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Undiagnosed HIV infection in a population of MSM from six European cities: results from the Sialon project

Date

Source

21.05.2015

Ferrer, L., Furegato, M., Foschia, J.-P., Folch, C., Gonzale...


Objectives: The purpose of this article is to assess the distribution of undiagnosed HIV infection in men who have sex with men (MSM) in Southern and Eastern European countries, to describe the differences in epidemiology and behaviour between undiagnosed, diagnosed HIV-positive and HIV-negative MSM and to identify factors associated with undiagnosed HIV infection in the study population. Methods: A multi-centre biological and behavioural cross-sectional study was conducted in 2008. Time–location sampling was used to recruit men attending different venues. A self-administered questionnaire was completed and oral fluid samples were collected to estimate HIV prevalence. Results: HIV prevalence was 17% in Barcelona, 12% in Verona, 6% in Bratislava, 5% in Ljubljana, 5% in Bucharest and 3% in Prague while undiagnosed HIV infection was 47, 62, 67, 83, 85 and 57%, respectively. Diagnosed HIV-positive men reported more casual partners than HIV-negative MSM (mean: 19 and 9, respectively) (P < 0.001), and they were more likely to self-reported condyloma in the last year than undiagnosed HIV-positive and HIV-negative men (15, 1 and 3%, respectively) (P < 0.001). Factors associated with undiagnosed HIV infection included attending sex-focused venues (OR = 2.49), reporting syphilis in the previous 12 months (OR = 2.56), using poppers at last sexual intercourse (OR = 3.36) and having had an HIV test in the previous year (OR = 2.00). Conclusions: Many HIV infections remain undiagnosed, and there is evidence of the persistence of frequent risk behaviours and sexually transmitted infections (STI) despite knowledge of HIV-positive status, emphasising the need for a multidimensional approach to HIV/STI prevention. Access to HIV testing should be considered a priority in prevention programs targeted at MSM, especially in Eastern Europe.


The risk of fall injury in relation to commonly prescribed medications among older people--a Swedish case-control study

Date

Source

21.05.2015

Kuschel, B. M., Laflamme, L., Moller, J.


Background: Older people not only consume more medication but they also represent a group at high risk for adverse effects such as injurious falls. This study examines the association between the medications most commonly prescribed to older people in Sweden and fall injuries. Methods: This is a population-based, matched, case-control study of 64 399 persons aged ≥ 65 years in Sweden admitted to hospital because of a fall injury between March 2006 and December 2009, and four controls per case matched by gender, date of birth and place of residence. The prevalence of the 20 most commonly prescribed medications was compiled for the 30-day period before the index date. The association between those medications and injurious falls was estimated with odds ratios and corresponding 95% confidence intervals using conditional logistic regression. Results: Ten of the top 20 most commonly prescribed medications, and in particular the three medications affecting the central nervous system (CNS), significantly increased the risk of fall injuries (highest for opioids and antidepressants) but not the seven cardiovascular ones, who had a protective effect (lowest for angiotensin converting enzyme inhibitors and selective calcium channel blockers). Conclusions: The adverse effect of several commonly prescribed medications may seriously threaten their positive effects on the well-being and quality of life of older people. Their association with injurious falls is of particular concern as falls are prevalent and often leading to severe consequences. This needs to be acknowledged so physicians and patients can make informed decisions when prescribing and using them.


Information preferences of the general population when faced with life-limiting illness

Date

Source

21.05.2015

De Vleminck, A., Pardon, K., Roelands, M., Houttekier, D., V...


Background: Giving the public and the patients good information enables them to make effective choices about their care. This study describes public preferences for both themselves and their relatives on receiving information on end-of-life care topics when faced with a life-limiting illness and to identify associated factors. Method: This study used data from the cross-sectional Health Interview Study (HIS) 2008 that collected data from a representative sample (N = 9651) of the Belgian population. Results: Around 82% of respondents wanted to be informed always about diagnosis, chances of cure and available treatments, 77% wanted to be informed on life expectancy, 72% on options regarding palliative care and 67% on possibilities of prolonging or shortening life. Around 55% wanted their relative to be informed always about diagnosis, chances of cure, life expectancy and different treatments available, whereas 50% wanted this in relation to the options regarding palliative care and 46% on the possibilities of prolonging or shortening life. Younger adults, people with more education and people with a regular GP were more likely to want to be informed always. Younger adults and women were less likely to want their relatives to be informed always. Conclusion: The majority of the Belgian population wants to be informed always about end-of-life care topics when faced with a life-limiting illness. Physicians should be aware of the desired level of information and tailor information to individual patient preferences. Understanding population preferences may help to tailor patient education and health promotion programmes appropriately.


Time trend in Alzheimer diagnoses and the association between distance to an Alzheimer clinic and Alzheimer diagnosis

Date

Source

21.05.2015

Jorgensen, T. S. H., Torp-Pedersen, C., Gislason, G. H., And...


Background: Centralization of specialized health care in Denmark has caused increased geographical distance to health-care providers, which may be a barrier for Alzheimer patients to seek health care. We examined the incidence of Alzheimer diagnosis in Denmark between 2000 and 2009 and investigated the association between patients’ distance to Alzheimer clinics and Alzheimer diagnoses. Methods: Data of all individuals aged 65+ years were collected from Danish national registers. Incidences of Alzheimer diagnoses were analysed with joinpoint regression and hazard ratios (HRs) for Alzheimer diagnoses were analysed with Cox regressions. Results: The annual incidence of Alzheimer diagnoses increased with 32.5% [95% confidence interval (CI): 7.1–63.8] among individuals aged 65–74 years from 2000 to 2002 and with 29.1% (95% CI: 11.0–50.2) among individuals aged 75+ years from 2000 to 2003. For both groups, incidence during subsequent years stagnated (0.4%, 95% CI: –1.7 to 2.6; 2.3%, 95% CI: 1.5–6.). From 2008 to 2009, 8605 individuals got an Alzheimer diagnosis. These individuals had a shorter distance to Alzheimer clinics (16.6 vs. 19.1 km, P < 0.001), higher mean age (80.7 vs. 73.7 years, P < 0.001) and were more often women (63.1 vs. 55.9%, P < 0.001). There were inverse associations between distance to Alzheimer clinics and Alzheimer diagnoses (0–19 km: reference; 20–39 km: HR = 0.80, 95% CI: 0.70–0.92; 40–59 km: HR = 0.65, 95% CI: 0.52–0.81). Conclusions: The incidence of Alzheimer diagnoses stagnated from 2002/03 to 2009 in Denmark—a period during which distances to health-care providers in general increased. The inverse association between geographical distance to Alzheimer clinics and Alzheimer diagnoses suggests that distance exclude a segment of the elderly population from an appropriate diagnostic workup and treatment.


Low measles vaccination coverage among medical residents in Marseille, France: reasons for non-vaccination, March 2013

Date

Source

21.05.2015

Korhonen, T., Neveu, A., Armengaud, A., Six, C., Danis, K., ...


Background: During 2008–12, France and Europe experienced large measles outbreaks, involving also healthcare workers (HCW). We aimed to estimate the vaccination coverage (VC) of measles among medical residents of the University of Aix/Marseille, in South-Eastern France. Methods: In March 2013, we conducted a cross-sectional study among all medical residents of the Medical Faculty of Aix/Marseille. We used a self-administered questionnaire to collect information on self-reported VC and reasons for vaccination and non-vaccination. We compared proportions, using the chi-squared test and prevalence ratios (PRs) with 95% confidence intervals (95% CIs). Results: Of 1152 eligible residents, 703 (61%) participated in the study and 95 (14%; 95% CI: 12–17%) reported having had measles in the past. Of all participants, 613 (93%; 95% CI: 91–95%) reported having been vaccinated against measles and 389 (76%; 95% CI: 73–80%) received two doses. Only 268 (38%) reported having visited an occupational health physician. Vaccinated individuals were more likely to report easy access to vaccination as the main motivation for measles vaccination, compared with unvaccinated residents (435; 71% and 21; 45%; P < 0.001, respectively). Conclusions: VC among the medical residents of the University of Aix/Marseille was well below the recommended 95% coverage for two doses of measles vaccination. The majority of the study participants had not visited an occupational health doctor. Lack of easy access seems to represent major barriers to measles vaccination. We recommend that the student union, occupational health services and hospitals co-operate and address these problems in order to improve VC in this group.


Forty-year trends in cardiovascular risk factors in Finland

Date

Source

21.05.2015

Borodulin, K., Vartiainen, E., Peltonen, M., Jousilahti, P.,...


Background: Finland has experienced remarkable changes in population levels of coronary heart disease risk factors and mortality over the past decades. The National FINRISK studies have monitored risk factors in major non-communicable diseases from 1972 to 2012. The 40-year changes in those risk factors are presented. Methods: Study population included participants aged 30–59 years in the series on independent random population samples. Data were collected in 5-year intervals in 1972–2012. FINRISK studies so far comprised 53 589 men and women who participated in a health examination, gave a venous blood sample and filled in questionnaires. Serum total cholesterol, systolic and diastolic blood pressure, and body mass index (BMI) were measured using standardized protocol, and smoking status was recorded. Results: Total serum cholesterol decreased remarkably until 2007, but after that has increased. Systolic blood pressure has continued to decline over time since 1972, while decrease in diastolic blood pressure has levelled off during the last 10 years. Smoking prevalence has markedly decreased. BMI has increased in the population, but most significantly in the earlier survey years, not the past 10 years. Conclusions: After three decades of favourable development, the population risk factor levels showed some increase in total cholesterol and diastolic blood pressure. This emphasizes the need for continued efforts towards national disease prevention and health promotion.


The role of conspicuity in preventing bicycle crashes involving a motor vehicle

Date

Source

21.05.2015

Tin Tin, S., Woodward, A., Ameratunga, S.


Background: Bicycle use, despite its proven health and other benefits, is rarely part of everyday travel for many people due to the perceived risk of injury from collision crashes. This article investigated the role of physical vs. attention conspicuity in preventing bicycle crashes involving a motor vehicle in New Zealand. Methods: The Taupo Bicycle Study involved 2590 adult cyclists recruited in 2006 (43.1% response rate) and followed for bicycle crash outcomes through linkage to four national databases. A composite measure of physical conspicuity was created using latent class analysis based on the use of fluorescent colours, lights and reflective materials, and the main colour of top, helmet and bike frame. Attention conspicuity was assessed based on regional differences in travel patterns and the amount of riding in a bunch. Cox regression modelling for repeated events was performed with multivariate adjustments. Results: During a median follow-up period of 6.4 years, 162 participants experienced 187 bicycle–motor vehicle crashes. The crash risk was not predicted by the four latent classes identified and the amount of bunch riding but was higher in Auckland, the region with the lowest level of bicycle use relative to car use. In subgroup analyses, compared to other latent classes, the most physically conspicuous group had a higher risk in Auckland but a lower risk in other regions. Conclusion: Conspicuity aids may not be effective in preventing bicycle–motor vehicle crashes in New Zealand, particularly in Auckland, where attention conspicuity is low.


Tuberculosis among migrant populations in the European Union and the European Economic Area

Date

Source

21.05.2015

Odone, A., Tillmann, T., Sandgren, A., Williams, G., Rechel,...


Background: Although tuberculosis (TB) incidence has been decreasing in the European Union/European Economic Area (EU/EEA) in the last decades, specific subgroups of the population, such as migrants, remain at high risk of TB. This study is based on the report ‘Key Infectious Diseases in Migrant Populations in the EU/EEA’ commissioned by The European Centre for Disease Prevention and Control. Methods: We collected, critically appraised and summarized the available evidence on the TB burden in migrants in the EU/EEA. Data were collected through: (i) a comprehensive literature review; (ii) analysis of data from The European Surveillance System (TESSy) and (iii) evidence provided by TB experts during an infectious disease workshop in 2012. Results: In 2010, of the 73 996 TB cases notified in the EU/EEA, 25% were of foreign origin. The overall decrease of TB cases observed in recent years has not been reflected in migrant populations. Foreign-born people with TB exhibit different socioeconomic and clinical characteristics than native sufferers. Conclusion: This is one of the first studies to use multiple data sources, including the largest available European database on infectious disease notifications, to assess the burden and provide a comprehensive description and analysis of specific TB features in migrants in the EU/EEA. Strengthened information about health determinants and factors for migrants’ vulnerability is needed to plan, implement and evaluate targeted TB care and control interventions for migrants in the EU/EEA.


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