Subjective health status and health-related quality of life among women with Recurrent Vulvovaginal Candidosis (RVVC) in Europe and the USA

Abstract Background Recurrent vulvovaginal candidosis (RVVC) is a chronic condition causing discomfort and pain. Health status and health-related quality of life (HRQoL) in RVVC were never previously described using validated questionnaires. The objective of this study is to describe subjective health status and HRQoL and estimate health state utilities among women with RVVC. Methods A cross-sectional online survey was conducted among women who reported having suffered four or more yeast infections over the past 12 months, in five European countries (France, Germany, Italy, Spain and the UK) and the USA. Index scores were derived from the EQ-5D, a questionnaire providing a single index value for health status. The SF-36 questionnaire was used for HRQoL assessment. Information on disease severity, treatment patterns and productivity was also collected. Results 12,834 members of online research panels were contacted. Among them, 620 women with RVVC (5%) were selected to complete the full questionnaire. The mean EQ-5D index score was 0.70 (95% confidence interval: [0.67, 0.72]) and the difference between women with a yeast infection at the time of questionnaire completion and other respondents was 0.05 (p = 0.47). The EQ-5D index score increased significantly with the time since last infection (p \u3c 0.001). 68% of women reported depression/anxiety problems during acute episode, and 54% outside episodes, compared to less than 20% in general population (p \u3c 0.001). All SF-36 domain scores were significantly below general population norms. Mental health domains were the most affected. The impact on productivity was estimated at 33 lost work hours per year on average, corresponding to estimated costs between €266/year and €1,130/year depending on the country. Conclusions Subjective health status and HRQoL during and in between acute inflammatory episodes in women with RVVC are significantly worse than in the general population, despite the use of antifungal therapy. The average index score in women with RVVC is comparable to other diseases such as asthma or COPD and worse than diseases such as headache/migraine according to US and UK catalogs of index scores. The survey also revealed a significant loss of productivity associated with RVVC

Prevalence and determinants of Leishmania major infection in emerging and old foci in Tunisia

International audienceBackground: Zoonotic Cutaneous Leishmaniasis (ZCL) due to Leishmania major (L. major) is still a serious public health problem in Tunisia. This study aimed to compare the prevalence and risk factors associated with L. major infection in old and new foci using leishmanin skin test (LST) in central Tunisia. Methods: A cross sectional household survey was carried out between January and may09 on a sample of 2686 healthy individuals aged between 5 and 65 years. We determined the prevalence of L. major infection using the LST. Risk factors of LST positivity were assessed using a logistic regression model. Results: The overall prevalence of LST positivity was 57% (95% CI: 53-59). The prevalence of L. major infection was significantly higher in the old focus (99%; 95% CI: 98-100) than in the emerging foci (43%; 95% CI: 39-46) (p = <0.001). Multivariate analysis of LST positivity risk factors showed that age, the nature of the foci (old/emerging), personal and family history of ZCL are determinants of positive LST results. Conclusion: The results updated the current epidemiologic profile of ZLC in central Tunisia. Past history of transmission in a population should be considered as a potential confounder in future clinical trials for drugs and vaccines against L. major cutaneous leishmaniasis

Trends in the leading causes of childhood mortality from 2004 to 2016 in Qatar

Introduction: Childhood mortality is an important health indicator that reflects the overall health status of a population. Despite the decrease in global childhood mortality rates over the past decades, it still remains an important public health issue in Qatar. Methods: The data from 2004-2016 were extracted from the Qatar Ministry of Public Health Birth and Death Database. International Classification of Diseases (ICD-10) was used for coding the causes of death. The childhood mortality rate was defined as the probability of a child dying between the first and the fifth birthday, expressed as the number of deaths per 1,000 children surviving to 12 months of age. The sex ratio was calculated by dividing the mortality rate of males by that of females. Mann-Kendall trend test was performed to examine time trends. Relative risks were calculated to examine differences by nationality (Qatari and non-Qatari) and sex. Results: A significant decrease in mortality rate of children aged one to five was observed from 1.76 to 1.05 per 1000 children between 2004 and 2016 (Kendall tau=-0.6, p=0.004). Three prominent causes of mortality were motor vehicle accidents, congenital malformations of the circulatory system, and accidental drowning/submersion. A statistically non-significant decrease in childhood mortality from motor vehicle accidents was oberved for all nationalities (total (Kendall tau=-0.03), Qatari (Kendall tau=-0.14), and non-Qatari (Kendall tau=-0.12)). A significant decrease was seen for total accidental drowning and submersion (Kendall tau=-0.54, p=0.012), while no statistically significant decrease was seen for total congenital malformations of the circulatory system (Kendall tau=-0.36, NS). The Qatari population did have a significant decrease in childhood mortality due to congenital malformations of the circulatory system (Kendall tau=-0.67, p=0.003) and accidental drowning and submersion (Kendall tau=-0.55, p=0.016). Conclusion: The study is a first attempt to evaluate childhood mortality statistics from Qatar and could be useful in supporting Qatar’s ongoing national health strategy programs

A diabetes risk score for Qatar utilizing a novel mathematical modeling approach to identify individuals at high risk for diabetes

We developed a diabetes risk score using a novel analytical approach and tested its diagnostic performance to detect individuals at high risk of diabetes, by applying it to the Qatari population. A representative random sample of 5,000 Qataris selected at different time points was simulated using a diabetes mathematical model. Logistic regression was used to derive the score using age, sex, obesity, smoking, and physical inactivity as predictive variables. Performance diagnostics, validity, and potential yields of a diabetes testing program were evaluated. In 2020, the area under the curve (AUC) was 0.79 and sensitivity and specificity were 79.0% and 66.8%, respectively. Positive and negative predictive values (PPV and NPV) were 36.1% and 93.0%, with 42.0% of Qataris being at high diabetes risk. In 2030, projected AUC was 0.78 and sensitivity and specificity were 77.5% and 65.8%. PPV and NPV were 36.8% and 92.0%, with 43.0% of Qataris being at high diabetes risk. In 2050, AUC was 0.76 and sensitivity and specificity were 74.4% and 64.5%. PPV and NPV were 40.4% and 88.7%, with 45.0% of Qataris being at high diabetes risk. This model-based score demonstrated comparable performance to a data-derived score. The derived self-complete risk score provides an effective tool for initial diabetes screening, and for targeted lifestyle counselling and prevention programs.Peer reviewe

Characterizing epidemiology of prediabetes, diabetes, and hypertension in Qataris: A cross-sectional study

Objectives To characterize the epidemiologic profiles of prediabetes mellitus (preDM), diabetes mellitus (DM), and hypertension (HTN) in Qataris using the nationally representative 2012 Qatar STEPwise Survey. Methods A secondary data analysis of a cross-sectional survey that included 2,497 Qatari nationals aged 18–64 years. Descriptive and analytical statistical analyses were conducted. Results Prevalence of preDM, DM, and HTN in Qataris aged 18–64 years was 11.9% (95% confidence interval [CI] 9.6%-14.7%), 10.4% (95% CI 8.4%-12.9%), and 32.9% (95% CI 30.4%-35.6%), respectively. Age was the common factor associated with the three conditions. Adjusted analyses showed that unhealthy diet (adjusted odds ratio (aOR) = 1.84, 95% CI 1.01–3.36) was significantly associated with preDM; that physical inactivity (aOR = 1.66, 95% CI 1.12–2.46), central obesity (aOR = 2.08, 95% CI 1.02–4.26), and HTN (aOR = 2.18, 95% CI 1.40–3.38) were significantly associated with DM; and that DM (aOR = 2.07, 95% CI 1.34–3.22) was significantly associated with HTN. Population attributable fraction of preDM associated with unhealthy diet was 7.7%; of DM associated with physical inactivity, central obesity, and HTN, respectively, was 14.9%, 39.8%, and 17.5%; and of HTN associated with DM was 3.0%. Conclusions One in five Qataris is living with either preDM or DM, and one in three is living with HTN, conditions that were found to be primarily driven by lifestyle factors. Prevention, control, and management of these conditions should be a national priority to reduce their disease burden and associated disease sequelae.This publication was made possible by NPRP grant number 10-1208-160017 from the Qatar National Research Fund (a member of Qatar Foundation)

Type 2 diabetes epidemic and key risk factors in Qatar: A mathematical modeling analysis

Introduction We aimed to characterize and forecast type 2 diabetes mellitus (T2DM) disease burden between 2021 and 2050 in Qatar where 89% of the population comprises expatriates from over 150 countries. Research design and methods An age-structured mathematical model was used to forecast T2DM burden and the impact of key risk factors (obesity, smoking, and physical inactivity). The model was parametrized using data from T2DM natural history studies, Qatar's 2012 STEPwise survey, the Global Health Observatory, and the International Diabetes Federation Diabetes Atlas, among other data sources. Results Between 2021 and 2050, T2DM prevalence increased from 7.0% to 14.0%, the number of people living with T2DM increased from 170 057 to 596 862, and the annual number of new T2DM cases increased from 25 007 to 45 155 among those 20-79 years of age living in Qatar. Obesity prevalence increased from 8.2% to 12.5%, smoking declined from 28.3% to 26.9%, and physical inactivity increased from 23.1% to 26.8%. The proportion of incident T2DM cases attributed to obesity increased from 21.9% to 29.9%, while the contribution of smoking and physical inactivity decreased from 7.1% to 6.0% and from 7.3% to 7.2%, respectively. The results showed substantial variability across various nationality groups residing in Qatar - for example, in Qataris and Egyptians, the T2DM burden was mainly due to obesity, while in other nationality groups, it appeared to be multifactorial. Conclusions T2DM prevalence and incidence in Qatar were forecasted to increase sharply by 2050, highlighting the rapidly growing need of healthcare resources to address the disease burden. T2DM epidemiology varied between nationality groups, stressing the need for prevention and treatment intervention strategies tailored to each nationality

Temporal Dynamics and Impact of Climate Factors on the Incidence of Zoonotic Cutaneous Leishmaniasis in Central Tunisia

Old world cutaneous leishmaniasis is a vector-borne disease occurring in rural areas of developing countries. The main reservoirs are the rodents Psammomys obesus and Meriones shawi. Zoonotic Leishmania transmission cycle is maintained in the burrows of rodents where the sand fly Phlebotomus papatasi finds the ideal environment and source of blood meals. In the present study we showed seasonality of the incidence of disease during the same cycle with an inter-epidemic period ranging from 4 to 7 years. We evaluated the impact of climate variables (rainfall, humidity and temperature) on the incidence of zoonotic cutaneous leishmaniais in central Tunisia. We confirmed that the risk of disease is mainly influenced by the humidity related to the months of July to September during the same season and mean rainfall lagged by 12 to 14 months

La transition des individus par des épisodes de pauvreté : de l’ajustement de la consommation à la reconfiguration identitaire

International audienceThis research explores the coping strategies implemented by consumers crossing a temporary period of financial restraint. Our findings show that, in addition to traditional adjustment strategies mobilized by permanently poor consumers, individuals facing a temporary precarious situation deploy strategies allowing them to emancipate from the market based primarily on resistance to consumption and on adoption of deviant behaviors. These adjustments of consumption are coupled with identity arrangements to ensure self-congruence with the experienced precarious situation. Finally some implications related to the opportunities to prevent and include consumers temporarily impoverished are drawn for the market, public authorities and civilian society organizations.Cette recherche explore les stratégies d’ajustement de la consommation mises en œuvre par les individus traversant des épisodes de pauvreté ainsi que les arrangements identitaires à l’œuvre lors de ces transitions. Elle montre que ces individus déploient, outre les stratégies d’ajustement mobilisées par les consommateurs « durablement pauvres », des stratégies d’émancipation du marché reposant notamment sur la résistance à la consommation et l’adoption de comportements déviants. Ces adaptations de la consommation se doublent d’accommodements identitaires permettant d’assurer une congruence du soi avec la situation vécue. Enfin, des implications relatives aux opportunités de prévenir et d’inclure ces consommateurs transitoirement pauvres sont dressées pour le marché, les pouvoirs publics et les organisations de la société civile