Risk of COVID-19 death for people with a pre-existing cancer diagnosis prior to COVID-19-vaccination: A systematic review and meta-analysis.

While previous reviews found a positive association between pre-existing cancer diagnosis and COVID-19-related death, most early studies did not distinguish long-term cancer survivors from those recently diagnosed/treated, nor adjust for important confounders including age. We aimed to consolidate higher-quality evidence on risk of COVID-19-related death for people with recent/active cancer (compared to people without) in the pre-COVID-19-vaccination period. We searched the WHO COVID-19 Global Research Database (20 December 2021), and Medline and Embase (10 May 2023). We included studies adjusting for age and sex, and providing details of cancer status. Risk-of-bias assessment was based on the Newcastle-Ottawa Scale. Pooled adjusted odds or risk ratios (aORs, aRRs) or hazard ratios (aHRs) and 95% confidence intervals (95% CIs) were calculated using generic inverse-variance random-effects models. Random-effects meta-regressions were used to assess associations between effect estimates and time since cancer diagnosis/treatment. Of 23 773 unique title/abstract records, 39 studies were eligible for inclusion (2 low, 17 moderate, 20 high risk of bias). Risk of COVID-19-related death was higher for people with active or recently diagnosed/treated cancer (general population: aOR = 1.48, 95% CI: 1.36-1.61, I2 = 0; people with COVID-19: aOR = 1.58, 95% CI: 1.41-1.77, I2 = 0.58; inpatients with COVID-19: aOR = 1.66, 95% CI: 1.34-2.06, I2 = 0.98). Risks were more elevated for lung (general population: aOR = 3.4, 95% CI: 2.4-4.7) and hematological cancers (general population: aOR = 2.13, 95% CI: 1.68-2.68, I2 = 0.43), and for metastatic cancers. Meta-regression suggested risk of COVID-19-related death decreased with time since diagnosis/treatment, for example, for any/solid cancers, fitted aOR = 1.55 (95% CI: 1.37-1.75) at 1 year and aOR = 0.98 (95% CI: 0.80-1.20) at 5 years post-cancer diagnosis/treatment. In conclusion, before COVID-19-vaccination, risk of COVID-19-related death was higher for people with recent cancer, with risk depending on cancer type and time since diagnosis/treatment.

Diagnostic Performance of a Fecal Immunochemical Test-Based Colorectal Cancer Screening Program According to Ambient Temperature and Humidity.

Exposure of the fecal immunochemical test (FIT) to different ambient temperatures and humidity is unavoidable in population-based screening programs in Southern European countries, and it could lead to a decrease in target colorectal lesions. The objective was to evaluate the effect of ambient temperature and humidity on the FIT sensitivity in a population-based screening program for colorectal cancer (CRC) using an ecological design. The retrospective cohort included individuals aged 50−69 years who participated in CRC screening (Barcelona) from 2010−2015, and were followed until 2017 to identify interval CRCs. The positivity rate, and detection rates for advanced polyps and CRC were compared according to ambient temperature, humidity, and quarters of the year. A positive FIT was defined as the detection of ≥20 µg Hb/g in feces. The monthly ambient temperature and humidity were recorded on the day that the FIT was performed. In total, 92,273 FIT results from 53,860 participants were analyzed. The FIT positivity rate was lower at >24 °C than at ≤24 °C (p = 0.005) but was not affected by humidity. The temperature's impact on positivity did not lead to a decrease in the FIT detection rate for advanced neoplasia or the interval cancer detection rate in a program where the samples were refrigerated until the analysis and screening invitations were discontinued in July and August.

Short-term impact of the COVID-19 pandemic on a population-based screening program for colorectal cancer in Catalonia (Spain).

The COVID-19 pandemic caused the suspension at all levels of the Catalan FIT-based CRC screening program on March 12, 2020. Screening invitations to FIT were resumed on September 1, 2020. We aimed to assess the short-term impact of the pandemic and describe strategies implemented to minimize harm by the disruption of the FIT-based CRC screening in the Metropolitan Area of Barcelona. We analyzed participation rate, colonoscopy adherence, time intervals to colonoscopy, detection rates, and advanced-stage cancers in 2019 and 2020. To identify perceived distress levels during the suspension of the screening we conducted a phone interview. As a result of the suspension, 43% of the individuals due for screening did not receive their invitation by December 31, 2020. A percent decrease of 5.1% in participation and of 8.9% in colonoscopy adherence among invitees between January-March was observed, with a recovery to 2019 levels when the screening activities were restarted. The time interval between a positive test to colonoscopy was longer in 2020 than in 2019. A decrease in advanced neoplasia rate and an increase in later stages of CRC were also observed. Individuals with a positive test did not report higher levels of perceived distress compared to those with a negative test. Although the disruption of screening had a temporary impact on participation and colonoscopy adherence, timing delay continues and a large backlog in the invitation of the target population remains. Thus, it is critical to implement strategies to minimize the long-term effects.

Role of community pharmacies in a population-based colorectal cancer screening program.

In Catalonia (Spain), population-based colorectal cancer (CRC) screening offers biennial fecal occult blood testing to men and women aged 50-69 years old. The program is organized in screening hubs, most of which use a pharmacy-based model to distribute and collect fecal immunochemical test (FIT) kits The comprehensive evaluation of CRC screening programs, which include the role and implications of pharmacy involvement, is essential to ensure program quality and identify areas for further improvement. The present study aimed to assess the adherence of community pharmacies to the CRC screening program and to analyze data on FIT kit distribution and collection in the Metropolitan area of Barcelona (Catalonia, Spain). Time to FIT completion was assessed by Kaplan-Meier estimation, and with the log-rank test. A Cox regression model was used to adjust for other variables associated with the completion of FIT such as sex, age, deprivation score index and previous screening behavior. Overall, 82.4% of pharmacies adhered with CRC screening program. Out of 82,902 FIT kits distributed to screening invitees 77,524 completed FIT kits were returned to pharmacies (93.5%) with a participation of 39.8% among the 193,766 invitees. From those who completed a FIT, the median time to return the kit was 3 days. FIT completion time was significantly lower among women, older age, high deprivation score index and previous CRC screening (p < 0.005). Our findings highlight the large involvement of community pharmacists with CRC screening program as well as a high quality in the process of FIT distribution and collection.

Text messaging as a tool to improve cancer screening programs (M-TICS Study): A randomized controlled trial protocol.

BACKGROUND: Short message service (SMS) based interventions are widely used in healthcare and have shown promising results to improve cancer screening programs. However, more research is still needed to implement SMS in the screening process. We present a study protocol to assess the impact on health and economics of three targeted SMS-based interventions in population-based cancer screening programs. METHODS/DESIGN: The M-TICs study is a randomized controlled trial with a formal process evaluation. Participants aged 50-69 years identified as eligible from the colorectal cancer (CRC) and breast cancer (BC) screening program of the Catalan Institute of Oncology (Catalonia, Spain) will be randomly assigned to receive standard invitation procedure (control group) or SMS-based intervention to promote participation. Two interventions will be conducted in the CRC screening program: 1) Screening invitation reminder: Those who do not participate in the CRC screening within 6 weeks of invite will receive a reminder (SMS or letter); 2) Reminder to complete and return fecal immunochemical test (FIT) kit: SMS reminder versus no intervention to individuals who have picked up a FIT kit at the pharmacy and they have not returned it after 14 days. The third intervention will be performed in the BC screening program. Women who had been screened previously will receive an SMS invitation or a letter invitation to participate in the screening. As a primary objective we will assess the impact on participation for each intervention. The secondary objectives will be to analyze the cost-effectiveness of the interventions and to assess participants' perceptions. EXPECTED RESULTS: The results from this randomized controlled trial will provide important empirical evidence for the use of mobile phone technology as a tool for improving population-based cancer screening programs. These results may influence the cancer screening invitation procedure in future routine practice. TRIAL REGISTRATION: Registry: NCT04343950 (04/09/2020); clinicaltrials.gov.

The role of socio-demographic determinants in the geo-spatial distribution of newly diagnosed HIV infections in small areas of Catalonia (Spain).

BACKGROUND: Spatial visualization of HIV surveillance data could improve the planning of programs to address the HIV epidemic. The objectives of the study were to describe the characteristics and the spatial distribution of newly diagnosed HIV infection in Catalonia and to identify factors associated with HIV infection rates. METHODS: Surveillance data from the national registry were presented in the form of descriptive and ring maps and used to study the spatial distribution of new HIV diagnoses in Catalonia (2012-2016) and associated risk factors at the small area level (ABS, acronym for "basic health area" in Catalan). Incident cases were modeled using the following as predictors: type of municipality, prevalence of young men and migrant groups, GBMSM activity indicators, and other variables at the aggregated level. RESULTS: New HIV diagnoses are heterogeneously distributed across Catalonia. The predictors that proved to be significantly associated with a higher rate of new HIV diagnoses were ABS located in the city of Barcelona (IRR, 2.520; P < 0.001), a higher proportion of men aged 15-44 years (IRR, 1.193; P = 0.003), a higher proportion of GBMSM (IRR, 1.230; P = 0.030), a higher proportion of men from Western Europe (IRR, 1.281; P = 0.003), a higher proportion of men from Latin America (IRR, 1.260; P = 0.003), and a higher number of gay locations (IRR, 2.665; P < 0.001). No association was observed between the HIV diagnosis rate and economic deprivation. CONCLUSIONS: Ring maps revealed substantial spatial associations for the rate of new HIV diagnoses. New HIV diagnoses are concentrated in ABS located in urban areas. Our results show that, in the case of HIV infection, the socioeconomic deprivation index on which the Catalan government bases its budget allocation policies among the ABS should not be the only criterion used.

Trends in human immunodeficiency virus diagnoses among men who have sex with men in North America, Western Europe, and Australia, 2000-2014.

PURPOSE: The aim of the article was to investigate recent trends in human immunodeficiency virus (HIV) diagnosis rates among men who have sex with men (MSM) in high-income countries in North America, Western Europe, and Australia. METHODS: Data on annual rates of HIV diagnoses among MSM aged 15 to 65 years from 2000 to 2014 were collected from 13 high-income countries. Joinpoint regression software was used to empirically determine country-specific trend periods. Trends in HIV diagnosis rates and in the proportion of diagnoses occurring in young MSM aged 15 to 24 years were analyzed using Poisson regression and log-binomial regression, respectively. RESULTS: Six countries experienced an increasing trend from 2000 to 2007-08 followed by either a stable or declining trend through 2014. Five countries had recently increasing trends, and two countries had one stable trend from 2000 to 2014. All 13 countries experienced increases in the proportion of diagnoses occurring in young MSM. CONCLUSIONS: Since 2008, half of the 13 high-income countries examined experienced stable or decreasing trends. Still, some countries continue to experience increasing HIV trends, and young MSM are increasingly represented among new diagnoses. Efforts to support early sexual health promotion, reduce barriers to pre-exposure prophylaxis, and improve care engagement for young MSM are critical to addressing current HIV trends.

Estimating the HIV undiagnosed population in Catalonia, Spain: descriptive and comparative data analysis to identify differences in MSM stratified by migrant and Spanish-born population.

OBJECTIVE: Undiagnosed HIV continues to be a hindrance to efforts aimed at reducing incidence of HIV. The objective of this study was to provide an estimate of the HIV undiagnosed population in Catalonia and compare the HIV care cascade with this step included between high-risk populations. METHODS: To estimate HIV incidence, time between infection and diagnosis and the undiagnosed population stratified by CD4 count, we used the ECDC HIV Modelling Tool V.1.2.2. This model uses data on new HIV and AIDS diagnoses from the Catalan HIV/AIDS surveillance system from 2001 to 2013. Data used to estimate the proportion of people enrolled, on ART and virally suppressed in the HIV care cascade were derived from the PISCIS cohort. RESULTS: The total number of people living with HIV (PLHIV) in Catalonia in 2013 was 34 729 (32 740 to 36 827), with 12.3% (11.8 to 18.1) of whom were undiagnosed. By 2013, there were 8458 (8101 to 9079) Spanish-born men who have sex with men (MSM) and 2538 (2334 to 2918) migrant MSM living with HIV in Catalonia. A greater proportion of migrant MSM than local MSM was undiagnosed (32% vs 22%). In the subsequent steps of the HIV care cascade, migrants MSM experience greater losses than the Spanish-born MSM: in retention in care (74% vs 55%), in the proportion on combination antiretroviral treatment (70% vs 50%) and virally suppressed (65% vs 46%). CONCLUSIONS: By the end of 2013, there were an estimated 34 729 PLHIV in Catalonia, of whom 4271 were still undiagnosed. This study shows that the Catalan epidemic of HIV has continued to expand with the key group sustaining HIV transmission being MSM living with undiagnosed HIV.

Predictors of advanced disease and late presentation in new HIV diagnoses reported to the surveillance system in Spain / Determinantes de enfermedad avanzada y presentación tardía en los nuevos diagnósticos de VIH notificados al sistema de vigilancia epidemiológica en España

Objective: To present surveillance data on advanced disease (AD) and late presentation (LP) of HIV in Spain and their determinants. Methods We included all new HIV diagnoses notified by the autonomous regions that consistently reported such cases throughout the period 2007-2011. Coverage was 54% of the total Spanish population. Data sources consisted of clinicians, laboratories and medical records. AD was defined as the presence of a CD4 cell count <200cells/μL in the first test after HIV diagnosis, while LP was defined as the presence of a CD4 cell count <350cells/μL after HIV diagnosis. Odds ratios and their 95% confidence intervals (OR, 95% CI) were used as the measure of association. Logistic regressions were fit to identify predictors of AD and LP. Results A total of 13,021 new HIV diagnoses were included. Among these, data on the outcome variable were available in 87.7%. The median CD4 count at presentation was 363 (interquartile range, 161-565). Overall, 3356 (29.4%) patients met the definition of AD and 5494 (48.1%) were classified as LP. Both AD and LP increased with age and were associated with male sex and infection through drug use or heterosexual contact. All immigrants except western Europeans were more prone to AD and LP. Multivariate models disaggregated by sex showed that the effect of age and region of origin was weaker in women than in men. Conclusions Despite universal health care coverage in Spain, men, immigrants and people infected through drug use or heterosexual contact seem to be experiencing difficulties in gaining timely access to HIV care (AU)

Objetivo: Se presentan los datos de vigilancia sobre enfermedad avanzada y presentación tardía de los nuevos diagnósticos de VIH en España, y sus determinantes. Métodos Se incluyeron todos los nuevos diagnósticos de VIH de 2007-2011 en el ámbito de las comunidades autónomas que notificaron de forma constante durante todo el periodo (54% de la población española). La fuente de información fueron clínicos y laboratorios. Se definió como enfermedad avanzada un recuento < 200 linfocitos CD4/μl en la primera determinación tras el diagnóstico, y como presentación tardía < 350 linfocitos CD4/μl. Se usaron la odds ratio y su intervalo de confianza del 95% como medida de asociación. Para el análisis multivariado de los factores asociados a enfermedad avanzada y presentación tardía se ajustó un modelo de regresión logística. Resultados Se incluyeron 13.021 nuevos diagnósticos, de los cuales el 87,7% tenía información de la variable de estudio. La mediana de CD4 fue de 363 (rango intercuartílico: 161-565). Durante el periodo, 3.356 pacientes (29,4%) cumplían la definición de enfermedad avanzada y 5.494 (48.1%) se clasificaron como presentación tardía. Tanto la enfermedad avanzada como la presentación tardía aumentaban con la edad, se asociaban al sexo masculino y a la transmisión a través del uso de drogas inyectadas o heterosexual. Ser inmigrante de cualquier origen, excepto de Europa Occidental, se asociaba a enfermedad avanzada y presentación tardía. Desagregando por sexo, el efecto de la edad y de la región de origen fue más débil en las mujeres que en los hombres. Conclusión A pesar de la cobertura universal en España, los hombres, los inmigrantes, los usuarios de drogas inyectadas y las personas infectadas por relaciones heterosexuales parecen tener más dificultad para acceder al seguimiento clínico (AU)

Predictors of advanced disease and late presentation in new HIV diagnoses reported to the surveillance system in Spain.

OBJECTIVE: To present surveillance data on advanced disease (AD) and late presentation (LP) of HIV in Spain and their determinants. METHODS: We included all new HIV diagnoses notified by the autonomous regions that consistently reported such cases throughout the period 2007-2011. Coverage was 54% of the total Spanish population. Data sources consisted of clinicians, laboratories and medical records. AD was defined as the presence of a CD4 cell count <200cells/µL in the first test after HIV diagnosis, while LP was defined as the presence of a CD4 cell count <350cells/µL after HIV diagnosis. Odds ratios and their 95% confidence intervals (OR, 95% CI) were used as the measure of association. Logistic regressions were fit to identify predictors of AD and LP. RESULTS: A total of 13,021 new HIV diagnoses were included. Among these, data on the outcome variable were available in 87.7%. The median CD4 count at presentation was 363 (interquartile range, 161-565). Overall, 3356 (29.4%) patients met the definition of AD and 5494 (48.1%) were classified as LP. Both AD and LP increased with age and were associated with male sex and infection through drug use or heterosexual contact. All immigrants except western Europeans were more prone to AD and LP. Multivariate models disaggregated by sex showed that the effect of age and region of origin was weaker in women than in men. CONCLUSIONS: Despite universal health care coverage in Spain, men, immigrants and people infected through drug use or heterosexual contact seem to be experiencing difficulties in gaining timely access to HIV care.

Incidencia de nuevos diagnósticos de VIH en España, 2004-2009 / Incidence of new HIV diagnoses in Spain, 2004-2009

Objetivo Describir la incidencia de nuevos diagnósticos de infección por el virus de la inmunodeficiencia humana (VIH) y su tendencia. Métodos Se incluyeron los nuevos diagnósticos de VIH notificados en 2009 en las 15 comunidades autónomas con sistemas de información (64% de la población española). Para analizar las tendencias durante 2004-2009 se incluyeron las nueve comunidades con datos en ese periodo. Se obtuvo información clínico-epidemiológica de las hojas de notificación de casos y se realizaron distribuciones de nuevos diagnósticos y diagnóstico tardío según distintas variables. Para evaluar las tendencias se ajustó un modelo de Poisson. Resultados En 2009 se notificaron 2.264 nuevos diagnósticos de VIH, la mayoría en hombres (80%). La mediana de edad al diagnóstico fue de 36 años (rango intercuartílico 29-43) y el 37,6% de los casos eran inmigrantes, destacando los latinoamericanos y los subsaharianos. La categoría de transmisión más común (42,5%) fue la de hombres que tienen sexo con hombres, seguida de la heterosexual (34,5%) y la parenteral (8,1%). Al diagnóstico, la mediana de CD4/μl era de 347 (rango intercuartílico: 152-555) y un 50,2% tenían <350. La tasa media de incidencia de nuevos diagnósticos entre 2004 y 2009 fue de 91,14 por millón de habitantes; se observó una tendencia creciente de las tasas entre los hombres que tienen sexo con hombres, y decreciente de la transmisión parenteral. Conclusiones La epidemiología del VIH en España ha cambiado mucho respecto a los años 1990. Actualmente predomina la transmisión sexual, sobre todo entre los hombres que tienen sexo con hombres, y los inmigrantes son parte importante de la epidemia. En 2004-2009, la tendencia es heterogénea en las tres categorías de transmisión más relevantes (AU)

Objective To describe the incidence of new HIV diagnoses and its trend in Spain. Methods All new HIV diagnoses notified to the case-registries of 15 autonomous regions (64% of the total Spanish population) in 2009 were analyzed. To evaluate trends from 2004 to 2009, data from only nine regions were available. Clinical-epidemiological data were obtained from the notification forms. Distributions of new HIV diagnoses and late diagnoses according to several variables were performed. The Poisson distribution was used to evaluate trends. Results In 2009, 2264 new HIV diagnoses were notified, mostly in men (80%). The median age at diagnosis was 36 years (interquartile range 29-43) and 37.6% of affected individuals were immigrants, mostly from Latin-America and sub-Saharan Africa. The most common transmission category (42.5%) was men who have sex with men (MSM) followed by the heterosexual and parenteral modes of transmission (34.5% and 8.1%, respectively). The median CD4 count at diagnosis was 347 (interquartile range: 152-555), and CD4 count was <350 in 50.2% of patients. From 2004 to 2009, the mean incidence rate of new HIV diagnoses was 91.14 per million inhabitants; an increasing trend for rates in MSM, as well as a decreasing trend for the parenteral mode of transmission, were observed. Conclusions In Spain, the epidemiology of HIV infection has changed since the mid-1990s. Currently, the most frequent transmission category is sexual transmission, particularly among MSM, and immigrants are an important part of the epidemic. Heterogeneous trends for the three main transmission categories were observed from 2004 to 2009 (AU)

[Incidence of new HIV diagnoses in Spain, 2004-2009]. / Incidencia de nuevos diagnósticos de VIH en España, 2004-2009.

OBJECTIVE: To describe the incidence of new HIV diagnoses and its trend in Spain. METHODS: All new HIV diagnoses notified to the case-registries of 15 autonomous regions (64% of the total Spanish population) in 2009 were analyzed. To evaluate trends from 2004 to 2009, data from only nine regions were available. Clinical-epidemiological data were obtained from the notification forms. Distributions of new HIV diagnoses and late diagnoses according to several variables were performed. The Poisson distribution was used to evaluate trends. RESULTS: In 2009, 2264 new HIV diagnoses were notified, mostly in men (80%). The median age at diagnosis was 36 years (interquartile range 29-43) and 37.6% of affected individuals were immigrants, mostly from Latin-America and sub-Saharan Africa. The most common transmission category (42.5%) was men who have sex with men (MSM) followed by the heterosexual and parenteral modes of transmission (34.5% and 8.1%, respectively). The median CD4 count at diagnosis was 347 (interquartile range: 152-555), and CD4 count was <350 in 50.2% of patients. From 2004 to 2009, the mean incidence rate of new HIV diagnoses was 91.14 per million inhabitants; an increasing trend for rates in MSM, as well as a decreasing trend for the parenteral mode of transmission, were observed. CONCLUSIONS: In Spain, the epidemiology of HIV infection has changed since the mid-1990s. Currently, the most frequent transmission category is sexual transmission, particularly among MSM, and immigrants are an important part of the epidemic. Heterogeneous trends for the three main transmission categories were observed from 2004 to 2009.

[Epidemiology of human inmunodeficiency virus infection: delay in diagnosis]. / Epidemiología de la infección por virus de la inmunodeficiencia humana. Retraso en el diagnóstico.

Epidemiological surveillance of HIV infection has made notably progress over the last decade, improving knowledge of its characteristics and adapting treatment accordingly. On the other hand, the delayed diagnosis of HIV infection is still an important problem to reduce transmission and improve epidemic control both national and internationally. Although the increased availability of new testing technologies over the last ten years, progress, although statistically significant,in reducing late diagnosis in Spain has been, insufficient in terms of public health, meaning that additional efforts should be put in place to review strategies and increase accessibility to tests, population awareness and decrease the lost opportunities for early diagnosis.

Epidemiología de la infección por virus de la inmunodeficiencia humana. Retraso en el diagnóstico / Epidemiology of human inmunodeficiency virus infection: delay in diagnosis

La vigilancia epidemiológica de la infección por el VIH ha experimentado en los últimos 10 años notables mejoras que favorecen el conocimiento de la epidemiología de la infección adaptando las intervenciones sanitarias a las características de la epidemia. Por otra parte, el retraso del diagnóstico de la infección por VIH, tanto en el ámbito nacional como internacional, constituye un problema importante para la disminución de la transmisión del virus y el control de la epidemia. Durante los últimos 10 años, a pesar de la aparición de nuevas tecnologías de diagnóstico, la disminución del retraso diagnostico en España ha sido, aunque estadísticamente significativo, insuficiente en términos de salud publica, lo que nos obliga a revisar las estrategias utilizadas tanto para aumentar la accesibilidad a la prueba y la alerta de la población, como para disminuir las oportunidades perdidas para el diagnóstico temprano (AU)

Epidemiological surveillance of HIV infection has made notably progress over the last decade, improving knowledge of its characteristics and adapting treatment accordingly. On the other hand, the delayed diagnosis of HIV infection is still an important problem to reduce transmission and improve epidemic control both national and internationally. Although the increased availability of new testing technologies over the last ten years, progress, although statistically significant, in reducing late diagnosis in Spain has been, insufficient in terms of public health, meaning that additional efforts should be put in place to review strategies and increase accessibility to tests, population awareness and decrease the lost opportunities for early diagnosis (AU)

Retraso diagnóstico de la infección por el virus de la inmunodeficiencia humana en España / Delayed diagnosis of HIV infection in Spain

Objetivos Analizar el porcentaje de retraso diagnóstico (RD) de la infección por el virus de la inmunodeficiencia humana (VIH), su tendencia y factores asociados a partir de los datos procedentes del Sistema de Información de Nuevos Diagnósticos de VIH (SINIVIH) en España.Métodos Estudio descriptivo sobre las personas diagnosticadas de VIH durante 2003–2007 en las 8 comunidades autónomas (CCAA) actualmente participantes. Se definió como RD la presencia de <200CD4/μl al diagnóstico. Mediante regresión logística se obtuvieron las odds ratio (OR) y su intervalo de confianza al 95% (IC95%).Resultados Se notificaron 5.785 nuevos diagnósticos de VIH, de los que 4.798 disponían de cifra de CD4 al diagnóstico. De estos, el 37,3% cumplieron la definición de retraso. Un 19% adicional tenía entre 200–350 CD4. El porcentaje de RD era menor en mujeres que en hombres (32,9% frente a 38,6%), y mayor en heterosexuales (42,4%) y usuarios de drogas inyectadas (UDI) (40,1%) que en los hombres que mantienen relaciones sexuales con hombres (HSH) (26,7%). Ajustando por CCAA y año de diagnóstico la probabilidad de RD en españoles es mayor en hombre (OR=1,49; IC95%:1,21–1,85); en: 30–39 años (OR=2,08; IC95%:1,63–2,67), 40–49 años (OR=3,98; IC95%:3,07–5,16) y >49 años (OR=6,77; IC95%:5,10–9,00) frente a 20–29 años; y en heterosexuales (OR=1,75; IC95%:1,43–2,15) y UDI (OR=1,75; IC95%:1,38–2,22) comparados con los HSH. El RD disminuyó de 2003 a (..) (AU)

Objectives To analyse the prevalence of delayed diagnosis (DD) of human immunodeficiency virus (HIV) infection, the trends over time and its determining factors from the Newly Diagnosed HIV-infected individuals Information System (SINIVIH) data, in process of being implemented in Spain.Methods Cross-sectional study of newly diagnosed HIV-infected individuals between 2003 and 2007 in the 8 currently participating Spanish autonomous regions (AR). DD was defined as a CD4 count <200cells/μL at diagnosis. Adjusted odds ratios with 95% confidence interval were calculated using logistic regression (OR; 95%CI).Results Among the 5785 newly diagnosed HIV cases reported, 4798 had a CD4 cell count at diagnosis. Of these, 37.3% met the DD definition. An additional 19% had between 200 and 350cells/μL. The proportion of DD was lower for women than for men (32.9% versus 38.6%). According to exposure category, it was higher in heterosexuals (42.4%) and injecting drug users (IDUs) (40.1%) than in men who have sex with men (MSM) (26.7%). In the Spanish patient group, in multivariate logistic regression analyses, adjusting for AR and year of diagnosis, men were more likely to have a DD (OR=1.49; 95%CI:1.21–1.85). Compared to younger patients (20–29 years), LD was more frequent in older: 30–39 years (OR=2.08; 95% CI:1.63–2.67), 40–49 years (OR=3.98; 95% CI:3.07–5.16) and >49 years (OR=6.77; 95% CI:5.10–9.00); and compared to MSM, was more frequent in heterosexuals (OR=1.75; 95% CI:1.43–2.15) and IDUs (OR=1.75; 95% CI:1.38–2.22). DD decreased from 2003 to 2007 (OR=1.38; 95% CI:1.08–1.76). The same associated factors were found in immigrants, but with different magnitude: stronger association with men, heterosexuals and IDUs, and weaker association with older age. (..) (AU)

[Delayed diagnosis of HIV infection in Spain]. / Retraso diagnóstico de la infección por el virus de la inmunodeficiencia humana en España.

OBJECTIVES: To analyse the prevalence of delayed diagnosis (DD) of human immunodeficiency virus (HIV) infection, the trends over time and its determining factors from the Newly Diagnosed HIV-infected individuals Information System (SINIVIH) data, in process of being implemented in Spain. METHODS: Cross-sectional study of newly diagnosed HIV-infected individuals between 2003 and 2007 in the 8 currently participating Spanish autonomous regions (AR). DD was defined as a CD4 count <200cells/µL at diagnosis. Adjusted odds ratios with 95% confidence interval were calculated using logistic regression (OR; 95%CI). RESULTS: Among the 5785 newly diagnosed HIV cases reported, 4798 had a CD4 cell count at diagnosis. Of these, 37.3% met the DD definition. An additional 19% had between 200 and 350cells/µL. The proportion of DD was lower for women than for men (32.9% versus 38.6%). According to exposure category, it was higher in heterosexuals (42.4%) and injecting drug users (IDUs) (40.1%) than in men who have sex with men (MSM) (26.7%). In the Spanish patient group, in multivariate logistic regression analyses, adjusting for AR and year of diagnosis, men were more likely to have a DD (OR=1.49; 95%CI:1.21-1.85). Compared to younger patients (20-29 years), LD was more frequent in older: 30-39 years (OR=2.08; 95% CI:1.63-2.67), 40-49 years (OR=3.98; 95% CI:3.07-5.16) and >49 years (OR=6.77; 95% CI:5.10-9.00); and compared to MSM, was more frequent in heterosexuals (OR=1.75; 95% CI:1.43-2.15) and IDUs (OR=1.75; 95% CI:1.38-2.22). DD decreased from 2003 to 2007 (OR=1.38; 95% CI:1.08-1.76). The same associated factors were found in immigrants, but with different magnitude: stronger association with men, heterosexuals and IDUs, and weaker association with older age. CONCLUSIONS: DD affects almost four in every ten newly diagnosed HIV-infected individuals, and is significantly more common among men, age group over 30 years, IDUs and heterosexuals. These are associated factors both in Spanish and immigrants, but in the last group the association is stronger. Strategies to increase the perception of risk among these groups are needed, as well as the implementation of the SINIVIH in the whole country to improve and to extend the information on DD.

La movilidad de la pelvis en el expulsivo / Pelvic mobility during expulsion

Este artículo se en marca en el trabajo de investigación Parir en movimiento.La movilidad de la pelvis en el parto, y en él se analizan las rotaciones de la cadera (rotaciones del fémur) que acompañan a las posiciones de separación de los muslos, en particular en la última fase del expulsivo, cuando la cabeza del feto llega en segundo, tercer y cuarto plano (estrecho medio e inferior de la pelvis) (AU)

This article is derived from the research work Bouger en accouchant.Comment le bassin peut bouger lors de l’accouchement (Giving birth inmovement. Pelvic mobility during childbirth). This article analyses the hiprotations (rotations of the femur) that accompany the positions in which the thighs are separated, in particular during the final expulsive phase,when the foetus' head arrives in second, third and fourth plane (midpelvis and pelvic outlet) (AU)

La movilidad de la pelvis en el expulsivo / Pelvic mobility during expulsion

Este artículo se enmarca en el trabajo de investigación Parir en movimiento.La movilidad de la pelvis en el parto, y en él se analizan las rotacionesde la cadera (rotaciones del fémur) que acompañan a las posicionesde separación de los muslos, en particular en la última fase delexpulsivo, cuando la cabeza del feto llega en segundo, tercer y cuartoplano (estrecho medio e inferior de la pelvis) (AU)

This article is derived from the research work Bouger en accouchant.Comment le bassin peut bouger lors de l’accouchement (Giving birth inmovement. Pelvic mobility during childbirth). This article analyses the hiprotations (rotations of the femur) that accompany the positions in whichthe thighs are separated, in particular during the final expulsive phase,when the foetus' head arrives in second, third and fourth plane (midpelvisand pelvic outlet) (AU)

In vitro evaluation of the type of implant bed preparation with osteotomes in bone type IV and its influence on the stability of two implant systems.

OBJECTIVES: 1) To evaluate and compare the stability of two types of implants in an animal model after preparing the implant bed with various sequences of osteotomes in bone type IV. 2) To evaluate the hypothesis of whether or not the sequence of using osteotomes influences the primary implant stability. MATERIAL AND METHOD: We selected bone from cow ribs, which in its cross section (the most medullar area of the bone) would be equivalent to a type IV human bone. We used fifteen ribs, in which six implant beds were prepared in each rib block using different preparation protocols for seating three conical Swiss Plus SPB implants of 3.7 x 10 mm versus three MK III parallel wall implants of 4 x 10 mm.Three preparations, each with a diameter, were made for the implants, using osteotomes that progressively increased the diameter of the implant bed. In the first preparation, the complete sequence of osteotomes was used; in the second preparation, the last osteotome was left out; and in the third preparation, the implant was placed after only passing through the first osteotome. Once the implants were seated, we proceeded to evaluate the stability (Osstell ISQ-value). The locations were randomly chosen (by a coin toss). RESULTS AND STATISTICAL ANALYSIS: We performed a statistical analysis of the ISQ values that were obtained during the different preparations carried out for the Mk III and Swiss Plus implants. The average range and standard deviation were calculated. The hypothesis was compared by a two-way variance analysis (type of implant/ different sequences of preparing the implant bed). It was considered significant for a p <0.05. The statistical results obtained for the values of the Mk III implant were significant (p = 0.042). CONCLUSIONS: The results of this in vitro study conclude that the tapered shape provides more primary stability to the implant and suggest that a short sequence of osteotomes in bone type IV provide more primary stability than the complete sequence.

In vitro evaluation of the type of implant bed preparation with osteotomes inbone type IV and its influence on the stability of two implant systems

Objectives: 1) To evaluate and compare the stability of two types of implants in an animal model after preparingthe implant bed with various sequences of osteotomes in bone type IV. 2) To evaluate the hypothesis of whetheror not the sequence of using osteotomes influences the primary implant stability.Material and Method: We selected bone from cow ribs, which in its cross section (the most medullar area of thebone) would be equivalent to a type IV human bone. We used fifteen ribs, in which six implant beds were preparedin each rib block using different preparation protocols for seating three conical Swiss Plus SPB implants of 3.7 x10 mm versus three MK III parallel wall implants of 4 x 10 mm.Three preparations, each with a diameter, weremade for the implants, using osteotomes that progressively increased the diameter of the implant bed. In the firstpreparation, the complete sequence of osteotomes was used; in the second preparation, the last osteotome was leftout; and in the third preparation, the implant was placed after only passing through the first osteotome. Once theimplants were seated, we proceeded to evaluate the stability (Osstell® ISQ-value). The locations were randomlychosen (by a coin toss).Results and statistical analysis: We performed a statistical analysis of the ISQ values that were obtained during thedifferent preparations carried out for the Mk III and Swiss Plus implants. The average range and standard deviationwere calculated. The hypothesis was compared by a two-way variance analysis (type of implant/ differentsequences of preparing the implant bed). It was considered significant for a p <0.05. The statistical results obtainedfor the values of the Mk III implant were significant (p = 0.042). Conclusions: The results of this in vitro study conclude that the tapered shape provides more primary stability to the implant and suggest that a short sequence of osteotomes in bone type IV provide more primary stability than the complete sequence (AU)

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