OBJECTIVES: HIV/AIDS surveillance methods are under revision as the diversity of HIV epidemics is becoming more apparent. The so called "2nd generation surveillance (SGS) systems" aim to enhance surveillance by broadening the range of indicators to prevalence, behaviors and correlates, for a better understanding and a more complete and timely awareness of evolving epidemics. METHODS: Concepts of HIV SGS are reviewed with a special focus on injecting drug users, a major at-risk and hard to reach group in Europe, a region with mainly low or concentrated epidemics. RESULTS: The scope of HIV/AIDS surveillance needs to be broadened following principles of SGS. Specifically for IDUs we propose including hepatitis C data as indicator for injecting risk in routine systems like those monitoring sexually transmitted infections and information on knowledge and attitudes as potential major determinants of risk behavior. CONCLUSIONS: The suggested approach should lead to more complete and timely information for public health interventions, however there is a clear need for comparative validation studies to assess the validity, reliability and cost-effectiveness of traditional and enhanced HIV/AIDS surveillance systems.
Insulin-dependent (type 1) diabetes is a prototypic organ-specific autoimmune disease resulting from the selective destruction of insulin-secreting beta cells within pancreatic islets of Langerhans by an immune-mediated inflammation involving autoreactive CD4(+) and CD8(+) T lymphocytes which infiltrate pancreatic islets. Current treatment is substitutive, i.e. chronic use of exogenous insulin which, in spite of significant advances, is still associated with major constraints (multiple daily injections, risks of hypoglycaemia) and lack of effectiveness over the long term in preventing severe degenerative complications. Finding a cure for autoimmune diabetes by establishing effective immune-based therapies is a real medical health challenge, as the disease incidence increases steadily in industrialized countries. As the disease affects mainly children and young adults, any candidate immune therapy must therefore be safe and avoid a sustained depression of immune responses with the attendant problems of recurrent infection and drug toxicity. Thus, inducing or restoring immune tolerance to target autoantigens, controlling the pathogenic response while preserving the host reactivity to exogenous/unrelated antigens, appears to be the ideal approach. Our objective is to review the major progress accomplished over the last 20 years towards that aim. In addition, we would like to present another interesting possibility to access new preventive strategies based on the 'hygiene hypothesis', which proposes a causal link between the increasing incidence of autoimmune diseases, including diabetes, and the decrease of the infectious burden. The underlying rationale is to identify microbial-derived compounds mediating the protective activity of infections which could be developed therapeutically.
Cites: J Immunol. 2000 Jun 1;164(11):5683-810820244
We present new and revised data for the phocine distemper virus (PDV) epidemics that resulted in the deaths of more than 23 000 harbour seals Phoca vitulina in 1988 and 30,000 in 2002. On both occasions the epidemics started at the Danish island of Anholt in central Kattegat, and subsequently spread to adjacent colonies in a stepwise fashion. However, this pattern was not maintained throughout the epidemics and new centres of infection appeared far from infected populations on some occasions: in 1988 early positive cases were observed in the Irish Sea, and in 2002 the epidemic appeared in the Dutch Wadden Sea, 6 wk after the initiation of the outbreak at Anholt Island. Since the harbour seal is a rather sedentary species, such 'jumps' in the spread among colonies suggest that another vector species could have been involved. We discussed the role of sympatric species as disease vectors, and suggested that grey seal populations could act as reservoirs for PDV if infection rates in sympatric species are lower than in harbour seals. Alternatively, grey seals could act as subclinical infected carriers of the virus between Arctic and North Sea seal populations. Mixed colonies of grey and harbour seal colonies are found at all locations where the jumps occurred. It seems likely that grey seals, which show long-distance movements, contributed to the spread among regions. The harbour seal populations along the Norwegian coast and in the Baltic escaped both epidemics, which could be due either to genetic differences among harbour seal populations or to immunity. Catastrophic events such as repeated epidemics should be accounted for in future models and management strategies of wildlife populations.
Gamma-hydroxybutyrate (GHB) is naturally present in the human body, but may also be used as an intoxicating drug. Information from several sources has suggested its increased availability and use in Norway. There have also been reports of an increasing use of the chemical precursor gamma-butyrolactone (GBL).There is currently a need for knowledge on symptoms, addictiveness and overdoses, as well as targeted preventive measures.
The article is based on a discretionary selection of articles resulting from a literature search in PubMed, as well as reports from Norwegian and European authorities and research institutions.
An intake of small amounts of GHB produces an intoxicating effect, whereas higher doses can result in poisoning. Deaths have been reported. The effect may be variable, due to a steep dose-response curve and interaction with alcohol and other intoxicants. Treatment of poisoning is symptomatic and supportive. Treatment of abstinence is also supportive, while delirium may be treated as delirium tremens.
Preventive measures should be tailored specifically to potential user-groups.
As the development in mean age of the population and life expectancy has been less favourable in Denmark than in the rest of Western Europe, the Ministry of Health decided to investigate statistics for the period, 1972-1990, for the main areas where Danish life expectancy was poorer. A sharp increase in the incidence of accidental poisoning with medical drugs and alcohol during the period was found to be a factor contributing to the poorer Danish statistics during the period. In the subcategory, death after a fall, there was an increase in incidence among the elderly, but the loss of life-years remained constant. The subcategory, fatal road accidents, manifested a marked reduction in incidence, despite the increase in traffic density during the period, and there was a reduction in the loss of life-years. Thus, in the category, accidental deaths, the increase in the incidence of accidental poisonings would appear to be the only factor contributing to the poorer development in mean age and life expectancy in Denmark.
Repeated epidemiologic study of atherosclerosis in males on the basis of autopsy material with 25-year interval (1963-66 and 1985-89) has been performed in 7 European cities (Malmö, Praha, Riga, Tallinn, Tartu, Kharkov, Yalta) and 4 Asia cities (Ashkhabad, Bishkek, Irkutsk, Yakutsk). Accelerated development of atherosclerosis in the 2nd study has been revealed in males in the majority of cities except Malmö and Praha. No significant differences in atherosclerosis of aorta and coronary arteries were found in these two cities. An increase of the calcinosis surface in the coronary arteries combined with a higher incidence of coronary stenosis was typical for the 2nd study. Atherosclerosis was less pronounced in the indigenous population of Ashkhabad, Bishkek and Yakutsk in both studied than in non-indigenous populations. There was a positive correlation in males between lethality of coronary heart disease and other cardiovascular diseases and the degree of coronary atherosclerosis. Thus, the course of atherosclerosis can change within the life of one generation.
High rates of tuberculosis, including multidrug-resistant tuberculosis (MDR-TB), have been reported from the former Soviet Union. Our laboratory has supported operational studies in jails in Baku, Azerbaijan, and Mariinsk, Siberia. Combining the results from these two penal systems, the rates of MDR-TB among 'newly enrolled' and 'non-responding' cases were 24.6% and 92.1%, respectively. Restriction fragment length polymorphism (RFLP) studies strongly suggest transmission of MDR-TB between prisoners. In Mariinsk, the high rates of MDR-TB have been associated with failure rates of 23%-50% among smear-positive cases receiving fully-supervised standard short-course treatment. There are no coherent guidelines for TB control programmes confronted by high pre-existing levels of MDR-TB but who have only limited laboratory, clinical, pharmaceutical and financial resources. A 'DOTS plus' strategy has been advocated in which an established TB control programme is complemented by facilities to treat MDR-TB patients. However, the exact format of these programmes remains unresolved. Further research is required to describe the natural history of MDR-TB infection, to determine the failure rate of (and the additional resistance induced by) standard short-course treatment when MDR-TB is prevalent, to decide whether standardised or individualised second-line regimens can be employed, and to define the laboratory facilities required by a 'DOTS plus' programme.
To assess the prevalence of ADHD symptoms and their relationship to psychopathology in adolescents from the European North of Russia.
The prevalence of ADHD symptoms is assessed by teacher reports in 536 adolescents. Internalizing and externalizing problems are assessed by teacher ratings and student self-reports.
Prevalence of individual ADHD symptoms ranges between 3.3% and 35%. Only 8.9% of boys and 3.6% of girls have positive ratings on six items in either inattention or hyperactivity subtype. These adolescents fare significantly worse regarding externalizing but not internalizing problems. Compared to girls with ADHD, boys with ADHD report higher levels of violent and nonviolent delinquency and are described by teachers as having more conduct problems. Possible ADHD status is associated with depressive symptoms in boys but not in girls.
The estimates of ADHD prevalence rates obtained in this study are similar to those of other countries, suggesting the need for identification and treatment of the disorder. Evaluation of associated disruptive behavior disorders and depression, particularly in boys, is warranted.