Pan-European Chikungunya surveillance: designing risk stratified surveillance zones

The first documented transmission of Chikungunya within Europe took place in Italy during the summer of 2007. Chikungunya, a viral infection affecting millions of people across Africa and Asia, can be debilitating and no prophylactic treatment exists. Although imported cases are reported frequently across Europe, 2007 was the first confirmed European outbreak and available evidence suggests that Aedes albopictuswas the vector responsible and the index case was a visitor from India. This paper proposed pan-European surveillance zones for Chikungunya, based on the climatic conditions necessary for vector activity and viral transmission. Pan-European surveillance provides the best hope for an early-warning of outbreaks, because national boundaries do not play a role in defining the risk of this new vector borne disease threat. A review of climates, where Chikungunya has been active, was used to inform the delineation of three pan-European surveillance zones. These vary in size each month across the June-September period of greatest risk. The zones stretch across southern Europe from Portugal to Turkey. Although the focus of this study was to define the geography of potential surveillance zones based on the climatic limits on the vector and virus, a preliminary examination of inward bound airline passengers was also undertaken. This indicated that France and Italy are likely to be at greater risk due to the number of visitors they receive from Chikungunya active regions, principally viraemic visitors from India. Therefore this study represents a first attempt at creating risk stratified surveillance zones, which we believe could be usefully refined with the use of higher resolution climate data and more complete air travel data.     

Tracking of cardiovascular risk factors among school children: a four-year population surveillance in Susa, Tunisia

In order to confirm the phenomenon of tracking of cardiovascular risk factors among school children, we undertook in 2003, a prospective survey of a population of 789 pupils aged 13 to 15 years who had participated in a first investigation on cardiovascular risk factors in 1999. We were able to follow and study 453 pupils (57.4% of the initial population). Prevalences of hypertension and obesity were respectively 11.3% and 6.1% without significant difference between sexes. On the other hand, hypercholesterolemia was significantly more elevated among girls than boys (16.1% versus 9.3%, p = 0.039). Children classified initially as hypertensive, obese or having a hypercholesterolemia were identified 4 years later at a subsequent exam as hypertensive, obese or having a hypercholesterolemia in respectively 25%, 48.9% and 59%. The stability of cardiovascular risk factors among children imposes an early screening for a better management and a policy of cardiovascular health promotion since childhood based essentially on prevention of risk factors in order to reduce the cardiovascular disease burden in adulthood.     

丙泊酚与睡眠障碍

目的基于健康手环探讨温泉泡浴对人群夜间睡眠质量的改善作用。方法在健康体检基础上,选择贵州省5个典型温泉地区符合泡浴质量要求并全程参与泡浴的311名志愿者作为观察对象,进行为期4周的温泉泡浴干预。采用Huawei Honor Band 3健康手环收集观察对象每天的夜间睡眠时间(min)、深睡眠比(%)、浅睡眠比(%)和快速动眼比(%)。采用重复测量方差分析比较各组每周夜间睡眠质量指标的差异,3种不同温泉类型泡浴对夜间睡眠质量的改善效果评价采用因子分析法。结果温泉泡浴可增加夜间睡眠时间和深睡眠比,同时降低浅睡眠比。与第1周相比,后3周夜间睡眠时间显著增高(P < 0.05),尤以第4周增高最为明显; 第3、4周深睡眠比显著高于第1、2周(P < 0.05),而浅睡眠比低于第1、2周(P < 0.05);快速动眼比在4周间变化不明显(P > 0.05)。进一步按地质学温泉理疗成分分类,发现温度型温泉可增加夜间睡眠时间、降低浅睡眠比; 温矿泉型温泉对增加夜间睡眠时间、深睡眠比和降低浅睡眠比均有一定的调节作用; 偏硅酸型温泉可增加夜间睡眠时间和深睡眠比,降低浅睡眠比和快速动眼比,改善夜间睡眠质量。因子分析结果提示,偏硅酸型温泉对于改善夜间睡眠质量的效果优于温度型温泉及温矿泉型温泉。\t\t\t结论温泉泡浴可不同程度改善人群的夜间睡眠质量,偏硅酸型温泉相对优于其他温泉类型。     

Variation in the prevention of cardiovascular risk factors. A population-based study

BACKGROUND: Published studies on clinical practice variability have mainly focussed on variability in the rates of hospitalization and surgical procedures. The objective of this study was to evaluate variability in the measurement of cholesterolemia and blood pressure in four professional groups and in the general population. METHODS: A cross-sectional survey was performed by mail in the city of Valencia (Spain). Five population groups were selected: physicians, nurses, lawyers, architects and the general population. The sample was obtained by random sampling of each group. RESULTS: Of all the questionnaires returned, only those returned by individuals surveyed (1,755) and their partners (1,296) were used (total: 3,050). The frequency of preventive cholesterolemia measurement was greater among nurses (55.7%) and physicians (54.1%) than among architects (38.9%), lawyers (38.2%) and the general population (35.1%). The frequency of preventive blood pressure measurement was also greater among physicians (47.7%) and nurses (42.2%) followed by architects (39.4%) and lawyers (38.8%) and was lower among the general population (32.2%). After adjusting by sex, age group, marital status, level of education, and employment, only lawyers (RR = 0.79; 95% CI, 0.6-0.9) and architects (RR = 0.77; 95% CI, 0.68-0.88) showed a significantly lower probability of determining cholesterol levels than physicians (basal category) and nurses (RR = 1.05; 95% CI, 0.93-1.18). The general population showed the lowest probability of measuring blood pressure (RR = 0.8; 95% CI, 0.65-0.97), although the differences were statistically significant only when compared with physicians. CONCLUSIONS: Preventive practices should be increased among groups in which they are less frequently performed until they are performed with the same frequency as among physicians and nurses. Efforts should be directed to increasing cardiovascular prevention programs in health centers.     

A study of cardiovascular risk in overweight and obese people in England

Objectives: To report current levels of obesity and associated cardiac risk using routinely collected primary care computer data. Methods: 67 practices took part in an educational intervention to improve computer data quality and care in cardiovascular disease. Data were extracted from 435 102 general practice computer records. 64.3% (229 108/362 861) of people age 15 y and older had a body mass index (BMI) recording or a valid height and weight record that enabled BMI to be derived. Data about cardiovascular disease and risk factors were also extracted. The prevalence of disease and the control of risk factors in the overweight and obese population were compared with those of normal body weight. Results: 56.8% of men and 69.3% of women aged over 15 y had a BMI record. 22% of men and 32.3% of women aged 15 to 24 y were overweight or obese; rising each decade to a peak of 65.6% of men and 57.5% of women aged 55 to 64 y. Thereafter, the proportion who were overweight or obese declined. The prevalence of ischaemic heart disease, diabetes mellitus and hypertension rose with increasing levels of obesity; their prevalence in those who are moderately obese was between two and three times that of the general population. Systolic and diastolic blood pressure, blood glucose even in non-diabetics, cholesterol and triglycerides were all elevated in the overweight and obese population.

Conclusion: Based on the recorded data over half of men and nearly half of women are overweight or obese. They have increased cardiovascular risk, which is not adequately controlled by current practice.     

Identifying areas at risk of low birth weight using spatial epidemiology: A small area surveillance study

ObjectivesTo assess the geographic distribution of Low Birth Weight (LBW) in New York State among singleton births using a spatial regression approach in order to identify priority areas for public health actions.MethodsLBW was defined as birth weight less than 2500 g. Geocoded data from 562,586 birth certificates in New York State (years 2008–2012) were merged with 2010 census data at the tract level. To provide stable estimates and maintain confidentiality, data were aggregated to yield 1268 areas of analysis. LBW prevalence among singleton births was related with area-level behavioral, socioeconomic and demographic characteristics using a Poisson mixed effects spatial error regression model.ResultsObserved low birth weight showed statistically significant auto-correlation in our study area (Moran's I 0.16 p value 0.0005). After over-dispersion correction and accounting for fixed effects for selected social determinants, spatial autocorrelation was fully accounted for (Moran's I − 0.007 p value 0.241). The proportion of LBW was higher in areas with larger Hispanic or Black populations and high smoking prevalence. Smoothed maps with predicted prevalence were developed to identify areas at high risk of LBW. Spatial patterns of residual variation were analyzed to identify unique risk factors.ConclusionNeighborhood racial composition contributes to disparities in LBW prevalence beyond differences in behavioral and socioeconomic factors. Small-area analyses of LBW can identify areas for targeted interventions and display unique local patterns that should be accounted for in prevention strategies.     

European surveillance on Creutzfeldt-Jakob disease: a case-control study for medical risk factors

Medical risk factors for Creutzfeldt-Jakob disease (CJD) were analyzed in a prospective ongoing case-control study based on European CJD surveillance. Detailed data on past and recent medical history were analyzed in 405 cases and controls matched by sex, age, and hospital. Data were correlated with polymorphism at codon 129 of the prion protein gene. Our analysis did not support a number of previously reported associations and failed to identify any common medical risk factor for CJD. Although not statistically significant, brain surgery was associated with an increased risk of CJD. A detailed medical history should be obtained in every suspected CJD case in order to identify iatrogenic sources of CJD.     

Clustering patterns of behavioural risk factors for cardiovascular diseases in Bangladeshi adolescents: A population-based study

ObjectivesTo examine the clustering of major behavioural risk factors for cardiovascular diseases (CVD) among adolescents in Bangladesh.MethodsNationally representative data from the 2014 Bangladesh Global School-based Student Health Survey were analysed in 2,978 adolescents (mean age: 14.2 SD 0.99; 60.0% females). We compared the observed (O) to expected (E) prevalence ratios of 64 possible combinations of the six behavioural risk factors (i.e., physical inactivity, sedentary behaviour, tobacco smoking, alcohol drinking, low fruit and vegetable intake, and overweight/obesity) to determine their clustering patterns. Poisson regression was used to examine the associations.ResultsThe most common single risk factor was low fruit and vegetable intake, followed by physical inactivity (87% and 59%, respectively). Overall, 18% of the adolescents had three or more risk factors, with males reporting higher prevalence than females (21% vs. 11%). The simultaneous occurrence of low fruit and vegetable intake, and physical inactivity was 30% greater in males (O/E ratio: 1.3, 95% CI: 1.2–1.4) and 20% greater in females (1.2, 1.2–1.3) than what was expected if there was no clustering. The analysis also demonstrated clustering of low fruit and vegetable, overweight/obesity, and high sedentary behaviour (2.5, 1.3–4.9), and low fruit and vegetable, overweight/obesity, and physical inactivity (1.4, 1.1–2.0) for males.ConclusionsThis study fills the gap in the scientific literature by providing evidence that behavioural risk factors tend to cluster among adolescents in Bangladesh. Early prevention programs with evidence-based strategies need to target adolescents who are at a greater risk of engaging in multiple risk behaviours.     

Status of novel cardiovascular risk factor and cardiovascular disease risk in an urban Cuban population--a pilot study

Cardiovascular disease is the main cause of death in Cuba, yet the prevalence of novel risk factors is not known. To examine the prevalence of risk factors of traditional and novel cardiovascular diseases (CVDs) among an urban Cuban population, a cross-sectional pilot survey was undertaken in Havana city, Cuba. Ninety-seven adults aged 45-60 years registered to receive medical care at a policlinic. The prevalences of rates of CVD risk factors were: hypertension (> or =140/90 mmHg) (53.6%), hypercholesterolaemia (total cholesterol >5.2 mmol/L) (47.0%), low high-density lipoprotein (HDL)-cholesterol (<1.03 mmol/L) (64.3%); diabetes (self-reported) (24.6%); metabolic syndrome (ATP III criteria) (58.2%); overweight and obesity (body mass index > or = 25 kg/m2) (78.0%); current smoking (39.3%); elevated level of C-reactive protein (3 15 micromol/L) (11.1%). The total carotenoid status was independently associated with waist-circumference and risk of diabetes and metabolic syndrome. In this small unrepresentative sample of people aged 40-65 years from Havana city, there was a high prevalence of traditional and novel CVD risk factors. The total serum carotenoid status appeared to be associated with an increased prevalence of CVD risk factors.     

Ethnic group differences in cardiovascular risk assessment scores: national cross-sectional study

Objectives. There are marked inequalities in cardiovascular disease (CVD) incidence and outcomes between ethnic groups. CVD risk scores are increasingly used in preventive medicine and should aim to accurately reflect differences between ethnic groups. Ethnicity, as an independent risk factor for CVD, can be accounted for in CVD risk scores primarily using two methods, either directly incorporating it as a risk factor in the algorithm or through a post hoc adjustment of risk. We aim to compare these two methods in terms of their prediction of CVD across ethnic groups using representative national data from England.

Design. A cross-sectional study using data from the Health Survey for England. We measured ethnic group differences in risk estimation between the QRISK2, which includes ethnicity and Joint British Societies 2 (JBS2) algorithm, which uses post hoc risk adjustment factor for South Asian men.

Results. The QRISK2 score produces lower median estimates of CVD risk than JBS2 overall (6.6% [lower quartile–upper quartile (LQ-UQ) = 4.0–18.6] compared with 9.3% [LQ-UQ = 2.3–16.9]). Differences in median risk scores are significantly greater in South Asian men (7.5% [LQ-UQ = 3.6–12.5]) compared with White men (3.0% [LQ-UQ = 0.7–5.9]). Using QRISK2, 19.1% [95% confidence interval (CI) = 16.2–22.0] fewer South Asian men are designated at high risk compared with 8.8% (95% CI = 5.9–7.8) fewer in White men. Across all ethnic groups, women had a lower median QRISK2 score (0.72 [LQ-UQ = ? 0.6 to 2.13]), although relatively more (2.0% [95% CI = 1.4–2.6]) were at high risk than with JBS2.

Conclusions. Ethnicity is an important CVD risk factor. Current scoring tools used in the UK produce significantly different estimates of CVD risk within ethnic groups, particularly in South Asian men. Work to accurately estimate CVD risk in ethnic minority groups is important if CVD prevention programmes are to address health inequalities.