Changing trends in measles vaccination status between 2004 and 2014 among children aged 12-23 months in Bangladesh.

OBJECTIVE: To assess the current measles vaccination status in Bangladesh, explain changing differentials in measles vaccination, and determine contexts that may improve measles vaccination coverage. METHODS: Secondary data analysis of datasets (2004-2014) from the nationally representative Bangladesh Demographic and Health Surveys that followed stratified, multi-stage cluster sampling design conducted both in urban and rural contexts. RESULTS: 5468 children aged 12-23 months were surveyed, of whom 892 (16%) reported non-compliance to measles vaccine. After simultaneous adjusting for covariates in multivariate logistic regression, children who came from a poor socio-economic background, who had mothers with no formal schooling, who were underweight, of higher birth order (≥4), who had adolescent mothers, who had a history of home delivery and who had no exposure to media were observed to be significantly associated with lack of measles vaccination. Measles vaccination coverage among children of adolescent mothers was consistently low. Despite lack of media exposure, measles vaccination status gradually increased from 26% in 2004 to 33% in 2014. Lack of maternal education was no longer associated with measles vaccination status in 2007, 2011 and 2014. Stunted children continued to be associated with lack of measles immunisation in 2014. Children with higher birth order demonstrated 53% excess risk for not being immunised with measles vaccine. Mothers with no exposure to mass media were two times more likely to have children without measles immunisation as indicated by BDHS 2014 data. CONCLUSIONS: Our findings will help policy makers formulate strategies for expanding measles vaccination coverage in order to achieve further reduction in disease burden and mortality in Bangladesh.

OBJECTIF: Evaluer l'état actuel de la vaccination antirougeoleuse au Bangladesh, expliquer l'évolution des écarts de vaccination antirougeoleuse et déterminer les contextes susceptibles d'améliorer la couverture vaccinale antirougeoleuse. MÉTHODES: Analyse des données secondaires des ensembles de données (2004 à 2014) des enquêtes démographiques et sanitaires du Bangladesh représentatives au niveau national, qui ont suivi un plan d'échantillonnage stratifié en grappes à plusieurs niveaux, mené à la fois dans des contextes urbains et ruraux. RÉSULTATS: 5.468 enfants de 12 à 23 mois ont été interrogés, dont 892 (16%) ont déclaré une non-adhésion au vaccin contre la rougeole. Après ajustement simultané des covariables dans la régression logistique multivariée, les enfants issus d'un milieu socioéconomique pauvre, dont les mères n'avaient pas de scolarité formelle, qui étaient en insuffisance pondérale, de rang de naissance supérieur (≥4), qui avaient des mères adolescentes, qui avaient un les antécédents d'accouchement à domicile et qui n'avaient pas été exposés aux médias étaient significativement associés à l'absence de vaccination contre la rougeole. La couverture vaccinale contre la rougeole chez les enfants de mères adolescentes était constamment faible. Malgré le manque d'exposition aux médias, le statut de vaccination contre la rougeole a progressivement augmenté, passant de 26% en 2004 à 33% en 2014. Le manque d'éducation maternelle n'était plus associé au statut de vaccination contre la rougeole en 2007, 2011 et 2014. Les enfants souffrant d'un retard de croissance ont continué d'être associés au manque de la vaccination contre la rougeole en 2014. Les enfants dont le rang de naissance était plus élevé ont démontré un risque de 53% en excès de ne pas être vacciné contre la rougeole. Les mères sans exposition aux médias de masse étaient deux fois plus susceptibles d'avoir des enfants sans vaccination contre la rougeole, comme l'indiquent les données BDHS 2014. CONCLUSIONS: Nos résultats aideront les décideurs à formuler des stratégies pour étendre la couverture vaccinale contre la rougeole afin de réduire encore la charge de morbidité et la mortalité au Bangladesh.

Programmatic outcomes and impact of rapid public sector antiretroviral therapy expansion in adults prior to introduction of the WHO treat-all approach in rural Eswatini.

OBJECTIVES: To assess long-term antiretroviral therapy (ART) outcomes during rapid HIV programme expansion in the public sector of Eswatini (formerly Swaziland). METHODS: This is a retrospectively established cohort of HIV-positive adults (≥16 years) who started first-line ART in 25 health facilities in Shiselweni (Eswatini) between 01/2006 and 12/2014. Temporal trends in ART attrition, treatment expansion and ART coverage were described over 9 years. We used flexible parametric survival models to assess the relationship between time to ART attrition and covariates. RESULTS: Of 24 772 ART initiations, 6% (n = 1488) occurred in 2006, vs. 13% (n = 3192) in 2014. Between these years, median CD4 cell count at ART initiation increased (113-265 cells/mm3 ). The active treatment cohort expanded 8.4-fold, ART coverage increased 8.0-fold (7.1% in 2006 vs. 56.8% in 2014) and 12-month crude ART retention improved from 71% to 86%. Compared with the pre-decentralisation period (2006-2007), attrition decreased by 5% (adjusted hazard ratio [aHR] 0.95, 95% confidence interval 0.88-1.02) during HIV-TB service decentralisation (2008-2010), by 17% (aHR 0.83, 0.75-0.92) during service consolidation (2011-2012), and by 20% (aHR 0.80, 0.71-0.90) during further treatment expansion (2013-2014). The risk of attrition was higher for young age, male sex, pathological baseline haemoglobin and biochemistry results, more toxic drug regimens, WHO III/IV staging and low CD4 cell count; access to a telephone was protective. CONCLUSIONS: Programmatic outcomes improved during large expansion of the treatment cohort and increased ART coverage. Changes in ART programming may have contributed to better outcomes.

OBJECTIFS: Evaluer les résultats du traitement antirétroviral (ART) à long terme durant l'expansion rapide du programme de lutte contre le VIH dans le secteur public d'Eswatini (anciennement Swaziland). MÉTHODES: Il s'agit d'une cohorte établie de manière rétrospective d'adultes VIH positifs (≥ 16 ans) qui ont commencé un ART de première ligne dans 25 établissements de santé à Shiselweni (Eswatini) entre janvier 2006 et décembre 2014. Les tendances temporelles de l'attrition dans l'ART, de l'extension de la couverture ART ont été décrites sur 9 ans. Nous avons utilisé des modèles de survie paramétriques flexibles pour évaluer la relation entre le temps écoulé avant l'attrition dans l'ART et les covariables. RÉSULTATS: Sur 24.772 initiations à l'ART, 6% (n = 1.488) ont eu lieu en 2006 contre 13% (n = 3.192) en 2014. Entre ces années, le nombre médian de cellules CD4 au début du traitement ART a augmenté (113 à 265 cellules/mm3 ). La cohorte de traitement actif a été multipliée par 8,4, la couverture ART par 8,0 (7,1% en 2006 contre 56,8% en 2014) et la rétention brute sous ART est passée de 71% à 86%. Par rapport à la période antérieure à la décentralisation (2006-2007), l'attrition a diminué de 5% (rapport de risque ajusté [aHR]: 0,95, intervalle de confiance à 95%: 0,88 à 1,02) au cours de la décentralisation des services VIH-TB (2008-2010), de 17% (HR: 0,83; 0,75-0,92) lors de la consolidation du service (2011-2012) et de 20% (HR: 0,80; 0,71-0,90) lors de la poursuite de l'extension du traitement (2013-2014). Le risque d'attrition était plus élevé pour le jeune âge, le sexe masculin, les résultats pathologiques de l'hémoglobine initiale et biochimiques, des schémas thérapeutiques plus toxiques, un stade III/IV de l'OMS et une faible numération des cellules CD4; l'accès au téléphone était protecteur. CONCLUSIONS: Les résultats programmatiques se sont améliorés au cours de l'expansion importante de la cohorte de traitement et de l'augmentation de la couverture ART. Les changements apportés au programme ART peuvent avoir contribué à de meilleurs résultats.

Decreased risk of HIV-associated TB during antiretroviral therapy expansion in rural Eswatini from 2009 to 2016: a cohort and population-based analysis.

OBJECTIVES: This paper assesses patient- and population-level trends in TB notifications during rapid expansion of antiretroviral therapy in Eswatini which has an extremely high incidence of both TB and HIV. METHODS: Patient- and population-level predictors and rates of HIV-associated TB were examined in the Shiselweni region in Eswatini from 2009 to 2016. Annual population-level denominators obtained from projected census data and prevalence estimates obtained from population-based surveys were combined with individual-level TB treatment data. Patient- and population-level predictors of HIV-associated TB were assessed with multivariate logistic and multivariate negative binomial regression models. RESULTS: Of 11 328 TB cases, 71.4% were HIV co-infected and 51.8% were women. TB notifications decreased fivefold between 2009 and 2016, from 1341 to 269 cases per 100 000 person-years. The decline was sixfold in PLHIV vs. threefold in the HIV-negative population. Main patient-level predictors of HIV-associated TB were recurrent TB treatment (adjusted odds ratio [aOR] 1.40, 95% confidence interval [CI]: 1.19-1.65), negative (aOR 1.31, 1.15-1.49) and missing (aOR 1.30, 1.11-1.53) bacteriological status and diagnosis at secondary healthcare level (aOR 1.18, 1.06-1.33). Compared with 2009, the probability of TB decreased for all years from 2011 (aOR 0.69, 0.58-0.83) to 2016 (aOR 0.54, 0.43-0.69). The most pronounced population-level predictor of TB was HIV-positive status (adjusted incidence risk ratio 19.47, 14.89-25.46). CONCLUSIONS: This high HIV-TB prevalence setting experienced a rapid decline in TB notifications, most pronounced in PLHIV. Achievements in HIV-TB programming were likely contributing factors.

OBJECTIFS: Ce document évalue les tendances des notifications de la tuberculose (TB) à l'échelle des patients et de la population lors de l'expansion rapide du traitement antirétroviral à Eswatini, où l'incidence de la TB et du VIH est extrêmement élevée. MÉTHODES: Les prédicteurs et les taux de TB associée au VIH à l'échelle des patients et de la population ont été examinés dans la région de Shiselweni à Eswatini de 2009 à 2016. Les dénominateurs annuels à l'échelle de la population obtenus à partir des données de recensement projetées et des estimations de la prévalence obtenues à partir d'enquêtes de population ont été combinés avec des données de traitement de la TB à l'échelle individuel. Les prédicteurs de la TB associée au VIH à l'échelle du patient et de la population ont été évalués à l'aide de modèles de régression logistique multivariée et binomiale négative multivariée. RÉSULTATS: Sur 11.328 cas de TB, 71,4% étaient coinfectés par le VIH et 51,8% étaient des femmes. Les notifications de TB ont été réduites de 5,0 fois entre 2009 et 2016, passant de 1.341 à 269 cas par 100.000 personnes-années. Le déclin était de 6,0 fois chez les PVVIH contre 3,0 fois dans la population négative pour le VIH. Les principaux prédicteurs de la TB associée au VIH à l'échelle des patients étaient les traitements antituberculeux récurrents (rapport de cotes ajusté [aOR] 1,40; intervalle de confiance à 95% [IC]: 1,19 à 1,65), un statut bactériologique négatif (aOR: 1,31; 1,15 à 1,49) et manquant (aOR: 1,30; 1,11 à 1,53) et le diagnostic au niveau des soins de santé secondaires (AOR 1,18; 1,06 à 1,33). Par rapport à 2009, la probabilité de contracter la TB a diminué pour toutes les années, de 2011 (aOR: 0,69; 0,58 à 0,83) à 2016 (aOR: 0,5; 0,43 à 0,69). Le prédicteur le plus prononcé de la TB à l'échelle de la population était le statut VIH-positif (rapport de risque d'incidence ajusté: 19,47; 14,89 à 25,46). CONCLUSIONS: Ce contexte de prévalence élevée de la TB-VIH a connu un déclin rapide du nombre de notifications de TB, plus prononcé chez les PVVIH. Les réalisations dans la programmation VIH-TB étaient probablement des facteurs contributifs.

Artefactual inflation of type 2 diabetes prevalence in WHO STEP surveys.

OBJECTIVES: In view of erroneous type 2 diabetes prevalence reported in 3 small Pacific Island countries, a study was conducted to investigate whether this error occurred in other countries which have conducted WHO STEPS surveys associated with glucose thresholds for point-of-care (POC) measuring devices calibrated to plasma. METHODS: Published STEPS surveys conducted over 2001-2017 were obtained. For each survey, information was obtained on diabetes prevalence, POC glucose measuring device, blood sample tested and the fasting glucose threshold used for prevalence calculations. POC device user manuals were obtained to determine calibration. The current WHO glucose threshold for type 2 diabetes was used: ≥7.0 mmol/l for plasma glucose; ≥6.1 mmol/l for whole blood glucose. RESULTS: POC devices were used in 75 of the STEPS surveys identified to measure blood glucose. An incorrect glucose threshold was employed in 17 surveys (23%) to define diabetes. The correct threshold was applied in 20 surveys (27%). Estimates from meta-analysis and meta-regression show that diabetes prevalence in surveys using the incorrect glucose thresholds have prevalences 50% higher than surveys which use the correct glucose threshold. A definite conclusion could not be made for 38 surveys (51%) because of the absence or unclear information on the glucose metre and/or the threshold employed. CONCLUSION: WHO STEPS surveys with likely incorrect published diabetes prevalences have been conducted across the globe, resulting in a 50% artefactual inflation. Inaccurate reporting of diabetes prevalence from widely cited STEPS surveys would have significant impacts on disease burden monitoring, policy development and resource allocation.

OBJECTIFS: Compte tenu de la prévalence erronée du diabète de type 2 rapportée dans 3 petits pays insulaires du Pacifique, une étude a été menée pour déterminer si cette erreur s'était produite dans d'autres pays ayant mené des surveillances STEPS de l'OMS, associées à des seuils de glucose pour des appareils de mesure aux points de soins, calibrés sur du plasma. MÉTHODES: Les surveillances STEPS publiées, menées entre 2001 et 2017 ont été obtenues. Pour chaque surveillance, les informations ont été obtenues sur la prévalence du diabète, l'appareil de mesure du glucose aux points des soins, les échantillons de sang testés et le seuil de glycémie à jeun utilisé pour les calculs de prévalence. Les manuels d'utilisation des appareils ont été obtenus pour déterminer l'étalonnage. Le seuil de glucose actuel de l'OMS pour le diabète de type 2 a été utilisé: ≥ 7,0 mmol/L pour le glucose plasmatique; ≥ 6,1 mmol/L pour le glucose du sang total. RÉSULTATS: Les dispositifs de mesure aux points des soins ont été utilisés dans 75 des surveillances STEPS identifiées pour mesurer la glycémie. Un seuil de glucose incorrect a été utilisé dans 17 surveillances (23%) pour définir le diabète. Le seuil correct a été appliqué dans 20 surveillances (27%). Les estimations issues de méta-analyses et de méta-régressions montrent que la prévalence du diabète dans les surveillances utilisant des seuils de glucose incorrects est supérieure de 50% à celle des surveillances utilisant le seuil de glucose correct. Une conclusion définitive n'a pu être tirée pour 38 surveillances (51%) à cause de l'absence ou du manque de clarté des informations sur le glucomètre et/ou le seuil utilisé. CONCLUSION: Les enquêtes STEPS de l'OMS avec des prévalences de diabète publiées probablement incorrectes ont été menées dans le monde entier, entraînant une inflation artéfactuelle de 50%. Des reports inexacts de la prévalence du diabète provenant de surveillances STEPS largement citées auraient des impacts significatifs sur la surveillance de la charge de morbidité, l'élaboration de politiques et l'allocation des ressources.

Attachment and coparenting representations in men during the transition to parenthood.

Coparenting is based on parents' representations of themselves as coparents. Attachment theory can be a useful framework to understand the way that different coparenting representations are developed during the transition to parenthood. This study aimed to analyze the association between men's attachment and coparenting representations at the first trimester of pregnancy and from the first trimester of pregnancy to 6 months' postpartum. A sample of 86 men was recruited and completed self-report measures of attachment and coparenting representations at the first and third trimester of pregnancy and at 1 and 6 months' postpartum. At the first trimester of pregnancy, higher attachment avoidance was associated with higher lack of coparenting support. From the first trimester of pregnancy to 6 months' postpartum, higher attachment avoidance was associated with (a) a steeper increase on lack of coparenting support, (b) an increase on coparenting conflict (while low attachment avoidance was associated with a decrease), and (c) a lower decrease on coparenting disagreement. This study may contribute to coparenting research by showing new evidence on attachment theory as a useful framework to understand how different coparenting representations are developed in men during the transition to parenthood.

La crianza compartida se basa en las representaciones que cada progenitor tiene de sí como responsable en conjunto de la crianza. La teoría de la afectividad puede ser un marco útil para comprender la manera como diferentes representaciones de la crianza compartida se desarrollan durante la transición a ser padres. Este estudio se propuso como meta analizar la asociación entre la afectividad de los hombres y las representaciones de la crianza compartida durante el primer trimestre del embarazo y a partir del primer trimestre del embarazo a los seis meses después del parto. Se reclutó un grupo muestra de 86 hombres quienes completaron medidas de auto-reporte sobre la afectividad y las representaciones de la crianza compartida al primer y tercer trimestre del embarazo, y al mes y seis meses después del parto. Al primer trimestre del embarazo, un más alto sentido de evitar la afectividad se asoció con una mayor falta de apoyo a la crianza compartida. Del primer trimestre del embarazo a los seis meses posteriores al parto, el más alto sentido de evitar la afectividad se asoció con (1) un más profundo aumento en la falta de apoyo a la crianza compartida, (2) un aumento en el conflicto de crianza compartida (mientras que el bajo nivel del sentido de evitar la afectividad se asoció con una baja), y (3) una más baja disminución en el desacuerdo de la crianza compartida. Este estudio pudiera contribuir a la investigación sobre la crianza compartida al mostrar nueva evidencia sobre la teoría de la afectividad como un marco útil para comprender cuán diferentemente se desarrollan las representaciones de crianza compartida en los hombres durante la transición a la paternidad.

Le coparentage est basé sur les représentations des parents d'eux-mêmes en tant que coparents. La théorie de l'attachement peut être une structure utile pour comprendre la manière dont différentes représentations de coparentages se développent durant la transition au parentage. Cette étude s'est donné pour but d'analyser l'association entre l'attachement des hommes et les représentations de coparentage durant le premier trimestre de la grossesse et du premier trimestre de la grossesse à six mois après la naissance. Un échantillon de 86 hommes a été recruté et a rempli des mesures auto-rapportées d'attachement et des représentations de coparentage au premier et au troisième trimestre de la naissance, et à un an et six mois après la naissance. Au premier trimestre de la grossesse le fait d'éviter l'attachement était lié à un manque de soutien de coparentage plus élevé. Du premier trimestre de la grossesse à six mois postpartum, le fait d'éviter l'attachement était lié à (1) une plus forte augmentation du manque de soutien de coparentage, (2) une augmentation du conflit de coparentage (alors qu'un faible fait d'éviter l'attachement était lié à une décroissance), et (3) une baisse du désaccord de coparentage. Cette étude contribue aux recherches sur le coparentage en montrant de nouvelles preuve de la théorie de l'attachement en tant que structure utile pour comprendre comment des représentations différentes de coparentage se développent chez les hommes durant la transition au parentage.

International Barcode of Life: Focus on big biodiversity in South Africa.

Participants in the 7th International Barcode of Life Conference (Kruger National Park, South Africa, 20-24 November 2017) share the latest findings in DNA barcoding research and its increasingly diversified applications. Here, we review prevailing trends synthesized from among 429 invited and contributed abstracts, which are collated in this open-access special issue of Genome. Hosted for the first time on the African continent, the 7th Conference places special emphasis on the evolutionary origins, biogeography, and conservation of African flora and fauna. Within Africa and elsewhere, DNA barcoding and related techniques are being increasingly used for wildlife forensics and for the validation of commercial products, such as medicinal plants and seafood species. A striking trend of the conference is the dramatic rise of studies on environmental DNA (eDNA) and on diverse uses of high-throughput sequencing techniques. Emerging techniques in these areas are opening new avenues for environmental biomonitoring, managing species-at-risk and invasive species, and revealing species interaction networks in unprecedented detail. Contributors call for the development of validated community standards for high-throughput sequence data generation and analysis, to enable the full potential of these methods to be realized for understanding and managing biodiversity on a global scale.

Cancer incidence in France over the 1980-2012 period: Hematological malignancies.

BACKGROUND: The classification of hematological malignancies (HMs) has changed in recent decades. For the first time, the French network of cancer registries (Francim) provides estimates for incidence and trends of HM in France between 1980 and 2012 for major HM subtypes. METHODS: Incidence was directly estimated by modeling the incidence rates measured in the cancer registry area. For each HM subtype, a "usable incidence period" was defined a priori, corresponding to the years for which all the registries collected them in a homogeneous way. For both sexes and each HM subtype, age-period-cohort models were used to estimate national incidence trends. RESULTS: Overall in France, there were an estimated 35,000 new HMs in 2012 (19,400 in men and 15,600 in women). Lymphoid malignancies accounted for more than two-thirds of HM incident cases (n=25,136). The incidence sex ratio (M/F) varied from 1.1 for classical Hodgkin lymphoma to 4.0 for mantle-cell lymphoma. The median age at diagnosis ranged from 62 to 81 years according to the major HM subtypes. Overall in both sexes, the top five most frequent HMs in 2012 were plasma cell neoplasm (about 4900 estimated cases), chronic lymphocytic leukemia/small lymphocytic lymphoma (4500 cases), diffuse large B-cell lymphoma and myelodysplastic syndromes (4100 cases), and acute myeloid leukemia (2800 cases). The incidence rates increased for follicular lymphoma and plasma cell neoplasm during the study period in both sexes. Classical Hodgkin lymphoma was relatively stable in men between 1980 and 2012 and increased in both sexes during the most recent period. Chronic myeloproliferative neoplasms, other than chronic myelogenous leukemia, are the only subtype that showed a slightly downward trend in incidence between 2003 and 2012 in both sexes. CONCLUSION: The striking differences in the incidence patterns by histologic subtype strongly suggest a certain level of etiologic heterogeneity among hematological malignancies and support the pursuit of epidemiologic analysis by subtype for HMs in international studies. Age-standardized incidence rates are essential to analyze trends in risk, whereas the number of incident cases is necessary to make provisions for healthcare resources and to evaluate the overall burden of HM.

Health policy for sickle cell disease in Africa: experience from Tanzania on interventions to reduce under-five mortality.

Tanzania has made considerable progress towards reducing childhood mortality, achieving a 57% decrease between 1980 and 2011. This epidemiological transition will cause a reduction in the contribution of infectious diseases to childhood mortality and increase in contribution from non-communicable diseases (NCDs). Haemoglobinopathies are amongst the most common childhood NCDs, with sickle cell disease (SCD) being the commonest haemoglobinopathy in Africa. In Tanzania, 10,313 children with SCD under 5 years of age (U5) are estimated to die every year, contributing an estimated 7% of overall deaths in U5 children. Key policies that governments in Africa are able to implement would reduce mortality in SCD, focusing on newborn screening and comprehensive SCD care programmes. Such programmes would ensure that interventions such as prevention of infections using penicillin plus prompt diagnosis and treatment of complications are provided to all individuals with SCD.

Increasing global participation in genetics research through DNA barcoding.

DNA barcoding--the sequencing of short, standardized DNA regions for specimen identification and species discovery--has promised to facilitate rapid access to biodiversity knowledge by diverse users. Here, we advance our opinion that increased global participation in genetics research is beneficial, both to scientists and for science, and explore the premise that DNA barcoding can help to democratize participation in genetics research. We examine publication patterns (2003-2014) in the DNA barcoding literature and compare trends with those in the broader, related domain of genomics. While genomics is the older and much larger field, the number of nations contributing to the published literature is similar between disciplines. Meanwhile, DNA barcoding exhibits a higher pace of growth in the number of publications as well as greater evenness among nations in their proportional contribution to total authorships. This exploration revealed DNA barcoding to be a highly international discipline, with growing participation by researchers in especially biodiverse nations. We briefly consider several of the challenges that may hinder further participation in genetics research, including access to training and molecular facilities as well as policy relating to the movement of genetic resources.

International Barcode of Life: Evolution of a global research community.

The 6th International Barcode of Life Conference (Guelph, Canada, 18-21 August 2015), themed Barcodes to Biomes, showcases the latest developments in DNA barcoding research and its diverse applications. The meeting also provides a venue for a global research community to share ideas and to initiate collaborations. All plenary and contributed abstracts are being published as an open-access special issue of Genome. Here, I use a comparison with the 3rd Conference (Mexico City, 2009) to highlight 10 recent and emerging trends that are apparent among the contributed abstracts. One of the outstanding trends is the rising proportion of abstracts that focus upon multiple socio-economically important applications of DNA barcoding, including studies of agricultural pests, quarantine and invasive species, wildlife forensics, disease vectors, biomonitoring of ecosystem health, and marketplace surveys evaluating the authenticity of seafood products and medicinal plants. Other key movements include the use of barcoding and metabarcoding approaches for dietary analyses-and for studies of food webs spanning three or more trophic levels-as well as the spread of next-generation sequencing methods in multiple contexts. In combination with the rising taxonomic and geographic scope of many barcoding iniatives, these developments suggest that several important questions in biology are becoming tractable. "What is this specimen on an agricultural shipment?", "Who eats whom in this whole food web?", and even "How many species are there?" are questions that may be answered in time periods ranging from a few years to one or a few decades. The next phases of DNA barcoding may expand yet further into prediction of community shifts with climate change and improved management of biological resources.

[Studying dysfunctional personality trends among sex offenders]. / Étude des tendances dysfonctionnelles de la personnalité chez des auteurs d'infractions sexuelles.

OBJECTIVE: A review of the literature reveals a consensus on the high prevalence of personality disorders among sexual offenders. Studies show that there is no unique personality profile for sex offenders. In France, little research has been conducted on this population with standardized assessment tools. The objective of the present study is to identify the distribution of personality disorders among sexual offenders using a new French questionnaire, i.e. the TD12. In view of the literature, we postulate that this tool will identify the diversity of personality disorders observed by various authors, but with a higher proportion of cluster B disorders. METHODOLOGY: This study was conducted among 56 men, including 28 sex offenders aged from 21 to 70 years old, and a control group of 28 men without psychiatric disorders. The sex offenders in this study are men convicted or charged with sex offenses of various kinds: exhibitionism, the recording, distribution and possession of pornography depicting minors, aggravated corruption of a minor, sexual assault of a minor, or rape of a minor. They were examined using an inventory of dysfunctional trends recently developed by Rolland and Pichot with the aim of assessing dysfunctional personality styles. The TD-12 questionnaire is composed of 140 items describing thoughts, feelings and behaviors. It is based on the diagnostic criteria of Axis II of DSM IV-TR and consists of twelve scales that match the personality disorders described in this diagnostic manual (ten officially recognized disorders and two additional disorders). RESULTS: From a categorical viewpoint, results indicate rigid dysfunctional trends with regard to avoidant personality disorder in sex offenders compared to the control group (Chi(2)=9.16; P=0.005). However, there were no significant differences between the two groups regarding the number of rigid dysfunctional trends. Potentially controllable dysfunctional personality trends are identified for the dependent personality (Chi(2)=6.72; P=0.02) and the depressive personality (Chi(2)=9.63; P=0.004). Moreover, the results show differences related to type of crime. The mean score on the Docile-Dependent scale is higher among subjects who had only downloaded images of child pornography (n=8) compared to subjects who had committed at least one sexual offense against a victim (n=20) (58.75±8.43 versus 49.55±11.66, P=0.04). CONCLUSION: These results are somewhat in contradiction with previous studies. The often described cluster B personalities are not significantly observed in this study. These results show the prevalence of avoidant personality disorder, which in fact corresponds to a clinically observed sex offender profile characterized by inhibition, relationship difficulties with adults, fear of being judged or rejected, and social isolation. The study also shows the value of considering the personality profile in relation to the modus operandi. It is important to continue this research on larger groups in order to refine the results.

La pratique contraceptive moderne chez les adolescentes au Bénin: Tendances, déterminants et perspectives / Modern contraceptive use among adolescents in Benin: trends, determinants and prospects.

RésuméLa pratique contraceptive moderne augmente lentement parmi les jeunes générations au Bénin. La présente étude analyse les tendances, les déterminants du recours aux contraceptifs et leurs mécanismes d'actions chez les adolescentes. Les approches socio-écologique et intersectionnelle ont été adoptées, avec une méthode d'étude mixte portant sur les adolescentes de 15 à 19 ans sexuellement actives et non enceintes. Le volet quantitatif recourt aux données des cinq enquêtes démographiques et de santé du Bénin entre 1996 et 2017-18, avec une analyse descriptive et une régression logistique binaire pas à pas. Les données qualitatives collectées par des observations, discussions de groupe et entretiens individuels auprès de différents acteurs nationaux, ont fait l'objet d'analyse de contenu. Les résultats révèlent une prévalence contraceptive moderne basse, passant de 4,6% en 1996 à 13,3% en 2017-18, avec le préservatif comme principale méthode utilisée (8,2%). En 2017-18, la probabilité d'utiliser les contraceptifs était plus élevée chez les adolescentes des ménages riches (OR = 2,3), les scolarisées (OR = 2,3), les célibataires (OR = 2,1), celles fréquentant les services de planification familiale (PF) (OR = 1,8), connaissant le cycle menstruel (OR = 1,6), et économiquement actives (OR = 1,5). Cependant, être Yoruba réduit les chances d'utiliser les contraceptifs (OR = 0,5). Les données qualitatives confirment ces résultats et les complètent en mettant en avant l'effet du cadre juridique favorable à la pratique contraceptive, la stigmatisation sociale des utilisatrices, et les infox véhiculées en communauté. Nous recommandons des efforts pour le maintien des filles à l'école, la généralisation des services de PF pour les adolescents, la communication communautaire, et la subvention des contraceptifs.

Prescribing Trends of the Sodium-Glucose Cotransporter-2 Inhibitors Among Different Physician Specialties in Canada (2015-2021).

OBJECTIVES: Landmark clinical trials have shown the sodium-glucose cotransporter-2 (SGLT-2) inhibitors to have cardiorenal benefits beyond their glucose-lowering effect. Clinical guidelines now recommend their use in patients with chronic kidney disease or heart failure, with or without type 2 diabetes, potentially affecting prescribing patterns among physician specialties. METHODS: Using monthly projected total retail dispensed prescription data from IQVIA's CompuScript database, we assessed trends in prescribing SGLT-2 inhibitors among 6 prescriber specialities from 2015 to 2021 in Canada. We assessed these trends at the class, agent, and dose level using joinpoint regression. RESULTS: From 2015 to 2021, the projected total retail dispensed prescriptions of SGLT-2 inhibitors from all prescribers increased. Relative to other prescribers, >60% of SGLT-2 inhibitor prescriptions were written by general practitioners or family physicians. The percentage of prescriptions from endocrinologists decreased (average annual percent change: mean, -10.8; 95% confidence interval [CI], -12.2% to -9.4%), whereas a dramatic increase was observed for cardiologists (mean, 44.1%, 95% CI, 32.9 to 56.2). The percentage from nephrologists also increased, albeit not statistically significant (mean, 12.4; 95% CI, -0.5 to 27.1). Significant changes in the agent and dose of SGLT-2 inhibitor prescribed were also observed among cardiologists and nephrologists. CONCLUSIONS: Between 2015 and 2021, there was a steady increase in the proportion of SGLT-2 inhibitor prescriptions from cardiologists and nephrologists, reflecting emerging evidence and guideline recommendations.

Leprosy trends in Zambia 1991-2009.

OBJECTIVE: To document leprosy trends in Zambia over the past two decades to ascertain the importance of leprosy as a health problem in Zambia. METHODS: Retrospective study covering the period 1991-2009 of routine national leprosy surveillance data, published national programme review reports and desk reviews of in-country TB reports. RESULTS: Data reports were available for all the years under study apart from years 2001, 2002 and 2006. The Leprosy case notification rates (CNR) declined from 2.73/10 000 population in 1991 to 0.43/10 000 population in 2009. The general leprosy burden showed a downward trend for both adults and children. Leprosy case burden dropped from approximately 18 000 cases in 1980 to only about 1000 cases in 1996, and by the year 2000, the prevalence rates had fallen to 0.67/10 000 population. There were more multibacillary cases of leprosy than pauci-bacillary cases. Several major gaps in data recording, entry and surveillance were identified. Data on disaggregation by gender, HIV status or geographical origin were not available. CONCLUSION: Whilst Zambia has achieved WHO targets for leprosy control, leprosy prevalence data from Zambia may not reflect real situation because of poor data recording and surveillance. Greater investment into infrastructure and training are required for more accurate surveillance of leprosy in Zambia.

Epidemiology and trends of ocular trauma hospitalizations in Chile from 2001 to 2020.

PURPOSE: To describe and analyze the characteristics and trends of hospital admissions for ocular trauma in Chile between 2001 and 2020. METHODS: We assessed hospitalizations due to ocular trauma in Chile using data from the hospital discharge registry of Chile's Department of Statistics and Health (DEIS). The JoinPoint regression analysis software was used to perform a trend analysis. RESULTS: From 2001 to 2020, a total of 37,425 patients were hospitalized in Chile with a diagnosis of "Injury of eye and orbit". The mean age was 36.7years, the mean length of stay was 6.85days, 82.4% of the patients were males, and 30.5% were open globe injuries. The average annual hospitalization rate over this period was 11.1/100,000 in the entire population (95% CI: 9.6-12.7), 18.7/100,000 in men (95% CI: 16-21.3) and 3.9/100,000 in women (95% CI: 3.3-4.5). Based on JoinPoint analysis, two temporal trends were identified for hospital admissions. Between 2001 and 2009, hospital admissions decreased 0.1% per year (P=0.876) and between 2009 and 2020 decreased 8.4% per year (P<0.001). On average, hospitalization rates decreased 5.3% per year (P<0.001) over the entire study period. CONCLUSION: Trauma is a significant cause of ocular morbidity in Chile, occurring mainly in middle-aged men. Since 2009, a significant decrease has been observed in hospitalization rates for ocular trauma in Chile.

Increasing Incidence of Type 1 and Type 2 Diabetes Among Canadian Children.

BACKGROUND: Diabetes mellitus is one of the most common pediatric chronic illnesses. Although a rising incidence of childhood type 1 diabetes (T1D) has frequently been documented, an almost 400-fold variation in incidence has been seen worldwide. We aimed to describe the trends in incidence of diabetes (type 1, type 2, all types) among children and adolescents living in the Greater Montréal area of Québec, Canada. METHODS: Using health administrative data (Québec Integrated Chronic Disease Surveillance System) and medical records from the 3 major pediatric diabetes centres in the Greater Montréal area, we conducted serial cross-sectional studies of children aged 1 to 15 years during the period from 2002 to 2010. We conducted a trend analysis of diabetes incidence over time using multivariate Poisson regression models. RESULTS: We identified 696 new cases of diabetes between 2002 and 2010. The age-standardized incidence of diabetes (all types) increased from 16.3 (95% confidence interval [CI], 12.4 to 21.2) to 27.8 (95% CI, 22.5 to 34.0) per 100,000, with annual incidence increasing, on average, by 5.2% per year (adjusted rate ratio [aRR], 1.052; 95% CI, 1.022 to 1.083). This was driven predominantly by the T1D annual increase of 5.4% (aRR, 1.054; 95% CI, 1.023 to 1.086). A low number of incident cases of type 2 diabetes limited trend analysis in this group. There were no significant interactions between year and sex or age. CONCLUSIONS: The annual incidence of T1D is increasing in Québec children and does not vary by sex or age. Further research into etiologic factors is indicated.

Trends and Determinants of Self-reported Aspirin Use Among Patients With Diabetes Stratified by Presence and Risk of Cardiovascular Diseases: A Repeated Pan-Canadian Cross-sectional Study.

OBJECTIVES: Our aim in this study was to quantify the prevalence over time and identify determinants of acetylsalicylic acid (ASA) use in patients with diabetes with and without cardiovascular disease (CVD) in a representative Canadian sample from 2005 to 2014, and to determine whether the use of ASA among patients with diabetes changed after the Diabetes Canada clinical practice guidelines updates. METHODS: Data from the Canadian Community Health Survey were used. Respondents who were at least 35 years of age and diagnosed with diabetes---not during pregnancy---were included and categorized into secondary prevention (previous heart disease or stroke) or primary prevention (high or low CVD risk) groups. A stratified and weighted multivariable logistic regression model was used to quantify ASA use and identify determinants of use. RESULTS: Our sample consisted of 15,100 respondents with diabetes (weighted sample of ∼2,429,900). Approximately 70% and 50% of Canadians with diabetes used ASA for secondary and primary prevention, respectively. Overall, the trend of ASA use was stable over the study period in both the secondary and the primary prevention groups. This trend did not change after the clinical practice guidelines update in 2008. Having a regular doctor and older age were associated with increased use of ASA. Other significant determinants independently associated with ASA use included income, body mass index, smoking, immigration status, gender and chronic diseases. CONCLUSIONS: Among patients with diabetes in Canada, ASA appears to be underutilized in secondary prevention and high-risk primary prevention populations. Future research should address whether regular use of ASA is associated with clinical outcomes among patients with diabetes.

Catheter ablation in adults with congenital heart disease: A 15-year perspective from a tertiary centre.

BACKGROUND: With the growing adult congenital heart disease (ACHD) population, the number of catheter ablation procedures is expected to dramatically increase. Data reporting experience and evolution of catheter ablation in patients with ACHD, over a significant period of time, remain scarce. AIM: We aimed to describe temporal trends in volume and outcomes of catheter ablation in patients with ACHD. METHODS: This was a retrospective observational study including all consecutive patients with ACHD undergoing attempted catheter ablation in a large tertiary referral centre over a 15-year period. Acute procedural success rate and freedom from recurrence at 12 and 24 months were analysed. RESULTS: From November 2004 to November 2019, 302 catheter ablations were performed in 221 patients with ACHD (mean age 43.6±15.0 years; 58.9% male sex). The annual number of catheter ablations increased progressively from four to 60 cases per year (P<0.001). Intra-atrial reentrant tachycardia/focal atrial tachycardia was the most common arrhythmia (n=217, 71.9%). Over the study period, acute procedural success rate increased from 45.0% to 93.4% (P<0.001). Use of irrigated catheters (odds ratio [OR] 4.03, 95% confidence interval [CI] 1.86-8.55), a three-dimensional mapping system (OR 3.70, 95% CI 1.72-7.74), contact force catheters (OR 3.60, 95% CI 1.81-7.38) and high-density mapping (OR 3.69, 95% CI 1.82-8.14) were associated with acute procedural success. The rate of freedom from any recurrence at 12 months increased from 29.4% to 66.2% (P=0.001). Seven (2.3%) non-fatal complications occurred. CONCLUSIONS: The number of catheter ablation procedures in patients with ACHD has increased considerably over the past 15 years. Growing experience and advances in ablative technologies appear to be associated with a significant improvement in acute and mid-term outcomes.

[Spatio-temporal analysis of the incidence of morbidity and mortality from severe malaria in the Sélingué health district, Mali]. / Analyse spatio­temporelle de l'incidence de la morbidite et de la mortalite du paludisme grave dans le district sanitaire de Selingue, Mali.

AIMS/OBJECTIVES/ASSUMPTION: In Mali, malaria is the leading cause of death and consultations in health facilities. The objective of this study was to examine trends in morbidity and mortality among children aged 0 to 15 years and to establish accurate mapping of the distribution of cases in health areas of the Sélingué health district. MATERIALS AND METHOD: A retrospective analysis of hospital records at the Sélingué district reference health center from 2010 to 2013 was conducted. Trend Chi2 and logistic regression were used, respectively, to compare changes in trends between health areas and to identify risk factors associated with malaria mortality. RESULTS: Among the 1282 cases of malaria, the incidence of severe malaria gradually decreased from 96.75 ‰ (671 cases) in 2010 to 34.23 ‰ (291 cases) in 2011, 19.76 ‰ (168 cases) in 2012 and 19.43 ‰ (152 cases) in 2013. From 2010 to 2013, there was an average monthly variation in October of 26, 6% cerebralmalaria and 23.3% malaria anemia by the month of July of the same year. Spatial variation of anemic forms of malaria between health areas (p < 0.001) was observed from 2010 to 2013. From 2012 to 2013, there was an overall decrease in the frequency of hospitalizations, incidence and death rate for severe malaria. In multivariate analysis, in the final model, malaria lethality was associated with the duration of hospitalization for more than three days (OR = 0.124); the year of hospitalization from 2010 to 2012 (OR = 0.813); the absence of blood transfusion of the patient (OR = 0.282); at the age of the patient in children under one year (OR = 0.356) and at the emergency anti-malarial treatment instituted with artemether (OR = 3.006) adjusting for the form of malaria. On the other hand, malaria lethality was not related to the form of malaria (p = 0.072), sex (p = 0.390), residence (p = 0.308), prior treatment before hospitalization (p = 0.949). at fever in children (p = 0.153) adjusting for other variables in the model. CONCLUSION: Hospital case fatality remains high with a drop in the incidence of morbidity and mortality; a monthly variation in morbidity and mortality with two peaks, July - August and October-November and the emergency treatment instituted with artemether, the length of hospital stay could be identified as associated factors.

BUT/OBJECTIFS/HYPOTHÈSE: Au Mali, le paludisme est la principale cause de décès et de consultations dans les formations sanitaires. L'objectif de cette étude était de déterminer l'incidence de la morbidité et de la mortalité chez les enfants de 0 à 15 ans et d'établir une cartographie précise de la répartition des cas dans les aires de santé du district sanitaire de Sélingué. MATÉRIELS, MÉTHODE: Une analyse rétrospective des dossiers d'hospitalisation des enfants de 0 à 15 ans au niveau du centre de santé de référence du district de Sélingué de 2010 à 2013 a été réalisée. Le test de Chi2 de tendance et la régression logistique ont été utilisés respectivement pour comparer les variations de l'incidence entre les aires de santé et identifier les facteurs de risque associés à la mortalité palustre. RÉSULTATS: Parmi les 1282 cas de paludisme, l 'incidence du paludisme grave a diminué progressivement de 96,75‰ (671 cas) en 2010 à 34,23 ‰ (291 cas) en 2011, 19,76‰ (168 cas) en 2012 et 19,43‰ (152 cas) en 2013 (Chi2 de tendance p < 0,001). La létalité palustre a été de 15,13%, et n'a pas significativement varié, avec 13,31 % en 2010 et 14,05 % en 2013. De 2010 à 2013, on notait une variation mensuelle moyenne en octobre de 26,6% neuro paludisme et 23,3% de paludisme anémique vers le mois de juillet de la même année. Une variation spatiale des formes anémiques du paludisme entre les aires de santé (p < 0,001) a été observée de 2010 à 2013. De 2012 à 2013, il a été observé une baisse globale de la fréquence des hospitalisations, de l'incidence et du taux de décès pour le paludisme grave. En analyse multivariée, dans le modèle final, la létalité palustre était associée à la durée de l'hospitalisation de plus de trois jours (OR = 0,124) ; à l'année d'hospitalisation de 2010 à 2012 (OR = 0,813) ; à l'absence de transfusion sanguine du patient (OR = 0,282) ; à l'âge du patient chez les moins d'un an (OR = 0,356) et au traitement d'urgence anti paludique institué avec l'artemether (OR = 3,006) en ajustant pour la forme du paludisme. En revanche la létalité palustre n'était pas liée à la forme du paludisme (p = 0,072), au sexe (p = 0,390), à la résidence (p = 0,308), au traitement antérieur avant l'hospitalisation (p = 0,949), à la fièvre chez l'enfant (p = 0,153) en ajustant sur les autres variables dans le modèle. CONCLUSION: La létalité palustre hospitalière reste élevée avec une baisse des incidences de la morbidité et de la mortalité ; une variation mensuelle de la morbidité et de la mortalité avec deux pics, juillet - août et octobre-novembre et le traitement d'urgence institué avec l'artemether, la durée d'hospitalisation ont pu être identifiés comme des facteurs associés.

The Health and Health Care of Adults With Type 1 And 2 Diabetes Across the Spectrum of Estimated Glomerular Filtration Rates.

OBJECTIVES: Little is known about the health and health-care patterns of patients with diabetes according to their estimated glomerular filtration rates, especially within a publicly funded health-care system. METHODS: Using linked health-care databases in Ontario, Canada, we performed a population-based study of adults 50 years of age and older (mean age, 68 years) with prevalent diabetes on January 1, 2014. We categorized patients according to their levels of kidney function (estimated glomerular filtration rate ≥90, 60 to 89, 30 to 59, 15 to 29 or <15 mL/min/1.73 m2, or the receipt of ongoing maintenance dialysis). We then followed patients for 2 years to determine: 1) their level of contact with health-care providers (i.e. visits to family doctors, specialists); 2) their use and repeated use of acute medical services (i.e. hospitalizations and emergency department encounters; 3) diabetes-related monitoring and screening (i.e. glycated hemoglobin and cholesterol tests, vision screening); 4) glycemic and lipid control; and 5) diabetes-related outcomes. RESULTS: There were 569,384 patients in our study. Most had estimated glomerular filtration rates between 60 and 89 mL/min/1.73 m2. At baseline, patients with lower kidney function had longer durations of diabetes and more comorbidities. Over 2 years of follow up, they had higher burdens of medical care, excessive diabetes monitoring and were underscreened for diabetes-related complications. Although metabolic control was reasonable across groups, patients with low kidney function had more hospital encounters and more diabetes-related complications. CONCLUSIONS: Patients with diabetes and low kidney function are a vulnerable population that faces health system challenges and care gaps. Suggestions for policy and practice are discussed.