Under-vaccinated groups in Europe and their beliefs, attitudes and reasons for non-vaccination; two systematic reviews

BACKGROUND

Despite effective national immunisation programmes in Europe, some groups remain incompletely or un-vaccinated ('under-vaccinated'), with underserved minorities and certain religious/ideological groups repeatedly being involved in outbreaks of vaccine preventable diseases (VPD). Gaining insight into factors regarding acceptance of vaccination of 'under-vaccinated groups' (UVGs) might give opportunities to communicate with them in a trusty and reliable manner that respects their belief system and that, maybe, increase vaccination uptake. We aimed to identify and describe UVGs in Europe and to describe beliefs, attitudes and reasons for non-vaccination in the identified UVGs.

METHODS

We defined a UVG as a group of persons who share the same beliefs and/or live in socially close-knit communities in Europe and who have/had historically low vaccination coverage and/or experienced outbreaks of VPDs since 1950. We searched MEDLINE, EMBASE and PsycINFO databases using specific search term combinations. For the first systematic review, studies that described a group in Europe with an outbreak or low vaccination coverage for a VPD were selected and for the second systematic review, studies that described possible factors that are associated with non-vaccination in these groups were selected.

RESULTS

We selected 48 articles out of 606 and 13 articles out of 406 from the first and second search, respectively. Five UVGs were identified in the literature: Orthodox Protestant communities, Anthroposophists, Roma, Irish Travellers, and Orthodox Jewish communities. The main reported factors regarding vaccination were perceived non-severity of traditional "childhood" diseases, fear of vaccine side-effects, and need for more information about for example risk of vaccination.

CONCLUSIONS

Within each UVG identified, there are a variety of health beliefs and objections to vaccination. In addition, similar factors are shared by several of these groups. Communication strategies regarding these similar factors such as educating people about the risks associated with being vaccinated versus not being vaccinated, addressing their concerns, and countering vaccination myths present among members of a specific UVG through a trusted source, can establish a reliable relationship with these groups and increase their vaccination uptake. Furthermore, other interventions such as improving access to health care could certainly increase vaccination uptake in Roma and Irish travellers.

Young male sex workers are at high risk for sexually transmitted infections, a cross-sectional study from Dutch STI clinics, the Netherlands, 2006-2012

Background

Male sex workers (MSW) are particularly exposed to sexually transmitted infections (STI) including HIV. In the Netherlands, data about STI among MSW are scarce. We estimated chlamydia, gonorrhoea, syphilis and HIV diagnoses among MSW attending STI clinics and determined associated factors to guide prevention policies.

Methods

Using 2006–2012 cross-sectional national surveillance data from Dutch STI clinics, we calculated the proportion of consultations with a positive test for any of three bacterial STI or HIV among MSW. Associated factors were determined by using Poisson logistic regression with robust variance.

Results

We identified 3,053 consultations involving MSW, of which 18.1 % included at least one positive bacterial STI test and 2.5 % a positive HIV test. Factors associated with bacterial STI and/or HIV diagnoses were respectively age groups < 35 y.o. and self-reporting homo- or bisexual preferences (aRR = 1.6; 95 % CI: 1.3–2.1), and age group 25–34 y.o. (aRR = 2.7; 95 % CI: 1.2–6.5) and self-reporting homo- or bisexual preferences (aRR = 24.4; 95 % CI: 3.4–176.9). Newly diagnosed and pre-existing HIV infection were associated with an increased risk for bacterial STI (aRR = 2.7, 95 % CI: 1.7–2.6 and aRR = 2.1, 95 % CI: 2.2–3.4 respectively). MSW with no history of HIV screening were more likely to be tested positive for HIV compared to those with a previous HIV-negative test (aRR = 2.6, 95 % CI: 1.6–4.3).

Conclusion

Health promotion activities should target MSW who are young, homo- or bisexual, those who are HIV-infected or who have never been tested for HIV, to increase early diagnosis, prevention and treatment.

Functional MRI evidence for the decline of word retrieval and generation during normal aging

This fMRI study aimed to explore the effect of normal aging on word retrieval and generation. The question addressed is whether lexical production decline is determined by a direct mechanism, which concerns the language operations or is rather indirectly induced by a decline of executive functions. Indeed, the main hypothesis was that normal aging does not induce loss of lexical knowledge, but there is only a general slowdown in retrieval mechanisms involved in lexical processing, due to possible decline of the executive functions. We used three tasks (verbal fluency, object naming, and semantic categorization). Two groups of participants were tested (Young, Y and Aged, A), without cognitive and psychiatric impairment and showing similar levels of vocabulary. Neuropsychological testing revealed that older participants had lower executive function scores, longer processing speeds, and tended to have lower verbal fluency scores. Additionally, older participants showed higher scores for verbal automatisms and overlearned information. In terms of behavioral data, older participants performed as accurate as younger adults, but they were significantly slower for the semantic categorization and were less fluent for verbal fluency task. Functional MRI analyses suggested that older adults did not simply activate fewer brain regions involved in word production, but they actually showed an atypical pattern of activation. Significant correlations between the BOLD (Blood Oxygen Level Dependent) signal of aging-related (A > Y) regions and cognitive scores suggested that this atypical pattern of the activation may reveal several compensatory mechanisms (a) to overcome the slowdown in retrieval, due to the decline of executive functions and processing speed and (b) to inhibit verbal automatic processes. The BOLD signal measured in some other aging-dependent regions did not correlate with the behavioral and neuropsychological scores, and the overactivation of these uncorrelated regions would simply reveal dedifferentiation that occurs with aging. Altogether, our results suggest that normal aging is associated with a more difficult access to lexico-semantic operations and representations by a slowdown in executive functions, without any conceptual loss.

Assessment of everyday executive functioning in children with frontal or temporal epilepsies

Executive functions are particularly vulnerable in case of brain disruption during childhood, when the brain is not fully mature. Some studies showed impairments of executive functions in children with epilepsy, but only a few of them investigated the impact of executive dysfunctions on daily life. The aim of this study was to understand the everyday executive functioning of children with epilepsy both at home and in school. We administered the Behavior Rating Inventory of Executive Function to parents and teachers of 53 children (7-16 years of age) with structural epilepsies or epilepsies of unknown cause of temporal lobe (n=25) or frontal lobe (n=28). The results indicated a global executive impairment in the whole group of patients, compared with normative data, with no difference between the group with temporal lobe epilepsy (TLE) and that with frontal lobe epilepsy (FLE), except for monitor domain, which seemed more frequently impaired in the group with FLE. Congruence between parent and teacher ratings was found. The frequency of seizures was not related to executive dysfunction, whereas the number of antiepileptic drugs tended to positively correlate with working memory impairment. Onset of epilepsy at a younger age was also related to more executive difficulties but only according to teacher ratings. Lastly, duration of epilepsy was strongly associated with executive deficits reported in the context of school. Our results support the executive dysfunction hypothesis in daily life of children with structural focal epilepsy or focal epilepsy of unknown cause and are consistent with the early brain vulnerability hypothesis currently prevalent in the context of child neuropsychology. The BRIEF appears to be a clinically useful tool for assessing executive function impairment in this clinical population.

Simultaneous increase of Cryptosporidium infections in the Netherlands, the United Kingdom and Germany in late summer season, 2012

Binary file ES_Abstracts_Final_ECDC.txt matches

Simultaneous increase of Cryptosporidium infections in the Netherlands, the United Kingdom and Germany in late summer season, 2012

Starting August 2012, an increase in Cryptosporidium infections was reported in the Netherlands, the United Kingdom and Germany. It represented a 1.8 to 4.9-fold increase compared to previous years. Most samples were C. hominis IbA10G2. A case–control study was performed in the Netherlands but did not identify an endemic source. A case–case study in the north of England found travel abroad to be the most common risk factor.

Another possible food-borne outbreak of hepatitis A in the Netherlands indicated by two closely related molecular sequences, July to October 2011

In November 2011, a cluster of initially five cases of hepatitis A infection with closely related strains was identified in the Netherlands. England reported possibly related cases. Strains with identical sequences had been involved in previous outbreaks linked to semi-dried tomatoes. Investigation of the Dutch cluster suggested a link with ready-to-eat salads including those containing semi-dried tomatoes. Despite trace-back, a source was not identified. Vigilance is needed, and rapid sharing of data may help source-tracing.

Development and evaluation of tuberculosis screening scores in Brazilian prisons

BACKGROUND

Tuberculosis (TB) is highly endemic in Rio de Janeiro State prisons. In addition to TB screening at entry and passive case detection, active case identification may be warranted.

OBJECTIVES

To develop and evaluate performances of scores aimed at identifying "tuberculosis suspects" in order to target TB screening among inmates.

METHODS

Systematic chest X-ray screening was carried out in two prisons (n=1910). TB was diagnosed among individuals with X-ray abnormalities by sputum microscopic examination and culture or, if bacteriological results were negative, by response to TB treatment. Using this strategy as a reference, the clinical score proposed in WHO guidelines "TB Control in Prisons" was evaluated. Using the same variables in a logistic regression comparing TB and non-TB cases, another score was developed and evaluated. Finally, a 'new score', based on socio-demographic and clinical variables was developed and evaluated.

RESULTS

When applied to our study population (prevalence of active TB: 4.6%), these scores missed many TB cases (sensitivities: 56%, 72%, 74%, respectively). Among the "TB suspects", the probability of finding TB cases was low (positive predictive value: 10%). The scores had high negative predictive values (>97%); specificities (75%, 60%, 67%) were low. Performances were similarly poor for smear-negative and smear-positive cases.

CONCLUSION

The scores investigated performed poorly and would be unhelpful to target TB screening. Therefore, systematic X-ray screening may be considered, at least during the initial stages of the reinforced TB programme, in order to reduce the impressive burden of TB.

Working memory functioning in medicated Parkinson's disease patients and the effect of withdrawal of dopaminergic medication

Cognitive impairments in Parkinson's disease (PD) could be explained by a central executive (CE) deficit in A. D. Baddeley's (1986) working memory model. To test this hypothesis, verbal, spatial, and double span tasks were given to 12 medicated PD patients and control participants, with varying recall delays. The double span task was assigned to explore the coordinating and integrating function of the CE, and lengthening the recall delay was expected to implicate more attentional resources. PD patients had lower spans relative to controls in all tasks. However, the more specific implication of the CE was difficult to prove. One reason could be that PD patients were on dopaminergic treatment when tested. To control this effect, 12 PD patients on and off medication were studied in a second experiment using the same tasks. PD patients off medication had lower spans only in the double task; this result underlines the role of dopamine on working memory processes.

Working memory functioning in medicated Parkinson's disease patients and the effect of withdrawal of dopaminergic medication

Cognitive impairments in Parkinson's disease (PD) could be explained by a central executive (CE) deficit in A. D. Baddeley's (1986) working memory model. To test this hypothesis, verbal, spatial, and double span tasks were given to 12 medicated PD patients and control participants, with varying recall delays. The double span task was assigned to explore the coordinating and integrating function of the CE, and lengthening the recall delay was expected to implicate more attentional resources. PD patients had lower spans relative to controls in all tasks. However, the more specific implication of the CE was difficult to prove. One reason could be that PD patients were on dopaminergic treatment when tested. To control this effect, 12 PD patients on and off medication were studied in a second experiment using the same tasks. PD patients off medication had lower spans only in the double task; this result underlines the role of dopamine on working memory processes.

The phonological loop in medicated patients with Parkinson's disease: presence of phonological similarity and word length effects

OBJECTIVE

To test the verbal subsystem of Baddeley's working memory model (the phonological loop) in patients with Parkinson's disease.

METHODS

Fifteen patients with idiopathic Parkinson's disease and 15 controls were tested with a span paradigm to assess the effects reflecting the functioning of the phonological loop: the phonological similarity effect (in verbal and visual presentation), and the word length effect (in visual presentation).

RESULTS AND CONCLUSIONS

The patients did not show any dysfunction of the phonological loop, reflected by the presence of phonological similarity and word length effects, but had lower spans than controls. The implications of these results for the working memory model are discussed.

Working memory in medicated patients with Parkinson's disease: the central executive seems to work

OBJECTIVE

To determine whether a deficit of the central executive can explain the attentional deficits of patients with Parkinson's disease.

METHODS

Fifteen patients with idiopathic Parkinson's disease and 15 controls were given a dual task paradigm minimising motor demands and combining verbal, visual, or spatial span with two conditions of articulatory suppression.

RESULTS

Although the spans were systematically lower in medicated parkinsonian patients than in controls, suggesting a decrease of central processing resources, there was no direct evidence for a deficit of the central executive.

CONCLUSIONS

A deficit of the central executive either is not an inevitable feature of the disease, or is dependent on the nature of task (visuomotor v cognitive), or is corrected by dopaminergic medication.

Transforming growth factor-beta inhibits ovarian 17 alpha-hydroxylase activity by a direct noncompetitive mechanism

Transforming growth factor-beta1 (TGF-beta1) inhibits theca-interstitial cell (TIC) androgen biosynthesis while enhancing progesterone production without altering P45017 alpha protein content. The purpose of the present study was to define the mechanism of TGF-beta 1 inhibition of ovarian androgen production by determining the effects of TGF-beta 1 on steroidogenic enzyme messenger RNA (mRNA) expression and 17 alpha-hydroxylase activity in TIC in vitro. TIC isolated from hypophysectomized immature rat ovaries by Percoll gradient centrifugation were cultured with and without LH and TGF-beta 1 up to 6 days. At various times, cytoplasmic mRNA was extracted from the TIC, and P450scc, 3 beta-HSD and P450(17 alpha) mRNA were measured by specific assays, using RT-PCR. Treatment with TGF-beta 1 alone (0.1-100 ng/ml) had no effect on mRNA expression at 2 days but increased P450scc and 3 beta-HDS mRNA at 4 days. TGF-beta did not alter the LH stimulation of P450scc and 3 beta-HSD mRNA up to 6 days but caused a modest (2.5-fold) increase in P450 (17 alpha) mRNA at 2 days. Specificity studies with inhibin-A (30 ng/ml), activin-A (100 ng/ml), and MIS (300 ng/ml) demonstrated that the effects of TGF-beta 1 were unique within this family of peptides. We next examined the effect of TGF-beta 1 on 17 alpha-hydroxylase activity. Kinetic analysis revealed that the 17 alpha-hydroxylase enzyme has an apparent Michaelis-Menten constant of 3.42 mumol/liter and maximum velocity of 0.23 pmol/min x mg protein. TGF-beta 1 inhibited 17 alpha-hydroxylase activity by a noncompetitive mechanism with an apparent inhibin constant (Ki) of 46.4 pM. The results of our studies demonstrate that TGF-beta 1 directly inhibits TIC androgen production by a noncompetitive mechanism. This novel mechanism may be important in preventing excessive androgen production in developing ovarian follicles without preventing differentiation of the TIC.

Prolonged gonadotropin-releasing hormone agonist treatment of symptomatic endometriosis: the role of cyclic sodium etidronate and low-dose norethindrone "add-back" therapy

OBJECTIVE

To examine the safety and efficacy of combining cyclic sodium etidronate and low-dose norethindrone with a long-acting GnRH agonist (GnRH-a) for prolonged therapy of symptomatic endometriosis.

DESIGN

Prospective randomized open label study.

SETTING

Tertiary care university-affiliated reproductive medicine program.

PATIENTS

Nineteen regularly cycling women with laparoscopically diagnosed symptomatic endometriosis and 18 regularly cycling untreated controls without endometriosis.

INTERVENTIONS

All patients received a depot preparation of the GnRH-a leuprolide acetate IM monthly for 48 weeks. Group I patients (n = 10) received supplemental sodium etidronate cycled with calcium carbonate as well as 2.5 mg norethindrone daily. Group II patients (n = 9) received only supplemental 10 mg norethindrone daily. Group III volunteers (n = 18) were untreated and followed for bone density changes.

MAIN OUTCOME MEASURES

Disease extent at follow-up laparoscopy; pain, vasomotor, and vaginal symptom scores; bone mineral density (serial dual-energy roentgenogram absorptiometry scans); serum estrogens, lipids, and glucose and insulin response to glucose challenge.

RESULTS

Painful symptoms and extent of endometriosis were reduced in both treatment groups. Despite maintenance of a chronically hypoestrogenic state for 48 weeks, no changes in bone density over time or in comparison to group III untreated controls were noted. Similarly, no evidence of significant vasomotor symptoms were reported in either treatment group. However, adverse changes over time in circulating low-density lipoprotein (LDL) cholesterol and apolipoprotein A1 levels as well as the ratio of high-density lipoprotein to LDL were noted only in group II.

CONCLUSIONS

The combination of cyclic sodium etidronate and low-dose norethindrone with a long-acting GnRH-a served to safely prolong medical therapy of symptomatic endometriosis. Clinical efficacy was preserved while prophylaxis against significant hypoestrogenic side effects was achieved.

Changes of ovarian hormonal function with aging

Striking changes of ovarian function occur with aging. These changes begin subtly with reductions of fecundability being observed after age 25. The transition from reproductive to postreproductive life is characterized by menstrual irregularity including anovulation, or short luteal phases. The most prominent hormonal changes at the menopause are drastic reductions of estradiol and progesterone secretion by the ovary, reflecting the cessation of folliculogenesis and ovulation. Elevations of gonadotropins and reduction of inhibin levels also reflect the loss of folliculogenesis and ovulation. There are accompanying decreases of ovarian androgen secretion; however, the postmenopausal gonad directly secretes more testosterone after, than before, the menopause.

Effects of sodium etidronate in combination with low-dose norethindrone in patients administered a long-acting GnRH agonist: a preliminary report

OBJECTIVE

To assess the efficacy of combining sodium etidronate with low doses of the 19-nor-testosterone progestin norethindrone or using high doses of norethindrone alone as prophylaxis against the vasomotor instability and bone density loss induced by GnRH agonists alone.

METHODS

Eleven patients enrolled in this randomized study received the long-acting GnRH agonist leuprolide acetate 3.75 mg intramuscularly every 4 weeks for 24 weeks. Six patients (group I) self-administered sodium etidronate 400 mg/day orally for 14 days followed by calcium carbonate 500 mg/day orally for the next 42 days during three 56-day cycles. This regimen was supplemented by norethindrone 2.5 mg/day orally. Five patients (group II) self-administered norethindrone 10 mg/day orally. Two sets of controls were used. Group III consisted of ten previously reported patients who received the same GnRH agonist only. Group IV comprised 12 regularly cycling untreated controls. Bone mineral density, vasomotor symptoms, circulating estrogens, and lipids were assessed serially.

RESULTS

The significant vasomotor instability (P < .01) and bone mineral density loss (-4.8 +/- 0.9%; P < .05) experienced by patients in group III was prevented in those in groups I and II despite maintenance of a persistent hypoestrogenic state. Bone density changes in groups I and II were similar to those in untreated controls (group IV). Persistent decreases in high-density lipoprotein (HDL) cholesterol (P = .005) and increases in the low-density lipoprotein-to-HDL ratio (P < .05) were noted only in group II patients receiving supplemental high-dose norethindrone.

CONCLUSION

These preliminary data suggest that the addition of cyclic sodium etidronate in combination with low-dose norethindrone to GnRH agonists is an effective means of ameliorating the hypoestrogenic side effects induced by GnRH agonist alone.

Ovulation induction in women age 40 and older: the importance of basal follicle-stimulating hormone level and chronological age

OBJECTIVES

To determine pregnancy and livebirth rates for women age 40 and older undergoing ovulation induction and to assess the impact of basal follicle-stimulating hormone (FSH) on outcome in these patients.

DESIGN

Prospective, observational.

SETTING

Fertility service of university medical center.

PATIENTS

Infertile couples in whom the female partner was age 40 or older referred for ovulation induction therapy.

INTERVENTION

Assessment of basal hormonal status; ovulation induction.

MAIN OUTCOME MEASURES

Clinical pregnancy rate (PR), livebirth rate.

RESULTS

Analysis of 402 cycles in 85 women age 40 and older demonstrated a clinical PR of 3.5% per cycle (95% confidence interval [CI] 1.7% to 5.3%). The livebirth rate was 1.2% per cycle (95% CI 0.1% to 2.3%). Women with a basal FSH < 25 IU/L and age < 44 years had a clinical PR of 5.2% per cycle (95% CI 2.5% to 7.9%) compared with 0.0% per cycle (95% CI 0.0% to 2.1%) in cases in which either basal FSH was > or = 25 IU/L or age was > or = 44 (P < 0.005). The prognostic importance of basal FSH and chronological age was confirmed by multivariate logistic regression analysis. The predictive value of the resulting regression equation was high (R2 = 0.94; P < 0.01).

CONCLUSIONS

Pregnancy and livebirth rates are generally low during ovulation induction in women age 40 and older. In combination, basal FSH and chronological age are accurate predictors of PR, in these couples and can define a subset of patients with a more favorable prognosis. The spontaneous abortion rate in women who do conceive is high, substantially lowering the livebirth rate.

Internal jugular vein thrombosis after ovulation induction with gonadotropins

An unusual case of ovarian hyperstimulation syndrome complicated by internal jugular vein and mediastinal thrombosis is presented. Hemoconcentration and perhaps immobilization appear to be the most probable causative factors. The patient was successfully treated with heparin anticoagulation. An uneventful twin pregnancy resulted from the stimulation cycle.

Selective localization of calcium-binding protein in human brainstem, cerebellum and spinal cord

The 28,000-Da vitamin D-dependent calcium-binding protein, CaBP, which is induced by one hormonally active form of vitamin D3, 1,25-dihydroxyvitamin D3, was localized by immunocytochemistry in the human brainstem, cerebellum and cervical segment of the spinal cord. Positive structures (neurons and their processes) were restricted to some well-defined motor and sensory pathways. In motor regions, the highest density of immunoreactive sites was found in the Purkinje cell layer of the cerebellar cortex, and CaBP-positive neurons were also found in the reticular formation and the inferior olivary nucleus. In sensory pathways, positive neurons were mainly localized in structures associated with protopathic thermalgesia (pain and temperature), as well as in the solitary nucleus and parabrachial nucleus of the taste pathway.