Classification of high-risk depressed mood groups in cancer patients based on Health Ecology Model

BACKGROUND

Depressed mood affects a significant number of patients with cancer, and can impair their quality of life and interfere with successful treatment. Our study aims to create a predictive model for identifying high-risk groups of depressed mood in cancer patients, offering a theoretical support for preventing depressed mood in these individuals.

METHODS

The China Health and Retirement Longitudinal Study (CHARLS) provided the data for this research, which used CES-D as a tool to identify individuals with depressed mood. Influencing factors of depressed mood in cancer patients was analyzed using a binary logistic regression model. Using the Harvard Cancer Index, we classified the high-risk patients for depressed mood.

RESULTS

In present study, 52.96 % of cancer patients met criteria for depressed mood based on the CES-D. Significant correlations were found between depressed mood and factors such as gender, self-rated health, sleep duration, exercise, satisfaction with family, residence, education, life satisfaction, and medical insurance. Utilizing the Harvard Cancer Index, we classified patients into five risk levels for depressed mood, revealing a significant variation in the number of depressive patients across these levels (x2=99.82, P < 0.05). Notably, the incidence of depressed mood increased with the risk level among cancer patients (x2=103.40, P < 0.05).

LIMITATIONS

Lack of data on tumor typing and subgroups makes it unlikely to explore the specifics of depressed mood in patients with various types of cancer.

CONCLUSION

The determinants of depressed mood in cancer patients are multi-dimensional. The Harvard Cancer Index may be helpful in identifying high-risk populations.

Beyond the numbers: An in-depth look at Cameroon's fifth national COVID-19 vaccination campaign through geographical and gender lenses

BACKGROUND

Cameroon has been struggling with low Covid-19 vaccination coverage, with only 4.5 % of the population receiving the primary series as of November 2022. The COVID-19 Vaccine Delivery Partnership (CoVDP) conducted a high-level mission to Cameroon to assess progress and advocate for actions to address bottlenecks. The objective of the mission was to administer at least 3,000,000 doses of vaccines during the 5th Mass vaccination campaign. This study examines the factors contributing to the success of the campaign and uses a geographical and gender lens to assess the results.

METHODS

The study is a secondary analysis of data from the DHIS2 collected during the 5th mass vaccination campaign for Covid-19. Descriptive statistics were used to assess coverages per location and gender expressed in OR. sccess factors, and chi-squared tests were used to assess differences in vaccine distribution across regions and by gender.

RESULTS

This 5th vaccination campaign benefitted from a strong political commitment facilitated by CoVDP's mission, international support, collaboration, planning, supervision, and demand generation. The campaign recorded 2 019 118 administered vaccine doses, a staggering 46-fold increase in vaccinated individuals relative to the first round, with vaccination coverage reaching 10.1 % of the general population. However, the study reveals regional and gender disparities in vaccination coverage. Men had higher odds of being vaccinated than women in the three Sahel regions. Among individuals with comorbidities, the national coverage rate was only 14 %, and the Far North and East regions exhibited the lowest coverage rates. Janssen was the most used vaccine, and the total AEFI cases reported were 2 per 1000 vaccine doses.

CONCLUSION

The 5th COVID-19 vaccination campaign in Cameroon saw a strong political commitment and was the most successful so far. Despite the gains, there was gender disparity in coverage in some regions. It is important to continue the established momentum, ensure equitable access in the Sahel regions, and reach high-priority groups with primary series and booster doses.

Role of social organization engagement in high-risk groups intervention against HIV/AIDS: a case study from 176 cities of China

BACKGROUND

A high-risk prevention strategy is an effective way to fight against human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). The China AIDS Fund for Non-Governmental Organizations (CAFNGO) was established in 2015 to help social organizations intervene to protect high-risk populations in 176 cities. This study aimed to evaluate the role of social organizations in high-risk population interventions against HIV/AIDS.

METHODS

This study was based on the CAFNGO program from 2016 to 2020. The collected data included the number and types of social organizations participating in high-risk group interventions and the amount of funds obtained by these organizations each year. We explored the factors influencing the number of newly diagnosed AIDS cases using a spatial econometric model. Furthermore, we evaluated the effectiveness of intervention activities by comparing the percentages of the individuals who initially tested positive, and the individuals who took the confirmatory test, as well as those who retested positive and underwent the treatment.

RESULTS

Overall, from 2016 to 2020, the number of social organizations involved in interventions to protect HIV/AIDS high-risk populations increased from 441 to 532, and the invested fund increased from $3.98 to $10.58 million. The number of newly diagnosed cases decreased from 9128 to 8546 during the same period. Although the number of cities with overall spatial correlations decreased, the spatial agglomeration effect persisted in the large cities. City-wise, the number of social organizations (direct effect 19.13), the permanent resident population (direct effect 0.12), GDP per capita (direct effect 17.58; indirect effect - 15.38), and passenger turnover volume (direct effect 5.50; indirect effect - 8.64) were the major factors influencing new positive cases confirmed through the testing interventions performed by the social organizations. The initial positive test rates among high-risk populations were below 5.5%, the retesting rates among those who initially tested positive were above 60%, and the treatment rates among diagnosed cases were above 70%.

CONCLUSIONS

The spatial effect of social organizations participating in interventions targeting high-risk populations funded by CAFNGO is statistically significant. Nevertheless, despite the achievements of these social organizations in tracking new cases and encouraging treatment, a series of measures should be taken to further optimize the use of CAFNGO. Working data should be updated from social organizations to CAFNGO more frequently by establishing a data monitoring system to help better track newly diagnosed AIDS cases. Multichannel financing should be expanded as well.

Post-pandemic stress of COVID-19 among high-risk groups: A systematic review and meta-analysis

BACKGROUND

Post-Traumatic Stress Disorder (PTSD) is considered as a prevalent outcome of the COVID-19 pandemic. This study aimed to present a global picture of the prevalence of PTSD in high-risk groups for COVID-19 (HRGs-COVID19) and determine its risk factors.

METHODS

Cross-sectional studies published between March 11, 2020, and October 11, 2021, in English, were searched in seven databases on the prevalence of PTSD in HRGs-COVID19. After screening the retrieved records, their quality was assessed, and the required data were extracted. R-4.1.3 software and random effect model with 95 % confidence interval (CI) were used to synthesize and analyze the data.

RESULTS

The pooled prevalence of PTSD in HRGs-COVID19 was 30 % (95 % CI: 21-39 %). The pooled prevalence of PTSD was significantly different in terms of the variables of data collection during the lockdown, gender, and data collection season (P < 0.05). Subgroup analyses could not identify sources of heterogeneity.

LIMITATIONS

The included studies did not cover all HRGs-COVID19 such as smokers and the elderly.

CONCLUSION

Considering the higher pooled prevalence of PTSD in HRGs-COVID19 than the general population, COVID-19 patients, and health care workers, prioritizing this subgroup for prevention and treatment of psychological outcomes is highly recommended. Predicting and implementing psychological interventions early in the pandemic is more critical when applying restrictive measures and among HRGs-COVID19 women.

New infections and HIV-1 subtypes among febrile persons and blood donors in Oyo State, Nigeria

PURPOSE

There were approximately 37.9 million persons infected with HIV in 2018 globally, resulting in 770,000 deaths annually. Over 50% of this infection and deaths occur in sub-Saharan Africa, with countries like Nigeria being seriously affected. Nigeria has one of the highest rates of new infections globally. To control HIV infection in Nigeria, there is a need to continually screen high-risk groups for early HIV infection and subtypes using very sensitive methods. In this study, new HIV-1 infection and circulating HIV-1 subtypes among febrile persons and blood donors were determined. Performance characteristics of three commercial EIA kits were also evaluated.

METHODS

In total, 1028 participants were recruited for the study. New HIV-1 infection and subtypes were determined using enzyme immunoassays and molecular techniques, respectively. Sensitivity, specificity, predictive values, and agreements were compared among the EIA kits using PCR-confirmed HIV-positive and negative samples.

RESULTS

The overall prevalence of HIV infection in this study was 5.35%. The rate of new HIV infection was significantly different (p < .03674) among 1028 febrile persons (Ibadan: 2.22%; Saki: 1.36%) and blood donors (5.07%) studied. Three subtypes, CRF02_AG, A, and G, were found among those with new HIV infection. Whereas the commercial ELISA kits had very high specificities (94.12%, 100%, and 100%) for HIV-1 detection, Alere Determine HIV-1 antibody rapid kit had the lowest sensitivity score (50%).

CONCLUSION

Genetic diversity of HIV-1 strains among infected individuals in Oyo State, Nigeria, is still relatively high. This high level of diversity of HIV-1 strains may impact the reliability of diagnosis of the virus in Nigeria and other African countries where many of the virus strains co-circulate.

Meningococcal disease surveillance in the Asia-Pacific region (2020): The global meningococcal initiative

The degree of surveillance data and control strategies for invasive meningococcal disease (IMD) varies across the Asia-Pacific region. IMD cases are often reported throughout the region, but the disease is not notifiable in some countries, including Myanmar, Bangladesh and Malaysia. Although there remains a paucity of data from many countries, specific nations have introduced additional surveillance measures. The incidence of IMD is low and similar across the represented countries (<0.2 cases per 100,000 persons per year), with the predominant serogroups of Neisseria meningitidis being B, W and Y, although serogroups A and X are present in some areas. Resistance to ciprofloxacin is also of concern, with the close monitoring of antibiotic-resistant clonal complexes (e.g., cc4821) being a priority. Meningococcal vaccination is only included in a few National Immunization Programs, but is recommended for high-risk groups, including travellers (such as pilgrims) and people with complement deficiencies or human immunodeficiency virus (HIV). Both polysaccharide and conjugate vaccines form part of recommendations. However, cost and misconceptions remain limiting factors in vaccine uptake, despite conjugate vaccines preventing the acquisition of carriage.

A systematic review of BCG vaccination policies among high-risk groups in low TB-burden countries: implications for vaccination strategy in Canadian indigenous communities

BACKGROUND

Bacille Calmette-Guérin (BCG) vaccination against tuberculosis (TB) is widespread in high-TB-burden countries, however, BCG vaccination policies in low-burden countries vary. Considering the uncertainties surrounding BCG efficacy and the lower likelihood of TB exposure in low-incidence countries, most have discontinued mass vaccination, choosing instead a targeted vaccination strategy among high-risk groups. Given the increased risk of TB infection in Canadian Indigenous communities compared to the general Canadian population, these communities are a pertinent example of high-incidence groups in an otherwise low-burden country, warranting particular consideration regarding BCG vaccination strategy. This systematic review aims to synthesise and critically appraise the literature on BCG vaccination strategies in high-risk groups in low-incidence settings to provide policy considerations relevant to the Canadian Indigenous context.

METHODS

A literature search of the Medline and Embase databases was conducted, returning studies pertaining to BCG vaccine efficacy, TB incidence under specific vaccination policies, BCG-associated adverse events, and vaccination policy guidelines in low-burden countries. Study screening was tracked using the Covidence systematic review software (Veritas Health Innovation, Melbourne, Australia), and data pertaining to the above points of interest were extracted.

RESULTS

The final review included 49 studies, spanning 15 countries. Although almost all of these countries had implemented a form of mass or routine vaccination previously, 11 have since moved to targeted vaccination of selected risk groups, in most cases due to the low risk of infection among the general population and thus the high number of vaccinations needed to prevent one case in the context of low-incidence settings. Regarding identifying risk groups for targeted screening, community-based (rather than individual risk-factor-based) vaccination has been found to be beneficial in high-incidence communities within low-incidence countries, suggesting this approach may be beneficial in the Canadian Indigenous setting.

CONCLUSIONS

Community-based vaccination of high-incidence communities may be beneficial in the Canadian Indigenous context, however, where BCG vaccination is implemented, delivery strategies and potential barriers to achieving adequate coverage in this setting should be considered. Where an existing vaccination program is discontinued, it is crucial that an effective TB surveillance system is in place, and that case-finding, screening, and diagnostic efforts are strengthened in order to ensure adequate TB control. This is particularly relevant in Canadian Indigenous and other remote or under-served communities, where barriers to surveillance, screening, and diagnosis persist.

Prevention and control of meningococcal disease: Updates from the Global Meningococcal Initiative in Eastern Europe

The Global Meningococcal Initiative (GMI) aims to prevent invasive meningococcal disease (IMD) worldwide through education, research and cooperation. In March 2019, a GMI meeting was held with a multidisciplinary group of experts and representatives from countries within Eastern Europe. Across the countries represented, IMD surveillance is largely in place, with incidence declining in recent decades and now generally at <1 case per 100,000 persons per year. Predominating serogroups are B and C, followed by A, and cases attributable to serogroups W, X and Y are emerging. Available vaccines differ between countries, are generally not included in immunization programs and provided to high-risk groups only. Available vaccines include both conjugate and polysaccharide vaccines; however, current data and GMI recommendations advocate the use of conjugate vaccines, where possible, due to the ability to interrupt the acquisition of carriage. Ongoing carriage studies are expected to inform vaccine effectiveness and immunization schedules. Additionally, IMD prevention and control should be guided by monitoring outbreak progression and the emergence and international spread of strains and antibiotic resistance through use of genomic analyses and implementation of World Health Organization initiatives. Protection of high-risk groups (such as those with complement deficiencies, laboratory workers, migrants and refugees) is recommended.

Prevalence of hepatitis C infection among the general population and high-risk groups in the EU/EEA: a systematic review update

Background

Although significant improvement in efficacy measured by a sustained virological response, the high acquisition costs of direct-acting antivirals limit the access for patients and influence the costs of healthcare resource utilisation in hepatitis C. It is important to have the latest estimates of prevalence, especially in high-risk groups, for cost of illness, cost-effectiveness and budget impact studies.

Methods

Original studies on the estimates of the prevalence among general and high-risk groups in the European Union/European Economic Area (EU/EEA) were retrieved from Medline and Embase for the period from 2015 to 2018. All included studies were evaluated for risk of selection bias and summarised together in a narrative form. Results from previous reviews and updated searches were compared per country among different populations, respectively.

Results

Among the 3871 studies identified, 46 studies were included: 20 studies were used for the estimate of the general population; 3 for men who have sex with men (MSM); 6 for prisoners; and 17 for people who inject drugs (PWID). Compared with the results reported in previous systematic reviews, the updated estimates were lower than previously in most available countries. Anti-HCV general population prevalence estimates ranged from 0.54 to 1.50% by country. The highest prevalence of anti-HCV was found among PWID (range of 7.90–82.00%), followed by prisoners (7.00–41.00%), HIV-positive MSM (1.80–7.10%), HIV-negative MSM (0.20–1.80%), pregnant women (0.10–1.32%) and first-time blood donors (0.03–0.09%).

Conclusions

Our study highlights the heterogeneity in anti-HCV prevalence across different population groups in EU/EEA. The prevalence also varies widely between European countries. There are many countries that are not represented in our results, highlighting the need for the development of robust epidemiological studies.

Electronic supplementary material

The online version of this article (10.1186/s12879-019-4284-9) contains supplementary material, which is available to authorized users.

Colorectal Cancer Screening. Prim Care. 2019;46:135-148. [PMID: 30704654 DOI: 10.1016/j.pop.2018.11.001]

This article focuses on programmatic and opportunistic colorectal cancer screening. The pathogenesis and risk factors for colon cancer are discussed. Specific screening tests, screening in high-risk groups, and surveillance recommendations are reviewed. Important considerations for office practice, including improving screening implementation and cost issues, are addressed.

HIV/AIDS epidemic in West Bengal: An overview

Background

West Bengal is a low-prevalent state with high vulnerability for HIV. The state bears around 6% of HIV burden of India. With consistent effort on preventive, diagnostic, and curative services under National AIDS Control Program, HIV prevalence is gradually coming down. Our study objective is to determine the trend of HIV positivity among different groups/population attending Integrated Counseling and Testing Centres (ICTCs) over a period of 8 years and identify the group of population needing special attention.

Methods

The study was conducted with available program data year-wise from 2008-2009 to 2014-2015 among different groups of population who attended ICTCs for HIV testing. Year-wise positivity was calculated and trend analysis was performed by linear regression method keeping year as regressor. Similar methodology was applied for different typologies among the high-risk groups (HRGs) and trend analysis was done using linear regression for the study period from 2012-2013 to 2014-2015.

Results

HIV positivity among general male and non-pregnant individuals, HRG population, transgender (TG) population, and pregnant women showed a significant declining trend over the past 8 financial years, but the discordance rate remained almost the same. Regarding HIV positivity trend among different typologies of HRGs, trucker group showed a significant increase in HIV positivity over the past 3 years, whereas HIV positivity among other groups like female sex workers, men having sex with men, injecting drug users, and migrant labors did not undergo significant changes over the past 3 years.

Conclusion

HIV-preventive services among truckers need to be emphasized. HIV screening services among the TG population should be further scaled up through more number of targeted interventions.

Detection of serum Mg7-Ag, CEA and pepsinogens combined with magnifying narrow-band imaging endoscopy for screening early gastric carcinoma in high risk patients

AIM

To assess the clinical value of serum Mg7-Ag, carcinoembryonic antigen (CEA), pepsinogen (PG) I, PGⅡ and PGI/PGⅡ ratio (PGR) combined with magnifying narrow-band imaging endoscopy (ME-NBI) for screening early gastric cancer (GC) in high-risk patients.

METHODS

A total of 802 patients at a high risk for GC were selected for the study. ELISA was used to detect serum Mg7-Ag, PGI, PGII, and CEA levels, and the PGR was calculated. According to the results, the patients were categorized as Mg7-Ag (+) and Mg7-Ag (-), PGI (+) and PGI (-), PGR (+) and PGR (-), and CEA (+) and CEA (-). Gastroscopy was performed for all enrolled patients, and gastric lesions were examined by ME-NBI and pathological examination was performed. According to the pathological results, the patients were divided into an inflammatory group, a precancerous disease group, an atypical hyperplasia group, an early GC group and an advanced GC group. Serum Mg7-Ag, PGI and PGR values and the number of patients with positive results were compared among different groups, and the sensitivity, specificity and accuracy of these indexes, alone or in combination, for early diagnosis of GC were calculated.

RESULTS

Serum level of PGI in the non-inflammatory group was significantly lower than that in the simple inflammatory group (P < 0.05). Serum levels of Mg7-Ag and CEA in the GC group were significantly higher than those in the non-GC group (P < 0.05). However, serum level of Mg7-Ag in the early GC group was not significantly different from that in the advanced GC group, while serum CEA level of the advanced GC group was significantly higher than that in the early GC group (P < 0.05). The sensitivity of Mg7-Ag combined with ME-NBI for diagnosing early GC was significantly higher than that of PGR and PGI (P < 0.05), but there was no significant difference in specificity between each group (P > 0.05). The accuracy of CEA in the diagnosis of GC was the lowest, and the accuracy of Mg7-Ag and ME-NBI detection was significantly higher than that of PGR and PGI. The sensitivity and accuracy of combined detection of PGI + PGR, PGI + PGR + Mg7-Ag, and PGI + PGR + Mg7-Ag + ME-NBI increased gradually, while there was no significant difference in specificity (P > 0.05). Positive result of PGI + PGR + Mg7-Ag + ME-NBI combined with CEA (-) had significantly higher sensitivity and accuracy than PGI + PGR + Mg7-Ag + ME-NBI (P < 0.05), although there was no significant difference in specificity (P > 0.05).

CONCLUSION

Combined detection of serum Mg7-Ag, PG and CEA plus ME-NBI examination is of great clinical significance for screening early GC in highly suspicious people.

Screening for coeliac disease in children

AIM

Coeliac disease is a common but markedly under-diagnosed condition, which may lead to serious long-term complications if untreated. Both the diagnostic yield and true incidence have significantly increased during the last few decades and it is now one of the most common chronic gastrointestinal conditions in children. The aim of this review was to summarise the current concepts on screening for coeliac disease in children and adolescents.

METHOD

We conducted a non-systematic literature review of papers published about coeliac disease screening since the year 2000.

RESULTS

Our review showed that the diagnostic yield could be significantly improved by screening for at-risk groups, or even the whole population, but these approaches remain controversial. Evidence suggests that screening for certain high-risk groups could be beneficial, but untargeted mass screening is not currently recommended. However, whether the benefits of an early diagnosis would overcome the challenges of lifelong dietary treatment, especially in asymptomatic individuals who consider themselves healthy, are unclear.

CONCLUSION

There is moderate evidence that screening certain at-risk groups for coeliac disease could be beneficial, but more studies in different settings are needed before large-scale population screening can be recommended.

Interventions for prevention of type 2 diabetes in relatives: A systematic review

The relatives and partners of people with type 2 diabetes are at increased risk of developing type 2 diabetes. This systematic review examines randomized controlled trials, written in English that tested an intervention, which aimed to modify behaviors known to delay or prevent type 2 diabetes, among the relatives or partners of people with type 2 diabetes. Study quality was assessed using the Cochrane Collaboration's tool for assessing risk of bias. Seven studies met the inclusion criteria. The majority of studies were at low risk of bias. Six studies tested an intervention in first-degree relatives of people with type 2 diabetes and one in partners. Intervention components and intervention intensity across studies varied, with those targeting diet and physical activity reporting the most significant changes in primary outcomes. Only one study did not observe significant changes in primary outcomes. There were three main recruitment approaches: advertising in the community, recruiting people through their relatives with diabetes, or identifying people as high risk by screening of their own health care contacts. Some evidence was found for potentially successful interventions to prevent type 2 diabetes among the relatives and partners of people with type 2 diabetes, although finding simple and effective methods to identify and recruit them remains a challenge. Future studies should explore the effect of patients' perceptions on their family members' behavior and capitalize on family relationships in order to increase intervention effectiveness.