Severe Influenza-associated Respiratory Infection in High HIV Prevalence Setting,South Africa, 2009–2011

Data on influenza epidemiology in HIV-infected persons are limited, particularly for sub-Saharan Africa, where HIV infection is widespread. We tested respiratory and blood samples from patients with acute lower respiratory tract infections hospitalized in South Africa during 2009–2011 for viral and pneumococcal infections. Influenza was identified in 9% (1,056/11,925) of patients enrolled; among influenza case-patients, 358 (44%) of the 819 who were tested were infected with HIV. Influenza-associated acute lower respiratory tract infection incidence was 4–8 times greater for HIV-infected (186–228/100,000) than for HIV-uninfected persons (26–54/100,000). Furthermore, multivariable analysis showed HIV-infected patients were more likely to have pneumococcal co-infection; to be infected with influenza type B compared with type A; to be hospitalized for 2–7 days or >7 days; and to die from their illness. These findings indicate that HIV-infected persons are at greater risk for severe illnesses related to influenza and thus should be prioritized for influenza vaccination.     

Subsite Distribution of Gastric Cancer in an Area of High Prevalence—Northwest Iran

Background

The aim of the present study was to determine subsites of gastric cancer in East Azerbaijan, Iran—a high incidence region for gastric cancer and Helicobacter pylori infection.

Methods

Data were collected from 2002 through 2007 from patients who sought treatment for gastrointestinal symptoms or signs at a university clinic and subsequently underwent upper gastrointestinal endoscopy.

Results

Cancer was diagnosed and histologically confirmed in 362 patients (352 adenocarcinomas). The mean age of the patients was 64.57 ± 11.32 (range, 16–94 years) and the male-to-female ratio was 2.8:1. The gastric cardia was involved in 40.3% of patients with gastric adenocarcinoma, while the gastric fundus was involved in 3.7%, the gastric body in 49.1%, and the gastric antrum in 24.1% of patients. Complete evaluation for metastasis was possible in 144 patients; 61 were free of metastasis, and most of these patients underwent surgical therapy. Cardia involvement was not associated with the sex or age of patients.

Conclusions

Noncardia gastric cancer is still more frequent in East Azerbaijan, which is likely due to the very high prevalence of infection with Helicobacter pylori. The low rate of cancer involving the fundus is a target for further research on the etiology of gastric cancer.Key words: gastric cancer, subsite, gastric cardia, Iran     

High Prevalence of AmpC β-Lactamases in Clinical Isolates of Escherichia coli in Ilam,Iran

Objectives

Widespread use of β-lactam antibiotics could cause resistance to this group of antibiotics in pathogenic bacteria through the production of the enzyme β-lactamases. The aim of this study is to determine the molecular detection of AmpC β-lactamases among clinical Escherichia coli isolated from Ilam hospitals in Ilam, Iran.

Methods

One hundred and twelve clinical isolates of E. coli were collected from hospitalized patients and were identified by biochemical tests. They were evaluated for extended spectrum beta-lactamases (ESBLs) production, and the positive strains were subjected to AmpC enzymes; for detection of AmpC cluster genes, multiplex polymerase chain reaction was applied.

Results

The analysis showed 62.5% of isolates were ESBLs positive and that five strains revealed the AmpC cluster genes. This is the first report of FOXM cluster genes in E. coli in Iran.

Conclusion

Based on our results, the prevalence of AmpC β-lactamases is increasing in Iran, which caused failure in antibiotic therapy. So, the current study recommended the revision of antibiotic policy in Iranian hospitals.     

Prevalence of hemoglobin S in the State of Paraná, Brazil, based on neonatal screening

The Brazilian Ministry of Health created the National Neonatal Screening Program under ruling no. 822/2001, including neonatal screening for hemoglobinopathies. In the State of Paraná, neonatal screening is conducted by the Ecumenical Foundation for the Protection of the Handicapped. The prevalence rates were determined for homozygous and heterozygous hemoglobin S and Sbeta-thalassemia. Blood samples drawn on filter paper were examined by isoelectric focusing (IEF) and high-performance liquid chromatography (HPLC). From January 2002 to December 2004, 548,810 newborns were screened, with the detection of 21 with FS, two FSA/FS, and four FSA. After confirmatory tests at six months of age, 12 were defined as sickle-cell anemia, or a prevalence of 2.2:100,000 newborns; Sbeta-thalassemia was confirmed in 15 (2.7:100,000 newborns); and 8,321 newborns were diagnosed as heterozygous HbS (1,500:100,000 newborns). HbS prevalence in Paraná (in southern Brazil) is lower than in the Central-West, North, and Northeast of the country. Ethnic origin of the population, fetal deaths, and non-random procreation may contribute to the relatively low number of homozygous individuals in the State. Sbeta-thalassemia interaction suggests the presence of Euro-Mediterranean peoples in this population's miscegenation.     

Prevalence of obesity in a locality of the State of S?o Paulo, Brazil, 1987]

The prevalence of obesity in Araraquara, a county of 150,000 inhabitants situated 250 km from S. Paulo, Brazil was studied. The study population, of 18-74 yrs. of age, resident in the urban area in 1987, was composed of 1,126 inhabitants, 502 males and 624 females, selected through a cluster equiprobabilistic sampling process. The prevalence of overweight (Quetelet 25-29.9 Kg/m2) was 26.9% for males and 27.7% for females. The prevalence of obesity (Quetelet equal or greater than 30.0 kg/m2) was 10.2% for males and 14.7% for females. These percentages are high when compared with those of affluent Anglo-saxon countries. The reasons for this phenomenon are discussed in the light of the fact that the economy of the city is affluent and is dependent on agroindustrial activities. When own cut-off criteria (P85 and P95 for Quetelet for 20-29 yrs of age, for each sex) are calculated, the "lean pattern" for Araraquara County is leaner than that for the a United States population. This raises doubts as to the possibility of applying cut-off criteria of particular regions to regions of different characteristics.     

Prevalence of dental caries in schoolchildren in the rural area of Itapetininga, São Paulo State, Brazil

The present study is an attempt to characterize dental needs of the rural population in Itapetininga, S?o Paulo State, Brazil. One single dentist examined 291 children ages 5 and 12 years in rural schools, adopting WHO criteria for oral health surveys. Parents reported their children's socioeconomic characteristics and habits. Non-primary data gathered by the Brazilian health authority supplied information regarding the schoolchildren in the urban area of the town. Caries indices ranked as follows: dmft = 2.63 (5-year-old children) and DMFT = 2.45 (12-year-old children). The decayed component comprised 85.6% of the dmft and 34.2% of the DMFT, indicating limited utilization of dental treatment by children with decayed deciduous teeth. Caries prevalence was higher in rural schoolchildren than in their urban counterparts. Analysis of the results aims to improve planning of dental care.     

Prevalence of obesity in preschool children from five towns in São Paulo State, Brazil

Health and nutritional characteristics of children under 5 years of age were investigated through a cross-sectional study in 5 small cities from different regions in the State of Sao Paulo, Brazil, which displayed different socioeconomic profiles: Bady Bassit, Bofete, Jaborandi, Morungaba, and Riversul. Data were obtained using a systematic sampling from the 1991 National Census. Anthropometric data were collected from all children under 5 years of age living in the selected households. Nutritional status was determined by height/age and weight/height according to the National Center for Health Statistics -- NCHS standards. Stunting was defined as HAZ below -- 2 Z scores and obesity as WHZ above 2 Z scores. The study sample consisted of 987 children (490 boys and 497 girls). Prevalence of obesity was 6.6% (65) and stunting 5.0% (51). Per capita income displayed a significant and positive association with obesity (p = 0.018), in contrast to an inverse association with stunting (p = 0.038).     

Prevalence of tobacco use and associated factors among women in Paraná State, Brazil

This study aimed to estimate the prevalence of tobacco use and to describe the demographic profile of female smokers in Paraná State, Brazil. The study used a cross-sectional population-based design with cluster sampling (n = 2,153) of women 18 years or older in seven cities. Prevalence of smoking was 13.4%, ranging from 10% in Cascavel to 19% in Irati. According to multivariate analysis, city of residence, marital status, and schooling were significantly associated with tobacco use. Women in Irati (OR = 2.08; 95%CI: 1.22-3.54) were more likely to smoke than those in Cambé. Married women and widows were less likely to smoke (OR = 0.47; 95%CI: 0.30-0.73 and OR = 0.43; 95%CI: 0.22-0.87) than single women. Women living with a partner (but not married) were more likely to smoke than single women (OR = 2.49; 95%CI: 1.12-5.53), and women with university degrees were less likely to smoke than those with eight years of school or less (OR = 0.41; 95%CI: 0.22-0.87). The results confirm the need for tobacco control programs that take gender and regional differences into account.     

Monitoring of influenza viruses in Western Siberia in 2008–2012

Western Siberia is of great importance in ecology and epidemiology of influenza. This territory is nesting area for great amount of bird species. Territorial relations of Western Siberian birds that are established during seasonal migration are extremely wide since this region is an intersection point of bird migration flows wintering in different regions of the world: Europe, Africa, Middle East, Central Asia, Hindustan, and South East Asia. Reassortant influenza viruses that can cause outbreak among population may emerge in Western Siberia with high probability. Thus, it is extremely important to carry out widespread study of circulated viruses, their molecular biological properties, phylogenetic links in this region, as well as herd immunity to influenza virus serotypes with epidemic potential.     

Prevalence of malnutrition among children in Embu,São Paulo State,Brazil, 1996-1997

This paper focused on the nutritional profile of children in the municipality of Embu, S?o Paulo State, Brazil, in 1996-1997, to identify vulnerable population segments that require specific action by health services. The sample consisted of 320 children < or = 5 years of age distributed into four socioeconomic strata. The indices were expressed as z-scores: weight/age (W/A), height/age (H/A), and weight/height (W/H) to analyze the nutritional status, and the reference for normality was the NCHS curve. In all population strata and age groups, the height/age index was the most frequently affected, while the weight/height index had the fewest deficits. No statistically significant differences were observed in children's nutritional status between the four population strata or between the different age groups. Children with low birth weight showed the highest prevalence of deficits in all indices. In the municipality, the frequency of deficits were: H/A< 2z: 7.1%, W/H< 2z: 0.2%, and W/A< 2z: 2.9%. Height deficit can be used as an early warning, considering that loss observed over the course of years has future consequences.     

Spatial and temporal distribution of tuberculosis in indigenous and non-indigenous of Rondônia State, Western Amazon, Brazil

This study analyzed the spatial and temporal distribution of crude and adjusted rates of incidence of tuberculosis (TB) between 1997 and 2006, identifying areas of greatest risk to the indigenous and non-indigenous population of Rond?nia State, Brazil. An ecological study was conducted analyzing municipalities and Indian reserves, using the local empirical Bayesian method. The crude average rate of incidence of TB among the non-indigenous population was 35.6/100,000 inhabitants, while for the indigenous population it was 415.0/100,000. Rates greater than 600/100,000 were reported in the Karipuna, Sete de Setembro, Igarapé, Ribeir?o and Karitiana reserves. We observed a greater number of cases in under 15 year-olds with little schooling in contrast to the situation in the non-indigenous population. After making adjustments, the rates in some Indian reserves exceeded 240/100,000 inhabitants, while in coinciding municipalities incidence was between the range of 61-120/100,000. The Bayesian method led to decreased overall heterogeneity in rates. Evidence suggests that the indigenous population is more vulnerable to contracting TB and highlighted areas that require further attention to ensure the adequate control of TB in Rond?nia.     

Prevalence of vertebral fractures and risk factors in women over 60 years of age in Chapecó, Santa Catarina State, Brazil

Fractures are the main problems related to bone fragility in postmenopausal women and account for the increase in the risk of new fractures, mortality, and costs. This study's objective was to verify the occurrence of vertebral fragility fracture and correlate it with demographic, behavioral, and clinical factors in a Brazilian population. The cross-sectional study was based on a random sample of elderly women living in Chapecó, Santa Catarina State, Brazil. The sample consisted of 186 white women over 60 years of age. Of these, 48.9% had asymptomatic vertebral fractures, with higher prevalence in T11-12 and L4-5. Adjusted analysis showed a gradient between age and vertebral fracture, while fracture prevalence was 2.3 times higher in women over 80 years. Fracture prevalence was 1.44 times higher in sedentary as compared to non-sedentary women. Due to the high prevalence of asymptomatic vertebral fractures, the authors suggest the use of spinal x-rays in elderly women for fracture screening and prevention.     

Bridging Populations—Sexual Risk Behaviors and HIV Prevalence in Clients and Partners of Female Sex Workers,Bangkok, Thailand 2007

The aim of this study is to estimate HIV prevalence and assess sexual behaviors in a high-risk and difficult-to-reach population of clients of female sex workers (FSWs). A modified variation of respondent-driven sampling was conducted among FSWs in Bangkok, where FSWs recruited 3 FSW peers, 1 client, and 1 nonpaying partner. After informed consent was obtained, participants completed a questionnaire, were HIV-tested, and were asked to return for results. Analyses were weighted to control for the design of the survey. Among 540 FSWs, 188 (35%) recruited 1 client, and 88 (16%) recruited 1 nonpaying partner. Clients’ median age was 38 years. HIV prevalence was 20% and was associated with younger age at first sexual experience [relative risk (RR) = 3.10, 95% confidence interval (CI) 1.16–8.24] and condom use during last sexual encounter with regular partner (RR = 3.97, 95% CI 1.09–14.61). Median age of nonpaying partners was 34 years, and HIV prevalence was 15.1%. There were 56 discordant FSW–client pairs and 14 discordant FSW–nonpaying partner pairs. Condom use was relatively high among discordant FSW–client pairs (90.1%) compared to discordant FSW–nonpaying partner pairs (18.7%). Results suggest that sexual partners of FSWs have a high HIV prevalence and can be a bridge for HIV transmission to other populations. Findings also highlight the importance of initiating surveillance and targeted programs for FSW partners, and demonstrate a recruitment method for hard-to-reach populations.     

High Prevalence of Low Serum Biologically Active Testosterone in Older Male Veterans

Objectives

Assess the prevalence of hypogonadism in older male Veterans by comparing direct measurements of total testosterone (T) and bioavailable testosterone (BioT) versus indirect BioT values derived from existing and newly developed regression analyses.

Prevalence of cavities among adolescents in public and private schools in João Pessoa, Paraíba State, Brazil

The purpose of this study was to ascertain the prevalence of cavities among adolescents in public and private schools in Jo?o Pessoa, Paraíba State, Brazil, comparing the DMFT in terms of gender and age, as well as education levels and quality among mothers in these two types of schools. The sample consisted of 3,330 adolescents between twelve and fifteen years old: 1,665 attending public schools and 1,665 attending private schools. The DMFT was evaluated by the WHO criteria (1997), using the Kappa (0.92) intra-examiner agreement for cavity diagnoses and the Mann-Whitney and Kruskal-Wallis statistical analyses. The prevalence of cavities in public schools was 51.6%, compared to 9.3% in private schools. The DMFT for girls was 4.79 and 3.46 for boys in public schools (p<0.0001) and 2.11 and 1.65 (p=0.0007) in private schools. At the age of 12 years, the DMFT was 3.37 in public schools and 1.35 in private schools, while for the age of 15 it was 5.65 and 2.88 for each type of school. Among children whose mothers graduated from high school, the average DMFT was 4.21 in public schools and 1.81 in private schools. The prevalence of cavities was higher among girls in public schools, increasing with age and decreasing with higher education levels among mothers.