Predicting cardiovascular risk in the elderly in different European countries.

AIMS: The objective of this study was to develop risk functions for coronary heart disease and cardiovascular disease mortality for elderly men in different European countries. METHODS and RESULTS: The FINE Study is a prospective follow-up study of 2170 elderly men aged 65-84 years in Finland, Italy and The Netherlands. During 10 years of follow-up 289 men died from coronary heart disease and 545 men from cardiovascular disease. Risk functions were estimated using logistic regression analysis, in order to take competing causes of death into account. The results of the present study show that total cholesterol and smoking were the most important predictors of coronary heart disease mortality, and HDL cholesterol, systolic blood pressure and smoking of cardiovascular disease mortality. Left ventricular hypertrophy, being subject to coronary heart disease or cardiovascular disease in Finland and The Netherlands and use of antihypertensive medication in Italy, were also important predictors. For estimating the absolute risk of coronary heart disease and cardiovascular disease mortality in the elderly it is necessary to take into account the European country in which they live. CONCLUSION: Total and HDL cholesterol, systolic blood pressure and smoking remain important predictors of coronary heart disease and/or cardiovascular disease mortality in elderly men, but also left ventricular hypertrophy, being subject to coronary heart disease, use of antihypertensive medication and country are predictive of coronary heart disease and cardiovascular disease risk.     

Cotrimoxazole prophylaxis for HIV-positive TB patients in developing countries

Despite provisional recommendations from the World Health Organization and UNAIDS that cotrimoxazole (CTX) prophylaxis be offered to all individuals living with AIDS, including HIV-positive patients with TB, its routine use in developing countries particularly Africa has been minimal. Concerns were expressed regarding its effectiveness in areas of high bacterial resistance, that its widespread use might substantially increase bacterial cross-resistance in the community and that this intervention might promote resistance of malaria parasites to sulphadoxine-pyrimethamine. We review the current evidence on the above concerns and highlight the main operational considerations related to implementing CTX prophylaxis as a basic component of care for HIV-positive TB patients in developing countries.     

TB epidemiology in an elderly group in Japan

PURPOSE: To analyze the epidemiological situation of TB among the elderly in Japan. METHODS: By using the data of TB surveillance, national survey statistics and national basic survey of life. RESULTS: TB incidence in both sexes increased with age in all survey years. TB incidence among the jobless was higher than among employees in both sexes. TB incidence among female housekeepers was consistently lower than among other groups. TB incidence among both the employed and unemployed has declined rapidly in the last 15 years. The main mode of TB detection was the detection at clinics/hospitals irrespective of presence or absence of TB symptoms. The death rate was higher in cases with immunosuppressive therapy and cases with malignancy. CONCLUSION: Causes of higher TB incidence in the elderly unemployed population should be analyzed. Better detection of TB by improving passive case-finding for TB symptomatic and high-risk groups at clinics/hospitals will be recommended. To reduce the death rate, early diagnosis of TB with immunosuppressive therapy could be strengthened, however its impact might be limited.     

Interferon-gamma release assays and TB screening in high-income countries: a cost-effectiveness analysis.

OBJECTIVE: Interferon-gamma release assays (IGRA) are now available alternatives to tuberculin skin testing (TST) for detection of latent tuberculosis infection (LTBI). We compared the cost-effectiveness of TST and IGRA in different populations and clinical situations, and with variation of a number of parameters. METHODS: Markov modelling was used to compare expected TB cases and costs over 20 years following screening for TB with different strategies among hypothetical cohorts of foreign-born entrants to Canada, or contacts of TB cases. The less expensive commercial IGRA, Quanti-FERON-TB Gold (QFT), was examined. Model inputs were derived from published literature. RESULTS: For entering immigrants, screening with chest radiograph (CXR) would be the most and QFT the least cost-effective. Sequential screening with TST then QFT was more cost-effective than QFT alone in all scenarios, and more cost-effective than TST alone in selected subgroups. Among close and casual contacts, screening with TST or QFT would be cost saving; savings with TST would be greater than with QFT, except in contacts who were bacille Calmette-Guérin (BCG) vaccinated after infancy. CONCLUSIONS: Screening for LTBI, with TST or QFT, is cost-effective only if the risk of disease is high. The most cost-effective use of QFT is to test TST-positive persons.     

Mass incarceration can explain population increases in TB and multidrug-resistant TB in European and central Asian countries

Several microlevel studies have pinpointed prisons as an important site for tuberculosis (TB) and multidrug-resistant TB in European and central Asian countries. To date, no comparative analyses have examined whether rises in incarceration rates can account for puzzling differences in TB trends among overall populations. Using longitudinal TB and cross-sectional multidrug-resistant TB data for 26 eastern European and central Asian countries, we examined whether and to what degree increases in incarceration account for differences in population TB and multidrug-resistant TB burdens. We find that each percentage point increase in incarceration rates relates to an increased TB incidence of 0.34% (population attributable risk, 95% C.I.: 0.10–0.58%, P < 0.01), after controlling for TB infrastructure; HIV prevalence; and several surveillance, economic, demographic, and political indicators. Net increases in incarceration account for a 20.5% increase in TB incidence or nearly three-fifths of the average total increase in TB incidence in the countries studied from 1991 to 2002. Although the number of prisoners is a significant determinant of differences in TB incidence and multidrug-resistant TB prevalence among countries, the rate of prison growth is a larger determinant of these outcomes, and its effect is exacerbated but not confounded by HIV. Differences in incarceration rates are a major determinant of differences in population TB outcomes among eastern European and central Asian countries, and treatment expansion alone does not appear to resolve the effect of mass incarceration on TB incidence.     

广西南宁市3个县结核病防治效果分析

目的　分析南宁市3个县结核病防治效果。方法 对南宁市3个县2002-2005年结核病防治工作资料进行汇总分析。结果 南宁市3个县加强结核病控制工作,传染源发现和治疗效果逐年提高,4年来共接诊可疑肺结核症状者18513例,发现活动性肺结核病人7354例,其中涂阳病人2674例,涂阳病人登记率从2002年的11.37/10万上升到2005年的32.97/10万,初治涂阳病人治愈率从2002年的76.7%提高到2005年的89.9%。结论 南宁市3个县结核病控制工作取得明显效果,只有实施高质量的DOTS策略,才能保证高发现率、高治愈率。     

Differences in vitamin D status between countries in young adults and the elderly.

PURPOSE: To compare vitamin D status between countries in young adults and in the elderly. MATERIALS AND METHODS: Reports on vitamin D status (as assessed by serum 25-hydroxyvitamin D) from 1971 to 1990 were reviewed. Studies were grouped according to geographic regions: North America (including Canada and the United States); Scandinavia (including Denmark, Finland, Norway, and Sweden); and Central and Western Europe (including Belgium, France, Germany, Ireland, The Netherlands, Switzerland, and the United Kingdom). RESULTS: Vitamin D status varies with the season in young adults and in the elderly, and is lower during the winter in Europe than in both North America and Scandinavia. Oral vitamin D intake is lower in Europe than in both North America and Scandinavia. Hypovitaminosis D and related abnormalities in bone chemistry are most common in elderly residents in Europe but are reported in all elderly populations. CONCLUSIONS: The vitamin D status in young adults and the elderly varies widely with the country of residence. Adequate exposure to summer sunlight is the essential means to ample supply, but oral intake augmented by both fortification and supplementation is necessary to maintain baseline stores. All countries should adopt a fortification policy. It seems likely that the elderly would benefit additionally from a daily supplement of 10 micrograms of vitamin D.     

Occupational asthma in the developing and industrialised world: a review.

Occupational asthma is the most common occupational lung disease in industrialised countries, and the second most common occupational lung disease reported after pneumoconioses in developing countries. The median proportion of adult cases of asthma attributable to occupational exposure is between 10% and 15%. The population attributable fraction appears to be similar in industrialised and developing countries characterised by rapid industrialisation (13-15%), but lower in less industrialised developing countries (6%). The high-risk occupations and industries associated with the development of occupational asthma vary depending on the dominant industrial sectors in a particular country. High-risk exposure to cleaning agents and pesticide exposure in developing countries appear to be as important as exposure to isocyanates, cereal flour/grain dust, welding fumes, wood dust and, more recently, hairdressing chemicals, commonly reported in industrialised countries. The reported mean annual incidence of occupational asthma in developing countries is less than 2 per 100 000 population, compared to very high rates of up to 18/100 000 in Scandinavian countries. While occupational asthma remains under-recognised, especially in developing countries, it remains poorly diagnosed and managed and inadequately compensated worldwide. Primary and secondary preventive strategies should be directed at controlling workplace exposures, accompanied by intense educational and managerial improvements. Appropriate treatment remains early removal from exposure to ensure that the worker has no further exposure to the causal agent, with preservation of income. However, up to one third of workers with occupational asthma continue to remain exposed to the causative agent or suffer prolonged work disruption, discrimination and risk of unemployment.     

在高收入国家的γ干扰素释放试验与结核病筛查:成本-效益分析

目的:结核菌素皮肤试验(TST)是发现潜伏性结核感染(LTBI)的经典方法,目前γ干扰素试验(IGRA)也是可供选择的技术.我们比较了不同人群、不同临床状态下TST及IGRA的成本效益.方法:20年来加拿大对入境的外国移民或结核病接触者采用了不同的筛查策略,我们采用Markov模式比较了预期发现的病例数与成本的分析.并对比较便宜的商品试剂盒IGRA:γ干扰素定量测定(QFT)进行了调查.模型(model)输入数据均源于已发表的文献.结果:对入境移民,采用胸部X线拍片(CXR)是符合成本-效益原则的,而QFT是最不符合成本-效益原则者.序贯进行TST及QFT比任何情况下单一行QFT更符合成本-效益.在特定的(选择的)亚群中,也比单一进行TST更符合成本-效益原则.在密切接触者及不定期接触者中,采用TST或QFT筛查是节约成本的(cost saving):除在婴儿期后接种BCG的接触者外,采用TST的收益(savings)大于QFT.结论:只有在结核病高危人群中,以TST或QFT筛查LTBI是符合成本-效益的.TST阳性者再行QFT是最符合成本-效益原则的.     

T淋巴细胞斑点试验在结核病诊断中的临床应用

目的观察T淋巴细胞斑点试验(T-SPOT.TB)在结核病诊断中的临床应用价值。方法 205例疑似结核患者采用T-SPOT.TB试验、结核菌素试验(TST)和痰涂片检查,比较三种方法对结核诊断的灵敏性、特异性、假阳性率和假阴性率。结果 T-SPOT.TB试验的灵敏性明显高于TST试验和痰涂片检查(P<0.05);T-SPOT.TB试验的假阴性率明显低于TST试验和痰涂片检查(P<0.05)。结论 T-SPOT.TB具有更高的灵敏性,是结核筛检的有效试验方法。     

In the European Union, TB patients from former Soviet countries have a high risk of multidrug resistance.

SETTING: Fourteen countries of the European Union (EU). OBJECTIVE: To explore determinants of resistance to isoniazid and rifampicin (multidrug-resistant tuberculosis [MDR-TB]) among tuberculosis (TB) patients in the EU. DESIGN: Pooled TB case notification data for 2003 from the-Baltic States (Estonia, Latvia, Lithuania) and Austria, Belgium, the Czech Republic, Denmark, Finland, Germany, Luxembourg, The Netherlands, Slovenia, Sweden and the UK were investigated using bivariate and multivariable analysis. RESULTS: Of 12,109 cases with data, MDR-TB occurred in 709 cases, 91% of whom were from countries of the former Soviet Union (FSU), including the Baltic States. At multivariable analysis, MDR-TB was strongly associated with previous treatment in both Baltic and non-Baltic countries (adjusted OR 9.5 and 6.4, respectively), and inversely related to age >64 years (OR 0.4 and 0.2). In non-Baltic countries, MDR-TB was more strongly related to origin from the FSU (OR 19.7, reference non-Baltic EU) than from other regions (up to OR 2.3). Among cases pooled from all countries, provenance from the FSU was very strongly linked to MDR-TB in both previously untreated (OR 24.9) and previously treated (OR 53.7) cases. CONCLUSION: Within a context of increasing mobility, public health workers should be aware of a higher risk for MDR-TB among patients from the FSU as well as among patients previously treated for TB.     

结核感染T细胞斑点试验在结核病诊断中的应用价值

目的探讨结核感染T细胞斑点试验(T-SPOT.TB)在结核病诊断中的应用价值。方法 248例疑似结核患者采用T-SPOT.TB试验和结核菌素试验(TST),比较两者对结核诊断的灵敏性、特异性、假阳性率和假阴性率。结果 T-SPOT.TB试验的灵敏性和特异性明显高于TST试验(P<0.05);T-SPOT.TB试验的假阳性率和假阴性率明显低于TST试验(P<0.05)。结论 T-SPOT.TB具有更高的灵敏性和特异性,是结核筛检的有效试验方法。     

Incidence of suboptimal response to tumor necrosis factor antagonist therapy in inflammatory bowel disease in newly industrialised countries: The EXPLORE study

BackgroundIncidence of inflammatory bowel disease (IBD) is increasing in newly industrialised countries (NICs); however, data on suboptimal response to anti-tumor necrosis factor (anti-TNF) agents are limited.ObjectivesTo assess incidence and indicators of suboptimal response to first anti-TNF therapy in IBD patients in NICs.MethodsA chart review was conducted in ten countries from Asia-Pacific (APAC), Latin America (LatAm), and Russia and the Middle East (RME) regions among patients diagnosed with ulcerative colitis (UC) or Crohn's disease (CD), initiating anti-TNF therapy in 2010–2015. The cumulative incidence of suboptimal response to anti-TNF therapy was assessed using the following indicators: dose escalation or discontinuation, augmentation with non-biologic therapy, IBD-related hospitalization, or surgery.ResultsThe study included 1,674 patients (570 UC; 1,104 CD). At 24 months, 32.9% of UC (APAC: 45.1%; LatAm: 38.2%; RME: 23.8%) and 41.2% of CD patients (APAC: 54.1%; LatAm: 42.5%; RME: 29.5%) had experienced suboptimal response. The most frequent first indicator was non-biologic therapy augmentation in LatAm (41.7%), IBD-related hospitalization in RME (UC: 50.7%; CD:37.3%) and in APAC for CD (39.1%), and anti-TNF discontinuation in APAC for UC (38.3%).ConclusionSuboptimal response to anti-TNF agents is common in IBD patients in NICs. Observed regional differences in the incidence and indicators may reflect local practice and anti-TNF restrictions in IBD management.NCT Registration NumberNCT03090139.