Opinion about seasonal influenza vaccination among the general population 3 years after the A(H1N1)pdm2009 influenza pandemic

ObjectiveTo assess the opinions of the French general population about seasonal influenza vaccination three years after the A(H1N1)pdm 09 pandemic and identify factors associated with a neutral or negative opinion about this vaccination.Study designThe study was conducted using data collected from 5374 participants during the 2012/2013 season of the GrippeNet.fr study. The opinion about seasonal influenza vaccination was studied on three levels (“positive”, “negative” or “neutral”). The link between the participant's characteristics and their opinion regarding the seasonal influenza vaccination were studied using a multinomial logistic regression with categorical variables. The “positive” opinion was used as the reference for identifying individuals being at risk of having a “neutral” or a “negative” opinion.ResultsAmong the participants, 39% reported having a positive opinion about seasonal influenza vaccine, 39% a neutral opinion, and 22% a negative opinion. Factors associated with a neutral or negative opinion were young age, low educational level, lack of contact with sick or elderly individuals, lack of treatment for a chronic disease and taking a homeopathic preventive treatment.ConclusionsThese results show that an important part of the French population does not have a positive opinion about influenza vaccination in France. Furthermore, it allows outlining the profiles of particularly reluctant individuals who could be targeted by informative campaigns.     

Lifestyle risk factors,inflammatory mechanisms,and COVID-19 hospitalization: A community-based cohort study of 387,109 adults in UK

We conducted the first large-scale general population study on lifestyle risk factors (smoking, physical inactivity, obesity, and excessive alcohol intake) for COVID-19 using prospective cohort data with national registry linkage to hospitalisation. Participants were 387,109 men and women (56.4 ± 8.8 yr; 55.1% women) residing in England from UK Biobank study. Physical activity, smoking, and alcohol intake, were assessed by questionnaire at baseline (2006–2010). Body mass index, from measured height and weight, was used as an indicator of overall obesity. Outcome was cases of COVID-19 serious enough to warrant a hospital admission from 16-March-2020 to 26-April-2020. There were 760 COVID-19 cases. After adjustment for age, sex and mutually for each lifestyle factor, physical inactivity (Relative risk, 1.32, 95% confidence interval, 1.10, 1.58), smoking (1.42;1.12, 1.79) and obesity (2.05 ;1.68, 2.49) but not heavy alcohol consumption (1.12; 0.93, 1.35) were all related to COVID-19. We also found a dose-dependent increase in risk of COVID-19 with less favourable lifestyle scores, such that participants in the most adverse category had 4-fold higher risk (4.41; 2.52–7.71) compared to people with the most optimal lifestyle. C-reactive protein levels were associated with elevated risk of COVID-19 in a dose-dependent manner, and partly (10–16%) explained associations between adverse lifestyle and COVID-19. Based on UK risk factor prevalence estimates, unhealthy behaviours in combination accounted for up to 51% of the population attributable fraction of severe COVID-19. Our findings suggest that an unhealthy lifestyle synonymous with an elevated risk of non-communicable disease is also a risk factor for COVID-19 hospital admission, which might be partly explained by low grade inflammation. Adopting simple lifestyle changes could lower the risk of severe infection.     

Qualification of nursing potential in maternal mortality in Mexico

ObjectivesTo develop a method that measures nursing potential through the factor analysis of relevant nursing data and social context by taking maternal mortality as the study problem.MethodsA Cross-sectional and analytical study, a multivariate analysis was performed. The Nursing Coverage Index, the Human Development Index, population density and the proportion of nurses with a bachelor’s degree or upper degree, are studied by federative entity, only data from government sources are used. The Index of Nursing Qualification in Mexico (INQM) was constructed through principal component analysis.ResultsThe highest correlation was between the INQM and the Nursing Coverage Prioritization Index (NCPI), which was 0.849 (P < 0.01) and showed a strong positive linear relationship. The Population Density Prioritization Index (PDPI) shows a strong positive correlation with the INQM (0.716, P < 0.01). Three factors were extracted by principal component analysis and the INQM was generated with the three main components in a model. There is very low correlation between INQM and maternal mortality rate (MMR) and no statistical significance was found.ConclusionsThis study shows that nursing qualification must include economic, geographic and social variables. The INQM is an indicator that summarises the potential of each federative entity. Given these results, a contribution is provided for the application of these indices, which can help determine nursing potential in a specific geographical region.     

Embracing nature’s complexity: Immunoparasitology in the wild

A wealth of research is dedicated to understanding how resistance against parasites is conferred and how parasite-driven pathology is regulated. This research is in part driven by the hope to better treatments for parasitic diseases of humans and livestock, and in part by immunologists who use parasitic infections as biomedical tools to evoke physiological immune responses. Much of the current mechanistic knowledge has been discovered in laboratory studies using model organisms, especially the laboratory mouse. However, wildlife are also hosts to a range of parasites. Through the study of host-parasite interactions in these non-laboratory systems we can gain a deeper understanding of parasite immunology in a more natural, complex environment. With a focus on helminth parasites, we here explore the insights gained into parasite-induced immune responses through (for immunologists) non-conventional experimental systems, and how current core findings from laboratory studies are reflected in these more natural conditions. The quality of the immune response is undoubtedly a central player in susceptibility versus resistance, as many laboratory studies have shown. Yet, in the wild, parasite infections tend to be chronic diseases. Whilst reading our review, we encourage the reader to consider the following questions which may (only) be answered by studying naturally occurring parasites in the wild: a) what type of immune responses are mounted against parasites in different hosts in the wild, and how do they vary within an individual over time, between individuals of the same species and between species? b) can we use wild or semi-wild study systems to understand the evolutionary drivers for tolerance versus resistance towards a parasite? c) what determines the ability of the host to cope with an infection and is there a link with the type of immune response mounted? d) can we modulate environmental factors to manipulate a wild animal’s immune response to parasitic infections, with translation potential for humans, wildlife, and livestock? and e) in context of this special issue, what lessons for Type 2 immunity can we glean from studying animals in their natural environments? Further, we aim to integrate some of the knowledge gained in semi-wild and wild settings with knowledge gained from traditional laboratory-based research, and to raise awareness for the opportunities (and challenges) that come with integrating a multitude of naturally-occurring variables into immunoparasitological research.     

2011—2020年贵州省黔南州肺外结核流行病学特征分析

目的 了解黔南州2011—2020年肺外结核流行特征，为制定防控措施提供依据。方法 收集结核病管理信息系统登记的黔南州2011— 2020年肺外结核病例资料，采用描述流行病学方法进行分析。结果 2011—2020年黔南州肺外结核发病9 397例，年均报告发病率为28.12/10万，占全人群结核病的平均比例为19.12%（9 397/49 138），其发病率呈缓慢上升趋势；男性5 037例，占53.60%（5 037/9 397）；女性4 360例，占46.40%（4 360/9 397）。男女比例为1.16:1；全年均有病例，主要集中在第一季度和第二季度；黔南州12县（市）肺外结核患者发病数前三位分别是三都县12.60%（1 184/9 397）、罗甸县10.57%（993/9 397）和长顺县10.38%（975/9 397）。按民族分析，肺外结核中病例数前三位分别是苗族25.28%（2 376/9 397）、布依族21.68%（2 037/9 397）和水族15.56%（1 462/9 397）；10年间发病农民病例数占总发病数的63.50 %（5 967/9 397）；总体发病年龄46～60岁发病数最多。男性16～30岁和46～60岁发病数较多，呈“M”型双波峰形。女性发病数集中在31～60岁呈单波形；肺外结核以结核性淋巴腺炎最多，占全部肺外结核20.77%（1 952/9 397），其次是泌尿生殖系统结核病17.41%（1 636/9 397）和骨关节结核病13.86%（1 302/ 9 397）；发现方式以因有症状就诊和转诊为主，占83.25%（7 823/9 397）；肺外结核初治成功率96.92%（9 108/9 397），复治成功率73.36%（212/289）。结论 2011—2020年黔南州肺外结核病呈缓慢上升趋势，男性、农民、布依族、年龄46～60岁是肺外结核防治的重点人群。     

Dose optimization with population pharmacokinetics of ritonavir-boosted lopinavir for Thai people living with HIV with and without active tuberculosis

BackgroundPrior to dolutegravir availability, ritonavir-boosted lopinavir (LPV/r) was an alternative recommendation when first-line drugs could not be used. A high concentration of protease inhibitors was observed in the Thai people living with HIV (PLWH). Thus, dose reduction of LPV/r may be possible. However, the pharmacokinetics and dose optimization of LPV/r have never been investigated. This study aimed to develop a population pharmacokinetic model of LPV/r and provide dosage optimization in Thai PLWH.MethodsLPV and RTV trough concentrations from Thai PLWH were combined with intensive data. The data were analyzed by the nonlinear mixed-effects modeling approach. The influence of RTV concentration on LPV oral clearance (CL/F) was investigated.ResultsRifampicin (RIF) use increased LPV and RTV CL/F by 2.16-fold and 1.99-fold, respectively. The reduced dose of 300/75 and 200/150 mg twice daily provided a comparable percentage of patients achieving LPV target trough concentration to the standard dose for PI-naïve patients. For HIV/TB co-infected patients receiving RIF who could not tolerate the recommended dose, the reduced dose of 600/150 mg twice daily was recommended.ConclusionThe population pharmacokinetic model was developed by integrating the interaction between LPV and RTV. The reduced LPV/r dosage offers sufficient LPV exposure for Thai PLWH.     

A practical approach to evidence-based dentistry: How to search for evidence to inform clinical decisions

Background and OverviewKnowing how to search for evidence that can inform clinical decisions is a fundamental skill for the practice of evidence-based dentistry. There are many available types of evidence-based resources, characterized by their degrees of coverage of preappraised or summarized evidence at varying levels of processing, from primary studies to systematic reviews and clinical guidelines. The practice of evidence-based dentistry requires familiarity with these resources. In this article, the authors describe the process of searching for evidence: defining the question, identifying the question's nature and main components, and selecting the study design that best addresses the question.Practice ImplicationsDentists who wish to inform their decisions with the current best evidence can use these guidelines to define their questions of interest and search efficiently for this evidence.