RESUMEN
This paper analyses late presentation (LP) of HIV infection, and its determinants, among men who have sex with men (MSM) in Spain, newly diagnosed with HIV (2003-2011) in 15 sexually transmitted infection/HIV counselling and testing clinics. LP was defined as <350 CD4 cells/µL or AIDS. In total, 3,081 MSM were included (2,499 having CD4/AIDS); overall LP was 25.3%. LP was higher in men older than 34 years, those not previously HIV-tested (adjusted odds ratio (aOR):3.1; 95% confidence intervals (CI):2.3-4.2) , and those tested > 12 months before diagnosis (12-24 months (aOR:1.4; 95% CI:1.0-2.0); > 24 months (aOR:2.2; 95% CI:1.7-3.0)). LP was less likely in MSM reporting a known HIV-infected partner as infection source or symptoms compatible with acute retroviral syndrome. 'Region of birth' interacted with 'educational level' and 'steady partner as infection source': only African and Latin-American MSM with low educational level were more likely to present late; Latin-American men attributing their infection to steady partner, but no other MSM, had LP more frequently. In Spain, HIV testing among MSM should be promoted, especially those > 34 years old and migrants with low educational level. The current recommendation that MSM be tested at least once a year is appropriate.
Asunto(s)
Diagnóstico Tardío , Infecciones por VIH/diagnóstico , Homosexualidad Masculina , Adulto , África/etnología , Edad de Inicio , Centros Comunitarios de Salud , Consejo , Escolaridad , Infecciones por VIH/etnología , Infecciones por VIH/transmisión , Humanos , América Latina/etnología , Masculino , Persona de Mediana Edad , Parejas Sexuales , Enfermedades de Transmisión Sexual/diagnóstico , España/epidemiologíaRESUMEN
During 2000 to 2009, data on people undergoing HIV testing and on those newly diagnosed with HIV were collected in a network of 20 Spanish clinics specialising in sexually transmitted infections and/or HIV testing and counselling. The number of tests performed, overall and disaggregated by different variables, was obtained. HIV prevalence among first-time testers and HIV incidence among repeat testers were calculated. To evaluate trends, joinpoint regression models were fitted. In total, 236,939 HIV tests were performed for 165,745 individuals. Overall HIV prevalence among persons seeking HIV testing was 2.5% (95% CI: 2.4 to 2.6). Prevalence was highest in male sex workers who had sex with other men (19.0% (95% CI: 16.7 to 21.4)) and was lowest in female sex workers (0.8% (95% CI: 0.7 to 0.9)). Significant trends in prevalence were observed in men who have sex with men (MSM) (increasing) and heterosexual individuals (decreasing). The incidence analysis included 30,679 persons, 64,104 person-years (py) of follow-up and 642 seroconversions. The overall incidence rate (IR) was 1.0/100 py (95% CI: 0.9/100 to 1.1/100). Incidence was significantly higher in men and transgender females than in women (1.8/100 py (95% CI: 1.6 to 1.9), 1.2/100 py (95% CI: 0.5 to 2.8) and 0.1/100 py (95% CI: 0.09 to 0.2) respectively) and increased with age until 3539 years. IRs in MSM and people who inject drugs were significantly greater than in heterosexual individuals (2.5/100 py (95% CI: 2.3 to 2.7), 1.6/100 py (95% CI: 1.1 to 2.2) and 0.1/100 py (95% CI: 0.09 to 0.2) respectively), and an upward trend was observed in MSM. Our results call for HIV prevention to be reinforced in MSM and transgender women in Spain.
Asunto(s)
Serodiagnóstico del SIDA/estadística & datos numéricos , Infecciones por VIH/epidemiología , Seroprevalencia de VIH/tendencias , Heterosexualidad/estadística & datos numéricos , Homosexualidad Masculina/estadística & datos numéricos , Adolescente , Adulto , Terapia Antirretroviral Altamente Activa , Estudios de Cohortes , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Humanos , Incidencia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Prevalencia , Trabajadores Sexuales , Conducta Sexual , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/epidemiología , España/epidemiología , Abuso de Sustancias por Vía Intravenosa , Personas Transgénero , Poblaciones Vulnerables , Adulto JovenRESUMEN
Long-term dietary exposures to lead in young children were calculated by combining food consumption data of 11 European countries categorised using harmonised broad food categories with occurrence data on lead from different Member States (pan-European approach). The results of the assessment in children living in the Netherlands were compared with a long-term lead intake assessment in the same group using Dutch lead concentration data and linking the consumption and concentration data at the highest possible level of detail. Exposures obtained with the pan-European approach were higher than the national exposure calculations. For both assessments cereals contributed most to the exposure. The lower dietary exposure in the national study was due to the use of lower lead concentrations and a more optimal linkage of food consumption and concentration data. When a pan-European approach, using a harmonised food categorisation system and "European" concentration data, results in a possible health risk related to the intake of an environmental chemical for a certain country, it is advisable to refine this assessment, as part of a tiered approach, using national occurrence data, including an optimised linkage between foods analysed and consumed for that country. In the case of lack of occurrence data, these data can be supplemented with data from the "European" concentration database or by generating additional concentration data at country level.
Asunto(s)
Dieta/efectos adversos , Ingestión de Líquidos , Contaminantes Ambientales/toxicidad , Contaminación de Alimentos , Plomo/toxicidad , Contaminantes Químicos del Agua/toxicidad , Adolescente , Niño , Preescolar , Bases de Datos Factuales , Encuestas sobre Dietas , Europa (Continente)/epidemiología , Femenino , Alimentos/clasificación , Humanos , Lactante , Intoxicación por Plomo/epidemiología , Masculino , Medición de Riesgo , Factores de TiempoRESUMEN
Within the European project called EXPOCHI (Individual Food Consumption Data and Exposure Assessment Studies for Children), 14 different European individual food consumption databases of children were used to conduct harmonised dietary exposure assessments for lead, chromium, selenium and food colours. For this, two food categorisation systems were developed to classify the food consumption data in such a way that these could be linked to occurrence data of the considered compounds. One system served for the exposure calculations of lead, chromium and selenium. The second system was developed for the exposure assessment of food colours. The food categories defined for the lead, chromium and selenium exposure calculations were used as a basis for the food colour categorisation, with adaptations to optimise the linkage with the food colour occurrence data. With this work, an initial impetus was given to make user-friendly food categorisation systems for contaminants and food colours applicable on a pan-European level. However, a set of difficulties were encountered in creating a common food categorisation system for 14 individual food consumption databases that differ in the type and number of foods coded and in level of detail provided about the consumed foods. The work done and the problems encountered in this project can be of interest for future projects in which food consumption data will be collected on a pan-European level and used for common exposure assessments.
Asunto(s)
Bebidas/clasificación , Dieta , Contaminación de Alimentos/estadística & datos numéricos , Alimentos/clasificación , Adolescente , Niño , Preescolar , Cromo/administración & dosificación , Cromo/análisis , Bases de Datos Factuales , Europa (Continente) , Femenino , Colorantes de Alimentos/administración & dosificación , Colorantes de Alimentos/análisis , Inocuidad de los Alimentos/métodos , Humanos , Lactante , Internacionalidad , Plomo/administración & dosificación , Plomo/análisis , Masculino , Selenio/administración & dosificación , Selenio/análisisRESUMEN
In Spain, neither the HIV nor the STI national surveillance systems collect information on HIV/STI co-infection. However, there are two networks based on HIV/STI clinics which gather this data. We describe HIV prevalence in men who have sex with men (MSM) diagnosed with infectious syphilis and/or gonorrhoea in 15 STI clinics; and concurrent diagnoses of STI in MSM newly diagnosed with HIV in 19 HIV/STI clinics. In total, 572 MSM were diagnosed with infectious syphilis and 580 with gonorrhoea during 2005-2007. HIV prevalence among syphilis and gonorrhoea cases was 29.8% and 15.2% respectively. In the multivariate analysis, HIV/syphilis co-infection was associated with being Latin American; having a history of STI; reporting exclusively anal intercourse; and having sex with casual or several types of partners. HIV and gonorrhoea co-infection was associated with age older than 45 years; having no education or only primary education completed; and having a history of STI. In total, 1,462 HIV infections were newly diagnosed among MSM during 2003-2007. Of these, 31.0% were diagnosed with other STI at the same time. Factors associated with STI co-infection among new HIV cases in MSM were being Latin American; and having sex with casual partners or with both steady and casual partners. In Spain, a considerable proportion of MSM are co-infected with HIV and STI.
Asunto(s)
Brotes de Enfermedades/estadística & datos numéricos , Infecciones por VIH/epidemiología , Homosexualidad Masculina/estadística & datos numéricos , Adulto , Humanos , Incidencia , Masculino , Vigilancia de la Población , Medición de Riesgo , Factores de Riesgo , España/epidemiologíaRESUMEN
OBJECTIVE: To estimate mercury intake due to fish consumption among the individuals from Gipuzkoa participating in the European Prospective Investigation into Cancer (EPIC), and to validate the estimation of mercury exposure through diet, by measuring blood mercury level. DESIGN AND SETTING: The population for the EPIC Gipuzkoa cohort was recruited from 1992 to 1995. Each individual's diet was assessed regarding habitual intake over the previous year, using the diet history method. Blood samples were taken at the time of the interview. The mercury content of the fish species consumed was supplied by the Food Chemical Surveillance Programme in the Basque Country. SUBJECTS: For the estimation, 8417 volunteers, men and women, aged 35-65 years, of the EPIC cohort; for the validation, a random sample of 120 individuals stratified by fish intake was taken. RESULTS: The validation study confirmed the relationship between fish consumption and mercury intake, as well as between fish consumption and mercury in erythrocytes. 99.9% of individuals have intakes below 75% of the Provisional Tolerable Weekly Intake (PTWI) of mercury established by the World Health Organization. But the limit dosage recommended by the United States Environmental Protection Agency, measured by the average risk index, would be exceeded often. CONCLUSIONS: No individual from the cohort would exceed the PTWI of mercury. Nevertheless, owing to the amount of fish consumed, certain individuals would have mercury intakes approaching the recommended limits. With a view to the future, we believe mercury in fish must continue to be monitored closely in order to assess the risks for the population.