bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of gonorrhea and chlamydia in a community clinic for Men who Have Sex with Men in Portugal
Authors: Ribeiro S , de Sousa D , Medina D , Castro R , Lopes A , Rocha M 
Published: November 2019

Abstract

Background
Men who have sex with men (MSM) are at greater risk for sexually transmitted infections (STIs). Data on MSM chlamydia and gonorrhea prevalence estimates and associated risk factors is scarce. To our knowledge, this is the first study to describe the prevalence and the determinants of both chlamydia and gonorrhea infections in MSM in Portugal.

Methods
We conducted a cross-sectional study using data from 1,832 visits to CheckpointLX, a community-based center for screening blood-borne viruses and other STIs in MSM.

Results
Overall prevalence of chlamydia or gonorrhea in our sample was 16.05%, with 14.23% coinfection and 40.73% asymptomatic presentation among those testing positive. Anorectal infection was most common for chlamydia (67.26%), followed by urethral (24.78%) and oral (19.47%) infection. Oral infection was most common for gonorrhea (55.63%), followed by anal (51.25%) and urethral (17.50%) infection. In multivariate analyses, young age (U = 94684, p = 0.014), being foreign-born (χ2=11.724, p = 0.003), reporting STI symptoms (χ2=5.316, p = 0.021), inhaled drug use (χ2=4.278, p = 0.039) and having a higher number of concurrent (χ2=18.769, p &lt; 0.001) or total (χ2=5.988, p = 0.050) sexual partners were each associated with higher rates of chlamydia or gonorrhea infection.

Conclusions
Young and migrant MSM are a vulnerable population to STIs, as are those who use inhaled drugs and those with a higher number of concurrent or total sexual partners. Although Portugal has no guidelines on chlamydia and gonorrhea screening, our results point towards a need for greater awareness about the importance of high frequency screening for those at increased risk (i.e. every 3 to 6 months).

Key messages
Higher prevalence was found in young and migrant MSM, those with higher number of concurrent or total sexual partners, and those who use inhaled drugs. There is a need for greater awareness about the importance of high frequency STI screening for MSM at increased risk.
How to reach migrant transgender women in Paris? An example of collaborative sexual health action
Authors: Deslandes A , Troude P , De la Rochebrochard E , Cabral C , Shelly M , Segouin C , Piron P 
Published: November 2019

Abstract

Issue
In France, screening for HIV and sexually transmitted infections (STIs) is provided by free HIV and STIs screening centers called CeGIDD. Despite a complete combined prevention offer, the number of new HIV diagnosis has been stable for years. Transgender women have one of the highest HIV prevalence.

Description of the problem
Transgender women are a hard to reach population with multifactorial barriers in their access to healthcare including fear of stigma, leading to late HIV diagnosis and untreated STIs. The CeGIDD of a university hospital in Paris aimed to reach this public working with two associations, creating a free, complete sexual health action outside the hospital in a safe environment.

Results
The CeGIDD identified a Parisian association, PASTT, which accompanies transgender women, mainly migrants, in accessing healthcare and social rights. Its active file is around 1500 persons a year, mostly resorting to prostitution. Another association, AREMEDIA, pioneer in outreach interventions, was involved. The partnership allowed access to the public and to gather the funds for the intervention. It included counseling, screening, Pre Exposure Prophylaxis (PrEP), and took place once a week in PASTT facilities. Any participant could be referred to other physicians if they needed it, even if they lacked health insurance coverage. From September 2017 to November 2018, 212 persons attended the consultation and 26 received PrEP.

Lessons
Working together with several associative partners presents many challenges, from the definition of the objectives to operational coordination. Overcoming these difficulties lead us to reach a new public with a high risk for STIs and HIV.

Key messages
Community based sexual health actions dedicated to transgender women are a successful way to reach this public. The safe environment provided by the association is a great opportunity to familiarize them with the medical staff and to empower them regarding healthcare.
Identifying patients at risk of readmission for heart failure in the French national claim database
Authors: Constantinou P , Pelletier-Fleury N , Olié V , Gastaldi-Ménager C , Juillière Y , Tuppin P 
Published: November 2019

Abstract

Background
To reduce readmissions for heart failure (HF) among HF patients, most at-risk individuals could be targeted to benefit from adapted interventions. A better understanding of HF readmission predictors could help clinicians and regulators identify patients most at-risk. We focused, in particular, on distinguishing HF severity from overall health-state severity.

Methods
We studied predictors of HF readmission available in administrative data in a nationwide cohort of patients aged 65 years or older surviving an index hospitalization for HF in 2015 (N = 70 657). To take into account the competing mortality risk, we estimated subdistribution hazard ratios (sdHRs) of HF readmission and cause-specific hazard ratios (csHRs) for HF readmission and for death without HF readmission, over a 1-year follow-up period. We then computed cumulative incidences and daily rates of HF readmission for specific risk-groups.

Results
31.8% of patients were readmitted at least once for HF, among which 27.2% (8.6% of study cohort) were readmitted 30 days after discharge. 17.6% of patients died without any HF readmission. HF severity and overall health-state severity were the strongest HF readmission predictors (sdHRs 2.66 [95% CI: 2.52-2.81] and 1.37 [1.30-1.45] respectively, when comparing extreme categories). HF severity and length of index stay were more strongly associated with the rate (csHRs) of HF readmissions, whereas overall health-state severity and age were more strongly associated with the competing rate of death without HF readmission. Risk-groups defined upon HF severity and overall health-state severity had approximately 40% of separation in HF readmission proportion (21.9% versus 60.4%).

Conclusions
Our results stress the importance of considering both HF severity and overall morbidity and of accounting for the competing mortality risk to identify patients at-risk of HF readmission. Such patients could benefit from targeted transitional or post-discharge HF care.

Key messages
Heart failure patients can be stratified into risk-groups of readmission using administrative data. Identifying at-risk patients could help clinicians and regulators to target interventions.
Cardiovascular disease risk factors of military: A comparative assessment with civilians
Authors: Bell Ngan W , Essama Eno Belinga L , Essam Nlo’O A S P , Lemogoum D , Roche F , Mandengue S H , Bongue B 
Published: November 2019

Abstract

Background
Cardiovascular diseases are the leading cause of death in the world. Military population that seemed immune to these pathologies is now as exposed as the general population. The effective response to this public health problem first requires the identification of the level of exposure of populations. Thus, the objective of our study was to determine the prevalence of Cardiovascular Disease (CVD) risk factors of the Cameroonian military population compared to civilians.

Methods
We conducted a cross-sectional study. It involved subjects aged 18 to 58 years, recruited from October 30, 2017 to November 13, 2018 at the Fifth Military Sector Health Center. Five cardiovascular risk factors were assessed, smoking, harmful alcohol consumption, obesity/overweight, hypertension and diabetes. The STEPwise model proposed by the World Health Organization (WHO) was used to estimate the risk of cardiovascular diseases. Mann Whitney and Fisher exact tests were used for statistics comparison.

Results
The study included 489 subjects, 270 military personnel and 219 civilians. The median age of the two populations was not significantly different (30 years versus 33 years, p = 0.6939). The proportion of smokers was higher in the military (12.59% versus 9%, p = 0.0011). Alcoholism was also higher in the military population (60.74% versus 13.24%, p = 0.0000). Similarly, military personnel were more obese than civilians (58.15% versus 40.18%, p = 0.0000). Distribution of hypertension and diabetes was not significantly different between military and civilians (18.15% versus 16.89%, p = 0.8113) and (1.48% versus 3.20%, p = 0.2321) respectively. The proportion of subjects with a high cardiovascular risk was higher in the military (14.81% versus 7.76%, p = 0.0162).

Conclusions
CVD risk factors are more prevalent in Cameroonian military population than in civilians. This result suggests that, in addition to national preventive campaigns, special attention is needed for military population in Cameroon.

Key messages
Cardiovascular disease risk factors are more prevalent in Cameroonian military population than in general population. in addition to national preventive campaigns, special attention is needed for military population in Cameroon.
The Role of Niacin in Cardiovascular Disease Prevention: A Systematic Review and Meta-analysis
Authors: D’Andrea E , Hey S , Ramirez C L , Kesselheim A 
Published: November 2019

Abstract

Background
Niacin remains a therapeutic option for patients with cardiovascular disease, but recent studies have called into question the effectiveness of other HDL-C-raising drugs. We evaluated the evidence supporting current FDA-approved uses of niacin in cardiovascular prevention settings.

Methods
The systematic review included clinical trials involving niacin as a treatment for cardiovascular disease. The meta-analysis included randomized clinical trials reporting niacin’s effect on at least one long-term outcome: cardiovascular disease, coronary heart disease mortality, acute coronary syndrome, stroke, revascularization, major adverse cardiac events (MACE). Databases were searched up to October 2017. Study-level data were extracted and inverse-variance weighted methods were used to produce pooled risk ratios using random-effects models for between-study heterogeneity. Meta-regression analysis was used to assess the association between change in HDL-C and the log risk ratio of the pooled results.

Results
Out of 119 clinical trials, 17 documented niacin’s effect on at least one cardiovascular disease outcome. The meta-analysis covered 35,760 patients with history of cardiovascular disease or dyslipidemia. Cumulative evidence found no preventive effect of niacin on cardiovascular outcomes in secondary prevention. Stratified meta-analysis showed an association between niacin monotherapy and reduction of some cardiovascular events (acute coronary events, RR 0.74, 95%CI 0.58-0.96; stroke, RR 0.74, 95%CI 0.59-0.94; revascularization, RR 0.51, 95%CI 0.37-0.72). These results were mainly driven by two trials conducted in the 1970s and 1980s.

Conclusions
Niacin might have some use in lipid control for secondary prevention as monotherapy, perhaps in patients intolerant to statins, but evidence is from older studies on a population potentially not representative of current-day patients.

Key messages
Niacin might have some use for cardiovascular secondary prevention in patients intolerant to statins, but evidence is from older studies on a population not representative of current-day patients. The FDA has to review the approved indications for Niacin in cardiovascular secondary prevention.
The need for a transformation health systems research programme in Europe
Authors: Ricciardi W 
Published: November 2019

Abstract
Over the last decades, European health systems have faced growing common challenges: ageing related issues and continuous financial pressures call for innovative solutions on how to organise health care in an equitable and efficient manner. To address this situation there is an urgent need to bring in innovation and research evidence, in order to identify and implement more effective and sustainable ways to organise, manage, finance, and deliver high quality care to all European citizens. TO-REACH has been working to develop a Strategic Research Agenda which has the ambition to address the increasing challenges faced by health systems, directed to those policy areas relevant in the coming years. This living document will help preparing an European research programme that will maximise value of research public investment in this field by helping avoid duplication and failed implementation while ensuring systematic prioritisation of research areas that face greatest changes and highest need.
State of vaccine confidence in the European Union in 2018
Authors: Larson H , de Figueiredo A , Karafllakis E , Rawal M 
Published: November 2019

Abstract

Background
High confidence in vaccination programmes is crucial for maintaining high coverage rates. Across the European Union (EU), however, vaccine delays and refusals are contributing to declining immunisation rates in a number of countries and are leading to increases in disease outbreaks.

Methods
We assessed the overall state of confidence in vaccines among the public in all 28 EU member states and among general practitioners (GP) in ten EU member states, conducting the largest ever study on attitudes to vaccines and vaccination in the EU, eliciting the views of approximately 28,000 respondents across the 28 EU member states.

Results
We found that a number of member states (including France, Greece, Italy, and Slovenia) have become more confident in the safety of vaccines since 2015, but that the Czech Republic, Finland, Poland, and Sweden have become less confident. While GPs generally hold higher levels of vaccine confidence than the public, the survey found that 36% of GPs surveyed in Czech Republic and 25% in Slovakia do not agree that the MMR vaccine is safe and 29% and 19% respectively do not believe it is important. Countries whose GPs hold higher confidence in vaccines tend to have a larger proportion of the public expressing positive vaccination beliefs.

Conclusions
Even countries with well-established vaccination programmes and high levels of confidence are not immune to rising vaccine hesitancy. There is a need for continuous monitoring, preparedness and response plans to maintain and increase confidence in the importance, effectiveness and safety of vaccines, among both the public and health professionals.
Smokeless tobacco and waterpie use and risk of lunbg cancer
Authors: Paudyal P , Memon A , Rogers I 
Published: November 2019

Abstract

Background
Over 300 million people worldwide use smokeless tobacco (ST) with rates of use exceeding that of cigarette smoking in much of South-East Asia and amongst certain groups in the Middle East. This study investigated the association between consumption of ST use and waterpipe smoking and lung cancer risk.

Methods
A systematic review and meta-analysis was carried out to summarise the findings from the epidemiologic studies of the risk of lung cancer associated with ST use and waterpipe smoking. Search was carried out in MEDLINE, Embase, Web of Science and OpenSIGLE to identify studies published before 18th October 2018. A combination of MESH terms and keywords were used including lung cancer, smokeless tobacco, snuff, snus, betel quid, gutka, naswar, zarda, shisha. Only studies adjusted for cigarette smoking or conducted in non-smokers only were included in the analysis. Random effects meta-analysis was carried out to pool the risk estimates and subgroup analyses was carried out by tobacco type and in studies of non-smokers.

Results
The search yielded 1796 articles, of which 24 studies (19 studies of ST, four of waterpipes and one of both) including 6777 lung cancer patients were included in the meta-analysis. Lung cancer was found to be positively associated with waterpipe smoking (pooled OR 3·06 (95%CI 1·68 – 5·60) and betel quid tobacco chewing (pooled OR 1·77 (95%CI 1·06 – 2·95)). Among non-smokers, any type of ST use was associated with lung cancer (pooled OR 1·46 (95%CI 1·04 – 2·07).

Conclusions
Our study suggest positive associations between ST use and waterpipe smoking and lung cancer risk. Given the high prevalence of ST use in much of the developing world, public health policies and international tobacco control efforts should focus on aiming to reduce ST use in addition to cigarette smoking.

Key messages
The risk of lung cancer is approximately three times higher in waterpipe smokers than in non-smokers. International tobacco control efforts should focus on aiming to reduce smokeless tobacco use in addition to cigarette smoking.
Mapping variation in breast cancer screening: Where to intervene?
Authors: Padilla C , Soler Michel P , Vieira V 
Published: November 2019

Abstract

Introduction
Mammography screening can reduce breast cancer mortality among women aged 50 years and older. Small geographic areas with lower breast cancer screening uptake may reflect gaps in screening efforts. Our objective was to identify the geographic variations of breast cancer screening uptake among women aged 50-74 years in the Lyon Metropole area, France.

Methods
We used spatial regression models within a generalized additive framework to determine the clusters of census blocks with significantly lower risk of breast cancer screening uptake. Census block-level data on breast cancer screening participation rates were calculated for women aged 50-74 years who did a mammography between 2015-2016 after being invited with a letter by the cancer screening organization. Using smoothed risk maps adjusting for covariates, we estimated the impact of the spatial distribution of deprivation index, part of opportunistic screening on breast cancer screening participation.

Results
Between 2015 and 2016, the participation rate of organized breast cancer screening was 49.9%. As hypothesized, women living in highly deprived census blocks had lower participation rates compared to less deprived. However, women living in rural areas with fewer certified mammography services than in urban areas had the highest participation rate. Spatial analyses identified four clusters, one located in an urban area and three in suburban areas.

Conclusions
Our analysis indicates that depending on the location of the cluster, the influence came from different variables. Knowing the impact of site-specific risk factors is important for implementing an appropriate prevention intervention.

Key messages
Spatial analysis for cancer screening can help to improve health initiatives. This study contributes to a better understanding of the cluster-specific factors that explain geographic disparities.
Impact of Danish ban of industrial produced trans fatty acids on serum cholesterol levels 1993-2006
Authors: Bjornsboe K , Jakobsen M U , Bysted A , Fagt S , Christensen T , Joergensen T 
Published: November 2019

Abstract

Industrially produced trans fatty acids (ITFA) increase the LDL:HDL ratio and hereby the risk of cardiovascular disease (CVD). Therefore, ITFA has been reduced in Western Europe over the last decades but is still high in Eastern Europe and in subgroups of the EU population. Regulatory interventions are the only way to minimize ITFA intake for all. The Danish ITFA ban (2004) can elucidate the impact of elimination of ITFA on CVD. In Denmark cardiac mortality declined by 70% through 1980-2009. Data on ITFA intake and blood lipids from the 1990s, where the average Danish ITFA intake was about 3 g/d, and up to today are needed to study the correlation between intake of ITFA and serum cholesterol (CHOL). The Danish food composition databank has been updated with TFA intake values. Hereby the correlation between ITFA intake and CHOL level in Denmark from 1993 -2006 can be investigated.

Methods
Ecological analyses of ITFA and CHOL in participants from 3 cohorts: Diet, Cancer and Health (1993-1997); n = 57,054; 50-64 yrInter99 (1999-2001); n = 6,784, 30-60 yrHealth 2006 (2006); n = 3,471, 18-69 yr

Results
ITFA-intake was 0.02 g/d in Inter99. Data will be extended to include ITFA intake data of all cohorts as well as age adjusted correlations with CHOL.
Mean CHOL all men (n = 31,675) declined from 6.3 ± 1.0 in 1993 to 5.4± 1.0 in 2006
Mean CHOL all women (n = 34,675) declined from 6.6 ± 1.5 in 1993 to 5.4± 1.1 in 2006
Similar declines were found in participants without self-reported hypercholesterolemia:
Mean CHOL men (n = 28,999) declined from 6.1 ± 0.9 in 1993 to 5.1± 1.0 in 2006
Mean CHOL women (n = 32,593) declined from 6.5 ± 1.5 in 1993 to 5.2± 1.1 in 2006
There was a significant decrease in CHOL (p &lt; 0.0001) from 1993, where average Danish intake of ITFA was about 3 g/d to 2006 where ITFA was banned

Conclusions
Data show a non-treatment related significant decline in CHOL. Data from 2000 and 2006 are collected in younger populations, which may explain lower CHOL levels.

Key messages
Cholesterol decline significantly in Danish participants simultaneously with ITFA elimination. Results are important for decision makers in countries which consider ITFA regulation.
Effects of salt reduction on cardiovascular risk factors. The STRIVE-study
Authors: Toft U , Riis N L , Lassen A D , Trolle E , Bjørnsbo K S 
Published: November 2019

Abstract

Potential adverse effects of reducing salt intake in the general population are discussed. This study aims to explore the effect of gradually reducing salt intake in a real-life setting.
The study was a 4-month cluster RCT with families randomly assigned to either A) salt reduced bread, B) salt reduced bread and dietary counselling or C) standard bread (control) Participants in intervention A received bread gradually reduced in salt content from 1.2 g salt/100g (regular) to 0.6 g salt/100g in ryebread and 0.4 g salt/100g in wheat bread. Participants in intervention B received the same bread as intervention A but in addition, they received dietary advise on how to further reduce their salt intake and promote potassium. The control group received regular bread (blinded). Changes in outcomes were assessed using linear mixed models.

Results
A total of 89 Danish families (155 adults; 156 children) participated in the study. A total of 291 (94%) participants completed the intervention. Results are preliminary. Intention to treat analyses showed no significant effects of the salt reduction intervention on changes in systolic and diastolic blood pressure, plasma triglyceride. A small, but significant (-0.26 mmol/l; P = 0.02) decrease in total plasma cholesterol was shown in intervention group A. Per protocol analyses, including only participants in the intervention groups that decreased their salt intake by at least 20% from baseline to 4-month follow-up, showed a significant decrease in diastolic (-3.5 mmHg; P &lt; 0.0001) and systolic (-6.3 mmHg; P &lt; 0.0001) blood pressure, total cholesterol (-0.25 mmol/l; P = 0.0009), LDL cholesterol (log. transformed) (-6%; P = 0.03) and plasma triglyceride (log. transformed) (-17%; P = 0.04). No significant effects were found for HDL plasma cholesterol, aldosterone, renin, plasma glucose and HbA1c.

Conclusions
Reduced salt intake were associated with beneficial changes in cardiovascular risk factors. No adverse effects were observed.

Key messages
Reduced salt intake were associated with benificial changes in cardiovascular risk factors. No adverse effects were observed.