Influenza vaccination coverage in the geriatric population of the State of Geneva, Switzerland

Background: In Switzerland, every year the Federal Office of Public Health publishes recommendations for the use of influenza vaccine in people over 65 years, patients of all ages suffering from chronic conditions or immunosuppression, families of the latter and health professionals. However, prior to the present study, there has been no evaluation of the degree to which these recommendations are implemented. The purpose of the survey described in this article was to evaluate flu vaccination coverage of the geriatric population living in the community, to obtain qualitative information on the motivation for receiving vaccination and to understand the network of communication on flu prevention. Methods: The study was performed on a random sample of 1,200 residents of the State of Geneva aged 65 years or older. It involved a mail questionnaire and semi-structured telephone interviews on a subsample of respondents. Results: The estimated vaccination coverage for 1994 was equal to 35.5% in persons 65 years-old or older. Receiving information from a physician was the major determinant in the decision to be vaccinated. Misconceptions about flu were common. Conclusions: The results of this study indicate that national recommendations concerning vaccination of elderly people are insufficiently observed in the State of Geneva. It is necessary to reinforce preventive messages that explain why flu vaccination should be performed. These messages should aim at correcting and completing elements of information already present in the at-risk populatio

Social Determinants of Late Presentation to HIV Care

Background: In recent years, increased attention has shifted toward evaluating social determinants of health, and understanding how community, environment, and system factors affect health outcomes. HIV policies and guidelines emphasize the importance of earlier HIV diagnosis and presentation for care. This study evaluated the role of individual and community-level factors in late presentation to HIV care. Methods: HIV-infected patients newly initiating outpatient HIV medical care at an academic medical center between 2005-2010 were included. Patients\u27 self-reported addresses at their first clinic visit were geocoded using geographic information systems software to the appropriate United States census block group. Using data from the U.S. Census Bureau’s 2005-2009 American Community Survey, community-level data was recorded for each patient\u27s census block group. Poisson regression was used to evaluate associations between individual- and community-level factors with late presentation for HIV care, defined as an initial CD4 count /mm3. Results: Among 609 patients, 341 patients (56%) had an initial CD4 count /mm3. At a community level, late presentation was significantly associated with the proportion of African Americans in a census block group (RR=1.47; 95%CI=1.19-1.81); with proportion living in poverty, lack of fuel, and lack of vehicle demonstrating borderline statistical significance. At an individual level, older patients were more likely (1.12; 1.06-1.19), while white females were less likely (0.45; 0.24-0.84) to present with a CD4 count /mm3. Conclusion: Both individual and community-level characteristics were associated with late presentation for HIV medical care. Research and interventions to promote earlier HIV diagnosis and care entry should include geographical information and social determinants of health to define priority populations

Absence of Chronic Human Immunodeficiency Virus Infection without Seroconversion in Intravenous Drug Users: A Prospective and Retrospective Study

It has been reported that human immunodeficiency virus type 1 (HIV-1) infection may exist in persons without specific antibodies for years. To measure the frequency of a silent carrier state, a study was conducted in a cohort of 124 intravenous drug users (IVDUs) without anti-HIV-1 antibodies. All the participants had engaged in high-risk behavior for HIV-1 transmission for a number of years until 1987 or later. Samples were analyzed at 6-month intervals for the presence of HIV-1 provirus using DNA amplification and for the appearance of anti-HIV-1 antibodies. HIV-1 provirus and antibodies were undetectable in 122 participants, whereas seroconversion was observed in 2. In one of these, both amplified HIV-1 pol gene segment and anti-HIV-1 antibodies were detected simultaneously, and in the other, provirus was detected 1 month before seroconversion. This study suggests that long-term HIV-1 infection without anti-HIV-1 antibodies is rare and that repeated antibody testing is sufficient to determine the HIV-1 status of a person no longer at high risk for HIV-1 infectio

Autoinducer production and quorum-sensing dependent phenotypes of Pseudomonas aeruginosa vary according to isolation site during colonization of intubated patients

<p>Abstract</p> <p>Background</p> <p><it>Pseudomonas aeruginosa </it>frequently colonizes and is responsible for severe ventilator-associated pneumonia in intubated patients. A quorum-sensing (QS) circuit, depending on the production of the two QS-signaling molecules (autoinducers, AIs) 3-oxo-C₁₂-HSL and C₄-HSL, regulates the production by <it>P. aeruginosa </it>of several virulence factors and is required for biofilm formation. Therefore QS-inhibition has been suggested as a new target for preventive and/or therapeutic strategies. However the precise role of QS during colonization and subsequent infections of intubated patients remains unclear.</p> <p>Results</p> <p>We wondered whether QS is active during colonization of intubated patients, and whether <it>P. aeruginosa </it>isolates growing inside the biofilm covering the intubation devices and those resident in the lungs of colonized patients differ in their QS-dependent phenotypes. We collected the intubation devices of eight patients colonized by <it>P. aeruginosa</it>. We detected 3-oxo-C₁₂-HSL on eight, and C₄-HSL on six of these devices. In three of these patients we also obtained <it>P. aeruginosa </it>isolates from tracheal aspirates at the time of extubation (n = 18), as well as isolates from the intubation devices (n = 25). We genotyped these isolates, quantified their AIs production, and determined three QS-dependent phenotypes (adherence capacity, biofilm and elastase production). The production of 3-oxo-C₁₂-HSL was consistently increased for isolates from the intubation devices, whereas the production of C₄-HSL was significantly higher for isolates from tracheal aspirates. Isolates from tracheal aspirates produced significantly higher amounts of elastase but less biofilm, and had a marginally reduced adhesion capacity than isolates from the intubation devices. Levels of 3-oxo-C₁₂-HSL and elastase production correlated statistically for tracheal intubation isolates, whereas levels of 3-oxo-C₁₂-HSL production and adhesion ability, as well as biofilm production, correlated weakly amongst intubation device isolates.</p> <p>Conclusion</p> <p>Our findings demonstrate that autoinducers are produced during the colonization of intubated patients by <it>P. aeruginosa</it>. The microenvironment, in which <it>P. aeruginosa </it>grows, may select for bacteria with different capacities to produce autoinducers and certain QS-dependent phenotypes. QS-inhibition might therefore affect differently isolates growing inside the biofilm covering intubation devices and those resident in the lungs.</p

Spousal migration and human papillomavirus infection among women in rural western Nepal

In April 2014 we investigated the association of migration of a woman's husband with her high-risk human papillomavirus (HR-HPV) infection status and her abnormal cervical cytology status in the Achham district of rural Far-Western Nepal

Preference for Human Papillomavirus–Based Cervical Cancer Screening: Results of a Choice-Based Conjoint Study in Zambia

The objective of this study was to assess the conditions under which Zambia women with a history of cervical cancer screening by visual inspection with acetic acid might switch to HPV-based testing in the future

Evaluation de la stratégie de lutte contre le cancer en Suisse, Phase 2, 2002 : document de synthèse

[Table des matières] 1. Introduction. 2. Méthode. 3. Conclusions et recommandations générales. 3.1. Stratégie. 3.2. Conclusions et recommandations concernant la stratégie, les structures et le fonctionnement, la collaboration avec l'extérieur. 3.3. Les 4 programmes nationaux. 3.4. Conclusions et recommandations pour les 4 programmes nationaux. 3.5. Bilan de l'expérience de la mise en place du dépistage du sein. 3.6. Conclusions et recommandations pour la mise en place du dépistage du sein. 3.7. Les données à disposition pour le suivi et l'évaluation de la stratégie nationale de lutte contre le cancer. 3.8. Conclusions et recommandations pour le suivi et l'évaluation de la stratégie nationale de lutte contre le cancer. 4. Annexes: Résumés des études 1 à 7. Etude 1: Suivi du développement de la stratégie nationale. Studie 2: Prozessevaluation und Prozessdokumentation. Studie 3: Mammographie-Screening in der Schweiz : eine retrospektive Analyse zur Umsetzung. Studie 4: Sekundäre Analyse der verfügbaren Indikatoren zur Messung der Ergebnisse des nationalen Krebsbekämpfungsprogrammes. Etude 5: Quel ancrage local des actions de la Ligue suisse contre le cancer ? : l'exemple de la prévention du mélanome. Studie 6: Begleitevaluation der Pilotphase des Aktionsmonats Brustkrebs. Etude 7: Accompagnement psychosocial des personnes ayant un diagnostic de cancer : étude de deux cantons

Partner notification for sexually transmitted infections in developing countries: a systematic review

<p>Abstract</p> <p>Background</p> <p>The feasibility and acceptability of partner notification (PN) for sexually transmitted infections (STIs) in developing countries was assessed through a comprehensive literature review, to help identify future intervention needs.</p> <p>Methods</p> <p>The Medline, Embase, and Google Scholar databases were searched to identify studies published between January 1995 and December 2007 on STI PN in developing countries. A systematic review of the research extracted information on: (1) willingness of index patients to notify partners; (2) the proportion of partners notified or referred; (3) client-reported barriers in notifying partners; (4) infrastructure barriers in notifying partners; and (5) PN approaches that were evaluated in developing countries.</p> <p>Results</p> <p>Out of 609 screened articles, 39 met our criteria. PN outcome varied widely and was implemented more often for spousal partners than for casual or commercial partners. Reported barriers included sociocultural factors such as stigma, fear of abuse for having an STI, and infrastructural factors related to the limited number of STD clinics, and trained providers and reliable diagnostic methods. Client-oriented counselling was found to be effective in improving partner referral outcomes.</p> <p>Conclusions</p> <p>STD clinics can improve PN with client-oriented counselling, which should help clients to overcome perceived barriers. The authors speculate that well-designed PN interventions to evaluate the impact on STI prevalence and incidence along with cost-effectiveness components will motivate policy makers in developing countries to allocate more resources towards STI management.</p