Epidemic Burden Research Articles

The epidemic study and burden of type 1 diabetes in China

Type 1 diabetes (T1D) threatens the health of children, adolescents and adults. Little was known on the epidemiological and health economic status of T1D in China, which hindered related policy making. The patients with T1D in China faced challenges including low frequency of blood glucose monitoring, improper insulin administration, poor glycaemic control, high rates of diabetic complications and heavy economic burden. The estimated incidence of T1D per 100000 persons years for all ages in China was 1.01 (95% confidence interval 0.18 to 1.84). Incidence per 100000 persons years by age group was 1.93 (0.83 to 3.03) for 0–14 years, 1.28 (0.45 to 2.11) for 15–29 years, and 0.69 (0.00 to 1.51) for ≥30 years. The proportion of new onset cases in participants aged ≥20 years was 65.3%. We found rapid increase of incidence of T1D in China. The current status of T1D in China was unsatisfactory and the patients were under heavy burden. We should conduct more clinical trials and appeal for support from government or other organizations and to help the patients with T1D.

ВОЗМОЖНОСТИ ПОВЫШЕНИЯ ЭФФЕКТИВНОСТИ ПРОФИЛАКТИКИ ЗАБОЛЕВАНИЯ У ДЕТЕЙ В ОЧАГАХ ТУБЕРКУЛЕЗНОЙ ИНФЕКЦИИ НА ПРИМЕРЕ ПЕРМСКОГО КРАЯ

The objective of the study : to characterize nidi of tuberculous infection of category I where children are living and effectiveness of tuberculosis prevention activities for the children living there. Subjects and methods . The degree of the risk of the epidemic breakout was assessed in the nidi of tuberculous infection where 520 children were living, results of skin tests were studied in 122 children from those nidi exposed to tuberculosis patients with no bacillary excretion, 263 children exposed to infectious patients, 112 children exposed to multiple drug resistant tuberculosis. The group of children (42 persons) from tuberculous infection nidi who developed active tuberculosis was also studied. Results of the study . It was found out that in two third of the nidi, where children were living, TB patients were excreting tuberculous bacilli, and in more than half of cases the source of infection was drug resistant, of which the majority of nidi (68.4%) had MDR MTB and 12.6% – extensive drug resistance. Each fifth case (21.5%) had concurrent HIV infection. In the nidus with a lethal case, 4.6% of children were contacting a case with TB/HIV co-infection and MDR/XDR. The mean age of the children who developed tuberculosis after exposure to the infection made 5.27± 3.17 years old, and 90.5% of cases were children exposed to a tuberculosis case with bacillary excretion, of 36.8% was exposed to an MDR TB case and 10.5% – to XDR TB. The hyperergic result of the test with TRA was confidently more frequent in all the groups versus Mantoux test (p < 0.05). It indicated of the heavy epidemic burden of the tuberculous infection nidus and proved the need to pay very close attention to this group of patients and their neighbors. In tuberculous infection nidi, where active tuberculosis was registered among children, the anti-tuberculosis activities were investigated and it was found out that their quality including preventive treatment was poor.

Empagliflozin: an exciting prospect in the treatment of diabetes

Type 2 diabetes mellitus (T2DM) continues to be a chronic and disabling disease that is associated with high mortality and morbidity. The epidemic burden of diabetes mellitus has increased in developing countries and Asia is considered as the “diabetic epicentre”. Type 2 diabetes (T2DM), is characterised by reduced secretion of insulin from pancreatic beta cells independently or associated with reduced response of peripheral tissues to circulating insulin. A proper glycaemic control is essential to delay the micro and macrovascular complications of T2DM. Standard anti-diabetic agents including insulin happen to induce minor to major adverse outcomes in certain populations over prolonged period of administration. Hence there has been a compelling need to develop newer and novel approach to treatment of T2DM. Sodium-glucose co-transporter 2 (SGLT-2) inhibitors are a novel category of drugs that happen to reduce glycaemic overload by inducing glycosuria. The safety, efficacy and tolerability profile of these drugs were studied separately under various trials and was approved for use in August 2014 by US-FDA. This review is an attempt to describe the history of SGLT-2 inhibitors, their mechanism of action, safety and efficacy as well as its current status among anti-diabetic agents.

Correlates of overall and central obesity in adults from seven European countries: findings from the Food4Me Study.

To identify predictors of obesity in adults and investigate to what extent these predictors are independent of other major confounding factors. Data collected at baseline from 1441 participants from the Food4Me study conducted in seven European countries were included in this study. A food frequency questionnaire was used to measure dietary intake. Accelerometers were used to assess physical activity levels (PA), whereas participants self-reported their body weight, height and waist circumference via the internet. The main factors associated (p < 0.05) with higher BMI per 1-SD increase in the exposure were age (β:1.11 kg/m2), intakes of processed meat (β:1.04 kg/m2), red meat (β:1.02 kg/m2), saturated fat (β:0.84 kg/m2), monounsaturated fat (β:0.80 kg/m2), protein (β:0.74 kg/m2), total energy intake (β:0.50 kg/m2), olive oil (β:0.36 kg/m2), sugar sweetened carbonated drinks (β:0.33 kg/m2) and sedentary time (β:0.73 kg/m2). In contrast, the main factors associated with lower BMI per 1-SD increase in the exposure were PA (β:-1.36 kg/m2), intakes of wholegrains (β:-1.05 kg/m2), fibre (β:-1.02 kg/m2), fruits and vegetables (β:-0.52 kg/m2), nuts (β:-0.52 kg/m2), polyunsaturated fat (β:-0.50 kg/m2), Healthy Eating Index (β:-0.42 kg/m2), Mediterranean diet score (β:-0.40 kg/m2), oily fish (β:-0.31 kg/m2), dairy (β:-0.31 kg/m2) and fruit juice (β:-0.25 kg/m2). These findings are important for public health and suggest that promotion of increased PA, reducing sedentary behaviours and improving the overall quality of dietary patterns are important strategies for addressing the existing obesity epidemic and associated disease burden.

Role of Influenza in ED Visits and Hospitalizations of Adults Over 65 Years in France

We aimed to estimate the influenza epidemic burden on ED attendances and hospitalizations among patients over 65y, during 2010-2015 period. Weekly numbers of visits and hospitalizations for influenza proxy-variables were modeled separately using a negative binomial regression model, including laboratory confirmed influenza identifications. Attendances and hospitalizations for acute bronchitis, pneumonia,COPD, dyspnea, asthma, acute cardiac failure, and dehydration were significantly associated with influenza positivity rate. We showed that the burden of influenza is underestimated among the elderly and should be better estimated using a dedicated diagnostic codes grouping.

Obesity and anthropometric indicators in a sample of males with Acute Coronary Syndrome in a health area with inclusion of inmates: case-control study

Obesity is a cardiovascular risk factor with a high epidemic burden on ischemic heart disease. The aim of this study was to analyze the anthropometric indicators of obesity in a sample of males who have had an Acute Coronary Syndrome (ACS) diagnosed in a prison referral hospital, and a control group. Cross-sectional case-control study in a Health Area with inclusion of a penitentiary center. The participants in this study were 204 males, 102 cases and one control selected for each case (n=102). We measured weight, height waist circumference (WC), umbilical waist (UW) and hip circumference. We calculated body mass index (BMI) and other anthropometric indicators: waist to-hip-ratios (WHR and UWHR), waist to-height-ratios (WHtR and UWHtR). We obtained the areas under the receiver operating characteristic curves (AUC), the odds ratio (OR) and the correlations in the infarcted people. Obesity was more prevalent in ACS (31.4% vs 9.1%; OR: 4.7). Other indicators show a discriminatory association. BMI (AUC: 0.699; OR: 3.9), WC (AUC: 0.750; OR: 6.3), UW (AUC: 0.777; OR: 10), inverse height (AUC: 0.619; OR: 2.1), WHR (AUC: 0.832; OR: 11.6); UWHR (AUC: 0.857; OR: 15.6), UWHtR (AUC: 0.800; OR: 8.9). In ACS the correlations for both WC and UW with waist to-height-ratios (WHtR and UWHtR) were strong (all r ≥0.90; p < 0.001). The anthropometric indicators of obesity are clearly associated with ACS. UW is the simple measurement with the best association. BMI is most weakly associated. UWHtR presents high discriminatory power and the best anthropometric correlation of risk that supports its use for the identification of males at risk of myocardial infarction in the general population and prison.

Spatial Accessibility to HIV Providers in Atlanta, Georgia.

AIDS Research and Human RetrovirusesVol. 31, No. 5 Images in HIV ResearchSpatial Accessibility to HIV Providers in Atlanta, GeorgiaSharoda Dasgupta, Michael R. Kramer, Eli S. Rosenberg, Travis H. Sanchez, and Patrick S. SullivanSharoda DasguptaSearch for more papers by this author, Michael R. KramerSearch for more papers by this author, Eli S. RosenbergSearch for more papers by this author, Travis H. SanchezSearch for more papers by this author, and Patrick S. SullivanSearch for more papers by this authorPublished Online:1 May 2015https://doi.org/10.1089/aid.2014.0365AboutSectionsView articleView Full TextPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Spatial Accessibility to HIV Providers in Atlanta, Georgia." AIDS Research and Human Retroviruses, 31(5), pp. 473–474FiguresReferencesRelatedDetailsCited BySpatial accessibility to HIV testing, treatment, and prevention services in Illinois and Chicago, USA27 July 2022 | PLOS ONE, Vol. 17, No. 7Integrating and Disseminating Pre-Exposure Prophylaxis (PrEP) Screening and Dispensing for Black Men Who Have Sex With Men in Atlanta, Georgia: Protocol for Community Pharmacies9 February 2022 | JMIR Research Protocols, Vol. 11, No. 2Geographic Density and Uptake of Pre-exposure Prophylaxis (PrEP) Among Young Gay, Bisexual and Other Sexual Minority Men: A Global Positioning System (GPS) Study5 April 2021 | AIDS and Behavior, Vol. 25, No. S2Epidemiology of HIV in the USA: epidemic burden, inequities, contexts, and responsesThe Lancet, Vol. 397, No. 10279Pharmacy-based pre-exposure prophylaxis support among pharmacists and men who have sex with menJournal of the American Pharmacists Association, Vol. 60, No. 4Willingness to Discuss and Screen for Pre-Exposure Prophylaxis in Pharmacies Among Men Who Have Sex With Men18 February 2020 | Journal of Pharmacy Practice, Vol. 6Geographic Access to Preexposure Prophylaxis Clinics Among Men Who Have Sex With Men in the United StatesAmerican Journal of Public Health, Vol. 109, No. 9Spatial Access and Willingness to Use Pre-Exposure Prophylaxis Among Black/African American Individuals in the United States: Cross-Sectional Survey4 February 2019 | JMIR Public Health and Surveillance, Vol. 5, No. 1Development of a comprehensive measure of spatial access to HIV provider services, with application to Atlanta, Georgia4 July 2016 | SpringerPlus, Vol. 5, No. 1Understanding Local Spatial Variation Along the Care ContinuumJAIDS Journal of Acquired Immune Deficiency Syndromes, Vol. 72, No. 1The Effect of Commuting Patterns on HIV Care Attendance Among Men Who Have Sex With Men (MSM) in Atlanta, Georgia24 August 2015 | JMIR Public Health and Surveillance, Vol. 1, No. 2 Volume 31Issue 5May 2015 InformationCopyright 2015, Mary Ann Liebert, Inc.To cite this article:Sharoda Dasgupta, Michael R. Kramer, Eli S. Rosenberg, Travis H. Sanchez, and Patrick S. Sullivan.Spatial Accessibility to HIV Providers in Atlanta, Georgia.AIDS Research and Human Retroviruses.May 2015.473-474.http://doi.org/10.1089/aid.2014.0365Published in Volume: 31 Issue 5: May 1, 2015Online Ahead of Print:April 6, 2015PDF download

Diversity of apolipoprotein E genetic polymorphism significance on cardiovascular risk is determined by the presence of metabolic syndrome among hypertensive patients.

BackgroundHypertension has a significant relevance as a cardiovascular risk factor. A consistent increase on world’s Metabolic Syndrome (MetS) incidence has been associated with an epidemic cardiovascular risk in different populations. Dislipidemia plays a major role determining the epidemic CV burden attributed to MetS. Apolipoprotein E (ApoE) is involved on cholesterol and triglycerides metabolism regulation. Once ApoE polymorphism may influence lipid metabolism, it is possible that it brings on individual susceptibility consequences for the development of MetS and cardiovascular risk. The objective of the study is to measure the discriminatory power of ApoE polymorphism in determining cardiovascular risk stratification based on the presence MetS in a cohort of hypertensive patients.MethodsIt was enrolled 383 patients, divided in two groups, classified by MetS presence (IDF criteria): Group 1: 266 patients with MetS (MetS +) and Group 2: 117 patients without Mets (MetS -). Patient’s data were collected by clinical evaluation, physical exam, file reviews and laboratory testing. Polymorphic ApoE analysis was performed by PCR amplification. Groups were compared on clinical and laboratory characteristics as well as allele and genotype distribution towards ApoE polymorphism. Mets CVD prevalence was analysed according to E4 allele prevalence.ResultsThe results evidenced 184 men (48%), 63,7% whites, 45,1% diabetics and 11,7% of patients were smokers. Mean age was 64,0 ± 12,0 years. When genotypic distribution was analyzed, E3/3 genotype and E3 allele frequencies were more prevalent. Among patients with MetS, we observed an independent association between CVD prevalence and E4 allele frequency (OR 2.42 (1.17- 5.0, p < 0,05)). On the opposite direction, in those without MetS, there was lesser CVD burden in E4 allele carriers (OR 0,14 (0,02-0,75)). These associations remained significant even after confounding factor corrections.ConclusionsThe results presented demonstrate that the association between ApoE gene and CVD may be modulated by the presence of MetS, with an increased CV burden observed among E4 allele carriers with the syndrome. On the opposite way, E4 allele carriers without visceral obesity had lesser prevalence of CVD.

Characteristics of the spatio-temporal network of cattle movements in France over a 5-year period

A good knowledge of the specificities of the animal trade network is highly valuable to better control pathogen spread on a large regional to transnational scale. Because of their temporal dynamical nature, studying multi-annual datasets is particularly needed to investigate whether structural patterns are stable over the years. In this study, we analysed the French cattle movement network from 2005 to 2009 for different spatial granularities and temporal windows, with the three-fold objective of exploring temporal variations of the main network characteristics, computing proxies for pathogen spread on this network, which accounts for its time-varying properties and identifying specificities related to the main types of animals and farms (dairy versus beef). Network properties did not qualitatively vary among different temporal and spatial granularities. About 40% of the holdings and 80% of the communes were directly interconnected. The width of the aggregation time window barely impacted normalised distributions of indicators. A period of 8–16 weeks would suffice for robust estimation of their main trends, whereas longer periods would provide more details on tails. The dynamic nature of the network could be seen through the small overlap between consecutive networks with 65% of common active nodes for only 3% of common links over 2005–2009. To control pathogen spread on such a network, by reducing the largest strongly connected component by more than 80%, movements should be prevented from 1 to 5% of the holdings with the highest centrality in the previous year network. The analysis of breed-wise and herd-wise subnetworks, dairy, beef and mixed, reveals similar trends in temporal variation of average indicators and their distributions. The link-based backbones of beef subnetworks seem to be more stable over time than those of other subnetworks. At a regional scale, node reachability accounting for time-respecting paths, as proxy of epidemic burden, is greater for a dairy region than for a beef region. This highlights the importance of considering local specificities and temporal dynamics of animal trade networks when evaluating control measures of pathogen spread.

Abstract 468: Diversity of Apolipoprotein E genetic polymorphism significance on cardiovascular risk is determined by the presence of Metabolic Syndrome among hypertensive patients

INTRODUCTION: Hypertension has a significant relevance as a cardiovascular risk factor. A consistent increase on world’s Metabolic syndrome (MetS) incidence has been associated with an epidemic cardiovascular risk in different populations. Dislipidemia plays a major role determining the epidemic CV burden attributed to MetS. Apolipoprotein E (ApoE) is involved on cholesterol and triglycerides metabolism regulation. Once ApoE polymorphism may influence lipid metabolism, it is possible that it brings on individual susceptibility consequences for the development of MetS and cardiovascular risk. OBJECTIVE: To measure the discriminatory power of ApoE polymorphism in determining the cardiovascular risk stratification based on the presence MetS in a cohort of hypertensive patients. PATIENTS AND METHODS: It was enrolled 401 patients, divided in two groups, classified by MetS presence (IDF criteria): Group 1: 275 patients with MetS (MetS +) and Group 2: 126 patients without Mets (MetS -). Patient’s data were collected by clinical evaluation, physical exam, file reviews and laboratory testing. Polymorphic ApoE analysis was performed by PCR amplification. Groups were compared on clinical and laboratorial characteristics as well as allele and genotype distribution in relation to ApoE polymorphism. Prevalence of CVD, in relation to Mets presence, was analysed based on allele 4 prevalence. RESULTS: The results evidenced 186 men (47,4%), 62,1% whites, 44,1% diabetics and 11,5% of patients were smokers. Mean age was 64,0±12,0 years. When genotypic distribution was analyzed, E3/3 genotype and E3 allele frequency were more prevalent. Among patients with MetS, we observed an independent association between CVD prevalence and allele E4 frequency(OR 2.42(1.17-1.5, p&lt;0,05)). On the contrary, in those without MetS, there was lesser CVD burden in E4 allele carriers(OR 0,14(0,02-0,75)). These associations remained significant even after confounding factor corrections. CONCLUSION: The results presented show that association between ApoE gene and CVD maybe modulated by de presence of MetS, with an increased CV burden observed among E4 carriers with the Syndrome. On the opposite way, E4 carriers without visceral obesity had a lesser prevalence of CVD.

Modeling scenarios for the end of AIDS.

At the end of 2012, 3 decades after the human immunodeficiency virus (HIV) was first identified, neither a cure nor a fully preventive vaccine was available. Despite multiple efforts, the epidemic remains an exceptional public health challenge. At the end of 2012, it was estimated that, globally, 35 million people were living with HIV, 2.3 million had become newly infected, and 1.6 million had died from AIDS-related causes. Despite substantial prevention efforts and increases in the number of individuals on highly active antiretroviral therapy (HAART), the epidemic burden continues to be high. Here, we provide a brief overview of the epidemiology of HIV transmission, the work that has been done to date regarding HIV modeling in different settings around the world, and how to finance the response to the HIV epidemic. In addition, we suggest discussion topics on how to move forward with the prevention agenda and highlight the role of treatment as prevention (TasP) in curbing the epidemic.

Community needs assessment of key populations-at-risk of HIV/AIDS in Nigeria's capital territory

Nigeria currently has one of the highest HIV and AIDS epidemic burden worldwide. Prevalence among key populations is currently, 34.1% (brothel-based sex workers), 21.95 (non-brothel-based), 37.6% (MSMs) and 9.3% for IDUs respectively. A huge gaps exists in the national response to key populations as a result of socio-cultural barriers and unfavorable political and legislative environment. This has become accentuated by the recently enacted anti-gay law. The Federal Capital Administration in collaboration with UNDP and UNFPA in 2013 commissioned a study on key populations in the Capital territory to identify services available to them, the gaps and opportunities for scaling up municipal responses for MSMs, FSWs and IDUs.

Chronic Kidney Disease in Central American Agricultural Communities: Challenges for Epidemiology and Public Health

This paper contextualizes the chronic kidney disease epidemic and related burden of disease affecting Central American farming communities. It summarizes the two main causal hypotheses (heat stress and agrochemicals), draws attention to the consequences of dichotomous reasoning concerning causality, and warns of potential conflicts of interest and their role in "manufacturing doubt." It describes some methodological errors that compromise past study findings and cautions against delaying public health actions until a conclusive understanding is reached about the epidemic's causes and underlying mechanisms. It makes the case for a comprehensive approach to the historical, social and epidemiological facts of the epidemic, for critically assessing existing studies and for enhanced rigor in new research.

Control of (Multi)Drug Resistance and Tuberculosis Incidence over 23 Years in the Context of a Well-Supported Tuberculosis Programme in Rural Malawi

BackgroundThe rise in tuberculosis (TB) incidence following generalized HIV epidemics can overwhelm TB control programmes in resource-limited settings, sometimes accompanied by rising rates of drug resistance. This has led to claims that DOTS-based TB control has failed in such settings. However, few studies have described the effect of a sustained and well-supported DOTS programme on TB incidence and drug resistance over a long period. We present long-term trends in incidence and drug resistance in rural Malawi.MethodsKaronga District in northern Malawi has an adult HIV prevalence of ∼10%. A research group, the Karonga Prevention Study, collaborates with the National Tuberculosis Programme to support core TB control activities. Bacteriological, demographic and clinical (including HIV status) information from all patients starting TB treatment in the District have been recorded since 1988. During that period isolates from each culture-positive TB patient were exported for drug sensitivity testing. Antiretroviral therapy (ART) has been widely available since 2005.ResultsIncidence of new smear-positive adult TB peaked at 124/100,000/year in the mid-90s, but has since fallen to 87/100,000/year. Drug sensitivity information was available for 95% (3132/3307) of all culture-positive cases. Initial resistance to isoniazid was around 6% with no evidence of an increase. Fewer than 1% of episodes involved a multi-drug resistant strain.DiscussionIn this setting with a generalised HIV epidemic and medium TB burden, a well-supported DOTS programme enhanced by routine culture and drug sensitivity testing may well have reduced TB incidence and maintained drug resistance at low levels.

A seroepidemiological study of pandemic A/H1N1(2009) influenza in a rural population of Mali

The swine-origin H1N1 influenza A virus (pH1N1(2009)) started to circulate worldwide in 2009, and cases were notified in a number of sub-Saharan African countries. However, no epidemiological data allowing estimation of the epidemic burden were available in this region, preventing comprehensive comparisons with other parts of the world. The CoPanFlu-Mali programme studied a cohort of 202 individuals living in the rural commune of Dioro (southern central Mali). Pre-pandemic and post-pandemic paired sera (sampled in 2006 and April 2010, respectively) were tested by the haemagglutination inhibition (HI) method. Different estimates of pH1N1(2009) infection during the 2009 first epidemic wave were used (increased prevalence of HI titre of ≥ 1/40 or ≥ 1/80, seroconversions) and provided convergent attack rate values (12.4-14.9%), the highest values being observed in the 0-19-year age group (16.0-18.4%). In all age groups, pre-pandemic HI titres of ≥1/40 were associated with complete absence of seroconversion; and geometric mean titres were <15 in individuals who seroconverted and >20 in others. Important variations in seroconversion rate existed among the different villages investigated. Despite limitations resulting from the size and composition of the sample analysed, this study provides strong evidence that the impact of the pH1N1(2009) first wave was more important than previously believed, and that the determinants of the epidemic spread in sub-Saharan populations were quite different from those observed in developed countries.

System-wide effects of Global Fund investments in Nepal

Nepal, with a concentrated HIV epidemic and high burden of tuberculosis (TB) and malaria, was perceived to have immensely benefited from grants by the Global Fund to Fight AIDS, Tuberculosis and Malaria in addressing the three diseases, amounting to total approved funding of US$80 million. This paper looks at the interaction and integration of Global Fund-supported programmes and national health systems. A mixed method 'case study' approach based on the Systemic Rapid Assessment Toolkit (SYSRA) was used to systematically analyse across the main health systems functional domains. The Country Coordinating Mechanism has been credited with providing the stewardship in attracting additional resources and providing oversight. The involvement of civil society for delivering key HIV and malaria interventions targeting high-risk groups was perceived to be highly beneficial. TB and malaria services were found to be well integrated into the public health care delivery system, while HIV services targeting at-risk groups were often delivered using parallel structures. Political instability, absence of continuity in leadership and sub-optimal investments in health were together perceived to have led to fragmentation of financing and planning activities, especially in HIV the programme. The demand for timely programmatic and financial reporting for donor-supported programmes has contributed to the creation of parallel monitoring and evaluation structures, with missed opportunities for strengthening and utilizing the national health management information systems.

Metabolic syndrome and cardiometabolic risk: An update

Several lines of evidence show that metabolic syndrome represents an important therapeutic challenge for the forthcoming years. This is because of the epidemic burden of this multifaceted disease, the adverse impact on cardiovascular risk, as well as the problems posed in its management. This paper will provide an up‐to‐date report on metabolic syndrome and cardiometabolic risk, focusing in particular on the epidemiological profile of the disease, the impact on risk profile and target organ damage as well as some of the main pathophysiological features of the condition. The general therapeutic recommendations, provided by the 2007 European Society of Hypertension/European Society of Cardiology Guidelines, will be briefly discussed.

Epidemiology and natural history of non-alcoholic fatty liver disease (NAFLD)

The authors summarize and update the most recent knowledge in the field of prevalence, natural history and incidence of Non Alcoholic Fatty Liver Disease (NAFLD) and Non Alcoholic Steatohepatitis (NASH). These novel diseases, firstly recognized at the beginning of the second millennium, arose suddenly to the attention of the clinicians, because they are the hepatic expression of the “so-called” metabolic syndrome. Due to the epidemic burden of obesity, diabetes, and metabolic diseases, NAFLD and NASH will become soon probably the most common hepatic disease worldwide, and they surely will keep busy our future young hepa-tologists.

HIV-associated nephropathy: epidemiology, pathogenesis, diagnosis and management

HIV-associated nephropathy (HIVAN) is the most well-known and aggressive kidney disease in HIV-1-infected patients. A variant of focal segmental glomerulosclerosis, it is characterized by the collapse of the glomerular tuft with podocyte hypertrophy/hyperplasia and foot process effacement, often with concurrent tubular microcystic dilation and tubulointerstitial nephritis. The disease has been intimately linked to the direct effect of HIV-1 on the kidney. It affects patients of African descent exclusively and is manifested by an acute decline in kidney function, most often in conjunction with high-grade proteinuria and uncontrolled HIV-1 infection. With the widespread use of highly active antiretroviral therapy (HAART), its prevalence is declining in Western countries. However, the epidemiology of the disease is not well defined in the poorest areas of the world, which bear a disproportionate share of the HIV-1 epidemic burden. Scientific evidence suggests that HAART can prevent the development of HIVAN. Furthermore, HAART, corticosteroids and inhibition of the renin–angiotensin axis are potentially helpful in delaying disease progression, as well as the need for renal replacement therapy.

Essential Features of a Surveillance System to Support the Prevention and Management of Heart Disease and Stroke

A strategic goal of the American Heart Association (AHA) is to reduce heart disease, stroke, and risk for both by 25%,1 and Healthy People 2010 (HP2010) established 4 national goals for heart disease and stroke prevention and management.2 However, the current health tracking systems (surveillance) in the United States cannot track progress toward these goals in a comprehensive and systematic manner. This article provides a brief overview of these goals, prevention and management strategies, and the role of surveillance in monitoring the impact of prevention and treatment efforts. It also provides a review of the existing surveillance system for monitoring progress toward preventing heart disease and stroke in the United States and recommendations for filling important gaps in that system. This information will serve as an important basis for advocacy to guide the development of a comprehensive surveillance system to support the current HP2010 and AHA goals and the likely future goal of eliminating the epidemic burden of heart disease and stroke. Recommendations are categorized as overarching (fundamental recommendations that cut across goal areas) or as goal-specific. They are further classified according to priority (P) (I for high priority and II for intermediate priority. No low-priority recommendations were made), staging (S) (I for early staging [1–2 years], II for intermediate staging [2–4 years], and III for later staging), and cost (C) ($ for items estimated to cost less than $10 million per year, $$ for estimates of $10 to $100 million, and $$$ for estimates exceeding $100 million). In addition, potential barriers to action are addressed. 1. A National Heart Disease and Stroke Surveillance unit should be established to produce annual reports on key indicators of progress in the prevention and management of heart disease and stroke. P I, S I, C $. 2. Cardiovascular disease (CVD), including cardiac arrests, …