bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neighbourhood food environments and body mass index among New York City adults
Authors: Stark James H , Neckerman Kathryn , Lovasi Gina S , Konty Kevin , Quinn James , Arno Peter , Viola Deborah , Harris Tiffany G , Weiss Christopher C , Bader Michael D M , Rundle Andrew 
Published: July 2013

BackgroundStudies evaluating the impact of the neighbourhood food environment on obesity have summarised the density or proximity of individual food outlets. Though informative, there is a need to consider the role of the entire food environment; however, few measures of whole system attributes have been developed. New variables measuring the food environment were derived and used to study the association with body mass index (BMI).MethodsIndividual data on BMI and sociodemographic characteristics were collected from 48 482 respondents of the 2002–2006 community health survey in New York City and linked to residential zip code-level characteristics. The food environment of each zip code was described in terms of the diversity of outlets (number of types of outlets present in a zip code), the density of outlets (outlets/km2) and the proportion of outlets classified as BMI-unhealthy (eg, fast food, bodegas).ResultsResults of the cross-sectional, multilevel analyses revealed an inverse association between BMI and food outlet density (−0.32 BMI units across the IQR, 95% CI −0.45 to −0.20), a positive association between BMI and the proportion of BMI-unhealthy food outlets (0.26 BMI units per IQR, 95% CI 0.09 to 0.43) and no association with outlet diversity. The association between BMI and the proportion of BMI-unhealthy food outlets was stronger in lower (<median for % poverty) poverty zip codes than in high-poverty zip codes.ConclusionsThese results support a more nuanced assessment of the impact of the food environment and its association with obesity.
Time series analysis of maternal mortality in Africa from 1990 to 2005
Authors: DerSarkissian Maral , Thompson Caroline A , Arah Onyebuchi A 
Published: July 2013

ObjectivesMost global maternal deaths occur in Africa and Asia. In response, the Millennium Development Goal (MDG-5) calls for a 75% reduction in maternal mortality from 1990 to 2015. To assess the potential for progress in MDG-5 in Africa, we examined the cross-sectional and longitudinal associations of socioeconomic, demographic and population-health factors with maternal mortality rates in Africa.MethodsWe used data from global agencies and the published literature to identify socioeconomic, demographic and population-health explanatory factors that could be correlated with maternal mortality in 49 countries of Africa for the years 1990, 1995, 2000 and 2005. We used correlation, negative binomial and mixed Poisson regression models to investigate whether there exist associations between potential explanatory factors and maternal mortality.ResultsSome African countries have made substantial progress towards achieving MDG-5 while others have fallen behind. Lower gross domestic product (GDP) and female enrolment in primary schools, but higher HIV prevalence, neonatal mortality rate and total fertility rate, were associated with higher maternal mortality.ConclusionsMaternal mortality rates in African countries appear to be declining. The mean maternal mortality ratios in Africa decreased from 695.82 in 1990 to 562.18 in 2005. Yet some countries are more likely than others to achieve MDG-5. Better socioeconomic, demographic and population health development appear to be conducive to better maternal health in Africa. Sustained efforts on all these fronts will be needed to close the gap in maternal survival and achieve MDG-5 in Africa.
Children's and adolescents' sedentary behaviour in relation to socioeconomic position
Authors: Coombs Ngaire , Shelton Nicola , Rowlands Alex , Stamatakis Emmanuel 
Published: July 2013

BackgroundSedentary behaviour is an emerging cardiometabolic risk factor in young people. Little is known about how socioeconomic position (SEP) and sedentary behaviour are associated in children and adolescents. This study examines associations between SEP and sedentary behaviour in school-age children and adolescents.MethodsThe core sample comprised 3822 Health Survey for England 2008 participants aged 5–15 years with complete information on SEP (household income, head of household occupational social class and area deprivation) and self-reported sedentary time (television viewing and other sitting during non-school times). Accelerometer-measured total sedentary time was measured in a subsample (N=587). We examined multivariable associations between SEP (including a composite SEP score) and sedentary time using generalised linear models, adjusting for age, sex, body mass index, physical activity, accelerometer wear time and mutually adjusting for the other SEP indicators.ResultsParticipants in the highest SEP category spent 16 min/day less (95% CI 6 to 25, p=0.003) watching TV than participants in the lowest SEP category; yet they spent 7 (2 to 16, p=0.010) and 17 (5 to 29, p<0.000) min/day more in non-TV sitting and total (accelerometry-measured) sedentary time, respectively. Associations across individual SEP components varied in strength. Area deprivation was not associated with sedentary time.ConclusionsLow SEP is linked with higher television times but with lower total (accelerometer-measured) sedentary time, and non-TV sitting during non-school time in children and adolescents. Associations between sedentary time and SEP differ by type of sedentary behaviour. TV viewing is not a good proxy for total sedentary time in children.
Geographic access to mammography screening centre and participation of women in the Quebec Breast Cancer Screening Programme
Authors: St-Jacques Sylvie , Philibert Mathieu D , Langlois André , Daigle Jean-Marc , Pelletier Éric , Major Diane , Brisson Jacques 
Published: July 2013

BackgroundThis study evaluated the impact of distance between women's residences and designated screening centres (DSC) on participation in the Quebec Breast Cancer Screening Programme, whether this impact varied according to the rural–urban classification and the proportion of participants who used the DSC nearest to their home.MethodsTravel distance between the residence of 833 856 women and the nearest DSC (n=85) was estimated. Data were obtained from administrative and screening programme databases. The analysis made use of a log-binomial regression model adjusting for age and material and social deprivation. The proportions of participants who used the DSC nearest to their residence were measured.ResultsCompared to women living <2.5 km from a DSC, absolute decreases of 6.3% and 9.8% in participation rate were observed for distances of 50.0 to <75.0 km (rate ratios (RR)=0.88, 95% CI 0.86 to 0.89) and ≥75.0 km (RR=0.81, 95% CI 0.79 to 0.83), respectively. The lowest participation (42%) was observed in Montreal Island. The distance at which participation started to decrease materially varied according to rural–urban classification. Participation rates decreased at distances of ≥25.0 km in the Montreal suburbs and midsize cities, at ≥12.5 km in small cities and at ≥50.0 km in rural areas (interaction p<0.0001). The proportion of participants who had their mammography at the nearest DSC decreased with increasing distance.ConclusionsDistance affects participation and this effect varies according to rural–urban classification. The lower participation in Montreal Island, where all women lived <12.5 km from a DSC, argues for a major impact of other characteristics or other dimensions of accessibility.
A survey of post-amputation pains in serving military personnel
Authors: Aldington Dominic , Small C , Edwards D , Ralph J , Woods P , Jagdish S , Moore R A 
Published: July 2013

IntroductionAmputation is a common injury in survivors of current military conflicts. The primary aim of this study was to establish the prevalence rate of phantom limb pain (PLP) in military personnel undergoing rehabilitation at the UK's Defence Medical Rehabilitation Centre. The secondary aims were to establish treatment failure rates and prevalence rates of phantom limb sensations (PLS) and residual limb pains (RLP).MethodA questionnaire survey was developed from that used in a previous study of pains in veterans. Questions were asked of the intensity of PLP, RLP and PLS over the previous month and the entire time since amputation. Treatment failure was defined as greater than ‘mild’ pain. A literature review for similar studies was undertaken.ResultsThere were 48 responders with 65 amputations. PLP in the previous month was reported by 49% of respondents and 20% were classed as treatment failures; 76% had PLP at some point and 56% were analgesic failures. PLS was commoner with 70% reported over the previous month and 66% at any time. 65% had RLP over the previous month, 31% were treatment failures and 80% had experienced RLP at some point and 63% of these were failures of treatment. Eight other papers were found for comparison.ConclusionsThis is the first paper that describes prevalence of pains associated with amputation in a serving military population. It also describes the use of analgesic failure as a concept and provides an encouraging rate of as low as 20% in this population.
PL02.3 HIV Transmission Dynamics; Can We Translate Knowledge into Action
Authors: Quinn T C 
Published: July 2013

BackgroundThere are 34 million people living with HIV globally, and 2.5 million people become newly infected last year. Although there have been some successes in prevention, the epidemic continues unabated in many populations, requiring more intensive and integrated behaviour and biomedical prevention programmes if we are to control HIV spread.MethodsA comprehensive review of randomised trials of behavioural and biomedical interventions aimed at decreasing HIV transmission and acquisition was performed and will be presented.ResultsIn addition to male circumcision, the most successful biomedical intervention has been the use of antiretroviral drugs (ARVs) for prevention of HIV perinatal transmission and sexual transmission among HIV discordant couples, and for the prevention of HIV acquisition via microbicides and oral pre-exposure prophylaxis (PrEP). All of thetransmissionstudies have demonstrated that reductions in viral load with ARVs to undetectable viral blood levels during birth, breast-feeding, or sexual intercourse reduces transmission by > 96%. This has been the greatest success in the HIV prevention field over the past two decades and continual scale-up of access to ARVs can be associated with marked reductions in HIV transmission and incidence. Decreasingacquisitionwith use of ARVs is totally dependent on high adherence (> 90%) to the medications in an uninfected population. Studies have had mixed results with some populations with high adherence demonstrating high efficacy using PrEP (> 70% efficacy) or microbicide (> 50% efficacy), while others with low adherence as measured by non-detectable blood levels of ARVs demonstrated no efficacy.ConclusionMultiple studies have confirmed that effective use of ARVs substantially reduces transmission and emphasise the critical importance of integrated behavioural and biomedical strategies. When treatment with ARVs is combined with other interventions involving voluntary counselling and testing, condoms, adherence to medications, and circumcision, the possibility of controlling HIV becomes a feasible and achievable goal.
PL03.3 Syphilis: From Pathogenesis to Control
Authors: Lukehart S A 
Published: July 2013

Syphilis is one of the most fascinating of all infections. Although its origin is still debated, the history of syphilis includes many famous (and infamous) persons, and the disease is featured in art and literature. Syphilis is caused by a corkscrew-shaped bacterium,Treponema pallidum, that was first identified over 100 years ago. It has a miniscule genome, and it lacks many of the common metabolic pathways. It is so fragile that it dies within hours outside of the host, yet it is capable of evading host defences to persist for decades within the host.Syphilis is known as “the great imitator” because its clinical manifestations, which can range from an ulcer or rash to blindness and insanity, can be mistaken for many other clinical conditions. In contrast, the infection can lie smouldering for many years, without any clinical evidence. After 70 years of use, penicillin continues to be an effective treatment, yet resistance to macrolide antibiotics like azithromycin has erupted inT. pallidumin many regions of the world. Physicians recognise that some persons who are treated for syphilis can be reinfected, sometimes multiple times. At the population level, the incidence of syphilis can wax and wane, often shifting from one population group to another.How doesT. pallidumcause the many manifestations of syphilis and still evade immune clearance? How does macrolide resistance develop and spread? Is there a biological basis for determining which patients can be reinfected or when the incidence of syphilis will decline in a given population? Molecular studies involving the laboratory and the clinic have shed insights into pathogenic mechanisms involved in invasion and dissemination, induction of host responses, and immune evasion byT. pallidum. Molecular epidemiology studies have begun to unravel the movement ofT. pallidumstrains throughout communities, and to shed light on the appearance of macrolide resistance. Our evolving knowledge about these issues will be discussed in the context of the natural history of syphilis.
PL04.2 Sex Hormones, HIV Infection and Unintended Pregnancy: Ever Since Adam and Eve
Authors: Cates W 
Published: July 2013

Regardless of the Genesis interpretation, human sexual behaviour is necessary for species survival. Biologically, steroidal sex hormones affect sexual function, reproductive capacity, and possibly infection risk. Women have 2 main sex hormones - oestrogen and progestin. These hormones function in two ways - endogenously to regulate the reproductive cycle and exogenously to control fertility.In the highest HIV prevalence regions, women wishing not to conceive have limited contraceptive choices - typically injectable progestins, oral oestrogen/progestin combinations or male condoms. None of these are in the top tier of contraceptive effectiveness.For nearly a quarter century, the hypothesis that women using hormonal contraceptives may be at increased risk of HIV acquisition has persevered. However, the results across multiple human studies have been mixed - some demonstrate increased HIV risk, but others do not. The strongest evidence that use of hormonal contraception may increase HIV susceptibility is for injectable progestin-only contraceptives. Observational studies have estimated that this method may increase HIV acquisition risk 1.4–2-fold. Their limitations include few endpoints, measurement error in contraceptive use, and likely confounding by behavioural factors. Evidence on HIV acquisition risk is weaker for oral contraceptives, and few data are available for other hormonal formulations including progestin implants or IUDs.In addition, trade offs between the alleged risks of hormonal contraception and those of an unintended pregnancy must be considered. Four mathematical models have addressed this question. Using different assumptions, analytic algorithms and levels of rigour, they all reached similar conclusions. Withdrawal of injectable progestins has adverse pregnancy consequences, switching to implants/IUDs has better outcomes than injectables, while switching to orals/condoms was worse. While the current situation creates a public health conundrum, it also presents an opportunity to expand contraceptive choice, and concomitant reproductive rights, for women exposed to HIV.
PL04.3 Protective and Non-Protective Immunity in STIs
Authors: Stingl G 
Published: July 2013

Protective and non-protective immunity in STIs.It is certainly remarkable that the causative agents of sexually transmitted infections (STIs) induce long-lasting protective immune responses only occasionally and insufficiently (T. pallidum, human papilloma viruses, herpes simplex virus, S. scabie) or not at all (C. trachomatis, N. gonorrhoeae”, C. albicans, human immunodeficiency virus, T. vaginalis).The reasons for this phenomenon are often microbe-related, but may also be due to peculiarities of the mucosal immune system. Evidence exists, for instance, that density and function of epithelial dendritic cells in the mucosa are different from those in the epidermis and, perhaps as a consequence of this, mucosal sensitization more often results in T cell non-responsiveness or anergy than epicutaneous sensitization.The relatively poor functionality of the adaptive immune response in the defence against the various STI-causing microorganisms can sometimes by compensated by cells and molecules of the innate immune system. Good examples of this are the overexpression of certain anti-microbial peptides in the vaginal epithelium and the imiquimod-induced cytotoxic response of plasmacytoid dendritic cells against HPV-infected targets.At a time where we are challenged with increased anti-microbial resistance to anti-microbial chemotherapy, research efforts are needed to better understand the mechanisms of microbe - host cell interactions and to use this knowledge for the development of better therapeutic strategies.
PL05.2 New Technologies in STI Diagnosis and Control: Promising Future
Authors: Gaydos C A 
Published: July 2013

BackgroundOver 350 million (M) prevalent cases of curable STIs are estimated worldwide: 100 M chlamydia (CT), 36M gonorrhoea (NG), 187 M trichomonas, and 36 M cases of syphilis. 34 M HIV infections are estimated worldwide. Human papillomavirus infections (HPV) and herpes viruses (HSV) are highly prevalent, yet are not often diagnosed. Technology has led to sensitive nucleic acid amplification tests (NAATs), allowing use of non-invasive specimens, like vaginal swabs and urine. NAATs are widely available, and novel approaches include point-of-care (POC) tests, internet availability, and self-testing. New serological tests have advanced diagnoses of HIV, HPV, and HSV. Yet, challenges to diagnosing STIs continue.MethodsTo discern where we are heading in the field of HIV/STI diagnostics research, new assays and new approaches to enhance care were reviewed.ResultsThere are commercial NAATs for CT/NG by 4–5 companies. Some are available on expensive robotic platforms, limiting their use in resource-constrained settings. Additionally, a new CT/NG NAAT that can return results in 90 minutes is available. Other rapid NAAT and hybridization POC assays are in the pipeline.There are two NAATs and a POC test for trichomonas. POC syphilis serology tests have proliferated, which is important to syphilis elimination. Several platforms offer NAAT tests for HPV and there is a NAAT for HSV ulcers. Rapid HIV POC and 4thgeneration tests have advanced earlier detection of HIV. A home oral-fluid HIV test can be purchased in the US. Patients perform their own HIV tests in Emergency Departments with excellent accuracy. Internet availability of select STI tests for home collection/outreach programmes offer novel approaches to increasing options offered to individuals at risk.ConclusionsLearning how to wisely and effectively use these tools can improve the detection of STIs and provide cost-effective ways to increase the number of patients being treated.
S01.3 Making Anal Sex Safe: Current Status of Products For Rectal Use
Authors: Cranston R 
Published: July 2013

There are no products available that make anal sex completely safe from the point of view of HIV acquisition, and the likelihood of this happening in the future is slim. However, in terms of risk reduction, there are practical interventions to implement, the possibility of new concepts to explore, and the promise in the future of an effective rectal microbicide.The individual risks of anal intercourse (apart from those posed by the insertive partner) are multifactorial and may be broadly broken down to three main areas: trauma, co-infection, and products that may all facilitate inflammation and so increase HIV acquisition risk.Trauma: The anal canal is a high pressure environment due to the combined effects of both internal and external anal sphincters and requires preparation prior to anal intercourse that may be usefully discussed in directed sex education to reduce traumatic injury.Co-infection: Human papillomavirus is an almost ubiquitous infection in sexually active adults and is an independent risk factor for HIV acquisition by both vaginal and anal intercourse. The vaccination of both boys and girls prior to sexual debut may have the potential to reduce HIV acquisition risk.Products: These may potentially harm and also protect. Many unregulated off the shelf sexual lubricant products have high osmolality and may contain Nononxynol 9 that can both injure and induce inflammation in rectal epithelium and so provide an environment conducive to HIV infection. However, the gel formulation of tenofovir has shown efficacy in reducing both HIV and herpes simplex virus acquisition (a cofactor for HIV infection) following vaginal application. The reduced glycerin rectal formulation of this product has been shown to be safe in a short Phase 1 study and is currently entering an extended safety Phase 2 study.These elements will be explored during this presentation.
S02.2 Overview of Rapid/Point of Care Diagnostic Tests For HIV and Current Challenges Associated with HIV Testing
Authors: Singh A E 
Published: July 2013

Advances in rapid/point of care testing (RPOCT) for HIV have transformed global capacity to reach individuals who might not otherwise have been tested for HIV, particularly in non-traditional health care settings. In addition to reducing patient anxiety associated with awaiting the results of standard laboratory tests, a positive HIV RPOCT may allow for urgent medical interventions which could in turn reduce the risk of transmission of HIV, e.g. in the mother to child setting and in blood and body fluid exposures. The availability of a rapid test result also has the potential to allow immediate linkage to care and to modify behaviour which might result in reduced transmission of infection.Despite these benefits, RPOCT has also resulted in new challenges to health systems. For example, false positive results create unnecessary anxiety and occasionally, unnecessary medical interventions.The majority of currently available HIV RPOCT detect HIV-1 and sometimes HIV-2 antibody. Some newer test kits include the detection of p24 antigen with the potential to enhance diagnostic sensitivity in early infections. Future research should focus on better combination antigen/antibody rapid assays or rapid tests to detect nucleic acid to improve the diagnosis of early HIV seroconversion and for early infant diagnosis. Another area of unmet need is the accurate detection of infection in individuals who have received HIV vaccine who may screen positive on rapid tests making distinguishing vaccination and disease difficult. Finally, future directions should combine testing for multiple infections (e.g. HIV, HBV, HCV and syphilis) in a single test kit.