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Stienen S, Salah K, Eurlings LW, Bettencourt P, Pimenta JM, Metra M, Bayes-Genis A, Verdiani V, Bettari L, Lazzarini V, Tijssen JP, Pinto YM, Kok WE. Targeting N-Terminal Pro-Brain Natriuretic Peptide in Older Versus Younger Acute Decompensated Heart Failure Patients. JACC Heart Fail 2016; 4:736-45. [PMID: 27395353 DOI: 10.1016/j.jchf.2016.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/02/2016] [Accepted: 05/03/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The aim of this study was to analyze the prognostic value and attainability of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in young and elderly acute decompensated heart failure (ADHF) patients. BACKGROUND Less-effective NT-proBNP-guided therapy in chronic heart failure (HF) has been reported in elderly patients. Whether this can be attributed to differences in prognostic value of NT-proBNP or to differences in attaining a prognostic value is unclear. The authors studied this question in ADHF patients. METHODS Our study population comprised 7 ADHF cohorts. We defined absolute (<1,500 ng/l, <3,000 ng/l, <5,000 ng/l, and <15,000 ng/l) and relative NT-proBNP discharge cut-off levels (>30%, >50%, and >70%). Six-month all-cause mortality after discharge was studied for each level in Cox regression analyses, and compared between elderly (age >75 years) and young patients (age ≤75 years). Thereafter, we compared percentages of elderly and young patients attaining NT-proBNP levels (= attainability). RESULTS A total of 1,235 patients (59% male, 45% >75 years of age) was studied. Admission levels of NT-proBNP were significantly higher in elderly versus younger patients. The prognostic value of absolute and relative NT-proBNP levels was similar in elderly and young patients. Attainability was significantly lower in elderly patients for all absolute levels and a >50% relative reduction, but not for >30% and >70%. For absolute levels, attainability differences between age groups were decreased to a large extent after correction for admission NT-proBNP and anemia at discharge. For relative levels, attainability differences disappeared after correction for HF etiology and anemia at discharge. CONCLUSIONS In young and elderly ADHF patients, it is not the prognostic value of absolute and relative NT-proBNP levels that is different, but the attainability of these levels that is lower in the elderly. This can largely be attributed to factors other than age.
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Affiliation(s)
- Susan Stienen
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Khibar Salah
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Luc W Eurlings
- Department of Cardiology, VieCuri Medical Center, Venlo, the Netherlands
| | - Paulo Bettencourt
- Department of Internal Medicine, Hospital S. João, University of Porto Medical School, Porto, Portugal
| | - Joana M Pimenta
- Department of Internal Medicine, Hospital S. João, University of Porto Medical School, Porto, Portugal
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Antoni Bayes-Genis
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Valerio Verdiani
- Department of Internal Medicine and Emergency, Careggi University Hospital, Florence, Italy
| | - Luca Bettari
- Department of Cardiology, Azienda Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Valentina Lazzarini
- Department of Cardiology, Ospedale San Pellegrino, Castiglione delle Stiviere, MN, Italy
| | - Jan P Tijssen
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Yigal M Pinto
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Wouter E Kok
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands.
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LaMontagne DS, Fenton KA, Pimenta JM, Catchpole M, Rogers PA, Randall S, Hewitt WG, Mallinson H, Underhill GS, McLean L, Gleave T, Harindra V, Ghosh AK, Tobin JM. Using chlamydia positivity to estimate prevalence: evidence from the Chlamydia Screening Pilot in England. Int J STD AIDS 2016; 16:323-7. [PMID: 15899088 DOI: 10.1258/0956462053654249] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Studies have suggested that positivity can be used to estimate the prevalence of Chlamydia trachomatis in large-scale chlamydia screening programmes. A recent pilot of opportunistic screening in England estimated that the prevalence among 16–24-year-old women in Portsmouth and Wirral was 9.8% and 11.2%, respectively. This study assessed the continued validity of positivity as an approximate for prevalence. We re-analysed data from the Chlamydia Screening Pilot to estimate positivity, calculated as total positive tests divided by total tests, and compared these estimates with the previously reported prevalence, measured as the number of women testing positive divided by the total number of women screened. Overall positivity was 9.4% in Portsmouth and 11.0% in the Wirral; these estimates were not statistically different from prevalence, regardless of health-care setting, age group or symptoms. We conclude that positivity can be used as a proxy for prevalence.
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Affiliation(s)
- D S LaMontagne
- Health Protection Agency, Communicable Disease Surveillance Centre, HIV and STI Department, 61 Colindale Avenue, London NW9 5EQ, UK.
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Salah K, Kok WE, Eurlings LW, Bettencourt P, Pimenta JM, Metra M, Verdiani V, Tijssen JG, Pinto YM. Competing Risk of Cardiac Status and Renal Function During Hospitalization for Acute Decompensated Heart Failure. JACC: Heart Failure 2015; 3:751-61. [DOI: 10.1016/j.jchf.2015.05.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 05/29/2015] [Accepted: 05/31/2015] [Indexed: 10/23/2022]
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Stienen S, Salah K, Eurlings LW, Bettencourt P, Pimenta JM, Metra M, Bayes-Genis A, Verdiani V, Bettari L, Lazzarini V, Tijssen JP, Pinto YM, Kok WE. Challenging the two concepts in determining the appropriate pre-discharge N-terminal pro-brain natriuretic peptide treatment target in acute decompensated heart failure patients: absolute or relative discharge levels? Eur J Heart Fail 2015. [DOI: 10.1002/ejhf.320] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Susan Stienen
- Department of Cardiology; Academic Medical Center; Amsterdam The Netherlands
| | - Khibar Salah
- Department of Cardiology; Academic Medical Center; Amsterdam The Netherlands
| | - Luc W.M. Eurlings
- Department of Cardiology; Maastricht University Medical Center; The Netherlands
| | - Paulo Bettencourt
- Department of Internal Medicine, Centro Hospitalar de S. João; University of Porto Medical School; Porto Portugal
| | - Joana M. Pimenta
- Department of Internal Medicine, Centro Hospitalar de S. João; University of Porto Medical School; Porto Portugal
| | - Marco Metra
- Department of Medical and Surgical Specialties; Radiological Sciences and Public Health; University of Brescia Italy
| | - Antoni Bayes-Genis
- Department of Cardiology; Hospital Universitari Germans Trias i Pujol; Barcelona Spain
| | - Valerio Verdiani
- Department of Internal Medicine and Emergency; Careggi University Hospital; Florence Italy
| | - Luca Bettari
- Department of Cardiology; Azienda Istituti Ospitalieri di Cremona; Cremona Italy
| | - Valentina Lazzarini
- Department of Medical and Surgical Specialties; Radiological Sciences and Public Health; University of Brescia Italy
| | - Jan P. Tijssen
- Department of Cardiology; Academic Medical Center; Amsterdam The Netherlands
| | - Yigal M. Pinto
- Department of Cardiology; Academic Medical Center; Amsterdam The Netherlands
| | - Wouter E.M. Kok
- Department of Cardiology; Academic Medical Center; Amsterdam The Netherlands
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Salah K, Kok WE, Eurlings LW, Bettencourt P, Pimenta JM, Metra M, Bayes-Genis A, Verdiani V, Bettari L, Lazzarini V, Damman P, Tijssen JG, Pinto YM. A novel discharge risk model for patients hospitalised for acute decompensated heart failure incorporating N-terminal pro-B-type natriuretic peptide levels: a European coLlaboration on Acute decompeNsated Heart Failure: ELAN-HF Score. Heart 2013; 100:115-25. [PMID: 24179162 DOI: 10.1136/heartjnl-2013-303632] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Models to stratify risk for patients hospitalised for acute decompensated heart failure (ADHF) do not include the change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels during hospitalisation. OBJECTIVE The aim of our study was to develop a simple yet robust discharge prognostication score including NT-proBNP for this notorious high-risk population. DESIGN Individual patient data meta-analyses of prospective cohort studies. SETTING Seven prospective cohorts with in total 1301 patients. PATIENTS Our study population was assembled from the seven studies by selecting those patients admitted because of clinically validated ADHF, discharged alive, and NT-proBNP measurements available at admission and at discharge. MAIN OUTCOME MEASURES The endpoints studied were all-cause mortality and a composite of all-cause mortality and/or first readmission for cardiovascular reason within 180 days after discharge. RESULTS The model that incorporated NT-proBNP levels at discharge as well as the changes in NT-proBNP during hospitalisation in addition to age ≥75 years, peripheral oedema, systolic blood pressure ≤115 mm Hg, hyponatremia at admission, serum urea of ≥15 mmol/L and New York Heart Association (NYHA) class at discharge, yielded the best C-statistic (area under the curve, 0.78, 95% CI 0.74 to 0.82). The addition of NT-proBNP to a reference model significantly improved prediction of mortality as shown by the net reclassification improvement (62%, p<0.001). A simplified model was obtained from the final Cox regression model by assigning weights to individual risk markers proportional to their relative risks. The risk score we designed identified four clinically significant subgroups. The pattern of increasing event rates with increasing score was confirmed in the validation group (BOT-AcuteHF, n=325, p<0.001). CONCLUSIONS In patients hospitalised for ADHF, the addition of the discharge NT-proBNP values as well as the change in NT-proBNP to known risk markers, generates a relatively simple yet robust discharge risk score that importantly improves the prediction of adverse events.
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Affiliation(s)
- Khibar Salah
- Heart failure Research Center & Department of Cardiology, Academic Medical Center, University of Amsterdam, , Amsterdam, The Netherlands
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Abstract
Thrombocytopenia (TCP) is a haematological condition known to occur in chronically infected hepatitis C (HCV) patients and may interfere with diagnostic procedures, such as liver biopsy, because of risk of bleeding. It may also exclude patients from effective antiviral treatment. We conducted a systematic literature review of articles and conference abstracts, to assess the prevalence of TCP among those with HCV and to describe demographics, liver disease stage and treatment characteristics of these patients. Studies of individuals with confirmed chronic HCV infection were included in the review if the study had a clear definition of thrombocytopenia and a sample size of at least 50 subjects. The final selection included 27 studies (21 articles and six abstracts). The definitions of thrombocytopenia varied between studies and were based either on platelet counts, with threshold levels ranging between ≤ 100 × 10(9) and ≤ 180 × 10(9) /L, or on criteria set in haematological guidelines. The prevalence of TCP ranged from 0.16% to 45.4% and more than half of the studies reported a TCP prevalence of 24% or more. Because of the different TCP definitions, heterogeneity in study design and insufficient data on study characteristics such as age, gender, HCV treatment rates and disease severity an overall summary estimate of TCP prevalence among patients with HCV was not feasible. However, the relatively large prevalence in the majority of the studies suggests that there may be a substantial number of HCV patients at risk of bleeding complications and reduced likelihood of successful HCV antiviral treatment.
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Affiliation(s)
- K S Louie
- Worldwide Epidemiology, GlaxoSmithKline, Stockley Park, Middlesex, UK
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Salah K, Kok WE, Eurlings LW, Bettencourt P, Pimenta JM, Bettari L, Bayes-Genis A, Verdiani V, Tijssen JG. Prognostic Value of Discharge Levels of N-Terminal Pro-Brain Natriuretic Peptide in 1301 Patients: A European Collaborative Study. J Card Fail 2010. [DOI: 10.1016/j.cardfail.2010.06.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Arama V, Cercel AS, Vladareanu R, Mihai C, Mihailescu R, Rankin J, Goschin S, Filipescu A, Rafila A, Arama S, Hristea A, Malkin JE, Pimenta JM, Smith JS. Type-specific herpes simplex virus-1 and herpes simplex virus-2 seroprevalence in Romania: comparison of prevalence and risk factors in women and men. Int J Infect Dis 2010; 14 Suppl 3:e25-31. [PMID: 20106695 DOI: 10.1016/j.ijid.2009.07.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Revised: 07/07/2009] [Accepted: 07/17/2009] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To determine herpes simplex virus (HSV)-2 and HSV-1 seroprevalence in women and men in Romania. METHODS A cross-sectional seroprevalence survey was conducted between 2004 and 2005 on a total of 1058 women and men representative of the population of Bucharest. All participants were aged 15-44 years and completed a structured questionnaire. A blood sample was collected to detect IgG anti-HSV-1 and HSV-2 serum antibodies using the HerpeSelect ELISA (Focus Diagnostics). RESULTS A total of 761 women (median age 29 years) and 297 men (median age 29 years) were included. Overall, HSV-2 seroprevalence (15.2%) increased with age. Among women, HSV-2 seroprevalence increased from 11.0% in 15-19-year-olds to 38.3% in 40-44-year-olds. Among men, seroprevalence increased from 4.0% in 20-24-year-olds to 27.1% in 40-44-year-olds. HSV-2 seroprevalence was significantly higher among women than men (17.0% vs. 10.8%). HSV-1 seropositivity was high (87.2%) in all age groups, with no clear trend by age or by sex. In addition to older age and female sex, risk factors for HSV-2 included greater number of lifetime sexual partners, lower educational attainment, and history of genital vesicles. Lower educational level and rural residence were associated with a higher risk of HSV-1 seropositivity. CONCLUSIONS In Romania, HSV-2 seroprevalence was higher in women than men, and was within European limits and lower than that in Africa and the USA. In contrast, HSV-1 seroprevalence was generally higher than that previously recorded in similarly aged populations in Western Europe.
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Affiliation(s)
- V Arama
- Professor Dr. Matei Bals National Infectious Diseases Institute, Bucharest, Romania
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Papadogeorgakis H, Caroni C, Katsambas A, Pimenta JM, Avdeliodi C, Kotrotsou T, Frangoulis E, Smith JS. Herpes simplex virus seroprevalence among children, adolescents and adults in Greece. Int J STD AIDS 2008; 19:272-8. [PMID: 18482949 DOI: 10.1258/ijsa.2007.007142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim was to study the type-specific seroprevalence of Herpes simplex virus (HSV)-1 and HSV-2 infections and the associated risk factors in children, adolescents and adults in Greece. A total of 1867 serum samples from children, adolescents and adults of both genders aged from 0 to 60 years were collected from three large hospital-referral centres in Athens. All sera were tested for type-specific antibodies to HSV-1 and HSV-2 using HerpeSelect IgG ELISA tests (Focus Diagnostics Cypress, Cal, USA). Overall age-adjusted seroprevalence of HSV-1 and HSV-2 was 72.0% and 10.2%, respectively. HSV-1 seropositivity was low in children up to nine years of age, increased sharply in adolescence, and was higher in females than males in each group surveyed. HSV-2 seropositivity was low (0.8%) below 20 years of age and increased to a maximum prevalence of 18.7% in men and 22.7% in women. Multivariate risk factor analyses indicated that HSV-1 seropositivity was associated with socioeconomic indicators (e.g. lower educational level, residency outside greater Athens), whereas HSV-2 was associated with sexual behavioural factors (e.g. being divorced, greater number of lifetime sexual partners). HSV-2 risk factor profiles were similar in women and in men. This first large seroprevalence study in Greece showed a high age-standardized HSV-1 seropositivity after adolescence and a relatively low age-standardized HSV-2 seroprevalence from birth to 60 years of age. Dual seropositivity to HSV-1 and HSV-2 was low (0.6%) in females under 20 years of age, suggesting that the potential use of an HSV-2 prophylactic vaccine in adolescents could reduce the spread of HSV-2 infection.
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Affiliation(s)
- H Papadogeorgakis
- Department of Microbiology, A. Sygros Dermatology Hospital, University of Athens, Greece
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Smith JS, Rosinska M, Trzcinska A, Pimenta JM, Litwinska B, Siennicka J. Type specific seroprevalence of HSV-1 and HSV-2 in four geographical regions of Poland. Sex Transm Infect 2006; 82:159-63. [PMID: 16581747 PMCID: PMC2564693 DOI: 10.1136/sti.2005.015446] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To examine the type specific seroprevalence of herpes simplex virus (HSV) types 1 and 2 infections, stratified by age and gender, and associated risk factors for HSV-2 seropositivity in Poland. METHODS 2257 serum samples of individuals from 15-65 years were randomly selected from serum banks in four different geographical regions of Poland, including the Zachodnio-pomorskie, Warmińsko-mazurskie, Lubelskie, and Mazowieckie districts. Type specific serum antibodies to HSV-1 and HSV-2 were detected using HerpeSelect IgG ELISA tests. RESULTS Overall prevalences of type specific HSV-1 and HSV-2 serum antibodies were 90.4% and 9.3%, respectively. Age standardised HSV-2 seroprevalence was higher in women (9.7%) than men (8.8%) (p = 0.06), and increased notably with age from 4% in 15-24 year olds to 12% in those aged 50-65 years. HSV-1 seroprevalence was consistently higher than HSV-2 seroprevalence in each specific age group, ranging from 74.5% in 15-24 year olds to 98.8% in 50-65 year olds. HSV-2 seroprevalence varied significantly by geographical region, with the highest prevalence in the Zachodnio-pomorskie district (12%). Significant multivariate risk factors for HSV-2 seropositivity included older age, female gender, and geographical place of residence. CONCLUSION This large survey found a notably high seroprevalence of HSV-1, even among young female adolescents 15-19 years of age (80%). HSV-2 seropositivity was under 12% in all age groups surveyed in Poland, tending to be among the lowest overall HSV-2 seropositivity rates reported thus far in Europe.
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Affiliation(s)
- J S Smith
- Department of Virology, National Institute of Hygiene, Warsaw, Poland
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Rana RK, Pimenta JM, Rosenberg DM, Warren T, Sekhin S, Cook SF, Robinson NJ. Sexual behaviour and condom use among individuals with a history of symptomatic genital herpes. Sex Transm Infect 2006; 82:69-74. [PMID: 16461610 PMCID: PMC2563838 DOI: 10.1136/sti.2004.012989] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study describes the differences in sexual behaviour in individuals with genital herpes (GH) during "symptomatic" and "asymptomatic" periods of the disease. METHODS A cross sectional questionnaire was undertaken by 1193 individuals attending clinics between 1998 and 2001. All participants in this analysis were in heterosexual, monogamous partnerships, self identified with a history of symptomatic GH and with confirmed HSV-2 infection. RESULTS Sexual activity reported during asymptomatic v symptomatic periods of GH was 98% v 40% (p<0.001), 76% v 29% (p<0.001), and 25% v 11% (p<0.001) for vaginal, oral, and anal intercourse, respectively, while "always" condom use during asymptomatic and symptomatic periods was 20% v 35% (p<0.001), 2% v 7% (p<0.001), and 10% v 15% (p = 0.131), respectively. The proportion of individuals who either abstained from vaginal intercourse or "always" used condoms was 21% v 74% (p<0.001), for asymptomatic v symptomatic periods. Multivariable analyses indicated that factors associated with engaging in intercourse during symptomatic periods of GH included current intrauterine device use (adjusted odds ratio (aOR) = 2.96, 95% confidence interval (CI) = 1.46 to 6.02); living in Latin America (aOR = 2.16, CI = 1.19 to 3.91) or Europe (aOR = 1.67, CI = 1.21 to 2.28), compared with North America; previous sexually transmitted disease (aOR = 1.42, CI = 1.08 to 1.89); a higher number of sexual acts per month (aOR = 1.09, CI = 1.06 to 1.11); and a higher number of GH recurrences per year (aOR = 1.08, CI = 1.03 to 1.12). CONCLUSIONS These data indicate that the majority of people with GH either abstained from intercourse or "always" used condoms during symptomatic periods of GH. However, condom use was relatively low during asymptomatic periods in comparison with symptomatic periods. These results highlight that further education on GH prevention is warranted, particularly for symptomatic periods.
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Affiliation(s)
- R K Rana
- Worldwide Epidemiology, GlaxoSmithKline, Greenford Road, Greenford, Middlesex, UB6 0BE, UK
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Adams EJ, LaMontagne DS, Johnston AR, Pimenta JM, Fenton KA, Edmunds WJ. Modelling the healthcare costs of an opportunistic chlamydia screening programme. Sex Transm Infect 2004; 80:363-70. [PMID: 15459403 PMCID: PMC1744903 DOI: 10.1136/sti.2004.009654] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To estimate the average cost per screening offer, cost per testing episode and cost per chlamydia positive episode for an opportunistic chlamydia screening programme (including partner management), and to explore the uncertainty of parameter assumptions, based on the costs to the healthcare system. METHODS A decision tree was constructed and parameterised using empirical data from a chlamydia screening pilot study and other sources. The model was run using baseline data from the pilot, and univariate and multivariate sensitivity analyses were conducted. RESULTS The total estimated cost for offering screening over 12 months to 33,215 females aged 16-24 was 493,412 pounds . The average cost (with partner management) was 14.88 pounds per screening offer (90% credibility interval (CI) 10.34 to 18.56), 21.83 pounds per testing episode (90% CI 18.16 to 24.20), and 38.36 pounds per positive episode (90% CI 33.97 to 42.25). The proportion of individuals accepting screening, the clinician (general practitioner/nurse) time and their relative involvement in discussing screening, the test cost, the time to notify patients of their results, and the receptionist time recruiting patients had the greatest impact on the outcomes in both the univariate and multivariate sensitivity analyses. CONCLUSIONS Results from this costing study may be used to inform resource allocation for current and future chlamydia screening programme implementation.
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Affiliation(s)
- E J Adams
- Statistics, Modelling and Economics Department, Communicable Disease Surveillance Centre, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, UK.
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Pimenta JM, Catchpole M, Rogers PA, Perkins E, Jackson N, Carlisle C, Randall S, Hopwood J, Hewitt G, Underhill G, Mallinson H, McLean L, Gleave T, Tobin J, Harindra V, Ghosh A. Opportunistic screening for genital chlamydial infection. I: acceptability of urine testing in primary and secondary healthcare settings. Sex Transm Infect 2003; 79:16-21. [PMID: 12576607 PMCID: PMC1744586 DOI: 10.1136/sti.79.1.16] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To determine the acceptability of opportunistic screening for Chlamydia trachomatis in young people in a range of healthcare settings. DESIGN An opportunistic screening programme (1 September 1999 to 31 August 2000) using urine samples tested by ligase chain reaction (LCR). Data on uptake and testing were collected and in-depth interviews were used for programme evaluation. SETTING General practice, family planning, genitourinary medicine clinics, adolescent sexual health clinics, termination of pregnancy clinics, and women's services in hospitals (antenatal, colposcopy, gynaecology and infertility clinics) in two health authorities (Wirral and Portsmouth and South East Hampshire). Main participants: Sexually active women aged between 16 and 24 years attending healthcare settings for any reason. MAIN OUTCOME MEASURES Uptake data: proportion of women accepting a test by area, healthcare setting, and age; overall population coverage achieved in 1 year. Evaluation data: participants' attitudes and views towards opportunistic screening and urine testing. RESULTS Acceptance of testing by women (16-24 years) was 76% in Portsmouth and 84% in Wirral. Acceptance was lower in younger women (Portsmouth only) and varied by healthcare setting within each site. 50% of the target female population were screened in Portsmouth and 39% in Wirral. Both the opportunistic offer of screening and the method of screening were universally acceptable. Major factors influencing a decision to accept screening were the non-invasive nature of testing and treatment, desire to protect future fertility, and the experimental nature of the screening programme. CONCLUSIONS An opportunistic model of urine screening for chlamydial infection is a practical, universally acceptable method of screening.
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Affiliation(s)
- J M Pimenta
- PHLS Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK
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Pimenta JM, Catchpole M, Rogers PA, Hopwood J, Randall S, Mallinson H, Perkins E, Jackson N, Carlisle C, Hewitt G, Underhill G, Gleave T, McLean L, Ghosh A, Tobin J, Harindra V. Opportunistic screening for genital chlamydial infection. II: prevalence among healthcare attenders, outcome, and evaluation of positive cases. Sex Transm Infect 2003; 79:22-7. [PMID: 12576608 PMCID: PMC1744609 DOI: 10.1136/sti.79.1.22] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To determine the prevalence and treatment outcomes among young women screened opportunistically for genital Chlamydia trachomatis and to evaluate the impact of screening in those participating. DESIGN An opportunistic screening programme (1 September 1999 to 31 August 2000) using urine samples, tested by ligase chain reaction (LCR). In-depth interviews were used for programme evaluation. SETTING Screening was offered in two health authorities at general practice, family planning, genitourinary medicine (GUM), adolescent sexual health, termination of pregnancy clinics and women's services in hospitals (antenatal, colposcopy, gynaecology and infertility clinics). Main participants: Sexually active women (16-24 years) attending for any reason. MAIN OUTCOME MEASURES Screening data: prevalence of infection by age and healthcare setting; proportion of positive patients attending for treatment. Evaluation data: participants' attitudes and views towards screening and follow up. RESULTS In total, 16 930 women (16-24 years) were screened. Prevalence was higher in younger women (16-20) than those aged 21-24 years and was highly variable at different healthcare settings (range 3.4%-17.6%). Prevalence was approximately 9% in general practice. The role of the project health advisers in managing results and coordinating treatment of positive individuals was essential; the vast majority of all positives were known to be treated. Women felt that screening was beneficial. Improving awareness and education about sexually transmitted infections is required to alleviate negative reactions associated with testing positive for infection. CONCLUSIONS Prevalence of infection outside GUM clinics is substantial and opportunistic screening using urine samples is an acceptable method of reaching individuals with infection who do not normally present at specialist clinics.
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Affiliation(s)
- J M Pimenta
- PHLS Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK
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