Consecutive Cross-sectional Surveys Research Articles

Malnutrition in infants aged 6-23 months in China's poorest rural counties from 2016 to 2021: cross sectional study.

To assess trends and differences in child malnutrition by population subgroups among infants aged 6-23 months in China's poorest rural counties. Six consecutive cross sectional surveys were conducted annually. The study was conducted in 116 counties in 19 provinces from 2016 to 2021, representing China's 832 poorest counties. A total of 210 088 participants were selected through a multistage cluster sampling procedure; all participants were infants aged 6-23 months. Prevalence of anaemia, stunting, wasting, overweight, and growth status in children (measured by length-for-age and weight-for-length z scores). Four main malnutrition forms were prevalent in 2016: anaemia (prevalence 18.3%), stunting (7.5%), wasting (4.7%), and overweight (3.1%). The prevalence of any two coexisting malnutrition forms was low. All four forms of malnutrition decreased from 2016 to 2021. Anaemia decreased by more than half, with an annual reduction rate of 9.11% (95% confidence interval (CI) 4.83% to 13.20%). Stunting was reduced by over a third, with an annual reduction rate of 10.44% (7.56% to 13.22%), which is faster than the World Health Organization's target of 3.9%. Differences in child growth by county gross domestic product quarters were small and decreased over time, but growth differences related to education persisted. Infants whose mothers completed education up to primary school level had approximately twice the risk of stunting (adjusted rate ratio 2.29 (95% CI 1.87 to 2.81)) and wasting (1.73 (1.40 to 2.13)) compared with children whose mothers had an education level of a college degree or above. Boys had poorer growth and higher anaemia than did girls. For all outcomes, differences related to sex and education were greatest at 6 months of age. Education related inequalities in growth of infants persists, with these differences particularly affecting children whose mothers completed education only up to primary school level.

Tobacco- and Nicotine-Containing Product Use in Italy: Results From Two Cross-Sectional Studies

BACKGROUND: Heated tobacco products (HTPs) are alternatives to cigarettes that heat rather than burn tobacco. The first HTP sold in Italy was _IQOS®_ (I-HTP), and while it has been available for nearly a decade, limited data are available on the use of these products. OBJECTIVE: To characterize how Italian adults (users of legal age) use tobacco- and nicotine-containing products (TNPs), including smoke-free products (SFPs), we surveyed this population about their current and past use of TNPs from 2018 to 2020. METHODS: Two consecutive cross-sectional surveys were conducted in representative samples of the general adult population (6,095 subjects from 2018 to 2019 and 6,118 from 2019 to 2020) and among adult I-HTP users (1,371 subjects from 2018 to 2019 and 1,401 from 2019 to 2020) in Italy. We assessed the prevalence of current TNP use in the general population sample and use patterns in the I-HTP_ _users sample. RESULTS: In the first cross-sectional study (2018-2019), cigarettes were the most used TNP (24.3%), while only a small proportion of the surveyed general population sample used e-cigarettes or I-HTPs (1.4% and 0.7%, respectively). Nearly all current I-HTP users were current adult cigarette smokers when they started using I-HTPs (98.0%). Both surveys showed low initiation, re-initiation, and relapse with I-HTPs, with the majority of current I-HTP users belonging to the intended audience of adults who already used TNPs. Some participants used both I-HTPs and combustible TNPs (38.6%); however, most (59.2%) used I-HTPs exclusively. I-HTP_ _users perceived the health risk (score 0 = no risk; score 100 = very high risk) associated with cigarette smoking higher (63.7) than that for I-HTP_ _use (42.6). Exclusive I-HTP users reported improved respiratory symptoms (reduced cough and phlegm) and exercise capacity compared to a year before they started using I-HTPs. Most current I-HTP users also reported improved smell and taste, better breath smell, and reduced stains or yellowing teeth. Overall, these results were more pronounced among exclusive I-HTP users. The results of the second cross-sectional study (2019-2020) were similar, except for an increase in I-HTP_ _use_ _(1.1% vs. 0.7% in 2018 to 2019). CONCLUSIONS: These studies show that most TNP users in Italy smoke cigarettes. The uptake of I-HTPs suggests that they are a viable alternative to cigarettes. Nearly all I-HTP users switched from cigarettes to I-HTPs. Furthermore, most I-HTP_ _users exclusively use the product. I-HTP users considered the health risk associated with I-HTP_ _use to be lower compared to cigarette smoking, but they did not perceive I-HTPs_ _as risk free. Study participants reported improvements on some health, hygiene, and appearance aspects after switching from cigarettes to I-HTPs. Our results suggest that SFPs can play a role in a harm reduction approach. Further studies are needed to continually monitor the prevalence of SFP use to provide long-term evidence of their impact.

Trends and factors influencing the mental health of college students in the post-pandemic: four consecutive cross-sectional surveys.

The long-term impact of COVID-19 on the mental health and well-being of college students, specifically trends over time after full removal of COVID-19 restrictions, has not been well-studied. Four consecutive cross-sectional surveys were conducted in December 2022 (N = 689), March 2023 (N = 456), June 2023 (N = 300), and November 2023 (N = 601) at a university in Sichuan Province, China. The proportion of students with COVID-19 panic decreased from 95.1 to 77.3% (p < 0.001). The prevalence of moderate anxiety and above decreased from 18 to 13.6% (p < 0.001), and the prevalence of moderate and above depression decreased from 33.1 to 28.1% (p < 0.001), while the prevalence of post-traumatic stress disorder (PTSD) increased from 21.5 to 29.6% (p < 0.005). Further, the proportion of suicidal thoughts increased from 7.7 to 14.8% (p < 0.001). Suicidal thoughts and self-injuries were significantly associated with COVID-19 panic, depression, anxiety, and PTSD. Students who reported being in close contact with COVID-19 patients in the past were more likely to develop PTSD. Further, COVID-19-induced panic was a risk factor for self-injury. One year after the COVID-19 pandemic, the overall mental health of college students was not optimal. Hence, we can conclude that the long-term impacts of COVID-19 on the mental health of college students may have already occurred. To mitigate this impact and prepare for the next major public health event, strengthening college students' mental health curricula and promoting healthy behaviors among college students should be a priority for universities and education authorities.

Identifying regional disparities of infant mortality rates in Bangladesh: insights from nationwide cross-sectional studies and a statistical modelling approach using linear mixed effects model with temporal variability

ObjectiveThe major objective of this project is to find the best suitable model for district-wise infant mortality rate (IMR) data of Bangladesh over the period 2014–2020 that captures the regional...

Seroprevalence, seroconversion and seroreversion of Borrelia burgdorferi-specific IgG antibodies in two population-based studies in children and adolescents, Germany, 2003 to 2006 and 2014 to 2017.

BackgroundLyme borreliosis (LB), caused by Borrelia burgdorferi (Bb), is the most common tick-borne infection in Germany. Antibodies against Bb are prevalent in the general population but information on temporal changes of prevalence and estimates of seroconversion (seroincidence) and seroreversion are lacking, especially for children and adolescents.AimWe aimed at assessing antibodies against Bb and factors associated with seropositivity in children and adolescents in Germany.MethodsWe estimated seroprevalence via two consecutive cross-sectional surveys (2003-2006 and 2014-2017). Based on a longitudinal survey component, we estimated annual seroconversion/seroreversion rates.ResultsSeroprevalence was 4.4% (95% confidence interval (CI): 3.9-4.9%) from 2003 to 2006 and 4.1% (95% CI: 3.2-5.1%) from 2014 to 2017. Seroprevalence increased with age, was higher in male children, the south-eastern regions of Germany and among those with a high socioeconomic status. The annual seroconversion rate was 0.3% and the annual seroreversion rate 3.9%. Males were more likely to seroconvert compared with females. Low antibody levels were the main predictor of seroreversion.ConclusionWe did not detect a change in seroprevalence in children and adolescents in Germany over a period of 11 years. Potential long-term changes, for example due to climatic changes, need to be assessed in consecutive serosurveys. Seroconversion was more likely among children and adolescents than among adults, representing a target group for preventive measures. Seroreversion rates are over twice as high in children and adolescents compared with previous studies among adults. Thus, seroprevalence estimates and seroconversion rates in children are likely underestimated.

Prevalence, Trends and Correlates of HIV, Syphilis and HCV Infection Among Chinese Local and Cross-border Migrant Female Sex Workers in the Sino-Vietnam Border Area of Guangxi, 2016-2021.

Female sex workers (FSWs) are considered a high-risk group for sexually transmitted infections (STIs). However, limited data exist on the prevalence and trends of HIV, syphilis and HCV among FSWs in the Sino-Vietnam border area. To determine the prevalence, trends and correlates of STIs among Chinese local FSWs (CL-FSWs) and cross-border migrant FSWs (CM-FSWs), we conducted consecutive cross-sectional surveys from 2016 to 2021, recruiting 7747 CL-FSWs and 932 CM-FSWs. The overall HIV, syphilis and HCV prevalence declined from 1.0%, 8.8% and 1.7% to 0.1%, 0.9% and 0.3%, respectively. There was no significant downward trend in the overall HIV and syphilis prevalence. However, HCV prevalence showed a decreasing trend among CL-FSWs. CM-FSWs had higher HIV prevalence (2.5% vs. 0.6%). Similarities and differences in STIs-related factors existed between CM-FSWs and CL-FSWs. For instance, receiving HIV-related services in the last year reduced the risk of HIV infection (for CM-FSWs: aOR = 0.234, 95% CI: 0.055-0.993; for CL-FSWs: aOR = 0.182, 95% CI: 0.058-0.567). Serving male clients at least 50 years old increased the risk of syphilis infection (for CM-FSWs: aOR = 4.277, 95% CI: 1.535-11.917; for CL-FSWs: aOR = 1.404, 95% CI: 1.087-1.815). Moreover, CM-FSWs with past-year STIs history had a higher risk of HIV (aOR = 34.976, 95% CI: 5.338-229.176) and HCV infection (aOR = 17.649, 95% CI: 1.846-168.846), both of which were associated with multiple factors in CL-FSWs. It is therefore necessary to develop effective, accessible, high-quality and targeted interventions for CM-FSWs and CL-FSWs.

Adolescent Mental Health during the COVID-19 Pandemic: The Interplay of Age, Gender, and Mental Health Outcomes in Two Consecutive Cross-Sectional Surveys in Northern Italy.

The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on the mental health and well-being of adolescents. This study aimed to investigate the development of health-related quality of life (HRQoL) and mental health among adolescents in Northern Italy by comparing cross-sectional surveys conducted in 2021 and 2022, with a particular focus on the influence of age and gender. The sample included adolescents aged 11-19 years from public schools in South Tyrol. Validated psychometric instruments were used to assess HRQoL, anxiety and depression symptoms, and psychosomatic complaints. Sociodemographic variables, COVID-19 burden, and pandemic-related factors were measured. Statistical analyses included chi-square tests, correlation coefficients, and logistic regression analyses. The results indicated that while the self-reported burden of adolescents decreased significantly in 2022 (n = 1885) compared to 2021 (n = 1760), there were no significant differences in symptoms of anxiety, depressive symptoms, low HRQoL, and increased psychosomatic complaints between the two surveys for both early and late adolescents. Females consistently had higher percentages for all outcome variables, and symptoms of anxiety increased with age in females, but not in males. Both genders experienced an increase in depressive symptoms and low HRQoL with age. The co-occurrence of mental health outcomes was observed, suggesting overlapping patterns among anxiety, depression, low HRQoL, and psychosomatic complaints. These findings underscore the intricate relationship between age, gender, and mental health outcomes among adolescents during the pandemic. It is important to recognize that late adolescents may exhibit distinct vulnerabilities and may require tailored support approaches to address their specific mental health challenges, differing from those needed for early adolescents.

Lifestyle changes during the COVID-19 pandemic in Brazil: results from three consecutive cross-sectional web surveys

ObjectiveThe importance of a healthy lifestyle in preventing morbidity and mortality is well-established. The COVID-19 pandemic brought about significant lifestyle changes globally, but the extent of these changes in the...

Real-world data in late presentation of HIV infection in Suzhou, China: Results from four consecutive cross-sectional surveys, 2017-2020.

This study aimed to examine the real prevalence of late presentation of HIV infection and to identify factors associated with late HIV presentation among patients with newly diagnosed HIV/AIDS in Suzhou, China. Patients with newly diagnosed HIV/AIDS who registered in national AIDS surveillance system from 2017 to 2020 were included in this study. Late presentation (LP) of HIV infection was defined as HIV diagnosis with a CD4 count < 350 cells/μL or an AIDS-defining event. Multivariable logistic regression analyses were used to identify factors associated with LP. A total of 2,300 patients were enrolled. 1,325 were classified as late presenters, showing a high percentage of 57.6% (95% CI: 54.5-60.7%) and a rise (P = 0.004) over the four-year period. Patients with newly diagnosed HIV/AIDS who were older than 24 years of age (aOR = 1.549, P = 0.001 for 25-39 years; aOR = 2.389, P < 0.001 for 40 years and older), were Suzhou registered residents (aOR = 1.259, P = 0.026), and were from inpatient and outpatient (aOR = 1.935, P < 0.001) were more likely to be late presentation. This study showed a high percentage and a rise of late presentation of HIV infection among patients with newly diagnosed HIV/AIDS in Suzhou, China, which is a challenge for future prevention and control of AIDS. Targeted measures should be urgently implemented to reduce late HIV diagnosis.

Future trends of overweight and obesity in Belgium using Bayesian age-period-cohort models

Abstract Background Considering the current overweight and obesity epidemic and its associated increase in non-communicable diseases and healthcare costs, the current study aimed to project the trends in prevalence of overweight and obesity in Belgium using a Bayesian age-period-cohort (APC) model to support policy planning. Methods Height and weight of 58,369 adults aged 18+ years, collected in six consecutive cross-sectional health interview surveys between 1997 and 2018, were evaluated. Criteria used for overweight and obesity were defined as body mass index (BMI) ≥ 25, and BMI ≥ 30. A Bayesian APC model was applied to evaluate past trends and associated socio-demographic risk factors, and to forecast trends to 2019-2029. All analyses were performed based on integrated nested Laplace approximation (INLA) and took the complex survey design into account. Results The prevalence of overweight and obesity has increased between 1997 and 2018. If current trends continue, it is likely to that a further increase in the prevalence of overweight and obesity in the population will be seen by 2029 with a probability of growth of 51.2% and 73.3%, respectively. Forecasts indicated a potential prevalence of 50.1% [16.2%; 84.4%] in 2029 for overweight, and 21.4% [9.0%; 43.4%] for obesity. Among survey participants, middle-aged men with no higher education and a middle income showed the highest risk of overweight and obesity. Conclusions We projected an alarming increase in the prevalence of overweight and obesity. A decrease in cases seems very unlikely. There is an urgent need to target younger age groups for prevention and implementation of public educational programs to limit the increasing trend in overweight and obesity. Key messages • The occurence of obesity is likely to increase in the following 10 years. • Projection of trends can serve as a useful tool for policy planning on the mid- and longer term.

Asymptomatic and submicroscopic Plasmodium infections in an area before and during integrated vector control in Homa Bay, western Kenya

BackgroundLong-lasting insecticidal nets (LLINs) have been the primary vector control strategy until indoor residual spraying (IRS) was added in Homa Bay and Migori Counties in western Kenya. The objective of this study was to evaluate the impact of LLINs integrated with IRS on the prevalence of asymptomatic and submicroscopic Plasmodium infections in Homa Bay County.MethodsA two-stage cluster sampling procedure was employed to enroll study participants aged ≥ 6 months old. Four consecutive community cross-sectional surveys for Plasmodium infection were conducted in residents of Homa Bay county, Kenya. Prior to the start of the study, all study households received LLINs, which were distributed between June 2017 and March 2018. The first (February 2018) and second (June 2018) surveys were conducted before and after the first round of IRS (Feb–Mar 2018), while the third (February 2019) and fourth (June 2019) surveys were conducted before and after the second application of IRS (February–March 2019). Finger-prick blood samples were obtained to prepare thick and thin smears for microscopic determination and qPCR diagnosis of Plasmodium genus.ResultsPlasmodium spp. infection prevalence by microscopy was 18.5% (113/610) before IRS, 14.2% (105/737) and 3.3% (24/720) after the first round of IRS and 1.3% (11/849) after the second round of IRS (p < 0.0001). Submicroscopic (blood smear negative, qPCR positive) parasitaemia reduced from 18.9% (115/610) before IRS to 5.4% (46/849) after IRS (p < 0.0001). However, the proportion of PCR positive infections that were submicroscopic increased from 50.4% (115/228) to 80.7% (46/57) over the study period (p < 0.0001). Similarly, while the absolute number and proportions of microscopy positives which were asymptomatic decreased from 12% (73/610) to 1.2% (9/849) (p < 0.0001), the relative proportion increased. Geometric mean density of P. falciparum parasitaemia decreased over the 2-year study period (p < 0.0001).ConclusionsThese data suggest that two annual rounds of IRS integrated with LLINs significantly reduced the prevalence of Plasmodium parasitaemia, while the proportion of asymptomatic and submicroscopic infections increased. To reduce cryptic P. falciparum transmission and improve malaria control, strategies aimed at reducing the number of asymptomatic and submicroscopic infections should be considered.

Progress towards the UNAIDS 95-95-95 targets among pregnant women in South Africa: Results from the 2017 and 2019 national Antenatal HIV Sentinel Surveys.

ObjectivesThe UNAIDS 95-95-95 global targets for epidemic control aim to ensure by 2030 that 95% of HIV-positive people know their HIV status, 95% of people diagnosed with HIV receive sustained antiretroviral therapy (ART), and 95% of people on ART have viral suppression. While data on the first and second 95 targets are routinely reported nationally, data on the third 95 target are not available for pregnant women in South Africa. The lack of data on the third 95 target limits the inclusion of low viral suppression as one of the contributing factors in MTCT root cause analyses. This study assessed progress towards the 95-95-95 targets among pregnant women between the ages of 15–49 years attending public health facilities in South Africa.MethodData were obtained from two consecutive national cross-sectional antenatal HIV sentinel surveys conducted between 1 October and 15 November in both 2017 and 2019. In each survey, data on age, knowledge of HIV status, ART initiation, and geographical location (province) were extracted from medical records. A blood specimen was collected from each woman and tested for HIV. Viral load tests were performed on HIV-positive specimens. Descriptive and multiple logistic regression analyses were performed to examine association between province and viral suppression (defined as viral load <50 copies/mL) using the combined dataset (i.e., both 2017 and 2019 data combined). All analyses considered the survey design.ResultsOf 10 065 and 11 321 HIV-positive women included in the 2017 and 2019 surveys, respectively, 96.0% (95% confidence interval (CI): 95.6–96.4%) and 97.6% (95% CI: 97.3–97.8%) knew their HIV-positive status; 86.6% (95% CI: 85.9–87.3%) and 96.0% (95% CI: 95.6–96.4%) of those who knew their HIV status were receiving ART; while 64.2% (95% CI: 63.2–65.2%) and 66.0% (95% CI: 65.1–66.8%) of those receiving ART were virally suppressed. Achievement of the third 95 target significantly varied by province ranging from 33.9–72.6% in 2017 and 43.4–77.3% in 2019. Knowledge of HIV-positive status, ART initiation, and viral suppression increased in both 15–24 and 25–49 year age groups between 2017 and 2019. In a multivariable analysis adjusting for survey year, gravidity, and education, the odds of viral suppression significantly varied by province (except KwaZulu-Natal and Western Cape, other provinces were less likely to attain viral suppression compared to Gauteng), age (adjusted odds ratio (AOR) for 15–24 years vs 25–49 years: 0.7, 95% CI: 0.6–0.8), and timing of ART initiation (AOR for ART initiation during pregnancy vs before pregnancy: 0.4, 95% CI: 0.5–0.6).ConclusionAlthough in 2019 the first and second 95 targets were achieved among pregnant women, meeting the third 95 target remains a challenge. This study highlighted the importance of promoting early ART initiation and the need to target young women in efforts to improve progress towards the third 95 target. Additionally, the provincial variation in viral suppression could be further investigated in future studies to identify and address the root causes underlying these differences.

Past, present, and future trends of overweight and obesity in Belgium using Bayesian age-period-cohort models

BackgroundOverweight and obesity are one of the most significant risk factors of the twenty-first century related to an increased risk in the occurrence of non-communicable diseases and associated increased healthcare costs. To estimate the future impact of overweight, the current study aimed to project the prevalence of overweight and obesity to the year 2030 in Belgium using a Bayesian age-period-cohort (APC) model, supporting policy planning.MethodsHeight and weight of 58,369 adults aged 18+ years, collected in six consecutive cross-sectional health interview surveys between 1997 and 2018, were evaluated. Criteria used for overweight and obesity were defined as body mass index (BMI) ≥ 25, and BMI ≥ 30. Past trends and projections were estimated with a Bayesian hierarchical APC model.ResultsThe prevalence of overweight and obesity has increased between 1997 and 2018 in both men and women, whereby the highest prevalence was observed in the middle-aged group. It is likely that a further increase in the prevalence of obesity will be seen by 2030 with a probability of 84.1% for an increase in cases among men and 56.0% for an increase in cases among women. For overweight, it is likely to see an increase in cases in women (57.4%), while a steady state in cases among men is likely. A prevalence of 52.3% [21.2%; 83.2%] for overweight, and 27.6% [9.9%; 57.4%] for obesity will likely be achieved in 2030 among men. Among women, a prevalence of 49,1% [7,3%; 90,9%] for overweight, and 17,2% [2,5%; 61,8%] for obesity is most likely.ConclusionsOur projections show that the WHO target to halt obesity by 2025 will most likely not be achieved. There is an urgent necessity for policy makers to implement effective prevent policies and other strategies in people who are at risk for developing overweight and/or obesity.

Trends in HIV Prevalence and HIV-Related Risk Behaviors Among Male Students Who Have Sex With Men From 2016 to 2020 in Nanjing, China: Consecutive Cross-Sectional Surveys.

BackgroundThe growing HIV epidemic among student men who have sex with men (MSM) necessitates immediate attention from public health. In China, male students who have sex with men (SMSM) were also at an increasing risk of HIV transmission. The aim of this study was to investigate the trends in HIV prevalence, HIV-related risk behaviors, and HIV testing, as well as analyze the factors associated with HIV infection among SMSM in Nanjing.MethodsData were collected through face-to-face questionnaire interviews and laboratory testing in Nanjing. The participants were recruited among SMSM by snowball sampling and internet-recruited convenience sampling annually from 2016 to 2020. The self-report data primarily included demographics, HIV knowledge, HIV-related behaviors, and HIV testing, while the laboratory test results of HIV and syphilis were collected. Linear-by-linear chi-square test was used to analyze the trends of HIV/syphilis prevalence and its risk behaviors. The binary logistic regression model was used to explore the factors associated with HIV infection.ResultsDuring the 5 years from 2016 to 2020, a total of 775 SMSM were recruited in our survey (220, 112, 171, 142, and 120, respectively). The HIV prevalence was 5.2, 6.3, 5.3, 7.0, and 8.3%, without a significant increasing trend (P = 0.277). Syphilis prevalence fluctuated from 5.7% in 2016 to 4.2% in 2020, without a significant decreasing trend (P = 0.318). The proportion of consistent condom use in anal intercourse (48.5 to 56.2%, P < 0.05), and HIV testing in the past 12 months (51.0 to 59.2%, P < 0.05) were increasing. A remarkable growing trend has been reported in the percentage of MSM with more than one male sex partner (46.2 to 59.2%, P < 0.05). Multivariate analysis showed that HIV testing in the past 12 months was a protective factor against HIV infection. MSM who had unprotected anal intercourse (UAI) in the past 6 months, recreational drug use, and currently syphilis infection were risk factors for HIV infection.ConclusionsWe observed stable HIV/ syphilis prevalence, increasing consistent condom use, increasing HIV testing rate, and increasing multiple male sex partners dramatically among SMSM in China. The original comprehensive intervention measures should be continuously strengthened for the subgroup. To satisfy the current HIV prevention requirements, new biological interventions should be introduced and carried out as major components of combination prevention programs.

The Prevalence of Pharmacological Neuroenhancement Among University Students Before and During the COVID-19-Pandemic: Results of Three Consecutive Cross-Sectional Survey Studies in Germany.

BackgroundAccording to the literature, the conditions of studying and living as well as the psychological, social and health behavior-related variables, which were strongly related to pharmacological neuroenhancement (PN) before the pandemic, significantly changed during the pandemic. For this reason, it is expected that the prevalence of PN among university students is higher during the pandemic compared to before the pandemic. Therefore, the present study aimed to investigate and compare the prevalence of PN among university students before and during the COVID-19-pandemic.MethodsThree online surveys assessing the 12-month prevalence of PN were conducted among university students at the University of Mainz, Germany. The first survey took place in summer term 2019 (before the pandemic), the second in summer term 2020 (during the first German lockdown), and the third in summer term 2021 (after the second German lockdown). Pearson's chi-square test was used to test whether the 12-month prevalence of PN differed significantly between the three surveys.ResultsThe 12-month prevalence of PN was 10.4% in 2019, 11.3% in 2020, and 8.0% in 2021. Chi-square tests revealed no statistical difference in the prevalence of PN between 2019 and 2020. Overall, the use of PN was lower in 2021 compared to 2019 (p < 0.0001) as well as in comparison to 2020 (p = 0.001). Only the use of cannabis slightly increased from 2019 to 2020 (7.1 vs. 8.3%) and decreased in 2021 (5.4%). At all three time points, cannabis was the most commonly used substance for the purpose of PN. Consequently, the results suggest that the prevalence of PN was highly intertwined with the prevalence of cannabis use for PN.DiscussionThe decrease in the prevalence of PN of around three percentage points in 2021 compared to the previous years was a surprising finding. It may be mainly due to the decrease in the prevalence of cannabis for the purpose of PN. However, the fairly high prevalence of PN of around 8% in 2021 is still an important finding that demonstrates that there is still an urgent need for prevention initiatives among university students to combat the use of PN.

Comparison of Two Surveys Using the Sexuality Assessment Tool (SexAT) in Flanders

From 2015 it is mandatory in Flanders, Belgium, to develop a policy to deal with sexual abuse in elderly care. Residential Aged Care Facilities (RACF'S) try to focus on this mandatory, but should also pay attention to implement an overall Sex and Intimacy Policy. This study contains a Comparison of two surveys (Messelis & Bauer, 2020 and Vander Stichele, e.a. 2020) in Flanders, Belgium, both using the Sexual Assessment Tool (SeAT, Messelis & Bauer, 2017). Both studies aimed to assess how supportive residential aged care facilities are of residents' sexual expression. In the survey of Messelis & Bauer 750 aged care facilities were contacted in 2017-2018 and 69 (9,2%) completed the SexAT survey after three reminders. Vander Stichele e.a. contacted 100 aged care facilities managers in 2019. Twenty of them (20% response rate) completed the SexAT after three reminders. Findings of the Messelis & Bauer survey indicate that 70% of the facilities rated 'very good' to 'good' (score between 21-59/69), while Vander Stichele e.a. found a prevalence of 76% of this score. Both found no facilities were rated 'excellent' (score greater than 60/69). In the category 'improvement needed' (score less than 20/69), percentages were 30% and 23%; a difference of 7% (CI95% of difference in percentage includes zero, not significant). There is room for improvement in residential aged care facilities for the support of sexual expression of residents. The more recent study confirms results of the previous one, and no significant evolution was observed in two consecutive cross-sectional surveys.

Cohort profile: the Mâncio Lima cohort study of urban malaria in Amazonian Brazil

PurposeThis population-based open cohort study aims to investigate biological and sociodemographic drivers of malaria transmission in the main urban hotspot of Amazonian Brazil.ParticipantsNearly 20% of the households in the northwestern...

Prevalence of HCV infection and related risk factors in drug users in Wenzhou, Zhejiang, 2011–2020

Objective To understand the prevalence of hepatitis C and related risk factors in drug users under sentinel surveillance in Wenzhou during 2011–2020 and provide evidence for the prevention and control of hepatitis C in this population. Methods A consecutive cross-sectional survey with standard questionnaire was conducted in about 400 drug users randomly selected in compulsory detoxification settings for the annual sentinel surveillance between April and July during 2011–2020, and basic demographic information and blood samples were collected from them. Multivariate logistic regression model was used to analyze the related risk factors of HIV infection. Results A total of 4052 drug users were included in the analysis, the prevalence rate of HCV infection was 41.91%. The average positive rate of HCV antibody was 54.10% during 2011–2013, and 36.65% during 2014–2020. However, the positive rate of HCV antibody increased from 30.00% in 2014 to 41.50% in 2020. Multivariate logistic regression analysis indicated HCV infection risk factors included age ≥30 years, living in Zhejiang, low education level, being traditional drug user or mixed drug user and injecting drug use. Among them, age ≥30 years, living in Zhejiang, being traditional drug user or mixed drug user and injecting drug use can explain the rise of HCV antibody positive rate from 2014 to 2020. Conclusion In the past 10 years, the prevalence of HCV infection in drug users in Wenzhou remained at a high level, showing a significant decline firstly and then a gradual rise. It is speculated that the early decrease of HCV infection level might be related to the improvement of the diagnosis and treatment of Hepatitis C, but the recent increase of HCV infection level is caused by the changes in the characteristics of drug users and the types or modes of drug use.

Prevalence and Predictors of Syphilis in Female Sex Workers in Eastern China: Findings from Six Consecutive Cross-Sectional Surveys.

PurposeFemale sex workers play an important role in transmitting HIV and syphilis from high-risk groups to the general population. However, epidemic trends and risk factors for syphilis in Chinese female sex workers (FSWs) remain unclear.MethodsUsing convenient sampling methods, 2482 FSWs were interviewed and tested for syphilis from 2014 to 2019, all of them were divided into two groups of high-grade FSWs and low-grade FSWs according to service solicited and clients price there were. Demographic data were collected and logistic regression analysis was used to identify risk factors for syphilis.Results43.67% of participants have received free condoms, 76.15% of them engaged in peer education of the 2482 FSWs tested for syphilis, 107 (4.31%) were positive. The prevalence of syphilis in high-grade FSWs was significantly lower than that in low-grade FSWs (3.14% and 5.62%, respectively).The overall prevalence of syphilis increased from 3.19% to4.47%. The percentage of FSWs received free condoms and engaged in peer education increased significantly. With upgraded awareness of syphilis, the number of FSWs having protected sex also increased significantly. It is also found that low-grade female sex workers are at greater risk of syphilis than those high-grade ones (odds ratio (OR) = 1.76, 95% CI 1.18–2.63, p < 0.05).ConclusionGreat awareness of syphilis and the increased utilization of condom did not reduce the prevalence of syphilis, especially in low-grade FSWs group. More effective integrated interventions should be developed for such populations.

Point prevalence survey on antimicrobial use in a tertiary private hospital in Malaysia

Background: The threat of antimicrobial resistance in healthcare settings is globally recognized. To design and implement effective antimicrobial stewardship (AMS) interventions, data regarding current antimicrobial prescribing patterns is pivotal. As such, this point prevalence survey aims to determine the baseline antimicrobial prescribing patterns at Sunway Medical Centre (SunMed), with the intention to formulate strategies for appropriate antimicrobial use through AMS programmes. Methods and materials: A consecutive 3-day cross-sectional survey was conducted in June 2019 using a convenient sampling method. The survey included all hospitalized patients of all ages from 17 non-critical care wards (total 416 beds) who were still receiving at least one oral or injectable antimicrobial at the time of the survey. Patients who were activated for discharge prior to the time of the survey and patients who admitted in daycare units and critical care units were excluded from the survey. Data was collected using a survey form modified from Global Point Prevalence Survey (PPS) tool designed by University of Antwerp, Belgium. Results: Out of 332 patients surveyed, 162 (49%) patients were on antimicrobials. 126 (78%) patients were on 1 antimicrobial while 36 (22%) patients were on multiple antimicrobials. A total of 69 (43%) patients had culture & sensitivity (C&S) taken prior to antimicrobials administration. Of 200 prescribed antimicrobials, 184 (92%) were used empirically (62.5% medical cases and 29.5% surgical cases), while 16 (8%) were targeted therapy. Cephalosporin, beta-lactam-beta-lactamase inhibitor combinations and macrolide were the top 3 antimicrobial class prescribed (39%, 30%, 12% respectively). The antimicrobials were prescribed for community-acquired infections (54%), followed by surgical prophylaxis (33%), internal healthcare-associated infection (HAI) (7.5%), external HAI (5%) and medical prophylaxis (0.5%). The three most common anatomical sites related infection treated with antimicrobials were pneumonia and respiratory tract infections (16%), bone/joint related surgical prophylaxis (13.8%) and gastrointestinal infections (13.8%). 11 (5.5%) antimicrobials prescribed were categorized as others while 2 (1%) were completely unknown indication. Conclusion: Our analysis indicated that the use of antimicrobials was high in SunMed, mainly empirically. There is a need to explore factors contributing to this and develop strategies for appropriate antimicrobial use through AMS programmes.