKGROUND: Staphylococcus aureus carriage is a known risk factor for staphylococcal disease. However, the carriage rates vary by country, demographic group and profession. This study aimed to determine the S. aureus carriage rate in children in Eastern Uganda, and identify S. aureus lineages that cause infection in Uganda. METHODS: Nasopharyngeal samples from 742 healthy children less than 5 years residing in the Iganga/Mayuge Health and Demographic Surveillance Site in Eastern Uganda were processed for isolation of S. aureus. Antibiotic susceptibility testing based on minimum inhibitory concentrations (MICs) was determined by the BD Phoenix™ system. Genotyping was performed by spa and SCCmec typing. RESULTS: The processed samples yielded 144 S. aureus isolates (one per child) therefore, the S. aureus carriage rate in children was 19.4% (144/742). Thirty one percent (45/144) of the isolates were methicillin resistant (MRSA) yielding a carriage rate of 6.1% (45/742). All isolates were susceptible to rifampicin, vancomycin and linezolid. Moreover, all MRSA were susceptible to vancomycin, linezolid and clindamycin. Compared to methicillin susceptible S. aureus (MSSA) isolates (68.8%, 99/144), MRSA isolates were more resistant to non-beta-lactam antimicrobials -trimethoprim/sulfamethoxazole 73.3% (33/45) vs. 27.3% (27/99) [p < 0.0001]; erythromycin 75.6% (34/45) vs. 24.2% (24/99) [p < 0.0001]; chloramphenicol 60% (27/45) vs. 19.2% (19/99) [p < 0.0001]; gentamicin 55.6% (25/45) vs. 25.3% (25/99) [p = 0.0004]; and ciprofloxacin 35.6% (16/45) vs. 2% (2/99) [p < 0.0001]. Furthermore, 42 MRSA (93.3%) were multidrug resistant (MDR) and one exhibited high-level resistance to mupirocin. Overall, 61 MSSA (61.6%) were MDR, including three mupirocin and clindamycin resistant isolates. Seven spa types were detected among MRSA, of which t037 and t064 were predominant and associated with SCCmec types I and IV, respectively. Fourteen spa types were detected in MSSA which consisted mainly of t645 and t4353. CONCLUSIONS: S. aureus carriage rate in healthy children in Eastern Uganda is high and comparable to rates for hospitalized patients in Kampala. The detection of mupirocin resistance is worrying as it could rapidly increase if mupirocin is administered in a low-income setting. S. aureus strains of spa types t064, t037 (MRSA) and t645, t4353 (MSSA) are prevalent and could be responsible for majority of staphylococcal infections in Uganda.


Asunto(s)
Antígenos Bacterianos/análisis , Portador Sano/epidemiología , Farmacorresistencia Bacteriana , Nariz/microbiología , Faringe/microbiología , Infecciones Estafilocócicas/epidemiología , Staphylococcus aureus/aislamiento & purificación , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Antígenos Bacterianos/clasificación , Antígenos Bacterianos/genética , Portador Sano/microbiología , Preescolar , Estudios Transversales , Farmacorresistencia Bacteriana/genética , Femenino , Técnicas de Genotipaje/métodos , Humanos , Lactante , Recién Nacido , Masculino , Staphylococcus aureus Resistente a Meticilina/genética , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Pruebas de Sensibilidad Microbiana , Tipificación Molecular/métodos , Mupirocina/farmacología , Mupirocina/uso terapéutico , Mucosa Nasal/microbiología , Vigilancia de la Población/métodos , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/clasificación , Staphylococcus aureus/genética , Uganda/epidemiología
14.
MMWR Morb Mortal Wkly Rep ; 68(48): 1112-1116, 2019 Dec 06.
Artículo en Inglés | MEDLINE | ID: mdl-31805034

RESUMEN

In 2005, the World Health Organization (WHO) Western Pacific Region countries, including China, resolved to eliminate measles by 2012 or as soon as feasible thereafter (1). As of 2018, nine* of the 37 Western Pacific Region countries or areas† had eliminated§ measles. China's Measles Elimination Action Plan 2006-2012 included strengthening routine immunization; conducting measles risk assessments, followed by supplementary immunization activities (SIAs) with measles-containing vaccine (MCV) at national and subnational levels; strengthening surveillance and laboratory capacity; and investigating and responding to measles outbreaks. Most recently, progress toward measles elimination in China was described in a 2014 report documenting measles elimination efforts in China during 2008-2012 and a resurgence in 2013 (2). This report describes progress toward measles elimination in China during January 2013-June 2019.¶ Measles incidence per million persons decreased from 20.4 in 2013 to 2.8 in 2018; reported measles-related deaths decreased from 32 in 2015 to one in 2018 and no deaths in 2019 through June. Measles elimination in China can be achieved through strengthening the immunization program's existing strategy by ensuring sufficient vaccine supply; continuing to improve laboratory-supported surveillance, outbreak investigation and response; strengthening school entry vaccination record checks; vaccinating students who do not have documentation of receipt of 2 doses of measles-rubella vaccine; and vaccinating health care professionals and other adults at risk for measles.


Asunto(s)
Erradicación de la Enfermedad , Brotes de Enfermedades/prevención & control , Sarampión/prevención & control , Vigilancia de la Población , Adolescente , Niño , Preescolar , China/epidemiología , Brotes de Enfermedades/estadística & datos numéricos , Femenino , Humanos , Programas de Inmunización , Incidencia , Lactante , Masculino , Sarampión/epidemiología , Sarampión/mortalidad , Vacuna Antisarampión/administración & dosificación
15.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(11): 1386-1391, 2019 Nov 10.
Artículo en Chino | MEDLINE | ID: mdl-31838809

RESUMEN

Objective: To investigate the status of self-measurement of body weight in overweight and obese adults in China and identify the related factors. Methods: A total of 87 670 adults were enrolled in this study, who were selected through multi stage cluster random sampling from 177 099 residents aged ≥18 years in 302 surveillance areas in China where the fourth chronic non-communicable disease and related factor surveillance project was conducted in 2013. The information about their demographic characteristics and body weight measurement were collected by using questionnaire. Their body height, body weight, waist circumstance and blood pressure were measured respectively through physical examination. Fasting venous blood samples were obtained and assayed for FPG, TC, TG, LDL-C and HDL-C levels. Venous blood samples after 75 g glucose intake were obtained and assayed for OGTT-2h level. The proportion of self-body weight measurement were analyzed after complex sample weighting. Results: The proportion of overweight and obese adults who had self-body weight measurement within 1 week, 1 month and 1 year were 18.9%, 23.0% and 30.2%, respectively. The proportion of those having self-body weight measurement within 1 week was higher in men than in women, and lowest in ≥60 years old group (P<0.05). The proportion of overweight and obese adults who had never measured their body weight was 20.5%, the proportion was higher in women than in men, and highest in ≥60 years old group (P<0.05). Older age (OR=0.73, 95%CI: 0.64-0.82) was risk factor for self-body weight measurement; female (OR=1.11, 95%CI: 1.03-1.19), higher education level (junior college and above OR=3.79, 95%CI: 2.89-4.97), high- income (OR=1.61, 95%CI: 1.31-1.98), dyslipidemia (OR=1.13, 95%CI: 1.04-1.23), diabetes (OR=1.15, 95%CI: 1.03-1.30) were the protective factors for self-body weight measurement. Conclusion: It is necessary to promote self-body weight measurement in overweight and obese adults in China. Targeted health education should be carried out for different groups to encourage regular self-body weight measurement to maintain healthy body weight.


Asunto(s)
Obesidad , Sobrepeso , Adolescente , Adulto , Anciano , Índice de Masa Corporal , China , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Sobrepeso/epidemiología , Vigilancia de la Población/métodos , Prevalencia , Factores de Riesgo
16.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(11): 1420-1425, 2019 Nov 10.
Artículo en Chino | MEDLINE | ID: mdl-31838815

RESUMEN

Objective: To understand the trends of smoking and passive smoking exposure in adults in Shaanxi province from 2007 to 2015. Methods: Data was from China Chronic Disease and Risk Factor Surveillance in 2007, 2010, 2013 and 2015 to calculate the rates of smoking, smoking cessation and passive smoking exposure, as well as the amount of smoking of smokers indicated by each surveillance. Cochran-Armitage test was used to assess the trends across survey periods. The weighting rate was calculated by using sampling weight and data from the 6(th) national census in 2010. Sensitivity analysis was done to test the trends as well. Results: The results of the surveillance indicated that the smoking rate in 2007 was 38.26%, highest in the results of four surveys, it decreased to 30.95% in 2013 and then increased to 34.11% in 2015 (Cochran-Armitage test: Z=2.46, P=0.014). The amount of smoking increased from 16.90 cigarettes per day in 2007 to 17.76 cigarettes per day in 2015. The overall rate of smoking cessation was 11.02% in 2007 and 16.95% in 2015 (Cochran- Armitage test: Z=-4.18, P<0.01). We observed the passive smoking exposure rate was 48.10% in 2010 and 63.88% in 2015 (Cochran-Armitage test: Z=-10.60, P<0.01). We found no difference in trends by sensitivity analysis. Conclusions: The smoking rate and amount of cigarettes smoked in adults in Shaanxi remained stable and at a high level. The rate of smoking cessation increased gradually, while the passive smoking exposure rate increased rapidly.


Asunto(s)
Vigilancia de la Población/métodos , Cese del Hábito de Fumar/estadística & datos numéricos , Fumar/epidemiología , Fumar/tendencias , Contaminación por Humo de Tabaco/estadística & datos numéricos , Adolescente , Adulto , Grupo de Ascendencia Continental Asiática/estadística & datos numéricos , China/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Fumar/etnología , Cese del Hábito de Fumar/psicología , Encuestas y Cuestionarios
17.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(11): 1439-1444, 2019 Nov 10.
Artículo en Chino | MEDLINE | ID: mdl-31838818

RESUMEN

Objective: To understand the infection rate and genotype distribution of high risk-human papillomavirus (HR-HPV) and the detection rate of different grades of cervical lesions in Han and Mongolian women in China and provide evidence for the development of screening and vaccination strategies for the prevention and control of cervical cancer in different ethnic groups. Methods: In June 2017, a multicenter, population-based study for cervical cancer screening in low-resource settings in China was conducted in three rural areas: Xiangyuan and Yangcheng counties in Shanxi province, and Etuoke county in Inner Mongolia Autonomous Region. A total of 9 517 women aged 30-65 years were included in the study, and two cervical and vaginal secretion samples were collected from them for HPV and PCR-based HPV DNA tests. The positive samples in any of two tests were used for PCR-based HPV genotyping test by using Sansure-pioneered One-Step Fast Release technology. Women with positive results in any the HPV tests were referred for colposcopy and punch biopsy was given if cervical intraepithelial neoplasia lesion (low-grade lesion or worse) was suspected in colposcopy evaluation. Endocervical curettage was performed if women had an unsatisfactory colposcopy exam (the squamocolumnar junction was not completely visible). Pathological detection result was used as the golden standard of diagnosis. Results: HR-HPV infection rates in Han and Mongolian women were 21.83% (1 842/8 438) and 24.93% (269/1 079), respectively. There were statistical differences in HPV infection rates between the two ethnic groups (χ(2)=5.328, P=0.021). The detection rate of cervical intraepithelial neoplasia grade 1 in Mongolian women (2.83%) was higher than that in Han women (0.87%), and the difference was statistically significant (χ(2)=33.509, P<0.001). There were no significant differences in cervical intraepithelial neoplasia grade 2 or worse detection rate between the two ethnic groups [Mongolian woman: 1.04% (11/1 059), Han Woman: 0.95% (80/8 378), χ(2)=0.069, P=0.793]. Among Han and Mongolian women with cervical intraepithelial neoplasia grade 2 or worse, the three most common HR-HPV types were HPV16, HPV52 and HPV58. There was no significant difference for multiple infection rate between Han and Mongolian women (41.37% vs. 44.35%, χ(2)=0.764, P=0.382). Conclusions: The results show that HPV infection rate in Mongolian women was higher than that in Han women. Close attention should be paid to HPV16, 52 and 58 in the prevention and control of cervical cancer in Han and Mongolian women.


Asunto(s)
Grupo de Ascendencia Continental Asiática/estadística & datos numéricos , Papillomaviridae/genética , Papillomaviridae/aislamiento & purificación , Infecciones por Papillomavirus/virología , Lesiones Precancerosas/virología , Neoplasias del Cuello Uterino/virología , Adulto , Anciano , China/epidemiología , Colposcopía , Detección Precóz del Cáncer , Femenino , Genotipo , Papillomavirus Humano 16/genética , Papillomavirus Humano 16/aislamiento & purificación , Humanos , Tamizaje Masivo/métodos , Persona de Mediana Edad , Papillomaviridae/clasificación , Infecciones por Papillomavirus/etnología , Infecciones por Papillomavirus/genética , Reacción en Cadena de la Polimerasa , Vigilancia de la Población , Lesiones Precancerosas/etnología , Lesiones Precancerosas/genética , Embarazo , Prevalencia , Neoplasias del Cuello Uterino/etnología , Neoplasias del Cuello Uterino/genética
18.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(11): 1476-1480, 2019 Nov 10.
Artículo en Chino | MEDLINE | ID: mdl-31838824

RESUMEN

Through the effort in nearly 40 years of Tanzania, the total number of reported cases, the prevalence of HIV/AIDS and the number of death have declined, while the number of patients receiving antiretroviral therapy has increased significantly in Tanzania. At the same time, however, there are new challenges that require more attention, such as the HIV spread to rural areas, middle and lower social classes, and female teenagers. Although the overall performance of the HIV/AIDS prevention and control response is great, there is still a need to survey the new trends of this disease at the micro-level in Tanzania. In addition, there is a necessity of interdisciplinary concern due to the prevalence of heterosexual anal sex in Tanzania.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/epidemiología , Epidemias , Infecciones por VIH/epidemiología , Vigilancia de la Población/métodos , Población Rural , Síndrome de Inmunodeficiencia Adquirida/transmisión , Adolescente , Adulto , Femenino , Infecciones por VIH/transmisión , Humanos , Masculino , Persona de Mediana Edad , Conducta Sexual , Factores Socioeconómicos , Población Suburbana , Tanzanía/epidemiología
19.
JAMA ; 322(24): 2399-2410, 2019 12 24.
Artículo en Inglés | MEDLINE | ID: mdl-31860046

RESUMEN

Importance: Invasive nontypeable Haemophilus influenzae (NTHi) infection among adults is typically associated with bacteremic pneumonia. Nontypeable H influenzae is genetically diverse and clusters of infection are uncommon. Objective: To evaluate an increase in invasive NTHi infection from 2017-2018 among HIV-infected men who have sex with men in metropolitan Atlanta, Georgia. Design, Setting, and Participants: A population-based surveillance study with a cohort substudy and descriptive epidemiological analysis identified adults aged 18 years or older with invasive NTHi infection (isolation of NTHi from a normally sterile site) between January 1, 2008, and December 31, 2018 (final date of follow-up). Exposures: Time period, HIV status, and genetic relatedness (ie, cluster status) of available NTHi isolates. Main Outcomes and Measures: The primary outcome was incidence of invasive NTHi infection (from 2008-2016 and 2017-2018) among persons with HIV and compared with NTHi infection from 2008-2018 among those without HIV. The secondary outcomes were assessed among those aged 18 to 55 years with invasive NTHi infection and included epidemiological, clinical, and geographic comparisons by cluster status. Results: Among 553 adults with invasive NTHi infection (median age, 66 years [Q1-Q3, 48-78 years]; 52% male; and 38% black), 60 cases occurred among persons with HIV. Incidence of invasive NTHi infection from 2017-2018 among persons with HIV (41.7 cases per 100 000) was significantly greater than from 2008-2016 among those with HIV (9.6 per 100 000; P < .001) and from 2008-2018 among those without HIV (1.1 per 100 000; P < .001). Among adults aged 18 to 55 years with invasive NTHi infections from 2017-2018 (n = 179), persons with HIV (n = 31) were significantly more likely than those from 2008-2018 without HIV (n = 124) to be male (94% vs 49%, respectively; P < .001), black (100% vs 53%; P < .001), and have septic arthritis (35% vs 1%; P < .001). Persons with HIV who had invasive NTHi infection from 2017-2018 (n = 31) were more likely than persons with HIV who had invasive NTHi infection from 2008-2016 (n = 24) to have septic arthritis (35% vs 4%, respectively; P = .01). Pulsed-field gel electrophoresis of 174 of 179 NTHi isolates from 18- to 55-year-olds identified 2 genetically distinct clonal groups: cluster 1 (C1; n = 24) and cluster 2 (C2; n = 23). Whole-genome sequencing confirmed 2 clonal lineages of NTHi infection and revealed all C1 isolates (but none of the C2 isolates) carried IS1016 (an insertion sequence associated with H influenzae capsule genes). Persons with HIV were significantly more likely to have C1 or C2 invasive NTHi infection from 2017-2018 (28/31 [90%]) compared with from 2008-2016 among persons with HIV (10/24 [42%]; P < .001) and compared with from 2008-2018 among those without HIV (9/119 [8%]; P < .001). Among persons with C1 or C2 invasive NTHi infection who had HIV (n = 38) (median age, 34.5 years; 100% male; 100% black; 82% men who have sex with men), 32 (84%) lived in 2 urban counties and an area of significant spatial aggregation was identified compared with those without C1 or C2 invasive NTHi infection. Conclusions and Relevance: Among persons with HIV in Atlanta, the incidence of invasive nontypeable H influenzae infection increased significantly from 2017-2018 compared with 2008-2016. Two unique but genetically related clonal strains were identified and were associated with septic arthritis among black men who have sex with men and who lived in geographic proximity.


Asunto(s)
Infecciones por VIH/complicaciones , Infecciones por Haemophilus/epidemiología , Haemophilus influenzae/genética , Adolescente , Adulto , Afroamericanos , Anciano , Artritis Infecciosa/etnología , Estudios de Cohortes , Georgia/epidemiología , Infecciones por Haemophilus/complicaciones , Infecciones por Haemophilus/etnología , Homosexualidad Masculina , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Filogenia , Vigilancia de la Población , Serotipificación , Adulto Joven
20.
Medicine (Baltimore) ; 98(50): e18190, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31852074

RESUMEN

The purpose of this study was to evaluate the association between tocolysis for preterm uterine contraction and the risk of nonreassuring fetal status.This was a retrospective cohort study using data from the Taiwan National Health Insurance Research Database. Pregnant women were enrolled if they delivered a baby during January 1, 2003 to December 31, 2011. The occurrence of the nonreassuring fetal status was compared between pregnant women with and without tocolytic treatment for preterm uterine contraction. Multivariable logistic regression models with adjusted cofounders were used to evaluate the association between tocolysis and the risk of nonreassuring fetal status.Of 24,133 pregnant women, 1115 (4.6%) received tocolytic treatment during pregnancy. After adjusting for covariates, pregnant women receiving tocolysis more than one time during pregnancy were found to have significantly higher risk of the nonreassuring fetal status when compared with pregnant women who did not receive tocolysis for uterine contraction (Odds Ratio = 2.70, 95% Confidence Interval: 1.13-6.49).Pregnant women with more frequent tocolysis for preterm uterine contraction during pregnancy had an increased risk of nonreassuring fetal status. Close evaluation of dose and duration of tocolytic treatment is necessary for pregnant women with preterm uterine contraction.


Asunto(s)
Sufrimiento Fetal/prevención & control , Trabajo de Parto Prematuro/prevención & control , Vigilancia de la Población , Tocólisis/métodos , Tocolíticos/uso terapéutico , Adulto , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Recién Nacido , Trabajo de Parto Prematuro/epidemiología , Embarazo , Estudios Retrospectivos , Taiwán/epidemiología
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