A randomized, blinded, controlled trial investigating the gastrointestinal health effects of drinking water quality.

A double-blinded, randomized, controlled trial was carried out in in Melbourne, Australia, to determine the contribution of drinking water to gastroenteritis. Melbourne is one of the few major cities in the world that draws drinking water from a protected forest catchment with minimal water treatment (chlorination only). Six hundred families were randomly allocated to receive either real or sham water treatment units (WTUs) installed in their kitchen. Real units were designed to remove viruses, bacteria, and protozoa. Study participants completed a weekly health diary reporting gastrointestinal symptoms during the 68-week observation period. There were 2,669 cases of highly credible gastroenteritis (HCG) during the study (0.80 cases/person/year). The ratio of HCG episode rates for the real WTU group compared to the sham WTU group was 0.99 (95% confidence interval, 0.85-1.15, p = 0.85). We collected 795 fecal specimens from participants with gastroenteritis, and pathogens were not more significantly common in the sham WTU group. We found no evidence of waterborne disease in Melbourne. The application of this methodology to other water supplies will provide a better understanding of the relationship between human health and water quality

Fecal colonization with vancomycin-resistant enterococci in Australia.

To assess the rate of fecal vancomycin-resistant enterococci (VRE) colon ization in Austalia, we examined specimens from 1,085 healthy volunteers. VRE was cultured from 2(0.2%) of 1,085 specimens; both were vanB Enter ococcus faecium, identical by pulsed-field gel electrophoresis, but with a pattern rare in Melbourne hospitals

Screening pregnant women for chlamydia : what are the predictors of infection?

Objectives: To determine the risk factors associated with chlamydial infection in pregnancy and the sensitivity and specificity of these when used for selective screening.Methods: A prospective, cross-sectional study of pregnant women aged 16&ndash;25 years attending four major public antenatal services across Melbourne, Australia. Between October 2006 and July 2007, women were approached consecutively and asked to complete a questionnaire and to provide a first-pass urine specimen for Chlamydia trachomatis testing using PCR.Results: Of 1180 eligible women, 1087 were approached and 1044 (88%) consented to participate. Among the 987 women for whom a questionnaire and a definitive diagnostic assay were available, the prevalence of chlamydia was 3.2% (95% CI 1.8 to 5.9). In a multiple logistic regression model, more than one sexual partner in the past year (AOR 11.5; 95% CI 7.1 to 18.5) was associated with chlamydia infection. The use of any antibiotic within 3 months (AOR 0.2; 95% CI 0.1 to 0.6) was associated with a decreased risk of infection. Screening restricted to women who reported more than one sexual partner in the past year would have detected 44% of infections in women aged 16&ndash;25 years and would have required only 7% of women to be screened. The addition of those women aged 20 years and under would have required 27% of women to be screened and detection of 72% of infections.Conclusions: Selective chlamydia screening of pregnant women based on risk factors can improve the yield from screening. However, the potential harm of missed infections among excluded women would need to be considered.<br /

Evaluating the impact and cost-effectiveness of chlamydia management strategies in Hong Kong:A modeling study

OBJECTIVES: To illustrate the epidemiologic and cost-effectiveness impact of shifting the focus from population-based screening toward a targeted management approach for genital chlamydia infection. DESIGN: Modeling study, implementing an individual-based, stochastic, dynamic network model. SETTING: Hong Kong. POPULATION: A hypothetical sample network of 10,000 people with a partnership distribution based on Hong Kong's sexually active population of reproductive age (age 18–49 years). INTERVENTIONS: In this study, we present several scenarios with different implementations of universal vs. targeted screening (based on partner numbers). We also explored the impact of (1) screening only, (2) screening plus expedited partner therapy, and (3) screening plus partner testing. PRIMARY OUTCOME MEASURES: Change of chlamydia prevalence before and after implementing the different strategies. The cost-effectiveness analysis reports total direct cost from a health provider perspective, the QALYs gained, and incremental cost-effectiveness ratios (ICER). RESULTS: In comparing the effects of universal screening only and targeted screening of the high-risk population, the mean prevalence during the 10th year of intervention was 2.75 ± 0.30% and 2.35 ± 0.21%, respectively (compared with 3.24 ± 0.30% and 3.35 ± 0.21% before the interventions, respectively). The addition of contact tracing to the latter targeted screening scenario reduces the mean prevalence during the 10th year of intervention to 1.48 ± 0.13% (compared with 3.31 ± 0.33% at baseline) in the best-case of testing before treatment and maximal contact-tracing effectiveness (40%). Overall, the most effective scenarios were those for which interventions focused on the high-risk population defined by the number of partners, with contact tracing included. The ICER for targeted screening with contact tracing at 20% and 40% efficiency was $4,634 and$7,219 per QALY gained, respectively (10-year time horizon). Expedited partner therapy did not significantly impact overall chlamydia prevalence and caused overtreatment. CONCLUSIONS: Our study suggests that targeted screening with strengthened contact tracing efforts is the most cost-effective strategy to reduce the prevalence of chlamydia in Hong Kong

The XMM–NEWTON Ω Project: I. The X-ray luminosity – temperature relation at z>0.4

We describe XMM-Newton Guaranteed Time observations of a sample of eight high redshift (0.45 < z < rvirial) bolometric luminosities, performed β-model fits to the radial surface profiles and made spectral fits to a single temperature isothermal model. We describe data analysis techniques that pay particular attention to background mitigation. We have also estimated temperatures and luminosities for two known clusters (Abell 2246 and RXJ1325.0-3814), and one new high redshift cluste r candidate (XMMU J084701.8 +345117), that were detected o ff-axis. Characterizing the L x − Tx relation as L x = L 6 ( T 6keV ) α , we find L 6 = 15 . 9 + 7 . 6 − 5 . 2 × 1044erg s − 1 and α =2.7 ±0.4 for an Ω Λ = 0 . 0 , Ω M = 1 .0, H0 = 50 km s − 1 Mpc − 1 cosmology at a typical redshift z ∼ 0 .55. Comparing with the low redshift study by Markevitch, 1998, we find α to be in agreement, and assuming L x − Tx to evolve as (1 + z ) A , we find A =0.68 ±0.26 for the same cosmology and A = 1 .52 + 0 .26 − 0 .27 for an Ω Λ = 0 . 7 , Ω M = 0 . 3 cosmology. Our A values are very similar to those found previously by Vikhlinin et al., 2002 using a compilation of Chandra observations of 0 .39 < z < 1 .26 clusters. We conclude that there is now evidence from both XMM-Newton and Chandra for an evolutionary trend in the L x − Tx relation. This evolution is significantly below the level expected from the predictions of the self-similar model for an Ω Λ = 0 . 0 , Ω M = 1 .0, cosmology, but consistent with self-similar model in an Ω Λ = 0 . 7 , Ω M = 0 . 3 cosmology. Our observations lend support to the robustness and completeness of the SHARC and 160SD surveys

Population-Level Effects of Human Papillomavirus Vaccination Programs on Infections with Nonvaccine Genotypes

We analyzed human papillomavirus (HPV) prevalences during prevaccination and postvaccination periods to consider possible changes in nonvaccine HPV genotypes after introduction of vaccines that confer protection against 2 high-risk types, HPV16 and HPV18. Our meta-analysis included 9 studies with data for 13,886 girls and women ≤19 years of age and 23,340 women 20–24 years of age. We found evidence of cross-protection for HPV31 among the younger age group after vaccine introduction but little evidence for reductions of HPV33 and HPV45. For the group this same age group, we also found slight increases in 2 nonvaccine high-risk HPV types (HPV39 and HPV52) and in 2 possible high-risk types (HPV53 and HPV73). However, results between age groups and vaccines used were inconsistent, and the increases had possible alternative explanations; consequently, these data provided no clear evidence for type replacement. Continued monitoring of these HPV genotypes is important

HIV prevalence ratio of international migrants compared to their native-born counterparts: A systematic review and meta-analysis.

BACKGROUND: People on the move, including international migrants, may face health inequities that expose them to a higher risk for HIV than native-born populations. We conducted a systematic review to calculate the HIV prevalence ratio of international migrants compared with native-born populations. METHODS: We searched five databases between January 2010 and March 2022. Using random-effects meta-analysis, we calculated the pooled HIV prevalence ratios (PR) by comparing the HIV prevalence of migrants with native-born populations. Our research protocol is registered in the International prospective register of systematic reviews (PROSPERO, CRD42021250867). FINDINGS: In total, 5,121 studies were screened, and 38 were included in the final analysis: 7,121,699 migrants and more than 270 million natives were included in the analysis. The pooled PR for any foreign-born migrants was 1·70 (95% CI 1·11 – 2·61, I2=99·67%, n = 33 studies), refugees was 2·37 (95% CI 0·33–16·99, I2=99·5%, n = 5), undocumented people was 3·98 (95% CI 0·11–143·01, I2=94·6%, n = 3), whilst asylum seekers was 54·79 (95% CI 17·23–174·23, I2=90·2%, n = 2). Meta-regression revealed that population type (adjusted R-squared 11.5%), region of origin (11.3%) and migrant type (10.8%) accounted for heterogeneity more than country-income (2.4%) and study setting (2.3%). INTERPRETATION: Although it was not possible to assess if HIV infection occurred in the country of origin or destination, the HIV prevalence ratio was higher among migrants than in native-born populations. Inclusive health policies and strategies for delivering HIV testing, prevention and treatment services for migrant populations tailored to their needs are urgently needed. FUNDING: J.J.O. and E.P.F.C. are supported by the Australian National Health and Medical Research Council (NHMRC) Emerging Leader Fellowship (GNT1193955 and GNT1172873, respectively)